Nearly 8 in 10 employers say GLP-1 coverage drives up benefit costs: Business Group on Health

By Cailey Gleeson – Nearly eight in 10 employers say GLP-1 drugs are a major contributor to rising healthcare costs, according to a new survey from Business Group on Health. The survey was conducted between February and March from 105 members of the non-profit organization. Most surveyed employers covered GLP-1s for diabetes, though 67% of respondents report covering the drug for weight management. Of respondents covering the use of GLP-1s, 10% said they would likely not continue coverage through 2027 and 72% said they would likely continue coverage. Read Full Article...

HVBA Article Summary

1. Employer Concerns Over GLP-1 Costs: Employers are increasingly worried about the financial impact of covering GLP-1 medications, especially as these drugs become more widely used for both diabetes and weight management. The survey highlights that the majority of employers see these drugs as a significant driver of rising benefit costs. This concern is heightened by the expectation of continued double-digit increases in overall healthcare expenses.

2. Future Coverage Decisions Remain Divided: While most employers currently covering GLP-1s plan to continue doing so, a notable minority are considering discontinuing coverage in the near future. Employers not currently offering coverage are generally not planning to add it, indicating a cautious approach to expanding benefits that could further increase costs. The introduction of new oral GLP-1 medications is expected to boost demand, but few employers anticipate any reduction in drug prices.

3. Broader Impact on Health Benefit Budgets: The rising use of GLP-1 drugs is contributing to broader increases in employer health benefit spending, with some surveys indicating that health benefit costs are now among the top financial concerns for business leaders. Employers are facing difficult decisions about how to absorb these costs without negatively affecting their business operations. The trend underscores the challenge of balancing employee health needs with the financial sustainability of employer-sponsored health plans.

The Convenient Narrative Letting Insurers Off the Hook

By Wendell Potter – Zack Cooper argued this week in The New York Times that Americans may be blaming the wrong culprit for rising premiums. In his view, the bigger driver is hospital market power—fueled by years of consolidation that policymakers have done little to stop. On that point, he’s on solid ground saying that hospital prices have climbed steadily, and oversight has lagged. Where the argument falls short is in how it portrays insurers. It suggests they are largely on the defensive—unable to push back on powerful hospital systems and left to rely on tools like prior authorization and claim denials as a workaround. Read Full Article...

HVBA Article Summary

1. Insurer and Hospital Consolidation Are Interconnected: The article argues that hospital consolidation, often blamed for rising healthcare costs, was itself a response to earlier consolidation among insurers. As insurers grew larger and gained more bargaining power, hospitals merged to counteract this influence. This cycle of consolidation on both sides has resulted in higher prices and premiums, ultimately impacting patients and employers the most.

2. Insurers Benefit from Higher Costs Due to Incentive Structures: The piece highlights that in many commercial insurance arrangements, insurers earn fees based on the total size of claims processed. This means that higher hospital prices can actually increase insurer revenues, weakening their incentive to aggressively negotiate lower prices. Regulatory measures like the Affordable Care Act’s medical loss ratio rules have not fully addressed this issue, as insurer profits can still rise with overall cost growth.

3. Cost-Shifting and Administrative Complexity Harm Patients: When insurers cannot control hospital prices, they often shift costs to patients through higher deductibles, narrower benefits, and increased use of prior authorization and claim denials. These practices make care harder to access and add layers of administrative complexity, which both insurers and hospitals have a vested interest in maintaining. The article contends that true reform requires addressing both hospital market power and insurer incentives, rather than focusing blame on one side.

Insurance companies' own employees struggle with out-of-pocket costs

By Allison Bell – The head of Lousiana health care delivery organization talked to a key senator Tuesday about how both health insurance premiums and health insurance out-of-pocket costs are reaching levels that are starting to push care out of reach even for some of the insurance companies' own employees. Kathy Oubre, the chief executive officer of the Pontchartrain Cancer Center in Covington, Louisiana, appeared at the first of two field hearings that the Senate Health, Education, Labor & Pensions Committee is holding in Louisiana this week. Sen. Bill Cassidy, R-La., the committee chair and a medical doctor himself, said he brought the committee to his home state to promote efforts to hold down the cost of health care and health insurance. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Rising Costs Impact Even Industry Insiders: The article highlights that escalating health insurance premiums and out-of-pocket expenses are making health care less accessible, even for employees of insurance companies themselves. Testimony from a cancer center CEO described how young actuaries working for insurers struggle to afford necessary medical care due to high deductibles. This suggests that the affordability crisis in health care is not limited to the general public but also affects those within the industry.

2. Employer Strategies and Tradeoffs: Employers face difficult choices between offering plans with high premiums and low deductibles or vice versa. The cancer center featured in the article provides a no-deductible, co-pay-only plan, which results in a significant annual cost per employee. These tradeoffs illustrate the financial pressures on both employers and employees as they try to balance comprehensive coverage with affordability.

3. Broader Implications for Health Care Access: The testimony and supporting data indicate that high out-of-pocket costs can deter individuals from seeking necessary medical care. A recent survey cited in the article found that over a quarter of U.S. workers avoided care due to cost concerns. This trend raises concerns about the effectiveness of current health insurance models in providing adequate access to health care, even among those who are insured.

Novo Nordisk's first quarter in four words: Pills, pricing, payments and pressure

By Elizabeth Cairns – A million patients with obesity are already taking Novo Nordisk’s Wegovy pill, CEO Mike Doustdar said Wednesday, despite the market entry of Lilly’s Foundayo. Novo’s pill had sales of 2.3 billion Danish krone ($353 million) in its first three months on the market, well in excess of Wall Street projections. “We have now been competing with our competitor for about a month,” Doustdar said during Novo’s first-quarter earnings call with media on Wednesday. “And as the numbers show, we have seen a continued interest in our pill. Read Full Article...

HVBA Article Summary

1. Novo’s Wegovy Pill Exceeds Sales Expectations: Novo Nordisk reported first-quarter sales for its oral Wegovy treatment that were more than two and a half times higher than analyst forecasts. Executives attributed demand to the pill’s effectiveness, tolerability, and limited drug interactions, while noting competitors have not significantly affected prescription growth. The company also described the launch as one of the strongest US pharma launches of the past decade outside of vaccines.

2. Novo Focuses on Market Expansion Rather Than Price Competition: Company leadership said current pricing for the Wegovy pill is supporting strong demand without major price competition. Novo also reported a significant rise in self-pay purchases, with more than half of US Wegovy sales now coming from out-of-pocket payments compared to just over 10% a year ago. Executives added that broader pressure on US drug pricing remains an industry challenge.

3. Growing Dependence on Semaglutide Raises Long-Term Concerns: Semaglutide-based products now account for roughly 75% of Novo’s quarterly drug sales, increasing investor focus on future patent and generic competition risks. Some international markets have already introduced generic semaglutide products, while the main US patent is expected to expire in the early 2030s. Novo said it continues exploring ways to strengthen and diversify its pipeline alongside reporting stronger-than-expected quarterly results.

Why payers must lead the charge for better employer-sponsored healthcare

By Pam Klein – THealthcare benefits have long played a role in attracting and retaining talent. But today, they're more than just a line item to manage or a traditional recruitment tool. Employers increasingly view benefits as a strategic lever for workforce engagement, productivity, and long-term business performance, and they're demanding bold, integrated solutions that deliver measurable impact across cost, experience and outcomes. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Employers Shift Focus Beyond Cost to Workforce Outcomes: The report found that 60% of benefits leaders now rank employee satisfaction as “very important,” placing it on the same level as healthcare cost management in decision-making. Employers are increasingly evaluating benefits strategies based on broader workforce metrics such as retention, productivity and engagement rather than focusing solely on reducing expenses. This shift reflects a growing view that employee experience directly contributes to organizational performance and long-term stability.

2. Balancing Cost and Access Is Emerging as the New Standard: According to the report, 40% of employers now prioritize both healthcare cost and access to care equally, compared with 38% that focus primarily on cost alone. In the last 12–24 months, 81% of employers implemented cost-management initiatives, including plan redesigns, digital tools and expanded voluntary benefits offerings. At the same time, approximately 70% of members reported they would pay an additional $10 per month for services such as price transparency tools, online scheduling and low-cost medication search, signaling strong demand for digital healthcare support.

3. Digital Experience and Service Quality Are Driving Benefits Decisions: While 59% of employers currently offer price transparency tools and 63% consider them “very important,” only 47% believe those tools are doing an “excellent” job meeting employee needs. More than half of employers also identified customer service responsiveness and communication effectiveness as critical factors in choosing benefits partners. The report further found that over one-third of employers are likely to switch their primary insurance carrier within the next year, particularly among mid-sized organizations, reflecting increased pressure on payers to deliver stronger performance, customization and integrated digital experiences.

Self-funded plan regulation: What matters

By Stephen George – "ERISA plans" aren't all equal. If regulators at the National Association of Insurance Commissioners want to talk about changing the regulations for self-funded employer health plans, they need to understand this. Group major medical insurance plans, which are regulated by the state insurance departments, are different from self-funded plans, which come under the federal Employee Retirement Income Security Act and are regulated by the U.S. Department of Labor. Traditional self-funded plans are different from level-funded plans. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Distinct Regulatory Structures: The article emphasizes that group major medical insurance plans and self-funded plans are governed by different regulatory bodies, with the former under state insurance departments and the latter under federal oversight via ERISA. This distinction is important because it affects how compliance and risk management are handled for each type of plan. Understanding these differences is crucial for policymakers considering changes to regulations affecting self-funded employer health plans.

2. Differences Between Traditional and Level-Funded Plans: Traditional self-funded plans typically involve higher stop-loss deductibles and greater financial risk for employers, who must be prepared to pay large claims within a short timeframe. In contrast, level-funded plans use lower stop-loss deductibles and shift much of the catastrophic risk to the insurer, reducing the employer’s direct financial exposure. Applying the same regulatory standards to both types could unfairly increase costs for level-funded plans without providing additional benefits to participants.

3. Potential Impact of Uniform Regulation: The author argues that imposing one-size-fits-all regulations on both traditional and level-funded self-funded plans could lead to unnecessary compliance costs for level-funded plan sponsors. Such regulatory changes may discourage employers from offering health benefits if compliance becomes too burdensome or expensive. The article suggests that regulators should tailor their approach, focusing on the unique risk structures and responsibilities associated with each plan type to avoid unintended negative consequences.

Allied National Launches a New Approach to Traditional Group Health Coverage

By Allied National – Overland Park, KS – May 6, 2026: Allied National, one of the original pioneers in level-funded and reference-based pricing (RBP) healthcare plans, proudly announces the launch of Freedom Open Access, an end-to-end network alternative solution and bold reimagining of its decades-long commitment to affordable, transparent, and member-centric healthcare. Controlling ever-rising healthcare costs remains a challenge for many employers. The continued cost surge driven by a combination of rising prices for medical services and increased utilization raise affordability concerns for many small employers. At the same time, navigating healthcare continues to be highly complex and fragmented for consumers who often feel lost and alone in that process. Read Full Article...

HVBA Article Summary

1. Introduction of Freedom Open Access: Allied National has launched Freedom Open Access, a new health coverage solution designed to address the persistent challenges of rising healthcare costs and system complexity. This offering is positioned as an alternative to traditional network-based plans, aiming to provide greater affordability and transparency for employers and their employees. The plan is set to be effective starting August 1, 2026.

2. Key Features and Member Benefits: The Freedom Open Access plan emphasizes transparent pricing, strategic direct contracting, and pricing benchmarks above Medicare levels. It offers members personalized advocacy services to help them navigate healthcare decisions and includes protections against balance billing, which can result in unexpected costs. The plan also allows members to see any provider without the traditional in-network or out-of-network restrictions, offering flexibility and choice.

3. Market Impact and Differentiation: Allied National’s approach is intended to differentiate itself in the group health market by focusing on consumer-centric innovation and flexible plan designs. The company highlights that this solution is tailored to meet evolving healthcare needs and provides a competitive edge for brokers and clients seeking modern alternatives. The launch reflects a broader industry trend toward reference-based pricing and open-access models as employers seek to manage costs while enhancing the member experience.