'Most Favored Nation' Drug Pricing Is the Headline — But the Real Crisis Runs Deeper

By Marschall S. Runge, MD, PhD - The outrage over prescription drug pricing in the U.S. is justified. Americans routinely pay two to three times more for medications than patients in other high-income countries. Even drugs developed with American science and manufactured on American soil often cost less abroad. Read Full Article… 

HVBA Article Summary

1. Reining in drug prices is a critical but partial fix: While U.S. drug spending hit $405 billion in 2022 (about 9% of total healthcare costs), focusing solely on lowering prescription prices won’t solve the system’s deep-rooted inefficiencies. To make healthcare truly affordable, reforms must also address the profit-driven intermediaries, administrative waste, and short-term insurance incentives that drive overall costs and undermine patient outcomes.

2. Pharmacy Benefit Managers (PBMs) and administrative waste drive up hidden costs: PBMs, originally created to secure discounts, often pocket manufacturer rebates rather than passing savings to patients, distorting prices and prescribing behavior. On top of that, administrative overhead consumes up to 30% of total healthcare spending — far surpassing Medicare or European systems — diverting billions away from direct care into bureaucracy, marketing, and executive pay.

3. Comprehensive reforms require government leverage and preserved innovation: Allowing Medicare and other public programs to negotiate prices like major purchasers abroad could dramatically lower costs at scale. But meaningful reform must also protect the U.S. pharmaceutical innovation engine while tackling systemwide inefficiencies. Without addressing the entire architecture of healthcare spending, patients and taxpayers will continue to shoulder unsustainable financial burdens.

House Passes Budget Bill, with Huge Medicaid Cuts and Potential Medicare Fallout

By Mark Hagland - In an all-night session that was finally gaveled down just before 7 a.m. on Thursday morning, May 22, the House of Representatives passed a comprehensive FY2026 federal budget bill, with only Republican votes, and all House Democrats voting against it. Read Full Article…

HVBA Article Summary

1. Massive Medicaid and Medicare Cuts with Major Coverage Losses: The “One Big Beautiful Bill Act” pushes through sweeping Medicaid cuts—estimated at $625 billion over 10 years—that could strip coverage from 8–10 million Americans, with up to 15 million ultimately uninsured when factoring in other provisions. The bill also triggers $500 billion in Medicare cuts starting in 2026 due to deficit rules, despite President Trump’s prior promises not to touch Medicare. These reductions hit vulnerable groups hard, including low-income families, people with disabilities, and rural populations, raising alarms from consumer advocates and healthcare leaders.

2. Historic Tax Cuts Paired with Soaring National Debt: This legislation delivers a massive tax break to the wealthiest Americans while raising the national debt by $2.3–$3.8 trillion over the next decade, per CBO estimates. To offset part of this, the bill slashes over $1 trillion from social safety net programs like SNAP and Medicaid. Despite these cuts, the package still expands the debt limit by $4 trillion, prompting concerns from economists and healthcare analysts that it will destabilize markets and force additional cuts to critical programs down the line.

3. Healthcare Industry and Hospitals Face Long-Term Financial Strain: While some Medicaid cuts may have delayed effects, hospitals and healthcare providers are bracing for major long-term impacts, including reduced reimbursement growth, higher uncompensated care burdens, and restrained supplemental payments. Industry groups like the American Hospital Association warn that freezing provider taxes and capping state-directed payments will undercut hospitals’ financial sustainability, particularly in Medicaid-heavy states, potentially weakening access to care and threatening the viability of rural and safety-net hospitals.

Voluntary benefits that protect financial futures as medical costs rise

By Kara Hoogensen - As medical expenses continue to rise in the United States, many workers are left financially vulnerable. Even with health insurance, out-of-pocket costs like deductibles, copays and uncovered services can quickly threaten the financial security of working Americans. Additionally, a growing number of employees lack sufficient emergency savings, with nearly 4 out of 10 American adults saying they couldn’t cover an unexpected $400 expense without going into credit card debt or borrowing money from friends, family or the bank. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Rising medical costs create urgent employee needs: Even employees with solid health insurance can face overwhelming financial strain when hit with a serious medical event like cancer, where out-of-pocket costs may spike by up to 68.1%. With over 2 million new cancer cases expected in the U.S. this year, the need for additional financial protections to safeguard employees’ stability during critical health events is more pressing than ever.

2. Employers seek cost-effective ways to enhance benefits: As 81% of small to midsized business owners express interest in expanding their benefits offerings, many are increasingly turning to voluntary benefits like hospital indemnity, critical illness, and accident insurance. These options allow employees to opt in at affordable group rates without adding to employer expenses, helping businesses boost employee retention and satisfaction even amid economic pressures.

3. Supplemental benefits bridge the gap between health and financial wellness: By offering employees access to customizable and affordable supplemental benefits, employers play a pivotal role in supporting both physical and financial well-being. These programs help employees cover unexpected expenses, reduce stress, and protect their financial futures, strengthening overall workplace wellness without straining the employer’s bottom line.

6th Circuit Reverses Blue Cross Blue Shield Claim Overpayment Dismissal

By Remy Samuels - A lawsuit accusing Blue Cross Blue Shield of Michigan of overpaying medical providers and participating in self-dealing, which had been dismissed by a district court, was remanded back to the district court by the U.S. 6th Circuit Court of Appeals on Wednesday. The 6th Circuit decision signifies a win for Tiara Yachts Inc., a Michigan-based company that designs and manufactures boats, as the appeals court found that Blue Cross Blue Shield acted as a fiduciary to the plan by exercising control over the plan’s assets. Read Full Article…

HVBA Article Summary

1. Allegations of Fiduciary Breach: Tiara Yachts claims that Blue Cross Blue Shield of Michigan (BCBSM) breached its fiduciary duties under ERISA by intentionally overpaying out-of-state medical claims through a practice known as “flip logic,” which shifted payments from discounted Host Blue rates to full provider charges. The lawsuit further alleges that BCBSM concealed this practice from plan sponsors, limited access to detailed claims data, and profited from inflated payments by collecting fees tied to those overpayments.

2. Appeals Court Reversal: While the district court initially dismissed Tiara Yachts’ claims, the 6th Circuit Court of Appeals reversed the dismissal, determining that Tiara Yachts had plausibly alleged that BCBSM exercised fiduciary control over plan assets, particularly through its authority to process payments and recover overpayments. The appeals court emphasized BCBSM’s discretion over its own compensation within the Shared Savings Program, reinforcing the argument that the insurer acted as an ERISA fiduciary and could be held accountable.

3. Implications for Plan Recovery: The 6th Circuit concluded that Tiara Yachts’ lawsuit sufficiently alleged harm not just to the company but to the entire health plan, meaning the employer is entitled to seek damages, restitution, and recovery of both the overpaid amounts and the profits BCBSM gained through its fee structures. This ruling clears the way for Tiara Yachts to pursue significant financial remedies on behalf of the plan, setting a notable precedent in fiduciary duty cases tied to claims administration.

Will Trump’s new EO really lower prescription drug prices?

By Tom Starner - It’s a fact that Americans—and, by extension, U.S. employers—pay the highest prescription drug prices in the world. In fact, according to a newly issued presidential executive order, the prices Americans pay for brand-name drugs are more than three times those of other countries that belong to the Organization for Economic Co-operation and Development (OECD). According to the same government fact sheet, the United States has less than 5% of the world’s population, yet it funds roughly 75% of global pharmaceutical profits. Read Full Article…

HVBA Article Summary

1. Employers’ Concerns About Cost Shifting: Robert Andrews of the Health Transformation Alliance (HTA) warns that lowering prescription drug prices only for public payers (like Medicare and Medicaid) could backfire by shifting higher costs onto commercial payers, such as employers. This would likely increase employees’ out-of-pocket expenses and reduce medication adherence, potentially worsening health outcomes.

2. Push for Value-Based Pricing: Instead of focusing solely on lowering drug prices, Andrews and HTA advocate for value-based pricing — where drug costs are tied to the actual medical outcomes they deliver, such as avoided hospitalizations or improved patient health. This approach aims to balance innovation incentives with fair pricing across all payers, including employers and employees.

3. Two Guiding Principles for Reform: Andrews outlines two key principles for tackling prescription drug pricing: (a) drug prices should reflect the measurable medical results they achieve, and (b) pharmacy benefit managers (PBMs) and other middlemen should only represent either the buyer or the seller — not both — to ensure that their compensation aligns with the value they provide, not inflated margins.

UnitedHealth’s former CEO resigns from board of directors 

By Jakob Emerson - UnitedHealth Group’s former CEO Andrew Witty has resigned from the company’s board of directors, effective immediately. Mr. Witty will not stand for re-election as a director during the company’s annual shareholder meeting scheduled for June 2, the company said in regulatory documents filed May 21. Read Full Article…

HVBA Article Summary

1. Leadership shake-up at UnitedHealth: On May 13, UnitedHealth announced the replacement of CEO Andrew Witty, who had served since 2021, with board chair and former CEO Stephen Hemsley, following what the company described as an “unusual and unacceptable” first-quarter performance driven by unexpectedly high medical utilization; Witty will remain involved as a senior adviser to help with the leadership transition.

2. Shareholder and executive moves: UnitedHealth is requesting shareholder approval for a substantial $60 million compensation package for Hemsley, signaling its commitment to stabilizing leadership; in a further show of confidence, Hemsley and four other senior executives purchased company stock on May 16, following a sharp downturn in the company’s market value over the past month.

3. Stock struggles continue: UnitedHealth’s stock fell more than 2% to $296.67 on May 22, capping off a dramatic 50% decline over the past six months, positioning the company as the worst-performing stock in the Dow Jones Industrial Average for 2025 so far, according to Barron’s, and raising concerns about investor sentiment and long-term recovery.

FDA Clears First Diagnostic Blood Test for Alzheimer's Disease

By Megan Brooks - The US Food and Drug Administration (FDA) has granted 510(k) clearance to the first blood test to aid in diagnosing Alzheimer’s disease (AD). The Lumipulse G pTau217/Beta-Amyloid 1-42 Plasma Ratio, from Fujirebio Diagnostics, Inc., is for the early detection of amyloid plaques associated with AD in adults aged 55 years and older who show signs and symptoms of the disease. Read Full Article…

HVBA Article Summary

1. Breakthrough blood test improves Alzheimer’s detection: The FDA has cleared the Lumipulse G pTau217/Beta-Amyloid 1-42 Plasma Ratio, a groundbreaking and less invasive blood test that measures specific biomarkers to assess the presence of amyloid plaques — key indicators of Alzheimer’s disease. This test significantly reduces the need for expensive PET scans or cerebrospinal fluid (CSF) tests, making Alzheimer’s diagnosis easier, faster, and potentially more accessible for patients showing early signs of cognitive decline.

2. Strong clinical accuracy supports expanded clinical use: Based on a multicenter clinical study involving 499 cognitively impaired adults, the Lumipulse blood test demonstrated a 91.7% positive agreement and a 97.3% negative agreement with PET scan or CSF test results. These robust accuracy rates indicate the test’s strong potential to reliably predict the presence or absence of amyloid pathology when used alongside comprehensive clinical evaluations, providing doctors with a powerful tool to guide further testing and treatment decisions.

3. Rising Alzheimer’s burden highlights the urgency of new tools: With nearly 7 million Americans currently affected by Alzheimer’s — a number projected to nearly double to 13 million by 2050 — the need for improved diagnostic tools is urgent. FDA Commissioner Dr. Martin Makary and experts at the Center for Devices and Radiological Health emphasize that innovations like this blood test represent a crucial step forward in supporting earlier and more effective Alzheimer’s diagnosis and treatment in specialized care settings, helping address a growing public health challenge.