Senate passes government spending package, including healthcare funding

By Heather Landi and Dave Muoio – The Senate on Friday passed legislation that would fund most government departments through the end of September, including the Department of Health and Human Services. The 71-29 vote came shortly after Senate Democrats and President Donald Trump made a deal to separate a funding bill for the Department of Homeland Security from five other spending bills. The agreement would fund DHS at existing levels for two more weeks to allow both parties to try to hash out a deal to impose new restrictions on federal immigration enforcement. Splitting off funding for DHS was a key demand from Senate Democrats. Read Full Article...

HVBA Article Summary

1. Bipartisan Deal Separates DHS Funding: The Senate passed a major government spending package after reaching a bipartisan agreement to separate Department of Homeland Security (DHS) funding from other appropriations bills. This move was crucial in overcoming a political impasse, as Senate Democrats insisted on splitting the DHS funding due to disagreements over immigration enforcement policies. The separation allows most government departments, including health agencies, to be funded while giving lawmakers more time to negotiate DHS-specific issues.

2. Healthcare Funding and Policy Extensions Included: The package allocates $116.6 billion in discretionary funding for the Department of Health and Human Services and implements a $100 million reduction in agency bureaucracy. It also extends several healthcare programs, such as telehealth waivers and virtual care, and provides supplementary funding for rural hospitals and facilities serving government-insured patients. Additional provisions aim to increase transparency for pharmacy benefit managers and require Medicare Advantage plans to maintain accurate provider directories.

3. Potential Impact of Delays and Shutdowns: Although the Senate passed the package, the House must still approve it, and a partial government shutdown was triggered due to the delay. The impact of the shutdown is expected to be minimal if the House finalizes the plan promptly. However, advocates warn that lapses in funding or program extensions, especially for telehealth, could disrupt care for vulnerable populations if not resolved quickly.

Telehealth flexibilities, hospital-at-home waivers lapse amid partial government shutdown

By Emily Olsen – The House originally passed the government funding package in January, shortly before appropriations was set to lapse near the end of the month. Funding bills for some agencies had already been enacted. The Senate appeared ready to pass the package too, given lawmakers have limited appetite for another lengthy government shutdown. Read Full Article...

HVBA Article Summary

1. Senate Approves Revised Health Funding Package with DHS Removed: In a 71–29 vote, the Senate approved a restructured appropriations package that advances health-related funding while setting aside more contentious items for later negotiation. The bill now excludes funding for the Department of Homeland Security (DHS), allowing lawmakers to focus solely on the health-related provisions. A two-week deadline has been established to revisit and renegotiate DHS appropriations separately, ensuring that essential health funding is not delayed further.

2. HHS Gains Significant Funding Boost and Drug Pricing Reforms: The legislation provides $116.8 billion in discretionary funding for the Department of Health and Human Services (HHS), marking a $210 million increase over fiscal year 2025 and exceeding the White House’s request by $33 billion. In addition to the funding increase, the bill introduces policy changes aimed at improving accountability in the pharmaceutical supply chain. These include new transparency requirements for pharmacy benefit managers (PBMs) and a ban on compensation models tied to drug manufacturers’ list prices under Medicare Part D. The package also delays scheduled cuts to Medicaid disproportionate share hospital payments until fiscal year 2028.

3. Longer-Term Extensions for Telehealth and Hospital-at-Home Programs: Responding to strong support from healthcare providers and patient advocates, the bill extends key care delivery models that emerged during the pandemic. Medicare’s expanded telehealth reimbursement policies will now remain in place through 2027, supporting continued access to remote care. Additionally, the Acute Hospital Care at Home Program is extended through September 30, 2030, allowing approved hospitals to deliver inpatient-level care in patients’ homes. These extensions aim to preserve care flexibility and avoid the disruptions that occurred when such programs lapsed during prior government funding gaps.

Trump administration pressed on details of drug price deals

By Peter Sullivan – The Trump administration is facing new pressure to disclose details about its confidential pricing agreements with big drug companies and whether they meaningfully lower costs for patients. Why it matters: President Trump has touted the "most favored nation" drug pricing deals as one of his signature accomplishments, but most of the details have been kept under wraps, including how the new prices are calculated. Read Full Article...

HVBA Article Summary

1. Transparency Concerns Surround Drug Pricing Deals: Public Citizen filed a Freedom of Information Act (FOIA) lawsuit to compel the release of the full text of drug pricing agreements made between the Trump administration and pharmaceutical companies like Pfizer and Eli Lilly. Although these deals were promoted as efforts to reduce U.S. drug costs, the lack of publicly available details has raised concerns. Critics argue that the administration’s refusal to disclose the agreements, citing proprietary and commercially sensitive information, undermines public trust and accountability. Congressional Democrats have echoed these concerns, requesting more information to assess whether the deals will truly benefit consumers.

2. Limited Impact on Drug Prices for Most Americans: Despite high-profile announcements, the agreements are unlikely to significantly reduce drug prices for the majority of Americans, particularly those covered by Medicare or employer-sponsored insurance. The most-favored nation pricing model in the deals is expected to apply primarily to Medicaid, which already benefits from lower prices. There is also ambiguity surrounding how new drugs—often launched first in the U.S.—would be priced without international benchmarks. Additionally, the TrumpRx portal offers some discounts, but relies on cash purchases, potentially limiting its accessibility for low-income or insured individuals.

3. Skepticism Over Broader Effectiveness and Industry Motives: Health policy experts and watchdog groups remain skeptical about whether these deals will achieve meaningful cost reductions for American consumers. There is concern that pharmaceutical companies may agree to only minor price cuts in the U.S. while offsetting them by increasing prices abroad, thereby preserving profits. While the administration has proposed pilot programs to test most-favored nation pricing in Medicare, these initiatives are geographically limited and expected to have minimal impact on overall spending. The underlying issue—that Americans pay more for prescription drugs than other developed nations—remains largely unresolved.

Labor Department proposes rule to force greater PBM transparency

By Paige Minemyer – The Department of Labor has issued a proposed rule that aims to inject additional transparency in pharmacy benefit manager relationships. The agency said Friday that the rule will make it easier for employers and plan sponsors, who serve as fiduciaries on pharmacy coverage, to meet their requirements under the Employee Retirement Income Security Act (ERISA). Under the rule, PBMs would be required to disclose key information, such as rebates and other payments from drug companies, to these fiduciaries for the first time. Read Full Article...

HVBA Article Summary

1. Increased Transparency Requirements for PBMs: The proposed rule by the Department of Labor would require pharmacy benefit managers (PBMs) to disclose detailed information about rebates, payments from drug companies, and compensation structures to employer fiduciaries. This move is intended to help employers and plan sponsors fulfill their fiduciary duties under ERISA. By mandating these disclosures, the rule aims to address concerns about hidden fees and opaque financial arrangements in the PBM industry.

2. Enhanced Oversight and Audit Rights: The rule would grant fiduciaries the right to audit PBMs to verify the accuracy of their disclosures. This provision is designed to ensure that PBMs are held accountable for their financial practices and that employers can better assess whether PBMs are acting in the best interest of plan participants. If PBMs fail to meet their obligations, the rule could provide additional relief mechanisms for fiduciaries.

3. Broader Regulatory and Legislative Scrutiny: The PBM industry has faced increasing scrutiny from regulators and lawmakers due to rising pharmacy and healthcare costs. Recent legislative efforts have advanced reforms targeting PBM practices, and the Federal Trade Commission is investigating major PBMs for potentially inflating drug prices. The proposed rule reflects a broader trend toward greater oversight and transparency in the pharmaceutical supply chain.

Anthem Blue faces $15M fine in California over appeals processes

By Allison Bell – Officials at the California Department of Managed Health Care are imposing a $15 million fine on Blue Cross of California — a company better known as Anthem Blue Cross — over concerns about how the company has been handling complaints since 2008. The department also required Anthem Blue Cross to agree to implement a corrective action plan. The plan requires the company to hire an outside auditor to review its compliance with the plan and to open up its records, systems, data and employees to the auditor, according to a letter of agreement posted on the department's website. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Improved but Plateaued Compliance: Anthem Blue Cross significantly increased its compliance with California's grievance review standards, moving from a rate of 55%–80% (between April 2021 and May 2024) to above 90% by June 2024. However, this improvement has since stalled, with the compliance rate plateauing between 90% and 92% through April 2025, which state regulators find insufficient given the extended timeline.

2. Regulatory Action and Ongoing Issues: Despite the reported progress, California regulators expressed concern over the duration it took Anthem to reach its current compliance level and cited continued deficiencies. These include delays in acknowledging over 16,000 grievances, failure to resolve nearly 5,000 in a timely manner, and a lack of proper documentation and professional oversight in quality assurance. As a result, the Department of Managed Health Care imposed $3.5 million in fines and referenced 175 earlier enforcement actions dating back to 2016.

3. Anthem’s Response and Commitments: In response to the regulatory scrutiny, Anthem Blue Cross stated it is actively working to address the concerns raised. The company highlighted several corrective measures taken in coordination with the Department of Managed Health Care, such as improving internal processes, enhancing transparency, and providing additional staff training. Anthem emphasized its continued focus on serving its members and meeting all regulatory requirements moving forward.

Surge in GLP-1, AI integration makes benefits design even more challenging

By Alan Goforth – Finding ways to provide an attractive benefits package at an affordable cost is nothing new for employers. This year, however, they also must factor in the growing popularity of costly GLP-1 treatments and rapid advances in artificial intelligence. "Across industries, leaders are shifting from a transactional view of employee benefits to a more purposeful approach that balances financial stewardship with the responsibility to support a workforce under growing strain," said Doug Hammond, CEO of NFP. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Pharmacy Strategy Becomes a Talent and Cost Pressure Point: GLP-1 medications are emerging as a central challenge in employer pharmacy strategy, now considered as critical as oncology and autoimmune treatments. Nearly one-third of employees say they would consider switching jobs for access to coverage, underscoring pharmacy design as a key talent retention issue. With pharmacy benefits becoming one of the most complex and fastest-changing areas in health care, employers face mounting pressure to balance clinical value with long-term affordability.

2. Cost Management and Supplemental Benefits Require Strategic Overhaul: Nearly 50% of employers expect their medical benefit budgets to rise in the coming year, prompting a renewed focus on sustainable plan structures and cost controls. Meanwhile, supplemental benefits remain underused—less than one-third of employees fully utilize them, and 13% forget they have them at all. Despite their ability to offer targeted support beyond core medical coverage, these benefits are often misunderstood, signaling a need for better communication and strategy alignment.

3. Wellbeing and Technology Integration Now Core to Workforce Strategy: Despite an increase in wellbeing program offerings, fewer than half of employers have a formal policy to address burnout. Financial stress remains a major gap, with 2 in 5 employees reporting less than $500 in savings. Additionally, as AI becomes embedded in hiring, development, and performance analytics, only fewer than 3 in 10 employers currently have an AI governance policy. These statistics reflect broader organizational challenges, emphasizing the importance of integrating wellbeing and technology to support long-term resilience and future workforce readiness.

Frequent Diet Soda Intake Linked to Fourfold Increased Dementia Risk

By Deborah Brauser – Frequent consumption of diet soda has been tied to an increased risk for dementia, although the association may be mediated by certain physical conditions. New findings from the Northern Manhattan Study (NOMAS) showed a fourfold increased dementia risk among dementia-free individuals who consumed more than one diet soda per day. In addition, the increased risk was found in individuals who were White or Black but not Hispanic. However, after excluding participants with either diabetes or obesity, this association was no longer significant. Read Full Article...

HVBA Article Summary

1. Diet Soda and Dementia Risk: The study found that individuals who consumed more than one diet soda per day had a significantly higher risk of developing dementia compared to those who drank less. This association was particularly evident among White and Black participants, but not among Hispanic individuals. The results suggest that frequent diet soda intake may be a potential risk factor for dementia in certain populations.

2. Role of Obesity and Diabetes: When participants with obesity or diabetes were excluded from the analysis, the association between diet soda consumption and dementia risk was no longer statistically significant. This finding raises the possibility that underlying health conditions, such as obesity and diabetes, may influence or confound the observed relationship. The researchers highlight the need for further investigation into how these conditions interact with diet soda intake and dementia risk.

3. Uncertainty and Need for Further Research: Experts commenting on the study noted that it is difficult to determine whether diet soda consumption directly causes increased dementia risk or if individuals with existing health issues are more likely to consume diet soda. The cross-sectional nature of the data collection limits the ability to establish causality or long-term patterns of consumption. Both the study authors and external experts agree that more longitudinal research is needed to clarify the relationship and inform clinical recommendations.