With Trump on the Way, Advocates Look to States To Pick Up Medical Debt Fight

By Noam N. Levey - Worried that President-elect Donald Trump will curtail federal efforts to take on the nation’s medical debt problem, patient and consumer advocates are looking to states to help people who can’t afford their medical bills or pay down their debts. Read Full Article…

HVBA Article Summary

1. State-Level Initiatives and Consumer Protections: As federal policies face potential rollbacks under the Trump administration, states are stepping up efforts to shield residents from medical debt. This includes passing legislation to keep medical debt off credit reports, regulating high-interest medical credit cards, and compelling hospitals to expand financial aid programs for patients.

2. Impact of Federal Retrenchment on Medical Debt: Proposed cuts to federal aid programs like Medicaid and ACA subsidies could undermine state-level protections, leading to higher insurance premiums, restricted access to affordable coverage, and increased financial strain on patients, particularly low- and middle-income individuals.

3. Bipartisan Momentum Against Medical Debt: States across the political spectrum, including New York, California, and Georgia, have enacted or are considering measures to address medical debt. Despite federal uncertainty, advocates remain optimistic about leveraging bipartisan support for consumer protections, credit reporting reforms, and expanded hospital accountability.

Eli Lilly, Pfizer stress independence of telehealth partners in response to senators

By Nicole DeFeudis - In response to lawmakers’ concerns, Pfizer and Eli Lilly said last week that they do not influence telehealth partners and their clinicians to prescribe their brand-name drugs. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Senators Question Anti-Kickback Compliance in Direct-to-Consumer Platforms: U.S. Senators raised concerns over potential anti-kickback law violations in LillyDirect and PfizerForAll, questioning the companies' compensation models for telehealth partners and whether prescribers are incentivized to recommend their drugs.

2. Companies Defend Telehealth Models: Both Lilly and Pfizer refuted the allegations, asserting their adherence to legal and ethical standards. Lilly emphasized that telehealth providers are under no influence to prescribe their medications, while Pfizer highlighted its fixed-fee structure with telehealth partners, independent of prescription outcomes.

3. Shifting Focus to Compounders: Lilly redirected scrutiny toward telehealth entities working with compounding pharmacies, alleging safety and regulatory risks associated with compounded versions of its medications. The company called for greater oversight of these practices in its response to the senators.

Secret to adviser success found in supply and demand

By Ben Conner - Brokers and advisers have come a long way in managing the supply chain and providing value in employee benefits, but the next critical step for success is focusing on demand. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Shifting from Supply to Demand: The traditional role of advisers as intermediaries between clients and insurance carriers has evolved into a deeper engagement with healthcare programs. Advisers now customize benefits, remove inefficiencies, and tailor solutions to diverse workforces. However, the next step is focusing on healthcare demand—addressing the needs of individuals and guiding them toward preventive care options that proactively manage health and reduce chronic illnesses.

2. Prioritizing Preventive Care and Wellness: Chronic conditions like high blood pressure and diabetes strain the healthcare system, often due to the reactive "sick care" model. Advisers have a unique opportunity to advocate for preventive care by designing benefit programs that include regular screenings, mental health resources, and wellness initiatives. This shift not only promotes healthier employees but also reduces long-term costs for organizations.

3. Deepening Understanding of Client Needs: To revolutionize healthcare benefits, advisers must understand a client’s organization holistically, from its mission to its workforce dynamics. Programs should reflect employees' genetic, lifestyle, and environmental factors to ensure relevance and effectiveness. By addressing demand, advisers can help create value-driven insurance programs that empower employees to take charge of their health and foster a culture of wellness.

Trump's health benefits team picks: The early reviews

By Allison Bell  - Four of President-elect Donald Trump's early picks for administration posts could affect everything from how many psychologists are in employer-sponsored health plans' provider networks to what exactly hospital indemnity insurance can do.. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Nomination Dynamics and Policy Impact: The nominees for key health benefits posts reflect diverse backgrounds, from hedge fund management to public health advocacy and television fame. While their expertise in some areas may provide fresh perspectives, their controversial histories and statements have sparked debate among policymakers and advocacy groups. The narrow Republican majority in the Senate heightens the importance of bipartisan negotiation and individual senator support during the confirmation process.

2. Industry and Stakeholder Reactions: Responses to the nominees vary significantly by industry and stakeholder group. While some organizations, like America's Health Insurance Plans (AHIP), expressed cautious optimism about collaboration, others criticized the nominees' qualifications and past actions. For instance, Robert F. Kennedy Jr.'s controversial vaccine views and Dr. Mehmet Oz's promotion of unproven medical treatments have drawn significant public health criticism, contrasting with praise from groups advocating for systemic reform.

3. Challenges for Confirmation and Governance: The nominees' unconventional backgrounds and polarizing reputations could complicate their confirmation in a Senate with a slim Republican majority. Key swing senators may wield considerable influence over the process. If confirmed, the appointees' ability to navigate complex regulatory frameworks and foster collaboration among the tri-agency team (IRS, EBSA, CMS) will be critical for shaping the future of health benefits and public health governance.

Bristol Myers Squibb latest drug company to sue HHS over 340B rebate model

By Heather Landi - Bristol Myers Squibb became the latest large drugmaker to sue the federal government over a plan to change how it doles out drug discounts to hospitals. Johnson & Johnson and Eli Lilly both filed lawsuits last month against the Health Resources and Services Administration (HRSA) and the Department of Health and Human Services (HHS) for blocking the implementation of its new 340B rebate model. Read Full Article…

HVBA Article Summary

1. Legal Challenge Against HHS Decision: Bristol Myers Squibb (BMS) has filed a lawsuit in the U.S. District Court for the District of Columbia challenging the Health Resources and Services Administration's (HRSA) rejection of its proposed 340B rebate model. BMS argues that its model aligns with the 340B statute, enhances transparency, and reduces duplicate discounting, while also facilitating expedited payments to covered entities that lower out-of-pocket costs for vulnerable patients.

2. Rebate Model Controversy: BMS’s proposed shift from upfront 340B discounts to a post-sale rebate model, starting with its Eliquis blood thinner in 2025, has sparked widespread opposition from the hospital industry. Critics warn the delayed rebates could financially strain safety-net hospitals, while BMS contends the model ensures program compliance and mitigates misuse of 340B discounts, citing parallels with existing practices such as the AIDS Drug Assistance Program (ADAP).

3. Broader Implications for 340B Program Integrity: BMS’s lawsuit underscores tensions over the evolving dynamics of the 32-year-old 340B program, which was created to support low-income, uninsured patients through manufacturer discounts. BMS alleges program abuse by some entities and argues that new measures, such as those in the Inflation Reduction Act, may exacerbate duplication of discounts. The company seeks judicial intervention to validate its rebate model and challenge HHS’s decision as unlawful.

Caregiving benefits are evolving: Are your clients on board? 

By Tim Weber - Chances are, your clients have employees coming in each day with much more than work on their minds. A significant number are serving as caregivers who are also trying to juggle the demands of their jobs with meeting the “here-and-now” caregiving needs of their loved ones. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. The Growing Caregiving Crisis and Workplace Impact: Caregiving responsibilities are taking a significant toll on employees, leading to increased absenteeism, presenteeism, and health-related costs for organizations. Over 20% of Americans are caregivers, with 56% being women, and nearly 67% report difficulties balancing caregiving with their jobs. The stress and financial burden associated with caregiving are driving employees to leave jobs, with 20% citing a lack of family care benefits as the reason. This crisis costs the U.S. economy nearly $44 billion annually.

2. Evolving Perceptions and Employer Expectations: The pandemic highlighted the urgent need for caregiving support, fundamentally altering perceptions around discussing personal challenges at work. Employers increasingly view enhanced caregiving benefits as essential for talent retention and recruitment. Flexible work schedules, tailored benefits, and supportive workplace cultures are becoming standard as organizations strive to address the unique needs of caregivers.

3. Strategies for Effective Caregiver Support: Employers can take actionable steps to support caregivers by auditing current benefits for gaps, introducing versatile solutions like lifestyle spending accounts and flexible schedules, and creating a culture where caregiving is openly acknowledged. Offering financial and legal resources, paid leave options, and initiatives to improve caregivers' mental health and financial stability ensures both employees and their families feel supported, reducing workplace stress and improving overall productivity.

Is The Great Gloom Affecting Your Workplace? 7 Strategies To Help

By Cheryl Robinson - Although the Great Resignation is declining, a concerning trend, dubbed The Great Gloom, has emerged in workplaces across industries over the last few years. This phenomenon reflects a widespread decline in employee engagement and satisfaction, fueled by organizational and societal challenges. Read Full Article…

HVBA Article Summary

1. Understanding the Great Gloom and Its Causes: The Great Gloom represents a significant decline in employee happiness, driven by factors such as return-to-office mandates, economic uncertainty, and increased workloads. This trend highlights the widening gap between employee expectations and workplace realities, with industries like healthcare experiencing acute dissatisfaction. Addressing these root causes requires a tailored, industry-specific approach to improve morale and engagement.

2. Effective Strategies for Addressing Employee Dissatisfaction: Combating the Great Gloom involves prioritizing employee experience through initiatives like flexible work arrangements, meaningful communication, career development, recognition programs, and wellness support. These strategies foster a more inclusive, supportive, and engaging workplace, demonstrating the organization's commitment to its workforce's well-being.

3. The Role of Leadership and Data in Driving Change: Leaders play a pivotal role in addressing the Great Gloom by leveraging tools to measure employee satisfaction, gathering regular feedback, and acting transparently on the insights gained. By fostering trust and accountability, leaders can bridge the disconnect between workers and organizational goals, creating a culture of collaboration, recognition, and continuous improvement.