Fortune 500’s top 25 healthcare companies

By Molly Gamble - The 71st Fortune 500 ranks America’s largest companies by 2024 fiscal year revenue. Key healthcare takeaways from the most recent listing from Fortune, released June 2. Read Full Article…

HVBA Article Summary

1. Healthcare giants dominate top Fortune 500 spots, reflecting their growing market power: UnitedHealth Group surged to No. 3 overall on the Fortune 500 list, surpassing Apple with over $400 billion in annual revenue, underscoring the massive scale of today’s top insurers. CVS Health also advanced to No. 5, followed closely by McKesson, Cencora, and Cigna, all of which command hundreds of billions in revenue. This highlights the dominant financial influence that insurers, pharmacy benefit managers, and health services companies now hold within the broader U.S. economy.

2. Medical facilities and pharmaceutical companies show notable movement, reflecting sector volatility: HCA Healthcare maintained its leading position among medical facility companies at No. 61, but pharmaceutical players showed more dramatic shifts — Eli Lilly, for example, jumped 27 spots to No. 100 after a striking 32% revenue increase. Meanwhile, Tenet Healthcare fell 11 places, and some major manufacturers like Johnson & Johnson and Danaher reported revenue declines. These movements point to the dynamic and sometimes unpredictable nature of financial performance across healthcare subsectors.

3. The Fortune 500 list remains unusually stable overall, even as healthcare companies reshuffle within it: Fortune described this year’s rankings as among the most stable seen in decades, with only 22 companies dropping off — the second-lowest turnover in 30 years. Longstanding leaders like Walmart (No. 1) and Amazon (No. 2) retained their top positions, reinforcing the durability of the biggest players. At the same time, healthcare companies were some of the most active climbers, signaling that even in a stable Fortune 500 landscape, the healthcare sector is experiencing significant internal shifts driven by growth, innovation, and strategic repositioning.

Trump budget proposal could help ICHRAs by keeping ACA exchange program alive

By Allison Bell - The administration of President Donald Trump may keep at least enough of the Affordable Care Act public exchange system alive in 2026 to support employers with individual coverage health reimbursement arrangements plans, or ICHRA plans. The U.S. Department of Health and Human Services assumes in a budget proposal posted on its website that the ACA's web-based health insurance supermarkets — HealthCare.gov and state-based ACA exchanges like Covered California — will continue to exist next year and operate roughly the way they're operating this year. Read Full Article… ^{_{(Subscription required)}} 

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1. ACA Exchange Funding Outlook: The Centers for Medicare and Medicaid Services (CMS) projects ACA exchange program spending at about $2.1 billion for fiscal year 2026, a 20% decrease from 2022, primarily due to cuts in marketing and navigator funding; infrastructure spending (such as IT systems and call centers) is expected to decline only slightly, by around 2.6%. Final funding levels depend on Congressional decisions and ongoing insurer participation.

2. ICHRA and CHOICE Program Developments: Employers increasingly use Individual Coverage Health Reimbursement Arrangements (ICHRAs) and Qualified Small Employer HRAs (QSEHRAs) to help employees buy individual health insurance. A new House proposal—the CHOICE arrangement program—would expand flexibility, letting employees choose between ICHRA-like accounts and traditional group plans, while providing favorable tax treatment for income used on CHOICE health coverage.

3. Potential Impact of Marketing Cuts on Enrollment: Debate continues over the effects of proposed reductions in ACA exchange marketing and outreach funding: supporters of cuts argue they mainly trim ineffective nonprofit and advertising spending, while critics and recent economic research suggest that federal advertising plays a key role in boosting enrollment, especially among younger and healthier populations, which helps stabilize the insurance risk pool.

2025 Milliman Medical Index

By Deana Bell, Jason Clarkson, Brent Jensen, Dave Liner, Annie Man, Andrew Naugle, and Andrew Timcheck - This year marks the twentieth anniversary of the MMI. Since its inception, the MMI has always quantified the cost of healthcare for the same family of four: a male age 47, a female age 37, a child age 4, and a child under age 1. The MMI family was “mathematically average” when it was created in 2005, with healthcare costs four times that of an individual. However, the composition of a ‘typical’ family unit and the distribution of healthcare costs among family members has changed significantly in the last 20 years, and this is no longer the case. Read Full Article… 

HVBA Article Summary

1. Healthcare Costs Reach New Highs: In 2025, the projected annual healthcare cost for a typical American family of four covered by an employer-sponsored health plan will rise to $35,119, up from $33,067 in 2024 — marking a $2,052 increase year-over-year. This figure represents nearly a threefold jump compared to $12,214 back in 2005, underscoring the long-term, compounding nature of healthcare inflation and the mounting financial burden placed on families, employers, and the healthcare system over the past two decades.

2. Outpatient and Pharmacy Costs Drive Increases: The average healthcare cost per individual rose by 6.7%, from $7,378 in 2024 to $7,871 in 2025. This increase is mainly driven by surging outpatient facility care costs (up 8.5%) and pharmacy expenses (up 9.7%), which together account for nearly 70% of the year-over-year total cost increase. This trend highlights the ongoing shift toward high-cost treatments and outpatient drug therapies, emphasizing the importance of managing site-of-care strategies and pharmacy spending to contain overall healthcare costs.

3. Specialty Drugs and Pricing Structures Impact Costs: A major factor in rising pharmacy costs is the growing utilization of high-priced specialty medications, especially GLP-1 receptor agonists (such as Ozempic, Wegovy, Mounjaro, and Zepbound), alongside the steady introduction of new, innovative drugs. While the entry of biosimilars into the market is expected to eventually introduce cost-saving competition, their impact has remained modest so far. Additionally, outpatient care costs are being driven up not just by clinical demand but by pricing structures — especially reimbursement models that apply percentage-based markups on billed charges for expensive drugs and implants — amplifying the rate of cost escalation.

GLP-1 obesity and diabetes drugs drive 17% of employee pharmacy claims, CBIZ reports

By Allison Bell - Wegovy and other GLP-1 obesity and blood sugar control drugs accounted for 17% of pharmacy benefits spending at CBIZ employer clients with self-funded health plans in 2024, up from 13% in 2023, according to a new health care report. The broker's clients spent spent $125 million on GLP-1 agonist drugs. That's up from $81 million in 2023 and $42 million in 2022. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Ozempic leads GLP-1 use among employees in employer plans: Ozempic, a GLP-1 agonist officially approved for diabetes management, emerged as the most widely used drug in its class among approximately 6,500 participants in CBIZ-administered benefit plans. It outpaced other top GLP-1 medications such as Mounjaro, Wegovy, Zepbound, and Trulicity, reflecting strong employee demand for these treatments within employer-sponsored coverage.

2. Employer healthcare spending remains substantial across company sizes: The CBIZ benchmarking report shows that small employers (1–99 employees) are spending an average of $9,119 per employee for individual health coverage and $24,842 for family coverage. Larger employers (100+ employees) reported slightly lower per-employee costs, averaging $8,435 for individual coverage and $23,968 for family coverage, underscoring the significant financial burden healthcare benefits place on employers across all segments.

3. GLP-1 drug coverage and patient adoption are on the rise: A growing number of employers—36% of those surveyed—now cover GLP-1 agonists for both weight-loss and diabetes treatment, an increase from 34% in 2024, according to the International Foundation of Employee Benefit Plans. Additionally, Fair Health data reveals a dramatic increase in use among overweight or obese patients, with GLP-1 prescriptions rising to about 11% in 2024, compared to just 2.5% in 2019, signaling expanding demand and shifting trends in treatment approaches.

Family health care costs soar to $35,000, driven by drugs and outpatient care

By Alan Goforth - Health care costs for a typical family of four have increased to $35,119 this year, according to the Milliman Medical Index. Costs for the average person increased by 6.7% to $7,871 in 2025 led by a 9.7% hike in pharmacy expenses and an 8.5% rise in outpatient facility care costs. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Outpatient facility and pharmacy costs are major drivers behind the continued rise in healthcare spending: Nearly 70% of this year’s total cost increase stems from these two areas, fueled by the growing use of high-cost drugs administered in outpatient settings, such as oncology treatments and radiopharmaceuticals, as well as the adoption of advanced medical technologies and reimbursement models that amplify costs when list prices climb significantly.

2. The financial burden is gradually shifting from employers to employees, particularly through rising payroll deductions: While employers still pay the majority of healthcare costs, their share has declined from 61% in 2005 to 58% today, while employee contributions via payroll have jumped from 21% to 27%. This shift has reduced employees’ direct out-of-pocket expenses, meaning they now contribute more upfront through deductions rather than at the point of care.

3. Healthcare costs for American families have surged at a striking pace over the past two decades: Since 2005, healthcare expenses have nearly tripled, with annual cost growth averaging 6.1%, far surpassing increases in any other household expense category. Outpatient facility care, in particular, has seen a massive 286% increase, reflecting how more complex and costly medical procedures are now routinely performed outside of inpatient hospital settings.

GLP-1s Treat and Even Reverse Some Forms of Liver Disease

By Sara Novak - In the past two decades, the global prevalence of metabolic dysfunction–associated steatohepatitis (MASH) has increased dramatically as a result of the obesity epidemic. Researchers project that by 2040, rates of MASH will increase by 55%. Prior to that most liver diseases were caused by alcohol use and hepatitis C, a viral infection that primarily affects the liver. Read Full Article…

HVBA Article Summary

1. GLP-1 agonists show strong potential in treating MASH (formerly NAFLD): Recent high-profile studies, including those published in The New England Journal of Medicine, JAMA Internal Medicine, and Nature Medicine, reveal that GLP-1 medications like semaglutide can significantly reduce liver fat buildup, lower inflammation, decrease scar tissue, and even reduce the risks of severe outcomes like liver failure and liver cancer. These findings suggest GLP-1s may offer a groundbreaking approach to not just slowing but potentially reversing the progression of MASH, which until now had limited treatment options.

2. Primary care physicians play a critical and proactive role in early detection: Primary care doctors are often the first line of defense in spotting MASH, making it vital for them to screen carefully, even when liver enzyme levels are only slightly above normal — especially in patients with underlying metabolic risks such as diabetes, obesity, or high cholesterol. Beyond routine bloodwork, imaging tools like elastography, which measures liver stiffness, can help detect fibrosis early, enabling doctors to intervene before the disease advances to cirrhosis or permanent liver damage.

3. GLP-1 medications could reshape future treatment strategies despite current FDA limitations: While GLP-1 agonists are not yet FDA-approved specifically for treating MASH, experts believe these drugs hold strong promise for earlier-stage intervention, unlike current therapies such as resmetirom that are limited to advanced disease. If approvals come through, this would mark a significant shift in how primary care physicians approach MASH, opening up opportunities to treat younger patients and those with metabolic risk factors before irreversible liver damage occurs — potentially transforming patient outcomes on a wide scale.