Double-digit medical cost increases expected globally in 2025

By Alan Goforth - Health insurers expect global medical costs to increase by double digits for the third consecutive year, according to a survey conducted by WTW. Survey respondents cited increased utilization of health services, rising pharmacy costs and new medical technologies as the primary drivers of overall medical costs. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Rising Medical Costs and Regional Variations: Employers face a growing challenge as global medical costs are projected to increase by 10.4% in 2025, matching this year’s rate. Regional trends reveal North America will experience a rise from 8.1% in 2024 to 8.7% in 2025, while U.S. insurers forecast a jump from 9.3% to 10.2%. Other regions, such as Asia Pacific, the Middle East, and Africa, anticipate sharper increases, while Europe and Latin America expect slower growth. Despite slight cooling in some areas, the long-term trend remains elevated, with insurers projecting sustained high demand for health care services over the next three years.

2. Key Drivers of Escalating Costs: Several factors are fueling the persistent rise in medical costs, including advancements in medical technologies and pharmaceuticals, which drive up care expenses globally. Overburdened public health systems lead individuals to seek private care, increasing reliance on costly private providers. Additionally, heightened health care utilization, particularly in mental health services, continues to strain resources and contribute to rising costs.

3. Employer Strategies to Mitigate Costs: Employers can adopt proactive strategies to manage these rising costs while enhancing the value of health benefits. Initiatives include leveraging digital health solutions and vendors to optimize wellbeing resources, reducing unnecessary utilization, and reassessing the sourcing of private health coverage for efficiency. By taking these steps, employers can better navigate the financial challenges posed by escalating medical expenses.

EEOC lawsuits are down in 2024: Here's what this means for employers

By Deanna Cuadra - It's been a relatively slow year for the U.S. Equal Employment Opportunity Commission (EEOC), with an unexpected decline in the number of lawsuits filed by the federal agency. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. ADA-Related Lawsuits on the Rise: The EEOC filed 110 lawsuits in 2024, marking a 24% drop compared to the prior year. However, lawsuits under the Americans with Disabilities Act (ADA) accounted for 41% of cases, reflecting an ongoing focus on disability-related workplace issues. Legal experts advise employers to ensure compliance with ADA requirements, including equal opportunities for employees needing leave or with disabilities.

2. Democratic Majority and Budget Constraints: Despite expectations of increased litigation following the EEOC's shift to a Democratic majority, the commission faced budgetary limitations that likely contributed to the reduced caseload. Attorneys caution that this dynamic, coupled with the EEOC's strategic focus areas, could still lead to a rise in litigation in coming years.

3. Employer Vigilance and Strategic Enforcement: Employers are encouraged to familiarize themselves with the EEOC's 2024-2028 Strategic Enforcement Plan, which emphasizes protections for underserved groups, such as individuals with mental health disabilities or arrest records. Maintaining compliance with guidance and proactively addressing risk areas is critical, as private plaintiff attorneys remain ready to pursue cases even if EEOC litigation trends slow.

The State of Health Insurance Coverage in the U.S.

By The Commonwealth Fund - An estimated 26 million Americans, or 8 percent of the U.S. population, lacked health insurance in 2023.¹ While the United States still lags countries that have universal coverage, today’s uninsured rate represents a sea change from the years prior to the Affordable Care Act (ACA), when twice as many people — 49 million, or 16 percent of the population — lacked health coverage.² Read Full Article… 

HVBA Article Summary

1. Expanded Coverage Under the ACA: The Affordable Care Act (ACA) has significantly reduced the number of uninsured Americans, particularly through enhanced premium subsidies and restored outreach funding. These measures led to a record 21 million marketplace enrollments in 2024, providing affordable coverage options for low- and moderate-income households and those transitioning from Medicaid after pandemic-era protections ended.

2. Persistent Challenges in Health Coverage: Despite these gains, gaps remain. Approximately 9% of working-age adults are uninsured, 12% experienced coverage lapses, and 23% were underinsured in 2024. Factors contributing to underinsurance include high deductibles and out-of-pocket costs, particularly for those with employer-sponsored plans. Medical debt, delays in care, and inadequate dental and mental health coverage highlight ongoing barriers to comprehensive access.

3. Policy Recommendations for Improved Coverage: Policymakers are urged to act on several fronts: extending premium tax credits beyond 2025, closing the Medicaid coverage gap in 10 states, introducing auto-enrollment mechanisms, and addressing high healthcare costs. Measures like lowering deductibles in marketplace plans, adjusting employer-sponsored premiums based on income, and enforcing protections against medical debt can further expand access and affordability.

Weight-loss drug coverage rises among largest US employers, Mercer survey finds

By Amina Niasse - About 44% of U.S. employers with 500 or more employees cover drugs for weight loss in 2024, up from 41% in 2023, according to a survey from consulting firm Mercer released on Wednesday. Read Full Article… 

HVBA Article Summary

1. Increased Coverage for Weight-Loss Drugs: In 2024, 64% of U.S. employers with over 20,000 employees provided coverage for weight-loss medications, including GLP-1 drugs like Wegovy and Zepbound, compared to 56% in 2023. These drugs, which significantly aid in weight loss, have driven up healthcare costs, prompting employers to implement stricter authorization requirements to ensure targeted use among eligible patients.

2. Rising Employer Healthcare Costs and Adaptations: The annual healthcare cost per employee increased by 5% to $16,501 in 2024, with employers expanding health plan options and focusing on outcome-based cost metrics to manage expenses. Nearly one-third of large employers now offer Exclusive Provider Organization (EPO) plans, some of which do not require deductibles, reflecting a trend toward diversified and cost-managed healthcare offerings.

3. Broader Benefits Beyond Weight-Loss Drugs: Alongside weight-loss medication coverage, fertility treatment benefits also grew, with 47% of companies with over 500 employees covering in vitro fertilization (IVF) in 2024, up from 45% in 2023. Mercer’s survey highlighted employers' efforts to balance rising costs with enhanced benefit offerings to meet employee needs.

Owens & Minor Sues Anthem Over Mismanaging Health Plan, Lack of Transparency

By Remy Samuels - Owens & Minor Inc., a health care logistics company, filed a complaint against Anthem Blue Cross and Blue Shield on Monday, claiming that the third-party administrator refused to provide necessary claims data and overpaid certain claims on behalf of the plan sponsor, resulting in unnecessary costs. Read Full Article…

HVBA Article Summary

1. Fiduciary Scrutiny and Compliance Under CAA: This case underscores the heightened scrutiny fiduciaries face in managing health plans, especially under the Consolidated Appropriations Act of 2021. The CAA mandates plan sponsors to ensure that healthcare fees are fair and reasonable, imposes transparency requirements, and prohibits gag clauses on data sharing. Owens & Minor Inc.'s request for plan data from Anthem aligns with its fiduciary duty to monitor plan administration and compliance with these regulations.

2. Allegations Against Anthem's Management Practices: The lawsuit alleges that Anthem engaged in misconduct by withholding critical plan data, mismanaging assets, and prioritizing its own financial gain. Claims include overpayments for health services, kickbacks, double payments, and retaining rebates meant for the plan. Additionally, Owens accuses Anthem of using the BlueCard program to inflate costs and obscure pricing structures, further complicating Owens' ability to fulfill its fiduciary responsibilities.

3. Implications for Industry Transparency and Oversight: This case highlights the ongoing challenges in achieving transparency between plan sponsors and third-party administrators, reflecting broader industry concerns. It aligns with the Federal Trade Commission's recent actions against pharmacy benefit managers for opaque pricing practices, signaling a regulatory push to address systemic issues in health plan administration and cost management.

Lilly Pill Cuts Genetic Form Of Cholesterol Nearly 86% in Study

By Julie Steenhuysen - The highest dose of an experimental pill developed by Eli Lilly dramatically lowered an inherited form of high cholesterol in a mid-stage trial, according to data presented at a medical meeting… Read Full Article… 

HVBA Article Summary

1. Breakthrough in Oral Lp(a) Treatment: Eli Lilly's muvalaplin, the first oral drug targeting elevated lipoprotein(a) [Lp(a)], demonstrated significant reductions in Lp(a) levels, with up to 85.8% reduction measured by a novel intact particle test, compared to a placebo. This stands out in a field dominated by injectable therapies, offering a promising alternative for the one in five individuals globally affected by high Lp(a), a major risk factor for heart disease.

2. Clinical Trial Highlights: In a Phase 2 trial involving 233 adults, muvalaplin reduced Lp(a) levels by 47.6%, 81.7%, and 85.8% at doses of 10 mg, 60 mg, and 240 mg, respectively, using the intact particle test. Adverse events were similar between the muvalaplin and placebo groups, emphasizing the drug's safety profile. However, long-term studies are needed to confirm whether lowering Lp(a) translates into fewer cardiovascular events like heart attacks and strokes.

3. Advancements in Injectable Therapies: At the same American Heart Association meeting, Silence Therapeutics shared results from its siRNA-based injectable therapy, zerlasiran, which achieved 80%-85% Lp(a) reduction over 36-60 weeks with no major safety concerns. Similar progress was reported for other injectable treatments from Amgen, Novartis, and Lilly. These developments underscore the growing competition and innovation in targeting high Lp(a).

Americans like the employer health benefits tax exclusion: Will it remain under Trump?

By Allison Bell - Most Americans want to keep the federal income tax exclusion for employer-sponsored health benefits in place, and support for keeping the exclusion in place is bipartisan. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Strong Voter Support for Tax-Free Employer-Provided Health Insurance: The American Benefits Council's Election Night survey revealed overwhelming support for maintaining the tax-free status of employer-provided health insurance. About 93% of the 800 voters polled agreed that this policy encourages employers to offer high-quality, affordable health coverage, while only 7% believed taxing such benefits could raise federal revenue and reduce overuse of healthcare services.

2. Broad Opposition to Taxing Health Benefits Across Political Lines: America's Health Insurance Plans (AHIP) conducted a July survey of 1,000 individuals with employer-provided health insurance. The results showed that only 29% supported the idea of taxing employee health benefits, with opposition being widespread—58% overall, including 61% of swing voters, 59% of Republicans, and 55% of Democrats.

3. Potential Political Repercussions of Taxing Health Benefits: According to AHIP’s survey, 63% of participants indicated they would be less likely to vote for a congressional candidate who supported taxing health benefits, signaling potential electoral consequences for policymakers considering such changes. This sentiment was consistent across different political affiliations, further highlighting the unpopularity of the proposal.