RFK Jr. appears confused about Medicaid, Medicare during confirmation hearing

By Emily Olsen - Robert F. Kennedy Jr., President Donald Trump’s pick for HHS secretary, appeared confused about key aspects of Medicare and Medicaid during a contentious Senate confirmation hearing Wednesday, including making mistakes about how the massive federal insurance programs are funded. Read Full Article…

HVBA Article Summary

1. Kennedy’s Unclear Understanding of Medicare and Medicaid: During his Senate confirmation hearing, the nominee, Kennedy, demonstrated a limited grasp of how Medicare and Medicaid function, particularly regarding their funding mechanisms and cost-sharing structures. His comments on Medicaid deductibles and Medicare's payment structure drew pushback from lawmakers, including Sen. Maggie Hassan, D-N.H., who corrected his statements on Medicaid funding and cost-sharing.

2. Potential Confirmation Hurdles: Kennedy’s exchange with Sen. Bill Cassidy, R-La., could impact his confirmation prospects. With key Republican senators like Susan Collins, Lisa Murkowski, and Mitch McConnell likely to oppose his nomination, Cassidy’s potential dissent could be crucial in determining Kennedy’s fate in the Senate.

3. Political Context and Medicaid Funding Concerns: The debate over Medicaid remains a central issue, with Republican lawmakers considering cuts to the program to offset tax cuts. Additionally, the Trump administration’s recent freeze on federal financial assistance caused temporary disruption for states relying on Medicaid payments, though the White House later rescinded the freeze.

Many Community Pharmacists Won’t Carry Drugs in Medicare Negotiation Program, NCPA Warns

By Marissa Plescia - Many independent pharmacists may decide or have already decided not to carry drugs in the Medicare Drug Price Negotiation Program due to financial challenges, the National Community Pharmacists Association (NCPA) told the Centers for Medicare and Medicaid Services (CMS) on Monday in a comment letter. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Impact on Independent Pharmacies: A survey by NCPA found that 60.4% of independent pharmacists are considering not stocking at least one of the first 10 drugs selected for Medicare price negotiations due to anticipated financial losses, while 32.8% have already decided against it. This could severely limit patient access to these medications.

2. Financial Struggles and Pharmacy Closures: Independent pharmacies are already facing significant financial challenges, with 80.3% reporting a decline in financial health in 2024, and nearly a third (30.3%) considering closing in 2025. The reimbursement structure and delays in manufacturer refunds under the negotiation program may worsen these struggles.

3. Diverging Industry Perspectives: While independent pharmacies and drug manufacturers have opposed the Medicare Drug Price Negotiation Program, citing financial and operational concerns, organizations such as AARP and Patients for Affordable Drugs support it, emphasizing the benefits of lowering prescription drug costs for consumers.

Johnson & Johnson Lawsuit Over Health Plan Partially Dismissed

By Remy Samuels - A U.S. district judge in New Jersey has granted, in part, Johnson & Johnson’s motion to dismiss a lawsuit against the company alleging mismanagement of its health plan costs. The court ruled on Friday that the plaintiff, Ann Lewandowski, lacked Article III standing to claim that she suffered economic injury by paying higher premiums and out-of-pocket costs due to J&J’s “mismanagement” of its health plan. Read Full Article… 

HVBA Article Summary

1. Standing Issues Led to Dismissal of Key Claims: The court dismissed two primary claims, ruling that the plaintiff, Lewandowski, failed to establish an actual injury under Article III standing. Judge Quraishi found that allegations of higher premiums, deductibles, and copays were speculative and not directly linked to J&J’s actions, meaning a favorable ruling would not redress the alleged harm.

2. Potential for Case Revival with Additional Plaintiffs: Although the main claims were dismissed, legal experts suggest that the case could be revived by adding new plaintiffs who can demonstrate direct financial harm. This approach may allow the lawsuit to proceed and further challenge fiduciary standards for employer-sponsored health plans under the Consolidated Appropriations Act of 2021.

3. Growing Scrutiny of Pharmacy Benefit Managers (PBMs): The case against J&J underscores broader concerns about PBM practices and their financial arrangements with health plan sponsors. The Federal Trade Commission’s recent report on the “opaque” nature of PBM pricing highlights the importance of transparency and fiduciary responsibility in managing employee prescription drug benefits.

Medicare Advantage prior authorization rates keep climbing: 10 things to know

By Rylee Wilson - The number of prior authorization determinations issued by Medicare Advantage insurers continued to grow in 2023, according to a new report from KFF. The report, published Jan. 29, examines data from 2023, the latest year available. That year, Medicare Advantage insurers made 49.8 million prior authorization determinations, or 1.8 per MA enrollee. Read Full Article…

HVBA Article Summary

1. Increase in Prior Authorization Requests: The growing number of Medicare Advantage (MA) beneficiaries has led to an annual increase in prior authorization determinations since 2021, although the number of requests per beneficiary remained stable from 2022 to 2023.

2. Trends in Denials and Appeals: While MA insurers denied 6.4% of prior authorization requests in 2023 (down from 7.4% in 2022), the majority of denials were not appealed. However, the percentage of denied requests that were appealed has increased since 2019, and more than 80% of appeals resulted in approval.

3. Variation Among Insurers: Prior authorization rates and denial rates vary significantly among insurers. Humana and Anthem had the highest rate of prior authorization determinations per beneficiary, while Kaiser Permanente had the lowest. Centene had the highest denial rate at 13.6%, while Humana had the lowest at 3.5%.

The Benefits Of Benefits: Driving Employee Experience And Engagement

By Tim Pratte - Want to boost engagement? I recommend you start with the benefits experience—because when you get that right, the rest tends to fall into place. But let’s start with an obvious truth: Employees don’t wake up in the morning thinking about their benefits. And I don’t blame them. Most benefits materials are dense, boring and make assembling IKEA furniture look fun. Read Full Article…

HVBA Article Summary

1. Benefits Engagement is Critical to Employee Engagement: A Quantum Health survey shows that while most employers recognize the importance of benefits engagement in reducing costs and improving satisfaction, only 20% believe their employees are truly engaged. Without benefits engagement, overall employee engagement is unlikely to succeed.

2. A Better Benefits Experience Requires Personalization, Choice, and Flexibility: Employees value benefits that cater to their individual needs, offer diverse options, and accommodate different work arrangements. Organizations that provide tailored, accessible, and well-communicated benefits foster higher engagement and retention.

3. HR and Business Leaders Must Take Action to Drive Engagement: Companies can enhance benefits engagement by optimizing utilization with clear communication, aligning benefits with company culture, and measuring success through data-driven insights. Prioritizing benefits as a core part of the employee experience strengthens loyalty and business performance.

5 Health Topics Likely to Come Up During Robert F. Kennedy Jr.’s Hearings

By Noah Welland - Robert F. Kennedy Jr., President Trump’s nominee for health secretary, has amassed a significant national following with his suspicions of vaccines, weight-loss drugs and the American diet. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Vaccine Policy and Oversight: Mr. Kennedy’s past skepticism about vaccine safety and regulation raises concerns about how he might use his authority as health secretary. He could influence vaccine approvals, CDC recommendations, and federal contracts affecting vaccine access for millions of children.

2. Healthcare Programs and Subsidies: With major health insurance programs like Medicare, Medicaid, and the Affordable Care Act covering over 160 million Americans, Mr. Kennedy will face scrutiny over his stance on federal subsidies, potential Medicaid cuts, and whether he supports policies that would weaken or uphold Obamacare.

3. Food and Chronic Disease Policy: Mr. Kennedy’s views on food policy, additives, and environmental toxins, along with his call to remove fluoride from water, could lead to regulatory shifts in FDA oversight. His position on corporate influence in agriculture and federal food programs may also face pushback from lawmakers representing rural states.

How Important is a Financially Empowered Workforce for a Successful Business?

By SHRM - Financial wellness is steadily gaining recognition as people become more aware and thoughtful about financial literacy and stability. Financial wellness has become paramount with rapid advancements in both personal and professional spheres. Read Full Article… 

HVBA Article Summary

1. The Growing Importance of Financial Wellness in the Workplace: Financial wellness is no longer just an individual concern; it is a critical factor in employee productivity, morale, and retention. Organizations must develop strategic financial wellness programs to ensure employees are financially stable, which in turn contributes to overall business success.

2. Financial Stress and Its Impact on Employees: Many employees, particularly younger generations, struggle with financial literacy and managing expenses. Rising living costs, concerns about retirement, and financial emergencies create stress that affects job performance and satisfaction. Employers need to assess whether their financial benefits truly address these concerns.

3. Bridging the Gap Between Employer Support and Employee Needs: A disconnect often exists between what employers believe they provide and how employees perceive financial support. Addressing this gap with data-driven financial wellness initiatives can help reduce financial stress, enhance job satisfaction, and ultimately improve retention and productivity.

Unrelenting 'cost surge' at BCBS Vermont: CEO

By Jakob Emerson - Blue Cross and Blue Shield of Vermont is sounding the alarm about the escalating financial challenges facing the state's healthcare system, noting that "the cost surge was unrelenting through 2024." Read Full Article…

HVBA Article Summary

1. Escalating Financial Losses: BCBS Vermont has faced substantial financial losses, with paid claims increasing by 17% annually since 2020, resulting in a cumulative $100 million depletion in member reserves over five of the last six years. In October 2024 alone, the insurer experienced a record $13.6 million loss in paid claims.

2. Higher Spending Compared to Peers: The insurer's spending is significantly higher than other Blue Cross Blue Shield plans in the Northeast (33.5%) and exceeds the national average by 42.7%, driven by rising costs of medical services, medications like GLP-1s, and specialty treatments.

3. Strategic Actions for Financial Stability: In response to escalating claim costs, BCBS Vermont requested the highest-ever premium increases in the state's history for individual and small group plans in 2024. Additionally, the insurer's affiliation with BCBS Michigan in 2023 is expected to save $10 million in administrative costs over three years. The company has also launched a multiphase stabilization plan, urging coordinated action among state officials, providers, health plans, and employers.