Drugmakers to raise US prices on over 250 medicines starting Jan. 1

By Michael Erman - Drugmakers plan to raise U.S. prices on at least 250 branded medications including Pfizer (PFE.N), COVID-19 treatment Paxlovid, Bristol Myers Squibb's (BMY.N), cancer cell therapies and vaccines from France's Sanofi (SASY.PA), at the start of 2025, according to data analyzed by healthcare research firm 3 Axis Advisors.  Read Full Article… 

HVBA Article Summary

1. Moderate Price Increases Dominate: Nearly all drug price hikes announced for January 1 are below 10%, with a median increase of 4.5%, consistent with trends from the previous year. Drugmakers have scaled back significant price hikes in recent years following public backlash and regulatory scrutiny.

2. Shift Toward Launch Price Strategy: With limited room for substantial annual price hikes due to expanded penalties, pharmaceutical companies are increasingly focusing on launching new drugs at higher prices. A Reuters analysis revealed that U.S. drug launch prices in 2023 were 35% higher than those in 2022.

3. Brand-Specific Adjustments and Trends: Companies like Pfizer, Sanofi, and Bristol Myers raised prices across various drugs, often citing investments in drug development or the transformative potential of treatments. Simultaneously, Merck cut prices for some diabetes medications, reflecting a mixed approach to pricing adjustments amid rising scrutiny.

Medicare's new $2,000 prescription drug cap goes into effect Jan. 1. Here's how it works.

By Aimee Picchi - Starting Jan. 1, millions of Americans who get their prescription drugs through Medicare could get a major financial break when a $2,000 out-of-pocket spending cap on medications goes into effect. The yearly price cap has been in the works since President Joe Biden signed the Inflation Reduction Act into law in 2022, with that legislation including provisions tackling drug costs for seniors as well as other Americans. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Impact on Seniors: The new $2,000 out-of-pocket cap on Medicare Part D prescription drugs is expected to benefit approximately 19 million seniors, with an average savings of $400 each. This cap is a significant shift in reducing financial burdens for seniors who previously had no out-of-pocket spending limit for prescription drugs under Medicare.

2. Simplifying Cost Management: The cap eliminates the "donut hole," a costly coverage gap that left seniors responsible for substantial out-of-pocket expenses until catastrophic coverage took effect. With the cap in place, Medicare recipients can now better manage their healthcare budgets, avoiding difficult trade-offs between essential needs like medications and groceries.

3. Comprehensive Coverage: The cap applies to all drugs listed in a Medicare Part D plan's formulary and will be automatically implemented for enrollees. While it excludes premiums and medications not in the formulary or covered by Medicare Part B, it includes deductibles, copayments, and coinsurance for eligible drugs, ensuring more predictable costs for beneficiaries.

'The status quo of insured health care is not a viable path forward.'

By Laura Beerman - It's been three weeks since UnitedHealthcare CEO Brian Thompson was murdered. As is well known, the responses have ranged from tone-deaf — by both the public and UnitedHealth Group's CEO — to "Now What?," the nonviolent path needed to finally fix healthcare. Read Full Article…

HVBA Article Summary

1. The Root Problem: A Dysfunctional Four-Party System: Healthcare’s four-party system — comprising insurers, employers (sponsors), providers, and consumers — disrupts natural market dynamics, leading to rising premiums and systemic inefficiencies. The added layers between consumers and providers prevent a direct supply-demand relationship, perpetuating escalating costs without incentivizing meaningful change.

2. The Proposed Solution: Optimal Care Business Model (OCBM): The Christensen Institute advocates for the development and scaling of an Optimal Care Business Model, which aims to deliver the best care at the best cost by aligning stakeholder incentives. This model relies on actuarial engineering, AI-driven platforms, and quality dividends to promote cost transparency, eliminate suboptimal care, and stabilize premiums.

3. Why Past Efforts Failed and How OCBM Can Succeed: Previous attempts like value-based care faltered due to reliance on outdated business models and entrenched reimbursement systems. The OCBM focuses on innovation and creating a new value network to overcome these challenges. Scaling this approach requires significant buy-in from state and federal governments, with CMS playing a critical role as the largest payer capable of driving systemic transformation.

Cigna and union health care plans sue Minnesota over PBM regulations

By Allison Bell - Cigna is part of a coalition that's suing over an effort by Minnesota officials to regulate self-insured employer health plans' use of pharmacy benefit managers. Cigna and the other plaintiffs say the effort violates the federal Employee Retirement Income Security Act, by ignoring an ERISA provision that preempts state regulation of employee benefit plans. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. ERISA Preemption Dispute: Minnesota officials are attempting to enforce the Minnesota Pharmacy Benefit Manager Licensure and Regulation Act of 2019 without considering ERISA preemption, which is intended to give the U.S. Labor Department exclusive jurisdiction over multistate employee benefit plans. The plaintiffs argue that this enforcement exceeds the state's constitutional authority and violates ERISA's preemption provisions.

2. Lawsuit Details: The ERISA Industry Committee, along with Cigna and the National Labor Alliance of Health Care Coalitions, has filed a lawsuit in the U.S. District Court for the District of Minnesota against the Minnesota Department of Commerce and its commissioner, Grace Arnold. The plaintiffs claim the state law unlawfully impacts employer-sponsored benefit plans, including those with no direct ties to Minnesota.

3. Stakeholder Positions: Healthcare providers have historically criticized ERISA preemption for limiting state protections for providers and patients, while employers and benefit administrators argue that state challenges to ERISA preemption would increase the complexity and cost of offering health benefits. The suit underscores the ongoing tension between state regulatory efforts and federal preemption under ERISA.

How to transform healthcare with employee-first benefits

By Patrick Quigley - For decades, the American healthcare system has treated employees as passive participants rather than active consumers. While we've witnessed dramatic transformations in how people make informed decisions about everything from retail purchases to travel, healthcare remains stubbornly opaque — leaving employees to navigate a maze of networks, prior authorizations and unexpected bills. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Empowering Employees with Transparency and Choice: Employees should have access to clear, real-time pricing information for healthcare services and medications, enabling them to make informed decisions, much like they do in other aspects of their lives. By showcasing price differences and aligning incentives, employees can actively participate in cost-effective healthcare choices, transforming them from passive recipients to engaged consumers.

2. Removing Barriers to Care and Streamlining Decision-Making: The current system's bureaucratic hurdles, like preauthorization requirements, often delay or deny essential care. A fundamental shift involves letting healthcare providers make medical decisions without insurance company interference, ensuring timely and appropriate care while reducing unnecessary delays and costs.

3. Aligning Incentives for Mutual Benefit: By reimagining healthcare delivery to prioritize transparency and shared savings, employers can foster a system that benefits both parties. Forward-thinking models have shown that aligning incentives and removing cost-shifting practices can significantly reduce healthcare expenses for employers and employees, while improving access and outcomes.

Recovery-friendly workplaces create a unique economic opportunity

By Mark Bonta - In recent years, recovery-friendly workplaces have gained significant attention across the U.S., driven by a growing awareness of the value that individuals in recovery from substance use disorders (SUDs) bring to the workforce. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. The Business Case for Recovery-Friendly Workplaces: Creating recovery-friendly workplaces is both a moral imperative and a strategic decision for businesses. By supporting employees in recovery, companies can improve productivity, reduce turnover, and lower costs associated with untreated substance use disorders. This approach also aligns with national efforts to combat the opioid crisis and its economic impact, as substance use disorders cost the U.S. economy approximately $442 billion annually.

2. Infrastructure for Continuous Skill Development: Businesses can maximize the potential of employees in recovery by implementing robust systems for education and professional growth. Key strategies include mentorship programs, partnerships with community colleges for industry-relevant training, and leveraging workforce development grants to offset costs. This infrastructure not only enhances employee skills but also fosters a culture of growth and inclusion.

3. National and Economic Benefits: Supporting individuals in recovery has significant economic implications. Studies estimate that businesses can save over $8,500 annually for every person in recovery they employ, through reduced healthcare, turnover, and productivity costs. On a national level, integrating individuals in recovery into the workforce can increase labor force participation, reduce unemployment, and lessen reliance on social services, contributing to broader economic stability and growth.

2025 employee benefits & workplace predictions: Leadership

By Lilly Peterson - Leadership in 2025 will require a significant shift. Leaders will need to step up for their employees, which involves building trust, fostering empathy, and demonstrating authenticity. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Prioritize Leadership Development and Connection: Organizations must invest in leadership development programs that emphasize human connection, authenticity, and empathy to counter Gen Z's hesitancy toward management roles. Tailored mentorship and training can ease the transition into leadership, making it a sustainable and attractive career path.

2. Empower Middle Managers for Greater Impact: Middle managers, who balance leadership, projects, and people, require targeted support. Fostering resilience, optimism, and emotional intelligence will enable them to thrive while managing competing demands, ensuring their effectiveness as key drivers of organizational success.

3. Adopt Human-Centric and Personalized Approaches: By integrating human-centric leadership principles, such as emotional intelligence and mental health advocacy, and leveraging personalized digital tools, organizations can boost employee engagement, development, and well-being. These efforts will set the foundation for a dynamic and sustainable workplace culture.