FTC settles lawsuit with Optum Rx, ending its campaign against the ‘big three’ PBMs

By Chad Van Alstin – The Federal Trade Commission's (FTC) lawsuit against the “big three” pharmacy benefit manager (PBM) companies may nearly be over, as the agency has settled the case by getting concessions from each defendant. Read Full Article...

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1. FTC Concludes Antitrust Campaign Against Major PBMs: The settlement with UnitedHealth Group’s Optum Rx effectively brings the FTC’s legal challenge against the three largest pharmacy benefit managers to a close. The agency had alleged the companies inflated insulin prices through rebate practices that did not benefit health plans or pharmacies. Similar agreements were previously reached with Cigna’s Express Scripts and CVS’ Caremark. With all three cases resolved through settlements, the FTC’s broader adjudication process has been withdrawn.

2. Allegations Centered on Insulin Pricing and Rebates: Regulators accused the PBMs of using manufacturer rebates in ways that encouraged higher list prices for insulin. According to the FTC, these rebates were not consistently passed on to group health plans and pharmacies, potentially raising out-of-pocket costs for patients. Express Scripts and CVS agreed to change purchasing practices and pass through certain rebates to reduce insulin prices over time. The Optum Rx settlement is expected to address similar concerns, though final terms are still pending approval.

3. Optum Rx Signals Shift Toward Greater Transparency: Ahead of the finalized agreement, Optum Rx announced plans to increase transparency around drug pricing across the supply chain. The company said it would move away from traditional rebate-based pricing models toward a supply-and-demand fee structure. It also pledged to pass through 100% of manufacturer drug rebate discounts to clients by Jan. 1, 2028. These commitments may reflect the types of operational changes regulators are seeking to ensure lower drug costs for patients.

The ACA Death Spiral Is No Longer Just a Theory

By Wendell Potter – I’ve long warned that letting the enhanced ACA subsidies expire could set off a classic insurance death spiral: healthier people priced out first, a sicker risk pool left behind, higher premiums as a result, more healthy people priced out — rinse and repeat. Reports this week from KFF News and other media outlets about 2027 rate filings is the first time I’ve seen that mechanism actually measured rather than predicted. Read Full Article...

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1. Insurers Attribute Premium Hikes to Policy Changes: Preliminary 2027 rate filings in 16 states and Washington, D.C., show insurers seeking a median 14% premium increase, according to a Peterson-KFF analysis. Companies report that roughly four percentage points of the increase stem directly from the expiration of enhanced ACA subsidies, which they say is driving healthier enrollees out of the market. Additional increases, including a 12.7% impact cited by UnitedHealthcare in New York, are linked to new federal enrollment rules. Insurers are explicitly tying a measurable share of rising premiums to federal policy decisions rather than solely to underlying medical costs.

2. Enrollment Declines Concentrated Among Unsubsidized Consumers: Marketplace enrollment has fallen by about 3 million from last year, though the author notes this does not yet amount to a full market collapse. The effects are concentrated among roughly 5% of enrollees earning above 400% of the federal poverty line who lost subsidy protection when enhanced tax credits expired. Many subsidized, lower-income participants remain insulated because their financial assistance rises with premiums. However, continued premium growth could push more middle-income individuals out of coverage and expand the affordability crisis.

3. State and Federal Responses Could Alter the Trajectory: While the House passed a three-year subsidy extension in a 230–196 vote with bipartisan support, the measure stalled in the Senate and has not advanced. In the absence of congressional action, some states are turning to reinsurance programs to offset high-cost claims and reduce premiums, though enrollment has declined in all but one state. Ohio, for example, has seen a 32.4% drop in marketplace enrollment since February 2025, representing about 160,000 people. New Mexico stands out as the only state to fully replace expired federal subsidies with state funds, illustrating an alternative stabilization approach.

Lilly was already pharma's biggest company. Now it's doing deals to match

By Kyle LaHucik – Riding on its trillion-dollar heft and successes in treating obesity, Eli Lilly has now become a force in one area where it hasn’t historically been the main player: M&A. The Indianapolis-based drug giant disclosed 11 biotech acquisitions in the first half of 2026 — as many as it announced in the prior three years combined. That’s about a quarter of the industry’s 45 biotech acquisitions from January through June, as tracked by Endpoints News. Read Full Article... ^{_{(Subscription required)}}

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1. Lilly Accelerates Acquisition Strategy to Expand Its Pipeline: Lilly has significantly increased its business development activity in 2026, completing more than 20 partnerships and acquisitions during the first half of the year while leveraging an estimated $71 billion in dealmaking capacity. Rather than focusing primarily on replacing revenue lost to patent expirations, the company is targeting a broad range of therapeutic areas and technology platforms, including vaccines, in vivo cell therapies, sleep disorders, antibody-drug conjugates (ADCs), and pain treatments. The company has also increased its willingness to acquire clinical-stage assets, reflecting a shift from its previous emphasis on earlier-stage research.

2. Industry M&A Activity Continues to Gain Momentum: Global biopharma mergers and acquisitions are on pace to reach an annualized $303 billion in 2026, approaching the record-setting levels seen in 2019. Industry observers note that Lilly's pace of acquisitions and ability to complete transactions quickly is influencing competitors to evaluate opportunities and make investment decisions more rapidly. While many pharmaceutical companies are pursuing acquisitions to address future patent cliffs, Lilly's diversified approach emphasizes long-term pipeline development across multiple therapeutic categories.

3. Strong Financial Position Supports Continued External Innovation: Lilly's continued revenue growth and extended patent protection for tirzepatide provide financial flexibility to pursue acquisitions without immediate pressure to replace declining products. Company executives stated that external innovation is viewed as equally important as internally developed programs, making acquisitions a core component of Lilly's research and development strategy. Analysts also note that Lilly's financial resources, willingness to invest in earlier-stage programs, and reputation for advancing acquired technologies have made it an attractive partner for biotechnology companies seeking commercialization opportunities.

Federal judge blocks Colorado's historic drug price cap

By Alan Goforth – A federal judge has temporarily banned Colorado from capping the price of Amgen's arthritis drug Enbrel while a lawsuit challenging the state drug affordability board's action plays out. Read Full Article... ^{_{(Subscription required)}}

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1. Court Finds Likely Federal Preemption by Patent Law: Chief Judge Daniel Domenico ruled that Amgen is substantially likely to succeed on its claim that Colorado’s price cap is preempted by federal patent law. He determined that enforcing the cap could cause the company irreparable harm, particularly in its pricing negotiations with wholesalers and distributors. The decision emphasizes that patent-related pricing authority rests with federal law, limiting states’ ability to regulate patented drug prices directly.

2. Significant Financial Stakes for Amgen: Enbrel generated $2.23 billion in sales in 2025, making it one of Amgen’s top-performing drugs. The Colorado board had set an annual upper payment limit of about $31,000 for the medication. The court accepted Amgen’s argument that being forced to lower prices under the cap could disrupt existing and future contracts, creating financial uncertainty that cannot easily be reversed.

3. Broader Implications for State Drug Pricing Efforts: Colorado created the nation’s first Prescription Drug Affordability Review Board in 2021 to address high drug costs. The ruling referenced prior case law indicating that balancing drug affordability with innovation incentives is a policy decision reserved for Congress rather than individual states. While the judge acknowledged the state’s legitimate interest in helping residents afford medications, he suggested alternative approaches such as subsidies or negotiated discounts instead of imposing caps on patented drugs.

A new wording test on ‘Medicare for All’

By Jakob Emerson – Support for expanding Medicare into a government-run health plan for everyone swings by nearly 20 percentage points depending on how the idea is described to voters, according to new polling that arrives as the ACA marketplace is deteriorating and employer healthcare costs continue a seemingly neverending upward climb. Read Full Article...

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1. Public Support Depends Heavily on Framing: The poll tested three different descriptions of a Medicare-like plan among 1,493 likely voters and found wide variation in support. An opt-in version funded partly by enrollee premiums drew 28 points of net support, while an automatically enrolling version without a specified funding source reached 33 points. By contrast, a single government plan replacing private insurance and funded through higher federal taxes received just 11 points of net support. The results suggest that details about funding and whether private coverage would be eliminated significantly shape voter attitudes.

2. Voters Draw Clear Boundaries Around Coverage: Respondents showed strong support for government coverage of serious and high-cost services, with net support of 47 points for cancer and major illness treatment, 45 for emergency care, 43 for surgery, and 42 for prescription drugs and primary care. However, cosmetic procedures registered negative 31 points, and views on weight loss drugs such as Ozempic were split. When asked if they would give up their current insurance to join a Medicare-like plan, 70% said they would keep their existing coverage. Only 29% said they trust the federal government to administer such a program effectively.

3. Mounting Market Pressures Form the Backdrop: The polling comes as ACA marketplace enrollment has fallen 12% since February to about 19.2 million people, with nine insurers announcing marketplace exits after the 2026 plan year. Employer-sponsored coverage is also facing rising costs, with PwC projecting a 9% medical cost trend for 2027 following a 7.9% increase in 2026. Meanwhile, broader political momentum for sweeping reform remains limited in a Republican-controlled Congress, even as other surveys show two-thirds of voters favor new public insurance options or major system changes. This tension highlights a gap between dissatisfaction with the healthcare system and consensus around a specific replacement model.

UnitedHealthcare unveils Lifestyle Spending Accounts for employer plans

By Paige Minemyer – UnitedHealthcare is rolling out a new benefit option aimed at making it easier for employers to offer more personalized wellness programs. Called Lifestyle Spending Accounts (LSAs), the benefit allows employers to offer a stipend that members can put toward wellness solutions. The LSAs are integrated with UnitedHealth's UHC Store, which is a digital storefront where members can purchase select health and wellness programs at a discount. Read Full Article...

HVBA Article Summary

1. UnitedHealthcare Launches Lifestyle Spending Accounts: UnitedHealthcare has introduced Lifestyle Spending Accounts (LSAs) that complement health savings accounts (HSAs) and flexible spending accounts (FSAs), allowing members to purchase health and wellness products and services that are generally not eligible under traditional tax-advantaged accounts. The accounts are integrated into the UnitedHealthcare member app and online store, enabling members to access eligible services and pay directly without waiting for reimbursement. The initiative is designed to expand benefit flexibility while creating a more seamless consumer experience.

2. Personalized Benefits with Simplified Employer Administration: The LSA program allows employers to offer employees a broader range of personalized wellness options without managing multiple vendor contracts or providing every benefit to the entire workforce. UnitedHealthcare noted that employees have diverse health and wellness needs, making individualized spending options more effective than traditional one-size-fits-all benefit programs. The approach may also help smaller employers address benefit gaps while reducing administrative complexity and controlling benefit costs.

3. Consumer Choice Drives Broader Benefits Strategy: UnitedHealthcare said the LSA rollout reflects growing employee demand for greater choice and control over health and wellness benefits. The company expects the program to evolve as employers and members adopt the offering, with integration into the existing member app intended to improve awareness, engagement, and utilization. The launch also supports UnitedHealthcare's broader consumer-focused benefits strategy, which includes offerings such as the Surest health plan that emphasizes transparent, upfront healthcare costs and greater consumer decision-making.

Middle managers burning out due to AI, other mounting pressures

By Jimmy Nesbitt – A larger share of workers are experiencing low well-being than in the previous two years, according to a new survey from WebMD Health Services, which found those reporting the condition jumped nearly 40% over the past two years, and many saying they still aren't getting the support they need from their employers. Read Full Article... ^{_{(Subscription required)}}

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1. AI Adoption Is Linked to Higher Burnout: The survey found that 80% of workers are using AI tools, and employees who strongly believe AI makes them more productive are four and a half times more likely to experience burnout. Experts attribute this to the rapid pace of AI adoption and insufficient training. AI can amplify workloads by increasing information flow and decision-making demands. The result is heightened cognitive strain, even when productivity improves.

2. Middle Managers Face Disproportionate Strain: Middle managers report burnout rates more than three times higher than individual contributors. They are expected to manage both upward and downward, acting as connectors between leadership and frontline staff. As organizations adapt to hybrid work and new technologies, their responsibilities have expanded to include coaching, change management and operational oversight. However, companies often underinvest in targeted support for this group.

3. Trust and Support Are Critical to Engagement: Only one in 10 individual contributors describe themselves as highly engaged, compared with nearly one in three senior leaders. More than one-third of employees say their organization does not provide adequate support to navigate ongoing workplace changes. The research suggests that clear communication, visible leadership support and investments in mental health and financial well-being can strengthen trust. Employers are increasingly expanding access to mental health services and financial resilience programs to address these gaps.