DOL aims to finalize health broker compensation rules by December

By Allison Bell – The U.S. Labor Department hopes to release final health benefits agent and broker compensation disclosure regulations by December. The regulations will be part of a No Surprises Act implementation rule. The project also includes regulations for an air ambulance services provision in the act, which is supposed to protect patients with health coverage from huge bills when they use an out-of-network service to cope with a medical emergency. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Timing and scope of the rulemaking: The Labor Department aims to finalize health benefits agent and broker compensation disclosure regulations by December and will incorporate them into a No Surprises Act implementation rule. The project also covers an air ambulance services provision intended to shield patients from large out-of-network emergency bills. The rulemaking has been at the "final rule stage" for years and was listed in the department's recent semiannual regulatory agenda update.

2. Interagency history and contacts: The Employee Benefits Security Administration collaborated with the IRS, CMS and the Office of Personnel Management to release draft regulations in September 2021, indicating interagency involvement in the effort. Amber Rivers is listed as the project contact for the Labor Department. The article notes that the department may consider waiting for EBSA to have a permanent director before advancing the project.

3. Related EBSA agenda items and sequencing: EBSA's updated agenda also lists other health benefits rulemaking projects at the proposed stage, including transparency in coverage health price disclosure rules (drafts possibly this month), pharmacy benefit manager fee disclosure regulations (drafts possibly in November), and No Surprises Act advanced explanation of benefits rules (drafts possibly in April 2026). These items show a broader regulatory push on price and compensation transparency in health benefits. The department currently reports a total of eight projects at the final rule stage.

Why a US Judge Paused Several Provisions of the Marketplace Rule

By Marissa Plescia – Democrats recently notched a win when it comes to the Affordable Care Act Marketplaces. A federal district judge in Baltimore issued a stay in August on several provisions of the Trump administration’s Marketplace Integrity and Affordability Rule. The rule aimed to reduce fraud, waste and abuse in the Affordable Care Act Marketplaces, but would have also led to significant coverage losses (up to 1.8 million people). It would tighten eligibility verifications for ACA plans, shorten the annual open enrollment period, and prohibit subsidies to ACA plans for gender-affirming care, among other changes. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Court Temporarily Blocks Key ACA Rule Provisions: U.S. District Judge Brendan Hurson issued a stay on 7 of 9 provisions in the “Marketplace Integrity and Affordability Rule,” citing likely violations of the Administrative Procedure Act. These provisions include changes to enrollment, income verification, and premium subsidy rules under the Affordable Care Act (ACA). The court found the plaintiffs are likely to succeed in their challenge, and that enforcement of these provisions could cause irreparable harm.

2. Broad Legal and Political Pushback: The lawsuit was brought by several cities and advocacy groups, arguing the rule would hinder access to affordable healthcare. While the court's decision is a temporary win for these groups, it is part of a broader legal challenge that includes a separate lawsuit filed by Democratic attorneys general. The Biden administration has appealed Hurson’s ruling to the Fourth Circuit Court of Appeals.

3. Implications for Health Coverage and Open Enrollment: With open enrollment beginning November 1, uncertainty surrounds the implementation of the rule. Some provisions remain in effect, while others are paused. Experts and advocates warn that if the full rule takes effect—especially alongside potential expirations of enhanced ACA subsidies—it could increase premiums and reduce coverage, particularly impacting low-income, immigrant, and marginalized populations.

FTC drops appeals of noncompete ban

By Alan Condon – The Federal Trade Commission on Sept. 5 voted 3-1 to dismiss its appeals in two legal challenges to its 2024 rule banning noncompete agreements in employment contracts. On Sept. 5, the agency dismissed appeals in Ryan, LLC v. FTC and Properties of the Villages v. FTC and acceded to the vacatur of the noncompete rule, which a Texas federal judge struck down in August 2024. Read Full Article...

HVBA Article Summary

1. FTC's Noncompete Ban Faces Legal and Industry Pushback: The Federal Trade Commission proposed a rule that would have banned nearly all noncompete agreements, effectively nullifying over 30 million existing contracts. However, the rule faced strong dissent from within the FTC itself, with Commissioners Andrew Ferguson and Melissa Holyoak arguing that the agency overstepped its legal authority. They warned that the rule would have overridden state laws and caused a massive economic shift—potentially redistributing nearly half a trillion dollars.

2. Healthcare Industry Strongly Opposes the Rule: The healthcare sector mounted a particularly vocal opposition to the proposed rule, claiming it would worsen ongoing labor shortages and disrupt hospital operations. Organizations like the American Hospital Association and the Federation of American Hospitals warned that applying the rule to nonprofit hospitals—despite questions around the FTC’s authority to do so—would create unfair competition between taxpaying and tax-exempt facilities. Critics described the rule as harmful to both recruitment and retention of medical staff.

3. FTC Still Plans to Enforce Limits via Antitrust Laws: Although the noncompete ban will not be implemented as a formal rule, the FTC has made it clear that it will continue to target what it considers unlawful noncompete agreements. Chair Ferguson indicated that under current leadership, the commission intends to pursue individual enforcement actions through existing antitrust laws. This suggests an ongoing regulatory focus on noncompetes, but through a more targeted, case-specific approach rather than sweeping rulemaking.

Strategic tips on making open enrollment work

By Alexandra Powell – Open-enrollment season is marked by both anticipation and anxiety. The annual process of selecting benefits can feel overwhelming, especially as the landscape of work and well-being continues to evolve. As someone who has worked closely with organizations to re-engage teams and rebuild trust, I know that the right approach to benefits communication can transform open enrollment from a stressful obligation into an empowering opportunity. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Personalization and segmentation matter: The article argues that benefits should be framed in meaningful categories such as family well-being, financial wellness, career development and mental health so employees can see the value in their choices. It recommends advisers and employers tailor communications and offerings to employees' life stages and preferences. Technology such as AI-driven suggestion engines and decision-support tools can support personalization without overwhelming HR teams.

2. Manager advocacy strengthens enrollment outcomes: The piece emphasizes equipping managers with training, briefings and quick-reference toolkits so they can confidently answer questions and champion benefits. When managers are informed, they can personalize the benefits conversation and help build trust across teams. Advisers can support clients by creating manager-specific resources and workshops to increase frontline engagement.

3. Multi-channel communication and wellness priorities are essential: Employers should offer a mix of channels—centralized hubs, short videos, live Q&As and text reminders—and ensure materials are accessible and available in multiple languages or literacy levels. The article warns that engagement is crucial given Gallup's finding of a worldwide decline in employee engagement and a related $438 billion productivity loss, and it highlights mental health and financial wellness as top priorities. Ongoing, personalized connection and feedback loops help turn open enrollment from a transactional event into an opportunity for engagement and retention.

CVS Caremark sued over GLP-1 drug switch, citing ERISA breach

By Alan Goforth – A class-action lawsuit was filed last week against CVS Caremark in the Southern District of New York over its decision to replace Eli Lilly’s popular GLP-1 weight-loss drug Zepbound with Wegovy from Novo Nordisk. The coverage change made in July applies to the most common formulary template, which represents between 25 million and 30 million individuals overall, although the lawsuit was filed on behalf of two patients. The plaintiffs alleged that the pharmacy benefits manager is violating its fiduciary duty under the Employee Retirement Income Security Act, because their providers prescribed Zepbound as medically necessary for them. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Lawsuit alleges ERISA fiduciary breach: The plaintiffs claim CVS Caremark improperly denied coverage after changing its formulary to favor Wegovy over Zepbound. They say the denials ignored the language of the underlying plans and overruled recommendations of their medical providers. The complaint alleges those actions violate CVS Caremark's fiduciary duty under the Employee Retirement Income Security Act.

2. Coverage change affects millions but suit filed by two patients: The formulary change made in July applies to the most common template covering an estimated 25 million to 30 million people, though the current lawsuit was brought on behalf of two individuals. The plaintiffs argue Zepbound and Wegovy are not clinically interchangeable because they have different mechanisms of action, clinical outcomes and side-effect profiles. The article cites studies and reporting that tirzepatide products like Zepbound produced greater weight-loss results for some patients compared with semaglutide products like Wegovy.

3. CVS Caremark defends formulary move and offers exceptions process: CVS maintains Wegovy and Zepbound are "two clinically similar products" and says requiring manufacturers to compete will lower prices and broaden access. David Whitrap, CVS Health's vice president of external affairs, told CNN the formulary strategy maintains clinically appropriate coverage while using competition to drive lower costs and better outcomes. The company also said it has a medical exceptions process for rare cases where on-formulary options prove ineffective or cause harmful side effects, while plaintiffs seek restoration of Zepbound coverage and other equitable relief.

Optum: 3 emerging specialty drugs payers should be watching

By Paige Minemyer – Specialty and orphan drugs continue to dominate the development pipeline, and a new report from Optum Rx spotlights three products payers should be watching. The pharmacy benefit manager recently released its summer Notable New Drugs report, highlighting three products: Brinsupri (brensocatib), tolebrutinib and a subcutaneous version of Leqembi (lecanemab-irmb). All three are specialty drugs that aim to treat chronic conditions—non-cystic fibrosis bronchiectasis, multiple sclerosis and Alzheimer's disease, respectively. Read Full Article...

HVBA Article Summary

1. Specialty Drugs Dominate Market Impact: Specialty products now make up between 70% and 75% of all novel drug approvals each year, underscoring their growing importance and financial impact in the healthcare landscape. According to Arash Sadeghi of OptumRx, these high-cost, first-in-class therapies often become focal points for health insurers because they introduce new spending, unlike follow-on drugs that may lower existing costs by competing with established treatments.

2. Emerging Therapies Target Niche and Unmet Needs: Several new therapies are addressing conditions with significant unmet medical needs. For instance, Brinsupri (a DPP1 inhibitor) recently received FDA approval as the first treatment of its kind for bronchiectasis—a chronic lung condition affecting approximately 500,000 individuals in the U.S. Competing treatments for this condition can cost between $40,000 and $96,000 annually, highlighting the substantial financial implications for payers. Similarly, tolebrutinib may become the first approved treatment for non-relapsing multiple sclerosis, offering potential to significantly slow disease progression, though it requires liver monitoring due to past safety concerns.

3. Access and Adoption Depend on Delivery and Evidence: Innovations in drug delivery may improve patient access and potentially drive up demand. For example, a newly approved subcutaneous version of Leqembi—an Alzheimer’s drug previously administered intravenously in clinical settings—can now be self-injected at home after an initial IV induction phase. While this format may alleviate access barriers for patients and caregivers, widespread adoption will likely hinge on ongoing evidence of clinical effectiveness, real-world safety data, and provider comfort with this class of treatments.

The number of workers seeking employer help with finances doubled in two years, BofA reports

By Ginger Christ – Driven in part by a higher cost of living and inflation, double the number of workers are turning to their employers for help with their pressing financial needs, such as emergency savings, reducing debt and general financial wellness, according to Bank of America’s 2025 Workplace Benefits Report, released Wednesday. More than 1 in 4 workers wanted company assistance, compared to 13% in 2023, per the report, which was conducted in partnership with Bank of America Institute. Read Full Article...

HVBA Article Summary

1. Demand for Broader Financial Support: Many employees are seeking more than just a paycheck—they want resources to help manage their overall financial well-being. In particular, 33% of workers said they would like assistance in developing strong financial skills and habits, suggesting that financial literacy and planning support are becoming increasingly valued in the workplace.

2. Workplace Benefits Impact Retention: The availability—or lack—of workplace benefits is playing a growing role in employee retention. According to the report, 24% of workers have either left or seriously considered leaving their employer due to inadequate benefits, up from 15% the year prior. This signals that benefits packages may be a critical factor in talent retention strategies.

3. Gaps in Financial Security: Despite 67% of workers feeling confident about reaching their retirement goals, many face ongoing financial challenges. Over half (53%) haven’t reached their emergency savings goals, and a large majority (85%) report carrying some form of personal debt. These statistics highlight the financial pressures that persist for employees, even among those with long-term savings plans.

Idaho drops weight loss drug coverage for state employees

By Jakob Emerson – Idaho’s health plan for state employees, retirees and their dependents is dropping coverage for GLP-1s prescribed for weight loss, effective Nov. 1. The change does not impact GLP-1 coverage for diabetes, the state said Sept. 5. The new policy is expected to reduce premiums by $30 million to $50 million annually. Read Full Article...

HVBA Article Summary

1. High Cost of GLP-1 Drugs Is a Major Concern: States are increasingly scrutinizing the financial impact of covering GLP-1 medications for weight loss due to their high price. Despite growing use, these drugs have not led to offsetting cost reductions in related health conditions, according to state assessments.

2. Potential Impact on All Plan Members: The rising expenses associated with GLP-1 drugs may lead to broader financial consequences, such as increased cost-sharing or changes in health plan designs. This could affect both employees and employers if cost mitigation strategies are not implemented.

3. Trend Toward Dropping Coverage: Several states—including Louisiana, Ohio, and North Carolina—have recently ceased coverage of GLP-1 drugs for weight loss for public employees. Currently, fewer than half of U.S. states offer this coverage, signaling a broader move away from public funding for this use case.