Trump administration demands pharma companies begin drug price negotiations, a day after key deadline

By Daniel Payne - The Trump administration is pushing pharmaceutical companies to begin negotiations to bring their drug prices in line with what other countries pay — usually far less than Americans. “Under President Trump’s direction, HHS is demanding that pharmaceutical companies end their obstruction and come to the table—just as they already do with nearly every other economically comparable nation—to negotiate fair, transparent pricing for Americans,” an agency spokesperson said in a statement to STAT, adding that the companies were “prevent[ing] progress of lowering prices for the American people.” Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Lack of Specific Pricing Details Slows Progress: While pharmaceutical companies have held discussions with the administration, the negotiations have primarily involved broad conversations about the pharmaceutical market rather than specific pricing details. Companies are waiting for clearer information on which drugs will be included and how price targets will be determined, creating uncertainty and slowing progress.

2. Administration Proposes Direct-to-Consumer Sales at Lower Prices: The administration has announced plans to allow American patients to buy certain drugs directly from manufacturers at a "Most-Favored-Nation" price — the lowest price offered in comparable developed countries. However, important aspects of how this mechanism will function, especially for those with insurance coverage, have not yet been clarified.

3. Legal and Strategic Concerns Influence Industry Response: Drugmakers are weighing potential legal challenges to the policy and are hesitant to make binding commitments without more detailed guidance from the administration. Some companies also fear being publicly singled out by the Trump administration, contributing to a cautious and strategic approach as they consider their next moves.

DOL secretary talks about self-insured employer plans and PBM regulation at House hearing

By Allison Bell - U.S. Labor Secretary Lori Chavez-DeRemer seems to be warm to the idea of continuing to give employers' self-insured health plans freedom from state benefits regulations but leery about discussing the details. Chavez-DeRemer — a former House member who was confirmed to the Labor secretary post in March — took a question about self-insured health plans and the Employee Retirement Income Security Act last week, during a House Education and the Workforce Committee hearing on Labor Department priorities. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. ERISA Preemption Support: During the confirmation hearing, Chavez-DeRemer reaffirmed the Department of Labor’s ongoing commitment to the traditional ERISA self-insurance system and ERISA preemption, which exempts large, self-funded employer health plans from state-level benefit mandates and regulations. This protection has long been defended by industry groups as essential for maintaining stable and uniform employer-sponsored coverage across states.

2. Focus on Lowering Health Care Costs: Chavez-DeRemer highlighted the administration’s overarching objective to lower health care costs while ensuring employees have access to high-quality, affordable health coverage. She indicated a willingness to collaborate with private businesses and public entities and cited active discussions on regulating pharmacy benefit managers (PBMs) and promoting association health plans as part of broader efforts to improve employer-sponsored health benefits.

3. Pending Regulations on Short-Term Health Insurance: When questioned about short-term health insurance policies, Chavez-DeRemer noted that the Labor Department is still drafting regulations and cannot provide detailed answers at this stage. She emphasized that the final rules will be shaped through engagement with Congress and input from various stakeholders, reflecting ongoing deliberations about the role of short-term, lower-cost plans in the broader insurance market.

How AI Is Helping Psychiatrists Make Faster, Smarter Treatment Decisions

By Antônio Geraldo da Silvam and Anderson Gobbi - Psychiatrists often face a frustrating truth: half of all patients with major depressive disorder don’t respond to their first prescribed treatment. In many cases, it can take months of trial and error to find a therapy that works. But artificial intelligence may soon help change that. Read Full Article…

HVBA Article Summary

1. AI enables personalized antidepressant selection: Leveraging a wide range of patient-specific data — including brain imaging, genetic information, electronic health records, and passive smartphone data — AI models are achieving promising accuracy in predicting which antidepressants, such as SSRIs or bupropion, are most likely to work for individual patients, offering a more targeted approach than traditional trial-and-error methods.

2. Real-world applications are emerging globally: Large-scale clinical trials, such as those underway in Brazil, are embedding AI tools directly into psychiatric practice. By training models on data from hundreds of patients, these initiatives aim to personalize medication selection, reduce treatment dropouts, minimize adverse effects, and integrate AI into everyday mental health care workflows.

3. Ethical oversight is essential: As AI becomes more involved in psychiatric decision-making, strong safeguards around patient privacy, informed consent, data security, and the explainability of AI recommendations are critical. Regulatory bodies in Brazil and other countries are beginning to develop frameworks to ensure these technologies are implemented responsibly in clinical settings.

This platform simplifies healthcare navigation

By Lee Hafner - Thanks to a complex healthcare system, employees are burning hours and energy searching for the right providers and solutions. By offering comprehensive platforms that cater to some of the biggest health needs, such as preventative care and chronic conditions, benefit leaders can help workers quickly access the right care and achieve better results, says Dr. Jeff Jaques, the chief medical officer at digital health and well-being platform Personify Health. The best options have the right balance of human expertise and technology, he says. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Healthcare Navigation Is Overwhelming and Time-Consuming: Many employees are frustrated by the complexity of the healthcare system, facing high costs, long wait times, and burdensome coordination tasks — often spending around eight hours a month arranging care. Without better navigation tools, these issues are likely to worsen due to clinician shortages and rising healthcare expenses, making it harder for individuals to access timely and affordable care.

2. Integrated, User-Friendly Platforms Create Meaningful Benefits: Comprehensive healthcare platforms that combine AI-powered recommendations, expert support, and multi-channel engagement can guide employees through their healthcare journey. By integrating clinical, emotional, financial, and social support into one user-friendly system, these solutions help individuals make better health decisions, engage more frequently, and ultimately lower healthcare costs for both employees and employers.

3. Employers Gain a Competitive Edge with Comprehensive Benefits: Health insurance remains the most valued benefit for employees, but organizations that go further by offering simplified, comprehensive care navigation demonstrate a deeper commitment to employee well-being. This approach not only helps current staff but also serves as a key differentiator in attracting and retaining top talent, as job candidates increasingly evaluate employers based on the quality and accessibility of their healthcare offerings.

Benefits Think: How Trump's Rx executive order would slash costs

By André Wencker - President Donald Trump's executive order on May 12 instituting most-favored-nation (MFN) pricing of prescription drugs sought to ensure that Americans would pay no more than the lowest price charged in similar countries. Using an MFN model to set U.S. drug prices would have a considerable positive effect on American consumers, employers and governments. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. High U.S. Drug Prices vs. Other Countries: Americans pay 4.5 to 4.8 times more for drugs at the manufacturer level compared to countries like France and the UK, while consuming about 30% less medicine overall. This pricing disparity contributes to higher healthcare costs and is linked to lower life expectancy and health-adjusted life expectancy in the U.S. relative to Western Europe.

2. Potential Savings from MFN Pricing: Introducing a Most Favored Nation (MFN) pricing model, which ties U.S. drug prices to those in lower-priced countries, could yield massive savings—potentially reducing drug spending by $469 billion to $477 billion annually, and by up to $4.8 trillion over a decade. Additionally, lower drug prices would increase taxable income by reducing tax-deductible employer health plan expenses, further benefiting federal and state budgets.

3. Legal and Political Challenges: Despite the potential economic and systemic benefits of MFN pricing—including simplifying healthcare administration and curbing intermediaries like pharmacy benefit managers—strong legal opposition from the pharmaceutical industry remains. Without legislative reform and bipartisan support, implementing such a system remains legally and politically difficult under current regulations.

Industry Voices—Can payers collaborate with providers to control care costs?

By Theresa Hush - Recent strategy statements from the Centers for Medicare & Medicaid Services (CMS) make it clear that Medicare will hold providers financially accountable for patients’ care costs. Until now, CMS value-based payment models have been soft on cost control. For shared savings accountable care organizations, the CMS capped total risk and allowed providers to take time in accepting downside risk. No more. We can expect to see capitation and episodic payments in every value-based care payment model. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Comprehensive data integration is essential for value-based care success: To thrive under risk-based reimbursement, ACOs and providers must combine high-quality clinical data from EHRs with complete payer claims data. This integration allows them to accurately assess patient health, manage chronic conditions, prevent complications, and control costs while maintaining care quality.

2. Current payer-provider data sharing is insufficient and creates care gaps: The lack of full claims data from commercial insurers leaves providers with an incomplete view of patient care, especially for services delivered outside their organizations. This "cost blindness" hinders their ability to identify cost drivers, address preventable complications, and coordinate care effectively, which puts both patient outcomes and financial performance at risk.

3. Collaboration and innovation are needed to overcome data sharing barriers: While payers are hesitant to share claims data due to concerns over proprietary information and competitive pricing, there are feasible solutions—such as data masking, bundling, or third-party intermediaries—that can protect sensitive information while enabling providers to access the essential data needed for true value-based care collaboration.