Feds push back HIPAA security rule overhaul to July 2027

By Heather Landi – Federal regulators have delayed a major overhaul of the Health Insurance Portability and Accountability Act (HIPAA) Security Rule, pushing back final action on the rule by a year. Read Full Article...

HVBA Article Summary

1. Final Rule Delayed Until 2027: The Office of Management and Budget’s regulatory agenda now lists July 2027 as the target date for finalizing the updated HIPAA Security Rule. This postpones the expected release by roughly a year compared to the prior May 2026 timeline. The delay affects what would be the first significant update to the Security Rule in more than a decade. Healthcare organizations will have additional time before any new compliance requirements are finalized.

2. Proposed Rule Imposes Stricter Cybersecurity Standards: The draft update would require HIPAA-covered entities to implement specific technical safeguards such as encryption, multifactor authentication and network segmentation. It also calls for annual penetration testing, more detailed risk analyses and regularly tested incident response plans. Business associates would need to verify their own technical protections for electronic protected health information. The intent is to strengthen defenses against rising cyberattacks and ransomware incidents targeting healthcare organizations.

3. Industry Pushback and Parallel Privacy Changes: The 125-page proposal generated nearly 5,000 public comments and prompted criticism from hospitals, health systems and provider groups concerned about cost and implementation timelines. More than 100 provider organizations urged regulators to withdraw the proposal, citing financial and operational burdens. While the Security Rule update is delayed, HHS is moving ahead with changes to the HIPAA Privacy Rule. Those revisions are designed to improve patient access to information and facilitate care coordination while maintaining privacy protections.

Cigna's Evernorth division announces $100M specialty drug AI program

By Allison Bell – Cigna plans to use artificial intelligence systems to improve support for patients who take expensive drugs. The health insurer's Evernorth healthcare services business announced Wednesday that it will invest $100 million from now through 2028 in AI efforts. The new AI systems will serve patients who use specialty drugs. Accredo Specialty Pharmacy, an Evernorth division that provides specialty drugs for 1 million patients, is getting the new AI systems first. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. AI Deployment Focused on Specialty Pharmacy Operations: Evernorth is initially rolling out its new artificial intelligence capabilities within Accredo, its specialty pharmacy unit. The company plans to use AI to accelerate payment arrangements, prepare medications for shipment more efficiently, and position drugs closer to patients’ homes. Accredo is already using AI to schedule patient support calls, signaling that automation is being layered into multiple parts of the workflow. Over time, Evernorth intends to expand these tools to other pharmacy operations across its network.

2. Targeting Complex and Costly Drug Therapies: The initiative centers on specialty drugs, which are often high-cost, difficult to manufacture, and sometimes derived from living cells. These medications frequently require special storage, careful handling, and may be administered via injection or infusion rather than simple oral dosing. Patients who rely on them often manage chronic, serious, or life-threatening conditions. By improving logistics and coordination, the company aims to make the treatment process smoother for this vulnerable population.

3. Part of a Broader Industry AI Push: Cigna’s announcement follows a similar move by UnitedHealth, which said it would invest $3 billion in AI over two years. UnitedHealth has tied a portion of executive performance awards—20% for some leaders—to earnings from AI-driven products, underscoring the strategic importance of automation. CVS Health has also referenced AI initiatives in executive performance evaluations, though without disclosing comparable spending figures. Together, these developments suggest major insurers are increasingly embedding AI into operational and financial strategies.

Arch Insurance rolls out group benefits suite amid employer cost pressures

By Mark Rosanes – Arch Insurance North America has introduced a group voluntary benefits suite covering accident medical expense, hospital cash indemnity and annual travel insurance, targeting the out-of-pocket cost categories that employer-sponsored health plans most consistently leave uncovered. The launch is timed to a specific and well-documented market pressure: employer health benefit costs are rising at their fastest rate in 15 years, and the primary response is shifting more financial risk onto workers rather than absorbing it. Read Full Article...

HVBA Article Summary

1. Rising employer health costs are driving cost-shifting to workers: New survey data shows health benefit costs are projected to increase 6.5% per employee in 2026, the steepest climb in 15 years, and could have neared 9% without plan changes. Among more than 1,700 employers surveyed, 59% plan to implement cost-cutting adjustments in 2026, up from 48% the year prior. Much of this strategy centers on transferring more expenses to employees through higher deductibles and other plan design changes. As a result, workers are bearing a growing share of healthcare expenses.

2. High deductibles and productivity concerns create demand for voluntary benefits: Research from the Kaiser Family Foundation indicates that more than one-third of covered workers have single-coverage deductibles of $2,000 or more. The Employee Benefit Research Institute also found that employers without voluntary benefits reported higher group health premiums and lower workforce productivity. These findings suggest that supplemental coverage is increasingly viewed as a tool to help employees manage out-of-pocket costs. Voluntary offerings are positioned as a way to mitigate financial strain while potentially supporting employee performance.

3. Broker-focused design aims to simplify enrollment and placement: Arch’s new accident medical expense, hospital cash indemnity, and annual travel insurance products are structured without medical underwriting requirements. This approach reduces administrative complexity for HR teams and streamlines placement for brokers serving mid-market and small employer clients. Each product targets specific expense gaps, such as accident-related bills, hospitalization-related costs, and travel disruptions, rather than duplicating standard health coverage. The suite expands Arch’s broader employee benefits portfolio, which already includes disability, paid family leave, and Medical GAP insurance.

Prior Authorization is a Fight and AI Won't End It — Stop Pretending Otherwise

By Mika Newton – Every health tech conference this year will feature a panel titled something like “AI and the Future of Prior Authorization: Toward a Collaborative Care Ecosystem.” The speakers will use the words streamline, align, and partnership. A payer executive will sit next to a provider executive and agree, on stage, that we are entering a new era of cooperation. Read Full Article...

HVBA Article Summary

1. AI May Intensify Existing Power Imbalances: The author argues that AI will not resolve the adversarial nature of prior authorization but may instead amplify it. Payers are deploying AI more rapidly and at greater scale than providers, enabling them to generate denials far faster than appeals can be processed. This speed differential could industrialize denials, especially when backed by significant capital and legal resources. Ongoing litigation over algorithmic denial practices is cited as an early warning of how automated utilization management can outpace meaningful review.

2. Physician Concerns Reflect Systemic Harm: Referencing the American Medical Association’s latest physician survey, the article highlights widespread concern about AI’s impact on prior authorization. The survey found that 60% of doctors expect AI to increase denials, more than one in four report that prior authorization has led to a serious adverse event, and 95% report care delays. Additionally, one in three physicians say prior authorization criteria are rarely or never evidence-based. These findings suggest AI is being layered onto a system already associated with significant clinical and administrative strain.

3. The Core Issue Is Shared, Structured Evidence: The author contends that the real opportunity for AI lies in fixing the fragmented clinical record rather than accelerating denials or appeals. Currently, payers and providers operate with incomplete and separate data, leading to disputes based on partial information. A structured, comprehensive record accessible to both sides could allow decisions and appeals to be judged on transparent, auditable evidence. The proposed path forward emphasizes regulatory demands for AI-driven transparency and provider investment in stronger data infrastructure, rather than promises of superficial collaboration.

Copay Assistance Is Meant to Defray Drug Costs. Some Insurers Keep It Instead.

By Daniel Chang – For 16 years, Larry Gruber, a fitness coach from Wilton Manors, Florida, received a coupon card to help him pay for a psoriatic arthritis medication he needs that costs more than $7,700 a month. Each year, Amgen, which makes the drug, called etanercept (Enbrel), sent the coupon card worth thousands of dollars, and that counted toward Gruber's health insurance deductible and out-of-pocket maximum. Read Full Article...

HVBA Article Summary

1. Copay Accumulator Programs Shift Costs to Patients: Some commercial insurers use copay accumulator programs that prevent manufacturer assistance from counting toward a patient’s deductible or out-of-pocket maximum. In Gruber’s case, this meant he had to cover the full $10,600 out-of-pocket maximum instead of roughly $3,000 if the coupon had been applied. As a result, patients can face sudden and significant financial strain even when drugmakers provide substantial aid. Critics argue this practice effectively allows insurers to retain funds intended to reduce patients’ expenses.

2. State-by-State Patchwork and Limited Federal Action: Regulation of copay accumulators largely falls to states, and policies vary widely across the country. For 2026, nearly 40% of ACA marketplace plans include such programs, and in Florida 10 of 16 marketplace insurers use them. While 26 states, Washington, D.C., and Puerto Rico have enacted bans or restrictions, federal oversight remains unresolved after a 2023 court ruling vacated a prior policy. Pending federal rulemaking and proposed legislation like the HELP Copays Act have yet to establish a uniform national standard.

3. Debate Over Drug Pricing and Premiums: Insurers and their trade groups contend that copay coupons encourage use of higher-priced brand-name drugs and contribute to rising premiums. Pharmaceutical companies and patient advocates counter that the assistance improves access and that blocking it can disrupt care, particularly for patients without generic alternatives. Patients taking specialty drugs for chronic conditions such as autoimmune disorders, HIV, diabetes, and cancer are most affected. The dispute highlights broader tensions over how to balance drug affordability, insurance premiums, and access to medically necessary treatments.

UnitedHealthcare won 68% of payer-started No Surprises Act claim fights in new data

By Allison Bell – Some health insurers and health plan administrators are winning more of the No Surprises Act claim fights that they start than others. Turquoise Health — a company that's creating data dashboards for the U.S. health care finance system — is revealing the joys of NSA independent dispute resolution system victory and the agonies of defeat in a new table that reports IDR results by filing entity. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. UnitedHealthcare’s Success in Payer-Initiated Disputes: In the latest reported quarter, UnitedHealthcare initiated 31 No Surprises Act disputes that reached independent dispute resolution decisions. It prevailed in 67.7% of those cases, while providers won 32.3%. This suggests that when the insurer chooses to initiate a dispute, it often does so in cases where it believes it has a strong position. However, the total number of payer-initiated cases remains relatively small compared with provider filings.

2. Providers Dominate Overall Filing Volume and Win Rates: Providers and their representatives initiate far more IDR cases than payers. For example, HaloMD filed 341,866 resolved cases in the quarter, and providers won 88.4% of those disputes. To even appear in the Turquoise provider tab, a representative needed more than 21,000 resolved cases, highlighting the massive scale of provider participation. As a result, providers’ aggregate success rate across all disputes remains significantly higher than that of payers.

3. Overall Payer Win Rates Remain Low: Even though some payers post strong results in the disputes they initiate, their overall win rates tend to be under 20% because most cases are started by providers. The imbalance in who initiates disputes heavily influences aggregate performance statistics. The data also raises the possibility that the small number of payer-started cases could include coding errors rather than true payer-initiated disputes. This context is important for interpreting headline win percentages.

On its 60th birthday, SHRM’s nonprofit arm pushes for better caregiver support

By Ryan Golden – The SHRM Foundation, the nonprofit arm of the world’s largest HR association, wants practitioners to make a business case for initiatives that broaden access to job opportunities — especially for caregivers, President Wendi Safstrom said in a recent interview with HR Dive. Read Full Article...

HVBA Article Summary

1. Caregiving is widespread and requires cultural change: Safstrom emphasized that caregiving responsibilities affect a significant share of the workforce, citing federal data showing that more than 30% of U.S. adults spend time each day caring for someone. Because of this prevalence, organizations need more than formal benefits to respond effectively. She argued that leadership commitment and a workplace culture grounded in empathy are essential so employees feel safe identifying as caregivers. Without that top-down support, even well-designed policies may fall short.

2. Proactive support correlates with stronger business outcomes: A 2025 SHRM report based on a survey of 1,470 HR professionals found that employers taking a proactive approach to caregiver support reported better engagement, recruitment and retention results than those reacting case by case. Still, implementation gaps remain, including limited training for managers on how to support caregivers. The findings suggest that organizations can link caregiver initiatives to measurable talent outcomes. Framing these efforts as business-driven strategies may help secure broader executive buy-in.

3. Barriers and stigma still deter caregivers from using benefits: Survey data cited by SHRM show that many caregivers fear negative career consequences for accessing available support, including concerns about promotions or workload perceptions. Only a minority of organizations provide managers with dedicated resources to help navigate these situations, leaving employees uncertain about how they will be treated. Safstrom encouraged employers to create space for caregivers to explain employment gaps and translate lived experience into relevant skills. Such steps could improve recruiting outcomes and reduce stigma tied to caregiving responsibilities.

GLP-1 debate shifts as employers focus on managing demand, not coverage

By Gia Snape – The debate over GLP-1 medications has entered a new phase for US employer-sponsored health plans. The question is no longer whether to cover the blockbuster drugs, but how to manage rapidly growing demand without sacrificing their long-term health benefits. That shift is reshaping conversations across the employee benefits market, according to stop-loss carriers and benefits consultants interviewed by Insurance Business. Rather than viewing GLP-1s as a catastrophic claims threat, they increasingly see them as a pharmacy cost-management challenge. Read Full Article...

HVBA Article Summary

1. Short-term budget strain versus long-term clinical value: Employers are facing measurable cost pressures, with the 2026 Amwins Benefits State of the Market report estimating that some organizations are adding 2% or more to healthcare budgets to account for GLP-1 drugs. New formats, including oral versions, are expected to further expand access and utilization. However, some industry leaders argue that clinical evidence suggests these medications could improve outcomes in areas such as cardiac and kidney health. The debate centers on whether upfront pharmacy costs will be offset by reduced catastrophic or chronic medical claims over time.

2. Utilization growth is driving costs, not catastrophic claims: Stop-loss executives report that GLP-1s are not emerging as major individual large-loss claims but are instead increasing overall pharmacy spending due to higher participation rates. This shifts the issue from one of claim severity to one of frequency, as more employees begin using the medications. Research cited in the Amwins report suggests GLP-1 users may see slower overall medical cost growth compared to non-users, though long-term savings remain unproven. As a result, insurers currently view GLP-1s as a manageable trend compared to high-cost gene therapies that can reach millions per treatment.

3. Employers are adopting structured coverage with guardrails: Benefits consultants say companies are moving away from blanket coverage or exclusions and instead implementing eligibility controls tied to medical necessity. Pharmacy spending now accounts for nearly a quarter of total healthcare costs, and GLP-1s for weight management are contributing to premium increases of between 5% and 14%. Recommended safeguards include step therapy, BMI thresholds with comorbidities, participation in lifestyle programs and ongoing clinical reviews. Early internal data from Hub indicates that plans adopting utilization management strategies since 2023 have seen slower per-member-per-month GLP-1 spending growth than less structured plans.