The news: Insurance premiums are set to rise by 15% next year for the people who buy through the Affordable Care Act, per a new KFF analysis. Our take: While the Trump administration is eliminating the ACA tax credits, states where the president won the election account for 88% of ACA enrollment growth since 2020, per KFF research in April. When premium increases roll out across the ACA marketplace, and spillover into higher costs for hospitals and healthcare services, we expect plenty of political finger-pointing over fault, but little agreement on ways to improve US healthcare and keep consumers out of medical debt.

The trend: Over half of US adults with health insurance (51%) said they needed a prior authorization for a medical service or treatment in the past two years, according to a July 2025 KFF study. The final word: Prior authorizations can lead to delayed—or even denied—care. To date, health plans have not been held accountable for their increased frequency of coverage denials. That could soon change due to a flurry of bills on prior authorization reform at the state level—but for the time being, insurers’ promises and pledges are more PR spin than actionable improvement.

The news: CVS’s Q2 earnings topped estimates, buoyed by solid performance in its retail pharmacy segment and signs that its health insurance division is finally turning things around. Our take: CVS may not be thriving compared with earlier in the decade, but it’s in a good position relative to most of its rivals. That’s largely because of its diversified footprint across healthcare (pharmacy, insurance, PBM) that prevents the company from being overexposed in one struggling sector. CVS’ ongoing company turnaround could be a good sign for the similarly structured UnitedHealth, DOJ investigations notwithstanding.

The news: Pfizer and Bristol Myers Squibb will launch a direct-to-patient channel to sell their blockbuster blood thinner Eliquis at a reduced cash-pay price. Our take: Pfizer and Bristol Myers Squibb have anticipated the Eliquis patent loss and sales drop for years as part of the typical branded drug cycle. We see the new direct sales platform launch not as a play for new revenues, but rather a negotiating nod to the Trump administration. Only 10% of Eliquis patients are uncovered by insurance, so it’s a small market to court as a revenue-driving ploy. However, Trump has made it clear he’s open to using any levers possible to force lower drug prices, pushing pharma companies to offer good faith options and concessions.

The news: Roche is considering a direct-to-patient (D2C) sales channel for its prescription drugs, CEO Thomas Schinecker said in its Q2 earnings call. Our take: The complex US healthcare PBM and insurance system can’t easily flip to a pure-play D2C prescription sales market. However, we think it will become a reliable channel, especially for self-pay patients. Pharma marketers can court them with special pricing deals, a la Lilly and Novo, but ensure they stay on the right side of regulators.

The data: Around 2 in 5 employers and health plans will never consider covering GLP-1 drugs for obesity, according to a June 2025 report from Pharmaceutical Strategies Group. Our take: We don’t think a lack of insurance coverage for GLP-1s will lead to a market slowdown. Less generous insurance coverage of the drugs will force companies operating in the competitive cash-pay GLP-1 space to continue offering temporary discounts or lower their prices altogether.

Healthcare costs for Americans who have employer-sponsored health insurance spike 7% annually: Employers will need to be more restrictive with their plan offerings, creating an opportunity for D2C healthcare brands to reel in new customers.

General Medicine debuts as a platform where consumers can shop for medical care: While the healthcare marketplace concept isn’t new, the startup could have an upper hand by allowing people to see prices for medical care based on their unique health insurance details.

Clinicians want more support from pharma, but not via in-person sales meetings: Marketers need to create content that will proactively answer doctors’ questions about a drug’s cost/insurance coverage and how patients are responding to the treatment.

How we got here: UnitedHealth expected to garner sympathy and public support when its health insurance division’s CEO Brian Thompson was murdered last December. However, the fatality drew attention to business practices that spark anger among patients, such as denying care.

The initiative is likely a response to the negative press the insurance industry has been getting following the December murder of UnitedHealthcare CEO Brian Thompson and media reports of health plans increasingly using AI to deny patient care without human review.

An AFL-CIO analysis in June estimated 600,000 healthcare jobs could be eliminated, while increases in commercial insurance payments, resulting from uncompensated care, will cost $182-$485 per person. The bill also ends extended Affordable Care Act tax credits, which helped consumers pay for marketplace health insurance, and shortens enrollment periods.

Key stats: About 7.4 million Medicare and Medicaid members could have used their insurance to pay for weight loss drugs if Biden’s proposal had been finalized. But it would increase Medicare spending by $25 billion and Medicaid spending by $15 billion over the next 10 years, per CMS estimates.

The news: Digital health startup Virta Health is guaranteeing that its employer and health plan customers won’t increase spending on GLP-1 drugs for their members. Our take: Virta’s financial guarantee will likely catch the attention of employers and insurers, but it could quickly backfire from a financial perspective if it’s unable to curb GLP-1 prescription volume.

The trend: US adults have worse views of pharma and health insurance than any other healthcare sector, according to two March surveys of registered voters from Arnold Ventures and Fabrizio Ward.

Why it matters: Members who are satisfied with their health plan’s digital tools are more likely to stay loyal to their insurance provider. That’s much more important in Medicare Advantage plans where about one in five members report switching plans in the past two years, per The Commonwealth Fund.

Direct-to-patient models could pay off for pharma: But if pharma companies bypass middlemen such as insurers and PBMs, they’ll need to pay attention to where patients see the biggest needs for improvement to their healthcare experience— and not just try to fill as many new prescriptions as possible.

Only 9% gave it an A, boosted by 41% of Medicare recipients who awarded an A or B compared to only 22% of people with commercial insurance. The bigger picture: Consumers’ lack of trust and general dissatisfaction with insurers follows a trend of discontent that surfaced prominently after the murder of UnitedHealthcare CEO Brian Thompson in December.

Why it matters: Commercial insurance coverage for GLP-1s is dropping, and the current administration does not support expanding gov’t plans to cover the meds for obesity. North Carolina ended coverage for state employees in January 2024. Other insurers have also ended GLP-1 coverage for weight loss.

Many Vermonters can’t afford or access healthcare, even though most are insured: The issue isn’t lack of insurance, but rather underinsurance. We highlight this growing problem plaguing consumers across the US.

FTC warns ACA marketplace insurance marketers about deceptive claims: The warnings come during open enrollment season, a period that typically creates confusion among consumers.