Join HVBA at the Renaissance Nashville Hotel – A Premier Experience in the Heart of Music City

By Health & Voluntary Benefits Association® - The Health & Voluntary Benefits Association® (HVBA) is thrilled to extend a warm invitation to all benefits professionals for the upcoming Benefit Roadshow, scheduled for Wednesday, September 3, 2025. Read Full Article…

HVBA Article Summary

1. Premier Location & Exclusive Access: The HVBA Benefits Roadshow will be hosted at the upscale Renaissance Nashville Hotel, perfectly situated in downtown Nashville and directly connected to the vibrant Fifth + Broadway complex. This prime location offers attendees unmatched access to dining, shopping, and entertainment. Beyond the setting, participants will have exclusive opportunities to engage directly with HVBA’s Executive and Advisory Board Members—offering rare face time with some of the most influential leaders in healthcare and voluntary benefits.

2. Innovation-Focused Content: Central to the event is the HVBA Innovation Summit, featuring six high-impact power sessions designed to introduce attendees to groundbreaking advancements in healthcare and benefits. From revolutionary pharmacy models to cutting-edge data analytics and new employer risk strategies, the sessions are curated to deliver strategic insights and forward-thinking solutions that drive real change—particularly in the ongoing effort to control healthcare costs.

3. High-Value Networking & Complimentary Admission: The HVBA Networking Reception transforms traditional networking into a high-energy, results-driven experience. Attendees will enjoy a relaxed atmosphere with an open bar, butlered hors d’oeuvres, and curated introductions designed to spark meaningful professional connections. It’s a unique chance to meet business owners, solution providers, and industry leaders—all at no cost, thanks to generous sponsor support.

DOJ Questions UnitedHealth Doctors Re: Medicare Advantage Upcoding

By Wendell Potter - I’ve been at this for so long and have seen so much. And it’s hard to overstate how significant the latest revelations from The Wall Street Journal are. According to its reporting, the U.S. Department of Justice’s criminal health care-fraud unit is questioning former UnitedHealth Group employees about the company’s Medicare billing practices regarding how the company records diagnoses that trigger higher payments from taxpayers. Read Full Article…

HVBA Article Summary

1. Federal Investigation into Medicare Advantage Practices: The U.S. Department of Justice is conducting a criminal investigation into UnitedHealth and other Medicare Advantage providers for allegedly using a tactic known as "upcoding" — exaggerating the severity of patient diagnoses to secure higher reimbursement from the government. This probe reflects growing concern about potential misuse of taxpayer funds in the Medicare Advantage system.

2. Allegations Involving Incentives and Pressure: Prosecutors and federal agents are reportedly looking into claims that UnitedHealth trained doctors, used software tools, and offered financial bonuses to encourage the use of more lucrative diagnosis codes. Whistleblowers allege that such practices led to billions of dollars in extra payments, suggesting a systemic effort to maximize profits through questionable billing practices.

3. Calls for Greater Oversight: The investigation underscores long-standing concerns from policy experts and some regulators about the need for stronger oversight of the Medicare Advantage program. As enrollment in these private plans now surpasses half of all Medicare beneficiaries, critics warn that unchecked profit-driven practices may undermine the integrity of the system and divert resources away from actual patient care.

Congress revives fight for coverage for Wegovy and other weight-loss drugs

By Allison Bell - Members of the House have brought back efforts to pass the Treat and Reduce Obesity Act bill. The bill would have a direct effect only on Medicare Part D prescription drug plans: It would let the plans cover weight-loss drugs for obese people and for overweight people with weight-related health problems. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Proposed Medicare Expansions: The 2025 version of the Treat and Reduce Obesity Act would broaden Medicare coverage to include a wider range of anti-obesity medications, such as GLP-1 agonists (e.g., Wegovy) and GIP/GLP-1 combination drugs (e.g., tirzepatide in Mounjaro), as well as drugs like Qsymia. It would also allow more types of healthcare providers—not just primary care physicians—to deliver intensive behavioral therapy for obesity. This change aims to address the growing need for obesity care, as more than 40% of U.S. adults are classified as obese (CDC, 2023).

2. Potential Impact on Employer Health Plans: Expanding Medicare coverage and boosting federal research could influence private employer health plans by alleviating long-term costs related to obesity. In 2024, GLP-1 agonists accounted for an estimated 17% of employer pharmacy benefit spending, according to CBIZ. At the same time, obesity and overweight-related costs to U.S. employers were estimated at $425 billion in 2023, while the broader economic impact of obesity on the U.S. economy reached $1.4 trillion per year, or roughly 6% of GDP (Milken Institute).

3. Bipartisan Legislative Support and Long History: First introduced in 2011, the Treat and Reduce Obesity Act has resurfaced in 2025 with renewed bipartisan backing. The House version, introduced by Rep. Mike Kelly (R-PA) in June 2025, has five Republican and eleven Democratic co-sponsors. The Senate version, led by Sen. Bill Cassidy (R-LA), a physician and chair of the Senate HELP Committee, has support from twelve Democrats and six Republicans. This cross-party momentum reflects increasing concern over both the health and financial consequences of obesity in the U.S.

Republican senators unveil "portable benefits" bill for gig workers

By Emily Peck - Sen. Bill Cassidy (R-L.A.) unveiled a bill on Monday that would make it easier for companies to offer benefits to gig workers without making them full-fledged employees. Read Full Article…

HVBA Article Summary

1. Legislation Overview: The Unlocking Benefits for Independent Workers Act aims to give companies the option to offer benefits such as health insurance, paid sick leave, and retirement savings to gig and self-employed workers. Crucially, it does so without requiring those companies to classify these individuals as employees, which would normally obligate them to provide full labor protections like unemployment insurance, overtime pay, and workers' compensation.

2. Political and Practical Context: The bill reflects a Republican-led effort to update labor laws in a way that aligns with a business-friendly approach, preserving flexibility for companies and workers. It enters a long-standing debate over whether gig workers should be classified as employees, a position supported by Democrats and labor advocates. While the Biden administration and some states have pushed for stronger worker protections, many companies and GOP lawmakers argue that maintaining independent contractor status better supports worker autonomy and business innovation.

3. Limitations and Outlook: Although the legislation introduces the concept of portable benefits, it does not mandate participation, and previous voluntary efforts by companies have shown only modest results. For example, a pilot program by DoorDash led to limited financial support for workers. Still, the proposal signals growing bipartisan interest in addressing benefit gaps for non-traditional workers, even if comprehensive reform remains a longer-term goal.

Employer health plans strain low-income families with high costs

By Alan Goforth - Workers with lower pay spend a higher share of their income on health premiums and out-of-pocket expenses than those with higher incomes. “While many employers pay a significant portion of health insurance premiums, some workers face relatively high contributions to enroll in coverage, particularly when enrolling dependents,” according to a new report from Peterson-KFF Health System Tracker. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Health insurance costs consume a larger share of income for lower-income families: Among families with employer-sponsored coverage, those earning at or below 199% of the federal poverty level spend an average of 9.6% of their income on health premiums and out-of-pocket medical expenses. In contrast, higher-income families (at or above 400% of the poverty level) spend only 3.4%, highlighting a significant disparity in the financial burden of health care based on income.

2. Health status of family members significantly impacts spending: Employer-insured families with at least one member in fair or poor health spend notably more on health care—5.9% of their income—compared to 3.7% for families in better health. This impact is more pronounced for middle-income families (200–399% of the poverty level), where the presence of a less healthy member can raise health care spending from 6.0% to 8.5% of income.

3. Rising employer-sponsored health costs disproportionately affect lower-income workers: As the overall cost of employer-based health coverage has increased, fewer lower- and moderate-income individuals are enrolling in these plans. The high cost of premiums and medical care creates financial barriers that can limit access to necessary health services and increase the risk of medical debt and economic instability for these families.

The Stelara Biosimilar Price War: How PBM-Affiliated Private Labels Are Reshaping the Market

By Drug Channels - The 2025 launch of biosimilars to Johnson & Johnson’s Stelara (ustekinumab) marks another turning point in pharmacy benefit dynamics. But unlike the chaotic rollout of Humira biosimilars, pharmacy benefit managers (PBMs) came prepared. Read Full Article…

HVBA Article Summary

1. PBMs Are Driving a New Era of Biosimilar Competition Through Private Labeling: Unlike the Humira biosimilar rollout, the 2025 Stelara biosimilar market reflects a more aggressive and structured approach by the major PBMs (CVS Caremark, Express Scripts, and Optum Rx). Each now uses affiliated private-label businesses to promote their own biosimilar versions, creating a layered pricing and formulary strategy that encourages competition but also complicates the market.

2. Wide Variability in Pricing and Formulary Placement Highlights Strategic Rebating: Despite biosimilars being interchangeable, list prices vary dramatically (5% to 90% below Stelara), and formulary inclusion is not always based on lowest price. PBMs often favor high-list-price options with bigger rebates or their own private-label versions, underscoring the continuing influence of gross-to-net strategies rather than purely cost-based decision-making.

3. PBM Market Strategies Could Undermine or Delay Government Price Regulation: The competitive environment shaped by PBMs may qualify as "meaningful competition" under the Inflation Reduction Act, potentially challenging or delaying the implementation of CMS-negotiated price reductions for Stelara. This illustrates the tension between policy-driven price controls and real-world market forces dominated by vertically integrated PBMs.

Healthcare, retirement and leave benefits top employer priorities for 2025, SHRM says

By Laurel Kalser - In 2025, HR professionals find themselves dealing with complex, contradictory challenges, and this is no less so when it comes to prioritizing employee benefits, which must both attract and retain talent and keep costs in check, recent studies show. Read Full Article…

HVBA Article Summary

1. GLP-1 Drug Coverage Is Growing but Costly: A growing number of employers (23%) now offer coverage for GLP-1 drugs used to treat type 2 diabetes and support weight management, reflecting strong employee demand. However, these medications come with a steep monthly cost of $700–$800, making them a significant driver of rising pharmacy expenses and overall healthcare spending.

2. Employers Are Strategizing to Manage Healthcare and Benefit Costs: As rising healthcare costs remain the top concern for 90% of employers, many are rethinking their benefit strategies. Nearly three-quarters (73%) are seeking better value by enhancing existing benefits or switching to more cost-effective vendors. Additionally, 44% plan to address high-cost medical conditions directly, and 37% aim to adopt preferred provider networks to improve cost control and care quality.

3. Retirement and Caregiver Benefits Show Mixed Progress: Retirement benefits remain a strong priority, with 93% of employers offering a 401(k) or similar plan and 85% providing a match—averaging 6.3%. However, innovative options like matching retirement contributions based on student loan repayment remain rare (just 4%). Meanwhile, support for paid caregiver leave has declined in 2025, potentially affecting retention, especially among employees balancing work with caring for family members.