Benefits broker tells Congress about small employers' health coverage cost pain

By Allison Bell - A benefits consultant from Des Moines went to Washington Tuesday to tell members of Congress that small employers are having trouble providing health benefits. Marcie Strouse, a partner at Capitol Benefits Group, testified at a House Ways and Means health subcommittee hearing on the U.S. health care system that government and industry bureaucracies hold all of the cards and keep small businesses out of the policymaking process. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Rising Costs for Small Businesses: Small companies are struggling with healthcare affordability, paying nearly twice as much for health coverage as large companies. In many areas, family premiums in the small-group market have surged significantly, rising by 85% over the past eight years, leading to a sharp decline in the percentage of small firms offering health benefits.

2. Proposed Solutions for Affordability: Strouse and Republican lawmakers advocate for expanding access to Health Savings Accounts (HSAs), making contribution limits more flexible, and improving Affordable Care Act (ACA) premium tax credit support for employees using Individual Coverage Health Reimbursement Accounts (ICHRAs). Strouse argues that all health plans now effectively function as high-deductible plans and calls for HSAs to be available alongside any health coverage type.

3. Debate Over ACA Subsidies and Research Funding: Democratic lawmakers and health advocates warn that Republican proposals, including reductions to ACA premium tax credit subsidies, could drive up insurance costs and lead to millions losing coverage. Additionally, concerns were raised over proposed $4 billion cuts to federal biomedical research funding, which could significantly impact chronic disease research and state-level health funding.

Trump is unlikely to end Medicare drug price talks — here’s what that means for patients and pharma

By Annika Kim Constantino - President Donald Trump likely won’t do away with a landmark process that allows Medicare to negotiate drug prices with manufacturers, even as he moves to erase Joe Biden’s other historic policy accomplishments. But Trump will likely make some changes to those price talks, and it may not require help from Congress. Read Full Article…

HVBA Article Summary

1. Trump’s Approach to Medicare Drug Price Negotiations: Trump is expected to modify rather than abandon the Medicare drug price negotiation process, potentially increasing transparency and broadening stakeholder involvement. His administration may reinterpret the law’s selection criteria, allowing for more flexibility in determining which drugs qualify for negotiations.

2. Potential Implications for Pharmaceutical Companies and Patients: Changes in how Medicare selects and prices drugs could have significant consequences for pharmaceutical companies and Medicare beneficiaries. Looser standards for determining market competition and adjusting how Medicare defines a single drug could benefit drugmakers while potentially impacting cost savings for patients and the government.

3. Legal and Congressional Challenges: Major legislative changes to the negotiation process would require Congressional approval, making them less likely. However, Trump could influence ongoing legal battles over the program’s constitutionality by choosing to defend or weaken its legal standing. The industry’s lawsuits remain unresolved, and Trump’s stance on them could shape the future of drug pricing policies.

CVS CEO David Joyner mounts defense of PBM industry amid ongoing scrutiny

By Paige Minemyer -CVS Health CEO David Joyner went on the defense of the pharmacy benefit management industry on the company's fourth-quarter earnings call Wednesday morning. PBMs have been under intense scrutiny from regulators and lawmakers who are concerned about the role that they play in the pharmaceutical supply chain as drug costs rise. However, the industry has shot back that is a critical bulwark against drugmakers and their pricing. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. PBMs as Cost-Saving Entities: PBMs like Caremark play a crucial role in counteracting rising drug prices, with Joyner emphasizing that they are the only entities in the supply chain focused solely on lowering costs. Despite this, they have been subjected to misleading rhetoric and scrutiny, particularly from the Federal Trade Commission.

2. Pharmaceutical Pricing and PBM Impact: Branded drug manufacturers significantly contributed to rising healthcare costs, adding $21 billion through price increases in January alone. Drugs without PBM negotiation tools have seen prices rise more than twice as fast as other medications, underscoring the value PBMs bring in managing costs.

3. CVS Financial Performance and Challenges: While CVS Health reported increased revenue year-over-year, profits declined due to elevated medical costs and challenges in its insurance division. Despite these setbacks, its integrated model continues to drive growth in key areas like pharmacy services and consumer wellness.

What a $2 Million Per Dose Gene Therapy Reveals About Drug Pricing

By Robin Fields - Vincent Gaynor remembers, almost to the minute, when he realized his part in birthing the breakthrough gene therapy Zolgensma had ended and the forces that turned it into the world’s most expensive drug had taken over. Read Full Article…  

HVBA Article Summary

1. The Role of Public and Charitable Funding in Drug Development: The development of Zolgensma was largely subsidized by taxpayers and private charities like Sophia’s Cure, which helped fund early research and clinical trials. Despite this, there were no conditions ensuring affordability or public return on investment, leading to a final product priced at over $2 million per dose.

2. Corporate Takeover and the Shift to Profit Maximization: As the drug showed promise, the biotech startup AveXis, led by venture capitalists and executives, took control, sidelining early advocates like the Gaynors. The company was later acquired by Novartis for $8.7 billion, leading to massive financial gains for investors and executives while leaving questions about the fairness of the pricing model.

3. The Broader Implications for Drug Pricing and Access: Zolgensma’s pricing set a precedent for gene therapies, with several now exceeding $2 million per dose. The lack of regulation on drug pricing in the U.S. allows pharmaceutical companies to charge as much as they deem profitable, raising concerns about accessibility and the ethics of monetizing life-saving treatments developed with public and charitable contributions.

Survey Finds That Healthcare Access and Affordability Are Top Concerns

By Pietje Kobus - Last week, the Rollins-Gallup Public Health Priorities Survey results were published by Emory University’s Rollins School of Public Health and Gallup. Access to healthcare and its affordability came out as a top concern for Americans.. Read Full Article…

HVBA Article Summary

1. Healthcare Access and Affordability: A quarter of respondents identified healthcare access and affordability as their highest priority, with more than half ranking it among their top three concerns. This priority spans various demographic groups, including differences in income, age, and education.

2. Government Responsibility: 75% of those who ranked healthcare access as a top priority believe the federal government is better equipped than state governments to address these issues, emphasizing the need for national-level action.

3. Broad Public Consensus: The survey highlights that Americans across different socioeconomic and demographic groups agree on the need for government to prioritize healthcare access, signaling widespread concern over insufficient progress in public health efforts.

Employers can meet Gen Z's expectations in 2025

By Patricia Pomies - As Gen Z gains influence in the workplace, HR leaders are seeing their impact on company culture, technology usage and benefit offerings. So, to attract and retain top talent in 2025, it's critical to understand what Gen Z values in their jobs — and how employers can adjust their benefits offerings to align with their priorities. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Flexibility and Work-Life Balance: Gen Z highly values flexible work arrangements, including remote and hybrid options, to maintain a healthy work-life balance. Employers that offer these benefits will have a competitive edge in attracting and retaining Gen Z talent.

2. Mental Health and Financial Wellness: Mental health support, student loan repayment assistance, and financial education are key priorities for Gen Z. They expect workplaces to provide comprehensive well-being programs that address both their emotional and financial stability.

3. Career Growth and Purpose-Driven Work: Gen Z seeks continuous learning opportunities, mentorship, and career advancement paths. They are also drawn to organizations that prioritize diversity, equity, inclusion, and corporate social responsibility, ensuring that their work aligns with their values and long-term goals.

Texas can regulate self-insured plans' PBMs, its attorney general rules

By Allison Bell - Texas Attorney General Ken Paxton has explained why he thinks Texas can apply two new pharmacy benefit manager laws to PBMs working with self-insured health plans. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. ERISA Preemption and Texas PBM Laws: The Employee Retirement Income Security Act of 1974 (ERISA) generally preempts state laws that regulate self-insured benefit plans to prevent a patchwork of regulations. However, Texas Attorney General Ken Paxton argues that Texas’ PBM laws should not be preempted because they do not directly reference or impose requirements on ERISA plans.

2. Legal and Regulatory Battle: Texas’ PBM laws are similar to Oklahoma’s, which are currently under review by the U.S. Supreme Court in Glen Mulready et al. v. Pharmaceutical Care Management Association. Paxton’s opinion supports state regulatory authority over PBMs, countering objections from employer groups and PBM trade organizations that argue such laws interfere with ERISA’s federal protections.

3. PBM Controversy and Stakeholder Positions: Pharmacy Benefit Managers (PBMs) play a crucial role in managing prescription drug benefits, but they face criticism for allegedly prioritizing their own profits over cost savings for payers and patients. While PBMs claim to reduce drug costs, opponents—including pharmacies and some employer groups—assert that PBMs exploit their market power to the detriment of competition and transparency.

Employee Benefits That Are Important for 2025

ACRISURE - The landscape of employee benefits continues to evolve in 2025. With advancements in technology, shifts in workforce demographics, and changing societal values, it's essential for companies to stay ahead of the curve in offering attractive and meaningful benefits. Read Full Article… 

HVBA Article Summary

1. Comprehensive Employee Benefits Are Crucial for Talent Attraction and Retention: In 2025, organizations must offer well-rounded benefits, including health and wellness programs, financial wellness support, and voluntary benefits, to remain competitive in the job market. Holistic health plans, preventive care, and mental health support will be increasingly valued by employees.

2. Financial and Family-Friendly Benefits Enhance Employee Satisfaction: Employers can support financial stability by offering retirement planning, student loan assistance, and financial education programs. Additionally, family-oriented benefits such as paid parental leave, childcare support, and elder care assistance will be essential in fostering a positive work-life balance.

3. Technology-Driven Perks and Professional Development Drive Engagement: Companies leveraging digital health platforms, automated HR services, and remote work stipends can enhance efficiency and employee experience. Furthermore, investing in continuous learning, career pathing, and skill development will be key in attracting and retaining top talent in an evolving workforce.