Industry Voices—To increase drug savings, show the cost of drugs and try a female doctor

By Hemant Bhargava and Mackenzie Clark - Prescription drug costs continue to climb and are a growing burden on patients, employers and taxpayers. Unlike other purchases, neither prescribers nor patients typically know the cost of a drug when it is prescribed nor the cost of comparable lower cost alternative drugs. Some progress is being made, but these efforts need to be accelerated to expand drug cost savings. Read Full Article…

HVBA Article Summary

1. Drug cost transparency at the point of prescribing shows proven savings but suffers from inconsistent delivery: Research on over 1 million prescriptions found that while providing prescribers with patient-specific drug prices and lower-cost alternatives can significantly reduce costs, access to this information varies widely depending on health plans and electronic health records. As a result, not all prescribers are receiving or acting on this critical data, limiting potential savings.

2. Prescriber behavior and electronic health record design both influence savings outcomes: The study revealed notable differences in how prescribers use cost information—some consistently choose lower-cost options while others overlook them—with female prescribers more likely to select cost-saving alternatives. Additionally, variability across electronic health record systems suggests that user interface and workflow design play a critical role in enabling or hindering effective cost-saving decisions.

3. Expanded adoption, aligned standards, and further research are needed to maximize cost savings: The article recommends that health plans and governments standardize and strengthen drug cost transparency requirements, while also tracking prescriber use and savings at a granular level. It further calls for research into how electronic health records deliver this information and the broader health and economic benefits of cost transparency, especially for vulnerable populations.

New LIMRA research bullish on broker role

By Bruce Shutan - Growing complexity within the employee benefits space, along with various economic developments, will offer benefit brokers and advisers tremendous growth opportunities in the future, new LIMRA research suggests. Nearly 60% of employers expect to have a greater reliance on brokers over the next five years, according to The Future Is Now — Workplace Benefits Distribution Amid a Changing Landscape. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. The broker role is shifting from transactional to consultative: Brokers are moving beyond simply helping employers choose benefits and carriers to providing broader advisory services. They’re now expected to guide employers through compliance challenges, digital solutions, and complex regulations—serving as strategic partners who help employers navigate an increasingly complicated benefits landscape.

2. Cost pressures are reshaping benefits strategies: With 70% of employers reporting that cost is a key driver of their benefits decisions, many are taking active steps to control spending. This includes negotiating better premiums, redesigning plan structures, and eliminating underused benefits. Brokers play a crucial role in helping employers balance cost savings with maintaining competitive, high-value benefits for employees.

3. Employers want more data-driven insights and executive alignment: As benefits decisions draw more involvement from the C-suite, brokers are under pressure to deliver stronger data, analysis, and reporting. Employers expect brokers to provide insights that justify benefits choices, demonstrate value, and align benefits strategy with broader business and financial objectives, especially in an uncertain economic environment.

Eli Lilly downplays CVS move to drop Zepbound coverage, shares plunge

By Bhanvi Satija and Patrick Wingrove - Eli Lilly (LLY.N), on Thursday downplayed CVS Health's (CVS.N), opens new tab decision to drop the company's obesity drug Zepbound from some lists of medicines it covers for reimbursement, but shares of the drugmaker still fell roughly 10% on investor worries that the move could blunt its sales momentum. Read Full Article… 

HVBA Article Summary

1. Lilly maintains market dominance despite CVS setback: Eli Lilly’s Zepbound has overtaken Novo Nordisk’s Wegovy in U.S. prescriptions, capturing over 50% market share, even as CVS announced it will drop Zepbound coverage in favor of Wegovy starting July 1 after securing lower prices from Novo. Lilly’s leadership in weight loss and diabetes drugs has pushed its market value past $800 billion, making it the world’s most valuable healthcare company.

2. Pricing and PBM dynamics intensify competition: CVS’s decision signals heightened pricing pressure in the GLP-1 obesity drug market, but analysts and investors believe the impact on Lilly’s sales will be limited as large employers often customize their own drug formularies. Lilly has already responded by cutting Zepbound prices and expanding lower-dose offerings to stay competitive amid PBM negotiations and compounding pharmacy challenges.

3. Strong earnings reinforce Lilly’s position: Despite lower Zepbound revenue from price cuts, Lilly posted higher-than-expected quarterly earnings with $12.73 billion in revenue and adjusted EPS of $3.34. Sales of diabetes drug Mounjaro surpassed forecasts at $3.84 billion, supporting continued growth as analysts predict both Zepbound and Wegovy will achieve $20 billion in annual sales by 2029 in the booming obesity drug market.

Aetna to exit individual market

By Rylee Wilson - Aetna will exit the individual ACA exchange market in 2026, citing continued underperformance. CVS Health reported its first quarter earnings May 1. On a call with investors, CEO David Joyner said the company determined there is “not a near or long-term pathway for Aetna to materially improve its position in the market.” Read Full Article… 

HVBA Article Summary

1. CVS projects significant financial losses in its individual exchange business: CVS Health has set aside a $448 million premium deficiency reserve to cover anticipated losses in its Affordable Care Act individual exchange business, signaling the scale of financial challenges it faces. The company estimates it will lose between $350 million and $400 million in 2025, according to CFO Tom Cowhey, reflecting mounting pressures in the individual market.

2. Aetna’s individual exchange membership represents a small portion of CVS’s overall business: Aetna currently covers approximately 1 million individual exchange members across 17 states, making it a relatively small part of CVS Health’s total membership base of 27.1 million. This limited footprint underscores why the company is prioritizing markets where it believes it can be more competitive and profitable.

3. CVS’s exit reflects broader market uncertainty and upcoming policy shifts: CVS Health’s decision to exit the individual exchange market highlights concerns over the program’s long-term viability, especially with enhanced federal subsidies set to expire at the end of 2025 unless extended by Congress. While these subsidies have driven record enrollment, their uncertain future adds volatility to the market’s outlook, influencing CVS’s strategic shift.

Teladoc acquires mental health firm UpLift as BetterHelp earnings slide

By Emily Olsen - The purchase of UpLift, which includes up to $15 million in additional earnout consideration based on performance, closed Wednesday. The mental health firm, founded in 2020, recorded revenue of about $15 million last year, and going forward will be included in Teladoc’s BetterHelp unit. The deal comes as BetterHelp, once a windfall for the business overall, has taken a hit as customers and revenue decline. Read Full Article…

HVBA Article Summary

1. BetterHelp revenue declines amid strategic shift: Teladoc’s mental health unit revenue dropped 11% year over year to $239.9 million in Q1, with adjusted EBITDA cut in half to $7.7 million and paying users down 4%. To boost growth, Teladoc is expanding insurance coverage through its acquisition of UpLift, aiming to improve affordability and conversion rates while maintaining a significant cash-pay business.

2. Broader integration and diversification efforts continue: Teladoc acquired virtual preventive care provider Catapult Health earlier this year to funnel patients into its chronic condition management programs. In Q1, chronic care enrollment rose 3%, while integrated care segment revenue increased 3% to $389.5 million with a 6% EBITDA gain, highlighting progress in its business-to-business offerings.

3. Financial pressures and external challenges weigh on outlook: Teladoc’s total revenue fell 3% to $629.4 million in Q1, with a net loss of $93 million, partly driven by a $59.1 million goodwill impairment tied to the Catapult acquisition. The company faces potential $5–$10 million adjusted EBITDA headwinds in 2025 from tariffs on imported medical equipment and is exploring mitigation strategies like exemptions, pricing adjustments, and alternative sourcing.

Elevance Health faces second 'ghost network' class action lawsuit

By Noah Tong - Another Elevance Health business, this time Carelon Behavioral Health, is accused of misleading beneficiaries seeking mental health services by pushing ghost networks, or inaccurate provider directories, to its members, a new lawsuit claims. Three plaintiffs are suing the company on behalf of more than 1 million Carelon patients through the Empire Plan in the New York State Health Insurance Program (NYSHIP). Read Full Article…

HVBA Article Summary

1. Carelon and Anthem are accused of inflating mental health provider networks with inaccurate or unreachable listings: The lawsuits claim that both insurers falsely advertised large networks of in-network mental health providers to attract customers, even though many of the listed providers were not actually available. This deceptive practice allegedly misleads patients into enrolling in plans that cannot deliver the promised access to care.

2. Secret shopper studies revealed alarming gaps in network access: Attorneys for the plaintiffs conducted secret shopper surveys, calling hundreds of providers listed in the insurers’ directories, and discovered that only 17% of Carelon’s and 7% of Anthem’s providers actually accepted the insurance and could see new patients. The findings expose how patients face significant barriers to obtaining in-network mental health care, often leading to delays, frustration, and higher out-of-pocket costs when forced to seek care elsewhere.

3. The lawsuits claim violations of multiple laws, including the No Surprises Act and Mental Health Parity and Addiction Equity Act: By knowingly maintaining inaccurate provider directories, Carelon and Anthem are accused of violating federal and state laws designed to protect consumers from surprise medical bills and ensure equal access to mental health treatment. The plaintiffs argue that these false directories not only breach legal and contractual obligations but also harm patients by driving them toward more expensive out-of-network providers or causing them to forgo care altogether.

Humana posts $1.2B profit in Q1

By Andrew Cass - Humana recorded a net income of $1.2 billion in the first quarter of 2025, up from a net income of $741 million during the same period last year, according to its April 30 financial report. Total revenue for the three months ended March 31 was $32.1 billion, up from $29.6 billion during the same quarter last year. Read Full Article… 

HVBA Article Summary

1. Higher operating expenses and rising medical loss ratio: Humana reported total operating expenses of $30.1 billion in Q1 2025, up from $28.4 billion last year, with a medical loss ratio of 87.4% for the quarter and a full-year projection between 90.1% and 90.5%.

2. Membership declines amid Medicare Advantage repositioning: Total medical membership fell to 14.8 million from 16.2 million year-over-year, with Medicare Advantage enrollment at 5.8 million; Humana expects to lose about 550,000 individual Medicare Advantage members in 2025 due to exiting unprofitable plans and markets.

3. Maintained earnings guidance and value-based care optimism: Humana reaffirmed its adjusted earnings guidance of $16.25 per share for the year, with leadership expressing confidence in growth opportunities for Medicare Advantage and value-based care through CenterWell and Medicaid expansion.