Group for self-insured ERISA plans fights state preemption battles

By Allison Bell - A group that represents employers with self-insured benefit plans is fighting two new state efforts related to self-insured health plans. The Employee Retirement Income Security Act of 1974 preempts state efforts to self-insured plans, and the ERISA Industry Group — ERIC — is continuing to fend off any initiatives that might nibble away at ERISA preemption and lead to the creation of a crazy quilt of state benefits rules. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. ERIC Challenges Tennessee's "Any Willing Pharmacy" Law: ERIC has filed a legal brief urging the U.S. District Court for the Eastern District of Tennessee to block enforcement of a state law requiring prescription plans to include any pharmacy willing to accept network terms. The organization argues that this law undermines employers' ability to manage pharmacy benefits and control costs.

2. Opposing Maryland's Data Collection Efforts: ERIC has also sent a letter to Maryland health officials opposing a state initiative to collect self-insured health plans' claims data indirectly through electronic health networks. ERIC contends this circumvents ERISA preemption, which restricts states from imposing reporting requirements on ERISA-governed health plans.

3. Legal Arguments Based on ERISA Preemption: In both cases, ERIC cites ERISA preemption principles to argue that state-level mandates interfere with federal oversight of employee benefit plans. The group references the U.S. Supreme Court’s ruling in Gobeille v. Liberty Mutual, asserting that only the U.S. Secretary of Labor—not state governments—has the authority to regulate ERISA plan reporting.

9 federal health policies that could change with the Trump administration

By Jeff Levin-Scherz - Donald Trump’s election and Republican control of both houses of Congress are likely to have substantial impacts on federal health policies and financing. Statements from the Trump administration and key regulatory appointees offer a glimpse into potential changes we may see. Companies should incorporate anticipated effects of these changes into their health benefit strategy. Read Full Article…

HVBA Article Summary

1. Potential Expiration of Enhanced Exchange Plan Subsidies: The expiration of ACA health insurance exchange subsidies at the end of 2025 may lead to a drop in enrollment, particularly among healthier individuals, resulting in higher premiums due to adverse selection. This could prompt increased enrollment in employer-sponsored plans while discouraging employer adoption of Individual Coverage Health Reimbursement Arrangements (ICHRAs).

2. Medicaid Funding Reductions and Employer Impact: A decrease in federal Medicaid funding could lead to state-level rollbacks of Medicaid expansion, stricter eligibility requirements, and a reduction in coverage. Employers may see an increase in employees seeking family coverage, potential financial strain on lower-income workers, and decreased provider access in certain regions.

3. Expansion of Short-Term Limited Duration Insurance Plans: Expected policy reversals could restore longer-term access to short-term limited duration insurance (STLDI) plans, which are less expensive but offer fewer benefits. Employers may have access to a wider array of low-cost options but must ensure that these plans meet employee needs and provide adequate coverage.

Aetna sues major drugmakers over alleged price-fixing conspiracy

By Alan Goforth - Aetna in late December sued 20 major pharmaceutical companies, accusing them of engaging in a conspiracy to fix prices for more than 100 generic medications. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Allegations of Price-Fixing and Market Manipulation: Aetna accuses major pharmaceutical companies, including Novartis, Pfizer, and Teva Pharmaceuticals USA, of engaging in a broad conspiracy to inflate the prices of 111 generic drugs. The lawsuit details how these companies allegedly coordinated price hikes—some exceeding 2,000%—and manipulated market dynamics to restrict competition and maintain artificially high prices.

2. Unlawful Practices and Evidence Destruction: The lawsuit outlines key tactics used in the alleged conspiracy, including market allocation (where companies refrained from bidding on contracts to avoid competition), coordinated price increases, and the deliberate destruction of evidence to conceal their activities. Aetna asserts that these actions led to significant financial losses for the insurer, as well as increased costs for consumers and government healthcare programs.

3. Legal and Financial Implications: Aetna is seeking treble damages along with injunctive and declaratory relief to prevent future anti-competitive practices. If successful, the lawsuit could result in substantial financial penalties for the defendants and set a legal precedent for addressing price-fixing in the pharmaceutical industry. The trial is scheduled to begin in 2026.

VC firms back exchange-based employee health benefits

By Lauren Berryman - Venture capital investors such as Index Ventures and Oak HC/FT are betting on startups including Thatch and Remodel Health that promise to usher in a new era of employer-sponsored health benefits, but the gambit faces steep challenges in a deeply entrenched group insurance market. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Employer Cost Pressures and Growing Interest in ICHRAs: Rising healthcare costs are driving employers to explore alternatives like Individual Coverage Health Reimbursement Arrangements (ICHRAs). While employer adoption has declined in recent years, interest remains due to persistent cost pressures and the potential for ICHRAs to offer flexibility in employee benefits.

2. Investment and Market Development in the ICHRA Space: Startups and investors continue to bet on the ICHRA market, with companies such as Thatch, Venteur, Take Command, and Remodel Health receiving significant funding. These firms are expanding technology, sales, and partnerships to improve adoption, despite employer hesitation.

3. Regulatory Uncertainty and Future Outlook: The future of ICHRAs remains uncertain due to shifting regulatory policies. While prior Trump administration policies favored these plans, potential changes to ACA subsidies could impact their attractiveness. Nonetheless, major insurers like Centene and Oscar Health are doubling down on ICHRAs as a growing segment of the insurance market.

New Weight Loss Drugs May Fight Obesity-Related Cancer, Too

By Carolyn Crist - The latest glucagon-like peptide 1 (GLP-1) receptor agonists have been heralded for their potential to not only boost weight loss and glucose control but also improve cardiovascular, gastric, hepatic, and renal values. Read Full Article…

HVBA Article Summary

1. GLP-1 Drugs and Cancer Risk Reduction: Research in 2024 has shown that GLP-1 medications significantly reduce the risk of 10 out of 13 obesity-associated cancers in patients with type 2 diabetes, including colorectal, liver, ovarian, and pancreatic cancers. These drugs promote weight loss, enhance insulin sensitivity, and lower insulin levels, which are believed to contribute to their protective effects.

2. Comparative Studies on GLP-1 and Cancer Prevention: Additional studies have reinforced the link between GLP-1 drugs and reduced cancer risks. Research from Case Western found a 44% lower risk of colorectal cancer in GLP-1 users compared to insulin users, with even greater reductions among overweight and obese individuals. Comparisons with bariatric surgery also demonstrated a stronger cancer risk reduction in GLP-1 users over a 10-year period.

3. Future Research and Potential Concerns: While GLP-1 drugs show promise in reducing obesity-related cancer risks, concerns remain about potential associations with kidney, thyroid, and pancreatic cancers. However, large-scale reviews and meta-analyses have found no conclusive evidence of increased risks. Future clinical trials will explore the long-term effects of GLP-1 medications, their impact on immune responses, and whether sustained weight loss post-treatment leads to lasting cancer risk reductions.

As employees navigate disasters, mental health support is critical

By Lee Hafner - When employees experience a traumatic event, like the devastating impacts of the LA fires, employers should have a plan to provide immediate support, followed by ongoing long-term care. Read Full Article… 

HVBA Article Summary

1. Prioritizing Employee Well-Being in Crisis: Employers in California are recognizing the importance of addressing immediate employee needs during disasters by offering flexibility, financial assistance, transportation, and housing. These efforts help restore a sense of safety and security, reducing stress and anxiety while reinforcing the company's commitment to its workforce.

2. Establishing Mental Health Support and Communication Channels: Organizations should implement clear policies for employees to communicate their needs, including family support provisions and psychological first aid (PFA). Regular check-ins, shared updates, and leadership training in crisis response can foster a sense of connectedness and provide critical emotional support in the aftermath of disasters.

3. Long-Term Mental Health Strategies and Resources: Beyond immediate disaster response, companies should maintain ongoing mental health initiatives, such as employee assistance programs (EAPs), partnerships with local mental health organizations, and flexible leave policies. Recognizing indirect trauma and providing continued access to mental health care ensures employees receive the necessary support, ultimately strengthening workplace resilience.

Medicare Advantage Enrollees Underuse Dental, Vision, Hearing Benefits

By Pearl Steinzor - Medicare Advantage (MA) enrollees do not utilize dental, vision, and hearing benefits at higher rates compared with traditional Medicare (TM) beneficiaries, despite these benefits being included in nearly all MA plans, according to new research.1 The findings suggest that low awareness of coverage and cost-sharing requirements may contribute to this underuse. Read Full Article…

HVBA Article Summary

1. High Out-of-Pocket Costs Despite Supplemental Coverage: While Medicare Advantage (MA) plans spent approximately $3.9 billion annually on supplemental benefits, enrollees still faced substantial out-of-pocket (OOP) expenses totaling $9.2 billion per year, supplemented by $2.8 billion from other private insurers. This highlights the financial burden on beneficiaries and the need for better cost-sharing strategies.

2. Limited Awareness and Utilization of Benefits: Although nearly all MA plans offer supplemental benefits, only about half of enrollees were aware of their dental and vision coverage. Additionally, MA enrollees did not receive more dental, vision, or hearing care than traditional Medicare (TM) beneficiaries, even among those with specific medical needs, suggesting that lack of awareness and cost-sharing barriers may limit service utilization.

3. Stable Benefit Access but Persisting Challenges: From 2017 to 2021, access to dental, vision, and hearing benefits in MA plans remained stable or improved despite concerns about payment changes. However, adjusted OOP spending was only marginally lower for MA enrollees compared to TM enrollees, and there were no significant differences in the likelihood of receiving key services, indicating that simply offering benefits does not guarantee increased usage.