RFK Jr. orders HHS to end 'extra-statutory' notice, public comment process in rulemaking

By Dave Muoio - Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. is closing the main avenue for members of the public to weigh in on pending health regulations and policy changes. Read Full Article…

HVBA Article Summary

1. HHS Policy Shift on Public Comment: The new policy statement from the Department of Health and Human Services (HHS), published by Secretary RFK Jr., eliminates the longstanding requirement for public comment periods on rulemaking related to agency management, public property, loans, grants, benefits, or contracts. This reverses a 1971 policy known as the Richardson Waiver, which previously encouraged transparency and public participation.

2. Concerns Over Transparency and Regulatory Impact: Critics, including industry groups and health policy experts, warn that bypassing public input could lead to weaker, error-prone regulations that lack proper vetting. The decision has sparked backlash from public health advocates, who argue that eliminating public comment undermines trust in HHS decision-making and contradicts RFK Jr.’s earlier pledges of “radical transparency.”

3. Political and Legal Implications: The policy shift raises legal questions about its alignment with the Administrative Procedure Act (APA) and Supreme Court precedent. Additionally, political figures and advocacy groups have condemned the move, with some calling for an immediate reversal, citing potential harm to public health policymaking and reduced accountability in government decision-making.

Top HHS spokesperson quits after clashing with RFK Jr.

By Adam Cancryn - The top spokesperson at the Health and Human Services Department has abruptly quit after clashing with Secretary Robert F. Kennedy Jr. and his close aides over their management of the agency amid a growing measles outbreak, two people familiar with the matter told POLITICO. Read Full Article…

HVBA Article Summary

1. Sudden Resignation and Internal Disputes: Thomas Corry resigned as assistant secretary for public affairs at HHS just two weeks into the role, citing disagreements with Secretary Kennedy and his deputy chief of staff, Stefanie Spear, over their management approach and decision-making processes.

2. Concerns Over Measles Response: Corry reportedly grew uneasy with Kennedy’s handling of the Texas measles outbreak, which has infected at least 146 people. Kennedy's reluctance to explicitly encourage vaccination, despite acknowledging the vaccine’s protective benefits, raised concerns about the administration’s public health priorities.

3. Broader Leadership Challenges: Corry’s abrupt departure underscores concerns about Kennedy’s leadership capabilities, given his lack of government experience and history as a vaccine skeptic. The influence of Spear over Kennedy’s decisions has also raised alarms within the administration, contributing to internal tensions.

Optum, Aetna reach 'dummy code' lawsuit settlement

By Jakob Emerson - Aetna and Optum have agreed to settle a nearly decade-long class action lawsuit that accused the companies of improperly charging administrative fees as medical expenses. Read Full Article… 

HVBA Article Summary

1. Allegations of Misleading Billing Practices: The lawsuit, filed in 2015, alleged that Aetna and Optum used "dummy codes" to misrepresent administrative fees for chiropractic services as medical charges, leading to undisclosed overpayments by plan participants and employers.

2. Settlement Terms and Financial Contributions: Aetna and Optum have agreed to a $4.8 million settlement, with Aetna contributing $4.6 million and Optum $200,000. Additionally, Aetna will cover $3.5 million in attorney fees.

3. Finalization and Court Approval: After initially opposing the settlement, Optum eventually reached an agreement under seal. The settlement is still subject to court approval, and class members will have the opportunity to opt out or object.

ERISA Advisory Council Currently ‘On Ice’

By Remy Samuels - Amid President Donald Trump’s efforts to reduce the federal bureaucracy, including the staffing cuts in the Department of Labor’s Employee Benefits Security Administration, advisory committees have also become targets, and the ERISA Advisory Council is currently “on ice,” according to sources. Read Full Article…

HVBA Article Summary

1. Delays and Uncertainty in ERISA Advisory Council Operations: The ERISA Advisory Council has not scheduled its first meeting of the year, and the Department of Labor has yet to publish key reports from last year, creating uncertainty about the council’s next steps. EBSA officials, including Lisa Gomez and Ali Khawar, highlight that the council provides valuable research and recommendations, but it remains unclear how it will proceed under the current administration.

2. Potential Impact of Executive Order on Advisory Councils: Former President Trump’s executive order requires federal agencies to submit lists of advisory committees for potential termination. However, Khawar clarifies that the ERISA Advisory Council is a statutory body and cannot be abolished through executive action alone. Despite this, concerns remain about whether the administration might push for legislative repeal or reduce the council’s capacity.

3. EBSA Faces Potential Budget Cuts and Workforce Reductions: Federal agencies, including EBSA, have been instructed to prepare reduction-in-force plans, raising concerns about further staff cuts in an already resource-constrained agency. Khawar warns that any reductions could severely impact EBSA’s ability to regulate private sector health and retirement plans, conduct enforcement, and develop thoughtful policies.

4 macro trends shaping employee benefits this year

By Jen Colletta - Uncertainty “looms” large over the American workplace today, analysts with professional services firm Marsh McLennan Agency recently wrote in the organization’s annual Employee Health & Benefits Trends report. From politics to the economy and the environment, employers will face “daunting challenges” keeping up with large-scale changes coming at an unprecedented pace and driving new trends in employee benefits. Read Full Article…

HVBA Article Summary

1. Adapting to a Multigenerational Workforce: With five generations in the workforce, HR and benefits leaders must design flexible benefits that appeal across age groups. Understanding generational differences in benefits engagement, career growth expectations, and workplace culture is crucial for trust and retention. Strategies such as mentorship programs and tailored communication methods can bridge generational gaps and enhance workforce cohesion.

2. AI’s Transformative Role in HR: AI is revolutionizing HR beyond task automation by providing data-driven insights to improve employee experience and workplace culture. To maximize AI’s potential, HR leaders should balance technological innovation with empathy, ensuring AI-driven strategies foster stronger connections and continuous growth among employees.

3. Rising Healthcare and Pharmacy Costs: The continued rise in healthcare costs necessitates data-driven approaches to benefits planning. HR leaders must analyze employee health trends, social determinants, and cost-driving factors to develop targeted programs. Additionally, scrutinizing pharmacy benefits management and making strategic adjustments—such as revising formularies or switching PBMs—can help control costs and optimize employer and employee spending.

$35.8B: Medicare diabetes drug costs skyrocket

By Alan Goforth - Medicare Part D spending for 10 selected diabetes drugs surged from $7.7 billion in 2019 to $35.8 billion in 2023, an audit by the U.S. Department of Health and Human Services Office of Inspector General found. At the same time, Part D spending for Ozempic increased from $552 million to $9.2 billion and the number of Part D enrollees filling a prescription for Ozempic increased from 142,479 to 1,465,482 (a 929% increase). Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Significant Increase in Part D Spending: Medicare Part D spending on key diabetes drugs, including Ozempic, Mounjaro, and Rybelsus, saw a dramatic rise between 2019 and 2023. Rybelsus experienced the largest increase, surging from $366,443 in 2019 to nearly $1.7 billion by 2023, a 2,182% increase. Similarly, spending on Ozempic was 16 times higher in 2023 compared to 2019.

2. Potential Financial Impact on Medicare: If the observed annual spending growth rate of at least 42% continues, total Medicare Part D spending on select diabetes drugs could exceed $102 billion by 2026. Given that Medicare Part D does not cover weight-loss drugs, this sharp increase raises concerns about whether these medications are being prescribed and reimbursed appropriately.

3. Need for Further Oversight and Audits: The Office of Inspector General (OIG) emphasized the importance of further investigation to determine whether Medicare payments for these diabetes drugs align with federal requirements. Additional audits are planned to assess compliance with Medicare regulations and ensure that claims are for medically accepted indications.

A changing approach to client prospecting

By John Forcucci - The rise of technology, particularly artificial intelligence, has revolutionized the way professionals identify, connect with and build relationships with potential clients. By leveraging these advancements and adopting new strategies, it’s possible to improve efficiency, personalize outreach and ultimately grow a business. Read Full Article…  

HVBA Article Summary

1. AI-Powered Prospect Identification: AI enables businesses to analyze client demographics, behaviors, and preferences to pinpoint ideal prospects. This ensures outreach efforts are directed toward individuals or businesses with the highest conversion potential, optimizing time and resources.

2. Enhanced Engagement through Personalization: AI-driven tools analyze a prospect’s online presence, financial goals, and significant life events to craft personalized messages. This level of customization strengthens trust, improves response rates, and differentiates businesses in a competitive market.

3. Automation of Routine Tasks: AI-powered chatbots and virtual assistants handle initial inquiries, schedule meetings, and send follow-up messages. By automating these tasks, professionals can focus on high-value interactions while maintaining consistent and efficient communication with prospects.

BCBS Massachusetts reports $400M loss driven by GLP-1 spending

By Rylee Wilson - Blue Cross Blue Shield of Massachusetts reported a $400 million operating loss in 2024, driven by spending on GLP-1 medications and other rising medical costs. The nonprofit insurer reported its financial results for 2024 on Feb. 28. The company posted a -4.3% operating margin in 2024, compared to a 0.4% margin in 2023.. Read Full Article…

HVBA Article Summary

1. Surging Medical Costs and GLP-1 Impact: Medical costs are increasing at the fastest rate in over a decade, with GLP-1 drugs being the most significant driver, accounting for nearly 20% of the insurer's pharmacy spending in 2024.

2. Cost-Cutting Measures and Repricing: To address rising costs, the insurer is repricing its plans and implementing cost-cutting strategies, including hiring freezes and job eliminations.

3. Long-Term Financial Challenges: The insurer does not anticipate cost trends to improve soon, prompting a more disciplined operational approach, mirroring challenges faced by other Blue Cross Blue Shield insurers struggling with the impact of specialty drug expenses.