The Cigna Group completes sale of Medicare businesses

By Alan Goforth - Health Care Service Corporation (HCSC) has successfully completed its purchase of The Cigna Health Group’s Medicare Advantage, Cigna Supplemental Benefits, Medicare Part D and CareAllies businesses. “This transaction is fully aligned with our mission of expanding access to quality health care by adding capabilities and deepening our geographic presence across the United States," said Maurice Smith, CEO, president and vice chair of HCSC. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. HCSC Expands Medicare Reach: With the completion of the transaction, HCSC now provides health coverage to 26.5 million individuals nationwide, including 4.3 million Medicare members. This expansion underscores HCSC’s growing role in supporting the evolving health and wellness needs of America’s aging population.

2. Ongoing Collaboration Through Evernorth: As part of the deal, Cigna and HCSC have entered into a four-year services agreement allowing Evernorth Health Services, a Cigna subsidiary, to continue delivering pharmacy benefit services to the Medicare businesses. This ensures a smooth transition with uninterrupted care and support for members.

3. Strategic Capital Deployment by Cigna: Cigna intends to use the proceeds from the transaction to align with its broader capital deployment strategy, primarily through share repurchases. At the same time, the company remains focused on supporting Medicare populations via Evernorth’s comprehensive portfolio of health products and services.

Medicine Meets AI Boom: Promise and Caution Go Hand in Hand

By Amanda Loudin - These days, you can’t turn around without encountering some sort of artificial/augmented intelligence (AI). From generative AI invading your word processing to web searches, security systems, and manufacturing equipment, AI is ubiquitous. So it’s no surprise that AI is dominating the conversations in medicine, too. But as with every possible application of AI, along with the promise, there must be guardrails and caution. Read Full Article…

HVBA Article Summary

1. Regulatory Oversight Is Critical: The American Medical Association (AMA) emphasizes the necessity of a strong regulatory framework to govern the use of AI in healthcare. For AI tools to gain and maintain the trust of patients and physicians, they must be safe, high-quality, clinically validated, and free from bias — held to the same rigorous standards as new medications and biologics.

2. Growing Adoption and Interest Among Physicians: Physician enthusiasm for AI is accelerating, with 62% of doctors reporting they use AI tools in 2024, up from 38% the previous year. While most are applying AI in lower-risk administrative areas like documentation and workflow optimization, this growing use reflects the increasing pressure on the healthcare system and the search for efficiency and relief from workforce shortages.

3. AI Enhances — Not Replaces — Clinical Decision-Making: AI is proving valuable in clinical settings by augmenting tasks such as diagnostic support in pathology, radiology, and early detection of conditions like sepsis. While the technology can accelerate workflows and improve patient safety, clinicians maintain control over final decisions. The AMA prefers the term “augmented intelligence,” highlighting AI’s role as a supportive partner rather than a replacement for human judgment.

Diagnosing primary care in America: ‘We need to fix it’

By Ron Southwick - Ripley Hollister, MD, has been practicing medicine since the mid-1980s, when Ronald Reagan was president and MTV played music videos all the time. Hollister loves being a primary care physician, but he says it’s become much harder. When he first began practicing, he had a group of patients with various medical needs, but he says the reimbursements were sufficient. That’s no longer the case, he says. Read Full Article…

HVBA Article Summary

1. Primary Care Faces Severe Underinvestment and Workforce Decline: The U.S. is seeing a troubling drop in primary care providers, including physicians, nurse practitioners, and physician assistants. With only 5% of healthcare spending going to primary care, the field is experiencing a “systemic under-investment,” making it less attractive due to lower pay, high stress, and long hours — driving new doctors toward specialties with higher earning potential.

2. Access Gaps and Rising Costs Underscore the Urgency: Over 30% of U.S. adults lack a regular source of primary care — the highest in a decade. Without consistent access, patients turn to more expensive options like emergency rooms, increasing overall healthcare costs. Strengthening primary care access can improve outcomes and reduce spending through earlier interventions and better chronic disease management.

3. Solutions Require Shifting Funding and Training Models: Experts call for smarter healthcare spending, including higher reimbursements for primary care and more investment in community-based medical education. Training physicians in real-world, community settings — rather than complex hospital environments — increases the likelihood they’ll pursue and stay in primary care roles.

ACA screening benefits may improve cancer detection rates, study suggests

By Allison Bell - Do the Affordable Care Act preventive cancer screening benefits really affect people's health? Nuo Nova Yang, a scientist at an American Cancer Society research center, and colleagues have come up with indirect evidence that cancer screening benefits might have an effect on how likely people are to beat cancer. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Short-Term Insurance Linked to Worse Cancer Detection: The study found that states permitting easy access to short-term health insurance—plans often lacking cancer screening benefits—had a 2.3% smaller improvement in cancer detection trends compared to states that banned such plans. Late-stage cancer diagnoses declined more in states with bans, suggesting better early detection where short-term plans were restricted.

2. ACA Preventive Coverage May Improve Outcomes: The findings support the idea that the ACA’s preventive services mandate—which requires major medical plans to cover cancer screenings without cost-sharing—may lead to better health outcomes by promoting earlier cancer detection. In contrast, short-term plans not subject to these rules may contribute to delayed diagnoses.

3. Policy Implications Ahead of Supreme Court Ruling: With the U.S. Supreme Court set to rule on the legality of the ACA’s preventive services mandate in the Braidwood case, the study could influence how employers and insurers assess the value of preventive care. If the mandate is overturned, more attention may shift to outcomes data like cancer detection rates when determining coverage policies.

Optum Rx says it will eliminate 10% of prior authorizations

By Rebecca Pifer - Prior authorization requires doctors to get approval from a patient’s health or drug plan before providing a medical service, like performing surgery or prescribing a medication. Insurers and PBMs argue prior authorization is important to reduce nonessential healthcare costs and ensure treatment is safe and effective. Read Full Article…

HVBA Article Summary

1. Prior Authorization Concerns Spark Reform: Physicians continue to raise concerns that prior authorization requirements delay critical care and increase administrative workload, sometimes resulting in severe health consequences or even patient deaths. These issues have fueled growing calls for health plans and PBMs to scale back such policies.

2. Optum Rx Eases Restrictions on Key Drugs: Responding to provider frustration and public pressure, Optum Rx announced it will eliminate reauthorization requirements for several widely used chronic condition medications, including Repatha, Leqvio, and Nurtec. The PBM stated that these drugs have proven long-term effectiveness and consistent dosage needs, making additional approvals unnecessary.

3. PBMs Face Rising Scrutiny and Competitive Pressure: As criticism mounts from lawmakers, regulators, and new market entrants, major PBMs like Optum Rx are making internal changes to deflect scrutiny and preserve their business models. These include adopting transparent pricing models and phasing out certain profit-retaining practices, with Optum Rx alone reporting $5.8 billion in profit last year.

The top 10 drugs losing US exclusivity in 2025

By Eric Sagonowsky, Angus Liu, Fraiser Kansteiner, Andrea Park, Kevin Dunleavy, and Zoey Becker - While each year features high-profile losses of exclusivity in the pharma industry, this year's list is something of a doozy. For one, Johnson & Johnson's Stelara is already facing off against several biosimilars, and several more are yet to come as the year plays out. Read Full Article…

HVBA Article Summary

1. Major Drugs Facing Generic Competition: Several blockbuster drugs, including Cosentyx (Novartis) and Jardiance (Boehringer Ingelheim/Eli Lilly), are set to lose U.S. exclusivity in 2025, potentially opening the door for generic and biosimilar versions to enter the market and reduce prices.

2. Significant Financial Impact: The combined U.S. sales of the top 10 drugs losing exclusivity exceed $17 billion, indicating a substantial financial hit for the pharmaceutical companies that currently hold market exclusivity.

3. Biosimilars on the Rise: The upcoming expirations highlight the growing momentum of biosimilars and generics, which are expected to bring increased competition, lower drug prices, and broader patient access across key therapeutic areas such as diabetes, autoimmune diseases, and oncology.

ERISA plans offer innovation necessary to reimagine healthcare

By Eric Vanderhoef - When navigating the complex landscape of employee healthcare benefits, brokers are challenged to present options that differentiate more than 50 basis points between insurance carriers. Many are stuck in the quagmire of selling only products that are available in marketplaces. But recycling the same solutions — notably those provided by BUCA plans (Blue Cross, UnitedHealthcare, Cigna and Aetna) — will not do much to contain costs or improve clinical outcomes. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. ERISA Plans as a Strategic Alternative: Traditional BUCA (Blue Cross, United, Cigna, Aetna) health insurance options are increasingly costly with little differentiation in quality. ERISA plans present a compelling alternative by allowing employers to contract directly with local providers, improving care coordination and reducing costs.

2. Broker Opportunity and Dual-Tiered Benefits: Brokers can become proactive change agents by creating ERISA plans in strategic markets. This enables them to offer two-tiered benefits—ERISA plans for cost-sensitive employees and BUCA options for those needing broader provider access—maximizing flexibility and savings for employers.

3. Market Differentiation and Replication Potential: Brokers who develop ERISA plans gain a competitive advantage, potentially replicating the model across employer groups. These plans not only improve employee health outcomes but also generate distinct revenue streams, offering long-term value for brokers and their clients.