Most people who get their health coverage through the ACA marketplace anticipate being unable to afford rising premiums if enhanced tax credits lapse, with many expecting they’ll have to forgo insurance, per a just-released KFF survey. Unaffordable insurance—or no coverage at all—will force people into difficult choices, such as delaying care and treatment or cutting other essentials to pay for healthcare. With coverage gaps possible as soon as next month, insurers will need to help members navigate changing eligibility and costs to avoid losing them.

House Democrats introduced a new healthcare bill on Thursday aimed at expanding prescription drug price negotiations and extending Medicare benefits to consumers covered by private insurance. The proposal is unlikely to advance out of the House, but it adds fuel to the ongoing debate over drug pricing, and increases the pressure on pharma companies.

Health insurance outranks all other factors when people consider their next career move, according to a recent survey from Talker Research and Oscar Health. While employers are unlikely to take on more healthcare costs soon due to their own financial strain, they must prioritize worker retention and use open enrollment for transparent communication on cost increases and plan adjustments

The US Senate is moving to end the government shutdown, but the compromise deal leaves out guarantees to extend the Affordable Care Act (ACA) healthcare tax credits. Without ACA subsidies, younger and healthier consumers will likely drop out of the insurance pool, leaving older and higher-risk enrollees behind. That would drive up premiums and further reduce plan enrollment, putting pressure on insurers and shrinking consumer choice.

Among patients newly prescribed GLP-1s for obesity, 90% either never start therapy or discontinue within a year. Novo and Lilly are using their direct-to-consumer online pharmacies to improve adherence, giving them clearer insight into why patients don’t fill or refill prescriptions to offer targeted support. Beyond that, drugmakers should work with their telehealth partners and pharmacies to give patients resources on managing side effects, navigating insurance issues, and understanding why maintenance dosing remains important after achieving some weight loss.

The average cost of employer-sponsored health insurance is expected to surpass $18,500 per US worker in 2026, according to a Mercer survey released this week. That would represent a 6.7% jump from 2025—the largest increase in 15 years. Employers must conduct due diligence of vendors that offer healthcare cost-containment solutions to ensure the products are effective and deliver actual savings. Companies will also want to thoroughly evaluate their contracts with pharmacy benefit managers to better understand their prescription drug benefits, while limits on GLP-1 coverage, especially as upcoming oral versions and new condition approvals drive up demand.

CVS Health’s Aetna is adding conversational generative AI (genAI) to its insurance website and mobile app. Aetna’s move highlights how insurers can use genAI to become more attractive to employer benefit packages.

Most consumers aren’t too familiar with the CDC’s recent COVID-19 vaccine guideline changes, and those who have heard about them say the updates are unlikely to affect their decision to get the shot, according to an October 2025 Pew Research Center survey. Vaccine makers can partner with medical groups and pharmacies to disseminate information through traditional and digital media. Communication shouldn’t challenge CDC guidance or politicize the issue, but should explain where to get the shot, note any insurance changes, and outline special considerations for people with certain medical conditions.

47% of US adults are worried about how they’ll pay for necessary healthcare expenses next year, according to a West Health and Gallup study published today. Consumer anxiety over rising insurance premiums, drug prices, and co-pay costs is accelerating, while geographic disparities are widening the gap in who can access and afford care.

Consumers lack familiarity with direct-to-consumer (D2C) pharma services, but many are open to purchasing prescription medications from drugmakers. Pharma companies entering the D2C market must boost awareness of the channel. Pharma brands and marketers should inform pharmacists and doctors of drugmakers' latest D2C options, since they’re key sources for patients with medication cost and coverage questions. They should also create clear educational materials showing how consumers can save on D2C prescriptions, backed by data on limited insurance coverage for certain drug categories.

President Donald Trump remarked late last week that the cost of brand-name GLP-1 drugs could drop to $150 in the US. Trump didn’t detail which insurance markets the lower-cost GLP-1s would apply to, or how he plans to force Novo Nordisk and Eli Lilly to drop their prices. With prescriptions surging, GLP-1 drugmakers must prepare for tougher scrutiny and calls from the government, doctors, and patients alike to make treatments more affordable. Pharma marketers should intensify messaging around their weight loss drugs being cost-effective over the long haul by preventing more serious chronic diseases.

Novo Nordisk lost its federal appeals court challenge of the prescription drug price negotiation program in the Biden-era Inflation Reduction Act (IRA) prescription drug price negotiation program, which could open the door for even more price checks. We see a path where the current administration revamps, or simply rebrands, IRA price negotiations as CMS negotiations to save taxpayer money and help consumers. Brands under pressure to drop prices through the IRA and executive orders should continue those good–faith efforts but also encourage the administration to put the same pressure on insurance companies and pharmaceutical benefit managers to lower healthcare costs.

Prescription drug prices along with other healthcare costs like hospital services and nursing homes, are growing faster than overall inflation, but slower than consumer costs like housing, food, and coffee, per GoodRx Research’s latest data. Pharma marketers need to use empathy to connect with the growing group of underinsured consumers. They should be transparent about prices and acknowledge the frustration consumers feel around the complexity of the US healthcare and insurance system. Proactively highlight help offered for consumers like financial assistance, savings tools, and patient support programs.

Novo Nordisk is partnering with Costco to offer the retailer’s members Ozempic and Wegovy for $499 per month, or about half off what the medications cost patients without insurance. Novo tapping into Costco’s customer base of over 100 million US cardholders is a savvy play, especially considering that Costco members skew toward higher-income compared with shoppers generally. Novo and Costco can specifically market to new mothers and families broadly who may be struggling with weight gain due to their busy lives.

More than three-fourths (78%) of US adults support extending federal funding tax credits for ACA insurance, according to a new KFF survey. That includes 57% of Republicans who support President Donald Trump. The tax credits are a key part of the current Senate stopgap funding negotiations. If subsidies are not extended, insurers need to prepare customer-friendly strategies to retain price-conscious enrollees, such as flexible plan options or help switching plans. They should also offer new digital health perks (or highlight existing ones) like mental health support and health-related discounts.

America’s Health Insurance Plans (AHIP) released a statement that its member health insurers will cover vaccines that were previously recommended by the CDC’s advisory committee with no cost-sharing for patients through the end of 2026. AHIP’s commitment is the first real market signal that major insurers will keep paying for children’s immunizations, as well as updated formulations of COVID-19 and flu vaccines, even if the government’s vaccine advisory panel changes its recommendations. Insurers should partner up with medical associations, pharmacies, and vaccine makers to disseminate information at a local level that makes folks aware of their right to vaccine coverage under their health plan.

The trend: Nearly one-quarter of patients (24%) who are pleased with the quality of their recent medical care may still change doctors in the next 6 months, according to a new survey from Huron Consulting Group. Our take: People used to have limited options for healthcare and just went with whatever was in their insurance network. But things are changing, and providers can no longer bet on this. To compete with new tech-savvy healthcare companies, traditional clinics and health systems need to adapt. While they may not be able to match them completely, they should at least adopt some of the features that patients want.

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: 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 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 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 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.