Trump says he'll sign order on 'most favored nation' drug price plans Monday

By Max Bayer - President Donald Trump said he’ll take executive action to have the US pay no more than other countries for drugs, a move that would expand price controls and is almost certain to generate strident opposition from the industry. In a Sunday social media post, Trump said he will move ahead with a long-expected “most favored nation” policy via executive order on Monday. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Trump’s Drug Pricing Plan Targets International Benchmarking: The proposed policy would link U.S. government drug spending to the lower prices paid in other countries, a move Trump argues could deliver immediate savings of 30% to 80% and potentially save the government trillions. Although details are scarce, the plan would revive the “most favored nation” pricing concept from his first term, signaling a major cost-control effort aimed at reining in pharmaceutical pricing.

2. Implementation Likely to Face Legal and Political Pushback: Any executive order would need to be translated into regulation, a process likely to trigger legal challenges from stakeholders. Trump may pursue a Medicare demonstration model again or expand the approach to Medicaid, but GOP lawmakers remain skeptical—associating the policy with Democratic-led healthcare reforms and expressing concern over its resemblance to government price-setting mechanisms.

3. Pharmaceutical Industry Pushes Back Strongly: The drug industry’s lobbying group, PhRMA, has sharply criticized the proposal, warning it could undermine billions in promised investments tied to U.S. manufacturing expansion. The group argues that the plan poses a long-term threat to innovation and patient access, setting the stage for heightened conflict between the administration and the pharmaceutical sector.

5.3M student loan borrowers now in default face wage garnishment this summer

By Lynn Cavanaugh - After five-year hiatus – and an end to pandemic-era relief on student loans during the Biden administration, the Department of Education announced this week that its Office of Federal Student Aid (FSA) will resume collections of its defaulted federal student loan. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Treasury Offset and Wage Garnishment Begin for Defaulted Borrowers: Starting this week, nearly 195,000 student loan borrowers in default will receive 30-day notices that their federal benefits, including tax refunds and salaries, may be withheld under the Treasury Offset Program. By early June, benefit checks will be affected, and later this summer, all 5.3 million borrowers in default could face wage garnishment without a court order.

2. Scope of the Student Loan Default Crisis: Out of 42.7 million student loan borrowers, over 5 million are already in default and another 4 million are at risk. With only 38% of borrowers current on their loans, the Department of Education warns that nearly 10 million could soon be in default, triggering aggressive collection measures such as wage garnishment and benefit offsets.

3. Support Measures and Collection Enforcement: Borrowers in default are being contacted by the Federal Student Aid office and encouraged to enter income-driven repayment plans or loan rehabilitation to avoid garnishment. The Department has expanded support services and authorized involuntary collections on older FFEL loans, asserting that all actions comply with the Higher Education Act after sufficient borrower notice.

AI assistants essential for value-based care, report finds

By Emma Beavins - Artificial intelligence assistants could ease the transition to value-based care for primary care practices, a new report by Phyx Primary Care found. VBC can be administratively burdensome due to its enhanced reporting requirements. Primary care practices report that the transition to VBC is often long and results in a mix of VBC and fee-for-service billing practices. Read Full Article…

HVBA Article Summary

1. Improved Efficiency and Reduced Burnout: In a study of 120 physicians using Navina’s AI assistant, providers reported a 40% reduction in clinical review time for complex patients and a 32% decrease in burnout—highlighting the tool's potential to ease administrative burdens in primary care.

2. Enhanced Documentation and Reimbursement Accuracy: The AI assistant helped providers summarize patient records, identify care gaps, improve documentation fidelity, and flag appropriate billing codes, contributing to a +0.153 increase in risk adjustment factor and a +1.9 point improvement in star quality ratings—key metrics in value-based care (VBC).

3. High Adoption Despite Study Limitations: The AI tool achieved over 90% ratings for usability, frequency of use, and trust in its recommendations. While the study lacked a control group and was based on retrospective provider surveys, the findings suggest AI scribes could be vital for independent practices navigating fragmented VBC models.

How are companies affording GLP-1 coverage?

By EBN Staff - As consumers are clamoring for access to pricey GLP-1 drugs for weight loss, employers are feeling  the need to modify or update their plans to accommodate new demands and costs. KFF's 2024 Employer Health Benefits Survey analyzed responses from 2,142 interviews with non-federal public and private firms to determine if employers are covering GLP-1s. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Limited Employer Coverage: According to KFF's 2024 Employer Health Benefits Survey, only 18% of employers currently cover GLP-1 medications, with larger organizations more inclined to offer coverage—28% of large firms reported doing so—highlighting a disparity based on employer size.

2. Low Likelihood of Expansion: Among the majority of employers not covering GLP-1s, 62% indicated they are not likely to introduce this benefit in 2024, largely due to concerns over the high cost of these medications and uncertainty around long-term return on investment.

3. Conditional Coverage Requirements: For the subset of employers providing GLP-1 coverage for obesity treatment, 53% require employees to meet specific prerequisites, such as enrolling in case management or participating in structured weight-loss or lifestyle programs, emphasizing a focus on behavioral support alongside medication.

Trump promises to order that the US pay only the price other nations do for some drugs

By Will Weissert and Amanda Seitz - President Donald Trump says he’ll sign an executive order on Monday that, if implemented, could bring down the costs of some medications — reviving a failed effort from his first term on an issue he’s talked up since even before becoming president. The order Trump is promising will direct the Department of Health and Human Services to tie what Medicare pays for medications administered in a doctor’s office to the lowest price paid by other countries. Read Full Article…

HVBA Article Summary

1. Trump Revives Most Favored Nation Drug Pricing Plan: Former President Trump pledged to reinstate a "Most Favored Nation" policy that would tie U.S. Medicare drug prices to those paid by countries with the lowest negotiated rates globally—targeting expensive Medicare Part B drugs like cancer infusions and injectables administered in clinical settings.

2. Potential for Government Savings, Fierce Industry Pushback: While the proposal could reduce Medicare Part B drug spending—estimated at $33 billion in 2021—by leveraging international pricing benchmarks, experts caution that Trump’s claim of “trillions” in savings is likely overstated. The pharmaceutical industry strongly opposes the move, warning it could harm innovation and give foreign governments undue influence over U.S. drug pricing.

3. Policy Echoes First-Term Efforts Blocked by Courts: Trump first attempted to implement a similar executive order in 2020, but it was ultimately blocked in court. His renewed effort faces legal and political hurdles, especially with expected resistance from drugmakers and lawmakers wary of disrupting Medicare’s pricing structure or reducing pharma profits.

Benefits Think: Mastering discipline in benefits consulting

By Butch Zemar - In the fast-paced world of benefits consulting, discipline is an essential skill that sets top consultants apart from the pack. It's easy to get overwhelmed by shifting regulations, evolving client needs and the sheer complexity of benefits programs. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Discipline as a Strategic Advantage: Maintaining discipline is a continual process that requires proactive structure and urgency. Benefits consultants can enhance their efficiency and impact by applying Parkinson’s Law—starting projects early and setting tight deadlines—and by embracing short-term planning frameworks like the 12-week year to maintain focus, momentum, and measurable progress.

2. 10x Thinking for Transformative Value: Rather than relying on incremental efforts or conventional solutions, benefits consultants should adopt a “10x mindset” to identify bold, high-impact strategies. This includes exploring innovative funding models, wellness initiatives, and alternative insurance designs that can deliver exponential value and reshape clients’ benefits programs.

3. Resilience and Continuous Learning: Setbacks are inevitable, but disciplined consultants use them as opportunities to grow. By journaling challenges, analyzing missteps, and refining their approach, consultants develop a resilient mindset that supports continuous improvement and long-term success in an increasingly complex industry.

Medicare is a natural fit for life insurance agents

By Federico Guardia - Integrating Medicare, Medicare Advantage plans and Medicare Supplement products into your life insurance practice is about offering a complete, client-focused solution that meets your clients’ evolving health and financial needs. Read Full Article…

HVBA Article Summary

1. Expanding Market Opportunity: With Medicare enrollment expected to grow to 80 million by 2030, insurance agents have an unprecedented opportunity to diversify their income streams. By helping clients evaluate Medicare Advantage, Medigap, and prescription drug plans, agents can generate recurring revenue through renewals, improve client retention, and differentiate themselves through year-round guidance and education in a complex market.

2. Natural Fit for Life Insurance Agents: Medicare products complement life insurance offerings by allowing agents to address both health and financial risks that arise during retirement. Life insurance agents are well-positioned to serve aging clients who are becoming Medicare-eligible, and by cross-selling Medicare coverage, they can deepen relationships, enhance client loyalty, and create a steady flow of referrals from existing policyholders and their families.

3. Strategic Growth Through Holistic Sales: Success in the Medicare market depends on a comprehensive approach that includes proper licensing, market understanding, strategic partnerships, and tailored client education. Agents who take time to evaluate healthcare usage, provider preferences, and budget constraints can deliver personalized Medicare solutions—building a sustainable, referral-driven business rooted in trust and long-term client value.