Senate committee schedules hearing on Trump's Labor secretary nominee

By Allison Bell - The Senate Health, Education, Labor and Pensions Committee has scheduled a Feb. 12 hearing on the nomination of Lori Chavez-DeRemer to be Labor secretary. Chavez-DeRemer is a Republican from Oregon who served in the U.S. House of Representatives in the previous Congress. Read Full Article…  ^{_{(Subscription required)}} 

HVBA Article Summary

1. Chavez-DeRemer’s Role in Labor and Employee Benefits: As the head of the U.S. Department of Labor, Chavez-DeRemer would oversee workforce development initiatives, including training and apprenticeship programs, as well as regulate employer-sponsored health and retirement plans through the Employee Benefits Security Administration (EBSA).

2. Potential Policy Changes and PBM Legislation: Chavez-DeRemer could influence key Biden-era labor and health policies, including mental health benefit standards and Affordable Care Act regulations for 2026. Additionally, given her past efforts in the House, she may play a role in shaping pharmacy benefit manager (PBM) reforms if legislation advances in Congress.

3. Confirmation Process and CMS Nomination: Her nomination requires Senate confirmation, with the Senate HELP Committee set to review her candidacy. In parallel, Dr. Mehmet Oz has been nominated to lead the Centers for Medicare and Medicaid Services (CMS), with Senate Finance Committee Chairman Mike Crapo expressing support for his commitment to healthcare accessibility and consumer choice.

Updated: Lilly posts 45% sales jump, culls four programs across obesity, Alzheimer's, heart failure and eczema

By Kyle LaHucik - Eli Lilly said Thursday that its fourth-quarter revenue jumped 45% to $13.53 billion over the prior year, though this fell short of earlier projections. The drugmaker also reiterated the $58 billion to $61 billion in anticipated 2025 revenue it outlined last month. Read Full Article…  ^{_{(Subscription required)}} 

HVBA Article Summary

1. Revenue Challenges and Market Expectations: Lilly’s revenue miss was anticipated after the company projected a $400 million shortfall in Q4 sales due to lower-than-expected wholesaler purchases of its obesity drug, Zepbound. This marked the second consecutive quarter of disappointing sales, contributing to a 7% share price drop in January. However, Lilly’s stock rebounded by 5% following its earnings report.

2. Competition and Market Expansion: As competition with Novo Nordisk intensifies, both companies are aggressively expanding manufacturing capabilities to meet soaring demand for obesity treatments. Lilly has committed over $23 billion to manufacturing expansions since 2020, with CEO David Ricks reaffirming confidence in the long-term potential of obesity drugs despite near-term turbulence.

3. Pipeline Adjustments and Financial Strategy: Lilly disclosed the discontinuation of several drug programs, including an early-stage obesity candidate and a failed Alzheimer’s drug, while increasing R&D spending by 18% to $3.02 billion in Q4. The company also took a $344 million asset impairment charge and has been actively investing in acquisitions, FDA approvals, and a $15 billion share repurchase initiative.

Where DOGE And The Tax Bill Should Intersect – OpEd

By John C. Goodman - In economics, the word "waste" has a very precise meaning. It's not in the eyes of the beholder. Instead, waste exists if there is a change that in principle could make everyone better off. Read Full Article…

HVBA Article Summary

1. Medicare Coverage Abroad Can Yield Significant Savings: Allowing Medicare to cover retirees' medical expenses in countries with lower healthcare costs could save up to $100 billion annually, reducing unnecessary expenses while still ensuring quality care for beneficiaries.

2. Reinsurance in Obamacare Exchanges Can Lower Premiums: State-level reinsurance programs have proven effective in reducing premiums, with some states seeing double-digit percentage decreases. Expanding this approach nationwide could save around $240 billion over ten years without requiring additional federal spending.

3. Revamping Employer-Provided Insurance with Tax Credits: Offering businesses the choice between the current tax exclusion or a fixed tax credit per employee could incentivize cost-saving measures. A 10% reduction in wasteful spending through this reform could generate over $500 billion in savings over a decade.

Voya’s stop-loss price increases average 21%, or higher, for 2025

By Allison Bell - Executives from Voya Financial told securities analysts Wednesday that the company is getting much tougher with employers that use stop-loss insurance to protect their self-insured health plans. U.S. employers use stop-loss insurance, or insurance for benefit plans, to manage risk at self-insured health plans. Read Full Article…  ^{_{(Subscription required)}} 

HVBA Article Summary

1. Soaring Loss Ratios and Financial Impact: Voya’s stop-loss business experienced a significant spike in its loss ratio, reaching 115% in Q4 2024, up from 76% a year earlier, leading to a $71 million operating loss despite overall company profitability.

2. Strategic Adjustments and Price Increases: To counter rising claims costs, Voya has implemented substantial rate hikes, averaging 21% across stop-loss customers, with even steeper increases in underperforming segments, while also refining its underwriting and risk selection process.

3. Industry-Wide Challenges and Market Response: The surge in stop-loss claims reflects broader challenges in employer-sponsored health benefits, with competitors like Cigna and Sun Life also reacting by forecasting significant price increases and scrutinizing risk pricing strategies.

Novo Nordisk is feeling the competition from compounded GLP-1s, exec says

By Shelby Livingston - Many Americans have flocked to cheaper, compounded versions of GLP-1 weight loss drugs in lieu of brand-name treatments. That competition is cutting into demand for Novo Nordisk’s prescriptions, a company exec said Wednesday. Read Full Article…  ^{_{(Subscription required)}} 

HVBA Article Summary

1. Novo Nordisk Acknowledges Growing Competition from Compounded Drugs: During its fourth-quarter earnings call, Novo’s U.S. head David Moore admitted that compounded versions of semaglutide and tirzepatide are growing faster than anticipated, posing a competitive challenge to the company’s blockbuster drugs, Ozempic and Wegovy.

2. Divergent Industry Perspectives on Compounded GLP-1s: While Novo Nordisk recognizes the financial impact of compounded drugs, Eli Lilly has downplayed their significance. In an October earnings call, Lilly’s CEO, Dave Ricks, stated that compounded GLP-1s had not affected the company’s financial performance, contrasting with Novo’s recent stance.

3. Regulatory Changes May Curb Compounded Drug Availability: The FDA has declared the tirzepatide shortage resolved and set deadlines for pharmacies to stop compounding the drug, although a trade group is challenging this order in court. Meanwhile, semaglutide remains on the FDA’s shortage list, and Novo is working to strengthen its supply chain to mitigate compounding competition.

Preserving access, affordability are Americans’ top healthcare priorities: Gallup

By Susanna Vogel - The new data on Americans’ perceptions of public health issues comes as the Trump administration is seeking to set its health agenda. Survey respondents polled between Dec. 2 and Dec. 15 were asked to choose their top three public health issues from a list of 15 they thought should get the highest priority from government leaders. Read Full Article…

HVBA Article Summary

1. Healthcare Access and Affordability as a Top Concern: A Gallup and Emory University survey found that healthcare access and affordability is the top public health concern among Americans, with a quarter of respondents prioritizing it over issues like food and water safety (18%) and chronic disease reduction (11%). Strengthening safety-net programs like Medicare and Medicaid was also a major concern, especially among Democrats.

2. Partisan Divides on Public Health Priorities and Trust in Information Sources: While both Republicans and Democrats support federal action on their top health concerns, they differ in priorities and trust sources. Republicans are more likely to prioritize food and water safety and less likely to trust the CDC, while Democrats prioritize safety-net programs and trust the CDC more than their healthcare providers. Younger adults favor scientific research, while older adults trust their doctors most.

3. Political Influence on Public Health Messaging and Trust: The Trump administration’s policies, including restricting abortion access and limiting CDC publications on gender identity and LGBTQ+ issues, may deepen the trust divide in public health. Experts warn that actions like the suspension of the Morbidity and Mortality Weekly Report could erode public confidence in health institutions at a critical time.

A year since the Change Healthcare breach, what have we learned?

By Mike Miliard - It's been nearly one year since reports started emerging that Change Healthcare, the enormous clearinghouse, was experiencing a significant cyberattack. The company – which processes claims for hundreds of thousands of physicians, pharmacies and others, trafficking some 15 billion transactions each year – had been hit by BlackCat ransomware and essentially debilitated. Read Full Article…

HVBA Article Summary

1. The Critical Need for Stronger Security Frameworks and Best Practices: The breach underscored the importance of implementing robust security measures, such as HITRUST frameworks, multi-factor authentication (MFA), and rigorous risk monitoring, to protect sensitive healthcare data. Industry leaders emphasized that security must be a priority rather than an afterthought.

2. Systemic Vulnerabilities and the Push for Legislative and Technological Innovation: The attack revealed longstanding security gaps in vendor and third-party systems, driving overdue legislative reforms and accelerating innovation in cybersecurity technologies, such as quantum security and enhanced endpoint detection.

3. The Importance of Cross-Industry Collaboration and Redundancy: The breach demonstrated the need for payers, providers, EHR vendors, and revenue cycle companies to work together, sharing insights and establishing redundant security layers to strengthen collective defenses against future cyber threats.

The hidden pitfalls of DIY benefits implementations

By Kim Shumate - In an era of increasing complexity in employee benefits, many organizations are finding that health and welfare (H&W) implementations are more than just an administrative task — they are a monumental challenge. Whether driven by a need to enhance the participant experience, improve compliance or simply stay competitive, implementing a new benefits administration system is no small feat. Read Full Article…  ^{_{(Subscription required)}} 

HVBA Article Summary

1. Thorough Vendor Selection is Critical for Fiduciary Responsibility: Plan sponsors must conduct a comprehensive market review before selecting a benefits administrator to ensure they receive appropriate service levels and fair pricing. Running a vendor search every five to seven years is essential to fulfilling fiduciary duties, requiring a detailed process that includes defining service scope, issuing requests for proposals, evaluating responses, and conducting finalist interviews. Even if the incumbent provider is retained, this process demonstrates due diligence and competitive benchmarking.

2. Managing Implementation Requires Significant Expertise and Coordination: Transitioning to a new benefits administrator is a complex undertaking involving multiple vendors, payroll platforms, and internal HR teams with already full workloads. Effective implementation requires coordinating across various parties with different systems and processes, ensuring accurate data transmission, and validating plan requirements. Without experienced project management, plan sponsors risk errors, delays, and resource strain that can disrupt the transition.

3. Data Accuracy and Seamless User Experience are Essential for Success: Ensuring the accuracy of converted data is fundamental to a smooth transition, as even minor errors can impact participant eligibility and compliance. Proper validation and rigorous system testing help prevent disruptions. Additionally, user experience is critical—participants must easily navigate the system to access their benefits. Clear communication, thorough service center training, and proactive open enrollment planning ensure a positive transition and long-term system effectiveness.