Trump’s Executive Order Demands Accountability In Hospital Price Transparency

By Rita Numerof - President Trump’s new hospital price transparency executive order directs federal agencies to enforce regulations that the president put into effect in his first term. Relevant federal departments have 90 days to determine the rules that will govern implementation of the EO. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Enforcement of Price Transparency: President Trump’s executive order represents a significant step toward enforcing long-ignored federal regulations that require hospitals and insurers to disclose actual, itemized prices—not estimates—in a standardized, easy-to-understand format. The goal is to equip patients with meaningful data to make informed choices about their care.

2. Accountability and Economic Impact: Despite existing legal requirements, many hospitals and insurers have failed to comply due to lax enforcement and minimal penalties. Strengthening oversight and applying meaningful consequences are critical to holding providers accountable, reducing unnecessary costs, and creating a more competitive, value-oriented healthcare system.

3. Empowering Patient-Consumers: Transparent pricing and quality metrics allow patients to act like informed consumers—especially for planned procedures and routine care—by comparing providers and services based on value. This shift empowers individuals to make smarter financial and healthcare decisions, promoting competition and helping to control overall healthcare spending.

If the Supreme Court kills 'free' ACA preventive care rules, what then?

By Allison Bell - The U.S. Supreme Court could kill part or all of the Affordable Care Act preventive services coverage requirements this year, but laws in many states should keep something like the current rules in place for employers with fully insured group health coverage. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. States Can Preserve Preventive Care Coverage: About 15 states have already embedded the ACA's preventive services package into state law, and more could follow by adding these benefits to their essential health benefits (EHB) lists. This would help maintain access to services like vaccinations, cancer screenings, and checkups even if federal requirements are rolled back.

2. State Regulators Play a Key Role: Sabrina Corlette advised that state insurance regulators can mitigate potential disruption by ensuring that state EHB rules follow public health experts' recommendations on who should receive specific types of care and how often. She also stressed the importance of requiring insurers to give consumers and policyholders advance notice of any benefit changes.

3. Implications of the Supreme Court Case: The Supreme Court is set to hear Braidwood v. Becerra, a case that challenges the legality of how certain ACA preventive services are determined. If the Court rules against the ACA, states could still enforce similar requirements for fully insured plans, but federal law would prevent them from applying those rules to self-insured employer plans. The outcome could significantly influence how preventive care is accessed across the country.

White House cuts $12B in health funds: 5 updates

By Madeline Ashley and Kristin Kuchno - HHS has abruptly canceled more than $12 billion in grants to state health departments that supported efforts to track infectious diseases, expand mental health services and modernize outdated systems, according to The New York Times. Late March 25, state health departments started receiving notices that $11.4 billion in grants from the CDC and roughly $1 billion in funds from the Substance Abuse and Mental Health Services Administration were being canceled immediately. Read Full Article…

HVBA Article Summary

1. CDC Halts COVID-19 Funding Programs: The CDC has officially discontinued $11.4 billion in COVID-19 response funds, instructing recipients to cease activities and spending related to the grants. These funds, once used for vaccinations, testing, and addressing health disparities, had been repurposed in 2024 for broader public health efforts like monitoring other respiratory viruses and supporting chronic disease research.

2. Impact on Public Health Infrastructure: The termination of funds is already affecting state and local public health responses, including efforts to manage a measles outbreak in Texas. Some states are preparing to lay off epidemiologists and data scientists due to the loss of federal support.

3. Political and Strategic Shift in Health Priorities: HHS spokesperson Andrew Nixon cited the end of the pandemic and a redirection of resources toward chronic disease initiatives aligned with former President Trump’s “Make America Healthy Again” agenda. This marks a broader shift in federal health policy away from emergency pandemic response.

Majority of workers feel their mental health struggles are ignored

By Henry Craver - Employees are struggling with mental health and its driving turnover. To make matters worse, many employers are unaware of the problem. That’s the gist of a recent report from Modern Health that found that 77% of employees experiencing a toxic workplace say their employers think the office is healthier than it really is. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Persistent Mental Health Struggles Post-Pandemic: Many employees—especially from Gen Z—continue to experience mental health issues that were expected to subside after the pandemic. Over half say their mental health has not recovered, and few believe their employers have meaningfully improved mental health support, pointing to a lingering crisis that remains largely unaddressed.

2. Work-Related Stress and Inadequate Support: A significant portion of the workforce feels compelled to push through burnout, with many perceiving that productivity is prioritized over their well-being. Despite the growing need for mental health resources, most employees feel current support systems are lacking and express a strong desire for expanded benefits and more effective assistance.

3. Business Risks and the Call for Action: The lack of sufficient mental health support is contributing to low morale and increased turnover, especially among younger workers—60% of Gen Z say they’ve considered leaving their jobs due to poor support. Experts urge companies to take proactive steps by fostering a supportive culture that prioritizes mental health as a key driver of long-term employee retention and organizational performance.

Will this summer be Telehealth’s last stand?

By Eric Wicklund - Telehealth and Hospital at Home advocates are once again celebrating an extension of key pandemic-era waivers with last week’s funding bill passage. But the six-month extension isn’t making things any easier for healthcare execs looking to plot long-term strategies. And while supporters are taking heart in the fact that Congress has consistently kept these programs in view, they also know that the cycle of kicking the can down the road has to end. Read Full Article… 

HVBA Article Summary

1. Summer Showdown for Telehealth and Hospital at Home: Healthcare leaders have until September 30 to make a compelling case for permanent CMS support of pandemic-era waivers, including telehealth flexibilities and the Acute Hospital Care at Home (AHCAH) program. The focus is on gathering strong data to demonstrate cost savings, better outcomes, and reduced complexity.

2. Evidence Needed to Secure the Future: While many organizations and advocacy groups push for multi-year extensions to study and refine these programs, critics argue that current evidence—especially around Hospital at Home—is limited in scale and scope. Leaders like Dr. Stephen Dorner emphasize the need for time and innovation to evolve care-at-home models.

3. Momentum Meets Uncertainty: Despite significant adoption and investment, the future of these programs hinges on whether Congress or CMS will act. The healthcare industry faces a make-or-break moment this summer, as temporary waivers risk expiration without a clear long-term policy decision.

GLP-1s are accelerating spending growth on traditional drugs, Evernorth research finds

By Rebecca Pifer - GLP-1s, short for glucagon-like peptide-1 receptor agonists, are a class of drugs that work by mimicking a hormone that regulates blood sugar levels. GLP-1s have been approved for diabetes for two decades, but more recent iterations of the drugs have shown strong efficacy in promoting weight loss and helping with related conditions, like heart disease and sleep apnea. Read Full Article…

HVBA Article Summary

1. High Demand Meets High Cost: GLP-1 drugs like Wegovy and Ozempic have experienced a surge in demand as popular weight loss aids, even though their list prices hover around $1,000 per month. Access remains limited, with only 59% of health plans and 22% of employers covering them for weight loss, putting them out of reach for many Americans who could benefit.

2. Driving Drug Spending Growth: These medications have become a major driver of rising prescription drug costs in the U.S., particularly since semaglutide was approved for weight management in 2021. In 2023 alone, GLP-1s accounted for nearly 47% of the total increase in drug spending, with costs rising more than 200%, according to Evernorth.

3. Push for Long-Term Solutions: Despite their effectiveness—helping patients lose 15% to 25% of their body weight—over half of users discontinue GLP-1s due to side effects or safety concerns, often regaining much of the lost weight. In response, insurers and healthcare companies are pairing prescriptions with behavior change programs to improve outcomes and protect their financial investment in the drugs.

Optum Rx to overhaul pharmacy reimbursement models

By Paige Minemyer - Optum Rx is shifting its payment models to better meet the needs of pharmacies and consumers, the pharmacy benefit manager announced [last] Thursday. The company said it will shift to a cost-based model, which will better align with "the costs pharmacies may face due to manufacturer pricing actions." The PBM expects the change to be a positive one for the more than 24,000 independent and community pharmacies it works with, along with its members. Read Full Article…

HVBA Article Summary

1. Optum Rx is Overhauling Its Pharmacy Payment Model: Optum Rx announced it will begin rolling out a new cost-based pharmacy payment model, with full implementation planned by January 2028. The goal is to better support independent and community pharmacies that are struggling under current reimbursement structures, which were originally designed to promote generics but are now outdated in the face of rising brand-name drug costs.

2. New Approach Targets Drug Access and Affordability: By linking pharmacy payments more directly to the actual cost of medications, the new model aims to ease financial pressures on pharmacies, enabling them to better stock high-cost branded and generic drugs. This change is expected to help prevent shortages and improve access to essential medicines for patients across the country.

3. Broad Support and Transparency Initiatives: The initiative has gained support from organizations like the Epic Pharmacy Network, which represents over 1,000 independent pharmacies. In parallel, Optum Rx is updating client agreements with employers and health plans to improve transparency around pharmaceutical costs—part of a broader response to increasing regulatory and legislative scrutiny of the pharmacy benefit manager (PBM) industry.