PART 1 (Day 1): From Farm Lights to Health Care Heights: The Pattern That’s Transforming America

By Dave Chase – Picture this: Iowa, 1916. A group of farmers starts building six miles of power line to their farms. Here’s the bold part: they built the infrastructure before securing a power source. They just started digging holes, setting poles, and stringing wire across the prairie. Their neighbors thought they’d lost their minds. But those farmers understood something powerful: When you want something badly enough, you build it yourself, even before you know exactly how every piece will work. Read Full Article...

HVBA Article Summary

1. The 3-2-1 Framework as a Historical Pattern for Solving Market Failures: The article introduces the 3-2-1 Framework as a repeatable model that has helped Americans address major systemic problems. It consists of three stages (pioneers prove a concept works, others replicate it, and government scales it), two types of actors (visionary builders and practical enablers), and one common trigger: market failure. This framework helped bring electricity to rural America in the 20th century and is now reemerging as a guide for tackling today’s health care challenges.

2. Community-Led Health Care Solutions Are Emerging and Delivering Tangible Benefits: Real-world examples show how communities are beginning to reform health care on their own, especially where traditional systems have failed. Efforts in Wisconsin and Ohio demonstrate that locally controlled health cooperatives can lower costs, improve access, and provide better outcomes. These grassroots initiatives have achieved major financial savings, enhanced employee benefits, and increased community well-being—demonstrating that the cooperative approach is viable and scalable.

3. Cooperatives Provide a Bipartisan Model with Potential for National Expansion: The article emphasizes that cooperatives resonate across the political spectrum, aligning with both conservative values of local control and liberal ideals of democratic ownership. As these health care models gain traction and produce results, the next logical step in the 3-2-1 process is for government to step in and expand what’s working—just as it did during rural electrification. The piece argues that with the right public policy, these community-driven solutions could address health care inequities on a national scale.

Cigna posts ‘low-drama’ fourth quarter following major FTC settlement

By Rebecca Pifer Parduhn – Cigna thinks negative attention on its pharmacy benefit manager Express Scripts is a challenge of the past, after reaching a settlement with the Federal Trade Commission in the agency’s lawsuit against the powerful drug middlemen. The FTC heralded the settlement announced Wednesday as landmark reform to Express Scripts’ business practices. But many of the reforms were already underway, given the PBM’s ongoing transition to a new rebate-free model, and shouldn’t affect profits, executives assured investors during a Thursday call. Read Full Article...

HVBA Article Summary

1. Strong Earnings Performance Despite Insurance Headwinds: Cigna’s fourth-quarter 2025 results surpassed analyst expectations, with adjusted revenue reaching $72.5 billion (up over 10%) and operational income increasing by 16%. While its insurance division saw a 16% drop in revenue due to the sale of its Medicare Advantage business, this was offset by strong growth in Evernorth, particularly Express Scripts and its specialty pharmacy services. The insurance segment's profit still grew 44% year-over-year, thanks in part to increased premiums on stop-loss products.

2. PBM Business Model Changes Seen as Net-Neutral for Profits: A key focus was the FTC settlement impacting Express Scripts’ compensation model, which will now rely on flat administrative fees rather than rebate-based incentives. While the new structure aims to improve transparency and reduce consumer drug costs, Cigna executives emphasized that the shift should not hurt profitability. This is because the company had already been moving clients to a rebate-free model announced in late 2025. Express Scripts is expected to maintain similar profit levels under the new approach, though the profit sources will evolve.

3. Regulatory Clarity Boosts Outlook and Market Confidence: The FTC settlement and newly enacted PBM reforms provide regulatory clarity for Cigna after years of scrutiny. Crucially, Cigna faces no financial penalties and is not required to force employer clients into the new model. Analysts see these developments as removing a major overhang on the company’s stock, which rebounded after the news. Cigna executives now view the reforms as a "clearing event" that validates their strategy and alleviates some regulatory pressure, particularly around vertical integration.

Novo's threat to sue Hims over compounded Wegovy pill may be on slim legal ground

By Shelby Livingston – Novo Nordisk’s threatened legal action against Hims & Hers for selling a compounded version of the pharma giant’s newly launched Wegovy pill may be far from a slam-dunk win. Dae Lee, an attorney at Buchanan, and other legal experts in pharmacy compounding said what Hims is doing is likely permitted under the Food, Drug, and Cosmetic Act. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Aggressive Price Undercut by Hims Sparks Legal and Market Volatility: Hims announced a compounded semaglutide pill priced at $99 per month, offering a substantial discount compared to Novo Nordisk’s FDA-approved pill at $149, which launched just one month earlier. Novo responded by calling the move “illegal mass compounding” and warned of regulatory and legal action to defend its product and the drug approval framework. Investor sentiment initially surged, with Hims' stock ($HIMS) rising 9% Thursday morning, but reversed course by the end of the day amid growing legal uncertainty.

   Legal and Regulatory Framework Creates Room for Compounding—With Limits: Pharmacies are permitted to compound branded drugs when there is a shortage, or if the formulation differs by at least 10% and a clinician certifies medical necessity. Hims claims its pill uses a “specialized formulation” designed to improve absorption. While Novo and Eli Lilly have sued dozens of compounders and telehealth firms, such cases often falter; courts have not found the products to violate the FDCA, nor accepted arguments that these drugs are being mass-produced under the guise of personalization. The FDA issued a warning letter in September to Hims over marketing language but did not challenge the compounding itself.

2. Patent Litigation Avoided Amid Fear of Undermining Billion-Dollar Drugs: Drugmakers have refrained from accusing compounders of patent infringement, wary that doing so could prompt USPTO reviews that might invalidate core patents, threatening multi-billion-dollar markets. As one legal expert noted, it would be like “putting the goose that lays the golden eggs on the chopping block.” Instead, companies like Novo have leaned on trademark suits, regulatory complaints, and canceled partnerships—such as a previous one with Hims. Meanwhile, state pharmacy boards are emerging as more active enforcers than the FDA, which remains resource-constrained and hesitant to act absent a public health issue.

PBMs to face new push for House pharmacy network bill

By Allison Bell – Employers' pharmacy benefit managers now face a new federal PBM transparency mandate and a new federal rebate pass-through mandate.Rep. Buddy Carter, R-Ga. — a longtime pharmacist who helped move the new employer PBM laws through Congress — said Wednesday that he plans to turn to getting the "Pharmacists Fight Back [in Federal Employee Health Benefit Plans Act]" bill through the House. Read Full Article...

HVBA Article Summary

1. Prescription Drug Pricing Standards for Federal Plans: A bipartisan bill would mandate that Pharmacy Benefit Managers (PBMs) managing prescription benefits for federal employees reimburse pharmacies at a minimum of the national average drug acquisition cost, plus a dispensing fee equal to 4% of the drug’s price (capped at $50). Additionally, PBMs would be barred from requiring plan participants to use specific or affiliated pharmacies, or from steering them toward or away from certain in-network pharmacies, promoting greater fairness and choice for consumers.

2. Potential Model for Broader Legislation: While the bill is limited in scope to federal employee health plans, lawmakers suggest it could serve as a legislative template for broader reforms affecting private-sector employer plans in the future. By establishing stricter rules around PBM conduct and transparency, it sets a precedent that could influence national policy debates around prescription drug costs and healthcare market fairness.

3. Ongoing Debate Over PBM Practices and Value: Lawmakers backing the bill, including Reps. Carter, Harshbarger, and Mackenzie, argue that PBMs operate as opaque intermediaries that drive up costs and undermine independent pharmacies. They advocate for reforms like fiduciary responsibilities and rebate transparency to realign PBM interests with patients and employers. In contrast, PBMs assert their strategies help restrain drug price growth—particularly for generics—and warn that excessive regulation could lead to higher healthcare costs for employers and plan participants.

What the federal spending package does for hospitals: Questions and Answers

By Ron Southwick – After a lengthy government shutdown in the fall, Congress and the White House managed to avoid a repeat and agree on a $1.2 trillion spending package for key federal programs. President Trump signed the spending bill Tuesday afternoon, and it offers some key provisions hospitals and healthcare providers have been seeking. Healthcare organizations are celebrating key extensions for telehealth programs. The bill includes an extension of Medicare waivers for telehealth programs through the end of 2027. In addition, the package also includes an extension of waivers for hospital-at-home programs through September 2030. Read Full Article...

HVBA Article Summary

1. Telehealth and Hospital-at-Home Program Extensions: The spending package extends Medicare waivers for telehealth programs through the end of 2027 and hospital-at-home program waivers through September 2030. These extensions provide stability and support for healthcare providers who have been advocating for multi-year extensions, especially after disruptions caused by the previous government shutdown. This will help maintain and potentially expand access to telehealth services nationwide.

2. Support for Rural and Safety-Net Hospitals: The package preserves funding for key Medicare programs supporting rural hospitals, such as the Medicare-dependent Hospitals and Low-volume Adjustment programs, which were at risk of lapsing. Additionally, it maintains funding for the Medicaid disproportionate share hospital (DSH) program until October 2027, which supports hospitals serving a high number of Medicaid patients. These measures are crucial for sustaining healthcare access in underserved and vulnerable communities.

3. Increased Funding for Medical Research and Health Programs: The package allocates $48.7 billion to the National Institutes of Health (NIH), marking an increase of about $415 million, countering proposed steep cuts. It also provides $9.2 billion for the Centers for Disease Control and Prevention and increases discretionary spending for the Department of Health & Human Services to $116.8 billion. Furthermore, funding for medical education and workforce development programs is largely maintained or increased, supporting the training of future healthcare professionals.

1 big thing: The dangers of using AI for mental health

By Caitlin Owens – Millions of Americans are using AI chatbots as therapists, despite alarming evidence that it may be unsafe to do so. Why it matters: America's mental health system isn't meeting the country's need for care. But while chatbots could be consequential treatment tools, they've also proven they can also be downright dangerous. Driving the news: The Johns Hopkins Bloomberg School of Public Health hosted a timely event this week on AI and mental health that I tuned into. Read Full Article...

HVBA Article Summary

1. Widespread Use of AI Chatbots for Mental Health Support: Nearly half of Americans with ongoing mental health conditions have turned to large language models (LLMs) like ChatGPT for support, particularly with anxiety, depression, and personal advice. While many report positive outcomes—with some even preferring chatbots over traditional therapy—there are growing concerns about harmful effects. Incidents involving “AI psychosis” and suicide highlight the risks of depending on these tools without clinical oversight, especially for vulnerable users seeking connection and guidance.

   Public Adoption Outpaces Professional Caution: The appeal of AI chatbots lies in their constant availability, nonjudgmental tone, and emotionally affirming responses. However, this surge in usage is occurring faster than the development of formal safety standards. The American Psychological Association has issued warnings against relying on AI tools as a substitute for licensed mental health providers, noting a lack of evidence that chatbots can safely diagnose or treat psychological conditions. This disconnect between widespread public use and professional regulation reflects the urgent need for clearer boundaries and education.

   Balancing Innovation with Responsibility: Experts like former NIMH director Thomas Insel emphasize that while chatbots should not be dismissed outright, they must be integrated thoughtfully into the mental health landscape. With the right guardrails and designs, AI tools could offer supplementary support, particularly where traditional care is inaccessible. But without mechanisms to challenge harmful thinking or promote lasting behavioral change, these tools risk reinforcing vulnerabilities. Responsible implementation will require empathy, oversight, and a commitment to prioritizing user well-being over engagement metrics.

Why Rhode Island's menopause legislation should motivate employers

By Lee Hafner – This piece is part of a series on menopause support in the workplace. You can read part one here. In June 2025, Rhode Island became the first state to pass legislation mandating workplace accommodations for women experiencing symptoms of menopause and related conditions.  Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Legislative Progress on Menopause Inclusion: Rhode Island’s House Bill No. 6161 amends the Fair Employment Practices Act to include menopause alongside conditions like pregnancy and childbirth. This formal recognition of menopause symptoms—such as hot flashes, fatigue, and sleep disruption—as potential workplace challenges underscores a shift toward supporting women beyond childbearing age. The bill mandates “reasonable accommodations” that do not interfere with business operations, setting a precedent for broader workplace health inclusion across life stages.

2. Employer Benefits of Proactive Menopause Support: Proactively addressing menopause in the workplace can help employers retain talent and reduce financial losses. According to a Catalyst survey, 84% of women want more menopause support from their employer, and 1 in 10 women have declined a job due to its absence. Additionally, a Mayo Clinic study found that menopause symptoms cost employers $1.8 billion in lost work time annually. With more millennials approaching this life stage, organizations that implement supportive policies—like flexible hours or temperature adjustments—may improve productivity and reduce costs.

3. Empathy and Education as Strategic Tools: Workplace leaders are encouraged to approach menopause support through empathy, awareness, and education. Dr. Suzanne Morgan notes that half the workforce is women, many of whom may experience brain fog, anxiety, insomnia, and decreased productivity during menopause. Encouraging open conversations, training benefit teams, and connecting employees with resources such as gynecologists and wellness experts not only help women navigate this transition but also demonstrate that their well-being and longevity are valued by the organization.