Challenge to US drug price negotiation program revived by appeals court

By Brendan Pierson - A U.S. appeals court revived a lawsuit on Friday by healthcare and drug industry groups challenging the first-ever U.S. law requiring pharmaceutical companies to negotiate drug prices with the government's Medicare health insurance program that covers 66 million people. Read Full Article… 

HVBA Article Summary

1. Court Ruling: The 5th U.S. Circuit Court of Appeals ruled that a Texas judge incorrectly dismissed a lawsuit from the Pharmaceutical Research and Manufacturers of America (PhRMA) and other healthcare groups, allowing the case challenging the Inflation Reduction Act's drug pricing provisions to proceed.

2. Price Negotiation Program: The case is part of at least eight lawsuits aimed at blocking a federal program that allows for price negotiations on certain drugs, which has already led to significant price reductions announced by the government for 10 drugs, effective in 2026.

3. Legal Arguments: The plaintiffs argue that the drug price negotiation program violates the U.S. Constitution by granting excessive power to federal regulators and imposing harsh penalties on non-compliant companies. The appeals court determined that the claims were based on the Inflation Reduction Act, not Medicare law, thus granting jurisdiction to the court.

Why UnitedHealthcare is putting a focus on simplicity in its AI strategy

By Paige Minemyer - It's not a secret that navigating the healthcare system is complicated, and the UnitedHealthcare team has rolled out a tool backed by artificial intelligence that aims to make it easier for members to shop around. Read Full Article…

HVBA Article Summary

1. Personalized Healthcare Navigation: The Find Care & Costs tool utilizes AI to provide members with personalized recommendations based on their specific health concerns and benefits packages, making it easier to find in-network services and understand associated costs.

2. User-Friendly Experience: Designed to simplify the healthcare journey, the tool allows users to search for providers using everyday language rather than complex medical terminology. It offers transparent cost estimates and access to patient feedback and quality metrics.

3. Positive Impact and Broader Strategy: Since its launch, the tool has seen a significant increase in user engagement and satisfaction, reflected in a 267% rise in net promoter scores. It aligns with UnitedHealth’s strategy to enhance member experiences through AI, not only in digital platforms but also in call centers, promoting a more streamlined and supportive service environment.

Prudential enters medical stop-loss market for self-funded plans

By Allison Bell - Prudential Financial is entering the U.S. stop-loss insurance market as some other insurers are wishing they hadn't. Stop-loss insurance protects employers with self-funded employee benefit plans against catastrophic losses. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Program Overview: Prudential's new program targets employers with at least 100 employees, providing stop-loss insurance for various claims, including prescription drugs, dental, vision, short-term disability, and medical insurance.

2. Historical Context: Prudential, once a major player in medical insurance, sold its medical business to Aetna in 1998 amid regulatory changes. Since then, it has navigated challenges like interest rate volatility and the impacts of COVID-19 on its life insurance operations.

3. Market Trends: The stop-loss insurance market has faced price increases due to COVID-19 and rising drug costs, with premiums for high-deductible plans rising approximately 13% annually from 2022 to 2024. Some competitors may be struggling due to previously low pricing strategies.

I’m a Doctor, and I’m Worried About What Comes Next for Our Health Care System

By Danielle Ofri - After maintaining an oddly low profile early in the election season, health care is a wallflower no more. Last week, the Republican vice-presidential nominee, JD Vance, suggested a second Trump administration might roll back the protections under the Affordable Care Act ensuring that patients with pre-existing conditions are covered. Read Full Article… 

HVBA Article Summary

1. Judicial Threats to the Affordable Care Act (ACA): The recent Supreme Court decisions have undermined the Chevron doctrine, shifting the responsibility of interpreting regulations from federal agencies to the courts. This change is expected to trigger numerous legal challenges against the ACA, potentially dismantling critical protections for patients and making it easier for industries to contest regulations.

2. Impact on Health Disparities: The anticipated legal battles could lead to inconsistent healthcare access across different regions, exacerbating health disparities. As regulations are weakened or overturned, the progress made in expanding coverage and improving health outcomes for underinsured populations may be reversed, leaving vulnerable communities at greater risk.

3. Public Support for Health Protections: Despite the political landscape, many health policies, including protections for pre-existing conditions and reproductive health rights, remain popular among the public. Grassroots initiatives and ballot measures could serve as a counterbalance to legislative rollbacks, emphasizing the importance of citizen engagement in preserving healthcare rights amidst ongoing political and judicial challenges.

Employees prioritize better health benefits over higher salary, survey finds

By Alan Goforth - Nearly 3 in 4 employed Americans would accept a job with a slightly lower salary if it offered better health care and medical coverage, including lower premiums and out-of-pocket costs, a new Voya Financial survey found. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Impact of Healthcare Costs on Retirement Savings: Over half of employed Americans (51%) report that rising healthcare costs significantly hinder their ability to save for retirement, highlighting the financial strain many workers face.

2. Employee Preferences for Benefits: A majority of employees express a willingness to trade salary for enhanced employer contributions to health savings accounts and better access to voluntary benefits, with 51% indicating they would stay with their employer if such offerings were provided.

3. Need for Personalized Guidance: There is a strong demand among employees (75%) for support in maximizing their workplace benefits. Digital tools that provide personalized guidance are increasingly recognized as essential for helping employees make informed decisions about their health and retirement plans.

FTC to sue major PBMs over insulin rebates, claiming they inflated patient cost

By Drew Armstrong - The Federal Trade Commission said that it is suing the three major US pharmacy benefit managers over their role in the insulin market, claiming that the companies’ practice of using large rebates has inflated costs for patients and distorted the market. Read Full Article…

HVBA Article Summary

1. FTC Lawsuit Against PBMs: The FTC is suing major pharmacy benefit managers (PBMs)—CVS Health, Cigna, and UnitedHealth Group—over their rebate practices related to insulin pricing, which the agency claims contribute to higher out-of-pocket costs for patients.

2. Rebate System Impact: The lawsuit highlights how the rebate system incentivizes PBMs to favor higher-priced insulin products that generate substantial rebates, ultimately harming patients who may be paying cash or have high-cost-sharing insurance plans.

3. Regulatory Pushback and Internal Disagreement: While the FTC seeks to reform the PBM industry, there is internal dissent within the agency and strong pushback from the PBMs themselves, who argue that the FTC's claims are unfounded and misrepresent the complexities of drug pricing.

HRSA tells J&J to 'immediately' end 340B rebate plan

By Dave Muoio - The Health Resources and Services Administration (HRSA) has told Johnson & Johnson to "immediately" end its plan to provide required 340B drug discounts after the fact via rebate. Read Full Article…

HVBA Article Summary

1. Implementation of Rebate Proposal: Johnson & Johnson (J&J) plans to initiate a new rebate policy for two drugs, Stelara and Xarelto, starting October 15, which aims to address alleged misuse of the 340B drug subsidy program. This will require certain hospitals to submit claims for rebates within 45 days of dispensing, with a six-month grace period.

2. Pushback from HRSA and Hospitals: The Health Resources and Services Administration (HRSA) has issued a strong objection to J&J's proposal, asserting that it violates the 340B statute and warning that implementation could jeopardize J&J's Pharmaceutical Pricing Agreement. HRSA demands that J&J halt the proposal immediately and notify them by September 30, 2024.

3. Impact on Disproportionate Share Hospitals: The proposed changes have raised significant concerns among hospitals, particularly disproportionate share hospitals, which rely heavily on the 340B program for financial support. Industry groups argue that J&J’s plan would force these hospitals to incur costs upfront, undermining the program’s intended goal of providing essential care to vulnerable patients.