Spending spikes & student loan debt are putting retirement savings at risk

By Kristen Beckman - Financial factors outside of workplace savings plans can have a significant impact on how employees save for retirement within plans. Two of those factors are spikes in consumer spending and student loan repayment, according to joint research conducted by the Employee Benefit Research Institute (EBRI) and J.P. Morgan Asset Management. Read Full Article…

VBA Article Summary

1. Prevalence of Spending Spikes: Research indicates that spending spikes, defined as a month where spending exceeds 125% of the median spending over the past year, are widespread among all workers. A staggering 90% of participants experienced a month with at least a 25% increase in spending, highlighting the commonality of financial fluctuations.

2. Magnitude and Impact: These spending spikes can be substantial, with 17% of individuals doubling their spending in a single month. More than half of employees faced spikes exceeding $2,500, underscoring the inadequacy of current emergency savings provisions, such as the $2,500 limit in SECURE 2.0's Pension-Linked Emergency Savings Accounts (PLESA).

3. Consequences and Solutions: Spending spikes often lead to increased reliance on credit cards and 401(k) loans to cover expenses, negatively impacting retirement savings. Employers can mitigate this by implementing strategies like automated savings, debt management education, and considering participant behavior in retirement plan design. Additionally, the intersection of student loan repayments and retirement savings highlights the need for tailored communication and incentives to strike a balance between debt repayment and long-term financial security.

Boehringer puts a target on Humira, says pushing it off formularies is necessary

By Zachary Brennan - For biosimilars to win, AbbVie has to lose, according to Boehringer Ingelheim. The German drugmaker on Wednesday said that its goal of getting more uptake for Humira biosimilars will require pushing AbbVie’s drug off of PBM formularies. Read Full Article…

VBA Article Summary

1. FDA Approval for Boehringer's High-Concentration Cyltezo Biosimilar: Boehringer Ingelheim's high-concentration, citrate-free formulation of its Humira biosimilar, Cyltezo, secured FDA approval. This approval marks a significant milestone in the company's efforts to penetrate the market and compete with AbbVie's Humira.

2. Formulary Strategy to Boost Market Penetration: Boehringer is strategically aligning with payers like CVS Health and Cigna's Evernorth to increase the accessibility and affordability of Cyltezo. Following Sandoz's success with its Humira biosimilar after partnering with CVS Health, Boehringer aims to replicate this model and expand its market share.

3. Payers' Influence on Biosimilar Adoption: Stephen Pagnotta, biosimilar commercial lead at Boehringer Ingelheim, emphasizes the pivotal role of payers in driving biosimilar adoption. With payers exerting pressure to remove brand-name Humira from formularies, Boehringer anticipates an acceleration in biosimilar uptake. This shift reflects the evolving landscape where payers wield considerable influence, compelling pharmaceutical companies to adapt their strategies to remain competitive.

Patients Hitting GLP-1 Plateaus? Here's How to Help

By Fatima Cody Stanford, MD and Richard Frank, MD - Drugs like semaglutide (Wegovy) and tirzepatide (Zepbound) are changing the game in obesity care. In clinical trials, they helped people lose as much as 15 to 20% of their body weight over the course of about a year -- and we've seen similar results in the real world since the drugs were approved for chronic weight management. Read Full Article…

VBA Article Summary

1. Managing Plateaus: Acknowledging the Inevitable: Plateaus are a common occurrence in weight loss journeys, including those involving GLP-1 medications. Despite initial successes, individuals may eventually reach a point where further weight loss becomes challenging due to factors like metabolic adaptation and hunger hormone responses. Educating patients about the likelihood of plateaus at the onset of treatment is crucial for managing expectations and fostering ongoing dialogue between physicians and patients regarding potential interventions.

2. Holistic Support for Sustainable Change: While GLP-1 medications offer promising avenues for weight loss, they are most effective when combined with lifestyle modifications. Providing patients with personalized dietary support from registered dietitians and integrating health coaching for tailored exercise routines can enhance the effectiveness of GLP-1 therapy. By prioritizing behavior modification alongside medication, patients can mitigate side effects, prevent malnutrition, and sustain healthy weight loss over time.

3. Addressing Underlying Factors: Mental Health and Obesity: Obesity often intersects with mental health conditions such as depression, anxiety, and disordered eating, presenting complex challenges to weight management. Recognizing the interconnectedness of mental health and obesity, integrating cognitive behavioral therapy (CBT) alongside GLP-1 therapy can help patients address harmful thought patterns and behavioral tendencies. By prioritizing mental health support, healthcare providers can mitigate the risk of exacerbating underlying conditions and promote holistic well-being throughout the weight loss journey.

How the virtual care market is shaking out in 2024 as Walmart, Optum exit the telehealth business

By Heather Landi - News this week that Walmart is shuttering all 51 health centers along with its virtual care services came on the heels of recent media reports that Optum also was exiting the telehealth business. Read Full Article…

VBA Article Summary

1. Telehealth Giants Retreating: UnitedHealth's closure of Optum Virtual Care and Walmart's shuttering of Walmart Health Virtual Care mark significant retreats by major players in the telehealth market. These closures suggest a reevaluation of the traditional telehealth model and a shift towards more integrated and holistic care experiences.

2. End of Telehealth 1.0: Industry experts indicate that the era of "telehealth 1.0," characterized by transactional virtual interactions, is coming to an end. Consumers increasingly demand a more comprehensive, longitudinal approach to healthcare that integrates virtual and in-person care seamlessly.

3. Rise of Hybrid Models: The future of virtual care lies in hybrid models that blend virtual and brick-and-mortar care seamlessly. Companies like Wheel are emphasizing technology-driven approaches to meet evolving patient needs and drive the next generation of virtual care, signaling a shift towards more sophisticated and consumer-centric healthcare experiences.

Wegovy Is Available Again After Shortages, FDA Says—But Supplies Are Still Limited

By Robert Hart - Some of Novo Nordisk’s popular weight loss drug Wegovy is back in stock in the U.S. after months of limited supplies, according to an update on the Food and Drug Administration’s website, though shortages are set to continue as booming demand for obesity drugs still vastly outstrips Big Pharma’s ability to ramp up production. Read Full Article…

VBA Article Summary

1. Wegovy Dose Availability: The 1.7 milligram dosage of Wegovy is now listed as available on the FDA’s drug shortage database, marking a significant update. Previously, this dosage had been listed as having limited availability due to heightened demand, making it the second highest injection dosage of the drug available in the U.S. market.

2. Limited Availability of Other Doses: Despite the availability of the 1.7 milligram dose, the FDA database still shows limited availability for lower doses of Wegovy injector, ranging from 0.25 milligrams to 1 milligram. Additionally, various other doses of both Wegovy and Ozempic, including 5 milligram, 7.5 milligram, 10 milligram, 12.5 milligram, and 15 milligram, are also experiencing shortages due to increased demand.

3. Market Dynamics and Future Projections: Novo Nordisk's semaglutide and Lilly's tirzepatide, present in drugs like Ozempic, Wegovy, Zepbound, and Mounjaro, constitute a burgeoning class of GLP-1 agonists. With their potential to address not only obesity but also other conditions like diabetes and cardiovascular disease, demand for these drugs is surging. Despite efforts to scale up production, both companies anticipate ongoing supply challenges, underscoring the immense market potential, estimated to reach $100 billion by 2030, and the dominant position Novo and Lilly currently hold in this lucrative sector.

FTC finalizes changes to data privacy rule to step up scrutiny of digital health apps

By Heather Landi - The Federal Trade Commission (FTC) finalized a rule Friday that aims to tighten the reins on digital health apps sharing consumers' sensitive medical data with tech companies. Read Full Article…

VBA Article Summary

1. Expanded Applicability: The FTC's finalized Health Breach Notification Rule (HBNR) now explicitly includes health apps, filling a previous regulatory gap to protect consumers' privacy. It mandates vendors of digital health records, including health apps not covered by HIPAA, to notify individuals, the FTC, and potentially the media in case of breaches of unsecured personally identifiable health data.

2. Broader Data Definition: The updated rule broadens the definition of personally identifiable health data, covering traditional health information as well as data inferred from fitness trackers and other sources like location data and health-related purchases. This ensures that emergent health data is also protected under the rule.

3. Enforcement and Penalties: The FTC's recent actions, including settlements with GoodRx and Premom, signal a shift towards enforcing the HBNR. With penalties imposed for non-compliance, the finalized changes aim to hold health-related apps and trackers accountable for unauthorized disclosures of consumers' health data, emphasizing transparency and consumer protection.

FTC Warns ‘Junk Patents’ Could Make Drugs Like Ozempic Pricier—Here’s How

By Ty Roush - The Federal Trade Commission is challenging hundreds of alleged “junk” patent listings filed by several pharmaceutical companies, which regulators claim could increase prices for medications like Novo Nordisk’s diabetes drug Ozempic by making it harder to produce generic drugs. Read Full Article…

VBA Article Summary

1. FTC Challenges Pharmaceutical Giants: The FTC issued warning letters to 10 pharmaceutical companies, including Novo Nordisk, AstraZeneca, GlaxoSmithKline, and Teva, challenging over 300 "junk" patent listings across 20 brand name products.

2. Identifying "Bogus" Patents: Some of these patents, such as Novo Nordisk's Victoza injection "button" and Ozempic's "injection device with torsion spring and rotatable display," are deemed "bogus" as they are not relevant to the drugs they represent, according to the FTC.

3. Impact on Drug Pricing and Market Entry: Improper patents listed in the FDA's Orange Book can delay the entry of cheaper generic alternatives into the market, thus keeping brand name drug prices artificially high. Generic manufacturers can challenge these listings under the Hatch-Waxman Act, potentially leading to a brief period of exclusivity for successful challengers.

DOL set to reverse Trump admin's contentious association health plan policy

By Noah Tong - The Department of Labor (DOL) will release a final rule that completely overturns a Trump-era policy allowing small businesses to skirt the Affordable Care Act (ACA) using association health plans. Read Full Article…

VBA Article Summary

1. Legal Overreach and ACA Evasion: The Trump administration's 2018 expansion of association health plans (AHPs) aimed to broaden insurance options for small employers and sole proprietors, but a federal judge later deemed it an overstep of authority under ERISA, designed to circumvent ACA coverage requirements. The upcoming rule seeks to upend the remaining aspects of the plan.

2. Public Opposition and Policy Reversal: The Department of Labor received feedback from various stakeholders, with a majority supporting the rescinding of the Trump rule. Criticism highlighted AHPs' ability to cherry-pick healthier individuals by excluding essential services like emergency care and prescription drugs, leading to concerns about market distortion and increased premiums for those left in ACA risk pools.

3. Implications and Political Dynamics: While some employers welcomed AHPs for their cost-saving potential, lawmakers were divided. Critics, like Virginia Foxx, saw the reversal as regressive, hindering access to quality healthcare. Conversely, supporters, such as Bobby Scott, praised the move, emphasizing the adverse effects of AHPs on ACA risk pools. The Biden administration's regulatory actions signal a shift in healthcare policy, but the potential for future reversals remains contingent on political dynamics, with the Congressional Review Act offering a route for policy changes under a different administration.

Walmart To Close Health Clinics In Latest Blow To Retail Healthcare

By Bruce Japsen - Walmart is closing its Walmart Health centers and virtual care business, saying it doesn’t see a sustainable business model in primary care.Read Full Article…

VBA Article Summary

1. Financial Fallout: Walmart's decision to shut down its 51 health centers and virtual care services underscores the significant financial investment and subsequent losses incurred. Despite spending tens of millions of dollars over the past five years to establish comprehensive healthcare facilities, the company faces insurmountable challenges in sustaining profitability within the evolving healthcare landscape.

2. Workforce Woes: The closure also highlights the broader difficulties in recruiting healthcare professionals, exacerbated by a nationwide healthcare staffing crisis and a competitive labor market. Walmart's struggle to attract and retain qualified medical staff mirrors industry-wide challenges faced by primary care clinics, compounded by the aftermath of the pandemic and the so-called "great resignation."

3. Strategic Shift: Walmart's pivot away from its health centers signals a strategic realignment towards leveraging its existing network of pharmacies and vision centers to provide trusted health and wellness services. While the closure marks the end of an ambitious venture into primary care, the company aims to refocus its efforts on delivering accessible and affordable healthcare solutions through its established retail outlets.

How much longer can employers endure rising healthcare costs?

By Deanna Cuadra - Year after year, employers are faced with rising healthcare costs that for many, feel out of their control. But as benefits budgets become tighter, it's past time for employers to enact what little agency they have and try to get to the bottom of what's driving their healthcare spend. Read Full Article…

VBA Article Summary

1. Escalating Healthcare Costs: U.S. employers are bracing for a 7% increase in healthcare expenses this year, marking a second consecutive year of surpassing the average 4-5% annual rise. Despite providing health insurance to over half of Americans, employers face mounting challenges in managing costs, particularly as chronic conditions drive up expenses.

2. Employee Financial Strain: Rising healthcare costs are not only burdening employers but also impacting employees directly. With premiums and out-of-pocket expenses climbing, workers are experiencing financial strain, with premiums becoming increasingly unaffordable for many. Medical debt, totaling $220 billion nationally, continues to afflict a significant portion of the workforce, leading to heightened financial stress.

3. Focus on Prevention and Cost Reduction: Employers are increasingly investing in preventative care measures to mitigate healthcare expenses. Incentivizing preventative care has shown promising results, with employers observing improvements in workforce health. However, while employers are taking steps to cut costs, such as integrating well-being programs and offering telehealth options, more substantial measures like exerting influence over insurance companies or shifting to value-based care models remain less common.

Employers feel the side effects of drugmaker control over Wegovy, Ozempic costs

By Kelly Hooper - North Carolina’s health insurance plan for state employees recently opted to stop covering popular new weight-loss drugs amid fears that costs could balloon to more than $1 billion over the next six years. Read Full Article…

VBA Article Summary

1. Access Hurdles for Public Employees: The decision in North Carolina to halt coverage of weight-loss drugs like Wegovy and Saxenda highlights a nationwide issue where public employees, numbering 750,000 in this case, are now required to pay out-of-pocket for these medications. The impasse arises from disagreements between the state, drugmakers, and the pharmacy benefits manager regarding coverage terms and pricing, leaving employees caught in the middle.

2. Struggle with Cost Management: Large employers across the United States are grappling with the soaring costs of advanced weight-loss drugs. Efforts to implement cost-saving measures, such as requiring patients to try lifestyle management programs before receiving prescriptions, have met resistance from drug manufacturers and pharmacy benefit managers. This conflict underscores the challenges employers face in balancing employee health benefits with financial sustainability.

3. Impact on Patient Access and Healthcare System: The standoff between stakeholders reflects broader issues within the U.S. drug pricing system, where manufacturers wield significant pricing power. Employers are forced to navigate complex negotiations that can ultimately restrict patient access to effective treatments. The situation not only affects individual patients but also has ramifications for employers, insurers, and government programs, potentially leading to increased costs and limited coverage options.