How Congress may approach healthcare reform under Trump

By Anastassia Gliadkovskaya and Noah Tong - With the election over and President Donald Trump officially inaugurated, all eyes in healthcare are turning toward how the sector might change. But as the first two weeks of his second term showed, keeping up with Trump’s actions—and their ramifications—requires full-time focus. Read Full Article…

HVBA Article Summary

1. Medicaid Cuts in Reconciliation: Andrew Schwab discusses the likelihood of Medicaid cuts being included in a reconciliation bill, analyzing the political and policy factors that could influence such decisions.

2. Department of Government Efficiency (DOGE): Schwab shares his views on the proposed Department of Government Efficiency, evaluating its potential impact on healthcare policy and government operations.

3. Bipartisan Opportunities: Despite political divides, Schwab identifies key areas where Republicans and Democrats may find common ground on healthcare legislation in the coming sessions.

Health benefits too complicated? There's an app for that

By Lauren Berryman - Employee health benefits have grown so complex that businesses are weaving in an additional layer with hopes of making it easier for workers to navigate them. Read Full Article…

HVBA Article Summary

1. Growing Employer Demand for Benefits Navigation: Self-insured businesses are increasingly partnering with benefits navigation companies like HealthJoy, Healthee, and Transcarent to help employees better understand and utilize their health benefits. These platforms aim to reduce confusion, improve the employee experience, and potentially lower healthcare costs by streamlining access to care and directing employees to cost-effective options.

2. Cost Pressures and Strategic Shifts: As employer health benefit spending is projected to rise by 5.8% in 2024, many companies are looking for ways to contain costs. While some cost-cutting strategies, such as increasing deductibles, may discourage care utilization, benefits navigation tools promise savings by guiding employees toward lower-cost providers, preventing unnecessary hospitalizations, and promoting preventive care.

3. Challenges and Uncertain ROI: Despite the promise of benefits navigation tools, their long-term financial impact remains unclear. While employers hope these services will help mitigate high-cost claims and improve healthcare efficiency, early adopters like SiriusXM acknowledge potential technical challenges and difficulties in measuring return on investment, making these initiatives a calculated but uncertain bet.

Emerging workplace benefit trends for 2025

By Ayo Mseka - Successfully selling employee benefits in today’s market requires a wide range of skills, including focusing on benefits that address employees’ concerns, engaging them regularly, and emphasizing how these benefits improve their well-being and financial security. Kara Hoogensen, senior vice president and head of Workplace Benefits at Principal, recently shared a few emerging trends in this growing market and offered some critical insights on finding success. Read Full Article…

HVBA Article Summary

1. Market Growth and Trends: The employee benefits market continues to expand, with supplemental health product sales reaching $543 million in Q3 2024. Key products such as accident, critical illness, and hospital indemnity insurance accounted for 91% of sales, growing by 11% year-over-year. Workplace life insurance and disability benefits are also expected to surpass historical growth rates, driven by a competitive labor market and employer efforts to enhance retention.

2. Emerging Trends in 2025: Personalization in employee benefits is gaining traction, with employers increasingly offering a diverse range of options to meet individual financial and healthcare needs. Many businesses are leveraging employee-paid benefits to provide flexibility without additional costs, while rising healthcare expenses are fueling demand for accident, critical illness, and hospital indemnity coverage.

3. Regulatory and Legislative Outlook: The potential policy shifts under the Trump administration could significantly impact the benefits landscape. Key areas of focus include expanding Paid Family and Medical Leave, upcoming tax policy changes related to employee benefits, and increasing employer education on supplemental benefits. Financial professionals should stay informed on these developments to navigate the evolving market effectively.

Association health plans can fix the small-group quality glitch: AHP advocate

By Allison Bell - Supporters of a new association health plan effort say well-designed AHPs can make the U.S. health insurance market much better for some without hurting anyone. Christopher Condeluci made the case for the new AHP proposals — and why the old criticisms are completely out-of-date — in a recent email interview. Read Full Article…  ^{_{(Subscription required)}} 

HVBA Article Summary

1. Expanding AHP Access for Small Employers and Individuals: Proposals for expanding Association Health Plans (AHPs) aim to make it easier for small employers and self-employed individuals to join together and negotiate better health coverage options. Supporters argue that AHPs provide more affordable and comprehensive plans compared to existing small-group and individual market plans, which often come with high deductibles and limited provider networks.

2. Legislative and Regulatory Developments: Efforts to expand AHPs have been subject to shifting regulations, with the Trump administration loosening restrictions and the Biden administration reversing those changes. Current legislative proposals seek to revive expanded AHP access, allowing small businesses to join AHPs without industry or geographic restrictions while ensuring compliance with key Affordable Care Act protections.

3. Debate Over Market Impact and Stability: Critics argue that AHPs could destabilize the fully insured small-group market by attracting healthier employees, leaving traditional insurers with older, sicker populations. However, AHP advocates counter that these concerns lack empirical support and that AHPs could actually expand coverage by attracting uninsured individuals and providing more competitive health plan options.

Teladoc Health acquires Catapult Health for $65M to boost chronic condition management, at-home testing

By Emma Beavins - Teladoc Health has signed a definitive agreement to acquire virtual preventive care company Catapult Health to bolster the early detection of health conditions and expand into at-home diagnostic testing. Read Full Article…

HVBA Article Summary

1. Strategic Acquisition for Growth: Teladoc is acquiring Catapult Health for $65 million, with an additional $5 million in contingent earnout consideration, making Catapult a wholly owned subsidiary. The acquisition is part of Teladoc’s strategy to expand its virtual care offerings and enhance chronic condition management services.

2. Integration of Preventive Health Services: Catapult Health’s VirtualCheckup solution, which provides at-home diagnostics and telehealth consultations, will be integrated into Teladoc’s platform. This allows Catapult’s patients to be seamlessly enrolled in Teladoc’s chronic care programs for conditions like diabetes and hypertension, improving access to care and generating cost savings for health plans.

3. Positioning for Future Growth Amid Market Pressures: Despite facing financial challenges and a competitive telehealth landscape, Teladoc sees the acquisition as a way to strengthen its value proposition. By leveraging Catapult’s technology and data capabilities, Teladoc aims to enhance its virtual care offerings, attract more customers, and drive sustainable long-term growth.

New FDA Approval Adds Chronic Kidney Disease to Ozempic’s Label

By Frank Vinluan - GLP-1 drugs are being studied in a growing number of indications, and Novo Nordisk can now claim to have the first medication in this class approved for chronic kidney disease. Read Full Article…

HVBA Article Summary

1. Expanded FDA Approval for Ozempic: The FDA has approved Ozempic for reducing the risk of worsening kidney disease, kidney failure, and death in patients with type 2 diabetes and chronic kidney disease, based on a successful Phase 3 clinical trial that showed a 24% reduction in kidney disease complications compared to a placebo.

2. Broader Market Potential Amid Regulatory Challenge: Ozempic's expanded label strengthens its position within the cardiovascular-kidney-metabolic syndrome treatment landscape, but the drug, along with other semaglutide-based products, faces upcoming pricing negotiations with Medicare, which could impact its market dynamics.

3. Novo Nordisk's Competitive Landscape: While Ozempic remains Novo Nordisk’s top-selling product, generating $12 billion in revenue in the first nine months of 2024, the company faces growing competition from Eli Lilly’s metabolic medicines portfolio, including Zepbound, which has also received expanded FDA approvals.

Specialty drugs and cancer surgery claims will push up stop-loss renewal prices, says Cigna CFO

By Allison Bell - Stop-loss insurance costs spiked at Cigna in the fourth quarter, and that will lead to price increases for employers renewing their coverage. Company executives talked about the coming wave of stop-loss increases Thursday, during a conference call with securities analysts. Read Full Article…  ^{_{(Subscription required)}} 

HVBA Article Summary

1. Rising Medical Costs and Stop-Loss Impact: Cigna’s chief financial officer, Brian Evanko, attributed the rise in medical costs to increased spending on specialty drugs, such as Keytruda, and higher inpatient surgery expenses. Stop-loss medical costs began climbing in the fall, but since most stop-loss users renew their coverage at the start of the year, Cigna could not immediately adjust rates, leading to a claims-to-premiums ratio that was 4% to 7% higher than expected.

2. Financial Performance and Strategy: Despite the cost challenges, Cigna reported $1.4 billion in net income for the fourth quarter, up from $1 billion the previous year, with revenue growing from $51 billion to $66 billion. To counteract rising costs, the company plans to implement pricing adjustments, cost efficiency measures, and investment strategies over the next two years.

3. Express Scripts and Pharmacy Benefit Transparency: Cigna’s pharmacy benefit manager, Express Scripts, saw revenue growth from $1.9 billion to $2.1 billion. Amid criticism over PBM transparency, CEO David Cordani emphasized efforts to lower patient drug costs by introducing more transparent pricing models, enhanced patient summaries, and increased disclosures for plan sponsors.

Vertex Pharma’s Opioid Alternative Wins FDA Approval, First in a New Class of Pain Meds

By Frank Vinluan - A novel Vertex Pharmaceuticals drug that takes a new approach to pain is now approved by the FDA, a landmark decision for a first-in-class product that brings patients a treatment alternative intended to avoid the addiction risks posed by opioid medications. Read Full Article…

HVBA Article Summary

1. FDA Approval and Clinical Findings: The FDA approved Journavx, a non-opioid pain treatment, based on Phase 3 studies that demonstrated significant pain relief after abdominoplasty and bunionectomy surgeries compared to a placebo. However, the drug showed mixed results when compared to the opioid Vicodin, with one study failing to achieve statistical significance and another where Vicodin outperformed Journavx.

2. Mechanism and Market Potential: Journavx works by selectively blocking the sodium channel NaV1.8, targeting pain signals in the peripheral nervous system rather than opioid receptors in the central nervous system. Analysts see this as a breakthrough in acute pain management, with Vertex positioning the drug as part of a larger non-opioid pain medication portfolio that could generate over $10 billion in peak sales.

3. Pricing, Reimbursement, and Regulatory Support: Vertex set a $15.50 per pill price for Journavx, which is expected to be supported by the NOPAIN Act, a new Medicare policy that incentivizes non-opioid pain treatments. Analysts believe the lack of addiction or abuse language in the drug’s FDA label will enhance its market uptake, further supporting its potential as a major player in pain management.