Employers face 35% surge in $1M medical stop-loss claims

By Allison Bell - U.S. employers with self-insured health plans watched a lot more huge claims show up in 2024. Self-insured plans were about 4.3 times as likely to receive $1 million claims in 2024 than in 2013, according to Tokio Marine HCC's latest annual stop-loss market report. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Significant Rise in High-Cost Claims: Tokio Marine HCC has seen a dramatic increase in the frequency of large stop-loss insurance claims, with $1 million+ claims rising from about 20 to over 80 per 1 million employees annually—equating to one such claim per roughly 12,500 employees. Similarly, $2 million claims have become far more common, with self-insured employers in 2024 about 13.5 times more likely to receive a claim at that level than in 2013. This trend indicates a growing burden of catastrophic healthcare costs for employers.

2. Slight Decrease in Average Claim Size: While the number of jumbo claims is increasing, the average severity of those claims has slightly declined. In 2024, for claims that exceeded the stop-loss deductible by at least $1 million, the average claim amount dropped by 3.8% to $1.76 million. This suggests some moderation in individual claim costs, even as overall claim frequency rises.

3. Ongoing Market Pressures and Uncertainty: Multiple forces are contributing to the rise in large medical claims and the overall cost of health care. These include inflation in general medical costs, provider resistance to cost-control measures, and the ACA’s prohibition on annual or lifetime coverage limits for essential health benefits. Cancer has become a leading cost driver, accounting for over 35% of stop-loss claims in 2024, while COVID-related respiratory costs have faded. As a result, stop-loss insurers anticipate continued tightening of the market, which may force employers—especially those with self-insured plans—to confront more difficult financial decisions.

Nearly 1 in 3 employers plan to expand voluntary benefits by 2027

By Carolyn Crist - Employers appear to be increasingly focused on comprehensive well-being programs to meet workforce needs, and nearly 1 in 3 U.S. organizations report plans to expand their voluntary benefit offerings by 2027, according to a July 9 report from Gallagher. Read Full Article…

HVBA Article Summary

1. Rising Focus on Quality-of-Life Benefits: Employers are placing greater emphasis on non-traditional benefits that enhance employees’ lifestyles and overall satisfaction. Offerings like pet insurance (now provided by 33% of employers, up from 23% in 2023), accident insurance, and perks discount programs (now offered by about 50% of employers, up from 44% in 2023) are becoming more common. These benefits aim to reduce personal stressors and improve the employee experience beyond just compensation and healthcare.

2. Voluntary Offerings as a Strategic Tool: A significant 67% of surveyed organizations recognize voluntary benefits as vital to a well-rounded financial well-being strategy. Offerings such as identity theft protection and legal plans not only help employees manage financial and legal risks but can also lead to lower stress levels and higher workplace productivity. These programs represent a shift toward more holistic employee care, addressing physical, emotional, and financial needs.

3. Creative and Personalized Benefits to Attract Talent: To compete for top talent, companies are adopting innovative and personalized benefit strategies. Emerging perks include lifestyle spending accounts, points-based reward systems, sabbatical expense support, and unique incentives like meal vouchers, free bikes, or taxi rides on holidays. Long-term care benefits — including home healthcare and adult day care — are now offered by 28% of employers, helping employees plan for future needs and reducing long-term stress.

Judge rejects AbbVie’s fight against Missouri 340B contract pharmacy law

By Nicole DeFeudis - AbbVie failed to convince a judge to strike down a Missouri law regulating 340B discounts, marking the second setback in two weeks in the drugmaker’s fight against alleged abuses in the federal program. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Lack of Legal Standing: Judge Stephen Clark of the U.S. District Court for the Eastern District of Missouri dismissed AbbVie's lawsuit against Missouri’s SB 751, finding that the pharmaceutical company lacked legal standing. The judge ruled that AbbVie's alleged harm arose from potential violations of federal law — specifically the 340B program — rather than any direct impact of the state law in question.

2. Nature of Dispute: At the heart of the case is AbbVie's objection to how contract pharmacies operate under the federal 340B drug discount program. AbbVie claimed some pharmacies purchase discounted drugs and resell them at full price for profit. However, the court concluded that these alleged abuses were tied to the federal program itself and not to any provision in Missouri's SB 751, making the injury not directly attributable to the state law.

3. Legal Outcome and Next Steps: The court dismissed the case without prejudice, meaning AbbVie is allowed to revise and refile its complaint. The judge set a deadline of July 25 for AbbVie to seek permission to amend its case. This ruling follows a similar outcome in Tennessee earlier this month, where another federal judge denied AbbVie’s attempt to block a comparable state law, also citing a lack of standing.

Why specialist pain clinics and addiction treatment services require strong primary care

By Olumuyiwa Bamgbade, MD - Specialist pain clinics and addiction management services are vital in addressing some of the most complex and costly health care conditions. However, their success depends on stable and robust primary care systems. Without strong primary care as a foundation, these health care initiatives risk fragmentation, poor continuity, and low patient accountability. Stable primary care ensures timely access, coordinated care, longitudinal monitoring, and patient engagement, all essential elements for the value-based care of chronic pain and addiction. Read Full Article…

HVBA Article Summary

1. Primary care is essential for continuity and coordination: As the health system’s first point of contact, primary care plays a vital role in managing chronic pain and substance use by providing consistent, long-term oversight. It helps identify early warning signs, ensures follow-through on specialist recommendations, monitors medications, and integrates psychosocial supports. Shared care models and interconnected health records allow primary care to coordinate with specialists, reduce treatment duplication, and align goals across providers.

2. Fragmented care leads to harmful patient-provider dynamics: When patients lack consistent primary care, they often enter specialist clinics with unresolved needs, emotional distress, and mistrust. Research shows that this can result in increased verbal aggression, emotional manipulation, and harassment toward pain clinic staff. These behaviors reflect deeper systemic failures and not just individual conduct, straining therapeutic relationships and contributing to clinician burnout, absenteeism, and diminished clinic safety.

3. Systemic reform requires stronger primary care integration: Effective and humane pain and addiction care cannot function in isolation. Instead, it depends on the presence of a stable primary care infrastructure that ensures continuity, promotes patient responsibility, and prevents specialist clinics from being overwhelmed. Investing in robust, relationship-based primary care is critical not just for patient outcomes, but also for clinician well-being, clinic sustainability, and reducing inequities in underserved populations.

Walgreens shareholders vote to approve $10B sale to Sycamore Partners

By Paige Minemyer - Walgreens Boots Alliance shareholders have voted to approve the company's sale to Sycamore Partners. The pharmacy giant announced Friday morning that 96% of the shareholder votes at a special meeting favored the merger, which would take Walgreens private, according to preliminary results. That includes 95% of unaffiliated shareholders voting for the deal. Read Full Article…

HVBA Article Summary

1. Walgreens Boots Alliance to Go Private in $10B Deal with Sycamore Partners: Walgreens has agreed to be acquired by private equity firm Sycamore Partners for $11.45 per share in cash, valuing the company at approximately $10 billion. Accounting for debt and future payouts, the total value could reach up to $23.7 billion. The sale is expected to close in Q3 or Q4 of 2025, pending regulatory and shareholder approvals.

2. Strategic Shift and Turnaround Plans: Going private is aimed at allowing Walgreens to focus on long-term strategic changes without public market pressures. CEO Tim Wentworth emphasized that Sycamore’s retail turnaround expertise will help accelerate Walgreens’ transformation, improve customer and employee experience, and drive value creation.

3. VillageMD Future in Flux and "Go Shop" Clause: Walgreens is exploring options for its financially struggling VillageMD unit, including a potential sale. A special committee has been formed to consider ways to enhance performance and prepare for future monetization. Additionally, Walgreens has a 35-day “go shop” period to entertain potentially better acquisition offers.

Texas judge overturns rule to remove medical debt from credit scores

By Alan Goforth - A federal judge in Texas has reversed a Biden administration rule that would have banned medical debt from appearing on credit reports and prohibited lenders from using medical information in lending decisions. The rule exceeds the authority of the Consumer Financial Protection Bureau and violates the Fair Credit Reporting Act, Judge Sean Jordan of the U.S. District Court for the Eastern District of Texas ruled. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Federal Judge Overturns CFPB Rule: A U.S. District Court judge in Texas ruled that the Consumer Financial Protection Bureau (CFPB) overstepped its authority by finalizing a rule to remove medical debt from credit reports. The judge stated that the Fair Credit Reporting Act does not grant the CFPB the power to eliminate this category of debt from reports, although it may influence how creditors use certain types of information.

2. Impact and Support of the Overturned Rule: The CFPB projected that the rule would have eliminated close to $50 billion in medical debt from credit reports, improving credit scores by an average of 20 points for about 15 million Americans and potentially leading to thousands more mortgage approvals each year. The rule gained support from public health organizations and political figures who argued that unexpected medical expenses should not limit access to loans or economic opportunity.

3. Ongoing Changes and Legal Landscape: Despite the federal court’s decision, the three major credit bureaus—Experian, TransUnion, and Equifax—have already implemented voluntary measures, such as removing smaller or newer medical debts from reports. Additionally, several states, including California, Colorado, and New York, have passed their own laws restricting how medical debt can be reported or collected, signaling continued momentum for reform at the state level.

Trump threatens 200% tariffs on pharmaceuticals

By Alexandra Murphy - President Donald Trump is threatening to impose tariffs of up to 200% on pharmaceuticals imported into the U.S., The Hill reported July 8. “If they have to bring the pharmaceuticals into the country, the drugs and other things into the country, they’re going to be tariffed at a very, very high rate, like 200 percent,” he said during a recent Cabinet meeting. Read Full Article…

HVBA Article Summary

1. Delayed Implementation of Tariffs: The proposed tariffs on pharmaceutical and semiconductor imports will include a grace period of up to 18 months, giving companies additional time to adapt their supply chains and operations before the measures take effect.

2. Pending Details and National Security Review: Final details about the tariffs are expected to be released at the end of July, following the conclusion of a national security investigation initiated by the White House in April to assess the risks associated with these critical imports.

3. Risks to Drug Supply and Hospital Care: Healthcare leaders and drugmakers have raised concerns that the tariffs could significantly disrupt global supply chains, potentially worsening existing drug shortages—especially for sterile, injectable generic medications that hospitals rely on heavily due to their low cost and vulnerability to supply interruptions.