Judges rule HHS holds authority over 340B rebate models

By Kristen Smithberg – A federal appeals court has ruled that pharmaceutical manufacturers cannot unilaterally replace upfront discounts under the 340B Drug Pricing Program with after-the-fact rebates, affirming the federal government's authority to approve how those price reductions are provided. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Appeals Court Affirms HHS Oversight Authority: The U.S. Court of Appeals for the District of Columbia Circuit upheld lower court rulings against several major drugmakers and a technology company that sought to implement their own rebate models. The court concluded that while the 340B statute allows for either discounts or rebates, the mechanism must be established or approved by the HHS secretary. In the court’s view, manufacturers cannot independently decide to substitute rebates for upfront discounts. This interpretation reinforces federal control over how 340B pricing reductions are structured and administered.

2. Dispute Centers on Proposed Rebate Models: The manufacturers’ proposals would have required hospitals and clinics to pay full price for drugs initially and then seek reimbursement for the difference between that price and the 340B ceiling price. Drugmakers argued the approach would help detect duplicate discounts and prevent program misuse. Hospitals and covered entities countered that the system would strain cash flow and increase administrative complexity, while also giving manufacturers leverage to delay or deny rebate payments. The ruling leaves such concerns unresolved but prevents unilateral implementation of those models.

3. Future Rebate Programs Remain Unsettled: The decision does not prohibit rebate-based systems entirely, nor does it determine whether a future HHS-designed rebate program would be lawful. HHS previously announced a rebate pilot in 2025, but it was challenged in court and later withdrawn after an injunction. The agency has since indicated it plans to propose a revised pilot through a Federal Register notice. Meanwhile, Congress is considering broader 340B reforms, including a Senate discussion draft that would expand hospital reporting and oversight requirements.

10 best, worst states for healthcare

By Kelly Gooch – New Hampshire is the best state for healthcare while Alaska is the worst, according to an analysis published July 27 by WalletHub. The personal finance company compared the states and the District of Columbia across three dimensions: cost, access and outcomes. Analysts then evaluated the dimensions across 44 metrics, including average monthly insurance premiums, hospital beds per capita, emergency room wait times, infant mortality rates and the share of patients readmitted to hospitals. Read Full Article...

HVBA Article Summary

1. Overall Rankings Highlight Regional Variation: The analysis places New Hampshire at the top overall, while Alaska ranks last among states for healthcare performance. Other high-performing states include Minnesota, Iowa and Rhode Island, whereas Mississippi, Georgia and Texas appear near the bottom. The rankings illustrate significant geographic differences in healthcare systems across the U.S. These disparities reflect how states balance affordability, provider availability and patient outcomes.

2. Different States Lead in Specific Categories: While New Hampshire leads overall, Iowa ranks first for cost efficiency and North Dakota leads in access to care. New Hampshire also tops the outcomes category, indicating strong performance in measures tied to patient results. This breakdown shows that no single state dominates every dimension of healthcare performance. Instead, strengths vary depending on whether the focus is affordability, availability of services or clinical results.

3. Methodology Based on 44 Healthcare Metrics: WalletHub’s evaluation incorporates dozens of indicators spanning insurance premiums, hospital capacity and quality measures. By scoring each metric on a standardized scale and calculating weighted averages, the study aims to create a balanced comparison across states and Washington, D.C. The use of cost, access and outcomes as core dimensions reflects common frameworks for assessing health system performance. Such methodology-driven rankings can influence policy discussions and public perception of state healthcare systems.

PBM Transparency Is Coming, and It’s About Time

By Jake Velie – The momentum toward pharmacy benefit manager transparency just got a significant boost. As reported by Allison Bell in BenefitsPro on July 17, 2026, DOL Secretary nominee Keith Sonderling told the Senate Health, Education, Labor and Pensions (HELP) Committee that drafting new PBM transparency regulations is a priority for the Department of Labor.¹ The full hearing is available on the Senate HELP Committee’s website for anyone who wants to hear it straight from the source.² Read Full Article...

HVBA Article Summary

1. Federal Momentum for PBM Oversight: The article highlights renewed regulatory focus on pharmacy benefit manager transparency under the Department of Labor. Keith Sonderling, as acting secretary with oversight of the Employee Benefits Security Administration, is positioned to influence ERISA-governed health plan rules. His comments signal that PBM accountability is being elevated as a policy priority. This shift could affect how employers evaluate and manage their pharmacy benefit arrangements.

2. Existing Laws Have Laid the Groundwork: Prior legislation, including the Consolidated Appropriations Act of 2021 and the Transparency in Coverage Final Rule, already introduced reporting and disclosure requirements for prescription drug costs and rebates. However, the interaction between newly enacted federal PBM transparency laws and draft DOL regulations has slowed implementation. The article suggests that rulemaking timelines remain uncertain despite public commitments. Employers may face a transition period where compliance expectations continue to evolve.

3. Employers Encouraged to Act Beyond Regulation: The author argues that transparency alone will not reduce prescription drug spending without active management strategies. He outlines a multi-lever approach that includes 340B pricing access, biosimilars offering 60–80% savings over brand drugs, and site-of-care optimization that can reduce infusion administration costs by 40–60%. Additional tactics such as manufacturer-direct contracting, variable copay programs, and clinical interventions are presented as complementary tools. The broader message is that employers should proactively pursue cost-containment solutions rather than waiting for regulatory mandates.

SMBs have more options than ever and worse advice

By Kasey Devine – The benefits industry spent a decade arguing that mid-market employers deserved the same funding sophistication as Fortune 500 companies. Level-funded plans. Group captives. ICHRAs. The options arrived. What did not arrive was the infrastructure to evaluate them. Not at Fortune 500 scale that allow consultants to build custom models, but rather at 100-person-company scale wherein one broker and a spreadsheet still run the show. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Funding Options Have Expanded Rapidly: The range of health plan funding models available to small and mid-sized employers has grown significantly in just a few years. In 2019, about one in 15 small firms offered a level-funded plan, but today more than a third of covered workers at small firms are enrolled in one. ICHRA enrollment nearly tripled in 2026, and more than 40% of employers are using or evaluating group captives, particularly among firms with fewer than 500 employees. What was once a limited carrier choice has evolved into multiple structurally different risk arrangements competing at renewal.

2. Cost Pressures Are Driving Structural Change: Employers are not exploring alternative funding models out of experimentation but in response to mounting financial strain. Nearly half of plan sponsors report claims exceeding $1 million, up from roughly a quarter the prior year, while ACA marketplace premiums rose 26% in 2026. These pressures are making the fully insured model less sustainable for many mid-market firms. As a result, companies are actively seeking arrangements that offer different risk-sharing and cost trajectories.

3. Broker Infrastructure Is Lagging Behind Complexity: Despite rising expectations, many brokers lack the tools to properly compare multiple funding structures side by side. Zywave’s 2025 survey found that 94% of employers expect high-quality risk management support, yet only 50% believe they receive it. Most quoting systems were built for fully insured comparisons and struggle to normalize data across level-funded plans, captives and ICHRAs. This mismatch means employer recommendations can vary widely depending on broker capability rather than on a consistent, data-driven analysis.

Industry survey finds MA enrollees have lower out-of-pocket costs than those in traditional Medicare

By Paige Minemyer – A new analysis finds that Medicare Advantage enrollees spend less on average than those in the traditional program, but report similar satisfaction levels. ATI Advisory conducted the study on behalf of the Better Medicare Alliance, analyzing data from the Medicare Current Beneficiary Survey and Cost Supplement files from 2021 to 2023. The analysis found that MA enrollees spent $2,824, or 36%, less out-of-pocket on average in 2023 compared to those in fee-for-service Medicare. Read Full Article...

HVBA Article Summary

1. Growing Gap in Out-of-Pocket Spending: The report indicates that the cost difference between Medicare Advantage and traditional Medicare has widened over time. Savings for MA enrollees in 2023 were 16% higher than in 2022, suggesting the financial gap is increasing. Researchers analyzed multiple years of survey data to track this trend. The findings point to sustained and potentially accelerating cost advantages for MA participants.

2. Lower Financial Burden for Vulnerable Populations: Twelve percent of MA beneficiaries reported spending more than 20% of their income on healthcare, compared to 24% of those in traditional Medicare. The lower spending trend held across income levels, racial and ethnic groups, regions and among people with multiple chronic conditions. More than half of MA enrollees have incomes below 200% of the federal poverty level, and more than three-quarters have at least three chronic conditions. These demographics suggest the program serves a population with significant health and financial needs.

3. Comparable Satisfaction and Preventive Care Use: Despite lower out-of-pocket costs, MA enrollees reported similar satisfaction levels regarding quality of care and access compared to traditional Medicare beneficiaries. The survey also found MA members were 15% more likely to have had an annual wellness visit. This indicates potential differences in preventive care engagement between the programs. Industry advocates argue the results demonstrate that affordability and care coordination can coexist within the MA model.

How cultivating employee-PCP relationships improves health, reduces costs

By Lee Hafner – Many employees — especially younger adults — don't see primary care providers, according to recent research, missing the crucial opportunity to maintain overall wellness, prevent serious conditions, and avoid higher healthcare costs. When employers foster employee-PCP relationships through education and offerings that improve access, both they and their workforce win, said Dr. Jeffrey Lin, chief medical officer at membership-based primary care network MDVIP. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Younger adults are disengaging from primary care: Research cited in the article shows that many young adults lack an ongoing relationship with a primary care physician and instead rely on urgent care for nonemergency issues. Even among those who have a doctor, fewer than half received an annual checkup. This pattern limits opportunities for early detection and long-term health planning. Without consistent preventive care, manageable risks can evolve into more serious and costly conditions.

2. Primary care access is tied to lower costs and better chronic disease management: Data referenced in the piece indicates that having a primary care clinician is associated with significantly lower overall healthcare spending for adults with chronic illnesses. Despite this, primary care accounts for a small share of total U.S. healthcare expenditures. Strengthening the primary care relationship can help coordinate specialist treatment and personalize disease management. For employers, this can translate into reduced spending on major cost drivers like cardiovascular and metabolic conditions.

3. Employers can play a direct role in strengthening PCP relationships: The article highlights strategies such as improving communication about preventive care and offering enhanced-access models like concierge primary care. Membership-based arrangements can provide longer visits, faster scheduling and more consistent follow-up, which help build trust between patients and physicians. A stronger relationship encourages ongoing engagement in health management and supports productivity at work. Benefit leaders are positioned to promote these models as part of a broader preventive health strategy.

Women's Oncology Market Could Reach $110B in 2030, but Gaps Remain - MedCity News

By Marissa Plescia – The women’s oncology market is poised for significant growth, but persistent gaps in funding, innovation and patient access continue to hold back progress, according to a new PwC report. Read Full Article...

HVBA Article Summary

1. Market Growth Driven by Pharmaceuticals and Targeted Therapies: The global market for women-specific cancers is currently valued between $65 billion and $75 billion and is projected to grow to as much as $110 billion by 2030, reflecting a 7% to 9% annual increase. Pharmaceuticals account for nearly 70% of the market’s value, fueled by strong reimbursement environments and scalable therapeutic innovation. Much of this expansion is being propelled by targeted therapies that are supplementing or replacing traditional chemotherapy. These treatments are enabling more personalized interventions and earlier use in the disease course.

2. Persistent Funding Disparities Across Cancer Types: While breast cancer has benefited from sustained research attention and capital, gynecologic cancers have lagged behind in both public and private investment. NIH funding data from 2025 shows ovarian cancer received roughly $43,000 per death in research support compared to nearly $70,000 for breast cancer. The report suggests that closing these funding gaps could unlock meaningful advancements across the patient journey. Increased capital flows into gynecologic cancers may help replicate the progress seen in breast cancer over past decades.

3. Opportunities in Early Detection and Care Delivery Innovation: Earlier detection remains a major unmet need, particularly for ovarian and other gynecologic cancers that are often diagnosed at later stages. The report highlights promising tools such as liquid biopsies, AI-enabled diagnostics, mobile screening initiatives and at-home testing to expand access and improve outcomes. Nearly 400 private funding deals totaling more than $6.5 billion between 2020 and 2025 underscore investor interest, especially in devices and diagnostics. Stakeholders including pharma companies, providers, payers and employers are encouraged to adopt AI, longitudinal care models and expanded coverage for evidence-based screening to close remaining gaps.