Musk, DOGE blocked from sensitive payment records as states fight to defend Medicaid funds

By Noah Tong - A new lawsuit is yielding quicker success in challenging the legality of Elon Musk’s Department of Government Efficiency (DOGE) takeover of the Treasury payment systems, which has opened up new, wide-reaching privacy concerns not limited to Americans’ healthcare records. Read Full Article…

HVBA Article Summary

1. Court Restriction on Payment Records: A federal judge in the Southern District of New York temporarily blocked Elon Musk and the Department of Government Efficiency (DOGE) from accessing sensitive payment records, citing concerns over data security and unauthorized access. The decision, prompted by a lawsuit from 19 state attorneys general, mandates that DOGE destroy any records in its possession and limits access to certain civil servants only.

2. Privacy and Security Concerns in Government Systems: Lawmakers and legal experts are raising alarms about Musk’s increasing influence over federal agencies, particularly his ability to access healthcare records within HHS and Treasury payment infrastructure. Unions representing government workers have filed lawsuits to restrict this access, arguing that it poses significant cybersecurity risks and violates federal privacy laws.

3. Potential Risks to Federal Benefits and Payments: Critics warn that Musk’s influence over government payment systems, including those handling Social Security, Medicare, and Medicaid disbursements, could have catastrophic consequences. There are growing concerns that politically motivated actions could disrupt critical federal payments, with some lawmakers fearing Musk and his allies might selectively halt funding to certain programs or agencies, leading to widespread financial instability.

SIIA Government Relations Update

By SIIA - Whether it’s President Trump signing Executive Orders to sell Federal property (e.g., sell buildings owned by the General Services Administration (GSA)); or the new DOGE led by Elon Musk shutting down a Federal Agency and reducing the government workforce through buying out Federal employees…each action is showing us how serious the Trump Administration is about controlling government spending. Read Full Article…

HVBA Article Summary

1. Congressional Inaction on Government Funding: With a looming March 14th deadline, House Republicans remain divided over spending cuts, hindering progress on a government funding deal. Conservative members push for significant reductions, while moderates fear political backlash from deep cuts. Meanwhile, House Democrats refuse to assist Speaker Johnson in averting a shutdown, increasing uncertainty over whether an agreement will be reached in time.

2. Reconciliation Process Faces Delays: House Republicans' internal disputes over government spending have caused them to miss a key deadline for initiating the Reconciliation Process. Without a Budget Resolution, their strategy for passing tax, energy, and immigration policies is at risk. Senate Republicans, frustrated with the delays, may take the lead with their own reconciliation bills, further complicating the legislative process.

3. Key Cabinet Nominees and Policy Priorities: President Trump’s Cabinet nominees are advancing, with RFK Jr. moving closer to confirmation as HHS Secretary and Dr. Oz preparing for his CMS Administrator confirmation vote. However, former Rep. Lori Chavez-DeRemer’s nomination for DOL Secretary faces opposition from Senate Republicans due to her pro-union stance. Meanwhile, healthcare policy discussions continue, including long-awaited clarifications on the Gag Clause Prohibition and state-level legislative efforts affecting self-insured plans.

The fate of virtual OUD treatment lies in a mess of intertwined final and proposed regulations

By Emma Beavins - A binding rule published in the final days of the Biden administration changes the way providers prescribe medications for opioid use disorder via telehealth. The Drug Enforcement Administration (DEA) rule allows for six months of prescribing buprenorphine virtually to a new patient. Read Full Article…

HVBA Article Summary

1. Limited Impact of the Buprenorphine Final Rule: While the DEA’s buprenorphine final rule provides a six-month window for virtual prescribing, it does not establish a long-term framework for telehealth-based opioid use disorder (OUD) treatment. Without a broader telemedicine registration system, virtual-only providers like Bicycle Health remain constrained by in-person evaluation requirements after six months.

2. Unfinished Special Telemedicine Registration Framework: The proposed special telemedicine registration framework, meant to enable broader telehealth prescribing of controlled substances, remains unresolved despite years of advocacy. The DEA’s initial attempt to introduce this framework in March 2023 received record-breaking public feedback but has yet to be finalized, leaving telehealth providers in regulatory limbo.

3. Potential Policy Shifts and Uncertain Future: The expiration of pandemic-era prescribing flexibilities in December 2025 could create significant challenges for virtual OUD treatment providers. The incoming Trump administration’s stance on telehealth-controlled substance prescribing remains unclear, heightening concerns that the buprenorphine rule may not be sufficient to maintain access to care.

The next generation of the benefits experience

By Anupam Gupta - While many sectors of the insurance industry have embraced advanced connectivity and automation, many benefits advisors still rely on disparate systems or multiple Excel spreadsheets in local and shared drives, separate from the agency’s management system. This leads to duplicative data entry, the need to search across various platforms for single data points, reduced productivity, and increased risk of errors, compliance issues, and security challenges. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Enhancing Operational Efficiency: The digital roundtrip of benefits streamlines the entire benefits lifecycle by integrating technology platforms, reducing manual errors, and automating key processes. This eliminates redundant data entry, improves compliance, and frees up advisors' time to focus on strategic consulting and client relationships.

2. Improving Customer Retention: By enabling real-time data flow and self-service tools, the digital roundtrip provides a seamless experience for clients and their employees. Faster response times, transparent plan options, and a simplified enrollment process enhance customer satisfaction, leading to stronger retention rates and long-term trust.

3. Driving Business Growth: A fully connected benefits ecosystem empowers agencies to optimize their workflows, reduce administrative burdens, and deliver superior service. The resulting cost savings, improved accuracy, and enhanced client experience position agencies for sustainable growth in an increasingly competitive market.

Some Patients — And Doctors — Turn to Microdosing GLP-1s

By Kathleen Doheny and Carolyn Crist - As glucagon-like peptide 1 (GLP-1) receptor agonist use becomes more prevalent, patients are using them for new indications — and at new dosages. Say hello to microdosing, or taking doses lower than the recommended therapeutic amount, for various reasons: Weight maintenance, metabolic health improvements, anti-inflammation and anti-autoimmune effects, fewer side effects, and lower costs. Read Full Article…

HVBA Article Summary

1. Growing Popularity and Accessibility of Microdosing: Advocates highlight that microdosing GLP-1 medications can reduce costs and side effects while still supporting weight loss and maintenance. This approach is especially favored by telemedicine providers who offer more affordable compounded versions, making the treatment accessible at a fraction of the cost of brand-name options.

2. Concerns Over Safety and Regulation: Critics warn of the risks associated with microdosing, including the lack of clinical guidelines, potential contamination, and inconsistent dosing. Physicians caution that compounded GLP-1s lack FDA approval, and some worry about patients self-administering doses without proper medical oversight.

3. Uncertain Future for Compounded GLP-1s: The availability of compounded GLP-1s is under scrutiny as pharmaceutical companies push for tighter restrictions. While current FDA policies allow compounding during shortages, the resolution of supply issues and regulatory changes could limit access to these lower-cost alternatives in the future.

One key word can drive meaningful engagement with passive enrollment

By Tom Smith - Ten years ago, when it came to benefits enrollment, many employees met “knee to knee” with an HR representative to enroll in their benefits. This was the norm. HR reps were essentially promised access to every employee at the worksite, where, crucially, employees either accepted or declined benefits. Read Full Article…  ^{_{(Subscription required)}} 

HVBA Article Summary

1. The Shift to Passive Enrollment and Its Challenges: Since the pandemic, benefits enrollment has increasingly shifted to a passive model, leaving employees with minimal guidance. This has led to issues such as poor communication, ineffective technology, and lower visibility for voluntary benefits, making it harder for employees to make informed decisions.

2. The Behavioral Economics Behind Requiring a Decision: The principle of the “power of the regret of no” suggests that requiring employees to actively accept or decline benefits increases engagement. When forced to make a decision, employees naturally evaluate their options and potential risks, leading to a higher likelihood of opting in for coverage.

3. A Simple Yet Effective Strategy for Higher Enrollment: By implementing a mandatory “yes” or “no” decision, HR teams can replicate aspects of traditional guided enrollments in a self-service world. This approach not only streamlines the process but also ensures that more employees secure valuable coverage, ultimately providing greater financial security.

Can AI Make Doctors Think Deeper?

By John Nosta - I think it's fair to say that artificial intelligence (AI) isn't just another clinical tool; it's a transformative force reshaping how clinicians approach patient care. Among the most exciting developments is the advent of large language models (LLMs)—tools that have relevance to both clinicians and patients. Read Full Article…

HVBA Article Summary

1. A New Form of Cognitive Collaboration: The integration of LLMs into medical decision-making is shifting the process from a solo cognitive task to an interactive dialogue. Physicians engage in an iterative exchange with AI, allowing for deeper analysis, expanded thinking, and more nuanced clinical reasoning.

2. Enhancing Clinical Perspectives with AI: LLMs provide a broader, more comprehensive medical perspective by drawing on extensive literature and real-world data. Clinical trials suggest that LLM-augmented physicians achieve similar performance to LLMs working independently, both outperforming conventional methods and challenging traditional approaches.

3. Balancing Speed and Accuracy for Better Outcomes: While AI-augmented decision-making may take slightly longer, the additional deliberation time enhances accuracy and safety. Clinical trial data indicate a statistically significant improvement in reasoning scores, reinforcing that thoughtful integration of AI can improve patient outcomes without compromising physician autonomy.

Wisconsin couple sues Walgreens, Optum Rx over son's death

By Alexandra Murphy - A Wisconsin couple has filed a lawsuit against pharmacy benefit manager Optum Rx and Walgreens, alleging their son's death was linked to a sudden price increase in his asthma medication. Read Full Article…

HVBA Article Summary

1. Allegations of Unaffordable Price Increase – The lawsuit claims that Optum Rx unlawfully raised the cost of Advair Diskus from $66 to $539 without medical justification or prior notice, making it unaffordable for Cole Schmidtknecht, who relied on the medication to manage his asthma.

2. Failure to Provide Assistance – The Schmidtknecht family alleges that Walgreens pharmacy staff did not offer alternative options or attempt to contact Optum Rx for an exception, leaving Mr. Schmidtknecht without a viable solution to obtain his medication.

3. Fatal Consequences and Legal Action – Unable to afford the medication, Mr. Schmidtknecht attempted to manage his asthma with a rescue inhaler but suffered a fatal attack. The lawsuit seeks over $75,000 in damages for the alleged negligence that contributed to his death.