State lawmakers seek restraints on wage garnishment for medical debt

By Rae Ellen Bichell – Lawmakers in at least eight states this year are aiming to reel in wage garnishment for unpaid medical bills. The legislation introduced in Colorado, Florida, Hawaii, Indiana, Maine, Michigan, Ohio and Washingtonbuilds on efforts made in other states in past years. This latest push for patient protections comes as the Trump administration has backed away from federal debt protections, healthcare has become more costly, and more people are expected to go without medical coverage or choose cheaper but riskier high-deductible insurance plans that could lead them into debt. Read Full Article...

HVBA Article Summary

1. Growing Legislative Efforts Across States: Multiple states, including Colorado, Florida, Hawaii, Indiana, Maine, Michigan, Ohio, and Washington, are introducing bills to restrict or ban wage garnishment for medical debt. These efforts reflect a broader trend of states stepping in to provide consumer protections as federal safeguards have been reduced. The legislative proposals vary, with some aiming for outright bans and others seeking to limit garnishment based on income or other criteria.

2. Debate Over Impact on Healthcare Providers and Patients: Supporters of these measures argue that wage garnishment for medical debt can push vulnerable individuals into financial hardship, especially those with low incomes or inadequate insurance. Critics, including debt collectors and some healthcare industry representatives, warn that restricting garnishment could threaten the financial stability of healthcare providers, particularly in rural areas, and may not address the root causes of healthcare affordability. The debate highlights the challenge of balancing patient protections with the need for providers to collect payments for services rendered.

3. Complexity and Effectiveness of Consumer Protections: Consumer advocates emphasize that broad, simple protections—such as banning wage garnishment for all types of debt—are more effective than complex rules that require debtors to navigate legal processes. Complicated protections may be underutilized because consumers are often unaware of them or find the process too burdensome. Some lawmakers are considering intermediate approaches, like increasing the portion of wages exempt from garnishment, while others push for comprehensive bans to ensure protections are accessible and effective.

No Surprises Act system hits employer plans hard

By Allison Bell – The No Surprises Act independent dispute resolution system is expensive, slow and usually favors the health care providers. A team at the U.S. Department of Health and Human Services has published data supporting those conclusions in a new report on implementation of the IDR system. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Employer Plans Face High Costs and Delays: The independent dispute resolution (IDR) system established by the No Surprises Act has created significant challenges for employer-sponsored health plans. In 2023, 85% of all disputes processed through the system involved private employer plans, highlighting the disproportionate effect on this group. The process averaged 91 days to resolve a dispute, with some cases taking over 300 days, and each review cost an average of $445, adding notable administrative and financial strain for employers.

2. Providers Prevail and Receive Substantially Higher Awards: The data shows that IDR reviewers ruled in favor of health care providers in 80% of hospital care cases. When providers won, the awarded payments were often much higher than standard commercial rates—for example, colonoscopy anesthesia disputes resulted in average awards of $1,252 compared to the typical $300 insurer payment, and pathology tissue exams saw awards of $161 versus the usual $51. These higher payouts may contribute to rising costs for employer health plans and could ultimately impact premiums for covered employees.

3. Patient Protections Remain Strong Despite Systemic Issues: While the IDR process has been criticized for inefficiency and favoring providers, the No Surprises Act has successfully protected patients from unexpected medical bills. Analysts estimate that the law shields patients from about 1 million surprise bills each month. However, ongoing concerns about the volume of ineligible claims and compliance with response deadlines suggest that further legislative or regulatory adjustments may be necessary to improve the system’s balance and effectiveness.

Big Insurance Earnings 2025: Stock Buybacks, Earnings Per Share, Market Capitalization

By Wendell Potter – As we first published yesterday, the seven largest for-profit health insurance conglomerates took in nearly $1.7 trillion from their customers in 2025 ($175 billion more than in 2024) and they booked more than $54 billion in profits. Today I will focus on the $12 billion of our premiums and other health care spending these companies used to buy back their own shares of stock to boost earnings per share, which benefits shareholders and top executives. Read Full Article...

HVBA Article Summary

1. Industry Profits and Share Buybacks: The seven largest for-profit health insurers in the U.S. reported significant revenue and profit growth in 2025, with a notable portion of their earnings directed toward stock buybacks. These buybacks, totaling over $12 billion in 2025 and $137 billion since 2015, are used to increase earnings per share, benefiting shareholders and executives rather than reducing costs for consumers. This financial strategy has drawn increased scrutiny from policymakers and the public.

2. Vertical Integration and Self-Dealing: Over the past decade, major insurers have expanded by acquiring healthcare delivery operations such as physician practices and pharmacies, leading to increased vertical integration. This allows insurance divisions to direct more patient care and spending to their own subsidiaries, a practice that would be considered self-dealing in other industries like banking. Such consolidation has raised concerns among lawmakers, prompting legislative proposals to limit or break up these conglomerates.

3. Impact on Healthcare Costs and Access: Despite their growing profits, these insurance conglomerates have not demonstrated an incentive to control the underlying costs of healthcare goods and services. Instead, rising costs are often passed on to consumers through higher premiums and out-of-pocket expenses. The dominance of for-profit insurers, as opposed to nonprofit models, is linked to higher overall healthcare spending in the U.S. and has contributed to ongoing debates about the structure and regulation of the health insurance industry.

Novo Nordisk to slash Wegovy list price in half in 2027 

By Nicole DeFeudis – Novo Nordisk said that starting next year, it will lower the list price of its popular GLP-1 products to $675 per month in a cost-cutting effort focused on patients with high insurance deductibles or copays. The cuts come as Novo Nordisk continues to grapple with pressure from compounders producing their own, often cheaper, versions of its blockbuster weight loss products. The company announced on Tuesday that its latest move will make it “easier and more affordable” to get “authentic” Wegovy and Ozempic. Read Full Article...

HVBA Article Summary

1. List Price Reduction and Medication Costs: Novo Nordisk announced that the new list price of Wegovy will be approximately half of its previous $1,350 monthly price, while Ozempic and Rybelsus remain listed at about $1,028 per month. The article notes that list prices often differ from patients’ actual out-of-pocket costs because insurers, pharmacy benefit managers, and rebate arrangements can significantly affect what individuals ultimately pay. As a result, the announced reduction may not translate directly into proportional savings for all patients depending on their insurance coverage.

2. Goal of Expanding Patient Access: Company representatives stated that the pricing change is intended to reduce financial barriers and allow more patients to access medications such as Wegovy and Ozempic. Novo Nordisk indicated that lowering the list price is part of broader efforts to make treatment more accessible without altering existing cash-pay discount programs. The company framed the adjustment as a step toward ensuring more patients can realize the therapeutic value of these medications.

3. Independence from Government Agreements and Safety Messaging: Novo Nordisk said the price adjustment is not connected to its “most favored nation” agreement with the Trump administration or to Medicare drug price negotiations under the Inflation Reduction Act. The company also emphasized that patients should avoid compounded or imitation versions of its medications, citing health and safety concerns. This statement reinforces Novo Nordisk’s position that approved branded products are preferable to alternatives produced by compounders.

Medicare Advantage growth decelerates as insurers shed members for 2026

By Rebecca Pifer Parduhn – Medicare Advantage growth continues to slow as health insurance giants pull back on the program, rattled by shrinking profits. Almost 35.5 million people were enrolled in the privatized Medicare programs as of February, compared with about 34.4 million people in the same month last year, according to new government data. That’s growth of about 3%, a figure that pales in comparison to MA’s historical growth, which could be as rapid as 10% annually. MA’s expansion has decelerated in recent years as insurers retreat from the program, spooked by unfavorable regulatory changes and rising medical spending cutting into once sky-high profits. Read Full Article...

HVBA Article Summary

1. Significant Enrollment Declines Among Major Insurers: UnitedHealthcare, the largest Medicare Advantage (MA) carrier, saw a 9% drop in enrollment from 10.3 million in October to just under 9.4 million in February. Other large insurers like Elevance, Centene, and CVS also reduced their MA memberships by 14%, 4%, and 3% respectively. These declines reflect a strategic pullback from the MA market as insurers adjust to lower profitability and regulatory challenges.

2. Humana’s Contrasting Growth Strategy: Unlike its peers, Humana expanded its MA enrollment by over 1 million members, reaching more than 7 million enrollees in February. This growth positions Humana as a potential new leader in the MA market, possibly surpassing UnitedHealthcare. However, this expansion comes with financial trade-offs, as Humana expects significantly lower adjusted profits per share in 2026 compared to the previous year.

3. Regulatory and Market Pressures Impacting MA Growth: The slower growth rate of about 3% in MA enrollment contrasts with historical rates of up to 10% annually, driven by insurers’ concerns over unfavorable regulatory changes and rising medical costs. The program faces scrutiny over overpayments and the use of algorithms, prompting calls for reform and tighter federal oversight. The Trump administration has shown openness to these reforms, including stricter risk adjustment standards and more aggressive audits.

New Haven sues PBMs, manufacturers for alleged inflated insulin prices

By Alan Goforth – The city of New Haven, Conn., alleges that Cigna, CVS Health and UnitedHealth Group inflated insulin prices over the past decade in a lawsuit filed in federal district court. The sweeping complaint includes pharmacy benefit managers Express Scripts, Evernorth, CVS Caremark and Optum Rx; insulin manufacturers Eli Lilly, Novo Nordisk and Sanofi; and group purchasing organizations. New Haven offers self-insured health plans for employees and eligible retirees. Because of what it terms an "insulin pricing scheme," it said it paid artificially inflated prices for insulin and other diabetes drugs from at least 2010 to 2019. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Allegations of Collusion and Price Manipulation: The lawsuit claims that insulin manufacturers and pharmacy benefit managers (PBMs) coordinated to set and maintain high list prices for insulin. It alleges that manufacturers provided secret rebates and fees to PBMs in exchange for favorable placement of their drugs on insurance formularies. This arrangement is said to have resulted in higher costs for both the city’s health plan and its beneficiaries.

2. Pattern of Synchronized Price Increases: According to the complaint, companies such as Sanofi and Novo Nordisk raised insulin prices simultaneously on multiple occasions, sometimes matching each other's price changes down to the decimal point within short timeframes. The suit also references internal communications from Eli Lilly showing executives closely monitoring and matching competitors’ price hikes. These actions are presented as evidence of potential anticompetitive behavior in the insulin market.

3. Broader Legal and Regulatory Context: New Haven’s lawsuit is part of a larger trend, with several other states—including Missouri, Delaware, Oregon, Virginia, and Indiana—filing similar legal actions against insulin manufacturers and PBMs. The city is seeking triple damages, punitive damages, and injunctive relief under federal and state antitrust and consumer protection laws. The outcome of these cases could have significant implications for drug pricing practices and the regulation of PBMs and pharmaceutical companies nationwide.

FDA Lists Multiple Concerns About Unapproved GLP-1 Drugs

By Miriam E. Tucker – The FDA has outlined numerous concerns about the sale and use of unapproved GLP-1 drugs for weight loss. The statement was posted the same week as the online telehealth company Hims & Hers announced a lower-priced compounded version of the semaglutide pill, prompting Wegovy manufacturer Novo Nordisk to threaten legal action, followed by Hims & Hers withdrawing the pill.  However, the new statement highlights concerns that extend beyond just those pertaining to that one product. Read Full Article...

HVBA Article Summary

1. Risks Associated With Unapproved and Compounded GLP-1 Drugs: The FDA warns that unapproved GLP-1 drugs, including compounded versions, have not been evaluated for safety, effectiveness, or quality. This lack of oversight can expose patients to significant health risks, such as improper dosing, contamination, or ineffective treatment. Compounded drugs should only be used in specific circumstances, such as when approved drugs are unavailable or unsuitable for a patient.

2. Concerns Over Fraudulent and Counterfeit Products: The FDA has identified cases of fraudulent compounded GLP-1 drugs, including mislabeled products and those containing incorrect or harmful ingredients. Some products have been found to list non-existent pharmacies or falsely attribute compounding to legitimate pharmacies. There have also been reports of adverse reactions, such as redness and swelling, linked to these counterfeit or adulterated drugs.

3. Regulatory Actions and Recommendations for Safe Use: In response to these issues, the FDA has implemented measures such as a "Green List" for safe imported ingredients and issued import alerts to prevent entry of questionable substances. The agency recommends that patients fill prescriptions for compounded drugs only at state-licensed pharmacies and consult resources like the FDA’s BeSafeRx site for guidance. Healthcare providers are urged to exercise caution when prescribing compounded GLP-1 products and to report any adverse events through the FDA’s Medwatch program.