Supreme Court backs away from PBM case, rejecting state efforts to control drug prices in self-funded plans

By Allison Bell - The U.S. Supreme Court today helped employers with self-insured health plans fight state efforts to regulate the plans' pharmacy benefit managers and other plan service providers. The court has decided against providing a "writ of certiorari," or official review, for a ruling by the 10th U.S. Circuit Court of Appeals on Glen Mulready et al. v. the Pharmaceutical Care Management Association. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Federal Preemption of State PBM Laws: The 10th Circuit Court rejected Oklahoma’s attempt to enforce state laws regulating pharmacy benefit managers (PBMs) on employer-sponsored health plans governed by the federal Employee Retirement Income Security Act (ERISA). The U.S. Supreme Court declined to review the case, reinforcing the long-standing principle that ERISA preempts most state-level efforts to regulate these plans.

2. Implications for State Regulation: This decision highlights the limited power states have to regulate PBMs operating within ERISA-covered employer health plans. It suggests that if significant changes to PBM oversight are to be made—especially for multistate or self-insured employer plans—such changes would likely need to come through federal legislation passed by Congress.

3. Ongoing Debate Over PBM Oversight: The ruling comes amid broader debates about the role and practices of large PBMs. Critics argue that these entities prioritize their own profits over cost savings for employers and patients, while PBMs and their supporters contend that federal preemption under ERISA ensures administrative efficiency and cost control, and that any new regulations should maintain this uniformity by coming from the federal level.

7 Major Takeaways from SHRM’s 2025 Employee Benefits Survey

By Kathryn Mayer - Employer decisions about employee benefits are continually top of mind, including choosing which benefits in an ever-growing list to offer to employees and navigating competing priorities such as holding down high benefits costs while attracting and retaining talent. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Health Care Remains the Top Priority: Health care continues to be the cornerstone of employee benefits, with 97% of employers offering coverage and 88% rating it as “very” or “extremely” important. Leave benefits and retirement savings plans are also viewed as essential, with 81% of employers prioritizing them. Flexible working options, family care support, and career development programs remain important as well, though flexible work benefits saw a slight dip in 2025.

2. Emerging Trends: GLP-1 and AI Benefits: Employers are increasingly embracing new and innovative benefits. This year, 23% of employers offer coverage for GLP-1 drugs used for diabetes and weight management — a notable addition as these medications gain public attention. Additionally, 16% now offer AI chatbot subscriptions (such as ChatGPT or Microsoft Copilot) as a tool to support employee productivity, suggesting a growing trend in tech-enabled benefits.

3. Shifting Benefit Offerings: While some benefits are expanding, others are on the decline. Paid leave to care for immediate or extended family has decreased slightly compared to last year. Flexible spending accounts (FSAs), both medical and dependent care, have also steadily declined since 2021. In contrast, supplemental offerings like critical illness insurance (now at 53%) and hospital indemnity insurance are becoming more popular, reflecting a shift toward financial protection for unexpected health events.

Hospitals warn of closures with Senate tax bill

By Ron Southwick - As far as hospitals are concerned, the Senate has turned the tax legislation into One Big Brutal Bill. Hospitals have widely condemned the Senate’s tax legislation, saying it was even worse than the House bill that health systems adamantly opposed. Read Full Article…

HVBA Article Summary

1. Senate Proposal Faces Strong Pushback from Health Care Community: The revised Senate GOP tax package includes a $25 billion boost over five years for rural hospitals and delays to provider tax changes that fund Medicaid. Despite these revisions, leading hospital organizations warn the bill threatens critical services and could lead to closures, particularly in rural areas. Critics argue the legislation would weaken two key Medicaid funding tools — provider taxes and state-directed payments — jeopardizing access to care for millions.

2. Potential Coverage Loss and Medicaid Reductions Raise Alarms: The Senate plan would gradually lower the provider tax cap from 6% to 3.5% by 2032, reducing states’ ability to draw federal Medicaid funding. According to the Congressional Budget Office, up to 11.8 million Americans could lose Medicaid coverage under the Senate bill, compared to 10.9 million under the House version. Hospital groups stress that service cuts could affect all patients in a community, not just Medicaid recipients.

3. Bipartisan Concerns and Legislative Uncertainty: While the bill is advancing, bipartisan opposition is growing. Some Republican senators, including Sen. Thom Tillis, have expressed concerns over hospital closures and pledged not to support the current version. Health care advocates are urging lawmakers to revise the bill, warning of broader consequences including longer wait times, reduced staff, and financial strain on both Medicaid and privately insured patients.

Why Employers Think the 340B Program Needs Reform

By Marissa Plescia -  The 340B Drug Pricing Program was created in 1992 and allows hospitals and clinics that treat a large population of low-income and uninsured patients to buy outpatient prescription drugs at a discount. It was intended to support safety-net providers and help them stretch their financial resources to serve more vulnerable patients. Read Full Article…

HVBA Article Summary

1. The 340B program has grown significantly and is under scrutiny from multiple stakeholders: From 2000 to 2023, the number of participating sites and drug purchases through the 340B program surged, prompting concerns about its size and scope. While drug manufacturers and some lawmakers have criticized the program for lacking oversight, employers argue that large, wealthy hospitals are benefiting disproportionately and not passing savings on to patients.

2. Employers report financial disadvantages tied to the 340B model: Employer groups claim they lose billions annually due to missed pharmacy benefit manager (PBM) rebates when drugs are dispensed through 340B channels. They argue that hospitals benefit from deep discounts while insurers and employers still pay full price, which they believe distorts drug pricing and undermines intended cost savings.

3. Debate continues over the program’s intent versus its current use: Hospitals and their advocates defend the program as a vital resource for funding uncompensated care and community services. Critics, including employer coalitions, call for greater transparency and reforms to ensure the program is limited to true safety-net providers and serves low-income patients as originally intended.

Senate committee backs nomination of Daniel Aronowitz to lead federal benefits agency

By Allison Bell - Members of the Senate Health, Education, Labor and Pensions Committee voted 14-9 Thursday to advance the nomination of Daniel Aronowitz to be the assistant Labor secretary in charge of the U.S. Labor Department's Employee Benefits Security Administration. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Aronowitz's Role and Background: If confirmed, Lisa Aronowitz would serve as the top federal official responsible for overseeing employer-sponsored benefit plans, including health, retirement, and other related programs. She brings extensive experience as a labor lawyer and previously served as president of a subsidiary of Ullico Casualty, highlighting her deep involvement in employee benefits and labor-related matters.

2. Bipartisan but Limited Support: The Senate HELP Committee, which is controlled by Republicans, approved Aronowitz’s nomination with support from all Republican members and two Democrats — Senators John Hickenlooper and Tim Kaine. While this shows some bipartisan support, most Democrats on the committee opposed the nomination, reflecting a divided stance on her appointment.

3. Policy Focus and Industry Reception: During her confirmation hearing, Aronowitz indicated she would prioritize advancing employee stock ownership plans (ESOPs), expanding employer access to association health plans, and improving enforcement of mental health parity laws. Her policy goals have been well received by advocates like the ESOP Association, whose president praised her commitment to addressing regulatory barriers and protecting the interests of millions of ESOP participants.

How benefit managers can select the right PBM

By Lee Hafner - As options for pharmacy benefit managers (PBMs) expand, focusing on fiduciary responsibility can help benefit leaders determine whether their current choice is the best for their workforce — or if it's time to partner with someone new. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Transparency and informed decision-making are critical in PBM selection: With growing calls for cost savings and clearer practices in healthcare, employers now have access to a wider range of alternative PBM models. To make the most of these options, benefit managers must understand how PBMs price medications, generate profits, and deliver services, ensuring decisions are rational, well-informed, and aligned with company goals.

2. Asking the right questions strengthens outcomes: To choose the best PBM partner, benefit leaders should ask detailed questions about pricing strategies, revenue sources, and service levels. It's also important to understand generic drug options and how incentives may influence recommendations from brokers or consultants, leading to more cost-effective and employee-focused benefit plans.

3. Expert and independent support can protect organizations and employees: Utilizing legal advisers, experienced brokers, and independent review committees can help organizations navigate complex PBM arrangements and compliance issues. This ensures decisions are made in employees’ best interests, reducing potential risks like litigation and improving access to affordable, high-quality medication coverage.

Combination Treatment Reduces Weight While Keeping Muscle

By Miriam E. Tucker - Combined use of semaglutide with an investigational monoclonal antibody called bimagrumab produced significant fat mass loss while preserving lean mass, results from the phase 2b BELIEVE study found. Loss of muscle mass is an emerging concern with increasing use of GLP-1 agonists for weight loss as lean body mass is estimated to account for up to 15%-40% of total weight loss from GLP-1 drugs. Read Full Article…

HVBA Article Summary

1. Bimagrumab Offers a Novel Mechanism for Obesity Treatment: Bimagrumab works by blocking activin pathways, which promotes muscle growth and reduces fat mass—distinct from GLP-1 drugs that suppress appetite. Its complementary action makes it promising both as a standalone therapy and in combination with GLP-1s for patients who can’t tolerate or don’t respond to incretins.

2. Combination Therapy Shows Superior Efficacy: In the BELIEVE study, the combination of high-dose bimagrumab (30 mg/kg) and semaglutide (2.4 mg) led to the greatest weight loss (22.1%), fat mass reduction (45.7%), and lowest lean mass loss (2.9%) compared to either drug alone. A higher percentage of participants achieved ≥20% weight loss and ≥30% fat mass reduction with the combination.

3. Safety Profile Is Promising but Requires Further Study: While efficacy results were described as “unprecedented,” safety concerns remain, particularly the transient rise in LDL cholesterol with bimagrumab. Muscle spasms, GI symptoms, and biochemical changes were noted. Experts emphasized the need for long-term safety data and clarity on muscle quality, cardiovascular effects, and statin management in future trials.