Gross-to-Net Bubble Hits $356B in 2024—But Growth Slows to 10-Year Low

By Drug Channels - Is the gross-to-net bubble—the ever-widening gap between brand-name drug sales at list prices and their net revenues after rebates and discounts—finally beginning to deflate? Drug Channels Institute (DCI) estimates that the gross-to-net reductions for all brand-name drugs reached $356 billion in 2024, a 7% increase over the previous year. Yet despite this record total, the bubble expanded at the slowest rate in at least a decade. Read Full Article… 

HVBA Article Summary

1. Slowing growth of the gross-to-net drug pricing bubble: The gap between brand-name drug list prices and the net revenues manufacturers actually earn reached an estimated $356 billion in 2024 but grew at its slowest pace in a decade. This slowdown is partly due to list price reductions for highly rebated drugs, such as insulin, and changing manufacturer pricing strategies aimed at reducing rebate-driven distortions in the market.

2. Lack of transparency fueling confusion and affordability issues: Most drug channel participants, including pharmacies, pharmacy benefit managers (PBMs), and plan sponsors, do not have access to manufacturers’ net pricing data, leaving patients and policymakers with an incomplete understanding of true drug costs. This opacity contributes to rising out-of-pocket expenses and misperceptions about drug price trends, as net prices remain flat or declining while list prices climb.

3. Market and policy changes reshaping pricing dynamics: Factors such as the uncapping of Medicaid rebate limits, manufacturers’ adoption of lower list prices, the Inflation Reduction Act’s pricing provisions, and the rise of direct-to-patient and cash-pay models are reshaping how drugs are priced and sold. These shifts are pressuring traditional rebate-driven models and may help slow the expansion of the gross-to-net bubble.

Telehealth gets a win in Trump’s tax package

By Ron Southwick - Most healthcare leaders have condemned the tax package for its impact on health care, with millions projected to lose Medicaid coverage and hospital leaders saying that some facilities may have to cut services or close. Read Full Article…

HVBA Article Summary

1. Permanent first-dollar telehealth coverage for HDHP-HSA plans: The recently signed tax and budget legislation permanently reinstates first-dollar coverage for telehealth services for Americans with High-Deductible Health Plans paired with Health Savings Accounts (HDHP-HSAs). This change, retroactive to January 1, allows tens of millions of individuals to access telehealth services without meeting their deductible, offering greater cost predictability for patients.

2. Mixed impact of the broader legislation on healthcare providers: While telehealth advocates view the provision as a major victory, hospitals and healthcare providers have expressed concern about other aspects of the law, particularly reductions in Medicaid funding. The telehealth community plans to work with Congress, the administration, and state governments as these provisions roll out to help mitigate potential negative impacts.

3. Ongoing efforts to secure broader telehealth extensions: Telehealth supporters are continuing to push for extensions—and eventual permanence—of other virtual care policies, including Medicare telehealth flexibilities and hospital-at-home programs. Current waivers are set to expire at the end of September, but there is bipartisan support in Congress for extending them, likely through additional federal spending legislation.

Many US employers plan to pare health benefits as weight-loss spending soars

By Amina Niasse - More than half of large U.S. employers plan to scale back healthcare benefits next year as rising costs from weight-loss and specialty drugs squeeze budgets, according to a new survey released by consulting firm Mercer on Wednesday. Read Full Article…

HVBA Article Summary

1. Rising healthcare cost-sharing for employees: A growing number of large employers (51%) plan to increase cost-sharing measures in 2026, such as raising deductibles and maximum out-of-pocket limits for employees, compared with 45% in 2025. This trend reflects the continued rise in healthcare expenses, including prescription drug costs, and signals that workers may face greater financial burdens for their health coverage in the coming years.

2. High cost of GLP-1 weight-loss drugs driving concern: GLP-1 medications, such as Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound, have become a major financial concern, with 77% of employers citing them as a top cost issue. Although these drugs are sometimes viewed as a way to reduce long-term health costs by helping employees manage weight-related conditions, their high list prices—exceeding $1,000 per month—are forcing many employers to reconsider offering coverage as overall benefits costs rise.

3. Growing scrutiny of pharmacy benefit managers (PBMs): Amid rising prescription costs and regulatory scrutiny, 34% of employers are considering switching from traditional pharmacy benefit managers like CVS Caremark, Express Scripts, and Optum Rx, while 40% are exploring alternative contracting models, such as pricing drugs based on pharmacy acquisition costs. These moves reflect a push for greater transparency, cost savings, and accountability within the prescription drug supply chain, as regulators question whether current PBM practices contribute to inflated drug prices.

US Children Face 80 Percent Higher Risk of Death Than Peers in Wealthy Nations

By Rachel Ann T. Melegrito - American children are dying at rates far exceeding those in other wealthy nations, with a new study showing that U.S. infants are about 80 percent more likely to die before their first birthday, and children overall face an 80 percent higher death rate than their peers in 18 other developed countries. The findings, published in JAMA Original Investigation, paint a troubling picture of pediatric health in the United States. Read Full Article… 

HVBA Article Summary

1. Child mortality and health outcomes in the U.S. significantly lag behind other wealthy nations: From 2007 to 2023, the United States experienced an excess of 54 child deaths per day compared to what would be expected if mortality rates matched those of peer countries. Infant mortality remains elevated due to premature births and sudden infant death syndrome, while deaths among children ages 1–19 are disproportionately driven by firearms and motor vehicle crashes. Firearms have now surpassed all other causes as the leading cause of death for American children.

2. Chronic physical and mental health conditions have surged among U.S. children over the past decade: Between 2011 and 2023, the percentage of children ages 3–17 with at least one chronic condition rose from roughly 26% to 46%, reflecting a nearly 20-point increase. Obesity now affects 1 in 5 children, and 1 in 7 girls begins menstruation before age 12, signaling shifts in overall health. Mental health concerns have escalated as well, with nearly 40% of high school students reporting persistent feelings of sadness or hopelessness by 2023.

3. A convergence of systemic and social factors is driving the pediatric health crisis in the United States: Worsening outcomes are linked to maternal health issues like rising rates of gestational diabetes, pre-pregnancy hypertension, and obesity, alongside widespread metabolic disease among adults. High levels of child poverty and income inequality push families toward cheaper, calorie-dense foods and older, less safe vehicles, while lifestyle factors such as heavy smartphone and social media use contribute to poor sleep, reduced activity, loneliness, depression, and obesity. Though not analyzed by this study, racial and socioeconomic disparities are likely amplifying these trends.

Transforming employer health benefits: Large employers’ activist role

By Aditya Gupta and David Knott - Employers are the largest purchasers of health insurance in the United States, representing approximately 165 million lives¹ and more than $800 billion in healthcare expenditures.² Large employers—those with more than 10,000 employees—are often innovators when it comes to benefit offerings, shaping the trends that are later adopted by small and medium-size employers. Read Full Article…

HVBA Article Summary

1. Rising healthcare costs and evolving employer roles are reshaping benefits strategies: Large employers, who issue around 300 RFPs annually and represent $16–$24 billion in revenue opportunities, are becoming more active in shaping health benefits as medical costs are projected to rise 9–10% annually through 2026. They are seeking innovative solutions, cost control measures, and broader partnerships to address pressures from inflation, new therapies, and complex benefit ecosystems.

2. Employers are increasingly open to alternative models and demanding measurable value: Many large employers are adopting or exploring value-based and innovative plan designs—such as virtual-first plans, reference-based pricing, and flexible co-payment structures—while scrutinizing programs for return on investment. Most require a minimum ROI (2:1 or 3:1) and are willing to reduce or eliminate offerings that don’t deliver significant financial or employee value.

3. Healthcare companies must adapt to remain competitive in the benefits market: To win and retain employer partnerships, healthcare providers and insurers are encouraged to shift toward year-round engagement, data-driven insights, hypercustomized proposals, and value-aligned pricing models (including pay-for-performance and shared savings). These strategies help differentiate them in a crowded marketplace and align with employers’ evolving priorities.

Talent attraction and retention in focus with shifting approach to employee benefits – Gallagher

By Keneth Araullo - US employers are shifting their approach to employee benefits in response to ongoing economic uncertainty and rising healthcare costs, according to the latest benefits market report from Gallagher. One of the report’s central findings is the growing pressure from healthcare costs. Read Full Article…

HVBA Article Summary

1. Employers are adjusting health and pharmacy benefits to remain competitive and control costs: In 2025, 31% of employers enhanced medical benefits and 12% improved pharmacy benefits to attract and retain talent, while 31% and 26% made adjustments to health and drug plans, respectively, for cost-control purposes. Administrative actions included changing plan carriers (29%) and conducting audits (16%), alongside a 13-point rise in pharmacy benefit manager contracts since 2024.

2. Coverage expansion is targeting specific health and reproductive needs: Employers are offering broader benefits, including hearing aid coverage (59%), autism-related therapies (54% for applied behavior analysis, 44% for other treatments), bariatric surgery (45%), and reproductive health services such as infertility treatments (48%), with increases noted in coverage for fertility medications, IVF, insemination, and cryopreservation.

3. Financial wellbeing and workforce stability remain key focus areas: About 67% of employers view voluntary benefits as vital, offering protections like identity theft coverage (39%), legal assistance (38%), and long-term financial products such as whole (36%), term (35%), and universal (17%) life insurance with long-term care benefits. HR teams, however, face challenges like “change fatigue” (44%), which affects benefit program implementation and communication.

GLP-1s may boost testosterone: Study

By Alexandra Murphy - Weight loss drugs like Ozempic and Mounjaro may help reverse low testosterone levels in men with obesity or Type 2 diabetes, according to research presented at the Endocrine Society’s annual meeting in San Francisco, NBC News reported July 14. Read Full Article…

HVBA Article Summary

1. GLP-1 medications linked to improved testosterone levels in men with obesity or Type 2 diabetes: A study of 110 men found that nearly half began with low or low-normal testosterone levels, but most achieved normal levels after up to 18 months on GLP-1 therapy. Researchers suggest the improvements likely stemmed from better weight management and reduced insulin resistance rather than hormone supplementation.

2. Natural hormone recovery may reduce need for testosterone therapy: While testosterone increases were more modest than those from replacement therapy, they occurred naturally during GLP-1 use. This raises the possibility that some men may be able to lower or discontinue testosterone treatments as their bodies restore normal hormone function.

   Long-term effects of stopping GLP-1 therapy remain unknown: The study did not evaluate testosterone levels after discontinuation of GLP-1 medications. Researchers caution that benefits may not persist if patients regain weight, underscoring the need for ongoing evaluation and individualized treatment planning.