House Republicans stand firm on association health plans

By Noah Tong - Republicans voted Wednesday morning in favor of a resolution disapproving of a Biden administration rule limiting access to association health plans. Read Full Article… 

HVBA Article Summary

1. Support and Opposition: The House Committee on Education and the Workforce voted 23-12 in favor of association health plans, which are endorsed by organizations like the National Federation of Independent Business. Proponents argue these plans offer increased flexibility and potential coverage for more individuals, while critics claim they undermine the Affordable Care Act and provide less comprehensive benefits.

2. Key Arguments: Rep. Tim Walberg, R-Michigan, highlighted that association health plans could cover 400,000 previously uninsured individuals and offer alternatives to current health insurance. In contrast, Rep. Bobby Scott, D-Virginia, criticized the resolution as an ineffective move that disregards recent Department of Labor actions and would create a two-tiered insurance market favoring healthier individuals.

3. Industry Reactions: The Federation of American Hospitals (FAH) opposes the resolution, warning that association health plans could destabilize insurance markets and weaken coverage. They argue these plans lack essential consumer protections and could incentivize problematic growth in multiple employer welfare arrangements.

On Healthcare, Trump and Harris Actually Have Some Similarities

By Marissa Plescia - If one watched Tuesday’s presidential debate on ABC News, one might be pardoned for thinking that Trump and Harris could not be more different when it comes to healthcare policy. Read Full Article… 

HVBA Article Summary

1. Abortion and Federal Protections:

   • Trump: Advocates for stripping federal protections related to abortion, preferring that states determine their own policies. This approach reflects his broader stance on reducing federal involvement in various issues.

   • Harris: Supports reinstating Roe v. Wade's federal protections to ensure consistent access to abortion services across states, emphasizing equal rights regardless of state-level regulations.

2. Healthcare Costs and Price Transparency:

   • Trump: Signed the No Surprises Act and introduced a price transparency rule requiring hospitals to post negotiated prices. His administration's efforts were foundational, but faced implementation challenges due to lack of standardization.

   • Harris: Continued and expanded on Trump’s price transparency efforts, creating more standardized rules to improve implementation. Both administrations share a common interest in increasing transparency and addressing anti-competitive actions in healthcare.

3. Prescription Drug Prices:

   • Trump: Implemented a voluntary $35 cap on monthly insulin prices through Medicare Part D and explored drug importation from other countries as a cost-control measure.

   • Harris: Passed the Inflation Reduction Act, mandating a $35 cap on insulin prices and allowing Medicare to negotiate drug prices. This approach represents a more direct intervention in drug pricing compared to Trump’s strategies.

US employers expect nearly 6% spike in health insurance costs in 2025, Mercer says

By Amina Niasse - U.S. employers expect health insurance costs to rise an average 5.8% in 2025, largely due to increased cost of medical services as well as higher use, according to a survey released by consulting firm Mercer on Thursday. Read Full Article… 

HVBA Article Summary

1. Rising Healthcare Costs for Employers: The year 2025 is projected to be the third consecutive year with healthcare costs for employers increasing by more than 5%, a significant jump from the 3% average increase seen in the previous decade. This rise is attributed to factors such as the higher cost of medical services, a shortage of healthcare workers, and increased spending on behavioral health and GLP-1 weight loss drugs.

2. Employer Cost-Management Strategies: In response to escalating costs, 53% of employers plan to implement cost-management strategies in 2025, up from 44% in 2024. These strategies will focus on reducing utilization by members with costly conditions and managing specialty drug expenses, which saw a 7.2% increase in 2024. High-cost gene and cellular therapies, sometimes exceeding $1 million, are a particular concern for employers.

3. Impact on Different Employer Sizes: Employers with 50 to 499 employees face the highest cost increases, with a projected 9% rise if no cost-management measures are taken, and a 6.3% increase if such measures are implemented. Smaller employers, who often have fully insured health plans with higher premiums and limited cost-saving options, are also significantly affected.

16 new weight loss drugs to enter market by 2029, economists say

By Paige Twenter - Competition is brewing for Novo Nordisk and Eli Lilly, two of the world's leading pharmaceutical weight loss companies, according to analysts. Read Full Article…

HVBA Article Summary

1. Pricing Pressure Expected: The anticipated launch of sixteen new obesity drugs between 2026 and 2029 is likely to increase competition and exert downward pressure on drug pricing. Morningstar and PitchBook forecast that prices could drop by over 10% annually by 2027, with Wegovy also facing potential CMS drug price negotiations in that year.

2. Emerging Competitors: Major pharmaceutical companies such as Roche, Amgen, Pfizer, AstraZeneca, and Boehringer are expected to enter the market, alongside potential acquisition targets like Viking Therapeutics and Structure Therapeutics, intensifying competition in the GLP-1 market.

3. Higher Standards Expected: While Novo Nordisk (Wegovy) and Eli Lilly (Zepbound) are currently industry leaders, the report suggests that upcoming obesity drugs may surpass these benchmarks in terms of efficacy, convenience, and tolerability.

300+ Provider Organizations Urge Feds to Prevent Leaked DEA Rule From Going into Effect

By Katie Adams - More than 330 healthcare organizations signed letters this week urging the White House and Congress to extend a telehealth prescribing flexibility that was introduced during the Covid-19 pandemic. Read Full Article… 

HVBA Article Summary

1. Impact on Patient Access: The expiration or alteration of the telehealth prescribing flexibility could result in millions of Americans losing access to essential healthcare treatments, particularly those in rural or underserved areas where access to in-person care is limited.

2. Current Flexibility and Potential Changes: Since 2020, providers have been able to prescribe controlled substances via telehealth without requiring an in-person visit. The DEA is considering new regulations that may end this flexibility for Schedule II drugs, although prescriptions for Schedule III-V drugs could still be allowed via telehealth.

3. Provider and Advocacy Responses: Over 300 provider organizations, including major healthcare entities and advocacy groups, have voiced strong opposition to the leaked DEA rule. They argue that strict regulations would exacerbate existing challenges in accessing mental health and substance use treatment, especially in areas with a shortage of healthcare professionals.

What to know about FDA’s new Digital Health Advisory Committee

By Karen Blum - The U.S. Food and Drug Administration recently created its first advisory committee for digital health. Read Full Article…

HVBA Article Summary

1. Committee Formation and Objectives: The FDA has established a new committee to address the complex issues arising from the rapid advancement of AI in healthcare. As highlighted by Thomas Maddox, M.D., the committee’s goal is to navigate the challenges of regulating AI technologies, including AI/ML, augmented reality, and digital therapeutics, ensuring their safe and effective integration into health care. The committee will provide expertise to enhance the FDA’s understanding of these technologies' benefits, risks, and clinical outcomes.

2. Meeting and Expert Composition: The committee will hold its first meeting on November 20-21, 2024, in Gaithersburg, MD, where members will discuss the impact of generative AI on medical devices. Comprising nine voting members and industry representatives from companies like Medtronic and Boston Scientific, the group includes academic experts and private sector leaders to provide a comprehensive perspective on digital health technologies.

3. Trends and Future Directions: Journalists should monitor emerging trends such as AI’s role in reducing clinician burnout by handling clerical tasks and improving clinical documentation. AI’s potential to streamline tasks like drafting patient communications and analyzing health records for treatment opportunities will be key areas of development. As AI continues to evolve, its integration into various clinical settings and decision support systems will be critical to watch.

AMGA survey finds primary care specialty compensation slowing compared to others

By Anastasia Gliadkovskaya - Medical groups and healthcare organizations reported a spike in compensation across a number of specialties in 2023, according to a recent survey. Read Full Article…

HVBA Article Summary

1. Specialty Compensation Trends: The survey revealed varying compensation increases across specialties, with notable spikes in radiology, anesthesiology, and pathology at 5.8%, while primary care saw a more modest rise of 3.6%. This marks a slowdown compared to the 6% median increase in 2022, reflecting the impact of previous CMS updates on E/M work RVU values.

2. Regional Compensation Variances: The survey highlighted significant regional disparities in compensation, with nearly 44% of the 85 specialties having the highest compensation in the West, while over 56% had the lowest compensation in the East. This indicates a pronounced regional divide in salary levels across the U.S.

3. Productivity and Compensation Dynamics: Productivity increases are driving compensation growth across specialties. For example, the top three primary care specialties saw a 4.3% increase in median compensation and a 4.6% rise in productivity. Advanced practice clinicians also mirrored this trend with compensation increases ranging from 4% to 9.3% and productivity surging up to 12.6%. However, overall median net collections increased by only 4.3%, lagging behind compensation growth and raising concerns about sustainability.

Rethinking the Role of PBMs in Health Care Reform

By Skylar Jeremias - Policy changes, such as banning spread pricing and delinking core issues, are crucial to realigning the pharmacy benefit manager (PBM) market and ensuring that the resources invested in health care go back to patients and care providers, claimed panelists at the Community Oncology Alliance Payer Exchange Summit. Read Full Article…

HVBA Article Summary

1. Challenges with Direct Contracting and PBM Transparency: The panel explored direct contracting between employers and pharmaceutical companies as a potential alternative to the traditional PBM model. While this approach could simplify pharmacy benefits and potentially lower costs, it faces significant administrative challenges for employers. Panelists Fred Barton and Joseph Shields, representing PBMs, highlighted efforts to shift public perception of PBMs, which are often criticized for limiting physician choices and increasing patient costs.

2. Impact of Rebate Schemes on Biosimilar Adoption: A report by the Biosimilars Council revealed that rebate schemes managed by PBMs have cost US patients and payers $6 billion by suppressing biosimilar adoption. This issue underscores the financial barriers created by PBMs that inhibit the broader use of cost-effective biosimilars.

3. Future Directions for PBM Market Reform: The discussion focused on the need for increased transparency and policy reforms to address the complexities and inefficiencies of the PBM market. Panelists advocated for breaking up vertical integration, fostering competition, and exploring new PBM models, including direct contracting, to enhance value for patients and employers. They stressed the urgency of legislative action to drive meaningful changes before large PBMs adapt to maintain their current practices.