Medicare’s new $2,000 cap on out-of-pocket drug costs could save patients thousands, AARP says

By Annika Kim Constantino - Most Medicare patients who hit the new $2,000 cap on out-of-pocket spending for prescription drugs could see massive savings, despite changes in premiums, according to a report released Thursday by AARP. Read Full Article…

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1. Significant Savings for Medicare Part D Enrollees: AARP reports that 94% of the more than 1 million Medicare Part D enrollees expected to hit the new $2,000 out-of-pocket cap in 2025 will see reduced costs, with an average savings of $2,474, or 48%. An estimated 62% will save over $1,000, while 12% will save more than $5,000.

2. Broad Impact on Older Adults with High Drug Costs: The cap is expected to be particularly beneficial for seniors struggling with expensive medications for conditions like cancer and rheumatoid arthritis. Many Medicare beneficiaries live on a fixed income, with a median of around $36,000 per year, making these savings critical for financial stability.

3. Long-Term Benefits and Medicare Cost Reductions: While some Part D premiums have increased for 2025, the lower out-of-pocket costs from the cap are expected to more than offset those hikes. The impact will grow as Medicare drug price negotiations take effect in 2026, further reducing costs for beneficiaries and generating significant savings for the Medicare program overall.

Drugmakers hiked prices for hundreds of drugs in early January

By Sydney Lupkin - Drugmakers raised the list prices on 575 name-brand drugs in just the first two days of the new year, according to drug price research firm 46brooklyn. Drugs for diabetes, HIV, cancer saw price hikes, among others. Read Full Article…

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1. Declining Drug Price Hikes: While annual drug price increases of 10% were once common, this year’s median hike is only 4%, potentially marking the lowest median increase in over a decade. Despite this trend, price changes can continue throughout the year, especially in January when many pharmaceutical companies traditionally raise prices.

2. Impact of Small Price Increases: Although many recent drug price hikes are modest, they still exceed the 2.7% inflation rate, triggering penalties in Medicaid and other programs. Over a drug’s lifetime, even minor increases add up significantly, with AARP reporting that the top 25 Medicare Part D drugs saw an average price rise of 98%.

3. Consumer Costs and Market Dynamics: The effect of price changes on consumers varies: uninsured individuals may pay more, while insured patients may see changes in copays or coinsurance. Higher list prices can sometimes lead to better insurance coverage due to rebates and negotiations. Additionally, some drugs, like Januvia, have seen price drops, though the reasoning behind these decreases remains complex and uncertain.

Top healthcare technology trends in 2025

By Emily Olsen - Uncertainty surrounding telehealth flexibilities and artificial intelligence regulation will shape healthcare technology trends this year, while cyberattacks continue to batter the sector, experts say. Read Full Article…

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1. AI Regulation in a New Administration: Healthcare organizations are navigating AI adoption while facing concerns about safety, accuracy, and regulatory uncertainty as Trump begins his second term. With the potential rollback of Biden's executive order on AI oversight, the industry could see shifts in federal research funding and regulatory frameworks. Health systems will seek greater transparency and partnerships with AI vendors to monitor model performance and ensure compliance.

2. Telehealth and Cybersecurity Pressures: The expiration of pandemic-era telehealth flexibilities in March adds uncertainty for virtual care providers, potentially hampering investment. Meanwhile, healthcare organizations continue to grapple with a rising wave of cyberattacks, as evidenced by high-profile incidents like the Change Healthcare breach, highlighting the need for stronger cybersecurity measures.

3. Resurgence in Digital Health Investments: After years of decline, digital health funding could rebound in 2025, with companies considering mergers, acquisitions, and IPOs. A successful public offering could encourage more firms to go public, while the industry's focus on automating administrative processes—such as billing and prior authorization—may drive further AI investments to improve financial sustainability.

UnitedHealth's PBM will pass 100% of rebates on to clients: Will more big PBMs follow?

By Allison Bell - Optum Rx, the UnitedHealth pharmacy benefit manager unit, will soon pass all rebates it gets from prescription drug manufacturers on to employer health plan sponsors and other clients. Read Full Article… ^{_{(Subscription required)}} 

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1. UnitedHealth's Rebate Policy Change: CEO Andrew Witty announced that UnitedHealth will stop keeping a small portion of negotiated drug rebates, addressing criticism from pharmaceutical manufacturers and PBM critics who argue that PBMs inflate drug costs. Witty emphasized that this move aims to eliminate confusion about PBM practices and reinforce transparency.

2. Ongoing PBM Scrutiny and Legislative Efforts: Pharmacy benefit managers (PBMs), including those operated by UnitedHealth, Cigna, and CVS Health, continue to face political and public scrutiny over their role in drug pricing. Lawmakers are considering bipartisan legislation to prohibit PBMs from retaining any portion of drug rebates, aligning with efforts to increase transparency in prescription drug pricing.

3. UnitedHealth's Financial Performance and Market Reaction: UnitedHealth reported $5.8 billion in net income for Q4 2024, a slight increase from the previous year. However, higher-than-expected healthcare costs and missed earnings expectations led to a 4% drop in UnitedHealth's stock price, with declines also seen in shares of major competitors like Cigna and CVS Health.

2025 sales & marketing tips: Building a better benefits business

By Lily Peterson - Creating and running a brokerage can be very difficult. The responsibilities of building a brokerage differ greatly from the responsibilities of working for one. A business leader has to take care of their employees, while also making sure everything is running smoothly. Read Full Article… ^{_{(Subscription required)}}

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1. Empowering the Next Generation: To ensure the long-term success of the industry, it’s crucial to create an environment that attracts and inspires young professionals. Exposure, education, and funding should be directed not just toward novel solutions but toward the people driving change. (Jessica Brooks Wood, Solome Tibebu)

2. Building Strong Workplace Cultures: A thriving business requires a team that feels valued, heard, and motivated. Leaders must prioritize transparency, respect, trust, and employee engagement to foster a culture of collaboration and excellence. (Logan Mallory, Cheri Wheeler, Eric Silverman, Rachel Ceccarelli)

3. Strategic Industry Adaptation: Success in the evolving industry landscape depends on understanding demographic needs, embracing transparency, and staying ahead of employer expectations for clarity and strategy. Companies that proactively adjust will lead, while those that resist change will fall behind. (Joe Boyle, Mark Williams, David Balat)

Lancet report offers a ‘new reframing’ for defining, diagnosing obesity

By Michael Monostra - A new international commission report has proposed new criteria for diagnosing obesity that could dramatically change the way it is categorized and managed in the future. Read Full Article…

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1. Redefining Obesity Diagnosis: The Lancet Diabetes & Endocrinology Commission has proposed a more comprehensive approach to diagnosing obesity, moving beyond BMI to include measurements such as waist circumference, waist-to-hip ratio, and body fat assessments. This shift aims to improve diagnostic accuracy and ensure that obesity treatment is more personalized and appropriate for individual needs.

2. Differentiating Clinical and Preclinical Obesity: The commission introduces a new framework distinguishing preclinical obesity (without organ dysfunction or physical limitations) from clinical obesity (marked by organ dysfunction or physical limitations). This classification aims to tailor medical interventions more effectively, focusing on risk reduction for preclinical cases and evidence-based treatments for clinical cases.

3. Addressing Weight Bias and Stigma: The report highlights the harmful impact of weight bias in healthcare and policy-making, calling for training and education to reduce stigma. It emphasizes that obesity should be viewed as a complex medical condition rather than a failure of personal responsibility, advocating for a more compassionate and informed approach to obesity management.

The positive impacts of employee financial wellness

By Borja Perez - The financial health of Americans is declining, with levels of financial vulnerability increasing. 70% of American households are financially unhealthy and day-to-day finances are worsening; more than half of Americans live paycheck to paycheck. Read Full Article… ^{_{(Subscription required)}} 

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1. Financial Wellness Enhances Workplace Productivity and Culture: Employers that offer comprehensive financial wellness programs see improvements in employee motivation, engagement, and overall workplace culture. With financially stressed employees being nearly five times more likely to be distracted at work, providing financial support can lead to a more focused and productive workforce.

2. Employees Are Actively Seeking Financial Support: A significant majority of workers (74%) express a desire for financial wellness benefits, and employers recognize the value of these offerings in talent acquisition and retention. With 84% of employers acknowledging that financial wellness tools increase retention and 81% stating they attract higher-quality candidates, these programs are crucial in competitive job markets.

3. Holistic Financial Wellness Includes Earned Wage Access, Education, and Physical Health: Employers can support their workforce by implementing financial wellness benefits such as Earned Wage Access (EWA), financial education, and physical health initiatives. These programs help employees manage immediate expenses, improve financial literacy, and maintain physical well-being—each of which directly contributes to overall financial stability and reduced workplace stress.

Teladoc joins Amazon’s digital health benefits program

By Emily Olsen - Amazon launched the benefits connector one year ago, starting with a partnership with chronic condition management company Omada. The technology and retail giant has since expanded the initiative, previously called Health Condition Programs, to more digital health companies, including behavioral healthcare provider Talkspace, online therapy and mental health firm Rula and digital physical therapy company Hinge Health. Read Full Article…

HVBA Article Summary

1. Teladoc Joins Amazon’s Benefits Connector: Teladoc Health has partnered with Amazon’s Benefits Connector to make its chronic care programs—diabetes, hypertension, pre-diabetes, and weight management—more accessible to eligible users. This initiative aims to streamline enrollment by verifying insurance coverage through the consumer’s employer or health plan.

2. Strategic Growth Opportunity for Teladoc: While executives acknowledge that immediate revenue gains are unlikely, they see the partnership as a long-term strategy to expand Teladoc’s chronic care offerings. The company currently has over one million active enrollees in its chronic condition management programs.

3. Teladoc’s Financial and Leadership Challenges: Amid restructuring efforts and cost-cutting initiatives, Teladoc continues to face financial struggles, reporting a $33.3 million net loss in Q3 2023. With CEO Chuck Divita, a former insurance executive, taking the helm in June, the company seeks to stabilize operations and explore new revenue opportunities through digital partnerships like Amazon’s marketplace.