Cassidy is circulating a proposed law to push down U.S. drug prices, backing a key Trump ambition

By John Wilkerson - Senate health committee Chair Bill Cassidy (La.) is the latest Republican to take an interest in legislation that would tie U.S. brand drug prices to lower prices in other wealthy countries, according to seven people following the issue. Republicans historically have opposed using so-called most-favored nation policy to lower drug prices, but that appears to be changing as President Trump backs the approach. Read Full Article… ^{_{(Subscription required)}}

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1. Draft Legislation Linking U.S. Drug Prices to Foreign Prices: Senator Cassidy has reportedly circulated a draft bill among industry lobbyists that would tie Medicare drug prices to the prices charged in selected foreign countries. However, the details of the draft remain uncertain, as no official text has been released and it is unclear if the version being discussed is current or has since been revised.

2. Different Proposals with Varying Scopes and Enforcement: Cassidy’s proposal would focus specifically on Medicare and include provisions for Medicare to recover overpayments when drug prices exceed foreign reference prices. In contrast, a separate bipartisan bill introduced by Senators Hawley and Welch would apply to all retail prescription drugs and enforce compliance through substantial civil monetary penalties based on price differences between the U.S. and several foreign countries.

3. Political and Legislative Context: Historically, Republicans have resisted policies they view as government price controls, and no Republicans supported the 2022 law authorizing Medicare to negotiate some drug prices. Nonetheless, recent bipartisan proposals indicate growing interest in considering international pricing models as a potential strategy to lower U.S. drug costs, although significant policy disagreements remain.

Congress Introduces Bill to Strengthen Healthcare Cybersecurity

By Allison Bell - UnitedHealthcare has made a new move in the fight to cope with sky-high costs for severe psoriasis, Crohn's disease and other chronic health conditions. The UnitedHealth Group division is taking Johnson & Johnson's Stelara — one of the most popular, best-known and most expensive "biologic" anti-inflammatory drugs — off the standard formulary for many plans in New York and New Jersey starting Sept. 1, according to a recent prescription benefits update. Read Full Article… ^{_{(Subscription required)}}

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1. UnitedHealthcare is shifting coverage to biosimilars: UnitedHealthcare plans to promote the use of two biosimilar versions of ustekinumab — Steqeyma and Yesintek — over the original Stelara. Patients may be required to obtain prior authorization or participate in step therapy programs, where they must try lower-cost options before being allowed to use Stelara in certain cases.

2. Biosimilars offer significant cost differences: There is a large price gap between the original drug and its biosimilars. For uninsured patients not receiving any discounts, Stelara’s annual cost can reach approximately $148,000, while Steqeyma and Yesintek are priced much lower at about $25,000 and $18,000 per year, respectively, making biosimilars a more affordable alternative.

3. Major insurers are adjusting formularies to manage costs: To control rising healthcare expenses, insurers like UnitedHealthcare, Cigna, and CVS are increasingly updating their formularies to prioritize lower-cost biosimilars for expensive anti-inflammatory drugs. UnitedHealthcare has taken a notable step by being one of the first large pharmacy benefit managers to completely remove Stelara from its standard formulary.

Four Ways Trump’s ‘One Big Beautiful Bill’ Would Undermine Access to Obamacare

By Julie Appleby - Major changes could be in store for the more than 24 million people with health coverage under the Affordable Care Act, including how and when they can enroll, the paperwork required, and, crucially, the premiums they pay. Read Full Article…

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1. Proposed Policy Changes Increase Administrative Requirements: The House-passed “One Big Beautiful Bill” would introduce new documentation requirements for ACA enrollees, ending automatic reenrollment and provisional eligibility for subsidies. Supporters argue this would reduce fraud and improper payments, while critics warn it could create burdensome paperwork and discourage enrollment, particularly affecting vulnerable groups.

2. Shortened Enrollment Periods and Special Enrollment Changes: The bill would shorten the annual ACA open enrollment period and eliminate a Biden-era special enrollment option for lower-income individuals. Proponents cite concerns about fraud and abuse under current policies, while opponents worry these changes could limit access to coverage for people experiencing life changes or with limited financial resources.

3. Potential Cost Increases Due to Expiring Subsidies: Enhanced premium subsidies enacted during the pandemic are set to expire, and the House bill does not propose extending them. Without these subsidies, millions could face significantly higher premiums, leading to an estimated 4.2 million more uninsured people by 2034, according to the Congressional Budget Office.

Real-World GLP-1 Weight-Loss Results Differ From Trials

By Miriam E. Tucker - In the real world, the use of semaglutide (Wegovy) and tirzepatide (Zepbound) produce far less weight loss than in the randomized clinical trials, largely because people discontinue using them early or use lower maintenance doses, new research found. Read Full Article…

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1. High Discontinuation Rates and Predominant Use of Low Maintenance Doses in Real-World Practice: In real-world data from the Cleveland Clinic, over 80% of patients prescribed semaglutide or tirzepatide used lower-than-recommended maintenance doses, and many discontinued treatment within the first year—more frequently than seen in controlled clinical trials. Despite these lower doses and high discontinuation rates, patients still achieved moderate weight loss, though typically less than outcomes reported in trials.

2. Weight Stability and Glycemic Improvements Persist Even After Early Discontinuation: Unlike randomized trials where discontinuation often leads to rapid weight regain, real-world patients generally maintained stable weight after stopping the medications. Furthermore, many patients with prediabetes continued to show improvements in A1c levels, with a substantial portion even returning to normoglycemia despite discontinuing treatment early.

3. Greater Weight Loss and Diabetes Prevention Linked to Higher Doses and Longer Treatment Duration: Patients who remained on higher doses for at least a year experienced significantly greater weight loss—up to 18% with tirzepatide—and were less likely to progress from prediabetes to type 2 diabetes. These findings emphasize the added metabolic benefits of longer treatment adherence and full-dose therapy.

53% of benefit managers know their wellness programs are failing employees

By Alyssa Place - Despite a near-universal rollout of wellness initiatives across organizations, the stark reality is that most well-being programs aren't meeting employees' needs. New findings from Insurope's annual Global Employee Benefits and Multinational Pooling Market Report reveal that while 84% of HR leaders believe wellness solutions have a positive impact on retention, absenteeism and employee satisfaction, many programs are falling short. Poor alignment with company culture, lack of personalization and low engagement were some of the top reasons for the disconnect. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Leadership Disconnect Undermines Wellness Efforts: More than half of benefit managers acknowledge a gap between the wellness programs offered and the daily actions of leadership. This disconnect creates a lack of authenticity, leading to reduced employee trust, lower engagement, and diminished participation in wellness initiatives, regardless of how comprehensive the programs may be.

2. One-Size-Fits-All Programs Fall Short: Many existing wellness programs are not inclusive or adaptable enough to meet the varied needs of today’s diverse workforce, spanning different generations, life stages, and personal circumstances. Without offering customizable options that support whole-person health — including physical, financial, and emotional well-being — companies risk continued low engagement and limited program effectiveness.

3. Employee Feedback is Crucial for Success: Actively gathering and implementing employee feedback is essential for building effective wellness strategies. When organizations listen and respond to their employees’ most requested benefits — such as flexible work arrangements, financial wellness programs, mental health support, and career development opportunities — they foster higher engagement, stronger retention, and a healthier organizational culture.

Congress Introduces Bill to Strengthen Healthcare Cybersecurity

By James Coker - US legislators have introduced a new Healthcare Cybersecurity Bill to Congress, which is designed to expand the federal government’s role in preventing and responding to data breaches of Americans’ medical data. Congressman Jason Crow (D-CO) introduced the bi-partisan legislation on June 10 as part of efforts to tackle surging healthcare data breaches in the US. Read Full Article…

HVBA Article Summary

1. Massive Data Breach Impact: In 2024, a ransomware attack on Change Healthcare led to the exposure of personal and medical data for approximately 190 million U.S. citizens. The incident not only compromised sensitive information but also caused widespread disruption to patient care and healthcare operations.

2. Legislative Response: The proposed Healthcare Cybersecurity Bill seeks to enhance cybersecurity protections across the healthcare and public health sectors. It mandates close collaboration between CISA and HHS to improve cyber threat intelligence sharing, provide specialized training to healthcare organizations, develop comprehensive risk management plans, and report progress to Congress.

3. Regulatory Updates: The Department of Health and Human Services announced plans to strengthen the HIPAA Security Rule, requiring healthcare providers to implement advanced security measures. These updates include setting authentication standards for IT system access and mandating continuous evaluation and testing of security protocols to better safeguard protected health information.

'The benefit platform wars have begun': Capital Rx absorbs Amino Health

By Noah Tong - Alternative pharmacy benefit manager and administrator Capital Rx is acquiring Amino Health, a care navigation company. The acquisition, the company said, will allow CapitalRx to offer a better member-facing experience to complement its unified claims platform on the back end. Read Full Article…

HVBA Article Summary

1. Capital Rx Expands with Amino Health Acquisition: Capital Rx, which serves 4 million members through its PBM business, acquired Amino Health to enhance its care navigation capabilities, enabling integrated medical and pharmacy claims processing alongside provider search, cost estimates, and appointment booking in one platform.

2. Strategic Focus on Unified Data and Scalability: The acquisition addresses previous challenges around data access by combining both companies' technologies into a single system that offers real-time, accurate information across claims and benefits, aiming for improved scalability and member experience.

3. Positioning in a Consolidating Market: With the integration of Amino Health and the creation of Judi Care, Capital Rx aims to compete more directly with other comprehensive benefit platforms like Transcarent, responding to employer demand for consolidated, one-stop health benefit solutions.