Why medical debt relief isn't a cure-all

By Caitlin Owens - Relieving patients of medical debt is en vogue around the country, but preventing it from accumulating in the first place is much harder because it requires addressing some of the U.S. health system's fundamental problems. Read Full Article… 

HVBA Article Summary

1. Impact of High Healthcare Costs: Medical debt in the U.S. is primarily a consequence of exorbitant healthcare prices and the financial structures imposed by insurers, such as high deductibles and out-of-pocket costs. Efforts to reduce medical debt must address these underlying issues, which can provoke significant political resistance even as prices rise.

2. State-Level Initiatives and Political Will: Various states, including North Carolina and California, are taking proactive measures to alleviate medical debt through legislative initiatives and hospital agreements. For instance, North Carolina's plan involves hospitals erasing $4 billion in medical debt in exchange for Medicaid funding, highlighting a growing trend in state-led debt relief efforts.

3. Spectrum of Policy Responses: Responses to medical debt range from immediate one-time relief to systemic changes that address the root causes of debt accumulation. While immediate relief offers tangible benefits, long-term solutions may require politically challenging reforms, such as regulating healthcare prices and enhancing financial assistance requirements for hospitals. The ongoing debate also scrutinizes the community benefits provided by nonprofit hospitals relative to their tax-exempt status.

Congressional staffers will now use this 'hidden' guide to health care

By Allison Bell - Aides to U.S. senators and U.S. representatives now have a new guide to your world, benefits pros: a health information and services resources handbook, Connecting Constituents to Health Information and Services: Resources for Congressional Offices, prepared by the Congressional Research Service. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Purpose of the Service: The in-house trade journal serves Congress members and their aides by conducting research projects and providing background articles that familiarize lawmakers and their staff with various topics, particularly in the healthcare sector.

2. New Health Information Services Guide: The guide is specifically designed for constituent services aides, assisting them in navigating complex issues like health coverage options and addressing constituent challenges, including identity theft and financial hardships related to healthcare.

3. Resourceful Content: The guide includes detailed descriptions of diverse health coverage types, practical advice for aiding constituents in accessing healthcare providers, and an appendix with past Congressional Research Service reports, ensuring aides have comprehensive resources at their fingertips.

Standards, audits and $1.3B: How Wyden and Warner propose to improve healthcare cybersecurity

By Emma Beavins - Democratic Sens. Ron Wyden, Oregon, and Mark Warner, Virginia, introduced new healthcare cybersecurity legislation Thursday that would establish minimum cybersecurity standards for hospitals and increase oversight of large healthcare organizations whose operational interruption could debilitate the healthcare system. Read Full Article… 

HVBA Article Summary

1. Proposed Legislation for Cybersecurity Resilience: The Health Infrastructure Security and Accountability Act aims to enhance cybersecurity in healthcare by establishing minimum security requirements for all healthcare organizations, particularly focusing on those of systemic importance. It includes provisions for audits, annual reporting, and financial support to bolster cybersecurity infrastructure, especially in rural and safety net hospitals.

2. Financial Support and Compliance Requirements: The bill proposes $800 million in funding over two years for rural and urban safety net hospitals to strengthen their cybersecurity defenses, followed by an additional $500 million for other hospitals. It mandates annual cybersecurity risk analyses and compliance statements, along with the hiring of independent auditors, to ensure ongoing adherence to cybersecurity standards.

3. Increased Penalties and Regulatory Oversight: To deter lax cybersecurity practices, the legislation plans to raise the statutory fining limits imposed by HHS for non-compliance. Additionally, it requires HHS to audit 20 healthcare organizations annually and report findings to Congress, fostering a culture of accountability within the industry amidst growing cyber threats.

Inside the GLP-1 'price war'

By Jakob Emerson - GLP-1 manufacturers are now offering significant discounts to entice payers and employers to cover their popular medications, The Wall Street Journal reported Sept. 20. Read Full Article…

HVBA Article Summary

1. High Costs and Coverage Challenges: Weight loss medications like Ozempic and Wegovy can exceed $10,000 annually, prompting insurers, health systems, and employers to reconsider coverage options, with some limiting or dropping benefits entirely.

2. Competitive Pricing Initiatives: Eli Lilly's introduction of Zepbound, priced as low as $399 per month, alongside a direct-to-consumer ordering website, aims to provide more accessible options compared to Novo Nordisk's Wegovy, which is priced higher.

3. Market Dynamics and Potential Price Reductions: The competition among manufacturers has led to increased rebates and price cuts, with analysts suggesting that further reductions may arise from drug price negotiations, the introduction of more GLP-1 drugs, and new oral formulations entering the market.

What is a qualified medical expense, according to the IRS?

By William Sweetnam, Jr. - We all know that health flexible spending arrangements (FSAs), health reimbursement accounts (HRAs) and health savings accounts (HSAs) provide a tax-effective way of funding an employee's health care expenses. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Compliance with the Internal Revenue Code (IRC): Advisers must adhere to the provisions and regulations of the IRC when administering Flexible Spending Accounts (FSAs), Health Reimbursement Arrangements (HRAs), and Health Savings Accounts (HSAs). Non-compliance can lead to severe tax penalties, affecting both the plan administrators and participants.

2. IRS Alerts on Misrepresentation of Expenses: The IRS has issued alerts warning that some companies misrepresent the conditions under which food and wellness expenses can be reimbursed from these accounts. Just having a doctor’s note does not validate personal expenses as qualified medical expenses eligible for reimbursement under FSAs, HRAs, or HSAs.

3. Need for Legislative Change: While the IRS cannot change the rules set forth in the IRC, there are calls for Congress to revise and expand the definition of qualified medical expenses. Past amendments, like those made during the COVID-19 pandemic through the CARES Act, show that legislative updates are possible, and advocates should focus on pushing for such changes rather than solely blaming the IRS for existing limitations.

Mental health and the need for benefits hit close to home for USAA

By Kristen Parisi - Employers have been increasing their focus on mental health benefits in recent years, as workers continue to deal with the lasting mental toll of the Covid-19 pandemic, and face high levels of burnout, isolation, and depression. Read Full Article…

HVBA Article Summary

1. Personal Impact on Mental Health Initiatives: Wayne Peacock, CEO of USAA, highlighted the urgent need for enhanced mental health support following the tragic suicide of an employee. This event prompted USAA to expand its mental health services and engage more deeply with the veteran community to combat the stigma surrounding mental illness.

2. Corporate Responsibility and Training: Julie Sweet, CEO of Accenture, emphasized the importance of mental health awareness, which was sparked by their partnership with the American Association for Persons with Disabilities. Accenture has since appointed a chief health officer and trained thousands of employees to become mental health allies, fostering a culture where discussing mental health challenges is normalized.

3. Building Trust and Community: Blake Moret, CEO of Rockwell Automation, discussed the necessity of establishing trust and purpose among employees, particularly during the uncertainties of the COVID-19 pandemic. All three leaders agreed on the vital role employers play in providing mental health benefits and creating a supportive workplace community, as these social connections are essential for employee well-being.

Novo Nordisk CEO open to GLP-1 price drop: 5 takeaways

By Alexander Murphy - Sen. Bernie Sanders highlighted a potential shift in the pricing of Ozempic during a Senate Health, Education, Labor and Pensions Committee hearing Sept. 24, during which three major pharmacy benefit managers said they would increase coverage if Novo Nordisk lowered the drug's list price. Read Full Article… 

HVBA Article Summary

1. CEO's Position on Drug Pricing: Novo Nordisk CEO Lars Fruergaard Jørgensen argued that high list prices for drugs like Ozempic and Wegovy are essential for patient access, linking them to the practices of pharmacy benefit managers (PBMs) during a recent hearing.

2. Impact of Rebates on Pricing: Jørgensen highlighted the complexity of drug pricing, explaining that the list price must account for rebates the company pays, indicating a significant relationship between drug prices and insurance coverage.

3. PBMs' Response to Pricing Claims: Representatives from major PBMs, including Cigna and CVS Health, countered Novo Nordisk's claims by stating that a reduction in list price would not harm Ozempic's formulary placement and could enhance patient access, suggesting that lower prices may actually benefit patients.

Tirzepatide Leads to Long-Term Glucose Control

By Nancy A. Melville - The majority of patients achieving high rates of glucose control and weight loss in the first year of tirzepatide treatment have sustained success in the second year; however, factors predicting a sustained response are less clear for weight loss, new research showed. Read Full Article… 

HVBA Article Summary

1. Sustained Glycemic Control: In the SURPASS-4 trial, about 80% of patients with type 2 diabetes who achieved an A1c level of 6.5% or greater than 10% weight loss at 52 weeks maintained these results at 104 weeks. This outcome was particularly prominent among those receiving higher doses of tirzepatide, with retention rates of 75% to 83% across the different dosage groups.

2. Weight Loss Outcomes: The trial showed that weight loss was significantly associated with tirzepatide dosage, with 35% to 65% of participants achieving over 10% weight loss at week 52, depending on the dose. The sustainability of this weight loss at 104 weeks was also notable, with retention rates between 79% and 82%. Predictors of sustained weight loss included a greater decrease in LDL cholesterol during the first 52 weeks.

3. Differentiated Responses: The analysis highlighted a divergence in the timelines for achieving glycemic control versus weight loss. Patients reached optimal glycemic control by around week 24, while significant weight loss continued until about week 52. This suggests that the mechanisms behind glucose regulation and weight reduction may operate differently, with glycemic control occurring independently of weight loss in the context of GLP-1 receptor agonists.