Bipartisan bill aims to break pharmacies away from health insurers and PBMs

By Allison Bell – Democrats and Republicans in Congress are working together on a new effort to keep health insurers and pharmacy benefit managers from owning pharmacies. The lawmakers are introducing a version of the Patients Before Monopolies Act bill for the 119th Congress. The bill would force health insurers and PBMs to sell any pharmacies that they own. Sens. Elizabeth Warren, D-Mass., and Josh Hawley, R-Mo., are returning as the lead sponsors of the bill in the Senate. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Bipartisan Support for Pharmacy Ownership Reform: The Patients Before Monopolies Act has garnered backing from both Democratic and Republican lawmakers in both chambers of Congress. This renewed effort reflects ongoing concerns about the consolidation of pharmacy ownership by health insurers and pharmacy benefit managers (PBMs). The bill’s bipartisan nature may increase its chances of advancing further than previous attempts.

2. Arguments For and Against the Bill: Proponents argue that separating pharmacy ownership from insurers and PBMs could help lower healthcare costs and reduce corporate influence in the prescription drug market. Critics, particularly the Pharmaceutical Care Management Association, warn that such measures could disrupt established systems for delivering specialty drugs and potentially lead to job losses. They also contend that drug manufacturers and wholesalers, rather than PBMs, are the primary drivers of high drug prices.

3. Legislative Process and Broader Context: The bill is currently under review by the Judiciary Committees in both the House and Senate, with additional involvement expected from the House Energy & Commerce Committee. This legislative push comes alongside other efforts, such as the Break Up Big Medicine Act, aimed at reducing vertical integration in the healthcare sector. The outcome of these bills could significantly impact how prescription drug benefits are managed and delivered in the United States.

384 hospitals with 5 stars from CMS

By Mariah Taylor – Ninety-four more hospitals earned a five-star quality rating from CMS in 2026 compared to 2025. CMS publishes its Overall Hospital Quality Star Ratings annually. The ratings, updated May 13, reflect a hospital’s performance across five quality measures: mortality, safety, readmission, patient experience, and timely and effective care. Read Full Article...

HVBA Article Summary

1. Increase in Five-Star Hospitals: The number of hospitals receiving a five-star rating from CMS rose significantly in 2026, reversing a previous decline. This increase suggests that more hospitals are meeting or exceeding the quality benchmarks set by CMS. The change may reflect improvements in hospital practices or adjustments in the rating methodology.

2. Comprehensive Quality Measures: CMS evaluates hospitals based on five key areas: mortality, safety, readmission, patient experience, and timely and effective care. These measures are designed to provide a holistic view of hospital performance and help patients make informed decisions. The annual update ensures that the ratings reflect the most current data available.

3. Transparency and Public Access: The CMS star ratings and the methodology behind them are publicly accessible, allowing stakeholders to understand how hospitals are assessed. This transparency supports accountability in the healthcare system and encourages hospitals to strive for higher quality. Patients and healthcare professionals can use these ratings as a resource for comparing hospital performance nationwide.

Novo, Lilly tout respective early response and weight loss maintenance data as GLP-1 rivalry intensifies

By Fraiser Kansteiner – Eli Lilly and Novo Nordisk are building cases for their incretin drugs, both new and old, as attractive weight loss maintenance options and a potentially speedier option to shed pounds, respectively. The companies’ new data sets, which focused both on Lilly and Novo’s respective obesity injectables Zepbound (tirzepatide) and Wegovy (semaglutide), as well as the companies’ newer oral launches Foundayo (orforglipron) and the Wegovy pill, were presented early this week at the annual meeting of the European Congress on Obesity in Turkey. With regards to the original dosing formats, Lilly assessed the potential of a lower, 5-mg Zepbound dose to help patients keep weight off a year after taking a maximum titrated dose of its GIP/GLP-1 agonist. Read Full Article...

HVBA Article Summary

1. Competitive Data on Weight Loss Maintenance and Speed: Both Eli Lilly and Novo Nordisk presented new clinical data at the European Congress on Obesity, focusing on their injectable and oral GLP-1 drugs for obesity. Lilly's studies examined the ability of a lower dose of Zepbound and the oral drug Foundayo to help patients maintain weight loss after initial treatment, including those switching from Novo's Wegovy. Novo, on the other hand, emphasized the rapid and significant weight loss achieved with its newly approved high-dose Wegovy injection and its oral Wegovy pill.

2. Shifting Market Dynamics in Obesity Treatments: Novo Nordisk's oral Wegovy pill has seen strong early uptake in the U.S., outpacing Lilly's Foundayo in prescription numbers during the initial months of launch. Despite this, analysts note that Lilly's prescription figures may be undercounted due to telehealth channels not fully captured in standard tracking. The rivalry between the two companies is intensifying as both seek to establish their products as leaders in the growing obesity drug market, particularly with the expansion into oral GLP-1 therapies.

3. Broader Implications for Patient Care and Treatment Options: The new data highlight the importance of providing multiple, long-term treatment options for obesity, a chronic condition requiring sustained management. Both companies are positioning their products to address concerns about maintaining weight loss after high-dose therapy and to offer alternatives for patients who may need to switch medications. The findings also underscore the broader benefits of these drugs, including improvements in physical function and quality of life for patients with obesity.

With ACA subsidies gone, employees need guidance

By Lee Hafner – Following the expiration of enhanced Affordable Care Act subsidies that made its plan premiums more affordable, many employee participants switched to its lower-premium, higher-deductible bronze option — and traded one financial challenge for another. When ACA subsidies ended at the beginning of this year, Americans who kept their plan from 2025 were expected to see an average 114% increase, or more than $1,000, in their annual premiums, according to KFF analysis of U.S. healthcare data. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Employees Choosing Lower-Tier ACA Plans Due to Cost Pressures: Many employees are opting for lower-tier ACA bronze plans because they have lower monthly premiums, helping reduce immediate out-of-pocket expenses. However, these plans often carry much higher deductibles and copays than silver plans, increasing the financial burden when medical care is needed. The article notes that some individuals may delay or avoid healthcare altogether because of the difficult tradeoffs between healthcare costs and other basic living expenses.

2. Need for Better Education Around Healthcare Plan Costs: The article emphasizes that employees may focus too heavily on monthly premiums during open enrollment without fully understanding the long-term costs associated with deductibles, copays, and out-of-pocket maximums. Benefit advisers and healthcare experts recommend using decision-support tools and personalized guidance to help employees compare total healthcare spending across plan options. The piece also highlights that many workers may qualify for cost-sharing reductions under silver plans, significantly lowering deductibles for eligible income levels.

3. Employers Encouraged to Improve Enrollment Communication Strategies: Benefit leaders are encouraged to provide ongoing, personalized education to help employees make informed healthcare decisions during open enrollment. Recommended strategies include live or recorded information sessions, scenario-based examples, employee surveys, and communication materials tailored to different employee situations. The article also explains that helping employees better understand their healthcare benefits may improve overall well-being, reduce stress, and support stronger workplace performance.

New payer-backed ad campaign pushes for No Surprises Act IDR reform

By Paige Minemyer – A new ad campaign takes aim at the "misaligned incentives" in the No Surprises Act arbitration process, arguing they "create a ‘fox guarding the hen house’ dynamic." The seven-figure campaign from the Coalition Against Surprise Medical Billing, called "Judge Fox," features a court battle between a pair of chickens and a pair of foxes. The chickens confer and say that a "reasonable judge" would not allow these foxes to freely set prices for medical bills. Then the judge also turns out to be a fox, meant to illustrate that private equity firms that own providers that purportedly flood the dispute resolution system may also operate the independent entities meant to mitigate these disputes. Read Full Article...

HVBA Article Summary

1. Concerns Over Arbitration Process: The Coalition Against Surprise Medical Billing is highlighting what it sees as problematic incentives within the No Surprises Act's independent dispute resolution (IDR) process. The campaign argues that private equity-backed providers are both major participants in disputes and may have influence over the entities that resolve them, potentially leading to conflicts of interest. This dynamic is depicted in the campaign's ad, which uses the metaphor of foxes judging a case involving chickens.

2. Dispute Volume and Provider Success Rates: Since the IDR portal launched in April 2022, there have been 3.3 million disputes, a figure much higher than regulators initially expected. Data cited by the coalition shows that providers win the vast majority of these arbitration cases, prevailing in 87% of decisions. This high success rate for providers has prompted payer groups to call for increased oversight and reform of the IDR process.

3. Ongoing Debate and Legal Challenges: The campaign is part of a broader debate between payers and providers regarding the fairness and effectiveness of the No Surprises Act. While payers argue that providers are exploiting the system for higher payouts, providers counter that payers are offering insufficient payment amounts during negotiations. The dispute has led to more than 30 lawsuits challenging aspects of the IDR process, and analysts expect elevated levels of arbitration activity to persist.

Drugmakers have to go through rigorous tests to get a lower tariff rate

By Anna Brown – Landing a reduced 20% tariff rate will require pharma companies to fill out extensive paperwork and be closely monitored by the Department of Commerce. President Donald Trump signed an executive order last month stating that companies making drug products overseas without a “most favored nation” deal would be hit by 100% tariffs, except for those onshoring their operations to the US, which would get the 20% rate. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. US Onshoring Requirements for Drugmakers: The federal government released an 11-page application process requiring pharmaceutical companies to detail how they plan to shift drug and active pharmaceutical ingredient (API) manufacturing to the United States. Companies must disclose where products are currently produced, whether manufacturing is handled internally or through third parties, and the level of investment planned for new US facilities or R&D centers. Initial application steps must be completed before June 12, with companies expected to increase domestic production “as much as possible” by January 2029.

2. Commerce Oversight and Manufacturing Exemptions: Drugmakers must provide forecasts showing how US-based manufacturing and sales are expected to change between 2025 and 2029. Any products that will not be moved to US production must be identified along with explanations for why onshoring is considered commercially unfeasible, such as small patient populations or expiring patents. All proposed manufacturing plans will be subject to approval, monitoring, and enforcement by the Department of Commerce.

3. Tariffs and MFN Agreements Influence Company Planning: Under the April executive order, pharmaceutical companies that do not complete construction of promised US manufacturing facilities by the end of Trump’s term could face tariffs increasing to 100%. Companies with “most favored nation” agreements with the White House are exempt from tariffs, provided they meet certain US investment commitments tied to the same January 2029 timeline. Drugmakers including AbbVie and Novartis are reported to be finalizing US expansion plans following the tariff announcement.

Transforming benefits with AI: A new era of human-centric solutions

By Ali Diab – The advent of artificial intelligence (AI) is reshaping industries worldwide, and the field of employee benefits is no exception. As organizations strive to offer comprehensive and personalized benefits packages, AI emerges as a powerful tool to revolutionize how benefits are delivered and experienced. By bridging the gap between complex data systems and human needs, AI has the potential to not only enhance operational efficiency but also create more meaningful, user-centric experiences for employees. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. AI Streamlines Benefits Administration: Artificial intelligence is increasingly automating routine tasks in benefits administration, such as enrollment, claims processing, and responding to employee inquiries. This automation reduces the administrative burden on HR professionals, allowing them to focus on more strategic initiatives. As a result, organizations can operate more efficiently and allocate resources to areas that directly impact employee well-being.

2. Personalization Enhances Employee Experience: AI-driven platforms are enabling highly personalized benefits experiences for employees, including tailored recommendations for healthcare providers, treatment options, and wellness programs. By leveraging data and natural language processing, these systems can address individual needs and preferences, empowering employees to make informed decisions about their health. This level of personalization can improve employee satisfaction and engagement with their benefits.

3. Strategic Insights for HR Leaders: The use of AI in analyzing workforce data provides HR leaders with valuable insights into trends and gaps in benefits offerings. Predictive analytics powered by AI can help organizations anticipate future health and wellness challenges, allowing for proactive benefits design. This strategic approach supports both employee well-being and organizational competitiveness in attracting and retaining talent.

Employers say they’re doing enough to help with medical costs, but workers disagree

By Ginger Christ – Three-quarters of employers believe they’re doing enough to help workers manage medical costs, but fewer than half of employees agree, a Prudential Financial study released Monday found. That “highlights a significant disconnect between how employers believe they are supporting employees and how employees say they feel,” per the study. More than 7 in 10 workers said they’ve experienced at least a 5% increase in medical costs, and 22% said they’ve faced increases of 15% or more, Prudential found. Rising medical costs are putting pressure on employers and employees alike, intensifying financial stress across the workforce. Read Full Article...

HVBA Article Summary

1. Disconnect Between Employers and Employees: The Prudential Financial study reveals a notable gap between employer perceptions and employee experiences regarding support for medical costs. While most employers believe their efforts are sufficient, less than half of employees feel adequately supported. This disconnect may contribute to dissatisfaction and a lack of trust in workplace benefits.

2. Impact of Rising Medical Costs on Employees: Increasing medical expenses are causing significant financial stress for workers, affecting both their mental and physical health. Some employees are delaying or forgoing necessary medical care due to cost concerns, which can have long-term health and productivity consequences. This trend highlights the broader implications of healthcare affordability challenges in the workforce.

3. Potential Consequences for Organizations: Financial stress related to medical costs can lead to lower productivity, increased absenteeism, and higher turnover among employees. The study suggests that employers who improve communication about available benefits and take a holistic approach to employee well-being may be better positioned to support their workforce. Addressing these issues proactively could help organizations maintain stability and retain talent.