UnitedHealth Group’s PR Stunt Disguised as Generosity

By Wendell Potter – As we reported last week, UnitedHealth’s CEO Stephen Hemsley announced just hours before facing angry and fed-up lawmakers on Capitol Hill that his company was going to do something truly magnanimous. For this entire year, Hemsley promised, UnitedHealthcare will make an enormous sacrifice and return all of its Obamacare profits to The People. To hell with Wall Street. This means that UnitedHealth will not share any of its Obamacare profits with its shareholders. Read Full Article...

HVBA Article Summary

1. PR Strategy Over Substantial Change: UnitedHealth Group’s announcement to rebate all Obamacare profits was timed to coincide with CEO Stephen Hemsley’s Congressional testimony, suggesting a calculated public relations move rather than a significant financial sacrifice. The company did not issue a press release, instead embedding the news in testimony, which resulted in favorable media coverage and a rise in its stock price. This indicates that the announcement was designed to generate positive attention and goodwill with minimal actual cost to the company.

2. Structural Advantages Limit Impact: UnitedHealth’s vertically integrated structure allows it to funnel premium dollars to its own subsidiaries, such as physician practices and clinics, thereby reducing reported profits from its Obamacare business. This internal arrangement enables the company to meet regulatory requirements while minimizing the likelihood of issuing substantial rebates to customers. As a result, the promised rebates are expected to be minimal and unlikely to significantly affect UnitedHealth’s overall financial performance.

3. Competitive Pressure on Rivals: The move is expected to put pressure on smaller competitors who rely more heavily on Obamacare exchange profitability, as noted by financial analysts. If broader rebate rules are implemented in response to UnitedHealth’s announcement, these competitors could face greater financial strain. The strategy is seen as a way for UnitedHealth to strengthen its market position while making a gesture that has little impact on its own bottom line.

House votes 341-88 for spending package with PBM transparency provisions

By Allison Bell – Members of the U.S. House voted 341-88 today to pass the Consolidated Appropriations Act, 2026 spending package — a big, "must-pass" bill that includes two employer pharmacy benefit manager provisions. One PBM provision in the "minibus package" would require PBMs to offer employers detailed prescription plan activity information, to help sponsors know whether they and the participants are getting a good deal. Sponsors would have a duty to monitor whether the compensation they were paying PBMs, benefit plan administrators, stop-loss providers and other providers was reasonable. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. PBM Reform and Oversight Enhancements: The legislation includes significant reforms targeting Pharmacy Benefit Managers (PBMs). It would require PBMs to pass all negotiated rebates and discounts directly to insurance plans rather than retaining them. It also obligates plan fiduciaries to evaluate whether the compensation paid to PBMs and other service providers—such as dental and stop-loss insurance providers—is reasonable. Furthermore, the bill introduces new transparency and operational standards for PBMs that administer Medicare Part D prescription drug plans, aiming to increase accountability in the drug pricing system.

2. Minibus Spending Package Advances with Mixed Party Support: The $1.2 trillion "minibus" spending package has cleared the House and now awaits Senate consideration. It plays a crucial role in averting a potential federal government shutdown set for February 1. The package maintains flat funding for the U.S. Labor Department’s Employee Benefits Security Administration at $191 million. While many Democrats initially opposed bringing the bill to the floor—primarily due to blocked amendment votes on immigration and health subsidy issues—the final passage received bipartisan support, with 149 Democrats ultimately voting in favor due to the restoration of some medical research and social program funding.

3. Potential Senate Expansion and ACA Subsidy Debate: As the minibus package moves to the Senate, lawmakers are debating whether to expand it to include additional provisions, notably one that would reinstate higher premium subsidies for individuals and families purchasing coverage through Affordable Care Act (ACA) marketplaces. These temporary COVID-era subsidies expired on December 31, 2025, leading to what critics have labeled a "subsidy cliff" that could increase costs for many consumers. Senate negotiations may influence the final scope of the package, depending on whether these or other provisions are successfully added.

No Surprises disputes increasing even as arbiters catch up, CMS says

By Rebecca Pifer Parduhn – When the federal IDR portal opened in April 2022, arbiters were quickly slammed with a tsunami of disputes over contested medical bills. The process — set up by the No Surprises Act to stop health insurers and providers from penalizing patients who inadvertantly receive out-of-network care — has proved successful in shielding consumers from surprise charges, but continues to be bumpy. Read Full Article...

HVBA Article Summary

1. Dispute Volume and Backlog Trends: The number of disputes submitted to the federal independent dispute resolution (IDR) portal has surged, with nearly 1.2 million cases filed in the first half of 2025. Despite this increase, arbiters have managed to process over 1.3 million disputes during the same period, indicating progress in reducing the backlog. However, the system continues to face challenges due to the high volume and complexity of cases.

2. Concentration of Disputes Among Few Parties: A significant portion of disputes are initiated by a small group of provider organizations, many of which are backed by private equity. The top ten initiating parties accounted for almost 70% of all disputes, with just three entities responsible for about 44% of cases. This concentration has raised concerns among insurers and regulators that the IDR process may be used strategically by certain providers to maximize reimbursement.

3. Ongoing Eligibility and Cost Concerns: Many disputes submitted to the IDR process are found to be ineligible, which contributes to delays and administrative burdens. Although the percentage of ineligible disputes is declining as arbiters improve their review processes, these cases still slow down the system. Additionally, research suggests that the IDR process has led to billions of dollars in extra costs for the healthcare system, prompting calls for regulatory clarification and reform.

House report alleges CVS aimed to stifle pharmacy hub competition

By Paige Minemyer – A new report from the House Judiciary Committee alleges that CVS Health may have violated antitrust laws by preventing independent pharmacies from tapping into alternative pharmacy-hub options. The report, released last week as major health insurance executives were questioned for hours before two House panels, is born from a committee investigation launched in September 2024 into whether pharmacy benefit managers are stifling competition. Read Full Article... 

HVBA Article Summary

1. CVS's Competitive Strategy in Digital Pharmacy: CVS Health aimed to significantly expand its presence in the digital and hub pharmacy market. As part of this strategy, the company analyzed the competitive landscape and implemented network policy changes that, according to the committee's findings, sought to limit independent pharmacies from collaborating with rival hubs. These efforts included sending cease-and-desist letters and leveraging its large pharmacy network to potentially block out competition.

2. Regulatory and Legal Implications: The congressional committee raised concerns that CVS’s actions might have violated antitrust laws designed to protect fair market competition. The report further argued that current antitrust frameworks may be outdated and ill-equipped to handle the complexities introduced by emerging pharmaceutical technologies, calling for possible legislative updates to ensure robust competition in the evolving industry.

3. CVS’s Response and Policy Adjustments: In response to the committee’s investigation and allegations, CVS Health rejected the report’s conclusions, calling them misleading and inaccurate. The company maintained that its actions were driven by a responsibility to curb fraud, waste, and abuse in the pharmaceutical supply chain. CVS also highlighted that it revised its policies in 2023 to make it easier for pharmacies to access hub services, emphasizing that these changes were broad and not targeted at a specific hub, and that the company supports innovation that enhances patient care.

Eli Lilly to expand 340B reporting requirements

By Ella Jeffries – Eli Lilly and Co. will require all 340B covered entities to submit claims-level data for in-house pharmacy dispensing beginning Feb. 1, 2026. The new requirement expands Lilly’s existing policy, which has applied to contract pharmacies since December 2021, according to a Jan. 15 company news release. Read Full Article...

HVBA Article Summary

1. Mandatory Reporting Requirements for 340B Pricing Eligibility: Covered entities must report claims-level data for all Eli Lilly products under labeler codes 00002, 00077, and 66733 to the 340B ESP platform within 45 days of dispensing. For specified infused and administered drugs (e.g., Alimta, Erbitux, Kisunla), the deadline is extended to 60 days after administration. Non-compliance may result in a temporary loss of access to 340B pricing.

2. State and Entity-Level Exemptions from Reporting: Covered entities in 10 states, including Colorado and Oregon, are exempt from these reporting requirements. Additionally, Federally Qualified Health Centers and their look-alike entities in New Mexico are also excluded from the policy.

3. Opposition from the American Hospital Association (AHA): The AHA has publicly opposed the policy, arguing in a January 26 letter to the Health Resources and Services Administration that the reporting requirements are overly burdensome, potentially unlawful, and threaten hospitals' access to discounted 340B pricing. The AHA also raised concerns about the reliability of the 340B ESP platform and suggested penalties against Lilly.

Pet insurance is a voluntary benefit employees actually want

By David Hurley – Pet insurance is quickly becoming one of the most popular voluntary benefits. With 94 million U.S. households owning at least one pet and members of younger generations prioritizing pet care, offering this coverage signals that an employer understands what matters to a growing number of employees. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Zero-Cost, High-Impact Employer Benefit: Pet insurance is a voluntary benefit that employers can offer at no cost, as premiums are employee-paid. Despite its low implementation burden, the benefit signals organizational support for employees' personal lives, especially for those who view pets as family members.

   Retention and Engagement Among Younger Workers: Pet insurance strongly appeals to Gen Z and millennial employees, who often consider pets part of their core family unit. A Nationwide study found that 72% of Gen Z and millennial workers with pet insurance report being fully engaged at work, highlighting its value as a retention and engagement tool.

   Support for Employee Wellness and Financial Security: Pets contribute to emotional wellness by reducing stress and loneliness. Offering pet insurance also shields employees from major financial shocks, with emergency vet visits (e.g., foreign body ingestion) costing up to $3,045. This benefit is especially valuable for workers with limited emergency savings, helping them avoid tapping into 401(k)s or other critical reserves.

Why cover GLP-1s? They’ll lower employer healthcare costs, study says

By Caroline Colvin – Companies on the fence about offering an employee benefits plan that covers GLP-1s may find the following data helpful: A report from risk consultation firm Aon, released Jan. 13, suggests workers’ sustained GLP-1 use can reduce employers’ costs over time. Analysts looked at data for more than 50 million people, including 192,000 GLP-1 users, for a little over two years. By the 30-month mark, the medical cost growth was 6% lower for people with diabetes using GLP-1s compared to people with diabetes who didn’t use GLP-1s, researchers found. Read Full Article...

HVBA Article Summary

1. Health Benefits of GLP-1 Use: Individuals using GLP-1 medications — whether for diabetes management, weight loss, or general health — saw meaningful health improvements. These included a 9% lower growth in medical costs for those with high adherence, fewer hospitalizations for major cardiovascular events (such as strokes), and a notably reduced incidence of ovarian and breast cancer among women. These findings suggest a potential for significant long-term health benefits tied to consistent GLP-1 usage.

2. GLP-1 Coverage and HR Strategy Implications: Although only 23% of employers currently cover GLP-1 medications, Aon’s research points to a broader opportunity: integrating GLP-1 strategies into talent and benefits programs. When paired with initiatives that promote medication adherence and employee well-being, such strategies may not only enhance health outcomes but also serve as a differentiator in attracting and retaining talent in a competitive labor market.

3. Cost Considerations for Employers: GLP-1s are contributing to rising prescription drug expenses, which make up roughly a third of total healthcare costs. With U.S. employer healthcare spending projected to grow by 9.5% in 2026, organizations must conduct careful cost-benefit analyses. While GLP-1s are high-cost drugs, they may help offset other significant healthcare expenses by addressing conditions like obesity, diabetes, and cancer, which are among the most financially burdensome health issues for employers.