Benefits group CEO stumps for PBM bills at House hearing

By Allison Bell - Shawn Gremminger, president of the National Alliance of Healthcare Purchaser Coalitions, spoke on Capitol Hill Wednesday in support of two pharmacy manager bills that came close to passing in December. Gremminger appeared at a hearing on PBMs organized by the House Energy and Commerce Committee's health subcommittee. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Bipartisan Potential for PBM Bills: Rep. Diana DeGette indicated that all Democrats are ready to support the PBM (Pharmacy Benefit Manager) bills if they are moved to the House floor using the "suspension calendar," which expedites passage for widely supported measures. Rep. Brett Guthrie highlighted that the bills have sufficient bipartisan appeal to pass outside of the budget reconciliation process, emphasizing the need for collaborative effort between parties.

2. Key Provisions and Industry Impact: The PBM bills include sections 901 and 902 of the Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025, which aim to increase transparency in PBM operations. Section 901 mandates detailed PBM reporting for employers, while section 902 requires PBMs to pass on rebates from drug manufacturers to health plans. These provisions are designed to curb PBM practices that prioritize high-cost, low-value drugs and retain discounts without benefiting employers.

3. Challenges and Advocacy Efforts: Despite industry support for transparency, political challenges remain, notably influenced by opposition from high-profile figures like Elon Musk, who advocated for a stripped-down version of the appropriations package without PBM reforms. Gremminger, representing regional employer coalitions, urged lawmakers to revive sections 901 and 902, arguing they would ensure fairer formulary decisions and rebate distribution, ultimately benefiting employers and insured individuals.

Major Medicaid cuts are looming. Here's a look at the impacts they may have

By Paige Minemyer - Congress is poised to approve steep cuts to the Medicaid program, and multiple new studies seek to analyze the impacts significant changes could have on states and enrollees. Multiple scenarios for overhauling Medicaid are in play. In one, expansion funding rolled out under the Affordable Care Act (ACA) could be pulled back, and, in another, legislators could institute per capita spending caps on the program. Both options have historically been touted by conservatives seeking to reduce outlays. Read Full Article…

HVBA Article Summary

1. Impact on Spending and Coverage: Eliminating the federal match for Medicaid expansion could reduce spending by $1.9 trillion over a decade, potentially leading to 20 million people losing coverage, or a 24% decrease in overall enrollment. States would face difficult choices: either increase spending by 17% to maintain coverage or end the expansion, drastically reducing enrollment.

2. State-Specific Financial Burdens and Enrollment Effects: States like North Dakota, Indiana, Montana, Nebraska, Oregon, Colorado, Washington, and New York would need to raise spending by 30% to maintain coverage. Without federal funding, nine states, including New York and Michigan, would see the highest spikes in uninsured rates. Overall, Medicaid and CHIP enrollment could drop by 21.8%, particularly affecting young adults, seniors, Black individuals, and those in poor health.

3. Potential Consequences of Per Capita Caps: Introducing per capita caps could further reduce Medicaid spending by $532 billion to $1 trillion, or up to $2.1 trillion if combined with ending Medicaid expansion. This could result in up to 30 million people losing coverage. States trying to offset federal cuts might see expenditures rise by as much as 57%, disproportionately impacting poorer states struggling to close funding gaps.

Advocates lean on Trump's telehealth legacy to extend expiring flexibilities

By Emma Beavins - While lobbyists are supplicating President Donald Trump and the Republican-led Congress to continue their leadership on telehealth and extend expiring flexibilities—which Trump began during the COVID-19 pandemic—they no longer are asking for a concrete timeline. Read Full Article…

HVBA Article Summary

1. Urgent Call for Long-term Telehealth Flexibilities: Three hundred and fifty organizations have urged Congress to extend expiring Medicare telehealth flexibilities and restore telehealth access for commercially insured patients. While the groups prefer permanent solutions, they are open to long-term extensions, acknowledging the legislative process may take several years.

2. Congressional Uncertainty and Strategic Timing: Lobbyists are uncertain about the duration of the extension Congress may grant, with March 14 and March 31 being critical deadlines linked to government funding and healthcare program expirations. The possibility of including telehealth extensions in the funding bill is high, although details on specific policies and timelines are yet to be defined.

3. Broad Bipartisan Support and High Stakes: The push for extending telehealth flexibilities is supported by bipartisan lawmakers and is seen as crucial for continuing virtual care infrastructure investments and chronic disease management initiatives. The telehealth community, spanning from major hospitals to individual providers, is poised for strong advocacy if Congress risks allowing the flexibilities to lapse.

Health care accounted for one quarter of all federal spending in last fiscal year

By Alan Goforth - Health care is an inviting target for budget cutters in Washington. One of every four dollars in federal spending in fiscal year 2024 was used to pay for health programs and services. The next-largest categories are Social Security (21%), national defense (13%) and interest payments on the national debt (13%). Combined, these four categories account for nearly three-quarters of all federal spending. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Federal Spending on Health Programs: In fiscal year 2024, the federal government allocated $1.9 trillion to health care programs and services, representing 27% of all federal outlays, making it the largest category of federal spending. Additionally, forgone tax revenues due to subsidies for employer-sponsored insurance and ACA premium tax credits amounted to $398 billion.

2. Focus on Health Insurance Subsidies: Over 80% of federal support for health programs is directed toward subsidizing health insurance coverage, with 36% going to Medicare, 25% to Medicaid and CHIP, 17% to employment-based health coverage, and 5% to ACA coverage subsidies. Cuts to these programs could significantly impact access to health care and increase costs for consumers.

3. Discretionary Health Spending Overview: Discretionary spending constitutes a smaller portion of overall federal health support, with more than half ($128 billion) allocated to hospital and medical care for veterans. Additional discretionary funds are directed toward agencies like the National Institutes of Health and the CDC (4%), as well as global health initiatives. Despite its smaller share, discretionary spending remains critical for public health infrastructure and research.

Medicare spending on diabetes drugs surged over 5 years, US report shows

By Reuters - Medicare spending on some diabetes drugs, including popular treatments such as Ozempic, surged nearly five-fold to $35.8 billion between 2019 and 2023, a U.S. government watchdog's report showed this week. Medicare, the government-backed program for adults aged 65 and older and those with disabilities, only covers the use of GLP-1 drugs for diabetes, but not for weight loss. Read Full Article…

HVBA Article Summary

1. Decline in Spending on Older Diabetes Medications: The report from the U.S. Department of Health and Human Services' Office of the Inspector General highlights a decline in spending on older diabetes medications like metformin, while spending on newer GLP-1 drugs such as Novo Nordisk's Ozempic surged significantly over the past five years.

2. Explosive Growth in Ozempic Spending: Ozempic, which has gained popularity for both diabetes management and off-label use for obesity, experienced a more than 16-fold increase in spending, reaching $9.2 billion in 2023. The rapid growth in spending raises questions about whether claims were paid for appropriate use, according to the watchdog.

3. Policy and Regulatory Implications: The data may influence policy decisions, with HHS Secretary Robert Kennedy Jr. potentially using the findings to argue against the proposed expansion of GLP-1 drug coverage for weight loss. Critics, including Kennedy, suggest that focusing on these drugs might address symptoms of the obesity crisis rather than tackling root causes like food system issues.

Benefits Think: The caregiving crisis is upon us

By Amy Friedrich - Every day I hear team members, colleagues, and customers talk about the stress of juggling schedules to get kids to events, taking kids or parents to appointments, managing finances for their household and sometimes for their parents, and countless other challenges that come along with the important work of caregiving. For some, these caregiving responsibilities are expected, but we can't forget that for many people, becoming a caregiver is disruptive, and they may be thrust into the role unexpectedly. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Expanding Access to Paid Family and Medical Leave (PFML): To support the growing number of working caregivers, expanding access to PFML is essential. This includes extending the Employer Credit for Paid Family and Medical Leave (Fischer Tax Credit) beyond 2026 and enacting the proposed Credit for Caring Act of 2024, which provides a nonrefundable tax credit for working caregivers. These measures would alleviate financial burdens and incentivize employers to support employees balancing work and caregiving responsibilities.

2. Bolstering the Caregiving Industry and Support Services: As demand for caregiving services continues to rise, bolstering the caregiving industry is crucial. This includes incentivizing businesses that provide dependent care solutions, such as platforms for finding adult or childcare services and financial guidance tools. By supporting these businesses and encouraging employers to connect employees with these resources, we can enhance care accessibility while protecting financial stability for caregivers.

3. Addressing Economic Risks and Workforce Retention: The caregiving crisis poses significant economic risks, with a predicted $290 billion annual loss to U.S. GDP starting in 2030 due to caregiver shortages. To prevent this, collaborative efforts between employers and the government are needed to create comprehensive caregiving solutions. This involves developing consistent PFML policies, enhancing financial support for caregivers, and ensuring workforce retention by reducing the pressure on employees balancing work and caregiving duties.

Updated: Lilly joins Trump administration to announce $27B manufacturing commitment

By Zachary Brennan - Eli Lilly touted a huge new US manufacturing investment at an event on Wednesday, trotting out the news with a member of President Donald Trump’s cabinet as part of what has been a signature priority for the new administration. The drugmaker’s $27 billion investment will be made across four sites at locations to be announced later this year. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Major Infrastructure Investments and Job Creation: Eli Lilly has committed to $50 billion in new manufacturing infrastructure across Indiana, North Carolina, and Wisconsin, including three new API sites and an injectables site. This expansion is expected to create up to 13,000 new jobs, driven by increasing demand for its weight loss drugs and a strategic move to reshore small molecule manufacturing.

2. Policy Influence and Economic Impact: CEO David Ricks credited the 2017 Tax Cuts and Jobs Act as a foundational driver for Lilly's domestic investments, advocating for the continuation of these policies. However, he expressed caution regarding potential impacts from FDA budget cuts, particularly concerning drug review timelines and inspection processes, which could influence future investment decisions.

3. Strategic Expansion and Competitive Positioning: In addition to the $27 billion in new spending, Lilly continues to expand its US manufacturing footprint with recent investments, including a $4.5 billion clinical manufacturing site in Indianapolis and a $5.3 billion facility for tirzepatide production in Lebanon, IN. These strategic moves aim to secure supply chains, meet global demand, and strengthen Lilly's competitive position amid rising market opportunities for obesity and diabetes treatments.

How Technology is Transforming Open Enrollment in the U.S.

By AON - As U.S. employers navigate the rising costs of healthcare, which are expected to increase by 9.2 percent in 2025, they are making plan changes to manage these expenses. This balancing act involves adjusting employer contributions and providing employees with more valuable benefits. To achieve this, we see three big opportunities around the open enrollment process. Read Full Article…  

HVBA Article Summary

1. Enhance User Experience with Advanced Technology:

   • Implement omni-channel communication tools such as mobile apps, chatbots, videos, and virtual counselors to effectively educate and guide employees through the enrollment process.

   • Utilize AI-driven decision-support systems and virtual assistants to provide personalized guidance and seamless customer support, enhancing the overall user experience.

   • Streamline operations with digitized processes, including single sign-on capabilities and intuitive interfaces, ensuring consistent employee engagement and informed decision-making throughout the year.

2. Expand Choice with Multiple Insurance Carriers and Plan Options:

   • Offer a variety of health insurance carriers and plan types to enable employees to customize coverage based on their personal health needs and preferences.

   • Include voluntary benefits and lifestyle accounts, allowing employees to have greater flexibility and control over how they utilize their benefit dollars.

   • Provide transparent information, including consumer ratings and in-network/out-of-network provider details, to empower employees to make cost-effective and informed choices.

3. Empower Informed Decisions with Advanced Selection Tools and Continuous Education:

   • Leverage technology-enabled selection tools that assess employees' health and financial situations to recommend tailored benefit plans.

   • Extend communication and support beyond the traditional two-week open enrollment period with ongoing education campaigns and wellbeing initiatives.

   • Simplify the decision-making process by integrating voluntary benefits into decision-support tools, offering bundled recommendations for a more streamlined selection experience.