Medicare negotiations underway to lower prices for next batch of drugs

By Sydney Lupkin - As President Trump touts his own executive orders to lower drug prices, the Medicare drug price negotiations begun during the Biden administration are continuing behind the scenes. Two companies – Novo Nordisk and Amgen – confirmed to NPR that they had received opening price offers from the government, kicking off bargaining that could last through October. The Department of Health and Human Services did not respond to a request for comment on the status of negotiations. Read Full Article…

HVBA Article Summary

1. Medicare Drug Price Negotiations Continue Under Current Administration: The Medicare drug price negotiation process, authorized by the 2022 Inflation Reduction Act, is progressing into its second round, with 15 drugs—including Ozempic and Otezla—currently under negotiation. Final prices are expected by November 30, 2025, and would take effect in January 2027.

2. Bipartisan Implementation Despite Political Differences: Although the policy began under the Biden administration, actions taken by the Trump administration—such as issuing draft guidance for a third negotiation round—signal an intention to continue the program, at least in the near term, in accordance with congressional mandates.

3. Ongoing Debate Over Long-Term Future of the Program: While the Trump administration has allowed the current negotiations to proceed, conservative policy proposals like Project 2025 advocate for repealing Medicare’s price negotiation authority. In the meantime, such plans call for implementing the law with caution to mitigate perceived risks.

How states are taking the lead on AI in health care

By Ron Southwick - Congress hasn’t passed much legislation covering the use of artificial intelligence in the healthcare industry, but some states are not waiting on Washington, D.C. Some state legislatures have crafted bills designed to offer some regulations of the use of AI in health care, analysts say. Read Full Article…

HVBA Article Summary

1. States Lead AI Regulation Amid Federal Inaction: Over 250 AI-related bills have been introduced in 34 states so far in 2025—more than double the number from 2024—largely due to limited federal legislative action. States are addressing AI use in areas such as healthcare, privacy, consumer protections, and algorithmic bias, though a federal proposal may restrict state-level regulation for the next decade.

2. Healthcare AI Laws Focus on Transparency, Oversight, and Patient Protection: States like California, Colorado, and Utah have enacted or proposed laws requiring disclosures when AI tools are used in healthcare decisions. New measures aim to ensure human oversight, protect mental health chatbot users, allow appeals for AI-driven decisions, and increase public transparency in insurer use of AI for claims and coverage.

3. AMA and Industry Seek Balance Between Innovation and Regulation: While AI adoption among physicians has nearly doubled since 2023, concerns persist over AI being used by insurers to deny care. AMA leaders and analysts support “thoughtful and measured” state-level regulation that protects patients without stifling innovation, particularly in clinical and administrative applications within hospitals and health systems.

Annual cost of insuring a family tops $35,000

By Maya Goldman - The cost of covering a family of four through workplace insurance now exceeds $35,000 — nearly triple what it cost 20 years ago as annual growth in health costs have far outpaced wages. Read Full Article…

HVBA Article Summary

1. Healthcare costs for families have surged far beyond wage growth: In 2025, the annual cost to cover a hypothetical family of four is $35,119 — a 188% increase since 2005, far outpacing the 84% growth in wages over the same period. The main cost drivers are pharmacy and outpatient facility care, which have risen 234% and 286%, respectively, over the past two decades.

2. Employers face mounting pressure amid persistent cost increases: While employers still cover 58% of healthcare costs, their share has declined from over 60% in 2005. At the same time, employee premium contributions have risen from 21% to 27%. In a tight labor market, employers are hesitant to shift more costs to workers, but rising demand for advanced, expensive treatments may force tough decisions.

3. Innovation and complexity are reshaping the healthcare cost landscape: Advances like GLP-1s and targeted cancer therapies are contributing to higher upfront spending, with the hope of long-term health benefits. Meanwhile, evolving care technologies and reimbursement structures — particularly those tied to billed charges — continue to fuel complexity and cost growth. Milliman’s modeling suggests costs will remain highly variable based on demographics, geography, and rebate structures.

Pharmacy, outpatient care drive family healthcare costs up 6%

By Jakob Emerson - Outpatient care and pharmacy costs were the main drivers of the 6.2% increase in healthcare expenses for a family of four from 2024 to 2025, according to the latest Milliman Medical Index. Milliman has tracked healthcare costs for 20 years and noted in its 2025 report that the composition of a typical family and the distribution of healthcare costs have shifted since its inception. Read Full Article…

HVBA Article Summary

1. Rising Healthcare Costs: In 2025, healthcare costs for a family of four with employer-sponsored insurance are projected to reach $35,119 — a 6.2% increase from 2024. The average cost per person also rose 6.7%, with pharmacy and outpatient facility care identified as the main cost drivers.

2. Long-Term Cost Trends and Shifting Burden: Since 2005, costs have surged most dramatically for outpatient facilities (up 286%) and pharmacy (up 234%). While employers continue to pay the largest share of healthcare expenses, their portion has declined slightly, with employees covering more through payroll contributions (up from 21% to 27%).

3. New Tool and Pharmacy Rebates Impact: A newly introduced interactive cost modeling tool accounts for variations by family composition and now incorporates pharmacy rebate data. Rebates are projected to offset 31% to 33% of allowed drug costs in the commercial large group market for 2025.

Employer group asks IRS to save health plans from surprise medical bills

By Allison Bell - The ERISA Industry Committee wants the Internal Revenue Service to help revamp the current No Surprises Act medical bill dispute resolution process, to keep the process from driving up plan costs instead of simply protecting patients from surprise bills. James Gelfand, the president of ERIC, told the IRS that it should repeal the regulations that now govern the NSA process. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. High Provider Success Rate in Dispute Resolutions: Since the No Surprises Act (NSA) dispute resolution process began, providers have won approximately 80% of cases, often receiving higher out-of-network payments than typical in-network rates. This trend has prompted discussion about the system’s alignment with the law’s original goals.

2. ERIC's Request for Regulatory Revisions: The ERISA Industry Committee (ERIC), which represents large employers with self-insured health plans, has asked the IRS and other agencies to revise NSA-related regulations. ERIC cited concerns about regulatory clarity and the balance between provider and payer interests in the current process.

3. Ongoing Disputes Around Out-of-Network Pricing: Legal challenges involving MultiPlan and out-of-network reimbursement practices continue. Providers have raised concerns about how pricing data is used, while plans and claim administrators say they rely on public information to manage claims effectively.

Benefits Think: Embedded clinical care is the future of healthcare navigation

By Stanley Crittenden, MD, FASN - In recent years, healthcare navigation has gone from being viewed as a nice-to-have to a must-have by many self-insured employers — with 37% now employing a healthcare navigation solution to ensure employees are accessing the right care. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. A New Clinical Standard Is Needed for Healthcare Navigation: The increasing complexity of healthcare — driven by rising chronic conditions, advanced therapies like GLP-1s and precision oncology, and higher employer costs — demands a reset in navigation solutions. Modern navigation must integrate longitudinal, clinician-led care to move beyond transactional support and effectively guide members through complex health journeys.

2. Clinician-Embedded Navigation Improves Outcomes and Reduces Costs: Embedding clinicians at the center of navigation enables real-time interventions, identification of care gaps, and personalized care planning. Unlike digital-first models that rely heavily on chatbots and non-clinical staff, clinically integrated teams can manage chronic conditions, coordinate provider care, and prevent unnecessary treatments or delays, ultimately improving outcomes and reducing employer healthcare spending.

3. Proactive Engagement Drives Better Patient Journeys and ROI: High-quality navigation requires timely, human engagement — not just app clicks or digital touchpoints. The example of “Meg” illustrates how clinician-led guidance, real-time data use, and connections to Centers of Excellence can transform a potentially fragmented care experience into a high-quality, cost-effective cancer journey. This model shows how meaningful clinical collaboration delivers both better care and measurable return on investment for employers.

Employers boost worker satisfaction by improving health care literacy

By Press Release - Optavise released its 2025 Healthcare Literacy Report. The report highlights the growing impact of person-to-person education in improving how employees understand and use their benefits, based on a survey of 2,041 U.S. workers with employer-sponsored health insurance. Read Full Announcement…

HVBA Article Summary

1. Personalized Education Drives Satisfaction and Understanding: Employee satisfaction (74%) and understanding (75%) of health plans are rising, particularly among those who receive one-on-one support from HR teams or third-party experts. In contrast, those relying solely on self-guided resources report significantly lower confidence. Personalized, human-centered benefits education is a clear driver of better plan comprehension and engagement.

2. Cost Awareness is Increasing but Impacts Care Decisions: A growing number of employees are actively comparing costs for treatments (44%) and prescriptions (45%), reflecting a shift toward cost-conscious healthcare behavior. However, cost concerns remain a barrier to care, with 55% of employees avoiding doctor visits due to expenses—highlighting the need for transparent pricing and accessible cost-comparison tools.

3. Wellness Incentives and Tailored Offerings Boost Participation: Engagement in wellness programs is high (86%) when employers offer incentives, especially for initiatives like fitness tracking, healthy eating, and mental health. Employees strongly value benefits that are personalized to their needs (96% say this is important), and targeted onboarding support—especially one-on-one guidance—can significantly improve benefit utilization and satisfaction.