There is a Bi-Partisan Bill to Rein in PBMs and Lower Drug Costs. It’s a Step in the Right Direction.

By Wendell Potter - Members of Congress from both political parties have joined forces to reintroduce a bill aimed at reforming how pharmacy benefit managers (PBMs) make their money at the expense of patients. As reported by ALM Benefits Pro, the Delinking Revenue from Unfair Gouging Act, or DRUG Act, would halt PBMs from tying their payments to the retail or wholesale prices of prescription drugs. Instead, PBMs would have to charge flat fees for their services — an approach that could reduce the financial incentives for PBMs to drive up drug prices. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. PBMs Profit from High Drug Prices: Pharmacy Benefit Managers (PBMs), largely owned by major insurers like Cigna, CVS/Aetna, and UnitedHealth Group, control 80% of the market and often profit more from prescription drugs than the manufacturers or local pharmacies. Their revenue is often tied to a percentage of drug prices, giving them little incentive to lower costs.

2. The DRUG Act Targets PBM Practices: Reintroduced by a bipartisan group of lawmakers, the DRUG Act aims to curb PBM influence by eliminating the incentives that drive up list prices. Supporters argue it will help reduce prescription costs and protect access to local pharmacies, which are being squeezed out by PBM profit tactics.

3. Bipartisan Momentum Builds Against PBMs: Growing bipartisan concern over PBM practices has led to the introduction of multiple bills aimed at reform. While the PBM lobby is expected to resist, there's a sense of real momentum in Congress to address the role PBMs play in rising drug costs and limited access to medications.

Senate Finance Committee advances Dr. Oz, Trump’s CMS chief pick

By Allison Bell - Members of the Senate Finance Committee voted 14-13 Tuesday to approve the nomination of Dr. Mehmet Oz to be the administrator of the Centers for Medicare and Medicaid Services. All Republicans on the committee voted for Oz, and all Democrats voted against him. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Senate Floor Showdown Ahead: The confirmation of Dr. Oz—nominated to oversee key federal health programs including Medicare, Medicaid, and enforcement of the ACA—now heads to a full Senate vote after a contentious committee process marked by bipartisan skepticism and pointed Democratic criticism.

2. Mixed Reception from Lawmakers: While Republican physicians on the Senate Finance Committee backed Oz, some Democrats expressed concern over his evasive responses on Medicaid funding and nursing home staffing standards, with Sen. Ron Wyden calling Oz’s answers “offensive” and lacking in basic factual substance.

3. Controversy over Tax Practices: Oz also faced scrutiny for reportedly taking advantage of a tax loophole to avoid paying Medicare and Social Security payroll taxes—an issue that drew sharp rebuke from Democrats who contrasted his practices with the obligations of everyday workers like nurses and firefighters.

6 Things to Know About Trump’s New CDC Director Pick

By Katie Adams - On Monday, President Donald Trump selected Susan Monarez — the current acting director of the Centers for Disease Control and Prevention — to lead the agency going forward. Read Full Article…

HVBA Article Summary

1. New CDC Nominee: President Trump has nominated Monarez to lead the CDC, replacing former nominee Dave Weldon, a physician and ex-congressman whose nomination was withdrawn due to a lack of Senate support. Weldon had drawn scrutiny for his skepticism toward vaccines.

2. Extensive Government Experience: Monarez has been serving as the CDC’s acting director since January 23 and previously held leadership roles at ARPA-H, the Department of Homeland Security, and the White House Office of Science and Technology Policy. Her career has largely focused on strengthening the nation's defense against biological and chemical threats.

3. Historic Nomination: If confirmed, Monarez would become the first nonphysician to lead the CDC in over 50 years and the first to be confirmed under a 2022 law requiring Senate approval for the role. She holds a PhD in microbiology and immunology from the University of Wisconsin–Madison.

Why 23andMe’s Genetic Data Could Be a ‘Gold Mine’ for AI Companies

By Andrew R. Chow - The genetic testing company 23andMe, which holds the genetic data of 15 million people, declared bankruptcy on Sunday night after years of financial struggles. This means that all of the extremely personal user data could be up for sale—and that vast trove of genetic data could draw interest from AI companies looking to train their data sets, experts say. Read Full Article…

HVBA Article Summary

1. Genetic Data as a Transformative Healthcare Asset: 23andMe’s genetic database represents an unprecedented opportunity for advancing precision medicine, personalized treatments, and agentic AI in healthcare. With high-quality, real-world genomic data, health systems and researchers could unlock insights previously hidden in traditional clinical datasets. However, acquiring this data carries reputational and regulatory risks due to prior breaches and public concerns about consent and data misuse.

2. Interdisciplinary Healthcare Applications: While the dataset holds immense promise for pharmaceutical R&D and clinical decision support, its potential extends to public health analytics, health insurance modeling, and patient risk stratification. For healthcare leaders, this is a rare chance to integrate contextual genomic information into systems of care—though doing so demands robust data governance and ethical oversight.

3. Patient Trust and Data Ethics at the Forefront: The controversy surrounding 23andMe’s potential sale underscores growing patient concerns about data sovereignty and privacy. Healthcare organizations must weigh the long-term risks of using data obtained without renewed patient consent, particularly as misuse could exacerbate inequities or trigger backlash. Safeguarding genetic data isn’t just a compliance issue—it’s essential to maintaining trust in digital health innovation.

GLP-1s outpace specialty drug spend for the first time: Report

By Jakob Emerson - GLP-1s are driving traditional drug spending in the U.S. to unprecedented levels, which now outpaces specialty drug spending for the first time, according to a March 25 report from Evernorth. The report is based on data collected from scientific literature, pharmacy claims, industry reports, and surveys of pharmacists, providers, health plan executives, large employers, and individual consumers. Claims analysis included 27.3 million members with commercial insurance coverage. Read Full Article…

HVBA Article Summary

1. GLP-1s Drive Sharp Increases in Drug Spending: Weight management drugs—especially GLP-1s—accounted for 46.8% of the total drug spend increase in 2024, with semaglutide’s annual growth rate jumping from 2.1% in 2021 to 12.8% in 2024. Overall U.S. prescription drug spending reached $723 billion in 2023, driven by chronic disease, inflation, and expanded treatment uses.

2. Demand and Utilization Surge Across Age Groups: Nearly 24% of consumers are now considering GLP-1s, and 65% of providers are willing to prescribe them. Utilization for weight loss is expected to climb 73.1% in 2025, with Gen Alpha (up 84.6%), Gen Z (67.8%), and millennials (47.7%) fueling rapid growth across all age groups.

3. Coverage Gaps and Dropout Rates Raise Sustainability Concerns: While 59% of health plans fully cover GLP-1s for weight loss, just 22% of employers do the same. Nearly half of plans require prior authorization, and 41% mandate mental health support. High discontinuation rates—driven by side effects, cost, and insurance barriers—underscore long-term challenges to access and adherence.

How healthcare organizations can decide which AI is worth implementing

By Caroline Catherman - It’s easy to get drawn in by flashy uses of AI in healthcare. It’s much harder to figure out which ones are actually good ideas and which ones just sound cool. “People like to fall in love with AI…and then suddenly [you] realize, wow, it costs a lot of money, and it’s more complex than we thought, and our scope creep is real. And suddenly, your project is failing,” Kathleen Walch, director of AI engagement and learning at Project Management Institute, a professional membership and training organization, told Healthcare Brew. Read Full Article…  

HVBA Article Summary

1. Start with solid data: AI is only as smart as the data it's trained on. Poor data quality, lack of organization, and missing governance structures can derail even the most promising AI projects. In healthcare, for example, a unified system like a master patient index helps ensure data accuracy and prevents issues like duplicate records or patient mix-ups.

2. Think big, but start small: A successful AI strategy begins with a clear goal and a narrowly defined problem to solve. Rather than launching an all-encompassing solution, start with a single, high-impact use case—like a chatbot answering one common question—then test and iterate. This makes it easier to measure impact and build toward broader applications over time.

3. Avoid overhype and underdelivery: Ambitious AI projects can fall apart without the right foundation or realistic expectations. IBM’s Watson for Oncology aimed to revolutionize cancer care but failed due to insufficient data and inflated promises. A more effective approach is to scale gradually—begin with one targeted use case, prove its value, and grow from there.

80% of Americans are stressed about daily expenses. Benefits can help

By Lee Hafner - Financial stress doesn't discriminate. The right benefit offerings and education can help employees make their money go further. New survey results from financial services firm Equitable show that thanks to ongoing inflation, 80% of Americans, regardless of income level, are concerned about day-to-day costs like groceries and child care, let alone the impact of unexpected expenses. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Education Empowers Financial Action: Nearly half of employees aim to boost savings and reduce expenses amid economic uncertainty. Benefits professionals can support these goals by helping employees understand and maximize the financial value of existing benefits—like FSAs, HSAs, and expert planning tools—even outside open enrollment periods.

2. Benefits for Every Life Stage: Tailoring communication to employees' life stages enhances the impact of benefits. Younger workers may value education reimbursement or home-buying help, while midlife and older employees might prioritize debt management, college savings, or retirement and medical planning. Supplemental health benefits like accident or hospital indemnity insurance can provide critical financial relief during unexpected events.

3. Communication is Key to Confidence: Ongoing, simplified communication—through personalized guidance, QR-enabled resources, and manager-led conversations—helps bridge the benefits knowledge gap. When employees clearly understand how their benefits work, they’re better equipped to manage daily expenses and navigate financial surprises with confidence.

Nayya Announces Referral Agreement with Mercer to Introduce Nayya to Employers across the United States

By Nayya - Nayya [yesterday] announced that it is working with Mercer to introduce its cutting-edge Nayya Claims service to a set of Mercer's voluntary benefit clients in the US. Nayya's innovative offering helps employers empower their employees. By analyzing claim data, Nayya's service, built on advanced technology, uncovers potential opportunities and identifies instances where employees may be eligible for additional voluntary benefits that might have been previously overlooked. Read Full Announcement…

HVBA Article Summary

1. Maximizing Healthcare Benefits: Nayya Claims leverages advanced claims analysis technology to scan employees’ medical records and identify overlooked reimbursement opportunities, enabling them to fully capitalize on their voluntary health benefits and avoid leaving money on the table.

2. Enhancing Employee Experience: In partnership with Mercer, Nayya delivers a secure and intuitive platform that simplifies the often-complex claims process, reducing administrative friction while significantly improving how employees engage with and perceive their benefits packages.

3. Driving Financial Empowerment: By proactively surfacing missed claims and helping employees recover eligible funds, the service promotes greater financial wellness, allowing workers to take meaningful control of their healthcare spending and contribute to a more financially confident and engaged workforce.