Employers beware: Supreme Court ruling 'for' ACA preventive services could still change the benefits

By Allison Bell - The U.S. Supreme Court recently issued a ruling that "saved" a big part of the Affordable Care Act preventive services benefits package. But Katharine Marshall, a policy expert at Mercer, suggests in a commentary that employers and their benefits advisors should continue to watch carefully for changes in ACA preventive services benefits coverage requirements. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. ACA Preventive Services Remain—for Now: Although the Affordable Care Act still mandates that non-grandfathered health plans cover preventive services like screenings and vaccines at no cost to patients, employers are being encouraged to evaluate whether they would maintain such coverage if federal guidelines change. This comes amid legal and administrative shifts that could impact the future scope of required services.

2. Supreme Court Preserves Task Force Structure: In the recent Kennedy v. Braidwood decision, the Supreme Court upheld the current method of selecting U.S. Preventive Services Task Force members, ruling that Senate confirmation is not required since the HHS Secretary can remove them at will. This outcome maintains the task force's ability to guide preventive care policy under the ACA, at least for the time being.

3. Future Changes Could Shift Employer Strategy: While existing preventive service mandates remain intact, ongoing litigation against other advisory bodies like the ACIP and HRSA could eventually lead to significant changes. Such shifts may benefit cost-conscious employers but could challenge those committed to offering consistent preventive care—especially when paired with high-deductible health plans that rely on preventive coverage to offset early out-of-pocket costs.

American Workers Spending Less Time Reviewing Workplace Benefits

By Emily Boyle - A Voya study reveals that in 2024, 49% of employed, benefits-eligible Americans reported spending less than 20 minutes reviewing workplace benefits information overall—a 7% increase from 2023. Voya’s Dena Faccio, senior vice president of total rewards, pointed to a statistic, reported by Schroders, that she summarizes as “employees spend[ing] more time thinking about what they want to watch on Netflix than they do … making choices around planning and investing for their futures.” Read Full Article…

HVBA Article Summary

1. Age Influences Benefits Review Time: The time employees spend reviewing workplace benefits varies significantly by age. Baby Boomers (ages 61–79) are much more likely to spend time reviewing their benefits, while Generation Z (ages 14–30) and Generation X (ages 45–60) tend to spend considerably less. The most striking gap is between Gen Z and Boomers—60% of Gen Z spent 20 minutes or less reviewing, compared to only 34% of Boomers, suggesting younger workers may be less engaged or less informed during open enrollment.

2. Employees Want More Guidance: A large majority of workers—75%—expressed a desire for better support and tools to help them navigate benefit decisions, such as saving for retirement, emergency funds, and health care expenses. Additionally, 83% said guidance on optimizing retirement savings is important, yet knowledge remains low—only 3% of respondents understood the full benefits of a Health Savings Account (HSA), indicating a substantial gap in benefits education and communication.

3. Growing Interest in Voluntary Benefits: Despite a general decrease in overall benefits review time, voluntary benefits are gaining attention and traction among workers. About 61% of benefits-eligible employees said they took advantage of voluntary benefit options and felt more confident in their financial security as a result. Furthermore, 55% reported spending more time reviewing these offerings than in previous years, pointing to a shift in employee interest toward customizable and extended coverage solutions like permanent life insurance and long-term care.

Senate passes reconciliation bill in 51-50 vote

By Dave Muoio - Following a record-breaking “vote-a-rama” session and a tie-breaker vote from Vice President J.D. Vance, the Senate has passed its version of the massive reconciliation bill that includes healthcare industry-opposed changes to federal health programs. Read Full Article…

HVBA Article Summary

1. Senate Passage and Division: The Senate passed a major Republican-led bill after a lengthy "vote-a-rama" session with over 26 hours of amendments. Three Republican senators—Susan Collins, Thom Tillis, and Rand Paul—broke ranks to vote against the bill, citing concerns ranging from rural hospital funding to fiscal impact. The bill must now return to the House before reaching President Trump.

2. Major Provisions and Fiscal Impact: The bill centers on extending 2017 tax cuts and adding short-term tax relief, partially offset by cuts to Medicaid and other health programs. While Republicans argue the bill meets reconciliation rules and minimizes fiscal burden, the Congressional Budget Office projects it will add at least $3.3 trillion to the national debt—an estimate criticized as undercounted by opponents and financial analysts.

3. Healthcare Industry Backlash: Healthcare organizations broadly condemned the bill, warning it could result in the largest rollback of healthcare coverage in U.S. history. Critics highlight nearly $1 trillion in Medicaid cuts and an estimated increase of over 11 million uninsured individuals, with serious consequences for hospitals—especially in rural and underserved areas. Many groups are urging the House to amend or block the bill’s healthcare provisions.

Prescription costs a burden for two-thirds of Americans, survey finds

By Alan Goforth - Two-thirds of Americans who filled a prescription in 2024 described the cost of their medication as a burden, a new survey from GoodRx found. “For millions of Americans, affording prescription medications is getting harder, not easier,” according to the survey report. “People are more likely than ever to view their prescriptions as a financial burden. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Affordability Concerns Rise Sharply: Nearly 4 in 10 Americans reported concerns about affording their medications in 2025, up from 27% in 2024. While 33% said medication costs were not a burden, a combined 68% described them as a minor to catastrophic burden. Prescription drugs now rank higher than housing, food, or transportation as a financial concern for many.

2. Widespread Financial and Lifestyle Adjustments: Forty-six percent of Americans made lifestyle or financial changes in 2025 to afford treatment, compared to 37% the year prior. Common actions included cutting back on leisure (30%) and essentials like food or clothing (28%), dipping into savings (16%), selling belongings (9%), or working more (15%). Some also incurred debt—25% used credit cards and 18% borrowed from family or friends.

3. Health Choices Impacted by Cost: Forty-two percent of respondents altered how they used prescriptions due to cost in 2025, up from 34% in 2024. These changes included delaying refills (16%), rationing doses (20%), and stopping medication altogether (13%). The report underscores a growing reliance on discount programs and copay cards, with a call to expand access and support to ease the burden.

Illinois Gov. Jay Pritzker signs pharmacy benefit manager regulation bill that prohibits ‘spread pricing’

By Allison Bell - Illinois Gov. Jay Pritzker has signed a bill that will establish a broad new framework for pharmacy benefit manager regulation in Illinois. The new state law, the Prescription Drug Affordability Act, will… Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. New Illinois PBM Regulations Aim to Increase Transparency and Limit Profit Practices: Illinois has enacted a law that regulates pharmacy benefit managers (PBMs) by requiring them to pass all negotiated drug rebates to employers, banning spread pricing and patient steering to preferred pharmacies, and mandating annual reports and audits. These rules primarily apply to employers with fully insured health plans.

2. Self-Insured Employer Plans Remain Exempt Due to Federal Preemption: The new law does not apply to self-insured employer plans, which are generally exempt from state regulation under the federal Employee Retirement Income Security Act (ERISA). This limits the scope of the law’s impact on larger or multistate employer plans.

3. Additional Health Reforms Target Insurance Practices and Mental Health Access: Governor Pritzker also signed the Healthcare Protection Expansion Act, which, among other provisions, requires insurers to cover patient travel for out-of-network care, restricts non-health-related expenses in medical loss ratios, and prohibits prior authorization requirements for mental health emergencies. Like the PBM law, it exempts self-insured plans.

Benefits Think: Support builds for employers' healthcare rescue role

By Andrew J. Seligsohn and Shawn Gremminger - Americans are feeling the squeeze of high prices across the economy — in both discretionary categories and core needs. Healthcare costs are a key concern, with rising provider prices as the greatest driver and this will likely remain so given the potential changes to Medicare, Medicaid and federal regulations of insurance markets. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Employees Want Employers to Act on Healthcare Costs: While employers have traditionally been hesitant to engage directly in healthcare cost control, fearing negative employee reactions, research indicates those concerns are unfounded. According to the survey, nearly two-thirds of respondents believe employer-based health insurance needs improvement, and eight in ten support public advocacy by employers to negotiate lower provider prices. This signals strong demand among employees for more active employer involvement in managing healthcare expenses.

2. Broad Support Exists for Policy Reform, But Trust in Government Is Low: The majority of respondents back regulatory measures to rein in healthcare costs—nearly 90% are concerned about high prices charged by hospitals, doctors, and other providers. There is strong support for policies such as mandatory price disclosures and caps on provider charges. However, only one-third of respondents trust government agencies to reduce costs effectively, and just 20%trust elected officials to do so, reflecting a deep skepticism about government-driven reform despite widespread demand for it.

3. Employers Are Viewed as Trustworthy Advocates: In contrast to government, employers are seen as more credible and better positioned to advocate for affordable healthcare. While employers do not set policy, they can use their influence—particularly by working with benefit brokers, advisers, and organizations like the National Alliance of Healthcare Purchaser Coalitions—to push for systemic changes. This approach is supported by eight in ten respondents, who favor collective employer action to negotiate fairer prices. The urgency is underscored by national healthcare spending, which reached $4.5 trillion in 2022, with rising provider prices being a major cost driver.

Novo abruptly ends obesity drug deal with Hims

By Jonathan Gardner - Novo Nordisk is terminating a marketing deal for its obesity drug Wegovy with Hims & Hers Health just eight weeks after it began, claiming the telehealth company “has failed to adhere to the law which prohibits mass sales of compounded drugs.” Read Full Article…

HVBA Article Summary

1. End of Drug Shortage Ends Compounded Versions: Hims and other telehealth companies had legally offered compounded versions of Wegovy during an FDA-declared shortage, which allowed them to grow rapidly in the obesity drug market. Now that the shortage has officially ended, Novo Nordisk is requiring partners to stop compounding and instead transition patients to its branded version of the drug.

2. Novo Nordisk Targets Safety and Market Control: Novo Nordisk criticized Hims for selling what it described as unsafe, compounded “knock-off” versions of obesity drugs using foreign or unverified ingredients under the claim of personalization. To regain control of the market and ensure supply, Novo has expanded its manufacturing capacity, including acquiring Catalent for $16.5 billion, and is now pushing partners to steer patients toward approved branded treatments.

3. Conflict Over Patient Choice and Market Tactics: Hims terminated its partnership with Novo, alleging that the pharmaceutical giant was trying to dictate clinical decisions and pressure providers to prescribe Wegovy regardless of individual patient needs. Hims framed the move as a defense of patient autonomy and clinical independence, but the fallout led to a sharp 30% drop in its share price amid investor concern.