Health Savings Accounts Won’t Fix Big Insurance’s “Money Sucking”

By Wendell Potter and Joey Rettino – After the longest government shutdown in U.S. history (a showdown triggered almost entirely by Republicans’ refusal to renew the Affordable Care Act’s enhanced premium tax credit) health care affordability is now a top concern for millions of Americans. And the polling reflects that outrage: Voters across the political spectrum blame the GOP for allowing the tax credits to lapse, threatening coverage and spiking premiums for 22 million marketplace enrollees. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Health Savings Accounts (HSAs) Primarily Benefit Wealthier Households: Originally created in 2003, HSAs offer tax advantages that disproportionately favor high-income individuals. In 2021, people earning over $1 million were the most likely to contribute to HSAs, while those making under $50,000 accounted for just 4% of contributions. Despite being pitched as a solution for affordability, HSAs are mostly inaccessible to the 40% of U.S. adults already in medical debt, as they require discretionary income to fund. As such, they function more effectively as tax shelters than as tools for broad health care affordability.

2. HSAs Do Not Address the Fundamental Drivers of Health Care Costs: HSAs must be paired with high-deductible health plans, which expose families to significant out-of-pocket costs before insurance coverage begins. These plans are often issued by major insurance companies like Cigna, Aetna, and UnitedHealthcare. Proposed HSA-based reforms would allow Affordable Care Act (ACA) enrollees to divert subsidies into HSAs instead of applying them toward lower insurance premiums. Critics argue this would convert guaranteed financial protections into limited-use accounts, potentially leaving individuals without enough funds to cover even a single specialist visit, much less costly treatments like chemotherapy or hospitalization.

3. Big Insurance, Banks, and Wall Street Are Poised to Gain from HSA Expansion: The article highlights how large corporations stand to profit significantly from a renewed focus on HSAs. For example, Optum Bank, a subsidiary of UnitedHealth Group, is the nation’s largest HSA custodian and would gain an additional consumer revenue stream. HealthEquity, Inc. manages tens of billions in HSA assets, earning fees and investment income, while Fidelity is rapidly growing its HSA platform by folding accounts into its broader investment services. Meanwhile, public trust in both insurers and financial institutions remains near historic lows, raising concerns that the expansion of HSAs would enrich corporations without improving care access or affordability for most Americans.

State legislators debate regulation of 'alternative funding programs' for high-cost drugs

By Allison Bell - State legislators are talking about employers' use of "alternative funding programs" for prescription drug benefits. The programs exclude coverage for some very expensive drugs, based on the assumption that the manufacturers or charities will help most patients who really need the drugs pay for the drugs. The National Council of Insurance Legislators included draft minutes for a discussion of the topic in a packet prepared for a recent in-person NCOIL meeting in Atlanta. The discussion occurred at an NCOIL state-federal relations committee meeting held earlier in the year.  Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Rising Drug Costs Driving Alternative Strategies: Republican Representative Jim Dunnigan of Utah noted that the state's largest health plan administrator is actively informing employers about using alternative funding program (AFP) strategies. These strategies are being adopted as a response to escalating prescription drug costs, which significantly impact overall health plan expenses. Dunnigan emphasized that most people are not willing or able to pay substantially higher health insurance premiums, making such alternative solutions appealing to employers.

2. Concerns Over Drug Importation in AFPs: Theresa Alban, the federal policy director at the Cystic Fibrosis Foundation, raised concerns about AFP providers promoting medication importation as a cost-saving tactic. She warned that these providers often use federal laws to reassure employers that importing expensive medications is legal, safe, and efficient. However, Alban reported that patients with cystic fibrosis have experienced problems with this process, indicating a disconnect between the assurances given and actual patient outcomes.

3. Legislative Consideration for Regulation Over Prohibition: During the legislative discussion, some lawmakers, including Illinois Representative Jeff Keicher, proposed that a better solution than banning AFPs might be to establish licensing and regulatory frameworks. This would allow for oversight of these programs while still giving employers access to potentially cost-effective options. The goal would be to balance cost containment with patient protection and accountability.

Nomi Health, Henry Ford Health partner on direct employer contracting

By Paige Minemyer – As employers continue to face elevated health benefits costs, Nomi Health is teaming up with Henry Ford Health to rethink the traditional paradigm. Henry Ford has signed on to join Nomi's direct network program, which offers direct contracting solutions to self-funded employers. The health system's participation marks a significant expansion in the offering, according to an announcement from the company. Read Full Article...

HVBA Article Summary

1. New Employer-Provider Model in Michigan: Michigan employers who enroll in the program will gain access to Henry Ford Health’s vast provider system, which includes more than 550 sites of care. This network offers a comprehensive array of services, including primary, specialty, and complex care, all made available to employees with $0 deductibles and copayments, and no surprise medical bills. The model aims to enhance both affordability and transparency for employees seeking healthcare services.

2. Nomi Health’s Strategic Rollout and Scaled Partnership: Nomi Health selected Michigan as its first "full platform" state, simultaneously launching its data, payment, and provider network platforms. The initial rollout focused on the western part of the state and included approximately 40 employers, representing around 10,000 workers. Following this pilot, Nomi used performance data from the early phase to secure a formal partnership with Henry Ford Health, establishing a foundational model for broader implementation across the country.

3. Commitment to Affordability, Value-Based Care, and Geographic Expansion: The partnership aligns with Henry Ford’s ongoing commitment to value-based care, building on its 2018 direct contract with GM. The model not only supports streamlined access to services and faster payments to providers, but also emphasizes virtual and home health options. Nomi Health, meanwhile, plans to expand this framework to other regions, actively pursuing provider relationships across the Midwest, South, and the Rockies. Equipped with transparent cost data, Nomi aims to replicate the Michigan model as a national blueprint for direct contracting in healthcare.

A broker's guide to breaking the rebate cycle

By Rae McMahan – Prescription drug costs remain one of the most pressing challenges in American healthcare. Even with insurance, many healthcare consumers struggle: 29% of adults report not taking their medications as prescribed due to cost. High deductibles, opaque pricing and complex formularies reliant on rebates often mean coverage doesn't equal affordability. Employers feel this pain, too, with pharmacy spending now among the fastest-growing and least predictable healthcare costs. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Value-Based Pharmacy Benefits Over Rebates: Employers should focus on pharmacy benefits that prioritize clinical and financial value instead of rebates. Value-based formularies use real-time data to reduce spending on high-cost, low-use drugs and ensure coverage aligns with employee needs. This approach can include cash pricing options and avoid the hidden costs tied to rebate-driven models. Transparent, pass-through PBMs help direct every dollar toward true value.

2. Transparency as a Fundamental Requirement: Transparency is essential for affordability and accountability in pharmacy benefits. Brokers should demand full PBM disclosure, including rebate retention, administrative fees, and spread pricing. Employers should work with partners who pass along true network pharmacy rates and operate independently to avoid conflicts of interest. These measures help uncover hidden costs and improve plan efficiency.

3. Empowered Prescription Decisions and Clinical Oversight: Members need real-time drug pricing and alternative options at the point of prescription to make informed decisions. Over half will request a lower-cost drug when they know it's available, improving adherence and reducing spending. Clinical oversight, like unbiased prior authorization, is also key to managing costs. For instance, one employer cut GLP-1 claims and utilization by nearly 30%, even as these drugs drove a 10.2% increase in U.S. drug spending in 2024.

Novo Nordisk reduces Ozempic, Wegovy prices

By Nathan Bomey and Maya Goldman – Novo Nordisk is lowering the cash price of its weight-loss drug Wegovy and diabetes treatment Ozempic. Why it matters: Consumer advocates and policymakers — including the Trump administration and Democrats in Congress — have been pressing for public and private efforts to make GLP-1 treatments more affordable. Zoom in: Novo — whose Ozempic has become a shorthand descriptor for weight-loss drugs for many Americans — is lowering the new standard monthly cash price of its two GLP-1 shots from $499 to $349. Read Full Article...

HVBA Article Summary

1. Novo Nordisk Introduces New Pricing and Promotional Offers for Ozempic: Novo Nordisk has unveiled a new standardized monthly price of $245 for Ozempic across its platforms, following an agreement tied to the White House’s upcoming TrumpRx initiative. To further attract self-pay customers, the company is offering an introductory deal of $199 for a two-month supply, valid through March 31. Despite these adjustments, the highest available dose of Ozempic will continue to be priced at $499 per month.

2. Federal Agreement Expands Access and Reduces Costs for Medicare Patients: Under a newly announced deal with the Trump administration, both Novo Nordisk and Eli Lilly will reduce the Medicare price of their GLP-1 drugs to $245 per month. This initiative will initially benefit seniors with severe obesity or qualifying chronic conditions such as cardiovascular disease, advanced kidney disease, and uncontrolled hypertension. Eligible Medicare enrollees will only be responsible for a $50 monthly copay for these medications, signaling a significant policy shift aimed at improving access.

3. Novo Aims to Reclaim Market Share Amid Intensifying GLP-1 Competition: The pricing revisions and Medicare partnership reflect Novo Nordisk’s strategic efforts to regain lost ground in the U.S. GLP-1 market, where it has seen increasing competition from rival Eli Lilly. Company executive Dave Moore highlighted that these measures align with a broader, long-term vision to make these therapies accessible to a much larger patient population in need of treatment.

MassMutual's benefits give working parents an extra holiday boost

By Paola Peralta – Working parents are just weeks away from the holiday onslaught of winter breaks, hectic schedules, holiday hosting and shopping trips. Benefit managers can help lighten their load and keep them focused on work with strategic support. Sixty-eight percent of working parents say juggling work and child care is one of their biggest sources of stress during the holiday season, according to a survey by Bright Horizons. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Holiday Season Intensifies Pressure on Working Parents: Many working parents struggle to manage increased caregiving responsibilities during the holidays, including school closures, family travel, and budgeting stress, all while facing year-end work deadlines. Over a third report needing back-up care or holiday camps due to these seasonal disruptions. Without adequate support, employers risk a disengaged, burned-out workforce during a critical time for productivity and retention.

2. Comprehensive, Flexible Benefits Are Key to Retention and Well-Being: Tailored support such as emergency child care, mental health services, and financial wellness tools help parents stay present and productive at work. Companies like MassMutual offer remote work weeks, customizable wellness stipends, and back-up care to meet varied family needs. These offerings are especially valued during high-stress periods but serve as long-term strategies for employee satisfaction and loyalty.

3. Listening and Accessibility Drive Impactful Caregiving Support: Organizations must go beyond offering benefits—they need to ask employees what they need, ensure resources are easy to find, and remove stigma around usage. MassMutual, for example, uses focus groups, employee surveys, and bundled benefit guides for different life stages, all available through their intranet. Leaders are advised to treat caregiving support as a year-round commitment, signaling to employees: We see you, we value you, and we’re here to help you thrive at work and at home.

How much damage did the federal shutdown do to telehealth?

By Mario Aguilar – Congress’ failure to pass a spending bill at the end of September led to the expiration of Covid-era policies that expanded the telehealth services covered by Medicare. An early analysis from researchers at Brown University School of Public Health suggests an immediate impact. The portion of traditional Medicare visits conducted over telehealth dropped by 24% in the first 17 days of October compared to the preceding three months. In Medicare Advantage, it dropped by 13%. Many providers continued offering services as there was — and remains — an expectation they will be retroactively paid. Read Full Article...

HVBA Article Summary

1. Telehealth Usage and Policy Uncertainty: Telehealth has become an essential part of healthcare for older Americans, with 6.7 million traditional Medicare beneficiaries—about 25% of those eligible—using these services in 2024. Despite its growing role, telehealth remains in a precarious position as its continuation depends on short-term policy extensions tied to government funding resolutions. With another extension only lasting through January, advocates are urging lawmakers to make Covid-era telehealth flexibilities permanent. Continued uncertainty could frustrate clinics to the point that they abandon telemedicine altogether.

2. Shifts in Medicare Payments for AI and Remote Monitoring: Medicare is expanding its coverage of AI tools, beginning in January with payments exceeding $1,000 for an AI product that analyzes heart CT scans to detect plaque linked to heart attacks and strokes. This reflects a broader trend of integrating AI into healthcare, but raises questions about cost-effectiveness and clinical value. At the same time, UnitedHealthcare plans to stop reimbursing doctors for remote patient monitoring (RPM) of chronic conditions like hypertension and diabetes, citing insufficient evidence. This move affects Medicare Advantage patients and has sparked concern among providers, as Medicare itself has yet to establish clear standards for RPM coverage.

3. CMS Launches AI Pilot to Reduce Waste: The Centers for Medicare and Medicaid Services (CMS) has launched a new pilot program—the Wasteful and Inappropriate Services Reduction (WISeR) model—to test the use of AI in the prior-authorization process for Medicare. Six companies, including venture-backed firms like Cohere and Innovaccer, will participate. The pilot focuses on procedures with low-value evidence or high potential for fraud, such as skin substitutes and nerve stimulation. While the goal is to cut down on unnecessary spending, critics worry that AI may be used to inappropriately deny care, especially since participating companies will profit from a share of the savings they generate.