HVBA Announces 18th Annual Board Meeting & Benefits Roadshow in Atlantic City

By HVBA – The Health & Voluntary Benefits Association (HVBA) today announced its 18th Annual HVBA event will take place November 19–20, 2025 at Ocean Casino Resort on the iconic Atlantic City Boardwalk. This year’s program features an Invite-Only VIP Dinner on November 19, followed by a full day of board programming, the HVBA Innovation Summit, and an evening Networking Reception with Leadership Awards Ceremony and Charity Component on November 20. Read Full Article...

HVBA Article Summary

1. Strategic Purpose & Networking: HVBA’s 18th annual event in Atlantic City is designed to harness the city’s legacy of bold innovation as a backdrop for candid conversations, actionable strategies, and high-value connections. The overarching goal is to help employers, brokers, and industry leaders align on priorities and build strong pipelines heading into 2026.

2. Event Highlights & Structure: The two-day program features an invite-only VIP dinner, dedicated board and leadership sessions, and the HVBA Innovation Summit with insights on growth, product innovation, and compliance. It culminates in a premium networking reception that includes leadership awards, a charity auction supporting veterans, and opportunities for meaningful business development.

3. Why Attend: Participants benefit from timely market intelligence on voluntary benefits, medical, and integrated solutions, as well as curated introductions that maximize relationship-building. The event emphasizes leaving with practical takeaways, new partnerships, and expanded business opportunities—with complimentary but limited registration available for licensed brokers and agents.

Federal, state scrutiny of PBMs could disrupt health care ecosystem

By Kristen Smithberg – Increased security on pharmacy benefit managers (PBMs) as well as state and federal action to rein in their influence could have impacts across a variety of stakeholders in the health care system, including patients, PBMs, pharmacies, health care plans and manufacturers. PBMs provide administrative services for prescription drug plans and act as an intermediary between health insurers, pharmacies and drug manufacturers. Their influence has expanded significantly to include claims processing, formulary management, and contracting with manufacturers and pharmacies. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Increased Oversight on PBMs: There is growing state and federal scrutiny on pharmacy benefit managers due to their expanded influence in the health care system, including claims processing, formulary management, and contracting. This increased attention could affect multiple stakeholders such as patients, PBMs, pharmacies, health care plans, and drug manufacturers. Legislative actions are being considered or enacted at both state and federal levels to address these concerns.

2. Potential Disruptions Across the Health Care Ecosystem: Proposed and enacted laws, such as bans on PBM-owned pharmacies, could disrupt patient access to pharmacies, influence specialty drug distribution, and alter contract and reimbursement dynamics. Independent pharmacies might find new opportunities, but much depends on their capacity and contracting terms. Health plans and manufacturers may face operational challenges and logistical disruptions as a result of these changes.

3. Market Consolidation and Its Implications: The PBM market has consolidated into a few large, vertically integrated entities, which has intensified concerns about monopolistic practices such as spread pricing, restricted patient choice, and under-reimbursement of independent pharmacies. Legislative efforts to require divestiture of PBM-owned pharmacies aim to address these issues but could introduce competitive and operational uncertainties across the pharmacy and PBM landscape.

Healthcare Cybersecurity: The Urgency Of Now

By Chuck Brooks – Healthcare exists at the intersection of trust and vulnerability. Every medical record, test result, and insurance claim is more than just data on a computer; it represents a person's identity, medical history, and, in many cases, the road to care. For years, I've warned in papers and briefings that the healthcare sector is particularly vulnerable. The most recent figures confirm that warning: healthcare breaches remain among the most common and costly in any business, and the gap between where healthcare security is and where it needs to be is expanding. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Healthcare Data Breaches Are Pervasive and Costly: In 2024, U.S. healthcare organizations experienced 588 data breaches, impacting approximately 180 million individuals—averaging over 750,000 records exposed daily. The average cost of a breach in the sector remains the highest across all industries at $7.42 million, even though this marks a slight decrease from the previous year. These breaches often take significantly longer to detect and contain than the global average, exacerbating financial, operational, and patient safety risks.

2. Cybersecurity Threats Are Growing in Complexity and Impact: Modern cyberattacks are becoming more sophisticated, leveraging unpatched vulnerabilities, phishing, and ransomware. Insider threats—due to errors, negligence, or malice—account for about 70% of breaches in healthcare. Emerging technologies like generative AI are both a threat and an opportunity: while attackers use AI to enhance speed and deception, defenders can use it for faster detection and response if deployed responsibly.

3. Cybersecurity Has Become a Governance and Patient Safety Imperative: Regulators now demand proactive, enterprise-wide risk management rather than basic compliance. Effective cybersecurity in healthcare requires integrated governance, robust systems architecture, staff training, and sector-wide collaboration. Investments in personnel and infrastructure are shown to reduce breach costs significantly, reinforcing that cybersecurity is inseparable from clinical safety and patient trust.

Who Will Pay for Prescription Drugs in 2033: DCI’s Takeaways from the Latest Government Forecasts

By Drug Channels – Over the summer, the boffins at the Centers for Medicare & Medicaid Services (CMS) released the latest projections for U.S. spending on healthcare. (See links below.) These data provide the latest official and apolitical look at the future of U.S. healthcare spending. The top line projections highlight the government’s official view that prescription drugs dispensed by retail and mail pharmacies will have a modest impact on U.S. healthcare costs. Read Full Article...

HVBA Article Summary

1. Medicare Drug Spending Forecast Adjusted Downward Due to Inflation Reduction Act (IRA): CMS now anticipates that the IRA will generate more substantial savings in Medicare Part D than previously expected, leading to lower projected drug spending. For instance, projected Medicare drug spending for 2032 is now $10 billion lower than prior estimates. These savings are driven by negotiated drug prices and inflation-linked price caps. However, Medicare drug spending growth will still fluctuate through 2033 due to demographic shifts and structural changes in coverage, such as the new manufacturer discount program.

2. Private Insurers’ Share of Drug Costs Will Increase Slightly, While Consumer Out-of-Pocket Burden Shrinks: Private insurance is projected to account for a modestly larger share of prescription drug spending—rising from 39% in 2023 to 41% by 2033—despite an overall decline in employer-sponsored insurance enrollment. Meanwhile, consumers’ out-of-pocket share for outpatient prescription drugs is forecasted to drop from 13% to 11% by 2033, though this remains significantly higher than their 2% share of hospital spending. These trends reflect shifting coverage dynamics and the implementation of new caps and rebates under the IRA.

3. Public Funding and Vertical Integration Will Continue to Shape the Drug Market: Government spending, primarily through Medicare and Medicaid, will continue to dominate the prescription drug landscape, with public funds projected to cover nearly half of outpatient retail drug spending by 2029. However, most of this funding will still be channeled through private entities like Medicare Advantage plans and pharmacy benefit managers (PBMs), reinforcing the trend toward vertical integration across insurers, PBMs, specialty pharmacies, and providers.

86% of employers increased cancer care spend since last year

By Alan Goforth – Cancer care is a major contributor to soaring employer health care costs. Eighty-six percent of employers say their cancer care spend has increased since last year by a median rate of 11%, a new survey from the International Foundation of Employee Benefit Plans found. “The data show that costs associated with oncological care have increased over the past year, reflecting a trend of higher health care costs overall,” said Julie Stich, the group’s vice president of content. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Significant Increase in Cancer Care Spending: A recent survey by the International Foundation of Employee Benefit Plans revealed that 86% of employers reported an increase in their cancer care spending compared to last year, with a median increase rate of 11%. This highlights cancer care as a significant factor in rising employer health care costs.

2. Use of Steerage Techniques to Manage Costs and Outcomes: Employers are employing various strategies such as nurse navigators (63%), second opinions (58%), and centers of excellence (42%) to steer plan members towards specific providers or treatments. These techniques aim to improve patient outcomes (66%), provide personalized support (59%), and negotiate better prices (33%).

3. Projected Ongoing Cost Increases in Healthcare: Employers anticipate a median health care cost increase of 10% in 2026, up from 8% this year, driven largely by catastrophic claims and specialty/costly prescription drugs, including cancer and GLP-1 drugs. Cost-sharing, plan design, and purchasing/provider initiatives are expected to be key approaches for managing these rising costs.

GLP-1 Scripts for Seniors? Expect Prior Authorizations

By Crystal Phend – Hurdles to receive GLP-1 receptor agonists rose sharply in the last several years for Medicare Part D beneficiaries, a national study showed. Nearly all plans instituted prior authorization from 2020 to 2025, and many started requiring coinsurance too, raising out-of-pocket costs, Matthew J. Klebanoff, MD, MSHP, of the University of Pennsylvania Perelman School of Medicine in Philadelphia, and colleagues reported in JAMA. Read Full Article...

HVBA Article Summary

1. Rapid Increase in Prior Authorizations: From 2020 to 2025, the proportion of Medicare Part D beneficiaries required to have prior authorization for GLP-1 drugs increased from a mere 2.8-5.0% to nearly 100%, indicating a significant rise in administrative hurdles for accessing these medications. This change covers nearly all Medicare Part D plans, reflecting a widespread shift in coverage policies.

2. Substantial Rise in Out-of-Pocket Costs: Alongside prior authorizations, out-of-pocket costs for GLP-1 receptor agonists increased sharply in 2025. Monthly costs rose from $75-138 in 2024 to $122-167 in 2025, driven by a coinsurance rate increase from 27-36% to 49-77%, creating financial challenges for beneficiaries relying on these treatments.

3. Influence of the Inflation Reduction Act and Plan Types: The Inflation Reduction Act of 2022 raised Part D plan liabilities, which likely incentivized plans to restrict coverage and increase cost sharing for expensive drugs like GLP-1s. Standalone Part D plans experienced the largest hike in coinsurance, possibly due to their inability to leverage Medicare Advantage rebates to reduce costs and promote adherence.

Telehealth’s uncertain future has providers preparing for the worst, hoping for the best

By Caroline Catherman – Congress is once again closing in on a deadline to extend Medicare coverage of home telehealth services. And, again, the decision has been left until the last minute. Telehealth has had new flexibilities since the Covid-19 public health emergency began, including expanded Medicare reimbursement. Read Full Article...

HVBA Article Summary

1. Pending Medicare Coverage Deadline: Congress is approaching a deadline to decide on extending Medicare coverage of home telehealth services, with the fate of expanded flexibilities often decided at the last minute. These flexibilities, initiated during the Covid-19 public health emergency, have been repeatedly extended but are currently uncertain, creating operational challenges for providers and trust issues for patients.

2. Implications of Expiration: If the telehealth flexibilities expire, most Medicare patients will be required to take telehealth from approved facilities instead of from home, except for limited cases such as mental health or substance use disorder treatment. This would also reinstate rural and location-based restrictions on telehealth access, reducing convenience and potentially decreasing patient volumes for providers.

3. Telehealth’s Value Demonstrated but Still at Risk: Telehealth usage surged during the pandemic and remains higher than pre-pandemic levels, supported by evidence showing improved patient health outcomes and cost savings. Experts argue that data now support broad Medicare coverage of telehealth services, but the uncertainty around policy renewal is leading some providers to consider discontinuing telehealth offerings, complicating future healthcare delivery.

83% of employees say better benefits makes them more productive

By Paola Peralta – It's no secret that better benefits lead to a more efficient workforce, but how much are employees with more comprehensive benefits actually outperforming their peers? Employees who feel fully supported through comprehensive benefits report being significantly more effective at work, with 83% saying they are always or almost always productive at work, according to a recent survey from HR technology and services provider Alight. Only 70% of less-supported employees say the same, meaning that organizations have to meet employees' benefit needs if they want employees to meet their expectations. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Better benefits correlate with higher productivity: According to a survey by HR technology provider Alight, 83% of employees with comprehensive benefits report being almost always productive at work, compared to only 70% of employees with less support. This suggests that employers can boost workforce efficiency by enhancing benefits offerings.

2. Comprehensive benefits improve employee retention and advocacy: The survey found that 67% of employees with comprehensive benefits plan to remain with their current employer, 64% report an exceptional employee experience, and 38% are highly likely to recommend their employer to others. Benefit programs also positively impact employee engagement and organizational reputation.

3. Employees value both benefit offerings and navigation support: Desired benefits include caregiving support, fertility services, digital therapeutics, and mental health apps, but employees also want help understanding and utilizing their benefits. Organizations should provide clear, authentic communication and effective tools to help employees navigate their total rewards packages.