The Markup You Were Never Shown: The Case for Mandatory Disclosure of PBM Spread—If Not an Outright Ban

By Ginny Crisp – In my first piece, I laid out the five revenue streams that run through every PBM contract. In this one, we’re going to discuss the first stream and the reform that is needed to spread pricing. As a reminder, spread pricing is the gap between what the plan sponsor (usually an employer) pays the PBM for a prescription and what the PBM pays the pharmacy that fills it. You may wonder, how is this different from a business that charges retail to a customer and pays the wholesale price to its supplier. This is considered an honest business practice as long as the customer knows the markup is there. Here is the difference, the plan sponsor never sees the markup and the contract is written intentionally to keep it that way. Read Full Article...

HVBA Article Summary

1. Spread Pricing Operates Behind Contractual Barriers: The article explains that pharmacy benefit managers (PBMs) control both the reimbursement paid to pharmacies and the amount billed to plan sponsors, allowing them to capture the difference as profit. Because pharmacy-to-PBM contracts and PBM-to-plan contracts are treated as proprietary, employers cannot see both sides of the transaction. This structural opacity makes it difficult for plan sponsors to verify whether pricing is reasonable. As a result, transparency is limited by design rather than by accident.

2. Federal Scrutiny Has Documented Significant Revenues: A January 2025 FTC staff report found that the three largest PBMs generated an estimated $1.4 billion in spread pricing revenue on specialty generic drugs over a six-year period. The article presents this as evidence that spread pricing is not an isolated occurrence but a widespread industry practice. While federal regulators have acknowledged the issue, the author argues that documentation alone does not curb the underlying incentive structure. The scale of the reported revenue underscores the financial stakes involved.

3. Recent Reforms Emphasize Disclosure Over Prohibition: Two federal actions in 2026—the Department of Labor’s proposed rule and the Consolidated Appropriations Act—require disclosure of compensation elements such as rebates and spread pricing. However, neither measure bans the practice outright, and key provisions will not take effect immediately. The author contends that relying on self-reported disclosures may allow compensation to be shifted in ways that evade scrutiny. She argues that either banning spread pricing or requiring full visibility into both pharmacy payments and plan sponsor charges would be necessary for meaningful transparency.

CVS settles with FTC, agrees to count TrumpRx drug purchases towards insurance

By Jody Godoy – CVS Health's (CVS.N), Caremark has finalized a ‌settlement with the U.S. Federal Trade Commission in which it agreed to curb use of after-market discounts known as rebates and count consumers' TrumpRx purchases toward their deductibles, an FTC spokesperson said on Tuesday. Read Full Article...

HVBA Article Summary

1. Settlement Targets Rebate Practices: The agreement requires Caremark to scale back its use of drugmaker rebates, a pricing practice regulators argue can inflate list prices and steer patients toward more expensive medications. The FTC has previously sued major pharmacy benefit managers over insulin pricing, alleging rebate arrangements distorted competition. This settlement follows similar action against other large PBMs and reflects broader scrutiny of the rebate-driven model. Regulators say reforming these incentives could lower overall drug costs.

2. TrumpRx Purchases to Count Toward Deductibles: Under the deal, payments made through the TrumpRx discount website will be applied to certain insurance plan deductibles once supporting regulations are in place. Previously, TrumpRx operated outside traditional insurance, limiting how much insured patients could benefit from discounted purchases. By integrating these payments into plan structures, the change could expand the program’s usefulness for consumers. The FTC expects the shift to contribute to significant savings on prescription drugs.

3. Additional Pricing and Transparency Changes: CVS said it will give clients the option to opt out of rebate-based payment models and instead move toward fee-based compensation. The company also committed to enhanced reporting on drug pricing and member payments to increase transparency. Small pharmacies will be offered reimbursement based on their actual drug acquisition costs plus a dispensing fee. CVS further announced it would cap insulin out-of-pocket costs at $25 per month as part of the settlement’s broader affordability measures.

HSA Council fights for vision plan bill inclusion

By Allison Bell – The Health Savings Account Council — a group for banks that offer health savings account programs — wants members of the National Council of Insurance Legislators to think about consumers with HSAs when drafting a new vision plan bill. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. HSA Council Seeks Broader Applicability in Model Bill: The HSA Council is urging NCOIL to ensure its draft vision plan model applies to individuals who have not yet met their high-deductible health plan deductibles. These consumers often pay for eye care services using HSA funds or personal cash. The council argues that excluding services paid entirely out-of-pocket could weaken the effectiveness of HSAs. It has formally communicated these concerns in a letter to lawmakers reviewing the proposal.

2. Model Bill Part of Broader Policy Debate: NCOIL’s Health Insurance & Long Term Care Issues Committee is set to discuss the proposed “Ensuring Access to Eye Care Services and Materials for Patients Through Transparent and Fair Business Practices” model at a national meeting in Boston. While NCOIL model bills do not directly change state law, they often serve as templates for state legislation. The vision plan proposal has been under development for months and was introduced by Kentucky state Rep. Deanna Gordon. The debate reflects broader disagreements about how vision benefits should be regulated.

3. Stakeholders Clash Over Scope and Market Impact: Multiple industry groups have submitted comments on the draft, including the Blue Cross Blue Shield Association and the National Association of Vision Care Plans. Some commenters want the bill narrowly tailored to avoid affecting major medical plans or self-funded employer plans governed by ERISA. Vision plan representatives have defended provider networks as necessary for quality and affordability, while an optometrist executive warned the current draft could give large plans excessive pricing power over independent providers. These differing perspectives highlight tensions between insurers, providers and consumer-focused groups.

Top 10 340B drugs in 2025

By Ella Jeffries – Ten medications accounted for about 28.6% of the $100 billion in 340B outpatient drug purchases in 2025, according to new data from HRSA released July 13. The figure comes as 340B purchases hit a record $100 billion for the year, continuing a stretch of double-digit annual growth for the program. Read Full Article...

HVBA Article Summary

1. Spending Concentrated in a Small Number of Drugs: A relatively small group of medications accounted for a significant share of total 340B outpatient drug purchases in 2025. This concentration highlights how spending within the program is heavily influenced by high-cost specialty therapies. Such reliance on a limited number of products may amplify the financial impact of price changes or policy shifts affecting those drugs. It also underscores the role of blockbuster therapies in shaping overall program expenditures.

2. Oncology Dominates High-Expenditure Rankings: Cancer treatments represented four of the top 10 drugs by 340B spending, reinforcing oncology’s outsized role in pharmaceutical costs. The prominence of these therapies aligns with broader national drug spending trends, where oncology remains a primary growth driver. High utilization and premium pricing of innovative cancer drugs continue to push spending upward. This pattern suggests oncology will remain central to 340B financial dynamics in the near term.

3. Diverse Therapeutic Areas Represented: In addition to oncology, the top-spending drugs span HIV, multiple sclerosis, diabetes and weight management, cystic fibrosis and cardiology. This range indicates that 340B spending growth is not confined to a single disease category. Instead, multiple chronic and specialty conditions contribute meaningfully to total expenditures. The mix reflects the expanding role of specialty and brand-name therapies across varied patient populations.

Health tech funding rises to $7.4B in the first half of 2026

By Ngai Yeung – Digital health startups raised $7.4 billion in venture funding during the first half of 2026, up $1 billion from the first half of 2025, according to research and venture firm Rock Health. Megarounds of $100 million or more fueled the rise in funding. They represented 45% of the first six months’ funding in dollar amount, even as deal activity stayed flat. The sector logged 244 deals in the first six months of the year, consistent with last year’s count of 245. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Mental Health and Weight Management Continue to Lead Digital Health Investment: Mental health remained the most-funded digital health category for the seventh consecutive year, supported by major funding rounds for companies such as Talkiatry and Grow Therapy. Weight management ranked second, driven largely by telehealth companies offering GLP-1-related services and attracting significant investment. Investors are also expanding interest into AI-enabled mental health tools, including chatbots, while telehealth platforms increasingly incorporate behavioral health into their service offerings.

2. Direct-to-Consumer Healthcare Models Gain Momentum: Nearly two-thirds of startups in the two most-funded categories primarily sell directly to consumers rather than through employers, hospitals, or health insurers. Growing consumer comfort with virtual care, transparent pricing, convenience, and personalized healthcare experiences has contributed to this shift, particularly among younger patients. Rising insurance costs and broader interest in wellness-focused healthcare have also supported continued growth in direct-to-consumer digital health models, though analysts note these trends could evolve as market and policy conditions change.

3. Investment and M&A Activity Reflect a Maturing Digital Health Market: More than half of the 20 digital health megarounds completed in 2026 were first-time large fundraising rounds, reflecting both the capital needs of maturing startups and strong investor demand for AI-focused companies. At the same time, the sector recorded 71 acquisitions in the second quarter, the highest quarterly total since 2021. Consolidation has been driven by startups accepting acquisitions below prior valuations and by larger companies seeking to build more comprehensive, integrated healthcare technology platforms.

Principal to acquire Beam Benefits in small business benefits deal

By Mark Rosanes – Principal Financial Group has agreed to acquire Beam Benefits, an employee benefits company serving more than 25,000 small businesses. The Des Moines, Iowa-based insurer, listed on Nasdaq as PFG, announced the agreement on July 7, 2026, without disclosing financial terms. Read Full Article...

HVBA Article Summary

1. Strategic expansion into small business benefits: The acquisition strengthens Principal’s position in the small and midsize employer segment, where Beam has established a digital-first distribution model. Beam serves more than 25,000 small businesses and generated approximately $175 million in premiums in 2025. Principal, which already works with 180,000 employers across various business lines, aims to deepen its reach in this market. The deal reflects a broader effort to capture growth among smaller employers seeking more tailored benefits solutions.

2. Digital platform and cost efficiency focus: Beam operates a cloud-native platform built with AI to process and price coverage, allowing it to scale without proportional increases in operational overhead. This technology-driven approach is designed to make serving small accounts more cost-effective compared to traditional brokerage models. Rising employer health costs — with average family premiums at $26,993 in 2025 and projected per-employee costs exceeding $18,500 in 2026 — have increased demand for more efficient benefit solutions. Principal expects Beam’s digital capabilities to complement its existing infrastructure and enhance service delivery.

3. Growth targets and market context: The transaction is expected to close in the second half of 2026, pending regulatory approvals and customary conditions. Principal said its 2026 capital deployment and earnings per share growth targets will remain unchanged, while the acquisition is projected to push Specialty Benefits premium and fee growth to at or above the high end of its 5% to 9% target range in 2027. Industry data show a gradual rise in self-insurance among small and midsize firms, underscoring shifting dynamics in the employer benefits market. Against this backdrop, insurers have increasingly pursued digital platforms to expand distribution and manage costs more effectively.

Brokers need to pay attention to patients' trust in health AI

By Deborah Ault – Patients are not waiting for health care to modernize. They are already using artificial intelligence to ask questions about symptoms, medications, diagnoses, treatment options, bills, benefits, and where they should seek care. The debate about whether consumers will adopt AI in health care is effectively over. The more important question for brokers and benefits advisors is who patients trust when the answer actually matters. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Trust Is Tied to Accountability, Not Just Technology: A cited Fierce Healthcare report found that patients are three times more likely to trust AI tools connected to their own physician or health system than public chatbots. This suggests consumers are not rejecting artificial intelligence outright but are evaluating who stands behind the information. The article argues that perceived accountability and clinical oversight drive trust more than novelty or convenience. For brokers, this means vendor credibility and integration with care delivery matter more than AI branding alone.

2. Clinical Oversight Should Outrank Benefit Optimization: The author emphasizes that health decisions often occur during stressful or potentially dangerous situations, when patients may ask insurance-related questions that mask urgent medical needs. AI systems must be designed to recognize red flags, escalate appropriately, and prioritize patient safety over network or cost considerations. Advisors are encouraged to ask vendors how their platforms handle conflicts between clinical urgency and benefit design. Ensuring that clinical appropriateness comes first is presented as a core safeguard for employers and employees.

3. Brokers Must Rigorously Evaluate AI Vendors: The piece urges benefits advisors to move beyond surface-level claims of AI capability and scrutinize who builds, reviews, and oversees the clinical algorithms. Key considerations include when cases escalate to licensed clinicians, what credentials those clinicians hold, and whether liability coverage exists if guidance is wrong. Advisors should also clarify whether platforms distinguish between education, navigation, and medical advice. This due diligence is framed as part of the broker’s responsibility to protect patient safety while adopting innovation.

Workplace Wellbeing Isn’t Bought. A New Global Study Says It’s Designed

By Vibhas Ratanjee – Most leaders believe they already know what makes work good. They have a wellbeing budget, a perks list and a recognition platform to prove it. What they rarely have is a way to tell a workforce that enjoys the work from one that simply has nowhere else to go. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Three Dimensions Shape Workplace Wellbeing: A five-year Gallup study conducted with the Wellbeing for Planet Earth Foundation and Persol surveyed more than 350,000 employed adults across 149 countries. Researchers identified three core drivers of wellbeing at work: enjoyment, purpose and choice. Each dimension operates on a different time horizon, from daily experience to long-term career trajectory. Together, they provide a more comprehensive measure of worker wellbeing than traditional metrics like retention or job satisfaction.

2. Choice Can Matter More Than Enjoyment for Full-Time Workers: While enjoyment is the strongest global predictor of life evaluations overall, the pattern shifts among full-time employees. In that group, having many choices in one’s work is associated with a 0.36-point increase in life ratings, compared with a 0.28-point increase tied to enjoyment. The study emphasizes that choice refers to agency within a role—such as autonomy and internal mobility—rather than simply the ability to quit. This finding challenges leaders to design career pathways and growth opportunities instead of focusing solely on workplace perks.

3. Burnout And Wellbeing Are Structural, Not Personal Issues: Separate Gallup research of nearly 7,500 full-time employees found burnout most strongly linked to workplace conditions such as unfair treatment, excessive workload, unclear communication, lack of manager support and unreasonable time pressure. None of these factors are individual shortcomings; they stem from organizational design and leadership decisions. The article argues that treating burnout as a personal problem misses the systemic roots of the issue. Sustainable wellbeing, therefore, requires redesigning roles and systems rather than adding short-term benefits or programs.