Health insurers promise RFK Jr. they'll fix prior authorization problems

By Allison Bell - Health insurers and their trade groups told Robert F. Kennedy Jr. and other federal regulators today that they will try to make the process of administering advance approval for patients' requests for coverage simpler and faster. America's Health Insurance Plans, the Blue Cross Blue Shield Association and the groups' member companies said that they will join together to… Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Streamlining Prior Authorization: Major health insurance organizations — including AHIP and the Blue Cross Blue Shield Association — have committed to overhauling the prior authorization process. This includes developing a standard electronic system, reducing the number of procedures requiring review, simplifying determination messages, and delivering faster decisions to both doctors and patients.

2. Patient-Centered Improvements: The insurers aim to make the process more patient-friendly by ensuring that individuals changing health plans can continue previously approved treatments without interruption. They also reaffirmed the practice of having clinical denials reviewed by live physicians, which helps preserve the integrity of medical decision-making.

3. Government Support and Accountability: Health leaders such as HHS Secretary Kennedy and CMS Administrator Dr. Mehmet Oz praised the insurers' voluntary commitments as a step in the right direction. They emphasized that the federal government will monitor the industry's progress closely to ensure meaningful reforms and hold stakeholders accountable to their promises.

The MFN Executive Order: A Global Reset for U.S. Pharma

By Glenn Hunzinger - The Trump administration reignited the U.S. drug pricing debate by signing a sweeping Executive Order on May 12, introducing a “Most Favored Nation” (MFN) pricing framework. This policy seeks to directly align what Americans pay for prescription drugs with the lowest prices paid in peer economies such as Germany, Switzerland, and Canada. Read Full Article…

HVBA Article Summary

1. Global Price Alignment Goals: The MFN Executive Order (EO) seeks to lower U.S. drug prices by tying them to the lowest prices paid internationally, aiming to reduce what the administration calls “global freeloading.” While the policy is ambitious, it faces major structural hurdles due to the fragmented U.S. pricing system and the absence of a legal enforcement mechanism to mandate compliance from manufacturers.

2. Affordability vs. Innovation Trade-offs: Although the EO could improve affordability for American patients in the short term, especially through potential DTC (direct-to-consumer) models, it risks shrinking pharmaceutical revenues. This revenue compression could negatively impact global R&D investments, particularly as other nations with fixed healthcare budgets may resist raising their own drug prices.

3. Geopolitical and Economic Uncertainty: By introducing the idea of using pharmaceutical pricing in international trade negotiations, the EO creates new geopolitical complexities. The U.S. may find itself in a contradictory position—seeking to import cheaper drugs while pressuring foreign governments to raise prices—potentially leading to trade tensions and supply chain disruptions.

Insurers pledge to smooth out the prior authorization process

By Paige Minemyer - Insurers large and small from across the country have announced a series of commitments they're making to reform one of the biggest pain points in the patient journey: prior authorization. Key steps include committing to reducing the number of services that are subject to prior auth, with "demonstrated" progress by Jan. 1, 2026. Read Full Article…

HVBA Article Summary

1. Major insurers pledge modernization of prior authorization (PA): Approximately 50 insurers, including the six largest publicly traded health plans and various Blue Cross Blue Shield organizations, have committed to streamlining and digitizing PA processes. A key goal is to enable 80% of electronic PA requests to be completed in real time by 2027, with a standardized framework in place by January 1, 2027.

2. Commitment to transparency, continuity, and accountability: Insurers have pledged to improve clarity around PA determinations, offer better patient communication, and preserve continuity of care during insurance transitions. Progress will be tracked and publicly reported to ensure accountability.

3. Mixed reactions and broader context: While industry and medical groups such as the American Academy of Family Physicians welcome the initiative, they emphasize that actual improvements in patient and provider experiences will be the ultimate measure of success. The effort comes amid rising public scrutiny of insurance practices, especially following recent high-profile events.

CMS drug price negotiations, explained

By Alexandra Murphy and Paige Twenter - CMS’ drug price negotiations are advancing, but new indications and exclusivity rules could complicate future pricing cycles. CMS gained the authority to negotiate list prices with drug manufacturers in 2022 with the Inflation Reduction Act. The law ended a 19-year ban on the government from directly negotiating the price of drug prices in Medicare Part D. Read Full Article… 

HVBA Article Summary

1. Legal and Policy Landscape: Despite strong opposition and lawsuits from the pharmaceutical industry, many legal challenges to Medicare drug price negotiations have failed. CMS Administrator Mehmet Oz has committed to defending the agency's authority, though uncertainties remain—especially regarding how future drug changes or international pricing directives may influence negotiations.

2. Negotiation Criteria and Timeline: Only brand-name drugs without generic or biosimilar competition and on the market for over 10 years are eligible for negotiation. CMS has finalized prices for 10 drugs effective January 1, 2026 (Part D), and is negotiating prices for 15 more drugs for 2027. Negotiations for Medicare Part B drugs will begin in 2028.

3. Significant Price Reductions: The negotiated prices represent substantial savings for Medicare. For example, Stelara's price drops from $13,836 to $4,695, and Imbruvica’s from $14,934 to $9,319. These reductions aim to curb high drug costs and improve affordability for beneficiaries.

Study: How does flexibility impact life insurance purchase decisions?

By Doug Bailey - In the world of life insurance, guarantees have long reigned as the gold standard—products with lifetime guarantees, no-lapse provisions, and steady premiums have been the go-to for risk-averse consumers. But new research suggests that the tide may be shifting to give more weight to flexibility —if, that is, financial professionals are willing to take the time to explain alternatives. Read Full Article…

HVBA Article Summary

1. Consumer Education Shifts Preferences: When consumers are given clear, jargon-free explanations of life insurance products—particularly regarding how cost and guarantee structures work—they tend to favor lower-cost policies with shorter guarantees. This challenges the long-standing assumption that lifetime guarantees are always preferred.

2. Cost and Flexibility Are Key Drivers: The study revealed that cost savings and policy flexibility are major decision-making factors for today’s life insurance buyers. Many respondents viewed the ability to save significantly over time and adjust their coverage as more valuable than having a fixed guarantee to an advanced age.

3. Presentation and Framing Matter: How life insurance options are communicated has a significant impact on consumer choices. When producers clearly present multiple policy options and explain how different scenarios could play out, consumers are more comfortable choosing flexible, lower-cost products over traditional, more rigid ones.

STRIDE: Semaglutide Reduces Progression of PAD by 54% in Type 2 Diabetes

By Patrick Cambell - New data from the STRIDE trial suggest the benefits of semaglutide 1.0 mg (Ozempic) on peripheral artery disease (PAD) in people with type 2 diabetes could be even more substantial than the initial trial indicated. Read Full Article…

HVBA Article Summary

1. Semaglutide improves walking ability and quality of life in PAD patients with type 2 diabetes: Results from the STRIDE trial showed that patients receiving semaglutide experienced significantly greater improvements in both maximum and pain-free walking distances, as well as enhanced quality-of-life scores after 52 weeks, compared to those on placebo. These improvements indicate meaningful functional benefits for patients with peripheral artery disease (PAD) and type 2 diabetes.

2. Benefits are independent of diabetes severity or treatment background: A detailed subanalysis presented at ADA 2025 revealed that semaglutide’s clinical benefits were consistent regardless of patients’ baseline HbA1c, duration or intensity of diabetes, BMI, or background use of SGLT2 inhibitors. This suggests that semaglutide is effective across a wide spectrum of patients with varying disease profiles.

3. Semaglutide may offer vascular protection beyond glucose control: Beyond its known effects on weight loss and glycemic control, semaglutide was shown to reduce the risk of PAD progression by 54% and improve cardiovascular and renal markers. These findings support its emerging role as a vascular protective agent that benefits multiple organ systems, including the heart, kidneys, and blood vessels.

The ROI of Mental Health in the Workplace: Data-backed insights for leaders

By Matthew Siegel, PhD - When Salesforce invested $6 million in comprehensive mental health programs, they saw a 42% reduction in sick days within 18 months—proving that employee well-being isn't an expense, but a strategic profit lever. This aligns with World Health Organization findings that depression and anxiety cost the global economy $1 trillion annually in lost productivity. Read Full Article…

HVBA Article Summary

1. Ignoring Mental Health is Financially Devastating: Untreated mental health conditions cost U.S. companies $47.6 billion annually, driven by lost productivity, absenteeism, and especially presenteeism, which is three times more expensive than employees simply staying home. Depression alone can cut productivity by 35%, underscoring the high price of inaction.

2. Investing in Mental Health Drives Tangible Returns: Companies that prioritize mental health experience measurable business benefits, including 30% lower employee turnover, 12% gains in productivity, and up to a 9:1 return on investment. Programs like those at Salesforce and Johnson & Johnson show how stigma reduction and sustained support can dramatically cut healthcare costs and boost organizational performance.

3. Effective Strategies Require Leadership, Flexibility, and Innovation: The most impactful mental health initiatives are those embedded in company culture—led by executives, supported by trained managers, and delivered through accessible, tech-enabled platforms. Features like 24/7 digital therapy, flexible schedules, biometric monitoring, and bonus-linked mental health check-ins drive participation, reduce stress, and prevent burnout before it starts.