US slashes 36% off Medicare spending on 15 high-priced medicines

By Patrick Wingrove and Deena Beasley - The U.S. Medicare health plan said on Tuesday that newly negotiated prices for 15 of its costliest drugs will save 36% on those medications compared with recent annual spending, or about $8.5 billion in net covered prescription costs. The prices go into effect in 2027, including a monthly price of $274 for Novo Nordisk's (NOVOb.CO), popular GLP-1 drug semaglutide, sold as Wegovy for weight loss and Ozempic for diabetes. Read Full Article…

HVBA Article Summary

1. Medicare's Drug Price Reductions Are Substantial: Medicare recently listed the net monthly price of Ozempic at $428, down significantly from its undiscounted list price of $959. This reflects the broader impact of Medicare's drug price negotiations, which yielded savings ranging from 38% to 85% across 15 medications. High-cost drugs such as AstraZeneca’s Calquence, Boehringer’s Ofev, and Pfizer’s Ibrance saw the steepest price reductions—each cut by over $4,000. These negotiations were enabled by the 2022 Inflation Reduction Act (IRA), reversing a longstanding policy that prohibited Medicare from bargaining with pharmaceutical companies.

2. Savings and Methodology Improved Over Last Year: Goldman Sachs estimates that the 2027 savings from this year’s round of negotiations will be 36% of net spending, surpassing last year’s 22% savings from a separate group of 10 drugs. Experts, including Professor William Padula of USC, note that Medicare is becoming more efficient in its pricing methodology. He also suggests that this latest group of drugs, being newer, may have had more flexibility ("wiggle room") for negotiation. Medications like GSK’s Trelegy Ellipta and AbbVie’s Linzess were significantly reduced in price—Trelegy dropped to $175 from $654, and Linzess fell to $136 from $539.

3. Industry Pushback and Global Comparisons Continue: As Medicare’s negotiation strategy unfolds, some analysts plan to compare the newly set prices with those in other high-income nations, aligning with the “most-favored-nation” (MFN) pricing concept promoted during the Trump administration. This approach could reveal how U.S. prices stack up globally and add pressure for further reforms. However, the pharmaceutical industry remains staunchly opposed to these efforts, arguing that government-mandated pricing harms innovation and access. "Whether it is the IRA or MFN, government price setting for medicines is the wrong policy for America," said Alex Schriver, spokesperson for PhRMA, the industry’s main lobbying group.

Dems: 'Massive profits' for carriers under GOP 'cash for coverage' ACA proposal

By Allison Bell – A Republican proposal to put cash in personal health accounts for some Affordable Care Act exchange plan users could be great for the companies that administer the accounts. Democrats on the Senate Finance Committee — who oppose the proposal — said in a report posted by Sen. Ron Wyden, D-Ore., last week that they want more information about how much financial services companies get for administering health savings accounts, flexible spending arrangements, and similar types of personal health accounts. Read Full Article... ^{_{(Subscription required)}}

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1. Potential Revenue Stream for Financial Institutions: Senate Finance Committee Democrats warned that the proposed ACA health accounts could operate similarly to commercial Health Savings Accounts (HSAs), allowing administrators to collect recurring fees. For example, OptumBank—administering 8 million active HSAs—charges monthly maintenance fees, $2.50 for ATM withdrawals, and a $20 outbound transfer fee. The report suggests these arrangements could result in consistent and significant profits for financial institutions and insurance providers.

2. Beneficiaries May Include Major Banks and Insurance Firms: The report names several entities likely to financially benefit from the creation of ACA health accounts, including UnitedHealth’s OptumBank, Bank of America, Fidelity, HSA Bank, and HealthEquity. By administering these accounts, these organizations could tap into new revenue streams through fees, potentially mirroring the structure and profitability of existing HSA management services.

3. Proposed Subsidy Expansion Under ACA Reform: Although the official text is not yet released, press reports indicate that the White House is considering a major update to the ACA subsidy framework. The revised plan may expand eligibility to individuals earning up to 700% of the federal poverty level—about $109,550 for a single person—compared to the original 400% threshold ($62,600). Under this proposal, enrollees who choose lower-premium plans would receive the cost savings in the form of deposits into their health accounts, potentially reshaping the way subsidies are distributed.

Lawmakers Introduce Multiple Bills Aimed at Medicare Advantage Reform

By Marissa Plescia – A group of 13 Democratic House Representatives introduced a package of eight bills last week that would crack down on Medicare Advantage and strengthen traditional Medicare. The package was introduced by Mark Pocan (D-Wisconsin) and cosponsored by Andre Carson (D-Indiana), Steve Cohen (D-Tennessee), Rosa DeLauro (D-Connecticut), Lloyd Doggett (D-Texas), Pramila Jayapal (D-Washington), Ro Khanna (D-California), Eleanor Holmes Norton (D-D.C.), Alexandria Ocasio-Cortez (D-New York), Jan Schakowsky (D-Illinois), Mark Takano (D-California), Shri Thanedar (D-Michigan) and Rashida Tlaib (D-Michigan). The bills fall under three categories. Read Full Article...

HVBA Article Summary

1. Delays and Denials of Care: Enhancing Patient Protections: A key focus of the legislative package is to address how Medicare Advantage (MA) plans delay or deny patient care. The proposed bills aim to reduce such practices by discouraging excessive prior authorization requirements, streamlining the appeals process when care is denied, and increasing transparency by requiring MA insurers to publicly disclose their rates of care delays and denials in advertisements. These measures are intended to ensure that patients receive timely and necessary medical services without bureaucratic barriers.

2. Overcharging Taxpayers: Curbing Fraud and Reducing Government Spending: The second category of reforms is designed to hold MA insurers financially accountable and protect taxpayer dollars. The legislation would prohibit companies with a history of defrauding the government from participating in Medicare Advantage, mandate that MA plans cost the government no more per beneficiary than traditional Medicare, and limit the number of plans insurers can offer to three annually. These efforts aim to simplify the marketplace, prevent profiteering, and ensure fairer use of public funds.

3. Strengthening Traditional Medicare: Preserving Choice and Access: To reinforce the integrity and accessibility of traditional Medicare, the bills propose safeguards against automatically enrolling seniors into MA plans, as suggested in Project 2025. Additionally, they would require the creation of a centralized national website to help individuals search for doctors by insurance plan. These initiatives are geared toward preserving genuine patient choice and improving access to accurate information when selecting healthcare providers under Medicare.

A look at how UnitedHealthcare is developing, deploying AI solutions

By Paige Minemyer – An insurer the size of UnitedHealthcare has a treasure trove of data, and that's one of the driving factors in the insurance giant's approach to artificial intelligence. Craig Kurtzweil, chief data and analytics officer for UnitedHealthcare's commercial business, told Fierce Healthcare in an interview that between member claims, information flowing through its call centers and interactions through its digital member experience, data are the connective tissue for much of its work. Read Full Article...

HVBA Article Summary

1. AI Integration Across Operations: UnitedHealth Group is implementing artificial intelligence on a large scale throughout its organization to improve efficiency, affordability, and the overall member experience. A key example is the Smart Choice tool, which uses AI to help members find in-network healthcare providers that match their personal preferences—such as location, language, and appointment availability—while also offering cost estimates and quality data. This tool has shown tangible cost savings, averaging $123 per visit when used.

2. Enhancing Member and Call Center Interactions: AI is playing a crucial role in transforming how UnitedHealth Group engages with its members, particularly through its call centers. AI-powered tools are helping staff quickly access relevant member data and suggested solutions, enabling more focused and meaningful conversations. Additionally, AI automates call transcriptions, reducing multitasking and allowing representatives to deliver more human-centered, attentive service experiences.

3. Focus on Ethical and Responsible AI Use: UnitedHealth Group is taking a structured and principled approach to deploying AI, recognizing the potential risks such as data bias and algorithmic errors. The company has instituted guiding principles around transparency, explainability, privacy, and accountability. All AI applications are subject to multiple layers of review and testing to ensure they are used responsibly and ethically, with the goal of building trust and maintaining high standards across their operations.

Is pet insurance worth it?

By Emily Guy Birken – If you’ve ever taken a sick pet to the vet’s office, you know the pain of seeing your four-footed family member hurting. Then, of course, comes the secondary anguish of figuring how to pay for their veterinary care, which may have you wishing you’d ponied up for pet insurance. While Insurify reports that the average cost of a routine vet visit is about $138 for a cat and $214 for a dog, emergency veterinary care can run the gamut from $300 to $10,000, according to Marketwatch. Read Full Article...

HVBA Article Summary

1. Pet Insurance Coverage Varies in Type and Scope: Pet insurance typically comes in three forms: accident-only, accident and illness, and wellness coverage. Accident-only is the most affordable, covering treatment for accidents only. Accident and illness plans are more comprehensive and may include limited wellness benefits. Wellness coverage, often bundled with other plans, covers routine care like vaccinations and dental work and is the most expensive. Coverage limitations exist—plans may exclude certain hereditary conditions or diagnostic exams, and insurers broadly define "preexisting conditions," often disqualifying anything occurring within the first year of coverage.

2. Premium Costs and Affordability Are Highly Variable: In 2024, average monthly premiums for accident-only plans were $16.10 for dogs and $9.17 for cats, while accident and illness plans averaged $62.44 for dogs and $32.21 for cats. However, these costs can rise as pets age or depending on breed-specific risks. To manage costs, pet owners can increase deductibles or select a lower coinsurance rate (e.g., 70% instead of the standard 80%), though this means they’ll pay more out of pocket per claim.

3. The Reimbursement-Based Claims Process Requires Upfront Payment: Pet insurance generally requires policyholders to pay veterinary costs upfront, then file a claim for reimbursement—after meeting an annual deductible. This means that even insured pet owners need to be financially prepared at the time of care. As a result, the article suggests that building a personal emergency fund equivalent to monthly premium amounts could be a practical alternative or complement to insurance, depending on a pet owner’s financial discipline.

Employers, workers to face healthcare ‘affordability crunch,’ Mercer warns

By Ginger Christ – Reports of ever-increasing healthcare costs are not in short supply. Last month, KFF’s 2025 Employer Health Benefits Survey showed that family premiums for employer-sponsored health insurance were up 6%, or $1,408, compared to last year. All told, family premiums were on average $26,993 in 2025, or higher than the cost of a new Toyota Corolla Hybrid, as KFF President and CEO Drew Altman put it. Read Full Article...

HVBA Article Summary

1. Healthcare Costs Expected to Rise in 2026: HUB International’s 2026 Benefits Cost Trend report projects an 8% to 10% increase in medical and prescription benefit costs next year. The rise is primarily driven by the growing use of high-cost drugs, such as GLP-1s for diabetes and weight management, and medications for autoimmune conditions. These increases add financial strain on both employers and employees. As a result, organizations are under growing pressure to find sustainable ways to offer competitive benefits without shifting excessive costs to their workforce.

2. Technology Investment May Reduce Costs Over Time: Although investments in healthcare technologies—especially AI—are currently contributing to higher costs, experts at WTW suggest these innovations could help lower cost trends in the long run. The short-term financial impact may be offset by future efficiencies and improved care delivery enabled by these tools. New technologies hold the potential to streamline administrative tasks, personalize care, and improve health outcomes at scale. This potential is encouraging some employers to maintain tech investment strategies despite present cost concerns.

3. Employers Taking Action to Improve Affordability: Employers are implementing strategies to make healthcare more affordable while maintaining access. According to Mercer, this includes offering more medical plan options, promoting high-performing providers, and providing specialized virtual programs. In 2025, 32% of large employers offered diabetes programs, 28% musculoskeletal care, and 23% fertility support—often at low or no cost to employees. These targeted programs not only support chronic condition management but can also reduce downstream healthcare spending by addressing issues proactively.

Employers boost financial wellness efforts as worker stress rises

By Jimmy Nesbitt – A growing number of companies are emphasizing the importance of financial well-being, seeing it as not just a benefit but also a core driver of performance and retention. According to a new Gallagher report on retirement benefits and financial coverages, nearly half of U.S. employers report that financial well-being has increased in importance in 2025. Eighty-eight percent of workers recognize a direct connection between financial stress and mental health. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Comprehensive Financial Support Programs Are Expanding: In response to increasing employee financial stress, companies are broadening their benefits beyond traditional retirement plans to include services like one-on-one financial coaching, debt counseling, estate planning, and educational tools. Frank Giampietro of EY highlights that basic financial planning is foundational to reducing burnout, which is often linked to employees’ perceived lack of financial control.

2. Financial Stress Correlates with High Employee Turnover: Financial instability is a significant driver of employee attrition. According to the 2024 Gallagher report, nearly two-thirds of employers experienced turnover rates of 10% or higher, with nearly half reporting 15% or more. Financially stressed employees are more likely to switch jobs, even for marginal pay increases, whereas organizations that support financial well-being foster loyalty and retention, particularly among Gen Z, who report the highest concern for day-to-day and future financial well-being.

3. Employee-Sponsored Financial Advice Remains Underutilized: Despite its potential to improve financial wellness, only 14% of U.S. adults use employee-sponsored financial advice programs, compared to 43% who rely on friends or family, according to a Gallup poll. Trust and privacy concerns, along with lack of awareness or time, contribute to low adoption. Educating employees and creating safe, confidential channels may increase engagement with these valuable yet underused resources.