What a big Republican win Tuesday could mean for Obamacare

By Dan Gorenstein - Though the fate of the Affordable Care Act has played a role in presidential elections in the U.S. for more than a decade, this race has been different. Apart from a few cameos, the 14-year old law — often called Obamacare — has been largely off-stage, as immigration, the economy and democracy dominate the fight between Vice President Kamala Harris and former President Donald Trump. Read Full Article…

HVBA Article Summary

1. Political Stakes and Public Sentiment: With 45 million Americans relying on the ACA for health coverage, its fate hangs in the balance as the upcoming elections approach. House Speaker Mike Johnson has called for “massive reform” of the ACA, while Vice President Kamala Harris warns that its repeal would jeopardize millions' insurance and reinstate the ability of insurance companies to deny coverage based on preexisting conditions. Public support for the ACA has notably increased, with 62% of Americans viewing it favorably.

2. Impact on Health Coverage: The ACA represents a significant shift in the healthcare landscape by mandating that insurers provide coverage regardless of preexisting conditions, thus improving access to health insurance for many Americans. Before the ACA, over a quarter of adults under 65 had preexisting conditions that would have resulted in coverage denial. The law also introduced essential health benefits, making health insurance more comprehensive.

3. Cost Dynamics and Reform Proposals: While the ACA has made health insurance more affordable for low-income individuals through tax credits, it also led to increased premiums overall due to the inclusion of mandated benefits. Republican alternatives to the ACA, such as high-risk pools and block grants for Medicaid, aim to reduce costs but may disproportionately affect older and sicker populations, highlighting the trade-offs involved in health policy reform.

Medicare, Chronic Disease, and Drug Prices: Where Trump and Harris Stand on Health Policy

By Marina Zhang - Despite accounting for over 17 percent of the United States’ GDP, health care access and affordability seem to receive limited attention during the 2024 presidential campaigns. Read Full Article…

HVBA Article Summary

1. Low Profile of Health Care Issues: For the first election season since 2004, health coverage policies have taken a back seat in campaign discussions, with significant health care issues such as affordability and access largely unaddressed by major candidates. This has raised concerns among health experts about the lack of serious engagement with pressing problems affecting millions of Americans.

2. Drug Pricing and Insurance Differences: Both candidates express a desire to reduce drug costs, but their approaches to health insurance vary significantly. While Vice President Kamala Harris aims to expand price caps and enhance the Affordable Care Act (ACA), former President Donald Trump focuses on reimporting cheaper drugs and maintaining a more flexible regulatory environment for insurance plans. Their differing strategies may impact how drug prices and insurance accessibility evolve.

3. Chronic Disease Focus and Health System Changes: The candidates have differing views on addressing chronic diseases and the structure of health programs like Medicare and Medicaid. Trump has proposed public health reforms and collaboration with health advocate Robert F. Kennedy Jr. to tackle chronic diseases, while Harris has emphasized enhancing benefits for seniors and low-income populations. The implications of these proposals could lead to significant shifts in health care delivery and funding mechanisms depending on the election outcome.

Novo Nordisk GLP-1 Drug Meets Goals of MASH Trial, Setting Stage for FDA & EMA Filings

By Frank Vinluan - The blockbuster Novo Nordisk obesity drug Wegovy has met the main goals of a pivotal test in metabolic dysfunction steatohepatitis, or MASH, results the drugmaker says support expanding the product’s label to include this prevalent fatty liver disease. Read Full Article…

HVBA Article Summary

1. Clinical Trial Results: In a Phase 3 clinical trial involving 1,200 participants with MASH and moderate-to-advanced liver scarring, 37% of those receiving Wegovy, along with standard care, showed improvement in liver fibrosis after 72 weeks, compared to 22.5% in the placebo group. Additionally, 62.9% of Wegovy patients achieved resolution of fatty liver disease without worsening fibrosis, compared to 34.1% in the placebo group.

2. Future Studies and Approval Plans: Novo Nordisk plans to submit applications for U.S. and EU approval of Wegovy for MASH in the first half of next year. The ongoing Phase 3 study consists of two parts, with Part 2 focusing on the long-term effectiveness of Wegovy in reducing liver-related clinical events, expected to yield data by 2029.

3. Market Implications and Analyst Perspectives: Analysts express cautious optimism regarding Wegovy's potential impact on MASH treatment, acknowledging its statistically significant results but emphasizing that it is not a definitive cure. There is a consensus that peptide drugs like Wegovy will likely become part of a broader treatment strategy for MASH, especially in conjunction with managing related conditions such as obesity and type 2 diabetes.

The Gloves Are Officially Off!

By William Sarraille - In a recently filed amicus brief, Eli Lilly, the drug manufacturer, takes the Health Resources and Services Administration, and part of the Department of Health and Human Services, to the proverbial woodshed. HRSA, which administers a huge federal pharmaceutical discount program that has been widely criticized for years, is accused of not acting in “good faith” in its oversight of the program. It’s a watershed moment in the troubled history of the agency. Read Full Article…

HVBA Article Summary

1. Legal Battle Over Contract Transparency: Sanofi's lawsuit under the Freedom of Information Act (FOIA) seeks to uncover contracts between covered entities (CEs) and contract pharmacies (CPs) that allegedly misuse billions in subsidies, highlighting the tension between pharmaceutical companies and the Health Resources and Services Administration (HRSA) regarding the legality of CP operations.

2. HRSA's Defense and Controversial Stance: HRSA defends the relationship between CEs and CPs, claiming that CPs act as agents for CEs and do not take title to discounted drugs, which is crucial for maintaining compliance with statutory prohibitions against diversion. However, this position is challenged by Lilly, which argues that HRSA’s claims are misleading and fail to reflect the reality of CP operations.

3. Concerns Over Program Integrity: Lilly's brief accuses HRSA of concealing evidence of widespread illegal conduct and diversion within the program, arguing that the agency's refusal to disclose contracts is an attempt to hide the truth from the public. The implications of this dispute raise significant questions about the effectiveness and integrity of the subsidy program designed to aid underserved populations.

Payer Roundup—NYC quits GLP-1 coverage for weight loss; Michigan files PBM opioid lawsuit against Express Scripts, Optum Rx

By Noah Tong - It turns out the drugs were only added to a list of covered medications in error, a spokesperson for the city told the Gothamist. The city will continue to cover GLP-1 drugs for diabetes. Read Full Article…

HVBA Article Summary

1. Cost Management and Coverage Changes: Health plans across the U.S. are increasingly limiting coverage for GLP-1 medications to treat diabetes while excluding them for weight loss, reflecting growing concerns over healthcare costs and the sustainability of insurance coverage.

2. Michigan's Legal Action Against PBMs: The state of Michigan has filed a lawsuit against pharmacy benefit managers (PBMs) Optum Rx and Express Scripts, alleging collusion with opioid manufacturers and receiving kickbacks, which raises accountability issues amid the ongoing opioid crisis affecting local communities.

3. Expansion of Medicare Advantage Plans: Several health insurers, including SCAN Health Plan and Alignment Healthcare, are expanding their Medicare Advantage offerings for 2025, introducing new plans that cater to specific demographics and health needs, indicating a trend towards personalized healthcare solutions for seniors.

How Offering Personalized Benefits Helps Retention, Company Culture

By Remy Samuels - From pet insurance to tuition reimbursement to gym memberships, there is no shortage of benefits products for plan sponsors to offer their participants, nor a shortage of vendors wanting to sell them. Read Full Article… 

HVBA Article Summary

1. Personalized Benefits Matter: Employers are challenged to provide a competitive suite of benefits that cater to diverse employee needs, especially during open enrollment season. Tina Wang emphasizes the importance of aligning benefits with employees’ values, which now encompass not just traditional offerings like medical and dental insurance but also nontraditional benefits such as paid family leave and mental health support.

2. Rise of Supplemental Benefits: Supplemental health benefits, such as accident insurance, hospital indemnity insurance, and critical illness insurance, are increasingly recognized for their value in filling financial gaps not covered by standard health plans. These benefits can be offered at little to no cost to employers and can significantly enhance employees' financial security, particularly for those opting for high-deductible health plans.

3. Growing Demand for Pet Insurance: The popularity of pet insurance is rising, particularly in the wake of the COVID-19 pandemic, as many employees consider pets as part of the family. Employers are encouraged to include pet insurance in their benefits offerings, as it reflects a commitment to employees' well-being and aligns with the growing expectation for comprehensive care for family members, including pets.

2024 Workplace Wellness Survey Finds Worker Concerns About Well-Being Trending Downward, Yet Half Examined Still Express Moderate Worry About Their Financial Well-Being

By EBRI - Results from the 2024 Workplace Wellness Survey published today by the Employee Benefit Research Institute (EBRI) and Greenwald Research found worker concerns about well-being are trending downward, yet half still express at least moderate concern about their financial well-being. Read Full Article… 

HVBA Article Summary

1. Worker Concerns About Financial Well-Being: While overall concern about well-being is trending downward, approximately 50% of workers still express moderate to high concern about their financial health, with saving for retirement being the top stressor for many. The survey indicates that a significant portion of the workforce views retirement savings as a crucial aspect of their financial security, despite ongoing apprehensions regarding employer contributions to these plans.

2. Satisfaction with Job and Benefits: The survey reveals that 56% of workers are very or extremely satisfied with their jobs, and satisfaction with benefits packages remains consistent with previous years. However, there is a clear demand for improvements, such as increased employer contributions and additional resources for financial wellness, highlighting areas where employers can enhance employee support.

3. Impact of Debt on Workers: A substantial three-quarters of workers report that their current debt levels are problematic, with credit card debt being a primary concern. Many workers attribute their debt to essential living expenses, such as groceries and utilities, underscoring the financial pressures that impact their overall well-being and job satisfaction.