Healthcare cases to watch in Trump's second term

By Brendan Pierson - When Republican President-elect Donald Trump takes office for the second time next year, he will inherit a slew of lawsuits challenging the Biden administration's healthcare policies. The cases will give him an immediate opportunity to change course, before any new rules or legislation are passed, and could offer an early look at his administration's approach. Here are some of the cases to watch.  Read Full Article… 

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1. Abortion Rights and Medical Emergencies: In the aftermath of the 2022 Supreme Court ruling allowing states to ban abortion, pivotal lawsuits have emerged, including challenges to abortion pill access and restrictions in medical emergencies. The Trump administration may reverse the Biden administration's defense of mifepristone access and federal emergency care laws, potentially shifting legal outcomes in favor of stricter state-level abortion bans.

2. Drug Pricing Negotiations: The Inflation Reduction Act's provision requiring Medicare drug price negotiations has faced industry backlash and legal challenges. While a wholesale repeal is unlikely, the Trump administration might prioritize extending market exclusivity for pharmaceutical companies, potentially weakening the law's effectiveness and enabling courts to chip away at its provisions.

3. Healthcare Policies and Protections: From preventive care mandates to transgender healthcare rules, the Trump administration could reshape key healthcare policies. This includes potentially halting the defense of requirements for insurance coverage of preventive services and dismantling protections against gender identity discrimination, signaling a shift away from the Biden administration's public health priorities.

The GLP-1 dilemma persists into 2025

By Jakob Emerson - Insurers and self-funded employers are making significant changes to their GLP-1 drug coverage policies in 2025, reflecting the financial and operational challenges posed by the high-cost medications. Read Full Article… 

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1. Strong Public Support for Coverage: According to an August 2023 KFF survey, 80% of U.S. adults believe insurers should cover weight loss drugs for adults diagnosed as overweight or obese. Additionally, 50% of respondents are willing to accept higher premiums to support such coverage, reflecting the growing recognition of weight management as a significant health priority.

2. Employer and Insurer Coverage Variability: While 44% of employers with 500 or more employees offer GLP-1 drug coverage for obesity, this figure rises to 64% for employers with 20,000 or more employees, per a 2024 Mercer survey. However, many insurers are implementing stricter coverage policies for GLP-1 drugs starting in 2025, often restricting access to specific patient groups or conditions to control rising costs.

3. Financial Strain from GLP-1 Drugs: The high demand and cost of GLP-1 drugs have significantly impacted insurers' financial performance. For example, UPMC Health Plan reported a $371 million operating loss in 2024 due to rising pharmacy expenses, including GLP-1s. Other insurers, such as Highmark Health and BCBS Massachusetts, have also reported substantial financial pressures linked to escalating claims for these medications.

The Chase for Novel Oral GLP-1 Obesity Meds Adds a New Contender

By Frank Vinluan - Obesity drugs that offer the benefits of currently available injectable drugs, but in pill form, are part of the next wave of metabolic medicines in development. Cardiometabolic disease biotech Corxel Pharmaceuticals is getting a contender in a deal that brings a Phase 2-ready drug candidate. Read Full Article… 

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1. Strategic Acquisition and Expansion: Corxel’s acquisition of VCT220 (now CX11) from Vincentage Pharma provides global rights to a promising oral GLP-1 receptor agonist, excluding Greater China. This move marks Corxel’s entry into the competitive obesity and diabetes treatment market, expanding its cardiometabolic pipeline with a drug candidate that has shown strong weight-loss efficacy and favorable safety profiles in Phase 2 trials.

2. Addressing Market Needs: CX11 offers a significant advantage as an oral small molecule GLP-1 drug, addressing challenges posed by injectable treatments like production costs and patient adherence. This positions Corxel among innovators exploring patient-friendly oral GLP-1 therapies, alongside AstraZeneca, Roche, and others, in the growing market for metabolic disorder treatments.

3. Pipeline Diversification and Growth: Beyond CX11, Corxel's portfolio includes JX10 (acute ischemic stroke) and JX09 (hypertension), emphasizing its commitment to cardiometabolic conditions. The recent sale of aficamten rights to Sanofi further underscores Corxel’s strategic focus on advancing its pipeline while leveraging partnerships to optimize resource allocation and market presence.

How Gen Z employees prioritize their benefits

By Courtney Hoff Dockerty - As more baby boomers retire, and Generation Z employees continue to enter the workforce, employers will need to adjust their company benefits to meet the needs and priorities of these young workers. Read Full Article… ^{_{(Subscription required)}}

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1. Mental Health and Flexibility as Top Priorities: Gen Z places high value on mental health support, with preferences for benefits like teletherapy, mental health apps, and employee assistance programs. Additionally, flexible work arrangements are a key priority for this generation, emphasizing work-life balance shaped by experiences during or post-pandemic. Employers must adapt by offering these modern benefits to attract and retain young talent.

2. Financial Wellness and Targeted Support: With only 27% of Gen Z workers feeling completely financially stable, compared to higher confidence levels in older generations, this group seeks benefits tailored to their unique challenges, such as student loan repayment assistance and budgeting tools. Employers can foster financial well-being by aligning benefit offerings with the specific needs of younger workers.

3. Importance of Communication and Personalization: Companies that frequently gather employee feedback and tailor benefits to individual and generational needs see better outcomes. Engagement surveys, digital tools, and open communication are critical to understanding priorities and aligning benefits with real-life challenges. This approach enhances employee satisfaction and strengthens workforce retention across all age groups.

Peering Into 2025: Will Next Year Be AI’s Huge Breakthrough Year?

By Mark Hagland - The evidence on 2024 is already in: this year has been an important one for the forward evolution of artificial intelligence (AI). Throughout this year, we’ve reported on important breakthroughs in the application of AI based on the testing of algorithms (sometimes called “traditional” AI, though for obvious reasons, that tag doesn’t really fit), and generative AI, across U.S. healthcare. Read Full Article…

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1. Transformative AI Centers in Healthcare: Major institutions like Mount Sinai Health System and Washington University School of Medicine have established cutting-edge AI research centers focused on revolutionizing healthcare delivery. These initiatives emphasize integrating AI across genomics, imaging, and electronic health records to improve diagnostics, streamline workflows, and enhance patient care.

2. Expanding Predictive Analytics and Generative AI Applications: The healthcare predictive analytics market is projected to grow exponentially, driven by advancements in AI-powered tools. Applications include improving patient engagement, optimizing clinical decision-making, and streamlining diagnostic imaging processes, as demonstrated by studies on large-language models (LLMs) in radiology and sepsis prediction.

3. Future AI Developments in Clinical and Operational Support: Looking ahead to 2025, AI advancements are expected to significantly improve healthcare workflows, from creating automated clinical notes to enhancing diagnostic accuracy and supporting interdisciplinary communication. These innovations aim to optimize both inpatient and outpatient care, : healthcare delivery more efficient and patient-centered.

Medicare $2,000 prescription drug cap starts Jan. 1

By April Rubin - Medicare's $2,000 prescription drug cap will take effect at the start of the new year. Why it matters: The yearly limit on out-of-pocket payments, under the Inflation Reduction Act, is expected to lower millions of seniors' medical costs. It will have a particularly significant impact for patients taking expensive drugs to treat cancer and other serious conditions. Read Full Article…

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1. Widespread Savings: By 2025, 3.2 million Americans are projected to save on prescription medications due to new Medicare policies, increasing to 4.1 million by 2029, with significant variations by state—9% of beneficiaries in Texas and up to 18% in Alaska expected to benefit.

2. Key Demographics and Spending: Nearly half of the Medicare enrollees benefiting from the new $2,000 out-of-pocket cap are aged 75 to 84, addressing a critical need for older beneficiaries. Historical data shows 1.5 million enrollees spent over $2,000 on prescriptions in 2021, highlighting the importance of the cap.

3. Broader Medicare Changes: The Inflation Reduction Act introduces transformative changes, including insulin capped at $35 per month, the option for capped monthly installment payments for prescriptions, and a Manufacturer Discount Program to reduce drug costs further.

Workplace health plan 'gap’ coverage: Sales up 6%

By Allison Bell - U.S. employers are using their non-major-medical, non-retirement benefits energy to help workers cope with holes in major medical insurance coverage. Insurers recorded $3.9 billion in new sales of the "other benefits" in the third quarter, up 3.6% from the total for the third quarter of 2023, according to new LIMRA survey data. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Shifts in Workplace Benefits Sales: The LIMRA survey revealed a mixed performance in workplace benefits sales. While new workplace life insurance sales saw a modest increase of 1% to $620 million, sales of disability insurance declined by 3% to $649 million. However, supplemental health insurance sales surged by 6%, reaching $2.6 billion.

2. Rising Popularity of Hospital Indemnity Insurance: Sales of hospital indemnity insurance policies climbed by 12%, and the number of employer groups offering these policies saw significant growth—up 20% in the third quarter and 41% in the first half of the year. These policies provide financial assistance to employees facing hospital-related expenses like deductibles and coinsurance.

3. Economic Influence on Future Sales Trends: Patrick Leary from LIMRA emphasized that the trajectory of non-major-medical and non-retirement benefits will hinge on broader economic conditions, including labor market trends and potential cost pressures from tariffs, which could challenge growth in employer-provided benefits.

DOJ files complaint against CVS for facilitating unlawful sale of prescription opioids

By Steve Leblanc - The Justice Department unsealed a civil complaint Wednesday alleging CVS Pharmacy Inc. and various subsidiaries filled “unlawful” prescriptions in violation of the federal Controlled Substances Act. Read Full Article…

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1. Allegations Against CVS: The federal complaint accuses CVS of violating the False Claims Act by seeking reimbursement from federal health care programs for unlawful prescriptions. These include excessive quantities of opioids, early refills, and dangerous "trinity" prescriptions. CVS is also alleged to have filled large volumes of prescriptions from "pill mill" prescribers, despite evidence from its pharmacists and internal data indicating such practices.

2. CVS's Response: CVS denies the allegations, emphasizing its cooperation with the DOJ investigation over four years and rejecting the claims as a "false narrative." The company argues that all prescriptions in question were for FDA-approved medications prescribed by licensed practitioners and vows to defend itself against the lawsuit, which it considers misguided.

3. Context and Broader Efforts: This lawsuit is part of a larger federal effort to hold companies accountable for their roles in the opioid crisis, which has led to over 80,000 annual deaths in recent years. Over the past decade, companies, including drugmakers and pharmacies, have settled cases amounting to $50 billion to combat the epidemic, with CVS potentially facing significant civil penalties if found liable.