HVBA Dallas Roadshow 2024

By HVBA - We are thrilled to share the highlights of our recent event, on June 27^th in Dallas, TX, which was an unforgettable experience for all attendees. Read Full Article…

HVBA Article Summary

1. Educational CE Sessions: The event featured comprehensive Continuing Education (CE) sessions led by industry experts, focusing on legislative updates related to employee benefits. Topics covered included the Consolidated Appropriations Act (CAA), Employee Retirement Income Security Act (ERISA), State Long Term Care (LTC) updates, “Junk Insurance,” and Medicare. These sessions aimed to equip participants with a thorough understanding of current changes and dynamics affecting their clients.

2. Networking and Scout Experience: Attendees enjoyed a special networking reception at Scout at The Statler in Dallas, fostering connections in a relaxed, engaging setting. The event provided ample opportunities for professionals to connect, share insights, and build long-term relationships, highlighted by speeches from industry leaders and a unique Scout experience.

3. Charity Auction and Community Commitment: The charity auction was a standout feature, drawing over 100 enthusiastic participants and raising over $36,000 for Trinity Oaks, a Purple Heart Wounded Warrior non-government ranch. This event underscored the community’s commitment to philanthropy, adding an element of fun and emphasizing the dedication and hard work of the entire HVBA team in creating a successful and meaningful event.

Stay tuned for “Philly in the Fall.”

US FTC to sue drug middlemen over insulin prices, source says

By Jody Godoy and Mariam E Sunny - The U.S. Federal Trade Commission is planning to sue UnitedHealth (UNH.N), Cigna (CI.N), and CVS Health (CVS.N), opens new tab over their tactics as middlemen in negotiating prices for drugs including insulin, a person familiar with the matter said on Wednesday. Read Full Article…

HVBA Article Summary

1. Investigation into PBMs and Drug Pricing: The three largest pharmacy benefit managers (PBMs)—UnitedHealth's Optum, CVS Health's CVS Caremark, and Cigna's Express Scripts—are under investigation for the rebates and volume-based discounts they negotiate with drug manufacturers. These practices are scrutinized for their impact on drug access and pricing. CVS has stated its intention to defend itself vigorously, while UnitedHealth declined to comment and Cigna was not immediately available for comment.

2. Impact on Insulin Pricing and Accessibility: The FTC's probe extends to insulin manufacturers, including Sanofi, Novo Nordisk, and Eli Lilly. While Sanofi claims compliance with the law and commitment to affordable access, Novo Nordisk declined to comment, and Eli Lilly did not respond. Despite President Biden's Inflation Reduction Act capping insulin prices at $35 per month for Medicare recipients, private insurance holders and uninsured Americans face significantly higher costs. A survey indicated that uninsured patients pay an average of $98 for Eli Lilly’s generic insulin, despite a pledge to reduce the list price to $25 per vial.

3. FTC's Interim Report on PBM Practices: The FTC's interim report highlighted that the three largest PBMs manage 79% of U.S. prescription drug claims and have gained significant influence over drug prices through extensive dealmaking. The report suggests that these companies have enriched themselves at the expense of smaller pharmacies and consumers. UnitedHealth's Optum, CVS Caremark, and Cigna's Express Scripts have all disputed the findings of the report.

As UnitedHealth and Cigna are Sued for AI-Based Claims Denials, Documents Suggest Major AI Expansion

By Matthew Cunningham-Cook - In November 2023, UnitedHealth was sued for improperly denying claims using an artificial intelligence algorithm, nH Predict, that critics say has a 90% error rate. The result, which impacts patients with Medicare Advantage, was that people who needed care didn’t get it — or they had to pay exorbitant fees. Read Full Article…

HVBA Article Summary

1. Expansion of AI Usage Despite Controversy: UnitedHealth's recent filings with the SEC reveal plans to significantly expand the use of AI and machine learning technologies in their operations, despite ongoing lawsuits and public criticism. This marks a new direction for the company, which previously did not emphasize AI in its annual reports.

2. Lobbying Efforts and Legislative Pushback: Both UnitedHealth and Cigna have initiated federal lobbying efforts on AI-related issues for the first time in early 2024. UnitedHealth has specifically lobbied against California's SB 1120, a bill that seeks to limit the use of AI in medical decision-making without supervision, highlighting the company's vested interest in maintaining its AI-driven policies.

3. Impact on Patients and Legal Repercussions: The use of AI algorithms by UnitedHealth has led to numerous care denials, significantly impacting patients who require long-term or skilled nursing care. Legal actions, such as the lawsuit led by the estates of Gerald Lokken and Dale Henry Tetzloff, underscore the detrimental effects of these AI-driven decisions, where patients and their families are forced to bear exorbitant out-of-pocket expenses due to denied coverage.

As Benefits Costs Increase, Employees Tighten Budgets

By Remy Samuels - With the cost of workplace benefits on the rise and inflation causing employees to tighten their budgets, many are looking to reduce or drop certain benefits to save money, according to new research from LIMRA. Read Full Article…

HVBA Article Summary

1. Decreasing Willingness to Spend on Benefits: LIMRA's 2024 BEAT Study reveals a decline in the amount employees are willing to spend on benefits, with the new median monthly expenditure at $120—excluding retirement savings—down $30 from previous years. Rising costs and inflation are major factors, leading employees to adjust their selections during digital open enrollment to stay within their comfort zones.

2. Lack of Benefit Understanding and Communication Gaps: The study highlights significant gaps in employee understanding of various benefits, such as long-term disability and critical illness coverage. While 72% of employees understand their dental benefits well, only 39% have a similar understanding of critical illness coverage. Improving education and communication, especially beyond open enrollment, is crucial, as nearly three-quarters of employees desire more frequent updates.

3. Interest in Bundling Benefits: A notable portion of employees, particularly younger and blue-collar workers, show interest in bundled benefit options, with three out of 10 favoring this approach to potentially save money. However, Landry notes that bundling can sometimes be more costly and may dilute specific benefits. Effective communication and partial employer-paid bundling could enhance the attractiveness and effectiveness of these packages.

US Senator Sanders optimistic Novo Nordisk can be pressured to cut Wegovy, Ozempic prices

By Ahmed Aboulenein - Senator Bernie Sanders on Wednesday expressed confidence that Novo Nordisk (NOVOb.CO), can be convinced to cut the U.S. prices of its popular Ozempic and Wegovy drugs used for weight loss by publicly shaming the company over how much it charges compared with prices in other countries. Read Full Article…

HVBA Article Summary

1. Senate Committee Hearing on Drug Prices: Novo Nordisk CEO Lars Jorgensen is scheduled to testify before the Senate Committee on Health, Education, Labor and Pensions (HELP) in September, addressing the high U.S. prices for Ozempic and Wegovy. The hearing, chaired by Senator Bernie Sanders, follows a successful strategy Sanders used last year to pressure pharmaceutical companies, including Novo, to lower insulin prices.

2. Pharmaceutical Industry Criticism: Senator Sanders emphasizes the need to focus on what he describes as the pharmaceutical industry's greed, particularly highlighting Novo Nordisk's pricing practices. Despite Novo's claim that the net prices of Ozempic and Wegovy have dropped by 40% since their launch, Sanders argues that these reductions are insufficient and do not benefit consumers due to the role of pharmacy benefit managers.

3. Impact on Consumers and Insurance: While over 80% of insured Americans pay $25 or less per month for Ozempic and Wegovy, Sanders points out that high drug prices still negatively impact consumers through increased insurance premiums and hospital costs. He calls for a significant reduction in the U.S. prices of these drugs, aiming for a price closer to the $155 cost in Canada, compared to the current U.S. list prices of $935.77 for Ozempic and $1,349.02 for Wegovy.

Health and Employer Groups Push for Improved Health Pricing Transparency

By Paul Mulholland - The ERISA Industry Committee and other benefits and health industry groups have endorsed two bills that aim to improve transparency and lower costs in the administration of health care plans. Read Full Article…

HVBA Article Summary

1. Lower Costs, More Transparency Act: Introduced by Representative Cathy Rodgers, this bill aims to improve hospital pricing transparency by requiring hospitals, clinical labs, imaging services, and ambulatory surgical centers that participate in Medicare to publish their prices, including discounted and negotiated charges. It also mandates pharmacy benefit managers to report rebates and fees for covered drugs to health plans and allows plan fiduciaries to audit claims and cost information without undue restrictions. Additionally, it prohibits the practice of spread pricing for pharmacies dealing with Medicaid.

2. Pharmacy Benefit Manager Reform Act: Introduced by Senator Bernie Sanders, this bill requires pharmacy benefit managers to report various pricing information to health plans, including prescription drug copayment assistance funded by drug manufacturers, a list of covered drugs billed under the plan during the reporting period, and the total net spending by the health plan on prescription drugs. It also mandates that PBMs report every six months on drugs purchased by the plan at pharmacies wholly or partially owned by the PBM.

3. Endorsements: Both bills have received endorsements from several influential organizations, including the Purchaser Business Group on Health, the American Benefits Council, the National Alliance of Healthcare Purchaser Coalitions, the Silicon Valley Employers Forum, the HR Policy Association, the Business Group on Health, and the Small Business Majority, reflecting broad support across various sectors for increased transparency and reform in healthcare pricing and pharmacy benefit management.

Employers can shift the dialogue around men's mental health

By Lee Hafner - Last month, health benefits business owner and public speaker Lester Morales posted a call to action on LinkedIn in the wake of two suicides of men who, on the surface, seemed to have it all. Along with some statistics, he talked about his own fears and insecurities and asked other men to do the same, initiating a far too rare — yet essential — discussion. Read Full Article…

HVBA Article Summary

1. Acknowledging the Crisis and Encouraging Conversations: The CDC reports a staggering statistic: nearly 80% of the almost 50,000 suicides in 2022 were men. Men often face significant barriers to discussing mental health issues due to societal stigma and a lack of awareness. Acknowledging the crisis and encouraging open conversations is crucial in addressing this silent epidemic. Building trusting relationships and redefining masculinity to include vulnerability and connection are essential steps in creating an environment where men feel comfortable seeking help.

2. The Economic Impact of Untreated Mental Health: Untreated mental health issues among men not only affect their well-being but also have a significant economic impact. The Meadows Mental Health Policy Institute estimates that employer costs for depression alone amount to $187.8 billion annually. Encouraging mental health care and wellness in the workplace, through supportive policies, employee resource groups, and role models who openly discuss their struggles, can help mitigate these costs and improve overall productivity.

3. Promoting Mental Health in the Workplace: Dr. Joel Axler emphasizes the importance of redefining masculinity and promoting mental health in the workplace. Public figures and workplace leaders can set powerful examples by sharing their own experiences with mental health struggles. Employers can support mental wellness by fostering a culture of work-life balance, offering flexible health benefits, and creating opportunities for social connections through organized groups. Leading by example, as Morales does with his gratitude journal and regular check-ins with employees, can create a culture where discussing mental health is normalized and encouraged.

AbbVie's Humira is still on top, but biosimilars are chipping away at its dominance

By Zachary Brennan - The share of AbbVie’s brand-name version of Humira has dropped to 82% of the total market, 13% less than in March, according to a Samsung report published Thursday. Read Full Article…

HVBA Article Summary

1. Market Dynamics and Shifts: The market for Humira and its biosimilars is experiencing significant shifts. CVS’ decision to favor Sandoz’s Hyrimoz has granted it a 13% market share, while other biosimilars struggle with only a 5% share despite their competitive pricing. Factors such as formularies and PBM practices are pivotal, with entities like Intermountain Healthcare's Scripius planning to exclude brand-name Humira, potentially paving the way for biosimilars to gain more traction.

2. Regulatory Changes and Implications: Recent regulatory developments, including the FDA’s shift on interchangeability for biosimilars, are poised to impact the market landscape. The FDA is moving towards eliminating the distinction between biosimilars and interchangeable biosimilars, which could streamline the approval process and increase market competition. This change follows the expiration of exclusivity dates for Boehringer Ingelheim’s Cyltezo, highlighting the evolving regulatory environment.

3. Challenges and Market Saturation: Despite the potential opportunities, the market for Humira biosimilars appears overly saturated, with many developers struggling to capture significant market share. Coherus BioSciences' sale of its Humira biosimilar for a mere $40 million, just three years post-FDA approval, underscores the challenges faced by companies in a crowded market. This situation highlights the complex interplay between pricing, market access, and regulatory factors in the biosimilar space.

Saving for retirement shouldn't be on employees alone: 3 ways employers can help

By Doug Sabella - Americans are facing a retirement savings crisis. Saving is a struggle for many amidst higher living costs, student loans and inflation. Pensions are few and far between. And more Americans are retiring than ever before, with 11,200+ Americans turning 65 every day from 2024 through 2027. Read Full Article…

HVBA Article Summary

1. Automate Retirement Plans: Introducing and automating 401(k) and other retirement plans can alleviate the administrative burdens and costs for employers. By leveraging technology, companies can streamline processes such as onboarding, managing contributions, and maintaining compliance, making retirement plans more accessible even for small and medium-sized businesses. This empowers employees to begin saving for their future without the extensive resources traditionally required.

2. Provide Financial Education: Offering retirement plans is just the beginning; employers must ensure that employees fully understand and can maximize these benefits. Providing financial education tools, resources, and access to financial advisors can help employees navigate retirement planning and broader financial wellness topics. Regular communication about plan changes and financial policies helps keep employees informed and engaged, ensuring they make the most of their benefits.

3. Expand Beyond Traditional Options: Beyond standard 401(k)s and IRAs, new options like the SECURE Act 2.0's "Starter 401(k)" provide cost-effective, low-administration retirement plans for employers. Additionally, expanding benefits to include health insurance, wellness perks, and commuter reimbursements can alleviate financial pressures on employees, enabling them to focus on retirement savings. By offering a comprehensive benefits package, employers can support their employees' financial stability and future planning more effectively.