States attempt to protect 340B with new bills: 7 notes

By Alexandra Murphy - As pharmaceutical companies push back against the 340B Drug Pricing Program, several states, including Utah, Colorado, Arkansas, Maine and Nebraska, are introducing legislation to protect the program and ensure continued access to discounted medications for safety-net hospitals and clinics. Read Full Article…

HVBA Article Summary

1. Protecting the 340B Program from Restrictions: Several states, including Utah, Colorado, Arkansas, Maine, and Nebraska, are introducing legislation to counter pharmaceutical companies' increasing restrictions on the 340B drug pricing program. These bills aim to preserve access to discounted medications for safety-net hospitals and clinics serving low-income communities.

2. Enhancing Transparency and Accountability: Some bills, such as Maine’s proposed legislation, emphasize transparency in how hospitals utilize 340B savings. By requiring clear reporting on fund usage, these measures seek to ensure that hospitals are using the discounts effectively to support patient care and essential services.

3. Sustaining Hospitals and Low-Income Patient Support: The 340B program is a crucial financial pillar for hospitals, particularly in rural areas. Legislative efforts, like Colorado’s Senate Bill 71, prevent pharmaceutical companies from limiting contract pharmacy use, ensuring hospitals can continue to serve vulnerable populations and maintain critical healthcare services.

US Health Agencies Sued Over Removal Of Health Data Websites

By Brendan Pierson - A medical advocacy group on Tuesday sued the main U.S. health agencies over the sudden removal of websites containing public health information in response to an executive order by President Donald Trump targeting what his administration deemed to be "gender ideology extremism." Read Full Article…

HVBA Article Summary

1. Lawsuit Allegations: Doctors for America filed a lawsuit against the CDC, FDA, and HHS, alleging that the agencies removed essential public health information from their websites, including data on youth behavioral health risks, HIV prevalence, and clinical trial diversity, following a directive from the U.S. Office of Personnel Management.

2. Impact on Public Health: The lawsuit argues that the removal of these resources deprives healthcare professionals and researchers of critical information needed to treat patients, design accurate clinical studies, and implement policies that protect vulnerable populations.

3. Legal Challenge and Response: The lawsuit seeks a court ruling that OPM's directive exceeded its authority and demands the restoration of the deleted webpages. While HHS and the CDC declined to comment, the FDA and OPM have yet to respond.

Aflac blames technical difficulties for a 33% drop in U.S. dental sales

By Allison Bell - Technical problems caused a 33% drop in dental sales at Aflac in the fourth quarter of 2024 — and they also hurt sales of the company's other voluntary and worksite insurance products. Read Full Article…  ^{_{(Subscription required)}} 

HVBA Article Summary

1. System Implementation Failure Impact: Aflac U.S. faced significant system problems due to a failed implementation, which required recovery assistance from a third-party administrator. These issues negatively affected broker and agent engagement, leading to weaker-than-expected sales in dental and vision insurance.

2. Decline in Dental and Vision Sales: Total U.S. dental and vision sales dropped from $33 million in Q4 2023 to $25 million in the latest quarter. The usual "halo effect" from dental insurance sales, which boosts voluntary benefits sales, was also diminished, impacting the sales of other products.

3. Financial Performance and Market Outlook: Despite challenges in U.S. sales, Aflac reported strong overall earnings, with net income rising to $1.9 billion on $5.4 billion in revenue. The U.S. unit posted $330 million in pretax adjusted earnings. Meanwhile, critical care and hospital indemnity insurance sales declined, but these products could benefit from potential regulatory changes.

Some of the Biggest Healthcare Stories from 2024 Involved Pharmacy. What’s Next in 2025?

By Tara Hanuscak - From record-high drug shortages to the explosive popularity of GLP-1 medications and the intensifying battle over the 340B drug discount program, many of the biggest healthcare stories of 2024 centered on pharmacy issues. Read Full Article…

HVBA Article Summary

1. The Growing Impact of GLP-1 Medications: The continued surge in demand for GLP-1 agonists, driven by their use in weight loss and diabetes treatment, is reshaping the pharmaceutical landscape. Key concerns include drug shortages, high costs exceeding $11,000 per year, and shifting insurance coverage policies. The Biden administration's proposal to expand Medicare and Medicaid coverage for weight-loss medications remains uncertain under the Trump administration, while compounded versions of GLP-1 drugs face regulatory scrutiny.

2. Escalating Legal Battles Over 340B and Drug Pricing: Pharmaceutical manufacturers are intensifying efforts to reform the 340B drug discount program, particularly by pushing rebate-based models that could significantly impact safety net providers. With multiple lawsuits challenging government restrictions, ongoing legal disputes over contract pharmacy participation, and complications arising from the Inflation Reduction Act, 2025 is set to be a pivotal year for the program’s future.

3. Continued Scrutiny of Pharmacy Benefit Managers (PBMs): The FTC and lawmakers from both parties have targeted PBMs for allegedly inflating drug prices and harming independent pharmacies. While bipartisan legislation to rein in PBMs has been introduced, substantial reform faces significant hurdles due to the entrenched role of PBMs in the healthcare system, the industry’s strong lobbying influence, and the incoming administration’s anti-regulatory stance.

Value-Based Care: One Priority Among Many

By Laura Beerman - Value-based care isn’t the only priority highlighted in The New Healthcare C-Suite Agenda: 2024-2025 Market Report. It’s just the only one where providers identified payers as part of both the solution and the problem. Read Full Article…

HVBA Article Summary

1. Value-Based Care (VBC) is a Priority, But Challenges Remain: Hospital and health system executives are prioritizing VBC, but they face significant hurdles, including workforce shortages, financial sustainability, and delayed patient care. While 44% of providers have at least one-fifth of their revenue in VBC arrangements, many still struggle with adopting the right models and ensuring financial stability.

2. Payers Play a Critical Role in VBC Success: Strong payer-provider collaboration is essential, as executives cite both payer partnerships (26%) and payer resistance (21%) as major factors in their VBC journey. With payers' support, providers can navigate the transition from fee-for-service, improve care quality, and achieve financial predictability.

3. Balancing Patient Outcomes and Financial Goals is Key: The top strategic initiative for providers is growing revenue (57%), yet the primary motivation for VBC participation is improving patient outcomes (41%). To succeed, VBC must go beyond pay-for-performance and align financial incentives with high-quality, equitable care that benefits both patients and healthcare organizations.

The prior authorization reform push continues

By Andrew Cass - Prior authorization reforms remain a major advocacy priority for provider trade groups in 2025, and several state lawmakers have also introduced legislation to bring changes to the process. Read Full Article…

HVBA Article Summary

1. Calls for Greater Accountability and Reform in Prior Authorization: The American Hospital Association (AHA) and the Medical Group Management Association (MGMA) are advocating for commercial health insurers to reduce excessive prior authorization requirements, which they argue hinder patient access to care and contribute to clinician burnout. They are pushing for more transparency, standardized processes, and automation to streamline approvals and reduce administrative burdens.

2. Legislative Efforts to Improve Prior Authorization: Several organizations, including the American Medical Association (AMA) and the Federation of American Hospitals (FAH), are urging Congress to pass the Improving Seniors’ Timely Access to Care Act, which aims to reform Medicare Advantage prior authorization by standardizing electronic transactions and increasing transparency. Additionally, states such as Indiana and Rhode Island are introducing legislation to limit or eliminate certain prior authorization requirements to improve patient access to necessary treatments.

3. Insurers Pledge to Simplify Prior Authorization Processes: The CEOs of UnitedHealth Group and Cigna have publicly acknowledged concerns about prior authorization and announced plans to simplify the process. UnitedHealth is investing in technology to speed up approvals for Medicare Advantage patients, while Cigna plans to make prior authorization faster and simpler in 2025, recognizing that easing these barriers may lead to additional costs but is necessary for improving patient care.

Weighing employer GLP-1 coverage considerations

By Kelsey Waddill and Sara Heath - As the demand for blockbuster weight loss drugs continues to soar, the question of employer GLP-1 coverage will loom large. The number of people taking GLP-1s or wanting to take the drugs is climbing. In a May 2024 KFF data brief, researchers found that 12% of patients in the U.S. have taken the drugs at some point in their lives. At the time of the survey, 6% of Americans were currently taking the drugs. Read Full Article…

HVBA Article Summary

1. Barriers to Accessing GLP-1s: High costs and limited insurance coverage create significant obstacles for patients seeking GLP-1 medications. The majority of those interested in the drugs cite affordability as a primary concern, while many insurers and employers remain hesitant to cover them due to their high price tags and limited regulatory approvals for weight loss.

2. Employer Dilemmas in Covering GLP-1s: Employers face financial and strategic challenges in deciding whether to cover GLP-1s. While these drugs show promise in treating obesity and associated chronic conditions, concerns about cost, long-term ROI, and employee turnover make full coverage a difficult choice.

3. Potential Benefits of GLP-1 Coverage: Despite financial constraints, some employers recognize the long-term advantages of providing coverage, including improved employee health, increased job satisfaction, and reduced costs associated with obesity-related conditions. Studies suggest that coverage could enhance workforce well-being and retention.

Elevance Health to buy insurance business from Google sister company

By Rylee Wilson - Elevance Health plans to acquire a stop-loss insurance subsidiary from Verily, a sister company of Google, the company confirmed in a statement to Becker's Feb. 7. Read Full Article…  ^{_{(Subscription required)}} 

HVBA Article Summary

1. Elevance Expands Insurance Portfolio: Indianapolis-based Elevance plans to acquire Granular Insurance Company, though the financial terms of the deal remain undisclosed. This acquisition aligns with Elevance's strategy to strengthen its insurance offerings.

2. Granular's Innovative Technology: Founded in 2020, Granular specializes in medical stop-loss, reinsurance, and fronting products, leveraging proprietary technology. The company was initially backed by Verily, Alphabet’s healthcare and life sciences subsidiary.

3. Elevance's Broader Acquisition Strategy: This deal follows Elevance Health’s recent acquisitions, including Indiana University Health’s health plan and its planned acquisition of CareBridge, a home health provider, highlighting its ongoing expansion efforts.