With both the Republican and Democratic conventions now finished and a little over two months until the U.S. presidential election, speculation over how nominees Kamala Harris or Donald Trump would influence health policy is beginning to heat up. To that end, Harris’ recent release of her economic policy outline has offered more clues about her highest priorities — while one former Trump administration official says he expects Republicans to largely avoid health care issues during the campaign.

“Just to be very clear, I think on the Republican side, you’re still not going to see much emphasis on health care,” Alex Azar, who was secretary of HHS under Trump, said during an Aug. 14 webinar hosted by Avalere Health. “President Trump is known to not just read from a teleprompter, so who knows,” he added, but it’s more likely that issues like inflation and immigration will be in the spotlight.

In what whistleblower attorneys say is a novel case, Humana Inc. has agreed to pay $90 million to settle False Claims Act allegations related to the Medicare Part D contracting process. The case was brought by a former employee who alleged Humana engaged in a “reverse-engineering” scheme to submit actuarially equivalent bids to CMS for Prescription Drug Plan (PDP) business that were based on inflated assumptions about the use of preferred pharmacies by low-income subsidy (LIS) members. Humana did not admit wrongdoing and stands by the merit of its assumptions.

The suit, U.S. ex rel. Steven Scott v. Humana Inc. (3:18-CV-00061-GNS-CHL), was originally filed in January 2016 in the U.S. District Court for the Central District of California. It remained under seal until 2017, after the U.S. Dept. of Justice (DOJ) declined to intervene.

The cost of providing health benefits to employees grew more than was projected in 2023 and is expected to rise by an eye-popping rate of 7.8% by 2025, according to an annual survey of large companies from the Business Group on Health. And to address those rising costs, employers are demanding greater accountability from their health plans, PBMs and other vendors.

“Health care costs is really the headline story of this year’s findings,” Ellen Kelsay, Business Group on Health president and CEO, said during an Aug. 20 virtual press briefing. Health care trend — or the rise in spending — was 6.8% in 2023, which was up from 4.6% in 2022 and greater than the 5.9% estimated trend.

Now that CMS has revealed the prices of the first 10 drugs subject to Medicare price negotiation, all eyes are on how Part D plans will cover those drugs on their formularies in 2026, when the new prices go into effect.

To that end, a recent poll from Zitter Insights offers some clues about how payers and PBMs are thinking about this thorny question.

The flash poll was conducted after CMS revealed the results of the first round of the Medicare Drug Price Negotiation Program, which was authorized by the Inflation Reduction Act. Through that process, Medicare for the first time set a Maximum Fair Price (MFP) for 10 branded drugs selected due to their high cost and lack of generic or biosimilar competition.

Nearly 12% of generic prescription drugs could have had lower out-of-pocket costs if they were purchased through the Mark Cuban Cost Plus Drug Co. (MCCPDC) rather than through a traditional pharmacy using health insurance, according to a recent JAMA Health Forum study. Karen Van Nuys, Ph.D., a leading health policy expert who was not involved in the study, tells AIS Health the Mark Cuban company is doing a “tremendous service” by making medication prices transparent, although she suggests that it remains to be seen whether the firm and other cash pharmacies will have a major impact on the prices plans and members pay for drugs.

Mark Cuban, a billionaire, founded MCCPDC in 2022 to bring more transparency to drug pricing and improve access to medications. The company discloses the amount it pays for drugs and then adds a 15% markup, $5 pharmacy fee and $5 shipping fee.

From 2021 to 2023, the median share of health care dollars that large employers spent on pharmacy costs rose from 21% to 27%, according to the Business Group on Health’s 2025 Employer Health Care Strategy Survey. The survey also found that 56% of responding employers identified GLP-1s — which treat Type 2 diabetes, obesity and other indications — as driving health care costs to a “great extent” or “very great extent,” making it the top-cited trend driver. The next most cited cost driver was “high-cost therapies.” And when listing their top pharmacy benefit-related concerns, employers put “appropriate use and/or long-term cost implications of GLP-1s and other newer weight management medications” at the top of their list, with 70% and 20%, respectively, saying they were very concerned or concerned about that issue.

Echoing a proposal championed by the Biden administration, Democratic presidential candidate Kamala Harris said recently that if elected, she hopes to apply a $35 out-of-pocket cap on insulin to everyone in the country — not just those on Medicare. But newly published research into state out-of-pocket insulin cost caps raises questions about how much of an impact such a policy would make.

So far, 25 states and Washington, D.C., have passed legislation capping patients’ monthly out-of-pocket costs for insulin, with upper thresholds set between $25 and $100. Those caps apply only to state-regulated health insurance plans. Meanwhile, the Inflation Reduction Act (IRA) capped Medicare enrollees’ monthly out-of-pocket costs for insulin at $35, effective in 2023.

Even after health plans were given the option to expand pre-deductible coverage in certain health plans, medication adherence didn’t significantly improve, according to a recent issue brief from the Employee Benefit Research Institute (EBRI).

Yet while the impact was minimal for most medications, Paul Fronstin, Ph.D., one of the report’s authors, says adherence was already high for the members evaluated, and the majority of insurers introduced copayments and/or coinsurance when expanding pre-deductible coverage.

When CMS on Aug. 15 revealed the prices of the 10 drugs subject to Medicare price negotiation, its much-anticipated disclosure still left many questions unanswered. In the managed care world, the biggest question mark remains how Medicare Part D plans will adjust their formularies in reaction to the new government-set prices — but one industry expert says it will be a while before more clarity emerges.

“These prices are effective Jan. 1, 2026, so they should not, in theory, impact the 2025 formularies,” which have been largely decided since April, says Jennifer Snow, founder of the health policy and reimbursement consulting firm Apteka LLC.

With policymakers and industry stakeholders increasingly focused on the cost savings opportunities tied to biosimilars, a new Health Affairs study sheds light on some of the factors that influence uptake of these near-copies of pricey biologic medications.

Among almost 200,000 commercial and Medicare Advantage enrollees who newly initiated one of seven biologic drugs with available biosimilar versions — filgrastim, bevacizumab, epoetin alfa, trastuzumab, pegfilgrastim, infliximab and rituximab — the share of people initiating a biosimilar increased from 1% in 2013 to 34% in 2022. Patients who were younger than 18 years were less likely to initiate a biosimilar than other age groups. Meanwhile, enrollees in commercial high-deductible health plans were more likely to use a biosimilar, compared with those in MA plans.