Trump says he will meet with 14 insurers over pricing

By Jakob Emerson – President Donald Trump said Jan. 6 that he plans to meet with 14 insurance companies “in a few days” to pressure them to lower prices for Americans. “We’re trying to solve the healthcare problem. We’re trying to get better healthcare at a lower price,” Mr. Trump said during an almost 90-minute speech to House Republicans, published by PBS News. Read Full Article...

HVBA Article Summary

1. Presidential Proposal to Redirect Healthcare Funds: President Trump renewed his push for lawmakers to divert federal healthcare funding away from insurance companies and instead send it directly to consumers. He criticized insurers for amassing large profits — reportedly increasing earnings by 1,700% over a short period — and argued that individuals should be empowered to purchase their own healthcare coverage with federal support. This proposal echoes a plan he initially introduced in the fall of the previous year.

2. Congressional Gridlock Over ACA Subsidy Extensions: The longest government shutdown in U.S. history, which occurred last year, was triggered by a standoff over the future of enhanced Affordable Care Act (ACA) subsidies that expired at the end of 2025. Democrats proposed a three-year extension of the subsidies, while Republicans backed an alternative approach focusing on health savings accounts (HSAs). Neither measure advanced in the Senate, leaving the issue unresolved.

3. Enrollment Surge and Coverage at Risk Without Extension: The enhanced subsidies significantly expanded access to ACA marketplace coverage by lifting the income cap beyond 400% of the federal poverty level and capping benchmark premium costs at 8.5% of household income. As a result, enrollment in the ACA marketplace rose sharply from 11.4 million in 2020 to 24.3 million in 2025. However, the Congressional Budget Office estimates that around 4 million people are at risk of losing coverage without legislative action. Although the House is expected to vote on a three-year extension this week, NBC News reports it is unlikely to pass in the Senate.

Schlichter Bogard Files 4 ERISA Complaints Related to Voluntary Benefits

By James Van Bramer – Schlichter Bogard LLC, a law firm known for aggressively pursuing Employee Retirement Income Security Act litigation on behalf of plaintiffs, filed four similar complaints against different employers in U.S. district courts in Illinois and New York. The complaints allege breaches of fiduciary duty related to the premiums charged for accident, critical illness, cancer and hospital indemnity insurance—voluntary benefits not subsidized by employers. Read Full Article...

HVBA Article Summary

1. Multiple Lawsuits Filed Alleging Fiduciary Mismanagement: Several major employers—Community Health Systems Inc., Laboratory Corp. of America Holdings, United Airlines, and Universal Services of America LP—along with their benefits consulting firms (Gallagher Benefit Services, Mercer, Lockton, and Willis Towers Watson), are named as defendants in recently filed federal lawsuits. The cases, brought in the U.S. District Courts for the Northern District of Illinois and Southern District of New York, allege that these companies failed to properly manage employee benefit plans. Specifically, the complaints accuse them of neglecting to monitor carrier selection, broker commissions, and loss ratios, which allegedly led to excessive premium costs for plan participants.

2. Allegations of Self-Dealing and Financial Harm to Employees: The complaints, each approximately 50 pages long, claim that the defendants and their consultants engaged in self-dealing and knowingly participated in each other’s alleged misconduct. This includes permitting brokers to sell expensive, low-value voluntary insurance products that incentivize claim denials and inflate premiums due to commission structures. Plaintiffs argue that this behavior resulted in employees overpaying for voluntary benefits—costs they would not have incurred had the fiduciaries fulfilled their legal duties—especially since employees pay 100% of these costs through payroll deductions.

3. Rising Use of Voluntary Benefits and Market Impact: The lawsuits highlight a growing reliance on voluntary benefits in the workplace, driven in part by rising healthcare expenses. According to data cited in the complaints from Eastbridge Consulting, the number of employers offering voluntary benefits grew by 27%, with employee participation increasing from 21% in 2014 to 28% in 2017. By 2018, nearly one-third of eligible employees were enrolled in these programs. The suits argue that this expanding market was misused by fiduciaries and brokers who prioritized financial incentives over offering value to employees, particularly targeting lower-wage workers most likely to purchase such benefits.

“Bullshit” — The New Way Health Giants Hide Billions

By Laura Wadsten – Three mysterious entities. Tens of billions in revenue. Our multinational investigation reveals how CVS, UnitedHealth, and Cigna created new subsidiaries to divert billions of dollars from health plans and patients. All three tried to keep it secret. None answered repeated questions. CVS sued to stop evidence [from] getting out. Cigna called the police on a reporter. And the cost isn’t just higher drug prices. People have died. Drug manufacturers pay billions in discounts, rebates and fees to pharmacy benefit managers (PBMs). But where does that money actually go? Read Full Article...

HVBA Article Summary

1. Opaque PBM GPO Structures Divert Billions: Major healthcare conglomerates CVS, UnitedHealth, and Cigna have created little-known subsidiaries—Zinc, Emisar, and Ascent—that act as PBM Group Purchasing Organizations (GPOs). These entities collect substantial fees from drug manufacturers, often with minimal staff and physical presence, and the revenue flow is largely hidden from health plans and patients. The arrangement allows parent PBMs to claim they pass through 100% of rebates while retaining additional profits via these GPOs, raising serious transparency and accountability concerns.

2. Legal and Regulatory Scrutiny Intensifies: State attorneys general, the Federal Trade Commission (FTC), and federal watchdogs have begun investigating and litigating against these PBM GPOs for withholding funds that should have been passed to health plans. Settlements and audits have already forced the return of tens of millions of dollars, and new legislation in states like California aims to close loopholes by redefining rebates to include GPO fees. Despite these efforts, the complexity and offshore nature of these entities make oversight and enforcement challenging.

3. Impact on Drug Costs and Patient Health: The diversion of funds and lack of transparency in PBM GPO operations contribute to higher drug prices and out-of-pocket costs for patients. The article documents cases where formulary changes driven by PBM incentives led to patients being unable to afford essential medications, with sometimes fatal consequences. Experts warn that these practices undermine the intended purpose of PBMs—to lower drug costs—and instead prioritize profit at the expense of patient access and health outcomes.

The hidden strain of special-needs caregiving on today's workforce

By Jimmy Nesbitt – Employers are working hard to understand the burdens on caregivers — but those caring for loved ones with special needs face a number of unique challenges that often go unnoticed in the workplace. Those responsibilities are like having a second full-time job, according to a new study by New York Life Group Benefit Solutions, which highlighted how gaps in workplace support can add to the stress that caregivers already face. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Significant Career and Financial Impact: Special-needs caregivers often experience disruptions in their professional lives, with 75% reporting an impact on their ability to work or advance. Many reduce their hours — 29% have shifted from full-time to part-time roles, and 14% have left the workforce entirely. The financial strain adds to the burden, as 54% struggle to cover basic expenses and 31% have delayed paying bills due to caregiving costs. These challenges underscore the importance of employers recognizing and addressing the long-term economic and career consequences faced by this group.

2. Gap Between Benefit Awareness and Utilization: While a majority of caregivers are aware of the benefits offered to them, only 68% actively use these resources. Barriers such as workplace stigma, lack of clear disclosure processes, and insufficient year-round communication from employers contribute to this underutilization. Notably, 22% of caregivers have not informed their employers of their caregiving role, and another 22% report facing negative stigma because of it. To close this gap, employers are encouraged to create open channels of communication, promote caregiving benefits consistently, and support employees at critical times, such as when they take or return from leave.

3. Need for Comprehensive and Inclusive Support: Caregivers of individuals with special needs express a strong need for tailored support. The most requested resources include backup or emergency caregiving assistance (49%), workplace flexibility (44%), and financial planning support (43%). Additionally, caregivers seek help navigating complex systems such as medical care, education, and government services. Cultivating a workplace culture that normalizes caregiving discussions and supports disclosure can lead to more meaningful engagement with benefits and improved outcomes for both employees and organizations.

Novo Launches Wegovy Weight-loss Pill for Sale in US

By Jacob Gronholt-Pedersen And Bhanvi Satija – Danish drugmaker Novo Nordisk is launching its once-daily Wegovy pill in the United States on Monday, offering doses of 1.5 milligrams and 4 mg at $149 per month for self-paying patients in an ‌intensely competitive weight-loss drug market. The pill was approved by the U.S. Food and Drug Administration last month, a boon to Novo Nordisk as it looks to regain ground lost to U.S. rival Eli Lilly. Lilly has previously said it ⁠expects a decision in March for its own weight-loss pill. Read Full Article...

HVBA Article Summary

1. Novo’s Wegovy Pill Offers Multiple Dose Options and Competitive Cash Pricing: Novo Nordisk has introduced its once-daily Wegovy weight-loss pill in several doses, including a 1.5 mg starter dose, and higher long-term options of 9 mg and 25 mg. The higher doses are priced at $299 for a month’s supply, while the 4 mg dose will increase to $199 starting April 15, according to the company's website. This pricing strategy, significantly lower than injectable alternatives which can exceed $1,000 per month, is designed to appeal especially to cash-paying customers and those who prefer oral medications over injections like Ozempic and the injectable version of Wegovy, which contain the same active ingredient, semaglutide.

2. Direct-to-Consumer Strategy Targets Cash Payers and Telehealth Channels: In a strategic shift away from traditional insurance-based drug pricing, Novo is targeting out-of-pocket consumers by making the Wegovy pill available at major U.S. pharmacies like CVS and Costco, and through a network of telehealth providers including Ro, LifeMD, GoodRx, WeightWatchers, and its own NovoCare Pharmacy. Shares of these telehealth companies rose between 3% and 14% in response. Additionally, under a deal involving former President Donald Trump’s administration, Novo and competitor Lilly will offer starter doses at $149 per month for Medicare and Medicaid enrollees, and for cash payers via the upcoming TrumpRx site, expected to launch this month.

3. Supply Readiness, Global Expansion, and Investor Optimism Bolster Novo's Outlook: With supply shortages having hindered the initial U.S. launch of the Wegovy injection, Novo has taken preemptive steps to ensure adequate inventory for its oral formulation. The remaining doses of the pill will be available by the end of this week. Meanwhile, the pill is under review by other regulators, with a decision in the UK expected by year-end, signaling potential global expansion. Market confidence was reflected in a 5% rise in Novo’s Denmark-listed shares and a 4.6% gain in U.S.-listed shares, while rival Lilly saw a 3.5% drop. Lilly, whose Zepbound injection has outpaced Wegovy in weekly U.S. prescriptions, plans to cap its own obesity pill (if approved) at $399/month for repeat cash buyers.

9 lessons drawn from a decade of next-gen benefits

By Nelson Griswold – Over the past decade, the benefits industry has undergone a seismic shift. The slow, grinding dissatisfaction with fully insured plans finally erupted into a full-blown revolution — a disruptive movement centered on transparency, accountability, quality and value known as next-gen benefits. As the movement enters its second decade, the results of the first are undeniable: hundreds of brokers transformed into consultative advisers. They're winning bigger, mid-market groups from bigger — even national — brokers; an eye-popping $8.2 billion in employer savings from next-gen strategies. The question now is simple: what comes next? Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Consultative and Strategic Advising is Key: The article emphasizes that the most successful benefits advisers have shifted from transactional roles to consultative, strategic partners. By aligning HR and C-suite perspectives, advisers can help organizations design health plans that meet both business objectives and employee needs. This approach fosters better decision-making and more effective outcomes for both employers and employees.

2. Self-Funding and Supply Chain Control are Emerging Trends: There is a growing movement toward self-funded health plans, with projections indicating millions of employees will transition to these models in the coming years. Advisers who understand and can articulate the financial advantages of self-funding, as well as those who actively manage the healthcare supply chain, are positioned to deliver greater value and cost savings to employers. This trend is reshaping the competitive landscape for benefits consulting.

3. AI and Community Collaboration Will Shape the Future: Artificial intelligence is highlighted as a transformative tool, providing advisers with deeper insights into risks, patterns, and outcomes that traditional brokers may miss. Additionally, the article notes that collaboration within adviser communities accelerates innovation and expertise, moving away from a zero-sum mindset. Those who embrace AI and actively participate in high-performance networks are likely to maintain a competitive edge in the evolving benefits industry.

Drug prices to keep rising through Trump's term

By Maya Goldman – The drug price hikes that are helping drive the health affordability crisis will continue for the rest of President Trump's term, key industry stakeholders are now predicting—despite his deals with drugmakers and Medicare negotiating lower prices. The big picture: Insurers, drug supply middlemen and hospitals who represent 13% of all pharmaceutical purchases predict single-digit price increases for branded drugs over the next three years, according to a new survey by TD Cowen. Read Full Article...

HVBA Article Summary

1. Drug Acquisition Costs Are Projected to Rise Despite Federal Policy Interventions: Despite bipartisan efforts to control drug prices—including the Inflation Reduction Act (allowing Medicare to negotiate prices) and past Trump administration deals with drugmakers—costs are still climbing. According to TD Cowen’s annual drug purchaser survey, payers such as insurers and pharmacy benefit managers expect an average 8% annual increase in drug acquisition costs over the next three years. This figure has remained unchanged in the 2022, 2023, and 2024 surveys. Prices for generic drugs are anticipated to increase more moderately by 2% over the same period.

2. High-Priced Innovative Drugs Are the Primary Cost Drivers: The expected cost increases are largely driven by expensive new medications, including those for cancer, diabetes, obesity, and cell and gene therapies. Notably, at least 350 medications, including common vaccines and cancer treatments, are slated for price hikes in 2024 alone. Although innovation in biopharma is delivering new treatment options, it is also fueling the ongoing upward trend in drug pricing. TD Cowen’s analysis stated, "As long as biopharma delivers innovation, we see no change in the upward trend in drug prices."

3. Patients May See Indirect Cost Increases Despite Policy Protections: While net drug prices rose only 0.1% in 2024 after rebates and discounts (per IQVIA), patients could still feel the impact through higher insurance premiums, as payers pass along rising acquisition costs. The Inflation Reduction Act’s out-of-pocket caps for seniors may drive increased drug usage—74% of purchasers expect usage to grow over five years—though only 44% believe Medicare negotiations will modestly lower costs, and 30% see no impact. Coverage for GLP-1 obesity drugs is expected to expand, and prices for some medications, like those for diabetes and rheumatological conditions, may decline due to patent expirations and competition.