Hospital contract provisions drive up employer plan costs, says Trump's economists

By Allison Bell – The people who give President Donald Trump advice about economics think that limiting the provisions hospital negotiators put in their provider network contracting could save employers and workers a lot of money. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Anticompetitive Contract Clauses Increase Employer Costs: A report from the White House Council of Economic Advisers argues that certain hospital contracting practices limit competition in markets where about 24% of employer health plan enrollees live. In those areas, dominant hospitals and affiliated physicians account for 57% of employer spending. The economists estimate that eliminating these provisions could reduce hospital prices by 18% and physician prices by 10%. If most of the savings flow through to employers and workers, overall coverage costs could fall between 4.1% and 9.2%, with a midpoint of 6.5%.

2. Potential Savings for Workers and Families: The analysts project nationwide savings of $20 billion to $35 billion annually if the contracting provisions were banned. That would translate into roughly $606 in yearly savings for workers with individual employer-sponsored coverage and about $1,755 for families. The report suggests that stronger insurer bargaining leverage would drive much of these reductions. Over time, increased competition could further compress prices as rival systems gain patient volume.

3. Policy and Legal Challenges Ahead: The economists focus on three mechanisms—anti-steering, anti-tiering and all-or-nothing bundled contracting—that they say often appear together and limit plan flexibility. Hospitals counter that they face high capital and labor costs and warn that financial pressures have already led to closures. The Department of Justice has recently challenged similar contract provisions, indicating growing regulatory scrutiny. However, past court rulings, including one involving vision plan steering restrictions, suggest that implementing broad bans could face legal hurdles.

PCMA Sues to Block Illinois, Tennessee PBM Laws, Citing ERISA Preemption

By James Van Bramer – The Pharmaceutical Care Management Association filed separate federal lawsuits challenging newly enacted pharmacy benefit manager laws in Illinois and Tennessee, arguing the state measures unlawfully interfere with employer-sponsored health plans governed by the Employee Retirement Income Security Act. The complaints, filed last week in U.S. district courts in Illinois and Tennessee, mark the latest escalation in the legal battle over state efforts to regulate PBMs. The pharmaceutical gatekeepers have faced increasing scrutiny from lawmakers, regulators and employers into prescription drug pricing and business practices. Read Full Article...

HVBA Article Summary

1. State Laws Target PBM Business Practices: In Illinois, the trade group is seeking to block the Prescription Drug Affordability Act, arguing that its pharmacy network restrictions and reporting mandates would raise costs for self-insured employers and limit their flexibility in designing benefits. State officials, including Governor JB Pritzker, have defended the law as a way to curb what they describe as predatory practices and to support local pharmacies. In Tennessee, the challenged FAIR Rx Act would prohibit PBMs from owning or controlling pharmacies, a move supporters say would improve pricing transparency. The PCMA contends the Tennessee measure could force the closure of more than 160 affiliated pharmacies and disrupt patient access.

2. Federal Preemption at the Center of the Dispute: The lawsuits hinge on the argument that ERISA preempts state laws that affect self-funded employer health plans. The association also claims the Tennessee statute conflicts with federal Medicare rules by influencing pharmacy network design. This legal strategy reflects a broader effort by PBMs and employer groups to shield multistate benefit plans from varying state requirements. Similar preemption concerns have been raised in other states, including California, where employer advocates warned that regulating PBMs without exemptions for self-funded plans could invite litigation.

3. Mounting Federal Oversight and Political Pressure: Even as PBMs challenge state reforms, they face expanding scrutiny in Washington. Congress has enacted new transparency requirements that will mandate detailed disclosures to employer health plans beginning in 2028, and the Department of Labor has proposed additional compensation reporting rules. Lawmakers have also introduced bipartisan legislation that would classify PBMs as fiduciaries under ERISA, potentially increasing their legal responsibilities. Congressional hearings have highlighted concerns about vertical consolidation in healthcare and the need to track compensation flows across related entities.

Insulin cost cap gets another look in Congress

By Peter Sullivan – A Senate plan to limit insulin costs in private insurance markets is getting new life after a key committee gave it bipartisan backing. Read Full Article...

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1. Bipartisan Support Revives Proposal: The Senate health committee advanced the insulin cost cap measure with a 15-8 bipartisan vote when it was added as an amendment to another bill. Although the underlying bill was postponed, lawmakers signaled that negotiations are ongoing to resolve technical concerns. Chairman Bill Cassidy said his issues are largely about avoiding overlap with recent pharmacy benefit manager reforms rather than opposition to the concept. Supporters are aiming for further committee action as early as next month.

2. Expansion Beyond Medicare: Congress previously capped insulin costs at $35 per month for Medicare beneficiaries in 2022, and the new proposal would extend that protection to people with private insurance. The bill also proposes a pilot program in 10 states to limit insulin costs for uninsured individuals. Sponsors include Sens. Susan Collins, Jeanne Shaheen, Raphael Warnock and John Kennedy, reflecting bipartisan sponsorship. Advocates argue that broader federal action is needed to close affordability gaps that remain outside Medicare.

3. Ongoing Affordability Concerns and Political Hurdles: The American Diabetes Association says insulin remains unaffordable for nearly 30% of people, citing survey data, even after some drugmakers voluntarily lowered prices. Research suggests that state-level caps have not significantly increased insulin use among commercially insured patients. Some Republicans have expressed reservations about federal intervention in private insurance markets, which could complicate passage. The measure could potentially be folded into a larger health package during a lame-duck session if standalone progress stalls.

How sticking with ICHRAs minimizes disruption, part 1

By Bruce Shutan – With both fully insured and self-insured group health plan premium increases exceeding the rate of inflation in recent years, benefit brokers and advisers have grown accustomed to white-knuckling their way through annual renewals. But it doesn't have to be that way, according to proponents of individual coverage health reimbursement arrangements known as ICHRAs. They suggested locking in this emerging alternative to traditional health insurance coverage over a three-to-five-year time horizon to help stabilize soaring health benefit costs. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Long-term ICHRA commitments can reduce annual volatility: Industry proponents argue that shifting to a three-to-five-year strategy with ICHRAs can ease the turbulence employers face during yearly renewals. Because transitioning to an ICHRA requires education, decision-support tools and hands-on guidance, a short-term approach may undermine its effectiveness. Early anxiety during open enrollment often subsides once employees become familiar with their plans. A longer runway allows employers and workers to fully adapt and realize potential cost stability.

2. Frequent shopping of ICHRAs may create unnecessary disruption: Experts note that employers who attempt to re-shop ICHRAs every year risk interrupting employee experience and plan continuity. Early adopters who stay committed and clearly communicate the model’s value have been able to rebuild HR and benefits strategies around it. Comparing the approach to retirement savings, advisers emphasize the importance of focusing on long-term outcomes rather than short-term fluctuations. This mindset shift supports accumulation of HRA and HSA balances over time and encourages more strategic benefits planning.

3. Broader choice and risk pooling reshape the value proposition: Under an ICHRA model, employees may choose from five or six carriers and as many as 50 to 100 plan options, expanding flexibility compared to traditional group plans. Advocates highlight that the individual market spreads risk across roughly 20 million people, which can lead to more predictable renewal patterns. As group coverage grows more expensive relative to individual plans, more employers are reconsidering the model. Brokers who fail to develop ICHRA expertise may struggle to demonstrate their strategic value and risk losing clients.

FDA approves Colorado's plan to import prescription drugs from Canada

By Alan Goforth – The U.S. Food and Drug Administration has given the state of Colorado permission to import lower-cost prescription drugs from Canada. The Colorado Department of Health Care Policy & Financing outlined a plan to import drugs that will reduce costs while ensuring public health and safety, according to the agency. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Federal Approval Advances State Drug Importation Efforts: The FDA’s authorization allows Colorado to move forward with a long-planned program to import prescription drugs from Canada. State officials describe the decision as a critical milestone after years of preparation and legislative backing. The program is designed to reduce costs while maintaining safeguards for public health and safety. Leaders view the approval as an initial step before operational and manufacturer-related challenges are addressed.

2. Projected Cost Savings and Legislative Background: Colorado began pursuing drug importation in 2019 after the Legislature passed a bill enabling the health department to develop the program. According to the approved application, the state estimates savings of $46 million over three years through reduced insurance premiums and lower out-of-pocket expenses. Officials also note they can collaborate with willing manufacturers to expand savings beyond the drugs currently included in the application. The financial projections are based specifically on the medications outlined in the state’s submission to federal regulators.

3. Industry Concerns and Broader Policy Debate: While several other states have pursued similar importation proposals, hospital pharmacy representatives have questioned whether Canada’s market can meet U.S. demand. Critics argue that supply limitations could undermine the intended impact on drug prices. They have also urged policymakers to consider alternative reforms, such as addressing pharmacy benefit manager rebate structures and expanding pharmacists’ authority to substitute clinically equivalent biologics. The debate underscores broader disagreements over how best to control prescription drug costs nationally.

GLP-1 Era Demands a New Model of Obesity Care

By Manuela Callari – The explosive demand for GLP-1 receptor agonists has exposed a massive rift between patient behavior, clinical infrastructure, and societal perception. At a panel discussion during the HLTH Europe 2026 conference, healthcare leaders agreed that while the science of metabolic health has entered a new era, the systems managing it remain stubbornly archaic. Read Full Article...

HVBA Article Summary

1. Obesity Care Must Shift to Lifelong Metabolic Management: Panelists emphasized that GLP-1 therapies should not be treated as short-term weight loss tools but as part of ongoing chronic disease management. Clinicians are increasingly focusing on nutritional adequacy, muscle retention, and body composition rather than just calorie reduction. Evidence discussed at the conference showed that many patients regain most of their lost weight within 18 months of stopping medication. This pattern reinforces the need for sustained lifestyle and medical support rather than episodic treatment.

2. Access Barriers Create Stark Inequities: Speakers highlighted persistent stigma, with some healthcare systems still framing obesity as a lifestyle choice instead of a disease. In the UK, the NHS plans to expand access to about 220,000 patients over three years, while the private sector already issues roughly 1.4 million prescriptions per month. Because public coverage is typically limited to those with a BMI over 40 and multiple comorbidities, many others must pay out of pocket. This dynamic contributes to a widening socioeconomic divide in who can obtain advanced metabolic therapies.

3. Economic Models May Underestimate Societal Benefits: Panelists argued that conventional health technology assessments rely on outdated assumptions, such as requiring 21 GP visits per year to manage GLP-1 therapy. They contended that digital platforms and virtual care can deliver treatment more efficiently and at lower cost. Real-world data presented showed nearly a 50% reduction in workplace sickness days within six months for patients in structured GLP-1 programs. With more than 190 metabolic drugs in development and competition expected to lower prices over the next 5 to 10 years, speakers suggested obesity medications could become a standard preventive tool similar to statins.

‘Don’t be scared. Be prepared’: 6 steps for preventing workplace violence

By Ryan Golden – It’s not easy for HR professionals to ponder that workplace violence could happen at their organizations, Jennifer Shaw, founder of Shaw Law Group, said during a SHRM26 presentation Tuesday. Yet, the reality is that such violence may occur in any work environment. “Frankly, everyone at this conference should be in this room, because this stuff is so important,” Shaw said. Read Full Article... 

HVBA Article Summary

1. Written, Specific Plans Are Foundational: Panelists emphasized that employers should maintain standalone, written workplace violence prevention policies, even where not legally mandated. These policies should be accessible to employees and supplemented by site-specific response plans that clearly designate roles and reporting channels. Generic or boilerplate policies may create liability risks if they fail to address the realities of particular worksites or job functions. Tailored documentation can also help employers meet obligations under OSHA’s general duty clause.

2. Hazard Assessment and Training Must Be Detailed and Practical: Effective prevention begins with identifying the types of violence most likely to occur in a given workplace, whether from customers, co-workers, patients or personal contacts. The speakers referenced federal guidance outlining four categories of workplace violence to help employers structure their assessments. Training should go beyond slogans and clearly define warning signs and required responses, while avoiding unnecessarily graphic content. Courts and juries may scrutinize whether employers relied on generic, off-the-shelf programs rather than meaningful, customized instruction.

3. Documentation, Feedback and Legal Compliance Reduce Risk: Thorough, contemporaneous documentation of incidents — including who, what, when, where, why and how — can strengthen an employer’s legal position and reveal patterns over time. Employers are encouraged to continuously reevaluate policies and incorporate employee feedback, such as concerns about facility access or security gaps. At the same time, policies must be consistently enforced and psychologically informed, acknowledging local or national events that may heighten awareness. The overarching message from the panel was that preparedness requires both legal rigor and attention to employee well-being.

US telehealth utilization climbs 10.1% in Q1, led by mental health visits: Fair Health

By Cailey Gleeson – Telehealth utilization increased 10.1% across the U.S. from the fourth quarter of 2025 to the first three months of 2026, a new report from Fair Health found. Read Full Article...

HVBA Article Summary

1. Regional Growth Patterns Differ Across the U.S.: While telehealth use rose nationwide, the pace of growth varied by region. The Midwest and Northeast saw the largest relative increases, outpacing gains in the South and West. These regional differences suggest that adoption trends may be influenced by local market dynamics, provider availability or payer policies. Despite the variation, every region experienced measurable growth over the period.

2. Mental Health Dominates Telehealth Diagnoses: Mental health conditions ranked as the top diagnostic category for telehealth visits across all age groups and regions in the first quarter of 2026. More than half of patients with a telehealth claim were treated for a mental health condition, underscoring the modality’s central role in behavioral healthcare delivery. However, utilization for mental health was lower among the youngest children and adults 65 and older compared to the overall population. Other common telehealth diagnoses included respiratory infections, obesity-related conditions, endocrine disorders and musculoskeletal issues.

3. Urban-Rural Gap Persists Despite Faster Rural Growth: Patients in urban areas were significantly more likely to have a telehealth claim than those in rural communities. Even so, rural areas posted a stronger quarter-over-quarter growth rate than urban areas. This indicates that while access disparities remain, rural adoption is accelerating at a faster clip. The findings point to a gradual narrowing of the gap, though overall usage levels still differ considerably.