California governor signs sweeping pharmacy benefit manager bill

By Allison Bell – California Gov. Gavin Newsom signed a bill Saturday that will revamp the laws governing pharmacy benefit managers operating in his state. The bill "represents the most aggressive effort in the country to lower prescription drug costs," Newsom said in a bill signing statement. The new California PBM law appears to be broader than the PBM laws recently adopted in states like Illinois and Massachusetts. Independent pharmacies and some employer groups predict that the new law will protect pharmacies from unfair efforts by health insurers and PBMs to rig the prescription drug market in their favor and to keep a big percentage of the discounts they negotiate for employers and other "payers." Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Comprehensive New Regulations for PBMs: The new California law, based on Senate Bill 41, imposes a fiduciary duty on pharmacy benefit managers (PBMs) to act in the best interest of self-insured employers. It prohibits PBMs from excluding independent pharmacies from their networks and from steering patients toward affiliated pharmacies. Additionally, PBMs must pass all manufacturer rebates to plan sponsors or participants and are banned from spread pricing practices. The law also places PBM oversight under the California Department of Managed Health Care, requiring quarterly and annual reporting.

2. Potential Impact on Drug Costs and Market Dynamics: Supporters, including independent pharmacies and employer groups, believe the law will protect pharmacies from unfair practices and increase transparency, potentially lowering prescription drug costs. Conversely, the PBMs' trade group, Pharmaceutical Care Management Association, argues that the law will not address drug manufacturers' pricing and predicts it could increase plan costs by about $1,800 per participant annually. This disagreement highlights ongoing tensions between stakeholders over the law's economic effects.

3. Legal and Implementation Challenges Ahead: The law does not exempt self-insured employer health plans, which are typically shielded from state regulation under ERISA, raising questions about enforceability. Past efforts to regulate health benefits in California have faced legal challenges and ballot measures that delayed or blocked implementation. The law's future effectiveness may depend on how courts interpret its provisions and whether business groups mount legal opposition. The involvement of the Department of Managed Health Care, with a governor-appointed director, may have influenced the governor's decision to sign the bill.

Trump Announces Deal With AstraZeneca to Lower Drug Prices

By Lawrence Wilson – President Donald Trump announced on Oct. 10 an agreement with AstraZeneca to lower drug prices in the United States. The U.K.-based pharmaceutical manufacturer will offer most-favored-nation drug pricing on all medications to Medicaid recipients, guaranteeing them the lowest price available in any developed country. AstraZeneca will also offer many medications at heavily discounted rates through TrumpRx.gov, which is expected to launch early next year. Read Full Article...

HVBA Article Summary

1. Major Investment and Drug Pricing Initiatives: Former President Donald Trump announced a significant collaboration with AstraZeneca, which includes a $50 billion investment in pharmaceutical manufacturing, research, and development within the United States. This initiative features the construction of a major facility in Charlottesville, Virginia, projected to create 3,600 jobs. Trump also highlighted his administration’s push to lower drug prices, notably through a “most-favored nation” pricing strategy that seeks to ensure Americans pay no more than the lowest prices paid in other countries.

2. Industry Response to Drug Price Pressure: In response to federal pressure and executive orders, several major pharmaceutical companies — including Pfizer, Amgen, Novo Nordisk, Sanofi, and Eli Lilly — voluntarily announced drug price reductions for U.S. patients, especially those who are uninsured or self-paying. Some companies committed to discounts of up to 60 percent on key medications and pledged large-scale investments in domestic R&D and infrastructure. These actions suggest a shift toward greater affordability and local production amid government efforts to reshape the drug pricing landscape.

3. Criticism of Voluntary Discounts and Calls for Reform: Despite the wave of price-cut announcements, advocacy groups such as Patients for Affordable Drugs expressed skepticism about relying on the goodwill of pharmaceutical companies. They argued that while the discounts are helpful, they remain inconsistent and insufficient for many patients, highlighting that a price like $239 per month is still unaffordable for large segments of the population. The group emphasized the need for systemic and enforceable policy reforms to ensure long-term, equitable access to medications.

Voters favor ending shutdown without ACA funding: Poll

By Elizabeth Casolo – Sixty-five percent of U.S. voters believe Democrats should accept a continuing resolution to end the government shutdown instead of holding out for extended ACA funds, according to a Harvard CAPS-Harris Poll. The survey ran Oct. 1-2, gathering results from 2,413 registered voters. Seventy percent of voters opposed the shutdown. While the majority of Democrats said they would prefer their party to continue the shutdown until ACA funds are secured, 90% of Republicans and 63% of independents and other party members think otherwise. Read Full Article...

HVBA Article Summary

1. Majority Support for Ending Shutdown: A significant majority of U.S. voters, 65%, support Democrats accepting a continuing resolution to end the government shutdown rather than holding out for extended ACA funding. This indicates a preference among the general public for government functionality over prolonged political standoffs related to healthcare funding.

2. Partisan Differences in Opinion: While most Democrats favor continuing the shutdown until ACA funds are secured, there is strong opposition from other political groups. Specifically, 90% of Republicans and 63% of independents and other party members oppose the shutdown, highlighting a clear partisan divide on the issue and differing priorities among voter groups.

3. Survey Details and Implications: The poll was conducted by Harvard CAPS-Harris over two days, October 1-2, 2025, with 2,413 registered voters participating. The results reflect current public sentiment during the shutdown and may influence political strategies and negotiations regarding government spending and ACA funding moving forward.

Out-of-pocket is out of reach for employees

By Laura Cave – For millions of Americans, healthcare isn't just a medical issue — it's a financial one. Even with insurance, out-of-pocket costs can feel insurmountable. Deductibles, co-pays, and prescription costs impact individuals and create ripple effects that impact employers, driving up absenteeism, reducing productivity and eroding employee satisfaction with their benefits. Surprisingly, the most challenging healthcare expenses aren't catastrophic hospital bills; they're everyday medical costs, like routine visits and lab tests. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Financial Burden of Everyday Healthcare Costs: Many Americans face significant financial challenges due to out-of-pocket healthcare expenses such as deductibles, co-pays, and prescription costs. These costs often lead to medical debt, with 47% of Americans owing less than $2,000, and two-thirds of medical debts arising from one-time or short-term expenses. This financial strain not only affects individuals but also impacts employers through increased absenteeism, reduced productivity, and lower employee satisfaction with benefits.

2. Limitations of Traditional Cost-Sharing Models: High-deductible health plans (HDHPs) and health savings accounts (HSAs) or flexible spending accounts (FSAs) often fail to adequately address affordability for pre-deductible care. Approximately half of American adults struggle to afford healthcare costs, and even relatively small medical bills can cause financial crises. This affordability gap results in deferred care, higher long-term costs, financial stress, and underutilization of benefits, which ultimately harms both employees and employers.

3. Innovative Payment Solutions Improve Affordability and Access: Flexible payment options like Health Payment Accounts (HPAs) can help employees manage out-of-pocket costs by allowing predictable, interest-free payments. A 2025 survey showed that nearly 80% of employees would have deferred care without an HPA, and 71% were more likely to stay with their employer because of this benefit. Bundling such payment solutions with HDHPs can make these plans more attractive by reducing upfront cost fears, improving access to care, and enabling employers to reallocate savings to other benefits.

Hospitals & Clinics Still Paid Unequally for Same Care, Research Shows

By Katie Adams – Fraud, waste and abuse remains rampant in the U.S. healthcare system, according to trends detailed in a new report published by market research firm Trilliant Health. Many of the trends uncovered in the report have to do with opaque payment practices. These practices contribute to widespread, often unexplained disparities in what hospitals and clinicians are paid for the same care — and some providers and health plans are quietly getting paid far more than others for the exact same services. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Payment Disparities Between Hospital Types: The report highlights significant differences in negotiated commercial rates between academic medical centers and safety net hospitals. Academic centers often receive much higher reimbursements for the same services — up to 6.4 times more in some regions — due to their complex cost structures, such as research and training programs.

2. Market Dynamics and Negotiating Power: Institutions with more administrative and expert resources, like academic medical centers, are better positioned to negotiate favorable rates. In contrast, safety net hospitals face challenges like high volumes of uncompensated care and a larger share of government-sponsored insurance, limiting their negotiating leverage.

3. Intra-Payer Variability and Transparency Implications: The report also found that commercial insurers, particularly UnitedHealthcare, pay significantly higher rates to their affiliated providers (e.g., Kelsey Seybold Clinic) than to unaffiliated ones for identical services. This raises concerns about internal pricing strategies and emphasizes the need for greater price transparency to ensure accountability and value for plan sponsors.

Americans expect longer lives, but only a third have saved for long-term care

By Alan Goforth – Most Americans believe they can look forward to more years in retirement than their parents experienced. The tradeoff, however, is that more than 6 in 10 also believe they eventually will require long-term care.Only 42% of baby boomers and 35% of Gen Xers say they have planned financially for the possibility of long-term care, according to Northwestern Mutual’s 2025 Planning & Progress Study. In addition, less than one-third of both groups have planned for the possibility they will need to provide these services for a loved one. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Widespread Concern but Limited Financial Planning: While most Americans anticipate longer retirements and acknowledge the likelihood of needing long-term care, only a minority have financially prepared for it. Specifically, 42% of baby boomers and 35% of Gen Xers have planned for their own long-term care needs, and fewer than one-third have planned to provide care for others. This gap highlights a significant financial blind spot for many families.

2. High Costs and Misconceptions About Coverage: The cost of long-term care, such as home health aides, is substantial, with annual expenses around $96,360 for eight hours of daily care. These costs are expected to rise, potentially exceeding half a million dollars by 2058. Many people mistakenly believe that health insurance or Medicare will cover these expenses, but Medicare typically does not cover independent or assisted living, underscoring the need for realistic financial planning.

3. Importance of Proactive Planning and Caregiving Impact: Proactive long-term care planning can provide individuals with more care options, protect loved ones from difficult decisions, and safeguard financial legacies. Approximately half of Americans have been caregivers, with many currently providing care, which can be emotionally, physically, and financially taxing. Comprehensive financial plans that combine risk products with investments are critical to managing these challenges and reducing family financial anxiety.

White House AI Action Plan: What Healthcare Leaders Must Do Now

By Jeff Elton – The White House’s release of its Artificial Intelligence (AI) Action Plan last month mentions “healthcare” several times, one of the few industries specifically called out. There’s a reason: Healthcare and life sciences are about to face unprecedented AI-driven regulatory changes that will reshape everything from research and development to drug approval submissions. The Food & Drug Association (FDA) already signaled a transition to AI-enabled infrastructure and support capabilities through its Elsa announcement earlier this year. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Openness to AI Integration is Crucial for Regulatory Alignment
   To stay compliant and competitive, organizations must move beyond legacy resistance to change—what the article calls “AI static friction.” Instead, they should cultivate “AI kinetic friction,” where openness to experimentation and innovation reduces barriers to implementation. This mindset shift is essential for adapting to new regulatory standards that are beginning to require AI-informed research methods, including AI-generated hypotheses and AI-assisted experimental designs, as part of standard practice in scientific and clinical research.

2. Data Accessibility and Collaboration are Key Enablers for AI Success
   Legacy systems that compartmentalize data and enforce overly rigid access controls are incompatible with modern, AI-first strategies. Organizations must adopt a new data paradigm that promotes broader access, real-time availability, and inter-organizational data sharing. By creating large-scale, high-quality, and recent datasets, and fostering partnerships across the industry, organizations can reduce bias, improve reproducibility, and accelerate biomedical innovation driven by AI capabilities.

3. Strategic Workforce and Infrastructure Evolution is Essential
   Successfully integrating AI into healthcare and life sciences requires more than just technological upgrades. Organizations need to strategically rethink their workforce structure by upskilling current employees and hiring new talent capable of managing and interacting with AI systems. Additionally, there must be a shift in infrastructure—especially for early-stage companies—toward on-demand computational resources and access to super-scale datasets. Combined, these changes will support faster, more confident decision-making and ensure readiness for the increasing role of AI in research and regulatory processes.