Express Scripts Just Got Sued for Racketeering. Here’s What That Means.

By Wendell Potter – A powerhouse law firm has filed a class action lawsuit that should make everyone who pays for prescription drugs through an employer or union health plan sit up and take notice. The target: Express Scripts, the nation’s largest pharmacy benefit manager — and its parent company, Cigna, where I used to work. The lawsuit was filed on February 17 in the U.S. District Court for the Northern District of Illinois by Bernstein Litowitz Berger & Grossmann, one of the most formidable class action firms in the country. The lead plaintiff is the Plumbers’ Welfare Fund, which provides health benefits for members of Chicago-based Plumbers Local 130. Read Full Article...

HVBA Article Summary

1. Alleged Scheme Involving Offshore Entity: The lawsuit claims that Express Scripts and its parent company, Cigna, created an offshore entity in Switzerland called Ascent to receive payments from drug companies. By routing these payments as "fees" rather than rebates, the companies allegedly avoided sharing the money with their clients, such as employers and unions, as required by contract. This arrangement is said to have enabled the companies to obscure the true flow of funds and increase their own profits at the expense of plan sponsors.

2. Potential for Significant Legal and Financial Consequences: If the plaintiffs prevail, the financial liability for Express Scripts and Cigna could be substantial, as the alleged scheme has been ongoing since April 2019 and affects a large number of clients nationwide. The lawsuit is filed under the Racketeer Influenced and Corrupt Organizations Act (RICO), which allows for treble damages, potentially multiplying the total amount owed. Given that the division involved represents a major portion of Cigna’s profits, a successful case could have a major impact on the company’s financial health.

3. Broader Implications for the Pharmacy Benefit Manager Industry: The case highlights longstanding concerns about the opacity and complexity of the pharmacy benefit manager (PBM) business model. The lawsuit, along with a recent Federal Trade Commission settlement over related issues, could prompt greater scrutiny of PBM practices industry-wide. Employers, unions, and government agencies that rely on PBMs to manage drug costs may begin to question whether these intermediaries are acting in their best interests or prioritizing their own financial gain.

Judge rules Aetna, Elevance, Humana must face Medicare kickback allegations

By Elizabeth Casolo – A judge denied a motion to dismiss a lawsuit alleging a broker kickback scheme involving CVS Health’s Aetna, Elevance Health and Humana, according to a March 25 filing in the U.S. District Court in Massachusetts. The judge also ruled that Medicare Advantage brokers GoHealth, SelectQuote and eHealth will continue to face litigation. In 2025, the government decided to intervene and the Department of Justice filed the sweeping lawsuit, building on a 2021 whistleblower complaint. The lawsuit alleged that, between 2016 and 2021, insurers agreed to pay brokers “hundreds of millions” in exchange for marketing services that steered beneficiaries away from competitor plans. Read Full Article...

HVBA Article Summary

1. Lawsuit Against Major Insurers and Brokers Moves Forward: The court's decision allows the Department of Justice's lawsuit, which alleges a kickback scheme involving Aetna, Elevance Health, Humana, and several Medicare Advantage brokers, to proceed. The government claims that these insurers paid substantial sums to brokers in return for steering Medicare beneficiaries toward their plans and away from competitors. This ruling means the core allegations of improper payments and anti-competitive conduct will be examined in court.

2. Discrimination and False Claims Act Issues Remain: The lawsuit also accuses Humana and Aetna of structuring payments to limit the enrollment of beneficiaries with disabilities, potentially impacting how brokers assisted disabled individuals seeking Medicare coverage. While the judge dismissed the unjust enrichment claim, the court found that the False Claims Act provides an adequate legal avenue for the government to seek financial recovery. The ongoing litigation will focus on both the alleged kickback and discrimination aspects.

3. Industry and Regulatory Scrutiny Intensifies: The case is part of a broader pattern of increased scrutiny of Medicare Advantage marketing and broker practices. Recent government investigations and shareholder lawsuits have highlighted concerns about misleading marketing and investor disclosures. The outcome of this case could influence future regulatory actions and industry standards for broker compensation and beneficiary protections.

Solving the ICHRA operations puzzle

By Allison Bell – As employer interest in individual coverage health reimbursement arrangements surges, health plans need to prepare for the operational realities of the ICHRA model. The HRA Council reported ICHRA adoption increased 52% among small employers and 34% among applicable large employers in 2025. ICHRA isn't a product, but rather a new distribution model for off-exchange plans. In these arrangements, employers provide a stipend for employee health insurance purchases instead of offering traditional group coverage. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Fragmented Ecosystem Challenges: The ICHRA model introduces a highly decentralized environment where employees may enroll in different plans through various platforms, leading to a disorganized flow of information. Each vendor or platform may have unique processes and data formats, making it difficult for health plans to manage enrollment and payment efficiently. This fragmentation requires health plans to adopt flexible and integrated systems to handle the complexity and ensure smooth operations.

2. Disruption of Standardized Workflows: Unlike traditional group health plans with centralized enrollment and predictable processes, ICHRA arrangements involve multiple sources of enrollment data and variable payment schedules. Health plans must reconcile premium payments from different payers for the same member, often without a centralized system of record. This increases administrative burdens and the risk of errors, potentially impacting member coverage and the overall experience.

3. Need for Long-Term Strategic Investment: As ICHRA adoption grows, health plans cannot treat it as a simple add-on to existing systems. They must invest in dedicated infrastructure and teams to manage the unique requirements of ICHRA, including reliable member identification and seamless data exchanges. Building scalable solutions will be essential for supporting the expanding volume of ICHRA-funded members and adapting to ongoing changes in the individual health insurance market.

How employees are spending their HSA dollars, from Amazon to GLP-1s

By Jimmy Nesbitt – Amazon has emerged as a top destination for Health Savings Account holders, as more consumers use the online giant to buy health and wellness products with their funds. The eighth annual HSA Spend Report from benefits provider Lively shows how HSA spending is shifting from hospitals and doctors to a broader ecosystem of consumer health brands and e-commerce platforms. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Amazon Sees Surge in HSA Spending: HSA spending at Amazon increased by 123% in 2025 compared to the previous year, making it one of the leading merchants by transaction volume. The growth reflects Amazon’s expanded focus on offering HSA- and FSA-eligible products to consumers. Other digital-first retailers and healthcare platforms, including Hims & Hers, Ro Health, Warby Parker, and 1-800 Contacts, also recorded increased HSA spending during the same period.

2. Growth in GLP-1 and Digital Health Platforms: The report found a major increase in HSA spending tied to platforms connected to GLP-1 medications. Spending at Lilly rose 5,610% year over year, while Hims & Hers saw a 134% increase, reflecting both increased adoption of branded medications and the expansion of digital platforms that combine consultation, prescription, and fulfillment services. The findings highlight how consumers are turning to digital health platforms for convenient access to treatment options.

3. Rising Mental Health Spending and HSA Balances: Spending on mental health platforms such as Headway, BetterHelp, and therapy-focused apps also increased in 2025 as virtual therapy becomes more normalized and stigma continues to decline. At the same time, average HSA balances reached $5,457 in 2025, an 11% increase from the previous year and the highest level recorded by the report. Despite rising healthcare costs, the data suggests many consumers are continuing to grow their HSA savings while using the accounts to pay for healthcare services.

Boston tightens employee drug coverage, including GLP-1s

By Elizabeth Casolo – The city of Boston will implement utilization management for its employees, according to a March 26 news release from Mayor Michelle Wu’s office. The Public Employee Committee voted to pass the agreement with unanimous consent. The city expects to save about $10.6 million. City revenue is expected to grow between 1.5% and 2.5%, while healthcare costs spike significantly. The news release attributed the steeper expenses in part to mounting interest in GLP-1s. Read Full Article...

HVBA Article Summary

1. Implementation of Utilization Management: Boston is introducing utilization management for employee healthcare benefits in response to rising costs. This approach is designed to control spending by reviewing and potentially limiting access to certain medications and treatments. The unanimous approval by the Public Employee Committee indicates strong support for this cost-saving measure.

2. Impact of GLP-1 Drugs on Healthcare Costs: The city specifically cited increased interest in GLP-1 medications as a significant factor driving up healthcare expenses. These drugs, often used for weight loss and diabetes management, have contributed to higher insurance claims and financial strain on health plans. The trend reflects broader national challenges as employers and insurers grapple with the popularity and cost of these medications.

3. Changes to Coverage with BCBS Massachusetts: The policy change affects employees covered by BCBS Massachusetts, which previously removed weight-loss drug coverage from its standard benefits while maintaining coverage for diabetes-related GLP-1s. Executives from the insurer have pointed to GLP-1s as a major reason for substantial operating losses in the past year. Large employers, including the city, now face decisions about whether to continue offering weight-loss drug coverage as part of their health plans.

UnitedHealthcare joins the health care AI race

By Alan Goforth – UnitedHealthcare Group has joined the AI revolution in health care. On Thursday, the company introduced Avery, a generative AI companion designed to create a simpler, more coordinated health care experience for members while empowering customer advocates to more efficiently respond to members. "People want health care to be easier to use and tailored to their personal needs," said Dan Kueter, CEO for UnitedHealthcare's commercial business. "Avery is one way we are responding to consumer demand for a more-coordinated and simpler experience and enabling our members to focus on what matters most -- getting and staying well." Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. UnitedHealthcare Launches Avery AI Companion: UnitedHealthcare has introduced Avery, a generative AI tool aimed at simplifying and personalizing the health care experience for its members. Avery is designed to assist with a variety of tasks, including coverage questions, appointment scheduling, cost estimates, and provider searches. The tool also supports customer advocates by providing real-time administrative assistance and insights into member history.

2. Expansion Plans and Reach: Avery is currently available to approximately 6.5 million UnitedHealthcare employer-sponsored health plan members and 160,000 Medicare Advantage members. The company plans to expand Avery's availability to a total of 20.5 million commercial, Medicare, and Medicaid members by the end of the year. This expansion reflects UnitedHealthcare's commitment to integrating AI solutions across its member base.

3. Broader Industry Adoption of AI in Health Care: The article highlights that other major companies, such as Amazon, Microsoft, and CVS Health, are also rolling out AI-driven health care solutions. These initiatives include tools for claim processing, appointment management, and personalized health insights. The rapid adoption of AI across the industry signals a significant shift toward technology-driven, consumer-focused health care services.

Can GLP-1 Drugs Prevent Worsening Mental Illness? Perhaps, Study Suggests

By Kristen Monaco – People with pre-existing depression or anxiety were less likely to have mental health worsening while taking a GLP-1 medication, observational Swedish data suggested. Compared with periods of non-use in the same individual, periods during which people were on semaglutide (Ozempic, Wegovy; adjusted HR [aHR] 0.58, 95% CI 0.51-0.65) or liraglutide (Victoza, Saxenda; aHR 0.82, 95% CI 0.76-0.89) were associated with a lower risk of a decline in mental health over an average follow-up of 5.2-years. Read Full Article… 

HVBA Article Summary

1. Study Links Certain GLP-1 Drugs to Lower Risk of Worsening Mental Illness: A large observational study of 22,480 Swedish patients with depression or anxiety found that use of some GLP-1 receptor agonists was associated with a lower risk of worsening mental illness. Worsening mental illness was defined as psychiatric hospitalization, sick leave for psychiatric reasons, self-harm, or suicide. The research represents the first within-individual study to examine this association among people using GLP-1 medications.

2. Semaglutide and Liraglutide Show Strongest Associations: The study found that semaglutide and liraglutide were linked with reduced risk of worsening depression, while semaglutide was also associated with lower risks of anxiety and substance use disorder. Other GLP-1 agents, including exenatide and dulaglutide, did not demonstrate the same associations, suggesting the potential benefits may not apply to all drugs in the class. Researchers suggested possible mechanisms including improved glycemic control, weight-related psychological benefits, and potential effects on brain pathways involved in mood regulation.

3. Findings Address Prior Safety Concerns but Require Further Research: Among 171 suicide deaths recorded during the study period, only one occurred while a patient was actively taking a GLP-1 medication, helping address earlier concerns about suicidality. The FDA had previously investigated reports of suicidal ideation but later concluded that clinical trial data did not show a causal link, and in 2026 requested removal of certain suicidality warnings from GLP-1 drug labels. Because the study was observational and lacked detailed data on factors such as symptom severity, weight change, and HbA1c levels, the researchers emphasized the need for randomized controlled trials to confirm the findings.