US will still pay at least twice as much after negotiating drug prices

By Deena Beasley - The U.S. government's first-ever negotiated prices for prescription drugs are still on average more than double, and in some cases five times, what drugmakers have agreed to in four other high-income countries, a Reuters review has found. Read Full Article…

HVBA Article Summary

1. New Price Disclosures and Savings: Medicare has announced maximum prices for the first ten high-cost drugs negotiated under the Inflation Reduction Act. This is the first time Medicare has disclosed actual drug prices, which are expected to save $6 billion in 2026, compared to prices in other wealthy nations that are significantly lower.

2. Price Discrepancies: A comparison reveals that U.S. prices for these drugs are substantially higher than those in countries like Sweden, Australia, and Canada. For example, a 30-day supply of nine of the ten drugs will cost Medicare $17,581 in 2026, whereas the same supply costs $6,725 in Sweden.

3. Impact of U.S. Pricing on Global Markets: The U.S. tends to pay more for drugs due to its willingness to cover higher costs, which in turn affects global pricing. The RAND Corp study highlights that U.S. health plans paid more than three times the amount for brand-name pharmaceuticals compared to other high-income countries, driving higher costs domestically and influencing international drug pricing strategies.

Size of physician networks varies widely among ACA Marketplace plans, study finds

By Alan Goforth - The size of physician networks can vary widely in plans purchased in the Affordable Care Act Marketplace. Read Full Gated Article…

HVBA Article Summary

1. Access Limitations in Marketplace Plans: Nearly 25% of individuals with Marketplace insurance reported difficulties accessing a provider covered by their plan due to appointment availability. Marketplace enrollees, in particular, faced more challenges compared to those with employer-sponsored insurance due to the variability in provider network size and design among different plans.

2. Network Breadth Variability: On average, Marketplace plans offered access to only 40% of local doctors, with significant disparities in network coverage. In some cases, plans included as few as 14% of doctors in large metro areas like Chicago, while rural plans generally offered better access to local physicians but had fewer doctors overall.

3. Cost Implications of Network Size: Silver plans with higher percentages of in-network doctors were associated with higher premiums. Plans with more than 50% of local doctors in-network cost 8% more than those with 25% or fewer participating doctors. Additionally, enrollees in certain counties faced higher costs to access plans with broader networks, with some needing to pay an extra $88 per month to secure a plan that included a majority of local physicians.

Six rating agencies to pay more than $49 million over recordkeeping failures

By Reuters - Six credit rating agencies agreed to pay a total of more than $49 million in civil penalties to settle U.S. Securities and Exchange Commission charges they broke recordkeeping rules, the regulator said Tuesday. Read Full Article…

HVBA Article Summary

1. Significant Fines Imposed: Moody’s Investors Service, S&P Global Ratings, Fitch Ratings, HR Ratings de Mexico, A.M. Best Rating Services, and Demotech faced substantial fines for failing to maintain and preserve electronic communications, with penalties ranging from $100,000 to $20 million.

2. Fines Breakdown: Moody’s and S&P will each pay $20 million, Fitch is fined $8 million, A.M. Best will pay $1 million, HR Ratings de México is penalized $250,000, and Demotech faces a $100,000 fine, according to the SEC.

3. Regulatory Trend: The SEC has been actively imposing fines on numerous companies for record-keeping failures, particularly focusing on the use of text messages and messaging apps like WhatsApp by employees.

When Cyber Security Breaches Are Inevitable, It's Time To Call For A New Approach

By Keith Ferrazzi - At the TED Conference in Vancouver this year, our Radical Innovators foundation hosted a forum with more than 60 of the world’s top CHROs, CIOs, and founders. On the agenda: how new technologies like AI and quantum computing can elevate our human experience, transforming how we work and live together. Read Full Article…

HVBA Article Summary

1. Rising Cybersecurity Threats and the Need for Resilience: Emerging technologies, while promising significant advancements, also escalate cybersecurity threats. Research from Proofpoint indicates that in 2023, 94% of cloud customers were targeted by cyberattacks, with 62% of those attacks resulting in successful breaches. As cyberattacks become increasingly sophisticated, the focus must shift from merely preventing breaches to building cyber resilience—ensuring businesses can sustain operations during and after attacks.

2. Essential Elements of Cyber Resilience: Effective cyber resilience involves four key elements: planning, practice, proactive detection, and partnerships. Planning includes having a robust, regularly updated resilience plan and investing in adequate backup solutions. Regular practice through simulations helps teams prepare for real crises. Proactive detection requires advanced tools to monitor and respond to threats, while partnerships with industry peers and public agencies enhance collective defense and up-to-date practices.

3. Adapting to Future Cybersecurity Needs: Embracing a cyber resilience mindset is crucial for adapting to the evolving threat landscape. Leaders must overcome resistance to change and integrate new strategies and technologies to maintain business continuity. This shift includes reassessing existing cybersecurity investments and policies to better align with the growing risks posed by emerging technologies.

The Clock is Ticking on Telemedicine Prescriptions

By Eric Wicklund - Telehealth advocates are gearing up for yet another battle with the federal government over the use of telemedicine to prescribe controlled medications, particularly in treatments for mental health and substance use disorders. Read Full Article…

HVBA Article Summary

1. Impending Expiration of Telemedicine Waiver: The pandemic-era waiver enabling providers to use telemedicine for prescribing controlled medications is set to expire at the end of this year, prompting urgent calls from telehealth advocates for an extension to allow time for the creation of new regulatory guidelines.

2. DEA's Proposed Guidelines Under Scrutiny: The DEA's proposed long-term guidelines for telemedicine prescriptions, which have been criticized as overly complex and restrictive, are currently awaiting federal review. Advocates argue that if these guidelines are approved, they could negatively impact the telemedicine industry and patients relying on virtual care.

3. Call for a Two-Year Extension: The Alliance for Connected Care is advocating for a two-year extension of the waiver to give the DEA adequate time to develop and implement a registration process for telemedicine prescriptions. They emphasize that extending the waiver is crucial for maintaining access to care, especially in rural and underserved areas where telemedicine has been particularly beneficial.

Uninsured, less educated patients less likely to question medical bills: study

By Emily Olsen - The study published last week in JAMA, which surveyed more than 1,000 people, found differences in those who advocated for themselves when receiving unaffordable or incorrect medical bills — which could worsen inequities in medical debt burden. Read Full Article…

HVBA Article Summary

1. Disparities in Bill Disputes: Patients with lower levels of education, financial literacy, and those without health insurance are less likely to contest medical bills. Research shows that only 20% of patients without a high school diploma and about 30% of those without insurance or on Medicare reach out to billing offices, compared to over 60% of individuals with higher education and private insurance.

2. Impact of Contesting Bills: Despite these disparities, disputing medical bills can be financially beneficial. Patients who challenged their bills often experienced positive outcomes, such as bill corrections (26%), improved understanding of their bills (18%), and price reductions (15%). However, 24% reported no change.

3. Broader Context of Healthcare Affordability: The study highlights ongoing issues with healthcare affordability in the U.S., where half of adults struggle with medical costs, and many delay care due to expenses. Efforts to mitigate medical debt include proposed rules to remove medical debt from credit scores and state initiatives to forgive residents' medical debt.

States could add dental benefits mandate for small group plans in 2027

By Allison Bell - States might be able to add dental health benefits to the essential health benefits package for their individual and small-group health insurance markets in 2027. Read Full Gated Article…

HVBA Article Summary

1. State Flexibility and EHB Package Changes: States have the option to enhance their Essential Health Benefits (EHB) packages by including additional benefits such as dental care for adults, now that federal restrictions have been lifted. States will need to follow procedures for public notice and comment before implementing such changes.

2. Impact on Small-Group Plans: If states choose to add dental benefits to their EHB packages, small-group health plans will be required to cover these benefits without imposing annual or lifetime spending limits, ensuring more comprehensive dental coverage for enrollees.

3. Future Considerations and State Actions: The decision to expand EHB packages with additional benefits will vary by state, influenced by federal support and state-level priorities. Conservative states may adopt minimal changes, while more progressive states might take advantage of the new flexibility to offer expanded benefits.

Tech will forever change employee benefits. Here's how.

By Jackie Stewart - Managing benefits can be exhausting. There is an immense amount of legal-sounding text to digest for health and life insurance plans. And even after reviewing that, employees may still be left wondering what the policies will actually cover. Read Full Gated Article…

HVBA Article Summary

1. Technological Advancements in Benefits: Companies are increasingly investing in HR technology to enhance the benefits experience for employees. With 45% of companies increasing their HR tech investments in 2023, there's significant potential for technology to make benefits more personalized, user-friendly, and effective.

2. AI's Transformative Role: Generative AI is poised to revolutionize the benefits space by streamlining tasks such as medical note transcriptions and simplifying benefits navigation. This could lead to improved health literacy, more efficient benefits management, and the ability to identify patterns in data that may be missed by human managers.

3. Personalization and Proactivity: Advances in technology are expected to make benefits offerings more tailored to individual needs and proactive in addressing employee requirements. This includes providing relevant benefits information based on personal circumstances and ensuring that benefits work seamlessly for employees without requiring them to recall extensive details.