Mychal Walker to lead NABIP

By Allison Bell – Mychal Walker is now the president of the National Association of Benefits and Insurance Professionals. The Georgia-based insurance agency owner and health policy player succeeds Susan Rider as the head of the Washington-based health professional group. He is taking the reins at NABIP a few months after the group dismissed its previous chief executive officer, Jessica Brooks Woods. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Leadership Transition at NABIP: Mychal Walker has stepped into the presidency of NABIP following the departure of its prior CEO earlier this year. He succeeds Susan Rider in leading the Washington-based association. The move comes during a period of organizational change and renewed focus for the professional group. Walker’s appointment signals continuity in leadership drawn from within the industry’s experienced ranks.

2. Policy Advocacy and Industry Priorities: Walker has indicated that expanding the association’s influence in health care policy will be a central goal. He also plans to elevate awareness of the role that licensed agents and brokers play in supporting employers and individuals. In addition, he highlighted operational challenges such as cybersecurity risks and the growing use of artificial intelligence as areas where members will need guidance. His agenda reflects both legislative engagement and practical business concerns.

3. Professional Background and Organizational Reach: Walker brings experience as president of The Walker Agency and as owner of CC and Associates, serving retirement and benefits clients in Georgia. He has held multiple public and industry leadership roles, including secretary of the Georgia Board of Public Health and past president of the Georgia Association of Health Underwriters. NABIP, founded in 1930 and formerly known as the National Association of Health Underwriters, represents about 100,000 health insurance professionals. The association also announced a broader leadership team that includes a president-elect, vice president, treasurer and secretary.

Cigna’s Express Scripts Pressured Over TRICARE Contract in Senate Hearing

By Wendell Potter – A Senate Armed Services Subcommittee on Personnel hearing last week highlighted growing concerns about the Pentagon’s relationship with Cigna’s Express Scripts, the pharmacy benefit manager (PBM) that oversees the military’s TRICARE pharmacy program. Read Full Article...

HVBA Article Summary

1. Senators scrutinize contract provisions and oversight: Lawmakers questioned whether TRICARE’s contract allows Express Scripts to retroactively adjust pharmacy reimbursements after prescriptions have been processed. Senators suggested that such provisions could enable forms of spread pricing, where intermediaries retain differences between what they charge and what they pay pharmacies. Sen. Elizabeth Warren pressed company leadership on audit transparency and accused the PBM of potentially overbilling taxpayers. Defense officials indicated it would be reasonable to revisit the contract structure in future negotiations.

2. Vertical integration raises conflict-of-interest concerns: Express Scripts administers prescription benefits for about 9.6 million service members, retirees, and their families, while also being owned by Cigna’s Evernorth subsidiary. Cigna acquired Express Scripts in 2018 for $67 billion, contributing to significant consolidation in the pharmacy benefit market. Lawmakers questioned whether a company managing a government pharmacy benefit should also own affiliated mail-order and specialty pharmacies that dispense medications under that benefit. Critics argue this structure may create incentives that disadvantage independent pharmacies and limit competition.

3. Independent pharmacies and watchdogs cite past pricing issues: A pharmacist testified that TRICARE contract terms had become unsustainable for independent pharmacies, describing industry practices as financially damaging to local providers. Another witness characterized disputed contract language as a “smoking gun” in a complex pricing arrangement. The article notes that at least two federal watchdog investigations previously found Express Scripts engaged in spread pricing in government health plans and failed to pass through all required savings. These findings have fueled bipartisan interest in broader reforms, including proposed legislation that would separate insurers, PBMs, and pharmacy businesses.

Clover Health reveals data breach in SEC filing

By Paige Minemyer – Clover Health has disclosed a data breach in a new securities filing, though details on the incident are scarce. The company said in a filing with the Securities and Exchange Commission, submitted July 17, that on July 4 it discovered "anomalous login activity on certain of its information systems." When the intrusion was uncovered, Clover activated response procedures and contacted third-party experts to contain the threat. Read Full Article...

HVBA Article Summary

1. Social Engineering Led to Unauthorized Account Access: Clover Health disclosed that a threat actor gained access to three non-managerial employee accounts through a social engineering attack. The compromised accounts supported broker-facing sales functions and member visit scheduling, providing access to certain personal information and protected health information, but not to corporate financial systems or claims data. The company said its investigation is ongoing to determine the full scope of the unauthorized access and any individuals who may have been affected.

2. Company Responded Quickly While Investigation Continues: Clover Health stated that it rapidly contained and terminated the unauthorized access and is continuing to strengthen its IT environment. The insurer plans to make any required regulatory disclosures and notify affected members as the investigation progresses. Company representatives also said they do not currently expect the incident to have a material impact on business operations or financial performance.

3. Incident Reflects Ongoing Cybersecurity Risks Across Healthcare: The breach highlights the continued cybersecurity challenges facing healthcare organizations, where sensitive patient data and legacy technology make organizations attractive targets for attackers. Industry analyses have shown healthcare remained one of the most targeted sectors for cyberattacks through 2024, including increased ransomware activity. The incident follows other high-profile healthcare cyber events, such as the 2024 Change Healthcare attack that ultimately affected approximately 190 million people.

Level-funded vs. self-funded: Why data beats group size

By Mehul Agarwal – For a mid-market employer, the choice between a level-funded and a self-funded health plan is one of the most consequential financial decisions on the table each year. It shapes cash flow, risk exposure, plan design freedom, and how much an employer can actually learn about the cost drivers inside its own population. In conversations with brokers and benefits advisors across the country, one theme comes up again and again: they want to guide that decision with real data, but the data they need is rarely in front of them when the timing matters most. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Funding Models Differ in Visibility and Control: The article emphasizes that choosing between fully insured, level-funded, and self-funded plans is not simply a budgeting exercise. Each structure determines how much claims data an employer can access and how much flexibility it has in shaping benefits. Self-funding offers greater transparency and customization but also exposes employers to more direct risk, typically mitigated through stop-loss coverage. Level funding attempts to balance predictability with increased access to claims information.

2. Group Size Alone Is an Incomplete Risk Measure: While enrollment thresholds and credibility improve with larger groups, the author argues that headcount does not fully capture a company’s risk profile. Factors such as claims history, demographic composition, chronic conditions, and concentration of high-cost claimants can materially change the funding equation. Two employers of similar size may face very different levels of volatility and opportunity. Relying solely on size can lead to overly cautious or misaligned funding decisions.

3. Usable Data Is the Critical Enabler: The central obstacle for many mid-market employers is not willingness but access to timely, unified data. Claims information is often fragmented across carriers and vendors, limiting its practical value. Advisors are encouraged to focus on what data will actually be available and actionable under each funding model. Treating funding as a progression—supported by improving data visibility—can help employers transition thoughtfully rather than making one-time, binary decisions.

The hidden cost of the GLP-1 boom: 5 notes

By Ella Jeffries – Average total payments for GLP-1 users without diabetes rose sharply between 2017 and 2022, even as patients personally paid less out of pocket, according to a Northwestern University study published July 16 in the Journal of the American Heart Association. Read Full Article...

HVBA Article Summary

1. Total Spending Growth Outpaced Diabetes-Related Use: The study found that overall payments for GLP-1 users without diabetes climbed far more quickly than for those with diabetes over the five-year period. This indicates that the drugs’ expansion into weight-loss and other non-diabetic uses has been a major driver of spending growth. The divergence suggests payers are absorbing increasing costs tied to newer prescribing trends beyond traditional diabetes treatment.

2. Cost Burden Shifted Away From Patients: Even though total payments increased substantially, individuals paid less out of pocket on average during the same period. The financial responsibility shifted more heavily to insurers, employers and public programs. This redistribution of costs may shield patients in the short term but could create broader systemwide financial pressure through higher premiums or public spending.

3. Utilization and Market Concentration Accelerated: GLP-1 use surged dramatically from 2017 to 2022, representing more than 20 million U.S. adults in survey data. By 2022, semaglutide accounted for the majority of prescriptions in both diabetic and non-diabetic populations, highlighting significant market concentration. Researchers cautioned that rising aggregate costs could influence insurance restrictions, taxes and premium levels, especially as Medicare rolls out a temporary $50 monthly copay program.

The limits of employee benefits education and what happens next

By Jennifer Hui – Most employers invest real effort in benefits education. They hold open enrollment meetings. They send guides, comparison resources and summary plan descriptions. They layer in emails and reminders. And still, employees reach out weeks or months later, unsure about how to use the coverage they selected. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Enrollment Education Focuses on Selection, Not Real-World Use: Traditional benefits communication is structured around open enrollment decisions, such as choosing plans and contribution levels. While this approach helps employees meet immediate deadlines, it does not fully prepare them for the complexities of actually using their coverage. Situations like interpreting an explanation of benefits or navigating prior authorization often arise months later, outside the enrollment context. As a result, even attentive employees may struggle when theory meets practice.

2. Changing Circumstances Create an Application Gap: Employees’ personal situations and plan details can shift throughout the year, from provider network changes to prescription reclassifications. These developments are difficult to anticipate during enrollment and can render earlier explanations insufficient. The authors describe this as an “application gap,” where general knowledge does not easily translate to specific, real-time scenarios. The challenge is less about inattention and more about timing and context.

3. Communication Alone Cannot Solve Ongoing Confusion: Increasing the frequency or variety of communications may improve recall, but it does not address highly individualized questions tied to specific bills or procedures. Benefits issues often emerge under stressful conditions, when employees need guidance tailored to their immediate circumstances. The article argues that education should be paired with resources designed for post-enrollment navigation. Personalized, situational support can complement foundational education and help employees act with greater clarity and confidence.

The Oral GLP-1 Tracker: Lilly’s Foundayo scripts tick up amid overall obesity market slowdown

By Angus Liu, Kevin Dunleavy, and Fraiser Kansteiner – With the recent launches of Novo Nordisk’s Wegovy pill and Eli Lilly’s Foundayo, the obesity market has started to shift toward oral GLP-1 drugs. While Novo leverages its first-mover advantage with the familiar Wegovy brand, Lilly is betting the freedom from the strict fasting and water requirements can give Foundayo an edge. Read Full Article...

HVBA Article Summary

1. Overall GLP-1 Market Softened in Mid-July: Following the Independence Day holiday, total GLP-1 prescriptions across obesity and diabetes indications fell 5.1% week over week, according to IQVIA data cited by Citi. Both Lilly’s Zepbound and Novo’s Wegovy saw sequential declines in obesity scripts, reflecting a broader market slowdown. The dip suggests seasonal or holiday-related volatility can meaningfully affect weekly prescription trends. Despite the pullback, competition between oral and injectable options remains intense.

2. Foundayo Shows Signs of a Prescription Inflection: After hovering around the 20,000-script range for several weeks, Foundayo climbed to 24,303 prescriptions in the latest update. This marks a notable break from its prior plateau and could indicate improving reimbursement coverage or growing brand awareness. Analysts have previously described the launch as muted compared to Novo’s pill, but this uptick may signal early momentum. Coverage expansions by major pharmacy benefit managers have been flagged as a potential catalyst.

3. Wegovy Pill Maintains Scale and Brand Advantage: Novo’s oral Wegovy continues to command significantly higher weekly prescription volumes than Foundayo, even as its scripts dipped from prior peaks. The pill consistently accounts for roughly one-third of total Wegovy prescriptions, indicating sustained patient and prescriber interest in oral formulations. Novo has also highlighted that a large share of new prescriptions comes from patients new to GLP-1 therapy, suggesting market expansion rather than simple switching. Brand familiarity and early launch timing appear to be contributing factors in its continued lead.