Big Insurance Q1 2026 Earnings Round Up

By Wendell Potter – The most recent numbers the nation’s largest for-profit health insurers have shared with investors tell a story the industry is eager to tell Wall Street: the worst is over. After two brutal years of earnings misses, executive firings, and stock price collapses driven by unexpectedly high medical spending, the seven biggest publicly traded health insurers have now completed their first-quarter earnings reports for 2026 and their shareholders are cheering. Every one of them beat analysts’ expectations in various ways, and most raised their full-year 2026 guidance. But before you read the company-by-company results, it is worth examining the mechanisms behind that recovery because the story the earnings releases tell is not quite the same as the story they leave out. Read Full Article...

HVBA Article Summary

1. Profit Recovery Driven by Cost Shifting: The largest for-profit health insurers improved their financial performance in Q1 2026 by raising premiums, cutting benefits, narrowing provider networks, and exiting less profitable markets. These actions led to a reduction in total medical membership by about four million people compared to the previous year. While these strategies pleased investors and improved earnings, they shifted costs onto patients, states, and the federal government rather than reducing overall medical spending.

2. Stock Performance Shows Partial Rebound: Most of the seven major insurers saw their stock prices rise year to date, rebounding from significant declines at the end of 2025. However, when compared to the same period a year ago, several companies—such as Molina, Cigna, and Elevance—remain below their previous valuations. This indicates that while there has been a recovery from recent lows, the sector has not fully regained its former financial strength.

3. Medical Loss Ratio as a Key Metric: Insurers’ profitability was closely tied to the medical loss ratio (MLR), which measures the percentage of premium revenue spent on medical care. Across the sector, MLRs generally decreased, signaling tighter cost management and increased profitability. Companies attributed these improvements to factors like repricing, benefit reductions, and milder flu seasons, but the underlying trend was a focus on maximizing margins, sometimes at the expense of coverage for higher-cost or sicker members.

ERISA plan administrator wins federal court ruling thanks to policy cover page

By Allison Bell – A new federal court opinion in California may prompt employers and their benefits advisors to quick look at benefit plan cover pages. U.S. Chief District Judge Richard Seeborg ruled last week that the courts should use North Carolina law when reviewing a worker's long-term disability insurance claim, not California law, because the insurer, Life Insurance Company of North America, made it clear that North Carolina law should apply. "The cover page of the policy contains the following provision: the policy 'is issued in North Carolina and shall be governed by its laws,'" Seeborg wrote in an opinion explaining an order granting the insurer's motion to have the court use California law when looking at the case. Life Insurance Company of North America was once owned by Cigna but is now owned by New York Life Insurance Company. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Choice-of-Law Clauses Can Override State Protections: The court's decision highlights that a clearly stated choice-of-law provision on a policy cover page can determine which state's laws govern a benefits dispute, even if the employee lives and works in another state. In this case, North Carolina law was applied instead of California law, despite the claimant's California residency and employment. This sets a precedent that employers and insurers may rely on such clauses to avoid certain state regulations.

2. Implications for Employee Protections: California has specific laws intended to protect workers from claim administrator abuse of discretion, but the court found that the North Carolina provision was not unreasonable or fundamentally unfair. The ruling suggests that employees may not always benefit from their home state's consumer protections if the policy specifies another jurisdiction. This could limit the recourse available to employees in states with stronger insurance regulations.

3. Potential for Further Legal Challenges: The plaintiff's legal team argued that the choice-of-law clause should not negate all state insurance regulations, especially when other state notices are included in the policy. Although the court upheld the North Carolina provision, the plaintiff's attorneys plan to continue litigating under North Carolina law. The outcome of future proceedings could further clarify the enforceability and limits of such policy provisions.

From LTC to future independence

By Chuck Greenblott – For decades, long-term care (LTC) planning has carried the same heavy baggage for brokers, agents, consultants and clients alike. It's a conversation often rooted in dependency, institutional settings and reactive decisions made under the shadow of a crisis. It's a model built for a different time. But a fundamental shift is underway, driven by your clients. Gen X and younger boomers aren't interested in surrendering control. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Shift from Dependency to Independence: The article highlights a significant change in how clients approach long-term care planning, moving away from a focus on dependency and crisis response. Modern clients, especially Gen X and younger boomers, are more interested in maintaining control and independence as they age. This shift requires advisers to reframe conversations and strategies to prioritize autonomy and proactive planning.

2. Five-Pillar Framework for Future Independence: The author introduces a comprehensive framework built around five pillars: lifestyle design, care strategy, family role clarity, financial architecture, and control/decision frameworks. This approach emphasizes starting with the client's desired lifestyle and working backward, rather than leading with insurance products. By integrating these elements, advisers can offer more holistic and personalized guidance that addresses both practical and emotional aspects of aging.

3. Broader Impact on Advisers and Employers: Adopting this new planning paradigm allows advisers to differentiate themselves by providing deeper, more meaningful counsel rather than focusing solely on product sales. It also creates opportunities for collaboration with other professionals and supports employee wellbeing by reducing stress related to family caregiving. Ultimately, this evolution in planning benefits both clients and the advisory profession by aligning services with the evolving needs and values of modern employees.

Lilly points to low-dose Zepbound and Foundayo as weight loss maintenance options

By Elizabeth Cairns – Reducing the dose of Eli Lilly’s obesity shot Zepbound could provide a safe, effective and potentially cheaper option for the maintenance of weight loss, according to new data. The findings come from a trial called SURMOUNT-MAINTAIN, and will be presented at the European Congress on Obesity in Istanbul on Wednesday. The conference will also see data showing that Lilly’s obesity pill Foundayo can work in the maintenance setting, potentially boosting the pill’s sales, which have disappointed so far. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Maintenance Therapy Still Preserves Much of Initial Weight Loss: Studies involving Zepbound found that patients who reduced their dosage or switched therapies regained some weight over time, but generally maintained a substantial portion of their earlier weight loss. Patients who lowered their Zepbound dose to 5 mg regained an average of 6.3% of their weight over one year, while those who transitioned to Foundayo regained about 5.5%. The findings suggest that dose reduction or oral maintenance therapy may offer alternatives for long-term weight management, although remaining on full-dose injectable treatment appears to preserve weight loss more effectively.

2. Lilly Positions Obesity as a Chronic Disease Requiring Long-Term Treatment: Eli Lilly and Company executives said the studies reinforce the idea that obesity should be managed as a chronic condition similar to hypertension or type 2 diabetes. Company representatives noted that many patients hope to discontinue therapy after reaching their weight goals, but evidence across multiple studies shows that stopping treatment often leads to weight regain. Lilly highlighted several maintenance options for patients, including continuing high-dose injections, lowering injectable doses, or switching to a daily oral medication depending on patient preference and treatment goals.

3. Cost and Side-Effect Profiles May Influence Maintenance Therapy Choices: The article noted that financial considerations are likely to play a significant role in how patients choose long-term obesity treatments, especially for those paying out of pocket. Switching from high-dose injectable Zepbound to lower-dose therapy or oral Foundayo could reduce annual treatment costs by several thousand dollars. Safety outcomes also differed between therapies, with lower-dose Zepbound showing relatively low discontinuation rates due to side effects, while patients switching to Foundayo experienced higher rates of nausea and vomiting.

Survey: Employers seeking greater transparency from pharmacy benefits

By Paige Minemyer – Employers want greater transparency in their pharmacy benefits, with many viewing a model that eschews rebates as a key way to get there, according to a new survey. The Penta Group surveyed 300 benefits decision-makers, half of whom hailed from companies with 1,000 to 4,999 workers and half from companies with more than 5,000 employees, for Evernorth. Most (92%) of those surveyed said a model that passes savings directly to members rather than uses rebates would improve transparency. In addition, 90% of those surveyed said PBM models without rebates would boost employee satisfaction and would make it easier for them to afford their medications. Read Full Article...

HVBA Article Summary

1. Strong Employer Demand for Transparent Pharmacy Benefits: The survey highlights a significant preference among employers for pharmacy benefit models that eliminate rebates and pass savings directly to members. This approach is seen as a way to simplify benefits and increase clarity for both employers and employees. The desire for transparency reflects broader trends in healthcare toward consumer-centric and easily understandable benefit structures.

2. Anticipated Impact on Cost Predictability and Satisfaction: Employers believe that moving to rebate-free, fee-based pharmacy benefit models will not only improve transparency but also make it easier to predict pharmacy spending. Many expect that such models will better align with organizational needs and enhance employee satisfaction by making medications more affordable. These anticipated benefits are driving interest in new approaches to pharmacy benefit management.

3. Industry Response and Implementation Timeline: In response to these preferences, Evernorth is launching its Signature Pharmacy Benefit Services model, which shifts away from traditional rebate and network-based structures. The new model will be rolled out to fully insured commercial clients in 2027 and become standard for all pharmacy benefits clients in 2028. This transition includes adopting a cost-plus reimbursement model for pharmacies and offering additional payments for clinical services, aiming to provide greater predictability and trust in pharmacy benefits.

Preventive care is collapsing, and employers may soon pay the price

By Jimmy Nesbitt – Just 17% of employees plan to get an annual physical this year, — a 45% decline from 2024, according to a new nationwide survey on workforce health  that reveals some concerning trends about what experts are calling the "collapse" of preventative care. The data was included in  HealthJoy's fourth annual Member Health Goals Report, which surveyed more than 100,000 members. Missing one routine doctor appointment may not seem like a big deal, but it can have major consequences down the road for both workers and employers, said David Lawrence, vice president of product strategy for HealthJoy. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Preventive Care Declines Raise Long-Term Cost Concerns: The report highlights a significant decline in employees receiving annual physicals and preventive care, despite many understanding that these services are covered by insurance. Factors contributing to the trend include primary care shortages, appointment scheduling difficulties, unexpected healthcare costs, and low employee engagement with benefits. Experts warn that missed preventive care can delay diagnoses and lead to more serious and expensive treatments later, increasing healthcare costs for employers over time.

2. Chronic Conditions and Mental Health Issues Continue to Rise: The study found that approximately 60% of respondents reported managing at least one chronic condition, with double-digit increases among adults over age 36 compared to the previous year. Nearly half of respondents also reported mental health concerns, reflecting either worsening mental health trends, reduced stigma around reporting, or both. The findings additionally point to a strong connection between chronic physical conditions and mental health struggles, particularly among individuals experiencing chronic pain.

3. Employers Are Encouraged to Take More Proactive Healthcare Approaches: The article emphasizes that employers may need to move beyond passive education efforts and adopt more personalized healthcare engagement strategies. Recommended interventions include targeted reminders for preventive care, easier appointment scheduling, virtual care options, and structured management programs for high-demand treatments such as GLP-1 medications. The report concludes that early action and stronger employee engagement could help improve health outcomes while reducing future healthcare and insurance costs.

Hims & Hers posts $92M loss in Q1 as it shifts to branded GLP-1 medications

By Heather Landi – Online health and wellness company Hims & Hers posted a $92 million loss in the first quarter as it transitions its weight loss business to selling branded GLP-1 weight loss treatments, shifting away from compounded GLP-1 drugs. During the same period a year ago, Hims & Hers posted a profit of $49.5 million. The company brought in revenue of $608 million in Q1, up 4% year-over-year. The company's stock was down about 15% in mid-day trading on Tuesday following the unexpected Q1 loss. Read Full Article...

HVBA Article Summary

1. Strategic Shift to Branded GLP-1 Medications: Hims & Hers made a deliberate move away from compounded GLP-1 drugs to focus on branded medications, including products from Novo Nordisk and Eli Lilly. This transition was accompanied by a partnership with Novo Nordisk and the dismissal of a related lawsuit, but it also resulted in significant restructuring costs and a temporary financial setback. The company expects this pivot to expand its addressable market and drive long-term growth.

2. Short-Term Financial Impact and Future Outlook: The shift to branded medications led to a $92 million loss in Q1 2026, including $33 million in restructuring costs and a decrease in gross margin compared to the previous year. Despite the loss, executives project a return to net profitability by 2027 and have raised full-year revenue guidance for 2026, anticipating substantial growth in both U.S. and international markets. The company is also investing in technology, data infrastructure, and new specialties to support its expansion.

3. Expansion Beyond Weight Loss and Emphasis on Technology: Hims & Hers is broadening its offerings beyond weight loss to include areas such as testosterone, menopause, and lab testing, with recent launches like a direct-to-consumer lab program and an AI agent for interpreting lab results. The company is also expanding internationally through acquisitions and aims to become a leading global consumer health platform. Investments in vertical integration, such as acquiring a peptide manufacturing facility, and ongoing regulatory developments around peptide therapies, are expected to further strengthen its market position.