Health & Voluntary Benefits Association (HVBA) Releases 2025 “Insights That Matter” Poll Report Update with Trends in Healthcare and Benefits

By HVBA – The Health & Voluntary Benefits Association® (HVBA) today announced the release of the second edition of its 2025 Insights That Matter: HVBA DIR Poll Report — presenting new findings from the most recent tranche of Daily Industry Report (DIR) polls — including Polls 46, 47, 48, 49, and 50. This release builds on the original 2025 report that further amplifies the collective voice and evolving priorities of health and voluntary benefits professionals across the U.S. workforce. Sponsored by MassMutual and Sydney Administrators, the refreshed report draws on the perspectives of thousands of benefits professionals — brokers, employers, HR teams, carriers, consultants, and administrators — and underscores new data, priorities, and key challenges that continue to shape the healthcare and benefits landscape. Read Full Article...

HVBA Article Summary

1. Regulatory Compliance Challenges: A notable 55.21% of health and benefits brokers surveyed identified the increasing burden of navigating new regulatory compliance requirements—particularly in relation to the One Big Beautiful Bill Act—as the most impactful change in their professional landscape. This reflects a broader concern across the industry regarding the complexity and pace of legislative developments affecting employee benefits.

2. Support for Domestic Drug Manufacturing: The majority of respondents expressed strong backing for a proposed policy that would impose a 100% tariff on imported branded or patented drugs unless pharmaceutical companies establish local manufacturing operations. Many believe such a move would incentivize domestic production, strengthen supply chain resilience, and potentially lower long-term healthcare costs.

3. Growing Interest in Workplace Violence Insurance: With 57% of professionals indicating support for Workplace Violence insurance, there is growing recognition of the risks associated with workplace incidents. Respondents cited both direct and indirect experiences as driving factors behind the perceived value of this coverage, suggesting a shift in how organizations prioritize employee safety and risk mitigation in their benefits planning.

8 Trends Employers Should Watch in 2026, Per Business Group on Health

By Marissa Plescia – As employers brace for significant healthcare cost increases in 2026, many are seeking out innovative strategies to manage the impact. This comes from the Business Group on Health’s newly released trends report, which highlights the key issues expected to shape 2026 health benefits and how employers plan to respond. “A volatile cost environment has been fueled by a complex and fragmented health care ecosystem, and it is faltering,” said Ellen Kelsay, president and CEO of the Business Group on Health, in a statement. “Employers remain committed to providing robust health and well-being offerings, yet they must act swiftly and strategically to manage costs while boosting health outcomes.” Read Full Article...

HVBA Article Summary

1. Rising Healthcare Costs Will Pressure Employer Strategies: Employers anticipate that 2026 will be one of the most difficult years in recent memory for healthcare affordability, with projected median cost increases of 9% and only a modest reduction to 7.6% after plan design adjustments. With recent years already seeing costs surpass forecasts—particularly in global markets where double-digit increases are possible—employers will be under pressure to implement strategic, cost-containing measures to manage these escalating expenses.

2. Preventive and Primary Care Will Become Critical to Cost Management: The continued rise in chronic diseases, coupled with an aging workforce and deteriorating population health, is expected to remain a key driver of employer healthcare spending. In response, employers are expected to renew focus on the foundational elements of care—emphasizing prevention, early intervention, and access to primary care services and screenings—as a long-term strategy to improve health outcomes and reduce high-cost interventions.

3. Technology and Policy Shifts Will Reshape Employer Health Plans: Artificial intelligence (AI) is set to play a major role in improving the efficiency and accessibility of benefits administration and healthcare delivery, but its potential to increase costs through revenue optimization by providers must be monitored. Meanwhile, evolving federal policies—especially those targeting pharmacy benefit managers (PBMs), Medicaid funding, and Affordable Care Act subsidies—introduce a layer of uncertainty that could have significant indirect effects on employer-sponsored plans. Staying ahead of these changes will be crucial for plan design and compliance.

Eli Lilly joins Novo Nordisk in reducing GLP-1 costs by lowering Zepbound price

By Alan Goforth – Eli Lilly has lowered the price of single-dose vials of its popular GLP-1 drug Zepbound on LillyDirect, the company’s digital health care platform. LillyDirect, which launched in early 2024, allows some consumers who lack insurance or who have inadequate coverage to access Zepbound and Mounjaro directly from the manufacturer through its Zepbound Self Pay Journey Program. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Lilly Expands Affordable Access to Obesity Medication Zepbound: Eli Lilly has lowered the cost of its obesity drug Zepbound in single-dose vial form to improve affordability and access. With a valid prescription under the Zepbound Self Pay Journey Program, patients can now purchase the starting 2.5 mg dose for $299/month, the 5 mg dose for $399/month, and all other approved doses for $449/month. This move aligns with Lilly’s broader commitment to reduce cost barriers and enhance delivery options for patients in need of obesity treatment.

2. Medicare Coverage and Competitive Pricing Expected in 2026: Starting as early as April, Medicare patients may pay no more than $50/month for Zepbound (multiuse pen) and Lilly’s once-daily weight-loss pill, pending FDA approval. Additionally, the Trump administration has pushed for lower GLP-1 drug prices, announcing that Medicare will cover Wegovy and Zepbound for older adults and that discounted versions will be available via TrumpRx, a federal direct-to-consumer website launching in 2026.

3. Novo Nordisk Responds with Discounts on Ozempic and Wegovy: In response to competitive pressure, Novo Nordisk is offering significant temporary discounts for out-of-pocket consumers. Patients with a prescription can get the two lowest doses of Ozempic and Wegovy for $199/month for two months, after which the price will rise to $349/month. These discounts are accessible through the respective drug websites and eligible pharmacies or telehealth providers.

House votes to pass 5-year hospital at home extension, sending bill to the Senate

By Emma Beavins - The House of Representatives unanimously voted to pass a bill Monday that extends the Medicare hospital at home program for five years. Hospital at home providers have been mired in uncertainty for years. Though Congress has repeatedly extended hospital at home flexibilities, it often only does so for a handful of months at a time. The Acute Hospital Care at Home program is overseen by the Centers for Medicare & Medicaid Services (CMS) and allows hospitals to transfer qualifying patients from the emergency department or an inpatient to their homes while still delivering inpatient-level care through a combination of telehealth, connected devices and home visits. Read Full Article…

HVBA Article Summary

1. Long-Term Extension Proposed for Hospital at Home Program: A bipartisan bill currently under consideration in the Senate seeks to extend the Hospital at Home program through January 30, 2026. If passed, this would be the longest extension the program has received since it was first launched during the COVID-19 public health emergency in late 2020. Notably, the bill also separates the program’s future from government funding cycles, offering greater operational predictability and stability for providers.

2. Program Lapse Highlighted Operational Challenges: The program’s authority lapsed during the recent 43-day government shutdown, leading to significant disruptions. Some providers were forced to quickly transition patients back to hospitals or into alternative care models, which proved challenging and inefficient. The proposed extension is intended to eliminate such disruptions in the future by ensuring long-term continuity and support for home-based hospital care.

3. Broad Support and Potential for Expansion: The bill has garnered support from over 100 organizations, including major healthcare systems and associations like the American Hospital Association and the American Telemedicine Association. Advocates argue that the Hospital at Home model delivers cost-effective, high-quality care while easing the burden on overstretched hospitals. A five-year extension could incentivize more hospitals to adopt or expand this model, further integrating it into the broader healthcare delivery system.

The 3 things keeping OpenAI's Sam Altman up at night

By Megan Morrone - OpenAI CEO Sam Altman is feeling three prongs of increased pressure that have him seeing red: Wall Street, chatbot users and Google. Why it matters: They're all testing a CEO known for staying cool at a time when his competitive advantage increasingly looks like it's under threat. That reportedly inspired him to declare a "code red surge" to employees Monday to focus on improving ChatGPT. Here's what's keeping Altman up at night. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Financial Sustainability Challenges: OpenAI is under increasing pressure to secure its own funding after the restructuring of its original partnership with Microsoft, which had previously helped offset the high costs of AI training and operations. Now, with a bold commitment to invest $1.4 trillion in infrastructure and build a gigawatt of new capacity weekly (at roughly $20 billion per gigawatt), the company must find new revenue streams to remain viable. These ambitious goals come at a time when concerns about circular investments, rising debt, and a softening job market are already shaking confidence in the broader AI sector.

2. User Safety, Mental Health, and Backlash: OpenAI continues to grapple with concerns over the unintended uses of ChatGPT, particularly in mental health scenarios where users have relied on the chatbot for emotional support or guidance. This has resulted in lawsuits from families of individuals who received poor advice during crises. While the company has responded by introducing parental controls and mental health safety measures, these have not fully satisfied critics or prevented ongoing legal action. Additionally, the launch of GPT-5 met with significant user backlash, with complaints that it felt like a less capable version of previous models — sparking accusations of "psychological paternalism" and alienating parts of its user base.

3. Intensifying Competition from Google Gemini: Google’s AI initiative, Gemini, is emerging as a formidable competitor, leveraging the tech giant’s extensive access to capital, data, and hardware. After initially lagging behind when OpenAI launched ChatGPT, Google has accelerated its development and recently released Gemini 3 Pro, a model that will power its core services, including Search. The model has been praised by industry leaders and is rapidly gaining adoption, with app downloads approaching ChatGPT's and estimates showing a doubling of its market share. OpenAI now faces the challenge of defending its lead as Google benefits from superior distribution channels and sustained momentum in AI innovation.

What Is Needed to Rebuild Trust in U.S. Healthcare?

By Katie Adams – Trust in the U.S. healthcare system is eroding — but this decline isn’t happening evenly across the system, one leader pointed out. People largely trust individual clinicians, but they tend to distrust payers, drugmakers and hospital leadership, said Kristin Wikelius, chief program officer at the United States of Care, a national health policy advocacy group. That split in trust becomes particularly apparent when patients move beyond the exam room. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Healthcare Transparency and Navigation Challenges: Many individuals regularly encounter conflicting information when trying to understand their healthcare costs and insurance coverage. For example, patients may receive different answers from insurers and providers about whether a procedure is covered or what it will cost. This lack of clarity makes the healthcare system feel confusing and opaque, undermining trust even among those who try to carefully navigate it.

2. Rising Costs and Delayed or Avoided Care: As healthcare costs continue to climb, individuals have limited options for absorbing these increases — unlike businesses or insurers, they can’t shift the costs elsewhere. This often results in people postponing or skipping care they need simply because they can’t afford it. Such a trend reinforces a reactive system focused on treating illness only when it becomes urgent, rather than promoting a proactive, preventive approach that maintains long-term health.

3. Public Demand for Stability Beyond Politics and Employment: The current system, where healthcare coverage is closely tied to employment or political outcomes, creates significant anxiety for many Americans. People are concerned that a job change or election result could jeopardize their insurance. There is strong public support for more stable, long-lasting policies that aren’t vulnerable to political shifts — and growing interest in reforms that emphasize continuity, affordability, transparency, and preventive care across party lines.

Optum Rx: Why payers should be watching these 3 pipeline drugs

By Paige Minemyer – Three drugs treating chronic conditions are set for Food and Drug Administration review by the end of the year, and a new report from Optum Rx digs into why payers should be watching these decisions. According to the report, the FDA is set to review an oral formulation of Novo Nordisk's GLP-1 Wegovy as well as depemokimab, a drug that treats eosinophilic asthma, and remibrutinib, a therapy for chronic spontaneous urticaria under the brand name Rhapsido. Read Full Article...

HVBA Article Summary

1. Emergence of Oral GLP-1 Drugs May Shift Treatment Landscape: Oral Wegovy, pending FDA approval, would be the first oral GLP-1 medication for weight loss, potentially shifting usage patterns from injectable to oral formats. It has shown similar efficacy and safety to its injectable counterpart, and additional studies are evaluating its potential cardiovascular benefits. However, payer experts caution that this may not lead to a surge in new patients but could shift existing users toward oral options.

2. Cost and Coverage Considerations Remain Central for Plan Sponsors: GLP-1 drugs, including injectable and oral formulations, are significant cost drivers with annual prices around $16,000. Employers and payers are weighing how to cover these therapies, especially as manufacturers like Novo Nordisk and Eli Lilly explore pricing deals and direct-to-employer models to broaden access while managing costs.

3. New Oral and Long-Acting Injectable Drugs Offer Dosing Alternatives: Depemokimab and Rhapsido introduce new treatment options in asthma and chronic spontaneous urticaria, respectively, with advantages in dosing frequency. Depemokimab offers six-monthly clinic-based injections compared to more frequent alternatives, while Rhapsido provides a daily oral alternative to injectable treatments. These innovations may influence patient preferences and adherence, but daily dosing could be a barrier for some.