Trump administration announces 15 new drugs for Medicare price negotiation program

By Ali Swenson – Drugs that treat Type 2 diabetes, HIV and arthritis are among 15 new medications chosen for a Medicare drug price negotiation program that allows the federal government to haggle directly with drug manufacturers, the Trump administration said Tuesday. The drugs selected include some of the medications on which Medicare spends the most money. That means the deals negotiated this year have the potential to deliver significant savings to taxpayers when they go into effect in 2028. “For too long, seniors and taxpayers have paid the price for skyrocketing prescription drug costs,” Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz said in a statement Tuesday. Read Full Article...

HVBA Article Summary

1. Expansion of Medicare Negotiation Program: The Trump administration's announcement adds 15 new drugs to the Medicare price negotiation program, bringing the total to 40 drugs with negotiated prices for enrollees. This expansion includes medications for a range of conditions such as diabetes, HIV, arthritis, and cancer. The inclusion of both Medicare Part B and Part D drugs marks a significant broadening of the program's scope.

2. Potential for Cost Savings and Impact on Seniors: By targeting drugs on which Medicare spends the most, the program aims to reduce costs for both taxpayers and seniors. The negotiated prices are expected to go into effect in 2028, potentially easing the financial burden of prescription drugs for millions of older Americans. The move has been welcomed by advocacy groups like AARP, which view it as a step toward addressing high drug prices.

3. Ongoing Debate and Industry Pushback: While the administration and some patient advocates support the negotiation program, the pharmaceutical industry has criticized the approach, arguing that government price setting is not the best solution. Industry representatives suggest that policymakers should focus on regulating insurers and pharmacy benefit managers instead. The debate highlights ongoing tensions over how best to manage drug costs in the U.S. healthcare system.

CVS accused of shutting out rival pharmacy hubs in House Judiciary investigation

By Rebecca Pifer Parduhn – The Judiciary Committee released its report Wednesday amid a flurry of hearings on the Hill digging into why healthcare is so unaffordable in the U.S. One theme that emerged in the hearings on Wednesday and Thursday was anger over massive healthcare conglomerates that appear to be restricting market competition to benefit their own businesses. Read Full Article...

HVBA Article Summary

1. Allegations of Anticompetitive Practices by CVS: The House Judiciary Committee report alleges that CVS used its market power to block independent pharmacies from partnering with rival pharmacy service companies, known as pharmacy hubs. CVS reportedly modified its network rules and used audits and cease-and-desist letters as tools to enforce these restrictions, aiming to protect its own hub business rather than competing fairly. This behavior could limit competition and reduce patient access to diverse pharmacy services.

2. Impact on Independent Pharmacies and Patients: Independent pharmacies faced threats of removal from CVS Caremark’s network if they continued working with competing hubs, risking loss of access to approximately 30% of insured Americans covered by CVS’s pharmacy benefit manager. The report warns that such tactics could harm entire communities by restricting their access to medications, highlighting the broader implications of CVS’s alleged conduct on healthcare availability and affordability.

3. Regulatory and Industry Context: The investigation into CVS occurs amid growing scrutiny of pharmacy benefit managers (PBMs), which dominate about 80% of the market through the 'Big Three' PBMs. Critics argue that PBMs’ business practices, including spread pricing and market consolidation, contribute to rising drug costs and pharmacy closures. The Federal Trade Commission is actively pursuing legal action against major PBMs for alleged price inflation, and bipartisan efforts in Congress aim to reform PBM practices to improve transparency and reduce drug prices.

57% of healthcare professionals have encountered or used unauthorized AI tools at work

By Anastassia Gliadkovskaya – Four in 10 healthcare professionals have encountered unauthorized artificial intelligence tools in their organizations, and 17% have used one, a new survey finds. The survey (PDF)—released this week by Wolters Kluwer Health, which offers AI tools designed for use in healthcare—reached 518 healthcare professionals, including providers and administrators, in December 2025. Specifically, 15% of docs in the survey admitted to using an unauthorized tool, and 19% of admins did. One in 10 respondents said they’ve used an unauthorized AI tool for direct patient care. The unauthorized access of AI tools is referred to as “shadow AI” in a report on the findings. Read Full Article...

HVBA Article Summary

1. Prevalence and Motivations for Shadow AI Use: The survey highlights that a significant portion of healthcare professionals are either encountering or actively using unauthorized AI tools in their workplaces. The main motivation for using these tools is to achieve faster workflows and improve efficiency, especially for administrative tasks. Providers are more likely to use unauthorized AI out of curiosity, while administrators focus on operational improvements.

2. Risks and Security Concerns: The use of unauthorized AI tools, or “shadow AI,” introduces notable risks such as potential security breaches and data privacy violations. The report references a study indicating that organizations lacking proper AI access controls are more susceptible to AI-related security incidents. These vulnerabilities can erode patient trust and result in costly consequences for healthcare organizations.

3. Policy Awareness and Future Outlook: Administrators are more involved in developing AI policies within healthcare organizations compared to providers, suggesting a centralized approach to policy management. Despite concerns about patient safety and privacy, nearly 90% of respondents believe AI will significantly enhance healthcare over the next five years. Addressing shadow AI requires understanding the underlying needs of staff and implementing secure, enterprise-level AI solutions rather than simply restricting access.

New year, continued legislation against PBMs

By Nicole Ortiz – Congress may not agree on whether or not to extend Affordable Care Act enhanced subsidies, but they sure do seem to agree on not liking PBMs. Pharmacy benefit managers got a special shout-out in a recent bipartisan spending deal, which called for overhauling how the system currently works. The bill passed in the House on Jan. 22. One element of the bill, led by Sens. Bill Cassidy (R-La.) and Bernie Sanders (I-Vt.), would prevent payments to PBMs from drug rebates, something PBMs have been criticized for—and sued over—in the past. Read Full Article...

HVBA Article Summary

1. Bipartisan Push for PBM Reform: The new spending bill represents a rare area of bipartisan agreement in Congress, focusing on increasing transparency and changing how pharmacy benefit managers (PBMs) operate. The legislation specifically targets the practice of PBMs receiving payments from drug rebates, which has been a source of criticism and legal action in the past. This move is part of a broader effort to address concerns about PBMs' influence on drug pricing and their role in the healthcare system.

2. Industry Resistance and Lobbying Efforts: PBMs, through their trade group PCMA, have voiced strong opposition to the bill, arguing that it could limit employers' flexibility and potentially increase prescription drug costs. The industry has significantly ramped up its lobbying efforts, with PCMA increasing its spending by 71% in early 2024 and investing a total of $18 million by the end of the year. This demonstrates the high stakes and intense pushback from PBMs as legislative scrutiny intensifies.

3. Market Shifts and Future Implications: Major PBMs have already begun adjusting their business models in anticipation of regulatory changes, with companies like Express Scripts, Caremark, and Optum Rx moving away from rebate-based models. The emergence of alternative PBMs and ongoing state-level efforts to address vertical integration signal a transformative period for the industry. Experts suggest that increased transparency requirements will challenge incumbent PBMs while creating opportunities for innovative competitors to reshape the market.

The GLP-1 dilemma: Balancing obesity care with a 12% spike in drug spend

By Kryijztoff Novotnaj and Nelly Rose – It's hard to escape the buzz – make that a roar – over the advances in GLP-1 medications like Ozempic and Wegovy. They've become a boon for controlling diabetes, their original purpose. But the real public excitement is over their effectiveness at managing one of its causes – obesity. Their exploding popularity andprice tags (between $936 to $1,340 monthly before insurance, rebates and discounts) raise tough questions for employers: Is coverage under employers' health plans something plan sponsors should provide? For diabetes, or obesity, or both? Is it sustainable to offer it for the long term? Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Rising Demand and Financial Impact: The popularity of GLP-1 medications for both diabetes and obesity management is driving significant increases in prescription drug spending for employers. With medical cost trends projected to rise by up to 12% due to these drugs, employers face difficult decisions about whether to include them in health plans. Balancing the benefits of improved employee health and retention against escalating costs is a central challenge.

2. Coverage Decisions Influence Recruitment and Wellness: Surveys indicate that access to GLP-1s is becoming a highly valued employee benefit, with many workers considering job changes based on coverage availability. Employers are increasingly viewing these medications as a differentiator in attracting and retaining talent, while also recognizing their potential to enhance productivity and reduce absenteeism. However, the decision to offer coverage must also account for sustainability and alignment with organizational wellness goals.

3. Data-Driven Policy Design Is Essential: Employers are encouraged to use analytics and modeling tools to assess the prevalence of obesity, current drug utilization, and the financial implications of various coverage scenarios. Evaluating both short- and long-term costs, as well as integrating wellness initiatives and medical management strategies, can help organizations make informed choices. Ultimately, GLP-1 coverage should be considered as part of a broader approach to workforce health that addresses underlying causes of obesity and promotes preventive care.

Benefits Think: What the Savannah Bananas can teach us about benefits

By Andrew McNeil – With another calendar year and open enrollment in our rearview mirror, let's look ahead through our respective windshields to some exciting possibilities. If you haven't yet seen the Savannah Bananas, do yourself a favor and look them up. They've taken one of America's most traditional, slow-moving pastimes — baseball — and turned it into an entertainment experience like know other (think a circus vs. Cirque du Soleil). Every game sells out. Fans travel across the country to watch. Their waitlist for tickets is over a million people. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Employee Experience Should Come First: Traditional employee benefits programs often prioritize compliance and cost over user experience. Inspired by the Savannah Bananas’ "fans first" model, the article argues that organizations should flip this script—starting with what employees need to feel supported, cared for, and understood. Designing benefits with empathy and personalization can enhance employee satisfaction, engagement, and retention.

2. Make Benefits Communication Engaging and Human: Benefits education is typically dry and jargon-heavy, making it difficult for employees to connect with or remember. Drawing on the Bananas’ entertaining approach to baseball, the article advocates for delivering benefits information in fun, relatable, and memorable ways—such as videos, games, and real-life stories—so employees actually pay attention and feel emotionally invested.

3. Break the Mold and Lead with Purpose: Just as the Bananas challenged baseball norms, benefits professionals are encouraged to question outdated industry practices—like rigid enrollment formats or overly formal communications. Innovation in this space doesn’t require new tech, just new thinking. The core message: reconnect with the human purpose behind benefits—helping people live better, more secure lives—and let that guide every decision.

National Integrative Health (“NIH”) Announces the Addition of Robert S. Shestack as President & Chief Operating Officer

By National Integrative Health (NIH) – January 27, 2026 – DES MOINES, IOWA. NIH is a fast‑growing consulting firm specializing in healthcare design, data, pharmacy, and analytics, helping employers better manage healthcare costs while improving care quality and access to personalized services for their employees. NIH has named Robert S. Shestack as its President & Chief Operating Officer. Prior to joining NIH, Mr. Shestack was most recently the Chief Revenue Officer at Juice Financial. Mr. Shestack also serves as the Chairman and CEO of the Health & Voluntary Benefits Association, a non-profit 501(c)(3) focused on education and networking opportunities related to providers and purchasers of healthcare and supplemental insurance programs. Read Full Announcement...

HVBA Article Summary

1. Leadership Appointment and Responsibilities: Robert S. Shestack has been appointed as President & Chief Operating Officer of National Integrative Health (NIH). In this role, he will lead NIH’s corporate strategy and growth efforts in the healthcare market as the company continues to expand its solutions. Additionally, he will maintain his focus on the growth and strategy of the Health & Voluntary Benefits Association (HVBA), where he serves as Chairman and CEO.

2. Extensive Industry Experience: Mr. Shestack brings over 35 years of strategic leadership experience in the healthcare sector, having held senior roles at notable organizations such as Willis Towers Watson, AmeriFlex, USI, Marsh / Mercer, AmWINS, and Juice Financial. His educational background includes degrees in Actuarial Science, Risk Management, and Business Law from Temple University, which supports his expertise in healthcare and benefits management.

3. NIH’s Market Position and Services: Since 2013, NIH has specialized in delivering innovative clinical strategies directly to employers and their employees, focusing on healthcare design, data, pharmacy, and analytics. The firm integrates seamlessly into existing initiatives or designs programs from the ground up, offering services such as healthcare delivery, provider case management, clinical consulting, and secure healthcare data solutions. NIH has helped clients save tens of millions in healthcare spending and serves a diverse client base including employers, brokers, population health companies, and unions.