DOL secretary nominee calls PBM transparency a 'priority'

By Allison Bell – Keith Sonderling called drafting new transparency regulations for pharmacy benefit managers a priority Thursday in Washington at a hearing on his nomination to be the next U.S. Labor secretary. "That's going to save billions and billions of dollars for health care plans, which is going to drive down the cost of health care plans," Sonderling told members of the Senate Health, Education, Labor and Pensions Committee, which organized the hearing. Shedding light on the money that PBMs and other companies in the middle are collecting could help employers drive prescription drug benefits costs down enough to give more employers the ability to afford to offer health benefits, Sonderling said. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. PBM Transparency Framed as Cost-Saving Measure: Sonderling emphasized that increasing transparency around pharmacy benefit managers would help reduce health plan expenses. He argued that clearer insight into intermediary compensation could enable employers to negotiate better terms on prescription drug benefits. The stated goal is to make employer-sponsored coverage more affordable by lowering underlying pharmacy costs. He characterized the initiative as a significant opportunity to curb overall health care spending.

2. Regulatory Timeline Remains Uncertain: Although Sonderling described PBM transparency as a priority, he declined to provide a specific timeline for issuing new regulations. He noted that the Department of Labor’s rulemaking process slowed after Congress enacted new federal PBM transparency laws around the same time earlier draft regulations were released. As a result, updated draft or final rules may not be issued in the immediate future. Lawmakers pressed for clarity, but the department is still reviewing its approach.

3. Broader Labor and Benefits Agenda: If confirmed, Sonderling would oversee regulations affecting employer retirement plans, Affordable Care Act provisions impacting health plans, and mental health parity enforcement. During the hearing, senators also questioned him on worker safety, unemployment issues and concerns related to the president’s business activities. He additionally voiced support for developing portable benefits solutions for gig workers that could allow multiple platforms to fund benefits without classifying workers as employees. He described that concept as an area of bipartisan interest among both companies and workers.

UnitedHealthcare exec says 'ineffective' No Surprises Act IDR process demands reform

By Paige Minemyer – Industry giant UnitedHealthcare is adding its voice to the chorus of insurers criticizing the current state of the No Surprises Act's independent dispute resolution process. During the company's earnings call on Thursday morning, company executives pointed to IDR as a drag on its commercial business. Dan Kueter, CEO of UnitedHealthcare Employer and Individual, said during the call that the "ineffective" process is "being exploited by select providers and select geographies."This, he said, is contributing to the overall cost trend in the commercial market. Read Full Article...

HVBA Article Summary

1. UnitedHealthcare Criticizes IDR as Cost Driver: A senior UnitedHealthcare executive described the federal independent dispute resolution (IDR) process as flawed and subject to exploitation by certain providers and regions. The company argues that the volume of disputes continues to grow, highlighting structural weaknesses in how the system operates. According to the executive, these dynamics are contributing to rising costs in the commercial insurance market. The insurer is calling for reforms to better align the process with congressional intent.

2. Dispute Volume and Payment Levels Raise Concerns: Company leaders cited data showing that roughly 40% of claims sent to IDR are ultimately deemed ineligible, and that 60% of arbitration cases are linked to just five organizations. They also pointed to escalating award amounts when providers prevail, with average determinations reaching about 11 times Medicare rates and some cases climbing as high as 30 times Medicare. Federal data show the IDR portal has received far more cases than originally projected, with annual volume far exceeding early expectations. These figures are being used by payers to argue that the system is being overused and driving up reimbursement levels.

3. Broader Policy Debate Intensifies: Other stakeholders, including the Congressional Budget Office and industry group AHIP, have echoed concerns about how the IDR framework may influence provider behavior. The CBO has suggested additional research is needed, noting the process could incentivize providers to remain out-of-network due to perceived leverage in arbitration. Insurers have pursued legal challenges against entities they say are responsible for high dispute volumes, but with limited success so far. Providers, however, contend that they resort to arbitration because insurers offer insufficient payments during initial negotiations.

States ranked by share of employer-sponsored plans that are fully insured

By Jakob Emerson – Hawaii has the highest share of employer health plans that are fully insured, at 65%, according to state-level data published by AHIP in July. Read Full Article...

HVBA Article Summary

1. Hawaii Leads in Fully Insured Plans: Hawaii ranks first among all states, with nearly two-thirds of employer-sponsored health plans structured as fully insured products. This places it well ahead of the national midpoint and signals a strong reliance on traditional insurance arrangements rather than self-funding. The ranking is based on state-level data compiled and released by AHIP in July.

2. Significant Variation Across States: The share of fully insured employer plans varies widely nationwide, ranging from 65% in Hawaii to 27% in Nebraska. Northeastern states such as New Jersey and Maine also rank near the top, each exceeding 55%. In contrast, several Midwestern and Southern states fall below 35%, highlighting substantial geographic differences in employer health plan design.

3. Most States Cluster in the Middle Range: A large number of states fall within the 40% to 50% range for fully insured employer-sponsored coverage. States such as California, Louisiana and South Carolina sit in the mid-40s, reflecting a more balanced split between fully insured and self-funded arrangements. This clustering suggests that while extremes exist, many states maintain a relatively even distribution between funding models.

1 in 9 Americans Now on GLP-1s

By Shrabasti Bhattacharya – GLP-1 use for weight loss rose to 11% among US adults in 2026, up from 3% in 2024, while obesity rates have declined from a peak of 39.9% in 2022 to 36.4% in 2026. Diabetes rates have stabilized since 2023. A web-based survey of 5065 US adults was conducted from May 28, 2026, to June 05, 2026, using the probability-based Gallup Panel, encompassing all 50 US states and the District of Columbia. Read Full Article...

HVBA Article Summary

1. Rapid Growth in Awareness and Adoption: Public awareness of GLP-1 medications for weight loss increased substantially, rising from 80% in 2024 to 91% in 2026. Over the same period, 15% of adults reported having used a GLP-1 drug at some point. These findings suggest that GLP-1 therapies have quickly entered mainstream awareness and use, reflecting expanding demand and broader cultural familiarity with these medications.

2. Brand vs Compounded Market Dynamics: Among current users, 68% reported taking brand-name GLP-1 medications, while 19% used compounded or custom-mixed versions and 12% were unsure of the type. Reported effectiveness was high across both categories, with 77% of compounded users and 74% of brand-name users describing the drugs as effective or extremely effective. Slightly more compounded users rated their medication as extremely effective (39%) compared with brand-name users (32%), indicating broadly similar satisfaction levels across formulations.

3. Cost Drives Switching to Compounded Versions: Individuals using compounded GLP-1 drugs were more likely to have switched from brand-name products than the reverse (35% vs 10%). Among those who moved to compounded versions, 66% cited cost or insurance coverage as the primary reason. These patterns suggest that affordability and coverage limitations are significant factors influencing treatment choices, potentially expanding access but also reshaping the competitive landscape of GLP-1 therapies.

Doc pay, price transparency on Congress’ healthcare agenda

By Emily Olsen – Lawmakers advanced or introduced a number of healthcare bills this [past] week, including a bipartisan measure that would reform how Medicare pays physicians — a long-awaited policy for doctors who argue their reimbursement doesn’t keep pace with the cost of care. Other legislation making moves in Congress include a bill that aims to improve transparency in Medicare Advantage prior authorizations and a policy that would help international healthcare professionals practice in the U.S. The raft of legislation comes ahead of the midterm elections this year, where healthcare is expected to be a key priority for voters. Read Full Article...

HVBA Article Summary

1. Bipartisan push to overhaul Medicare physician pay: Lawmakers introduced the Patients First Act to tie physician reimbursement updates to inflation and create a hybrid payment model for primary care that blends per-member monthly payments with fee-for-service. The bill would also establish a CMS task force focused on developing quality metrics and reducing administrative burden. Additional provisions would raise the budget neutrality threshold for physician pay updates and require notice-and-comment rulemaking for mandatory innovation center experiments. Provider groups have endorsed the proposal, arguing it would modernize payment policy and strengthen investment in primary care.

2. Medicare Advantage oversight gains momentum: The House Ways and Means Committee unanimously advanced the Improving Seniors’ Timely Access to Care Act by a 42-0 vote, signaling bipartisan concern about prior authorization practices. The bill would require MA plans to implement electronic prior authorization systems, clarify regulators’ authority to set decision timelines and mandate federal reporting on oversight. Lawmakers also moved forward the Medicare Advantage MLR Transparency Act on a 42-0 vote, which would require plans to publicly detail how much revenue is spent on patient care. Together, the measures aim to increase accountability and transparency in the MA program.

3. Price transparency and workforce bills reflect broader healthcare concerns: The Health Care Price Certainty for All Americans Act advanced out of committee on a 25-15 party-line vote and would expand disclosure requirements for providers and insurers, including publishing negotiated rates and providing patients with cost estimates. Supporters argue the policy would foster competition and impose stronger penalties on large firms that fail to share pricing data, while critics contend it could add complexity without addressing affordability challenges. Separately, bipartisan legislation in the Senate and House seeks to ease workforce shortages by helping internationally trained healthcare professionals enter U.S. practice. Lawmakers cited data showing more than 2 million college-educated immigrants are unemployed or underemployed, including roughly 270,000 with health-related degrees.

Employers weigh retention, costs in developing benefits strategies

By Susan Rupe – Employers are focusing on employee retention and well-being, while keeping an eye on costs, as they develop their workplace benefits strategies. Marsh McLennan Agency revealed the findings of its sixth annual National Benefits Strategy Survey, which examined employers’ priorities for providing benefits to their workers. A continued emphasis on employee retention and engagement stood out as the top issue among employers in this year’s survey, said Nick Pearce, Marsh McLennan Agency’s vice president and employee benefits insights and analytics practice leader. Read Full Article...

HVBA Article Summary

1. Cost Control Remains a Dominant Concern: Nearly all employers surveyed said managing medical expenses is a priority for 2026, with 94% highlighting it as important, up from 91% a year earlier. Additional financial pressures include pharmacy spending, retirement benefit cost effectiveness and recruitment-related expenses. To address these challenges, employers are changing carriers, launching targeted cost-control programs and shifting more expenses to employees through contributions and plan design changes. Many are also weighing higher deductibles, copays and narrower provider networks in the coming year.

2. Retention Tops the HR Agenda: Half of surveyed employers identified employee retention as their most important human resources focus for the next two years. Leaders emphasized that retention efforts are centered on keeping engaged, high-performing employees rather than simply maintaining headcount. Strategies have remained consistent, with strong attention to professional development, career growth and flexible work arrangements. Employers increasingly view engagement and workplace experience as essential components of long-term organizational stability.

3. Opportunity to Expand Health and Disease Management Support: Just 36% of employers reported offering a formal well-being plan, though those that do include initiatives such as health challenges, coaching and screenings. Experts noted that 60% of the U.S. workforce has at least one chronic condition that could be improved through lifestyle changes, yet many workplaces lack structured support to encourage those improvements. Strengthening disease-specific programs and encouraging relationships with primary care providers could improve health outcomes and reduce long-term risk. Expanding these strategies may also help employers achieve greater cost containment over time.

Healthcare sector faces persistent supply-chain security, identity management challenges

By Eric Geller – Healthcare organizations face one of the largest volumes of cyberattacks of any critical infrastructure sector, and those intrusions can also be some of the costliest. The new data from Fortified paints a picture of a healthcare industry struggling to combat ransomware attacks and other security compromises. Read Full Article...

HVBA Article Summary

1. Vulnerability Growth Is Outpacing Remediation Capacity: In the first half of 2026, healthcare organizations encountered 60% more critical or high-severity vulnerabilities than during the same period in 2025. At the same time, they addressed just 6% of identified risks, down sharply from 23% a year earlier. Researchers described the imbalance as visibility outstripping capacity, meaning organizations are finding more problems than they can realistically fix. This dynamic increases the likelihood that known weaknesses remain exploitable for extended periods.

2. Supply-Chain Risks Are Expanding Rapidly: Providers identified six times more supply-chain risks in early 2026 compared with the prior year, and nearly two-thirds were rated critical or high severity. Because hospitals depend on dozens of third-party technology vendors, a single breach can ripple across multiple organizations. The report notes that many healthcare entities lack formal programs to manage and remediate third-party risk exposures. As a result, assessments are surfacing gaps that organizations are not yet equipped to close efficiently.

3. Identity and Access Management Remains a Core Weakness: Healthcare organizations reported four times more identity- and access-related vulnerabilities in the first six months of 2026 than in the same period in 2025. The report found that 92% of healthcare network domains had at least one administrator account with a password unchanged for more than three years. Workforce churn, traveling clinicians and limited security staffing complicate account provisioning and deactivation. Fortified argues that strengthening identity controls and conducting regular incident-response training are essential to improving preparedness before a major breach occurs.

Ease strain on sandwich caregivers with these benefit categories

By Lee Hafner – The challenges of taking care of children and aging loved ones are leading many employees to struggle with their schedules, finances and personal health. Benefits that help them manage these areas can make all the difference. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Sandwich caregivers represent a significant share of the workforce: One in four adults serves as a caregiver, and nearly 30% of them are part of the “sandwich generation,” balancing care for children and aging relatives. This dual responsibility can strain employees’ time, finances and overall well-being. The article highlights that broad categories of support — including childcare, eldercare, financial wellness and preventive health — can meaningfully reduce that pressure. Employers that recognize the scale of this demographic are better positioned to tailor benefits that address overlapping caregiving demands.

2. Childcare and eldercare benefits can directly improve retention and productivity: Employers are expanding offerings such as on-site or subsidized childcare, backup care and access to caregiving services that help workers find providers for both children and older family members. Eldercare support, including help navigating healthcare and legal systems or accessing in-home services, can save employees hours of administrative work and emotional stress. Leaders cited in the article note that without workplace support, caregivers face higher risks of burnout and disengagement. By contrast, practical assistance can strengthen loyalty and long-term performance.

3. Financial wellness, preventive health and flexibility are critical complements: The high cost of eldercare and medical needs can derail caregivers’ retirement planning and personal financial goals, making access to financial coaching and long-term care projections especially valuable. Preventive health benefits, such as therapy and annual checkups, help caregivers sustain their own well-being while managing extensive responsibilities that can resemble a second job. Workplace flexibility — whether ongoing or situational — is repeatedly identified as one of the most important forms of support. Together, these benefits create a more holistic framework that helps employees manage both professional and personal obligations.