As drug price target deadline looms, pharma companies weigh options

By Daniel Payne - Trump administration officials are expected to release more details on their plan to lower prescription drug prices in the coming days and have been meeting with pharmaceutical industry leaders about the potential impacts. The drug companies, in turn, have been gaming out possible scenarios — and strategizing how they may respond to the White House, five people involved in the planning said. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. New Drug Pricing Policy Introduced: The Trump administration unveiled a "most-favored nation" policy designed to lower U.S. drug prices by aligning them with the lowest prices paid in other countries. President Trump signed an executive order requiring the Department of Health and Human Services to set specific price targets within 30 days, initiating a process of negotiations with pharmaceutical companies.

2. Uncertainty and Negotiations Ongoing: Key details of the policy remain unsettled, including which drugs will be targeted, the method of price reductions, and the potential enforcement mechanisms. Pharmaceutical companies are exploring different scenarios and outcomes as they engage in early-stage, high-level discussions with administration officials, with more concrete negotiations expected soon.

3. Industry Concerns and Possible Legal Challenges: The pharmaceutical industry has voiced strong concerns that the proposed pricing model could limit revenue for research and development, potentially harming innovation. While some companies are considering legal options to challenge the policy, many industry leaders remain cautious and are waiting for additional details before deciding on a definitive legal or negotiating strategy.

Benefits Think: How the power of process drives a strategic approach

By Butch Zemar - In the fast-paced world of employee benefits, too many consultants and brokers focus on results — revenue growth, client retention and premium reductions — without giving due attention to the processes that generate those outcomes. Revenue is a byproduct of well-executed processes and prioritizing strategic planning, operational efficiency and continuous improvement leads to long-term success for both consultants and the employers they serve. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Process Over Quick Wins: Sustainable business growth depends on developing disciplined, repeatable processes rather than chasing short-term revenue spikes or large clients without fixing underlying inefficiencies. A consistent, process-driven approach allows businesses to scale effectively and avoid amplifying existing problems.

2. Strategic Use of Technology: AI, automation, and digital tools offer significant opportunities to streamline operations, reduce errors, and improve cost management in benefits consulting. However, successful adoption requires a long-term view, proper training, and a phased implementation strategy to fully capture the return on investment.

3. Advisory Role & Long-Term Cost Control: Benefits consultants should shift from transactional selling and annual premium negotiations toward acting as strategic advisors. By helping clients implement proactive, multi-year cost containment strategies and collaborating closely with CFOs, consultants can align benefits programs with broader financial and organizational goals, delivering sustained value.

Drug pricing reform talks with US government lack clarity, industry executives say

By Bhanvi Satija and Christy Santhosh - Talks with the Trump administration about lowering U.S. drug prices have so far not provided clarity on when and how reduced prices will be implemented, top executives from Eli Lilly (LLY.N), and Merck (MRK.N), said at an industry conference on Tuesday. Read Full Article…

HVBA Article Summary

1. Executive Order on Drug Pricing: President Trump issued an executive order directing U.S. drugmakers to lower medicine prices by aligning them with the lowest prices paid by other high-income nations. The administration aimed to establish "most favored nation" price targets within 30 days, putting pressure on pharmaceutical companies to adjust their pricing structures.

2. Ongoing Discussions with Unclear Outcomes: Executives from major pharmaceutical companies including Pfizer, Merck, Lilly, and AbbVie reported that while discussions with the Trump administration are taking place, they remain focused on broad concepts without detailed negotiations. As of now, no specific agreements, timelines, or concrete policy frameworks have been finalized.

3. Complexity of Reform Implementation: Industry leaders emphasized that achieving meaningful drug pricing reform would likely involve complex regulatory adjustments or international negotiations between governments. This indicates that any significant changes may take considerable time and face multiple legal and logistical hurdles before becoming actionable.

Value-based care: How good ideas get crushed

By Mark Newman - Remember when value-based care was going to revolutionize American healthcare? A decade later, we’re still waiting while costs keep climbing. What happened? Simple—the healthcare industrial complex did what it always does: absorbed innovative ideas and neutralized them. Read Full Article…

HVBA Article Summary

1. Value-based care, while conceptually sound, has added complexity without curbing rising healthcare costs: Although value-based care aims to align payments with patient outcomes rather than service volume, its implementation alongside existing fee-for-service models has led to greater administrative complexity. Despite years of experimentation, healthcare spending continues to outpace inflation, with both premiums and out-of-pocket costs steadily increasing.

2. Innovative care models that bypass traditional insurance systems show greater success: Alternative models like direct primary care operate outside of the traditional insurance framework, eliminating middlemen and offering patients and employers clear, upfront pricing. These models are gaining rapid adoption, with a growing number of physicians transitioning to direct care arrangements, highlighting their appeal in delivering more efficient and patient-centered care.

3. Employers can play a pivotal role in reshaping healthcare delivery: By actively demanding full access to healthcare spending data, negotiating direct contracts with providers, and adopting alternative payment models such as HSAs or direct care subscriptions, employers can significantly reduce administrative waste. These actions not only lower costs but also improve employee access to high-quality care while minimizing bureaucratic inefficiencies.

Drug price reform: 5 state-level bills and their potential national impacts

By Wes Hill - By mandating full rebate pass-through and requiring “any willing provider” inclusion in pharmacy networks, SB 41 challenges some of the industry’s most entrenched practices. Given the sweeping nature of the provisions in this bill, it has the potential to have broad implications for the PBM landscape and could pave the way for wider adoption of similar reforms in other states. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Minimum Reimbursements for Critical Access Pharmacies: Illinois HB 3705 requires that critical access pharmacies be reimbursed at a minimum rate of the national average drug acquisition cost (NADAC) plus $15.55 per prescription. This provision is designed to help ensure these pharmacies can continue operating, especially in rural or underserved communities where access to pharmacy services is often limited.

2. Prohibition of Spread Pricing and Increased Transparency: The bill eliminates spread pricing by prohibiting PBMs from reimbursing pharmacies less than 90% of what they charge plan sponsors, addressing a major concern about PBM profit practices. It also increases rebate transparency by mandating that PBMs return at least 90% of manufacturer rebate payments directly to plan sponsors, aiming to reduce hidden costs in the drug supply chain.

3. Potential Cost Impact on Plan Sponsors: Supporters argue the bill will protect access to pharmacy care in vulnerable areas, but critics, including PBMs, warn that the increased reimbursement rates and transparency requirements may lead to higher costs for plan sponsors, as PBMs are likely to shift these expenses to employers and insurers once the law takes effect on January 1, 2026.

Beyond pay: How tailored benefits drive employee loyalty and retention

By Todd Martin - Picture this: You invest months recruiting and developing a top performer—only to watch them walk out the door six months later. Not for more money. Not for a bigger title. They left because someone else offered benefits that better fit their life—and their future. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Personalized Benefits Drive Retention: Today’s diverse workforce demands benefit programs tailored to individual life stages, goals, and priorities. Offering flexible, customizable options—such as health plans, mental health support, family care, and hybrid work arrangements—not only meets employees’ evolving expectations but also strengthens loyalty, engagement, and long-term retention.

2. Cost-Shifting Creates Long-Term Risks: Shifting rising healthcare costs onto employees through higher deductibles and out-of-pocket expenses may offer short-term financial relief for employers, but it often results in employees delaying or avoiding care. This leads to higher-cost claims down the road, decreased employee wellbeing, and erosion of trust and engagement—ultimately creating greater financial and cultural risks for organizations.

3. Ongoing Communication Builds Value: Providing benefits is only effective if employees fully understand and utilize them. Year-round, clear, and accessible communication—combined with employee feedback—ensures workers are aware of their options and feel supported. This ongoing dialogue drives higher utilization, increases satisfaction, and strengthens trust in leadership, making benefits a true driver of organizational success.

Health care costs soar to $1,425 out-of-pocket, vary wildly by state

By Alan Goforth - “Sharp increases in health care costs in recent years have made it difficult for some people to seek essential care,” WalletHub analyst Chip Lupo said. “Even in states with lower-than-average health care prices, residents’ incomes may not be enough to keep up with the cost, especially since virtually every part of Americans’ budgets has been impacted by inflation over the past few years.” Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Health care costs vary widely by state and can place a significant strain on household finances: WalletHub analyzed five key health care expenses across all states, showing that these costs, when compared to median household income, can consume a substantial portion of a family’s budget depending on where they live.

2. Adopting preventive measures and maintaining a healthy lifestyle are essential for reducing long-term health care expenses: Engaging in regular exercise, eating a balanced and nutritious diet, staying hydrated, getting enough sleep, and using preventive care services can help individuals avoid costly medical treatments and manage chronic conditions before they become serious.

3. Careful financial planning and smart money management can help individuals better cope with rising health care costs: Tactics such as securing adequate health insurance, budgeting for premiums and emergency funds, using telehealth services when appropriate, taking advantage of health savings accounts for tax benefits, and responsibly using rewards credit cards for medical payments can all contribute to lowering overall health care expenses.