Daily Industry Report - March 1

Your summary of the Voluntary and Healthcare Industry’s most relevant and breaking news; brought to you by the Health & Voluntary Benefits Association®

Jake Velie, CPT
Vice Chairman, President & COO
Health & Voluntary Benefits Association® (HVBA)
Daily Industry Report (DIR)

Robert S. Shestack, CCSS, CVBS, CFF
Chairman & CEO
Health & Voluntary Benefits Association® (HVBA)
Daily Industry Report (DIR)

VIP Admission & CE’s On Us!

NABIP members take concerns about employer-based insurance, health costs to Congress

By Susan Rupe - Members of the National Association of Benefits and Insurance Professionals are asking Congress to preserve and strengthen employer-sponsored health insurance, address the cost of health care, and keep Medicare beneficiaries’ access to advisors and brokers during their annual Capitol Conference. NABIP members will visit Congress on Tuesday and Wednesday this week. Read Full Article…

VBA Article Summary

  1. Support for Employer Compliance Relief: NABIP advocates for legislation that simplifies compliance with the Affordable Care Act (ACA) reporting requirements for employers offering health insurance. By supporting The Employer Reporting Improvement Act and The Paperwork Burden Reduction Act, NABIP aims to alleviate the burdensome and confusing nature of these requirements, making it easier for employers to comply and maintain the strength of employer-sponsored coverage.

  2. Maintenance of ERISA and Cost of Care Initiatives: The association opposes any actions that would undermine the Employee Retirement Income Security Act (ERISA), underscoring its importance in the effective administration of employee benefit plans. Additionally, NABIP supports the Lower Costs, More Transparency Act to implement site-neutral payment policies for Medicare and The Telehealth Expansion Act of 2023 to make certain telehealth service flexibilities permanent, addressing the cost of care and promoting access to affordable healthcare services.

  3. Opposition to Medicare Access Restrictions: NABIP challenges regulations that limit seniors' access to licensed agents and brokers, advocating against the requirement for recording calls with beneficiaries and opposing proposed changes by the Centers for Medicare and Medicaid Services (CMS) that would disrupt the current model of service provided by field marketing organizations (FMOs). The association argues that such regulations and proposed changes would reduce Medicare beneficiaries' options and potentially lead to increased premiums due to the need for carriers to develop new infrastructures to replace the services FMOs currently offer.

HVBA Poll Question - Please share your insights

What do you believe is the primary factor contributing to the average 20% increase in pharmacy costs as a percentage of total medical spending for businesses:

Login or Subscribe to participate in polls.

Our last poll results are in!


of Daily Industry Report readers who responded to our last polling question “absolutely believe and would engage in the legal importation of specialty medications” when asked if they would advise clients to import speciality or high cost brand drugs like Ozempic, Mounjaro, Wegovy from abroad to save 35-50% off U.S. prices of $850, $1,070, $1,670 per month respectively.

26.83% of respondents have no opinion on the matter or are neutral, neutral or uncertain, 25.25% would consider it, but not too familiar with the process, while 20.41% do not believe or have trust in medications being sourced outside of the U.S. pharmacies.

Have a poll question you’d like to suggest? Let us know!

Understanding available employee benefits helps advisors fill gaps, study says

By Ayo Mseka - According to a recent MDRT study, 69.7% of U.S. workers surveyed said they will have at least one employer-provided insurance policy in 2024 other than health insurance. In addition to term life insurance and long-term disability insurance, many employers offer more specific insurance policies to employees. Read Full Article…

VBA Article Summary

  1. Comprehensive Coverage and Planning: The Million Dollar Round Table study highlights the importance of financial advisors understanding the 2024 employee benefits options selected by Americans, emphasizing the role of such knowledge in comprehensive financial planning. With a range of coverages reported, including employer-provided short-term disability, accidental death and dismemberment, critical illness, and long-term care insurance, advisors can better tailor their advice and offerings. The survey also underscores the necessity of discussing the conditional nature of employment-based insurance and integrating permanent coverage for enhanced financial security.

  2. Healthcare and Retirement Insights: The survey reveals significant insights into health and retirement benefits, with 92.7% of Americans having health insurance and 43.4% of privately insured Americans expected to have a high deductible health plan in 2024. Retirement savings accounts are common, with 74.9% of Americans possessing at least one, yet a gap in professional financial advice utilization for these accounts suggests an opportunity for advisors to provide more comprehensive guidance and planning services.

  3. Diverse Benefits and Advisor Opportunities: Beyond traditional health and retirement benefits, the survey indicates a broad offering from employers, including paid parental leave, fertility treatment assistance, bonuses, profit-sharing, student loan repayment assistance, and stock options. These diverse benefits highlight the competitive nature of the marketplace for employers and the potential for advisors to offer personalized recommendations and strategies, ensuring clients fully leverage their benefits during significant life events and transitions.

Pharma companies ask court not to break up US states’ price-fixing lawsuits

By Mike Scarcella - A group of major pharmaceutical companies want an appeals court to force Connecticut and other states to remain in a coordinated legal proceeding over generic drug pricing, arguing that allowing them to pursue their claims separately would upend years of legal work and cause delays. Read Full Article…

VBA Article Summary

  1. Drug Companies' Appeal to 3rd Circuit: Pharmaceutical companies including Upshur-Smith, Teva, and Glenmark, among others, petitioned the 3rd U.S. Circuit Court of Appeals to maintain the inclusion of Connecticut and 45 other states in the antitrust litigation taking place in Pennsylvania. This action comes in response to a federal judicial panel's decision allowing these states to relocate their cases back to Connecticut, leveraging a new federal law enhancing state attorneys general's autonomy in filing and managing antitrust lawsuits. The appeal raises critical questions about the new law's reach, specifically whether it applies retroactively to ongoing disputes or solely to future cases.

  2. Impact of the Appeal on Antitrust Litigation: The ongoing litigation, which has been consolidated in Pennsylvania since 2016, involves allegations against numerous pharmaceutical companies accused of conspiring to artificially inflate the prices of generic drugs. The outcome of the 3rd Circuit's decision is significant, potentially affecting the litigation's momentum and the ability of states to pursue claims independently in their preferred jurisdictions. The drug companies argue against the retroactive application of the new law, suggesting that allowing states to relocate their cases could significantly delay the resolution of the underlying legal disputes.

  3. Responses from Involved Parties: The Connecticut attorney general's office has dismissed the pharmaceutical companies' appeal as a stalling strategy, indicating readiness to proceed with the litigation in Connecticut. Meanwhile, Upshur-Smith chose not to comment, and Teva and Glenmark have yet to respond. The companies have previously denied the allegations brought by the states. U.S. District Judge Cynthia Rufe, who is overseeing the multidistrict litigation in Philadelphia, has advised against permitting the states to transfer their cases back to Connecticut, emphasizing the potential benefits of coordinated pretrial proceedings in advancing the litigation efficiently.

Employers Struggle to Meet Employee Demand for Higher Pay, Better Benefits

By Remy Samuels - With increased turnover rates in 2023 and rising demands from employees for higher pay and better benefits, employers continue to face challenges in retaining and recruiting top talent, according to new research conducted by Franklin Templeton Investments. Read Full Article…

VBA Article Summary

  1. High Turnover and Changing Expectations: According to "The Voice of the American Employer Survey" by Franklin Templeton, which surveyed 1,000 U.S. employers with over 100 employees, 62% experienced layoffs, and 91% faced at least a 10% increase in staff turnover in the past 10 months. The turnover was split between voluntary (e.g., quitting) and involuntary (e.g., layoffs) terminations. The survey highlighted that employers are witnessing a shift in employee expectations, with 79% noting an increase in compensation expectations and 76% observing a higher value placed on work-life balance and career advancement, especially among younger employees.

  2. Benefits vs. Costs: While a majority of employers have increased the number or quality of benefits to attract and retain talent, 80% struggle with the rising costs of providing those benefits. Health insurance premiums have increased for 68% of employers in the last 12 months. Despite efforts to meet employees' growing demands for better compensation and benefits, 82% of employers agree that today's workplaces face challenges with "insatiable employees" who continually ask for more.

  3. Employee Concerns and Employer Misalignment: On the flip side, "The Voice of the American Worker Survey" by Franklin Templeton, which included responses from 2,001 U.S. adults, found that financial health is now more important than mental and physical health, marking a 15% increase in concern from 2023 to 2024. The majority of workers are worried about their income, standard of living, retirement savings, and healthcare costs. However, there's a disconnect between what employees value and what employers think they value; workers prefer increased pay and 401(k) matches over the benefits employers assume are preferred, such as improved health insurance and health savings accounts. This misalignment suggests employers need to better communicate and align benefits with employee needs.

Veteran Suicide Statistics Are Horrifying — What Is the VA Doing to Help?

By Katie Adams - In the U.S., veterans are 1.5 times more likely to die by suicide than nonveteran adults. Research shows that there were on average 17.5 veteran suicides per day in 2021, the latest year that data is available. Read Full Article…

VBA Article Summary

  1. VA Partnerships for Suicide Prevention and Care Accessibility: Shereef Elnahal emphasized the critical issue of veteran suicides, noting that 50% of veterans who die by suicide have never interacted with the VA. To address this, the VA is leveraging partnerships with health systems and utilizing an open veteran API to facilitate the exchange of care information. This initiative aims to identify veterans in crisis and connect them to VA benefits and resources, with the interoperability pledge involving major health systems like Kaiser Permanente and UPMC. An example of this in action is at Tufts Medicine, where veterans in suicidal crisis are identified and can receive care covered by the VA for 30 days, regardless of their enrollment status in the VA.

  2. Innovative Approaches to Veteran Support: The VA is also exploring novel methods to provide support to veterans, including partnerships with mental health companies Innerworld and Even Health for VR-based suicide prevention care. This approach focuses on peer support, allowing veterans to connect with others who have faced similar challenges. Furthermore, the VA is enhancing its veteran crisis line through a partnership with ReflexAI, which uses AI to train employees with simulations of interactions with veterans in crisis. This innovative training method aims to improve the quality of support provided to veterans reaching out for help.

  3. Exploration of Psychedelic-Assisted Psychotherapy: Elnahal highlighted the VA's involvement in clinical trials testing psilocybin and MDMA-assisted psychotherapy, with a funding allocation exceeding $2 million. These trials are investigating effective dosages and the integration of psychedelic treatment with talk therapy for conditions like PTSD. A notable mention was a veteran who experienced significant relief from PTSD symptoms after undergoing MDMA-assisted psychotherapy, underscoring the potential non-addictive benefits of psychedelics compared to the adverse effects associated with opioids. The anticipation of FDA approval for psychedelic treatments underscores a pioneering approach in addressing mental health issues among veterans.

Weight-loss drugs' costs threaten health insurance sustainability

By Kristen Shamus - Fecal microbiota transplants (FMTs) have played an important role in fighting disease. Because they consist of many complex bacterial strains, FMTs offer an optimal ecosystem to successfully engraft and impart therapeutic value upon the host. Read Full Article…

VBA Article Summary

  1. Challenges with Insurance Coverage and High Costs: Swayze, a teacher and mother, encountered difficulties in obtaining insurance coverage for Wegovy, a weight-loss drug that showed promising results for her friends. Despite her health conditions, including gestational diabetes and a family history of diabetes, her insurance did not cover the medication, citing no specific reason. The cost of Wegovy, approximately $1,300 monthly through GoodRx, is prohibitively expensive for many Michiganders, highlighting a significant barrier to accessing this treatment. Insurance coverage for obesity treatments like Wegovy varies, leaving many patients to face high out-of-pocket expenses.

  2. Health Benefits Beyond Weight Loss: GLP-1 medications, including Wegovy, offer multiple health benefits beyond weight loss, such as improved blood glucose control, reduced risk of cardiovascular events, and potential improvements in conditions like osteoarthritis, depression, sleep apnea, and acid reflux. Despite these benefits, the high cost of these drugs, ranging from $850 to $1,400 monthly, poses a challenge for both patients and the healthcare system. Physicians and insurers are grappling with the decision of who should receive these expensive treatments, especially when access to other health-promoting resources is limited for some patients.

  3. Insurance and Pharmaceutical Pricing Strategies: The article discusses the need for strategic approaches by insurance companies and pressure on pharmaceutical manufacturers to reduce the prices of GLP-1 medications. With the U.S. prices being significantly higher than those in Western Europe, there's a call for more sustainable pricing models to improve drug adherence and health outcomes. Some insurance plans have implemented restrictions, such as step therapy or prior authorization, to manage costs. However, the demand for these drugs continues to rise, stressing the importance of finding a balance between cost, accessibility, and promoting healthy lifestyle changes alongside medication use.

Five Medicare Advantage fixes we can all get behind (except the health insurance industry, of course)

By Wendell Potter - It’s no secret I feel strongly that “Medicare Advantage for All” is not a healthy end goal for universal health care coverage in our country. But I also recognize there are many folks, across the political spectrum, who see the program as one that has some merit. And it’s not going away anytime soon. To say the insurance industry has clout in Washington is an understatement. Read Full Article…

VBA Article Summary

  1. Align Prior Authorization Standards with Traditional Medicare: The article calls for Medicare Advantage (MA) plans to align their prior authorization requirements with those of traditional Medicare. This comes in response to the increased scrutiny and complaints regarding the delays and hurdles prior authorization creates for patients seeking treatment. Such measures aim to reduce unnecessary delays in care, prevent insurers from holding onto premiums longer for investment purposes, and ensure that MA plans are not more restrictive than traditional Medicare, as highlighted by the Biden administration's move to enforce this alignment starting in 2024.

  2. Protect Seniors from Marketing Scams: The piece advocates for stricter regulations on the marketing of MA plans to protect seniors from misleading or fraudulent advertisements. This includes banning ads that do not mention specific plan names, misleading uses of Medicare's name and logo, and the promotion of unavailable benefits. The call for a fixed payment to brokers to prevent them from steering seniors towards plans that offer the highest commissions, and the proposal to ban the sale of MA beneficiaries' contact information, are highlighted as crucial steps to protect seniors from deceptive practices.

  3. Be Real About Supplemental Benefits: The article criticizes the manipulation of supplemental benefits by insurers under MA plans, suggesting that many benefits are designed to be underutilized, allowing insurers to retain more funds. The upcoming requirement for insurers to submit detailed data on how seniors use these benefits is seen as a positive step. The hope is that this data will reveal the extent to which funds allocated for supplemental benefits are actually improving health outcomes or merely increasing insurer profits, urging CMS to ensure compliance and accountability.

Cyberattack on UnitedHealth still impacting prescription access: "These are threats to life"

By Nicole Sganga and Andres Triay - A cyberattack on the health technology provider Change Healthcare is wreaking havoc nationwide, as some hospitals and pharmacies cannot get paid, and many patients are unable to get prescriptions. Read Full Article…

VBA Article Summary

  1. Cyberattack on Change Healthcare: Change Healthcare, a subsidiary of UnitedHealth Group, experienced a significant cyberattack discovered on February 21, leading to immediate disconnection of affected systems. The attack has resulted in rejected insurance claims, impacting pharmacies and patients, particularly the elderly on fixed incomes. Change Healthcare, responsible for processing 15 billion transactions and affecting one in three U.S. patient records annually, confirms the attack has nationwide impacts on hospitals.

  2. Responsibility and Response: A Russian-speaking ransomware group, Blackcat (also known as ALPHV), claimed responsibility for the attack, alleging the theft of over six terabytes of sensitive medical data. UnitedHealth acknowledged the cybersecurity issue and is addressing it with the help of law enforcement and cybersecurity firms Mandiant and Palo Alto Network. Despite the breach, UnitedHealth's investigation has found no indication that its other subsidiaries have been compromised.

  3. Impact and Mitigation Efforts: The cyberattack has led to sustained system outages, causing billing complications across the healthcare sector, especially among smaller, less financially resilient hospitals. Over 90% of the nation's pharmacies have adjusted their electronic claim processing to lessen the attack's effects, with the remainder employing offline processing solutions. UnitedHealth and Change Healthcare are working on establishing workarounds for payments, but a timeline for full system restoration remains unclear, with the FBI involved in the ongoing investigation.

With Medical Debt Burdening Millions, a Financial Regulator Steps In to Help

By Noam N. Levey - When President Barack Obama signed legislation in 2010 to create the Consumer Financial Protection Bureau, he said the new agency had one priority: “looking out for people, not big banks, not lenders, not investment houses.” Read Full Article…

VBA Article Summary

  1. Expansion of CFPB’s Regulatory Focus to Health Care Debt: The Consumer Financial Protection Bureau (CFPB) has extended its regulatory oversight beyond traditional financial sectors to address the burgeoning issue of medical debt in the United States. This expansion includes targeting hospitals, nursing homes, and patient financing companies, reflecting a significant shift in the agency's focus under the direction of Rohit Chopra. The CFPB's efforts have included penalizing medical debt collectors, issuing warnings to health care providers and lenders, and preparing to unveil rules that would prohibit medical debt from appearing on consumer credit reports, aiming to alleviate the financial strain on Americans burdened by medical expenses.

  2. Controversy and Opposition: The CFPB's aggressive stance on medical debt collection and its initiative to remove medical debt from consumer credit reports have sparked debate and opposition from the collection industry. Industry representatives argue that the CFPB's actions could obscure the visibility of medical debt, potentially leading to unintended consequences, such as hospitals and medical providers demanding upfront payment for services. This opposition is set against the backdrop of a broader legal challenge to the CFPB's funding and authority, highlighting the contentious nature of the agency's expanding role in addressing medical debt issues.

  3. Impact and Rationale Behind CFPB's Actions: The CFPB justifies its focus on medical debt by pointing to the extensive and often inaccurate nature of medical debts on credit reports, which can severely impact Americans' financial lives. By targeting inaccurate and unfair practices in medical debt reporting and collection, the CFPB aims to protect consumers and address the broader crisis of medical debt that affects approximately 100 million Americans. The agency's actions are framed as necessary interventions in a health care system that has increasingly financialized patient care, leading to significant debt burdens for individuals, even those with insurance.

Aflac's CHRO urges companies to rethink their wellness strategies to keep Gen Z talent

By Paola Peralta - The recruitment and retention of Gen Z talent has quickly become a top priority for many organizations, and the key may lie in how they're choosing to approach employee wellness. Read Full Article… 

VBA Article Summary

  1. Financial Fragility and Mental Health Challenges: Jeri Hawthorne, Aflac's chief human resource officer, highlights that Gen Z is significantly impacted by financial instability and mental health issues, more so than previous generations. This group faces high levels of stress and anxiety, primarily due to financial instability driven by rising healthcare costs. A notable portion of Gen Z cannot afford unexpected medical expenses over $1,000, and many have delayed major purchases or further education because of healthcare costs not covered by insurance. Additionally, high levels of inflation and student loan debt exacerbate their financial and mental health challenges, making them prioritize well-paying jobs that offer flexibility in work location and hours.

  2. Workplace Commitment and Values: The financial and mental health pressures have influenced Gen Z's commitment to employers, making them more inclined to switch jobs or seek out organizations whose values align with their own. This generation values flexibility, overall well-being, and seeks employers that offer comprehensive benefits targeting physical, mental, financial, spiritual, and social health. Organizations that fail to adapt to these needs risk losing talented employees, as Gen Z is less committed to employers compared to previous generations and more willing to take career risks.

  3. Employer Response and Strategies for Retention: To attract and retain Gen Z talent, companies are urged to rethink their approach to employee wellness and benefits. Aflac, for example, has introduced five pillars of wellness focusing on comprehensive health and well-being, including volunteer opportunities, mentorship, and educational resources. Employers are encouraged to assess and fill gaps in their employee assistance programs, considering the whole person rather than just the employee's work output. By addressing the specific needs and values of Gen Z, organizations can better support their workforce's career and life journey, fostering a more committed and satisfied employee base.