Employer Healthcare Costs To Soar
After multiple years of high spending hikes for employer coverage, employers are facing perhaps a near-term record trend in 2026. The Business Group on Health released its annual survey and found that business firms are bracing for median cost increases of 9% in 2026. In the past two years, costs exceeded forecasts. And employers expect an 11% to 12% increase in pharmacy costs heading into 2026.
Ongoing demand for GLP-1s and other medications for weight loss is a significant cost driver. About 72% said that GLP-1s are impacting their 2025 healthcare costs to either a “great” or “very great” extent, up from 56% who said the same a year ago. The survey indicates that the number of employers covering these medications for weight loss may “stagnate” in an effort to control costs. Employers will also put on more guardrails like prior authorization. Some may end coverage.
Cancer is the leading driver of costs for the fourth year in a row. This trend is exacerbated by an increase in diagnoses and higher expenses for treatment. Mental health is also growing as a cost factor.
Employers are considering alternative pharmacy benefits managers (PBMs) and insurers as an option.
Finally, 66% are concerned the new tax law’s reductions to the Exchanges, Medicaid and Medicare will drive up hospital prices.
Additional articles: https://www.fiercehealthcare.com/payers/employers-brace-9-cost-increase-2026-business-group-health-survey and https://www.healthcaredive.com/news/employers-2026-healthcare-cost-trend-business-group-health/757907/
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#employercoverage #commercial #healthcare
https://www.modernhealthcare.com/insurance/mh-employer-healthcare-costs-report-2026
Medicare Advantage Marketing Rule Struck By Federal Judge
After issuing a stay some time ago, a district court in Texas ruled against the Department of Health and Human Services and vacated several significant provisions of a rule that sought major reforms of how Medicare Advantage (MA) plans market products.
The Centers for Medicare & Medicaid Services (CMS) sought in a 2024 rule to fix broker and agent compensation and raised the pay cap for new enrollments. At the same time, it eliminated certain contracts that led to extraordinary compensation for third-party marketing organizations and brokers, including volume-based bonuses. The current practices have led to allegations of steerage of members by these marketing entities to certain plans. The federal government is suing three large MA plans and marketing entities for fraud regarding these payments.
The judge said the rule exceeded statutory authority and violated the Administrative Procedures Act. This was an important reform, and the judge was clearly wrong-headed on this ruling. Of course, the government should have the right to control such payments related to a government program. Congress and CMS should work together to enact a law carrying out the reforms.
In other news, Elevance Health lost a lawsuit seeking to revise its Star rating for 2025. Elevance said it lost $375 million in Medicare bonus payments when its Star ratings dropped.
Last, JD Power published its list of the top MA plans in 10 markets. The study surveyed nearly 11,000 enrollees based on eight factors: level of trust; able to get health services how/when they want; helps to save time or money; product/coverage offerings met needs; ease of doing business; people—representatives, call center agents; resolving problems or complaints; and digital channels.
The average customer rating for MA plans in 2025 was 623 on a 1,000-point scale, compared to 652 in 2024. JD Power says the lower customer satisfaction was due to lower trust, unmet coverage needs, and administrative frustrations. At the same time, it found that high-performing plans excelled in digital engagement. First-year members struggle, with fewer than 40% saying their service expectations are met compared to 45% of longer-term members.
New enrollees had multiple challenges in onboarding, including explanation of benefits, finding in-network doctors, and prior authorization requirements.
Additional articles: https://www.fiercehealthcare.com/payers/judge-vacates-medicare-advantage-marketing-rule-provisions and https://www.modernhealthcare.com/insurance/mh-medicare-advantage-marketing-rule-dismissed/ and https://www.modernhealthcare.com/insurance/mh-elevance-medicare-advantage-ratings-lawsuit-dismissed/ and https://www.beckerspayer.com/payer/medicare-advantage/lowest-rated-medicare-advantage-plans-for-member-satisfaction-in-2025-j-d-power/
(Some articles may require a subscription.)
#medicareadvantage #fwa #marketing #stars #quality #cms #elevancehealth
Novo Nordisk Drops Weight-Loss Drug Price
Financially beleaguered Novo Nordisk and GoodRx announced a partnership this week to sell weight-loss products Ozempic and Wegovy at half their normal cost to cash-paying patients. Pen products are now $499 per month.
In other news, copycat versions of popular drugs like Ozempic and Mounjaro have continued to proliferate in a post-shortage era. Some blame the lack of government regulation. Compounding was supposed to end once the drug shortage was lifted, but compounding pharmacies say they are compounding individualized treatments.
Additional articles: https://thehill.com/policy/healthcare/5460116-novo-nordisk-goodrx-selling-ozempic-at-half-cost-for-customers-paying-cash/ and https://thehill.com/policy/healthcare/5457899-compounded-glp-1s-online-sales/
#drugpricing #glp1s #weightlossdrugs
Trump Administration Begins Targeting Noncitizens From Healthcare Programs
In part ushered in by the One Big Beautiful Bill Act (OBBBA), the Trump administration announced a new initiative Tuesday aimed at getting noncitizens disenrolled from the Medicaid program and the Children’s Health Insurance Program (CHIP).
CMS will begin providing states with monthly enrollment reports identifying individuals whose citizenship or immigration status could not be confirmed through federal databases. States now are mandated to review cases, verify citizenship or immigration status, and take appropriate actions (e.g., adjusting coverage or enforcing noncitizen eligibility rules).
Additional articles: https://www.medpagetoday.com/publichealthpolicy/medicaid/117074 and https://www.cms.gov/newsroom/press-releases/cms-launches-nationwide-push-remove-ineligible-medicaid-enrollees-uphold-citizenship-requirements
#medicaid #chip #coverage
https://www.beckerspayer.com/payer/medicaid/cms-launches-medicaid-enrollment-oversight-initiative
— Marc S. Ryan
