HHS sets pricing targets to lower US drug costs: 6 things to know

By Alan Condon - HHS is taking “immediate steps” to implement President Donald Trump’s executive order, Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients — a key initiative aimed at reducing healthcare costs. The department said it has established specific “pricing targets” that pharmaceutical manufacturers are expected to meet under the order. President Trump and HHS Secretary Robert F. Kennedy Jr. will publicly outline these commitments in the coming weeks. Read Full Article…

HVBA Article Summary

1. HHS Most-Favored-Nation Pricing Plan: Under a new executive order, HHS is directed to align U.S. prices for brand-name drugs without competition to the lowest price available in peer countries with comparable economies. The goal is to ease the financial burden on Americans who currently pay significantly more for prescription drugs.

2. Implementation Timeline and Uncertainty: HHS must present drug pricing reduction goals to pharmaceutical companies by June 11. If insufficient progress is made, the agency will begin rulemaking to enforce international reference pricing. However, the order lacks clear legal authority and raises questions about how it aligns with Medicare drug negotiations under the Inflation Reduction Act.

3. Broad Scope and Industry Pushback: The revived most-favored-nation model, broader than Trump’s earlier Medicare-only proposal, would apply to drugs under Medicare, Medicaid, and private insurance. HHS claims this could reduce drug prices by 50% to 90%, though pharmaceutical and biotech industries argue the model may hinder innovation and investment.

Are benefit plan administrators part of the cost problem?

By Allison Bell - Health benefits cost cutters are looking harder at employer health plans' "third-party administrators" — the outside firms that help employers run their health plans. Health Affairs, an academic journal with one of the highest academic journal impact factors in the world, published a commentary about the role of TPAs in the U.S. employer health benefits arena earlier this week. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Concerns About TPA Practices and Transparency: Karen Handorf and her colleagues argue that third-party administrators (TPAs) may contribute to rising employer healthcare costs by hiding critical plan information, favoring affiliated companies in cost-management programs, and retaining negotiated savings meant for employers or participants. They emphasize the need for greater transparency and oversight, especially when TPAs are owned by health insurers.

2. Policy Recommendations and Legislative Efforts: The authors call for federal policymakers to require TPAs to share more data with employers and address potential conflicts of interest. These concerns are reflected in current legislative efforts such as the bipartisan Hidden Fees Disclosure Act, which would mandate fee and data transparency for both TPAs and pharmacy benefit managers (PBMs).

3. TPA Market Influence and Pushback: With roughly 60% of the employer-sponsored health plan market served by TPAs—accounting for about $100 billion in annual revenue—their practices have significant economic impact. While critics call for accountability, TPA defenders argue that restrictions from insurers, such as confidentiality clauses, limit what TPAs can disclose, complicating employer oversight and reform efforts.

RFK Jr. budget hearing takeaways: Kennedy defends reorg, unaware of $11B grant terminations

By Noah Tong - Secretary Kennedy appeared unaware the Department of Health and Human Services (HHS) cancelled upwards of $11 billion in COVID-19 and public health grants to states, local governments and nonprofits earlier this year during a line of questioning with Sen. Chris Murphy, D-CT, in a Senate HELP committee hearing over the department's fiscal year 2026 budget request. Read Full Article…

HVBA Article Summary

1. Massive Grant Terminations and Workforce Cuts Spark Backlash: The Department of Health and Human Services (HHS), under Secretary Kennedy, canceled $12 billion in state-administered vaccine-related grants and executed broad staffing cuts across agencies like the CDC and NIOSH. These changes, justified by claims that the COVID-19 pandemic is over and HHS is refocusing on chronic disease, drew bipartisan concern over disrupted programs for long COVID, cancer, aging, and occupational health.

2. Budget Restructuring Criticized as Politically Motivated “Shift and Shaft”: Lawmakers, especially Democrats, accused HHS of bypassing Congress by eliminating or delaying funding for Congressionally approved programs, including NIH research (down $2.7 billion) and disease prevention offices. Critics called the consolidation of programs under the new “Administration for a Healthy America” an effort to quietly dismantle or marginalize public health priorities under the guise of efficiency.

3. Kennedy Defends Cuts as Strategic, Faces Intense Scrutiny: Kennedy defended the reorganization as a necessary response to decades of bureaucratic inefficiency, promising to follow the law on spending but emphasizing the need for dramatic change. He clashed with lawmakers on vaccine stances, public health leadership credentials, and food safety regulations, repeatedly asserting that his goal is to make HHS leaner, more focused, and aligned with the administration’s “Make America Healthy Again” agenda.

Some student loan borrowers see credit scores plummet by over 100 points: 'I don't have 2 or 3 years to wait for my score to come back'

By Kamaron McNair - Most federal student loan borrowers have been required to make monthly payments since those payments resumed in October 2023, following the nearly four-year pandemic pause. But borrowers who couldn't or didn't over that period were still shielded from some of the potential consequences, like having their delinquency reported to credit bureaus or defaulted loans sent to collections. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Student Loan Delinquency Now Impacts Credit: As of January 2025, loan servicers began reporting delinquent federal student loan accounts to credit bureaus, ending the pandemic-era grace period. Wage garnishments for borrowers over 270 days late are expected to resume soon, leading to significant credit score drops for unaware or financially struggling borrowers.

2. Widespread Confusion and Missed Communications: Many borrowers, like Kayla Quinones, missed key repayment notices and were unaware payments had resumed, resulting in severe credit score declines. A lack of clarity around loan servicers and repayment responsibilities left borrowers struggling to understand or act on Department of Education communications.

3. Recovery is Possible but Not Guaranteed: Borrowers such as Mervelline Aflata have taken steps to recover their credit, including requesting goodwill adjustments and disputing delinquency marks with credit bureaus. While some, like Aflata, succeeded in restoring their credit, others may face prolonged damage without clear guidance or responsive loan servicer support.

Trump administration to 'reconsider' mental health parity rule

By Paige Minemyer - The Trump administration revealed in a court filing that it does not intend to enforce a key regulation on mental health parity while it gives the rule another look. In the final months of the Biden White House, the departments of Labor, the Treasury and Health and Human Services finalized a rule that sought to strengthen requirements under the 2008 Mental Health Parity and Addiction Equity Act, which mandates that mental health services are covered on par with physical health benefits. Read Full Article…

HVBA Article Summary

1. DOJ Suspends Enforcement of Parity Rule Amid Lawsuit: The Department of Justice announced it will not enforce a new mental health parity rule while it considers modifying or rescinding it, requesting the court pause ongoing litigation filed by the ERISA Industry Committee (ERIC), which argues the rule exceeds federal authority and imposes unworkable requirements.

2. Rule Targets Benefit Limitations and Utilization Management: The challenged regulation would require health plans to analyze and address treatment barriers—such as prior authorization, step therapy, and restrictive network standards—intended to ensure parity in mental health and substance use disorder care under federal law.

3. Stakeholders Split on Delay of Parity Reforms: While employer groups like ERIC applauded the administration’s move as a step toward restoring flexibility in benefit design, mental health advocacy groups expressed disappointment, warning the delay undermines access to care and contradicts public commitments to addressing the mental health and opioid crises.

Weight-Loss Drugs Show Increasing Benefit in Skin Disease

By Miriam E. Tucker - Emerging data about benefits of the newer weight-loss drugs for some chronic skin conditions suggests their potential use in dermatology, as well as a role for dermatologists in obesity management. Glucagon like peptide 1 receptor agonist (GLP-1 RA) medications began as treatments for type 2 diabetes (T2D), then emerged as weight-loss drugs. Read Full Article…

HVBA Article Summary

1. GLP-1 RAs Show Promise Beyond Weight Loss and Diabetes Treatment: Newer GLP-1 receptor agonists (RAs), including semaglutide and tirzepatide, have demonstrated benefits across multiple conditions beyond type 2 diabetes and obesity, including cardiovascular risk reduction, kidney protection, sleep apnea, and skin diseases like psoriasis, psoriatic arthritis, and hidradenitis suppurativa (HS). Their effects may stem from both weight loss and direct anti-inflammatory or wound-healing actions due to GLP-1 receptors found in skin, immune cells, and hair follicles.

2. Emerging Dermatological Applications and Clinical Trials: Clinical and preclinical evidence supports the use of GLP-1 RAs for improving psoriasis symptoms and HS severity, with some effects appearing independent of weight loss or glycemic control. Eli Lilly is conducting Phase 3 and 4 trials evaluating tirzepatide as an adjunct to psoriasis treatments, while dermatologists consider GLP-1 RAs a potential paradigm shift for patients with obesity-related skin disease. However, barriers like side effects and the need for careful dose titration remain concerns.

3. Mechanistic Insights and Cautionary Notes: Studies suggest GLP-1 RAs enhance wound healing via mechanisms such as inflammation reduction, endothelial protection, and skin regeneration. However, results are mixed, particularly in glucose-tolerant individuals, and cutaneous side effects like injection site reactions and altered skin sensations have been reported, especially with older agents. Experts emphasize the need for multidisciplinary care, patient education, and further research to clarify long-term dermatologic efficacy.

UnitedHealth under criminal investigation for alleged Medicare Advantage fraud: WSJ

By Jakob Emerson - UnitedHealth Group is under criminal investigation by the Justice Department for alleged Medicare Advantage fraud, The Wall Street Journal reported May 14. Citing individuals familiar with the matter, the outlet said the DOJ has been investigating the company since at least last summer over its MA business practices, but exact criminal allegations are unclear. Read Full Article…

HVBA Article Summary

1. Mounting Legal and Financial Pressures: UnitedHealth is facing multiple federal investigations, including a reported DOJ probe into alleged Medicare Advantage (MA) billing fraud and scrutiny over its relationship with Optum. The DOJ is also attempting to revive a long-standing lawsuit alleging MA overcharges and is suing to block the company’s $3.3 billion acquisition of Amedisys.

2. Leadership Shakeup Amid Market Fallout: UnitedHealth abruptly replaced CEO Andrew Witty with former CEO Stephen Hemsley and suspended its 2025 earnings outlook after a poor Q1 performance linked to rising MA costs. These developments triggered a 13% stock drop on May 15 and contributed to a staggering $288 billion loss in market value within a month.

3. Operational Crises Intensify Scrutiny: In addition to financial and legal challenges, UnitedHealth has faced severe reputational hits, including the assassination of UnitedHealthcare’s CEO and a debilitating cyberattack on Change Healthcare. These crises have intensified concerns over the company’s internal controls and transparency as the nation’s largest MA insurer.