A day of innovation, deal-making, and purpose-driven networking at Ocean Casino Resort, November 20, 2025

ATLANTIC CITY, N.J. — September 11, 2025 — The Health & Voluntary Benefits Association (HVBA) today announced its 18th Annual HVBA event will take place November 19–20, 2025 at Ocean Casino Resort on the iconic Atlantic City Boardwalk. This year’s program features an Invite-Only VIP Dinner on November 19, followed by a full day of board programming, the HVBA Innovation Summit, and an evening Networking Reception & Charity Component on November 20.

“Atlantic City has a legacy of big stages and bold moves—a perfect backdrop for HVBA’s 18th year of catalyzing partnerships that help employers and their people thrive,” said Rob Shestack, HVBA Chair. “Attendees can expect candid conversations, actionable strategies, and real opportunities to build their 2026 pipeline.”

“Our model is simple: quality content + curated connections = business outcomes,” added Jake Velie, HVBA. “We’re excited to welcome the industry to Ocean Casino Resort for two energetic days that combine learning, relationships, and purpose.”

Event Highlights

• Invite-Only VIP Dinner — Wednesday, Nov. 19
  An intimate evening for HVBA leaders, sponsors, and select guests to connect and set the tone for the main event.
• HVBA Board & Leadership Programming — Thursday, Nov. 20 (AM)
  Focused sessions for HVBA Board Members and invited guests to align on 2026 initiatives and market priorities.
• HVBA Innovation Summit — Thursday, Nov. 20 (Afternoon)
  Fresh insights on growth, product innovation, compliance outlooks, and integrated health strategies—delivered by leaders building what’s next.
• HVBA Networking Reception & Charity Component — Thursday, Nov. 20, 5:00–8:00 PM
  A premium, business-forward reception designed for real conversations that lead to real deals. Includes butler-passed hors d’oeuvres and open bars, plus a purpose-driven auction supporting Trinity Oaks Outdoors’ “Honoring Our Heroes.”

Why Attend

• Deeper Connections, Faster: Intimate scale + curated introductions = time well spent.
• Right-Now Intelligence: What’s changing in voluntary, medical, and integrated solutions—and where growth will come from next year.
• Action Over Hype: Leave with new partnerships, clear takeaways, and a fuller pipeline.
• Complimentary Registration for Licensed Brokers & Agents (limited capacity).

Preliminary Schedule* (All times ET)

Wednesday, November 19

• Evening – Invite-Only VIP Dinner

Thursday, November 20

• 8:00 AM–12:30 PM – HVBA Board/Leadership Programming (invite only)
• 1:00–4:30 PM – HVBA Innovation Summit
• 5:00–8:00 PM – HVBA Networking Reception & Charity Component

*Final agenda and speakers to be announced.

Venue

Ocean Casino Resort
A contemporary, oceanfront property offering panoramic views, elevated dining, and seamless access to the Boardwalk—pairing modern luxury with Atlantic City’s storied energy.

Registration & Sponsorship

• Register: https://www.eventbrite.com/e/2025-hvba-benefits-roadshow-event-atlantic-city-nj-tickets-1478689583349?
• Sponsorship & Corporate Membership Inquiries: events@vbassociation.com
  Early interest is strong; capacity is limited.

Media Contact

Jenny Jenkins
Health & Voluntary Benefits Association (HVBA)
Cell: (561) 398-1060
Email: jjenkins@vbassociation.com
Website: www.vbassociation.com

About HVBA

The Health & Voluntary Benefits Association (HVBA) unites brokers, agents, consultants, carriers, and solution innovators to accelerate better benefits for employers and the people they serve. Through executive roundtables, regional roadshows, and its annual summit, HVBA delivers practical insights, curated partnerships, and purpose-driven community impact. Learn more at www.vbassociation.com.

Nashville, TN – September 3, 2025 – The Health & Voluntary Benefits Association (HVBA) hosted a record-breaking Benefits Roadshow in Nashville on September 3, 2025, bringing together industry leaders, innovators, and business professionals for a day of groundbreaking discussions, dynamic networking, and charitable giving. With standing-room-only attendance, the event marked one of HVBA’s most successful gatherings to date.

A Full Day of Impactful Programming

The day kicked off with a packed Board Meeting at the Renaissance Nashville Hotel, where board members and invited guests gathered for a half-day of strategic discussion. The morning set the stage for an afternoon of inspiration, learning, and connection.

At 1:00 PM, attendees filled the Music City Ballroom for the highly anticipated HVBA Innovation Summit, moderated by Mike Hirshberg, Division Sales Manager, MassMutual. The summit featured thought leaders and innovators from across the benefits and healthcare landscape, including:

• Robert S. Shestack, Chairman & CEO, HVBA – OBBBA 2025: Its Effect on Employee Benefits
• Mark Barbier on behalf of Mark Chibbaro, CRO, SGIC – Where Innovation Meets Impact
• Jeff Caldwell & Chris Davis, Claritev – Welcome to the New Claritev Broker Solutions
• Moshe Golomb, CEO, Juice Financial – Payment Solutions for Insurance
• Jim Senge, SVP, Ebix Health – A Digital Transformation Journey in Voluntary Benefits/Worksite Solutions
• Dr. Joseph Webb, CheckMySpot – When You’ve Got Skin in the Game, We Keep It in the Workplace

These sessions highlighted the innovations shaping the future of employee benefits, healthcare solutions, and digital transformation.

Networking, Partnerships, and Giving Back

Following the summit, the Networking Reception from 3:30 PM to 7:00 PM delivered an unmatched opportunity for collaboration. With premium open bars, butler-passed hors d’oeuvres, and lively reception stations, attendees forged new partnerships and celebrated shared successes.

Highlights included:

• Jake Velie, Vice Chair & President, HVBA; Chairman & CEO, National Integrative Health – The New Era of Pharmacy Economics
• Jennifer Carter, CEO, Medzown – Science-Powered Cost Containment for Cancer & Complex Disease
• A Trinity Oaks Outdoors Live Auction, featuring trips to Ireland and other incredible experiences, raising funds to honor and support America’s heroes.

The evening concluded with raffle drawings, networking celebrations, and enthusiastic feedback from attendees who called the event “off the charts.”

A Resounding Success

“From a full board meeting to an innovation summit packed with expertise, and a networking reception buzzing with energy, Nashville exceeded all expectations,” said Rob Shestack, Chairman & CEO of HVBA. “HVBA exists to connect, innovate, and give back—and Nashville proved what can happen when this community comes together.”

“Collaboration was the theme of the day,” added Jake Velie, Vice Chair & President of HVBA. “The energy in the room showed that people aren’t just attending—they’re engaging, partnering, and leaving with actionable strategies.”

About HVBA

The Health & Voluntary Benefits Association (HVBA) is a leading industry organization dedicated to advancing innovation, collaboration, and professional growth in the health and voluntary benefits space. Through events, education, and strategic partnerships, HVBA empowers brokers, consultants, carriers, and service providers to drive meaningful change and deliver better outcomes for clients, employers, and employees.

Contact

HVBA Media Relations
Jenny Jenkins
Global Brand Ambassador
jjenkins@vbassociation.com

Mount Laurel, NJ – The Health & Voluntary Benefits Association® (HVBA) today announced the release of its annual Insights That Matter: HVBA DIR Poll Results report, presenting a comprehensive look at the issues shaping the future of health and voluntary benefits in the U.S. workforce. Drawing from more than 24,000 responses across 35+ industry polls, the report highlights the priorities, concerns, and emerging solutions driving the healthcare and benefits landscape in 2025.

Sponsored by MassMutual and Sydney Administrators, the report reflects feedback from brokers, consultants, employers, carriers, and other stakeholders across the benefits ecosystem. It underscores the industry’s collective focus on mental health, price transparency, affordability, and employee engagement as top concerns for the year ahead.

Key Findings Include:

• Mental Health & Engagement: Flexible work schedules and Employee Assistance Programs (EAPs) were the most preferred initiatives for supporting employee mental health, with ongoing workshops identified as the most effective way to boost engagement.
• Rising Costs & Transparency: Over half of respondents cited rising healthcare costs and affordability as the most pressing challenge, while price transparency tools and reference-based pricing emerged as vital strategies for employers and brokers.
• Voluntary Benefits Growth: Supplemental health products (dental, vision, critical illness) and Accident Insurance remain the most valued voluntary benefits, with Gen X (ages 45–60) showing the highest engagement levels.
• GLP-1 Medications: A majority of respondents strongly disagreed with employers dropping coverage for GLP-1 weight-loss medications (like Mounjaro and Wegovy), citing employee health and retention concerns despite the cost challenges.
• Industry Knowledge Gaps: A majority of professionals reported being unprepared or unaware of compliance requirements tied to the Consolidated Appropriations Act (CAA), signaling a critical need for education and resources.
• Emerging Trends: Interest is growing in pet insurance, “travel as a benefit,” workplace violence coverage, and PTO liability reduction programs as organizations seek innovative ways to attract and retain talent.

“The voice of the benefits community is clear—employers, brokers, and carriers are demanding innovative, affordable, and accessible solutions to meet the needs of today’s workforce,” said Robert S. Shestack, CFF, CVBS, Publisher, Chairman & CEO of HVBA. “This report is a roadmap for the industry, offering actionable insights that reflect both immediate challenges and long-term opportunities.”

The full report, including detailed poll data and commentary, is available now to HVBA members and industry professionals.

For more information or to request the full Insights That Matter: HVBA DIR Poll Results report, visit https://vbassociation.com/discover-what-over-24000-professionals-think-about-2025s-top-benefits-trends/

Media Contact:
Sarah Hunt
Health & Voluntary Benefits Association®
Phone: (856) 200-8024
Email: info@vbassociation.com

About the Health & Voluntary Benefits Association® (HVBA)
The Health & Voluntary Benefits Association® (HVBA) and the Health and Voluntary Benefits Institute® (HVBI) are leading providers of comprehensive employee benefits solutions, compliance consulting, product development and industry certifications. With a commitment to innovation and excellence, HVBA & HBVI strives to empower employers and brokers with the tools they need to navigate the evolving landscape of healthcare and voluntary benefits. Through the Health & Voluntary Benefits Association® (HVBA) and the Health & Voluntary Benefits Institute® (HVBI), we are dedicated to advancing industry knowledge and promoting best practices for the benefit of all stakeholders.

About MassMutual (Massachusetts Mutual Life Insurance Company)
MassMutual is a leading mutual life insurance company that is run for the benefit of its members and participating policyowners. Founded in 1851, the company has been continually guided by one consistent purpose: we help people secure their future and protect the ones they love. With a focus on delivering long-term value, MassMutual offers a wide range of protection, accumulation, wealth management, and retirement products and services. For more information, visit www.massmutual.com.

Nashville, TN – Thursday, July 10 – The Health & Voluntary Benefits Association® (HVBA) is thrilled to extend a warm invitation to all benefits professionals for the upcoming Benefit Roadshow, scheduled for Wednesday, September 3, 2025.

We are excited to welcome you to the luxurious Renaissance Nashville Hotel, ideally situated in the vibrant heart of downtown Nashville. Directly connected to the dynamic Fifth + Broadway complex—featuring over 35 restaurants, shops, and live entertainment options—our venue offers unmatched convenience and access. Guests will also find themselves just steps away from hundreds of local hotspots, including the legendary Broadway, famously known as “Honky Tonk Highway.”

In addition to an exceptional location, attendees will enjoy exclusive opportunities to engage with the HVBA’s Executive and Advisory Board Members. Connect with influential leaders in the voluntary benefits and healthcare sectors in an intimate, high-energy setting designed to foster meaningful conversations and strategic relationships.

The HVBA Benefit Roadshow promises an engaging and informative experience for attendees. This exclusive event will feature our Innovation Summit with six (6) power sessions, introducing delegates to the latest products, services and solutions in the healthcare and benefits space.

“More than just an event, this is a bold demonstration of HVBA’s relentless drive to push innovation into the marketplace,” said Jake Velie, Vice Chairman & President of the Health & Voluntary Benefits Association® (HVBA) and Chairman & CEO of National Integrative Health. “Whether it’s revolutionary pharmacy solutions, advanced data analytics, or fresh strategies for managing employer risk, we’re breaking new ground and bringing never-before-seen ideas to the table. At HVBA, we’re not just keeping up—we’re leading the charge with powerful, forward-thinking solutions that tackle the toughest challenge in healthcare: cost control.”

Following these impactful sessions, attendees will have the opportunity to immerse themselves in HVBA’s Networking Reception with Open Bar & Butlered Hors d’oeuvres. 

The HVBA’s Networking Reception at the Benefits Roadshow is more than just an opportunity to mingle—it’s where meaningful connections turn into real business opportunities. Attendees gain direct access to a dynamic mix of professionals, business owners, and community leaders in a relaxed, high-energy environment designed for authentic conversations. Whether you’re looking to forge new partnerships, showcase your services, or simply expand your professional circle, this reception provides the perfect setting. With curated introductions, refreshments, and a collaborative atmosphere, the HVBA Networking Reception transforms casual networking into lasting value. Don’t miss the chance to connect, collaborate, and grow.

“We’re thrilled to bring the HVBA Benefits Roadshow to brokers across the industry — a dynamic event built to empower, educate, and connect,” said Rob Shestack, Chairman & CEO of the HVBA. “This is a unique opportunity for benefits brokers to gain strategic insights, expand their network with top carriers and solution providers, and stay ahead of the curve in an ever-evolving marketplace.”

In a gesture of appreciation to our attendees, HVBA is pleased to offer complimentary tickets to this event, made possible through the generous support of our sponsors.

To secure your spot at this exciting event and to access further details, please visit: https://www.eventbrite.com/e/2025-hvba-benefits-roadshow-nashville-tn-tickets-1388475901799?

For inquiries or additional information, please get in touch with Sarah Hunt, SVP of Administration at shunt@vbassociation.com or call (856) 326-5246.

Take advantage of this opportunity to be part of the HVBA Benefits Roadshow and take your professional network to new heights!

About Health & Voluntary Benefits Association® (HVBA):

HVBA is a leading organization dedicated to providing resources, education, and networking opportunities for professionals in the health and voluntary benefits industry. HVBA aims to foster collaboration, innovation, and excellence in the field through events, workshops, and online platforms.

Media Contact:
Sarah Hunt
SVP of Administration
shunt@vbassociation.com

We are thrilled to share the highlights of our recent event, on May 14^th in Houston, TX, which was an unforgettable experience for all attendees.

“This event was a powerful demonstration of the strength, collaboration, and forward momentum of our community,” said Jake Velie, Vice Chairman & President of the Health & Voluntary Benefits Association (HVBA) and Chairman and CEO of National Integrative Health. “Our goal was to create a space where professionals could learn, connect, and make meaningful contributions—and we delivered on that promise. But more importantly, this event showcased HVBA’s unwavering commitment to driving innovation into the marketplace. From groundbreaking solutions in pharmacy and data analytics to pioneering approaches in employer risk management, we introduced partners and strategies that have never been seen in this space before. HVBA is proud to be leading the way with cutting-edge solutions that are directly addressing the complex challenge of controlling healthcare costs.”

Here’s what was featured:

Innovation Summit: Attendees gained exclusive market insights, gaining firsthand knowledge of emerging trends and innovations shaping the future of voluntary benefits and healthcare strategies. Broker-centric content, focused on real-world solutions, sales strategies, tools, and revolutionary products and services shaping the next generation of benefits to better serve employer clients and expand their portfolio. These sessions ensured participants left with a thorough understanding of the current changes and dynamics affecting their clients. 

Attendees heard from industry leaders, including:

• MassMutual
• Fetch Pet Insurance
• National Workplace Violence & Safety Alliance (NWVSA)
• Juice Financial
• Summer
• American Public Life (APL)
• Motivity Care
• Uncommon Benefit Partners & National Integrative Health
• MediCircle

“The energy in Houston was incredible. We had a great mix of brokers and sponsors really leaning in, asking smart questions, and making meaningful connections,” said David Sherman, Chief Revenue Officer of the Health & Voluntary Benefits Association (HVBA) and Vice President at PTO Exchange. “It’s clear there’s a lot of excitement about what we’re building at HVBA—and we’re just getting started. Ask me about membership, happy to share why now’s the time to get involved.“

Experience at The Westin Houston Medical Center/Museum District: The event included a special networking reception at The Westin. This unique venue provided an engaging atmosphere where attendees could enjoy interactive content and meaningful networking opportunities. The attendee experience was designed to foster connections in a relaxed, intimate, and enjoyable setting.

Charity Auction & Raffle: Our charity auction was a highlight of the event, drawing enthusiastic participation from over 70 attendees. Bidders had the opportunity to win exclusive items while contributing to a worthy cause, Trinity Oaks, the only Purple Heart Wounded Warrior non-government ranch in the United States. The auction not only added an element of fun but also emphasized the community’s commitment to philanthropy, raising over $22,000 gross.

Networking Reception: After the Innovation Summit sessions, attendees gathered for the HVBA Benefit Roadshow Networking Reception. Throughout the event, attendees enjoyed a variety of five-star appetizers, food, and beverages. The culinary offerings were exceptional! This reception was an excellent platform for industry professionals to connect, share insights, and build long-term relationships. Brief speeches from industry leaders enhanced the networking experience.

“Thank you for putting together a great roadshow. I know it takes a ton of planning, event management, improvising, and so much more. It’s always great to get around some talented industry pros, and the conference was well done with good presentations. Trinity Oaks is awesome, and the prizes were great. Appreciate all that each of you do and thankful to be a small part of it,” shared Dennis Ontaneda, National Distribution Manager, Consumer Solutions & Voluntary Benefits Accident & Health for Zurich NA.

A special recognition goes out to our Executive and Advisory Board members, as well as our Sponsors, Attendees, and Members, who make these events possible.

“Our Houston event was a tremendous success, bringing together industry professionals to share knowledge, build connections, and support meaningful causes. We are grateful for the enthusiastic participation and generous contributions from everyone involved,” said Robert S. Shestack, Chairman & CEO of the Health & Voluntary Benefits Association and Chief Revenue Officer of Juice Financial. “This event showcased the best of our community’s commitment to excellence and collaboration. Stay tuned for HVBA in Nashville August 27 & 28th”.

For further information, please visit our website www.vbassociation.com. If you have any questions about sponsorship or membership, please reach out to Sarah Hunt at shunt@vbassociation.com.

By: Center for Connected Health Policy

An April 2025 report by Peterson Center on Healthcare, Evolving Remote Monitoring: An Evidence-Based Approach to Coverage and Payment, assesses remote patient monitoring (RPM) utilization across Medicare and Medicaid populations to provide policy insights around how remote monitoring technologies can improve clinical outcomes as well as reduce spending. The report looks at current coverage and reimbursement policies applicable to remote monitoring, the clinical benefits remote monitoring has been shown to provide, and recommendations to better align policies with clinical evidence.   According to the Centers for Medicare and Medicaid Services (CMS)’ Medicare Learning Network (MLN) Telehealth and Remote Patient Monitoring Fact Sheet, which was just updated last month, remote patient monitoring (RPM) allows a patient to collect their own health data using a connected medical device which automatically transmits the data to their provider. RPM encompasses both remote physiological monitoring and remote therapeutic monitoring (RTM). Remote physiological monitoring involves using non-face-to-face technology to monitor and analyze a patient’s physiological metrics, such as blood pressure, while remote therapeutic monitoring captures non-physiological data related to a therapeutic treatment, such as medication adherence. Medicare began reimbursing RPM in 2019, adding RTM reimbursement in 2022, and both of their respective code sets include three primary components: device supply, device set-up/education, and the provider’s time spent reviewing the data and managing treatment: RPM CPT & HCPCS CODES: Many state Medicaid programs have established RPM coverage policies similar to Medicare, with 41 states providing at least some type of RPM reimbursement based on CCHP’s research reflected in our policy trend maps. In terms of private payer RPM coverage, it is noted that RPM reimbursement across commercial insurers is not well-known, but some payers have adopted more narrow policies which limit the set of conditions eligible for RPM reimbursement.   The authors draw on the clinical benefit information gathered through the Peterson Health Technology Institute (PHTI) evaluations of digital health tools to treat the primary conditions associated with Medicare/Medicaid utilization of remote monitoring services: hypertension, diabetes, and musculoskeletal disorders. Additionally, there is some analysis of RPM duration of use by defining periods of continuous use as episodes to determine shifts in length of RPM use by condition. Overall, the analysis found that clinical effectiveness and duration of benefit vary by condition and product, and that remote monitoring is currently used by a very small percentage of Medicare/Medicaid populations. However, RPM utilization, as well as its duration of use, are quickly growing. Findings include:  Hypertension is the primary diagnosis for 57% of all Medicare beneficiaries with an RPM episode; musculoskeletal disorder is the primary diagnosis for almost 60% of beneficiaries with an RTM episode.The average RPM episode for hypertension lasts 6.6 months; the average RTM episode for a musculoskeletal disorder lasts 1.7 months.RPM blood pressure monitoring during periods of active medication management allows providers to quickly adjust patients’ hypertension medications, resulting in rapid improvements in blood pressure outcomes.Physical therapy RTM patients experience greater improvements in pain and function than those who receive only in-person physical therapy.RPM for diabetes may be most effective when targeting patients with the highest starting HbA1c levels and those who are at critical transition points in their care plan.One percent of Medicare beneficiaries use RPM today; they tend to be older, nonwhite, urban, more medically complex, and dually eligible for Medicare and Medicaid.Less than 0.2% of Medicare beneficiaries received RTM services in 2023; they tend to be older, white, women, and live in urban areas.In 2023, 451,000 patients in Medicare used RPM services, versus 44,500 in 2019.On average, the duration of continuous RPM use in Medicare rose from 1.7 to 5.2 months between 2019 and 2023. Based on these findings, the report recommends that policymakers consider:  1. Better aligning RPM coverage policies to the conditions/durations found to have the most clinical benefit. 2. Improving access to high-impact remote monitoring tools. 3. Requiring more specificity on RPM billing claims to improve data collection. The report makes an interesting suggestion in regard to the second recommendation, ensuring availability of high-impact remote monitoring tools. The evaluation found that most beneficiaries utilizing RPM were primarily located in urban areas. Therefore, to improve RPM access specifically in rural areas, which have higher rates of chronic disease and traditional access issues, it is suggested that CMS reassess its current geographic variations used for Medicare reimbursement. The authors acknowledge that the geographic variation seeks to align payment with local costs of living, but also highlight that it may limit national companies from offering digital health tools in more rural and low-cost regions.   In regard to the first recommendation, aligning policies with clinical evidence, the report notes that there currently is no Medicare limit on the conditions for which RPM may be used, as well as no limit on the duration of reimbursement. Nevertheless, the findings seem to show that current RPM condition/duration rates are already consistent with the clinical evidence in this area. For instance, the clinical evidence review found that RPM use in patients with hypertension is most valuable within the first six months, when active management of medications for blood pressure occurs. Meanwhile, Medicare utilization data found that an average RPM episode for hypertension lasts 6.6 months. In addition, the evidence shows that RTM improves outcomes for people with musculoskeletal conditions during targeted physical therapy episodes that last 2–4 months, while the average RTM episode for a musculoskeletal disorder was found to last 1.7 months.   The last recommendation relating to data collection also highlights that currently Medicare does not require RPM claims to explicitly report information related to the condition being treated and device being used, therefore the data and evidence available is not yet entirely clear.   As coverage of remote monitoring services and the devices used are still relatively new, it may be best for policymakers to first focus on strategies to increase both RPM access and data collection to form a more thorough evidence base before considering further refinements to RPM policies. RPM billing rules are already quite complex, and additional limitations may decrease both provider participation in utilizing RPM technologies in their practice, as well as patient access to the clinical benefits RPM provides.   For more information, please review Evolving Remote Monitoring: An Evidence-Based Approach to Coverage and Payment in its entirety. For information regarding RPM coverage and reimbursement policies within Medicare and Medicaid, please utilize CCHP’s Policy Finder to search by both topic and jurisdiction.

Source: Center for Connected Health Policy, personal communication, May 20, 2025

By: Center for Connected Health Policy

Policymakers have typically been cautious about enacting extensive regulations around artificial intelligence (AI), but as AI becomes more common, meaningful policy changes have gradually been accelerating. CCHP is currently monitoring 94 pending policies at both the state and federal levels regarding AI and healthcare through its Telehealth Legislation and Regulation tracker. Most significant AI policy adoption has occurred at the state level thus far, and recent AI developments at the federal level continue to focus around a largely deregulatory approach to its use.   Recent Federal AI Policy Developments As one of his first actions this term, on January 23, 2025, the President signed Executive Order (EO) 14179, Removing Barriers to American Leadership in Artificial Intelligence. The order seeks to revoke any existing policies that may limit American AI innovation, while also positioning the U.S. at the forefront of global AI leadership. In particular, the EO calls for the development of an Artificial Intelligence Action Plan across various federal agencies within 180 days of the order (by July 22, 2025), including identifying inconsistent policies that may be subject to revocation, as well as requiring the Office of Management and Budget (OMB) to revise particular prior administration procurement policies (OMB Memoranda M-24-10 and M-24-18) within 60 days of the order. In response, on April 7, 2025 the OMB released two new policy memos (M-25-21 and M-25-22) regarding federal agency use of AI and federal procurement. According to the fact sheet regarding the memos, they are meant to signal a fundamental shift toward pro-innovation and pro-competition policy, and away from more risk-averse approaches. The fact sheet also notes particular examples of how federal agencies are currently maximizing the benefits of AI, including the Department of Veterans Affairs (VA), which uses AI tools to optimize patient care, such as supporting the identification and analysis of pulmonary nodules during lung cancer screening exams to improve detection and life-saving diagnoses.   The key points included in the two new memos are summarized as follows: OMB Memorandum M-25-21, Accelerating Federal Use of AI through Innovation, Governance, and Public Trust – Rescinds and replaces OMB Memorandum M-24-10, Advancing Governance, Innovation, and Risk Management for Agency Use of Artificial Intelligence. – Directs agencies to: – Accelerate the Federal use of AI by focusing on three key priorities: innovation, governance, and public trust. – Remove unnecessary and bureaucratic requirements that inhibit innovation and responsible adoption, develop strategies that elevate AI adoption and innovation as a priority, while increasing transparency to the American public, civil society, and industry. – Invest in the American AI marketplace and maximize the use of US developed/produced AI products and servicesIdentify Chief AI Officers for each agency and OMB will convene an interagency council to maximize efficiencies and coordination – Implement minimum risk management practices for AI that could have significant impacts when deployed (high-impact AI) and prioritize safe, secure, and resilient AI. OMB Memorandum M-25-22, Driving Efficient Acquisition of Artificial Intelligence in Government – Rescinds and replaces OMB Memorandum M-24-18, Advancing the Responsible Acquisition of Artificial Intelligence in Government. – Seeks to ensure a competitive American Al marketplace – Acquiring solutions at the lowest cost, accelerating adoption of AI while avoiding costly dependencies on a single vendor, as well as communicating clear vendor requirements. – Aims to safeguard taxpayer dollars by tracking AI performance and managing risk – ensuring AI systems are consistent with their stated purpose and deliver consistent results to preserve public trust. – Promotes effective AI acquisition with cross-functional engagement, robust collaboration across agencies. OMB Memorandum M-25-22 also notes that its guidance should be considered in concert with other more general federal policies that may also apply to AI. Additionally, it states that for guidance on regulatory and non-regulatory approaches to AI applications outside of the federal government, agencies should consult OMB Memorandum M-21-06, Guidance for Regulation of Artificial Intelligence Applications, which was released November 17, 2020. The 2020 guidance is largely consistent with the above themes regarding encouraging innovation and growth in AI and reducing unnecessary barriers to the development and deployment of AI. It also notes consideration of non-regulatory approaches, including promoting sector-specific frameworks and voluntary standards. For instance, as mentioned in a recent TechTargetarticle regarding AI, the healthcare industry is already creating frameworks to ensure responsible uses of AI through collaboratives such as the Coalition for Health AI (CHAI)and the Trustworthy & Responsible AI Network (TRAIN). In terms of regulatory approaches, the memo also mentions that “agencies may use their authority to address inconsistent, burdensome, and duplicative state laws that prevent the emergence of a national market.”   Recent State AI Policy Developments As we see states adopting more AI policies, how those laws may interact with federal AI regulations will remain an important area to watch. We have seen a patchwork of inconsistent policy adoption across states and the federal government specific to telehealth over the years, which makes compliance and utilization of remote care increasingly more complicated. Nevertheless, states often have different interests and authorities that drive them to promote specific policy goals – such as improving access to care, protecting patient data, controlling costs, or mitigating risks related to new innovations – that may not always align with federal priorities. Some of the most common areas we have seen state AI policy focus around include states adopting their own AI advisory bodies, procurement related processes, as well as research and reporting policies. For instance, last year Indiana adopted SB 150 to create an artificial intelligence task force to study and assess use of AI technology by state agencies, while Maryland adopted SB 818, which requires state departments to conduct data inventories regarding artificial intelligence systems, as well as a subsequent report and recommendations, regarding the use of systems that employ artificial intelligence in health care delivery and human services. Another common policy found at the state level specific to healthcare is ensuring provider AI oversight and patient transparency related to AI uses. For example, California approved AB 3030 last year, which requires healthcare providers and facilities that use generative artificial intelligence to generate written or verbal patient communications to ensure that those communications include both a disclaimer that indicates to the patient that a communication was generated by generative artificial intelligence, as well as clear instructions describing how a patient may contact a human health care provider, employee, or other appropriate person. The bill would exempt from this requirement a communication read and reviewed by a human licensed or certified health care provider. Additionally, California adopted SB 1120, which requires health plans and insurers that use an artificial intelligence, algorithm, or other software tool for the purpose of utilization review or utilization management functions to ensure compliance with specified requirements, including that the artificial intelligence, algorithm, or other software tool bases its determination on specified information and is fairly and equitably applied. Arizona is also considering similar legislation, HB 2175, which would prohibit AI from being used by insurers to deny claims or prior authorizations for medical services and require a healthcare provider to review each claim or prior authorization request before issuing a denial.   Inconsistent Policies and Lessons from Telehealth As mentioned previously, the confusion that inconsistent policies may create can even be evidenced within the aforementioned federal guidance. For instance, Executive Order (EO) 14179 references a different definition for AI (15 U.S.C. 9401(3)) than OMB Memorandum M-25-21 (Public Law 115-232 (238(g))). Meanwhile, OMB Memorandum M-25-22 references a different definition for “artificial intelligence system” (Public Law 117-263 (7223(4)) and OMB Memorandum M-25-21 creates policies specific to “high-impact AI.” AI is considered high-impact when its output serves as a principal basis for decisions or actions that have a legal, material, binding, or significant effect on rights or safety. Therefore, as part of conducting internal reviews of high impact use, the memo states that agencies should evaluate the AI’s specific output and its potential risks when assessing the applicability of the high-impact definition. A high-impact determination is possible whether there is or is not human oversight for the decision or action. While different definitions often serve different purposes, they can also generate confusion around what is captured and required in each specific instance. This is why CCHP closely tracks the different definitions of telehealth on its website, as jurisdictions often create definitions specific to Medicare/Medicaid and private payers, as well as differing definitions for telehealth specific to provider professional requirements. While this may be common practice – different policy definitions within and across jurisdictions – it also may be an opportunity for policymakers to learn from the path telehealth policy has taken to address potential confusion at the forefront of policy creation, prior to adopting additional AI policies. Oregon for example, enacted HB 4153 last year to establish a task force on artificial intelligence that is required to examine and identify terms and definitions related to AI that may be used for legislation, beginning with examining terms and definitions used by federal agencies. Washington adopted SB 5838, which also creates an AI task force to assess current uses and trends, as well as benefits and risks, and make recommendations regarding AI legislation.   Public policy always has to walk a fine line between promoting technological innovation and protecting consumers, especially in healthcare, where both the care provided and policies implemented should remain as patient-centered as possible. Additionally, clear regulatory guidance across jurisdictions will better ensure policy compliance, though variations are often inevitable and reflective of different jurisdictional policy priorities. Therefore, as AI policy continues to progress, the availability of accurate resources and educational information regarding AI policy remains of utmost importance.   For more information regarding the recent federal AI policy developments, please review Executive Order (EO) 14179, OMB Memorandum M-25-21, and OMB Memorandum M-25-22 in their entirety. For more information on pending AI healthcare policy across jurisdictions, please access CCHP’s Telehealth Legislation and Regulation tracker.   Additional AI resources include: – The National Conference of State Legislatures (NCSL) tracks all AI related legislation on its various websites, including this summary of 2024 AI legislation, 2025 AI legislation, as well as an AI Policy Toolkit. – The Medicaid and CHIP Payment and Access Commission (MACPAC) recently held a panel focusing on the role of AI in the Medicaid prior authorization process, including opportunities to streamline processes as well as concerns related to algorithmic bias, inappropriate denials and oversight. – A recent TechTarget article covered how AI can benefit healthcare and common AI applications. – The California Telehealth Resource Center (CTRC) offers a number of healthcare AI resources in its AI toolkit. – The National Telehealth Technology Assessment Resource Center (TTAC) tracks related technologies, including AI enhanced telehealth devices. – The National Consortium of Telehealth Resource Centers (NCTRC) released an Artificial Intelligence in Rural Health Fact Sheet that can assist rural providers considering adopting AI tools and applications to enhance patient care. – The Coalition for Health AI (CHAI) offers collaborative guidance, including the Blueprint for Trustworthy AI Implementation. – The Trustworthy & Responsible AI Network (TRAIN), a consortium of healthcare leaders seeking to operationalize responsible AI principles. – The Health AI Partnership (HAIP), a multi-stakeholder collaborative seeking to empower healthcare organizations to use AI safely, effectively, and ethically. – The Healthcare Information and Management Systems Society (HIMSS) offers additional digital health resources, such as its AI and Emerging Technologies Toolkit for Healthcare Organizations. – The American Telemedicine Association (ATA) offers specific AI Principles and related resources.

By: Center for Connected Health Policy

The Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) recently released an additional extension of the effective date for two previously published federal final rules: Expansion of Buprenorphine Treatment via Telemedicine Encounter (Now Effective December 31, 2025)Continuity of Care via Telemedicine for Veterans Affairs Patients (Now Effective December 31, 2025)According to the new rule, the two telemedicine prescribing rules specific to buprenorphine and Veterans Affairs patients noted above, are now to be effective December 31, 2025. This date is consistent with the overall Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications rule, which permits providers to prescribe via telemedicine without meeting statutory in-person visit requirements through December 31, 2025. The announcement comes after another previous delay in these two particular rules taking effect (see more information in CCHP’s February 25th newsletter), as well as amidst the recent extension of the temporary Medicare telehealth waivers to September 30, 2025.   It is important to highlight that these telehealth extensions are specific to federal controlled substances prescribing rules and the federal Medicare program only. In addition, states have their own policies in place that may also impact the use of telehealth, including telehealth policies in state Medicaid programs, state private payer laws, and state professional requirements (all of which can be searched by topic and jurisdiction utilizing CCHP’s Policy Finder tool). While federal telehealth policy is mostly still governed by temporary allowances, state telehealth policies have largely stabilized since the onset of telehealth expansions in 2020, with many temporary changes already absorbed into permanent state policies. As you navigate through the following information it is important to remember that both federal and state policies govern a provider’s utilization of telehealth to provide care.   This week’s newsletter seeks to provide an overview of the recent federal telehealth extensions, a recap of the original prescribing rules released in January 2025, including the proposed special registration rule, while additionally highlighting potentially applicable state policies that providers should also be aware of to ensure full compliance when delivering care via telehealth.   FEDERAL PRESCRIBING RULES   Initial Release:The federal prescribing rules put forth by the DEA were released by the prior administration in January 2025.The original effective date for the final rules was set for February 18, 2025.(See CCHP’s January 21st summary for more details).Initial Delay:In February 2025, the effective date of the final rules was delayed until March 21, 2025.(See CCHP’s February 25th newsletter for more details).Latest Update (as of this newsletter’s writing):The most recent rule issued by the DEA further delays the effective date for:Telemedicine Prescribing of BuprenorphineTelemedicine for Veterans Affairs Patients The new effective date for both is now December 31, 2025.December 31, 2025 is the same date the currently in effect Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications expires.The Special Registration rule proposed in January 2025 with the Buprenorphine and Veterans Affairs final rules remains in proposed status with no current effective date. The public comment period for this rule closed on March 18, 2025. The initial delay of the final rules regarding buprenorphine and Veteran’s Affairs patients noted above sought to solicit public comment regarding the rules in response to the new administration’s White House memorandum, which called for “A Regulatory Freeze Pending Review” allowing agencies time for further review of any fact, law, and policy considerations prior to proposing, issuing, or finalizing any regulatory activities. In the latest rule, the DEA and HHS note receiving 32 comments related to the initial delayed effective date, and in response, “wishes to further postpone the effective dates for the purpose of further reviewing any questions of fact, law, and policy that the rules may raise.” Additionally, the rule notes that new effective dates for these rules do not functionally limit the ability to prescribe via telemedicine in the meantime, because the broader Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications permits telemedicine prescribing, without meeting in-person requirements, through December 31, 2025.   Final Buprenorphine Rule – Effective Date: December 31, 2025   Under the Controlled Substances Act, existing permanent prescribing law (which was active prior to the temporary telehealth waivers going into effect) authorizes telemedicine prescribing only under specified circumstances when no in-person visit has occurred, with few exceptions. The final rule, titled Expansion of Buprenorphine Treatment via Telemedicine Encounter, now creates an additional avenue for practitioners to meet an exception from the Controlled Substances Act when an in-person visit does not need to be conducted. The key provisions of this buprenorphine treatment expansion rule authorizing DEA-registered providers to prescribe buprenorphine for treatment of opioid use disorder (OUD) via audio-only or audio-video telemedicine include:  Prescription Drug Monitoring Program (PDMP) Review: Before issuing a telemedicine prescription for a Schedule III-V controlled substance approved for opioid use disorder (OUD) treatment, the provider must review the PDMP data for the patient’s state.Initial Prescription Limitations: Providers may prescribe an initial six-month supply (split among several prescriptions) without an in-person evaluation. Additional prescriptions require an in-person evaluation or must comply with other forms of telemedicine authorized under the Controlled Substances Act (CSA).Pharmacist Identity Verification: Pharmacists must verify patient identity before filling prescriptions.Notably, the rule does not impact provider-patient relationships where a prior in-person medical evaluation has occurred.   Final Veterans Affairs Rule – Effective Date: December 31, 2025   This final rule, titled Continuity of Care via Telemedicine for Veterans Affairs Patients, authorizes Department of Veterans Affairs (VA) practitioners to prescribe controlled substances via telemedicine to VA patients without a prior in-person evaluation, provided another VA practitioner has conducted an in-person evaluation at any time. Conditions include: Reviewing both the VA electronic health record (EHR) and the state PDMP where the patient is located.If the VA EHR or PDMP is unavailable, prescriptions must be limited to a seven-day supply until the provider can review the required data.This rule does not apply to non-VA-contracted practitioners or those providing care via the community care network (CCN).The DEA has indicated that while this rule is specific to VA practitioners due to their closed-system operation, it may consider extending similar authorities to non-VA providers in the future. Meanwhile, as noted previously, the DEA’s exemption from in-person requirements remains in place through December 31, 2025.   Proposed Special Registration Rule – Effective Date: TBD   The DEA has also proposed a rule, titled Special Registrations for Telemedicine and Limited State Telemedicine Registrations, to establish a permanent framework for telemedicine prescribing of controlled substances, outside of specific buprenorphine and Veterans Affairs circumstances discussed above, and after the expiration of the temporary expansions (discussed more below). The special registration rule was also released in January 2025 with the above two final rules, though because it was released as a proposed rule, rather than a final rule, it is not subject to the latest effective date extensions. This proposed rule creates a special registration framework that authorizes three types of telemedicine registration, in addition to additional prescribing, recordkeeping, and reporting requirements. The special registration framework requires registrants to utilize both audio and video components of an audio-video telecommunication system for each telemedicine encounter. The three types of special registration, include: Telemedicine Prescribing Registration: Allows qualified practitioners to prescribe Schedule III-V controlled substances.Advanced Telemedicine Prescribing Registration: Allows specialized practitioners (e.g., psychiatrists, hospice physicians) to prescribe Schedule II-V controlled substances.Telemedicine Platform Registration: Allows approved online telemedicine platforms to dispense Schedule II-V controlled substances through authorized providers.The proposed special registration rule also requires special registrants to maintain a State Telemedicine Registration issued by the DEA for every state in which a patient is treated by the special registrant, unless otherwise exempted. For additional information on special registration eligibility by provider type and limited exemptions to the state telemedicine registration requirement, as well as proposed registration processes, fees and reporting requirements, please see the proposed rule in its entirety. The public comment period for this rule closed on March 18, 2025. It is unknown how the rule and its review process may unfold as it moves forward within the current administration. Stay tuned to future CCHP newsletters for updates. Current Temporary Extension Rule – Expiration Date: December 31, 2025   While these final and proposed federal regulations discussed above would expand permanent controlled substance prescribing policies, they will not be as broad as what some have become accustomed to during the temporary waiver period, currently set to expire December 31, 2025. Under the latest Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications, which has now been extended three times since the flexibilities were initially implemented in 2020 (and is the only federal telehealth prescribing rule currently in effect), providers may prescribe controlled medications via telemedicine without conducting the statutorily required in-person medical evaluation of the patient. Meanwhile, the final and proposed prescribing regulations discussed above create more tailored and limited exceptions to the in-person medical evaluation requirement. Additionally, as noted above and discussed in more detail below, it is important to highlight that current state requirements should also be considered, as they may also apply to the provision of care and prescribing via telehealth.   FEDERAL MEDICARE POLICIES   As previously reported, another temporary federal telehealth policy extension occurred recently, specific to expanded Medicare coverage allowances also initially implemented in 2020. Under permanent federal Medicare policy, telehealth coverage is fairly limited and restricted to patients in rural areas and specific healthcare settings. Under the most recent federal Medicare policy extension, waivers of these limitations and related telehealth expansions are now maintained through September 30, 2025, including: Waiving geographic and specific site requirementsAllowing all eligible practitioners to furnish telehealth services, including federally qualified health centers (FQHCs) and rural health clinics (RHCs)Delaying mental health in-person requirementsAllowances for audio-onlyContinue to allow telehealth to be used to conduct the face-to-face encounter recertification for beneficiaries eligible for hospice care Extending the acute hospital at home programThe temporary Medicare telehealth waivers have been extended multiple times since they were initially enacted five years ago, similar to what has occurred with the federal prescribing allowances. The previous Medicare extension was set to expire yesterday (3/31/25), until Congress passed the latest Continuing Resolution in mid-March, adding at least six more months before the temporary Medicare waivers may potentially expire. As discussed in CCHP’s March 18 newsletter, while this extension can be seen as a step in the right direction, many telehealth stakeholders would prefer a longer and more permanent solution. However, as can be seen in some of the federal prescribing policies being considered, permanent solutions may come with additional stipulations and limitations as well.    STATE TELEHEALTH POLICIES   Individual states hold much of the authority around regulating telehealth. This includes implementing telehealth coverage rules that apply to state Medicaid programs and private payers. States are also responsible for adopting telehealth practice standards for providers licensed by state agencies. These standards may include various consent and prescribing requirements specific to the use of telehealth by a particular provider within the state’s borders. Additionally, telehealth is considered rendered at the patient’s location, so providers must be aware of and comply with multiple state policy frameworks applicable to telehealth if seeking to provide care across state lines. Federal laws applicable to Medicare and telehealth prescribing also stress that federal allowances are conditional upon providers additionally abiding by relevant state laws. Therefore, while federal policies (and the instability surrounding them) are very important to the overall telehealth landscape (especially if treating Medicare patients and prescribing controlled substances), state policies are potentially even more impactful, though often overlooked.   For instance, if a provider seeks to deliver care to Medicaid and commercially insured patients, coverage and reimbursement are primarily governed by state policy. Regardless of Medicare expansions, billing rules for other payers vary and may be more expansive or restrictive. Additionally, in regard to prescribing, providers should be aware that even though federal law establishes a baseline for controlled substance prescribing policies, states may impose stricter requirements, such as mandating in-person visits. For instance, Colorado statute prohibits providers registered as out-of-state telehealth providers from prescribing controlled substances. Similarly, Oklahoma statute states that telemedicine encounters cannot establish a valid physician-patient relationship for purposes of prescribing opiates, benzodiazepines, carisoprodol, or synthetic and semisynthetic opiates — unless it’s for prescribing opioid antagonists, partial agonists, or Schedule III, IV, or V controlled substances approved by the FDA for medication-assisted treatment or detoxification for substance use disorder. These examples illustrate how state laws can either entirely prohibit certain types of prescribing or impose additional criteria, even when federal law permits prescribing controlled substances without prior in-person visits or established physician-patient relationships (as a result of the telehealth waivers discussed previously).   Providers should be mindful of various state-specific nuances. For more prescribing details, refer to the online prescribing section of CCHP’s Policy Finder. Additionally, providers should also consult with the state agency that holds primary authority around licensing and overseeing their particular profession, both in their state as well as the state the patient is located, if applicable, to determine additional state professional requirements regarding the use of telehealth.   As mentioned previously, CCHP tracks both federal and state policies applicable to telehealth, which can be searched using CCHP’s Policy Finder tool by both jurisdiction and topic, including: Federal Telehealth PoliciesMedicare and State Medicaid Telehealth PoliciesLive VideoStore-and-ForwardRemote Patient MonitoringAudio-OnlyConsentOut-of-State ProvidersState Private Payer Telehealth RequirementsCoverage and Reimbursement ParityState Professional RequirementsConsentPrescribing/Establishing Provider-Patient RelationshipCross-State PracticeLicensure Compact MembershipAdditional topics are included in the Policy Finder that aren’t listed above, such as definitions for telehealth, miscellaneous telehealth policies, pending legislation/regulation, and professional board standards that may have been found specific to certain providers and states. As CCHP continues to track federal changes to telehealth policies, it is important to remain mindful of these state telehealth policies as well, and that they are also subject to change. CCHP is committed to keeping readers apprised of the latest telehealth developments at all policy levels, both through our weekly #TelehealthTuesday emails and through ongoing updates to the Policy Finder.   For more information on the recent Medicare telehealth waiver extension, please review the latest Continuing Resolution. For more information on the recent federal prescribing rule delay, review the latest rule in its entirety. Additional information on the individual federal prescribing rules referenced in this write-up and a timeline regarding the evolution of telehealth in federal prescribing policy can be accessed through the following links:Temporary Extension Rule (Currently in effect, expires December 31, 2025): Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled MedicationsBuprenorphine/VA Effective Date Delay to December 31, 2025: Expansion of Buprenorphine Treatment via Telemedicine Encounter and Continuity of Care via Telemedicine for Veterans Affairs PatientsPrevious Buprenorphine/VA Effective Date Delay to March 21, 2025: Initial Buprenorphine & VA Rule Delay Announcement and Comment RequestBuprenorphine Final Rule (New effective date December 31): Expansion of Buprenorphine Treatment via Telemedicine EncounterVA Final Rule (New effective date December 31): Continuity of Care via Telemedicine for Veterans Affairs PatientsSpecial Registration Proposed Rule (No effective date): Special Registrations for Telemedicine and Limited State Telemedicine RegistrationsCCHP Resource: Evolution of Telehealth Controlled Substance Prescribing Timeline (updated March 28, 2025)

Source: Center for Connected Health Policy, personal communication, April 1, 2025

In Burke County, a visit to the local pharmacy is more than just a routine errand it’s a familiar stop where you can count on a friendly smile behind the counter and personalized care. 

But small-town pharmacies across the country are facing a looming threat, one that many residents might not even realize exists: Pharmacy Benefits Managers or

PBMs. 

PBMs are the “middle- men” in the prescription drug supply chain. Originally established in the 1960s to help manage prescription benefits for insurers and negotiate drug prices with manufacturers, PBMs have grown into powerful Wall Street-traded corporations with significant control over what medications cost and how pharmacies are reimbursed.

According to the Federal Trade Commissions second interim staff report on prescription drugs released on Jan. 25, the three largest PBMs – CVS Caremark, Express Scripts, and OptumRx—now control about 79% of the market, and dictate anti-competitive contracts that leave small pharmacies struggling to survive.

One local pharmacy owner, who asked to remain anonymous, shed light on the harsh reality of below-cost reimbursements. We are losing on scrips,” they said. “A popular drug like Ozempic was $900-$950, and now that median price has jumped to $1,250. Of-ten, on brand-name drugs sold at the pharmacy, we net a loss of $20, sometimes even $60. Even with generics, we are still getting squeezed.”

These financial strains are the result of practices like spread pricing and below-cost reimbursements — two of the many complex strategies employed by PBMs.

Cristy Gupton, president of

Custom Health Solutions explained how this works: “PBMs reimburse the pharmacy at a lower amount while charging the health plan much more. The spread in between is what the PBM keeps.” The result is a situation where pharmacies often dispense medication at a loss, unable to cover even their acquisition costs.

These financial losses aren’t just a numbers game. When a PBM reimburses a pharmacy below cost, the pharmacy is left to make up the difference.

This is particularly difficult for brick-and-mortar pharmacies that lack the financial cushion of large chains.

“When our contract with the PBM causes a customer to either pay more or change what they have been taking, they blame us.” the pharmacist® said. “And then the PBM will redirect the customer to their pharmacy or mail order in-stead.” This is called patient steering, where the PBM steers patients to their commercial pharmacies promising lower co-pays and faster delivery of medication.

Gupton echoed this senti-ment, pointing to the opaque nature of PBM practices. “If it weren’t for PBMs. the price of insulin would be about $1.000 a year, about $80 a month.” she said. “The manufacturer’s cost has stayed fairly flat, but the margin that the patient has to pay is all in the PBM rebate. It’s extortion, in my opinion.” 

PBMs not only control pricing but also engage in practices that many see as anti-competitive. For example. PBMs often own their own pharmacies, including specialty and mail-order services.

The PBM can direct patients to these in-network options, leaving independent pharmacies out in the cold. “If we try to fight back against it then we risk getting audited, but PBMs won’t audit them-selves,” the local pharmacist said

Gupton explained how this anti-competitive behavior works: “PBMs come back later to the community pharmacy and charge them back DIR (Direct and Indirect Remuneration) fees. often called claw-backs. They create bureaucratic red tape that essentially says the community pharmacy didn’t follow all of the rules, so they take back the reimbursement.”

This practice creates an environment where local pharmacies operate under constant financial threat. “I’m trying to provide a service to my customers, but I can’t keep taking losses on scrips forever or I’ll have to close down,” shared the pharmacist.

Without state intervention, closure of small-town pharmacies across towns in Burke County could be a real outcome. According to the North Carolina Association of Pharmacists, more than 100 pharmacies closed between 2022 and 2024 with that number only projected to increase without legislation.

At the start of 2025, House Bill 246, which aimed to regulate Pharmacy Benefit Manager (PBM) practices in North Carolina, stalled in the state Senate and ultimately died from inaction.

In response, Rep. Heather Rhyne, along with several other members of the N.C. General Assembly, including Rep.Hugh Blackwell, introduced House Bill 163. a renewed effort to bring transparency and fair practices to the PBM industry in the state.

“We’re at a tipping point,” Gupton said. “If these trends continue, small-town pharmacies could disappear, leaving residents with fewer options, higher costs. and reduced access to critical medications.”

Nathanael Eure is a staff writer with The Paper. He mav be reached at 828-445-8595 or nathanael@thepaper.media.

The Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) have announced a delay in the effective date for the recently issued final rules regarding the telemedicine prescribing of buprenorphine and telemedicine for Veterans Affairs Patients (which are further detailed below). Originally scheduled to become effective February 18, the rules will now take effect on March 21, 2025. This decision aligns with the White House memorandum issued on January 20, which called for “A Regulatory Freeze Pending Review” to allow agencies further review of any fact, law, and policy considerations prior to proposing, issuing, or finalizing any regulatory activities. In particular, the DEA/HHS announcement cites the third paragraph of the Freeze Memo, which ordered agencies to consider postponing the effective dates for any recently published rules that have yet to take effect. The DEA and HHS have also confirmed that the waiver provisions established in the third extension of telemedicine flexibilities for prescribing controlled substances will remain in effect through December 31, 2025, ensuring that in-person visit requirements continue to be waived for the remainder of 2025. Public comments are being solicited on the postponement and whether the effective dates of the final rules should be extended beyond March 21. The notice also requests any comments related to potential issues of fact, law, or policy raised by the rules that should be considered. The comment period deadline is February 28. Below is a summary of the contents of the buprenorphine rule and Veterans Affairs rule, as well as a recap of the recently proposed Telemedicine Special Registration rule.  These rules were also summarized in a previous newsletter by the Center for Connected Health Policy (CCHP) when they were initially issued in January 2025. BUPRENORPHINE RULE Existing permanent law (which was active prior to the telehealth waivers going into effect) authorizes telemedicine prescribing only under specified circumstances when no in-person visit has occurred, with few exceptions. The new final rule, titled Expansion of Buprenorphine Treatment via Telemedicine Encounter, creates an additional avenue for practitioners to meet the requirements of the Controlled Substances Act when an in-person visit has not been conducted.  The key provisions addressing audio-only and audio-video telemedicine in the final buprenorphine rule include: – Prescription Drug Monitoring Program (PDMP) Review: Before issuing a telemedicine prescription for a Schedule III-V controlled substance approved for opioid use disorder (OUD) treatment, the provider must review the PDMP data for the patient’s state. – Initial Prescription Limitations: Providers may prescribe an initial six-month supply (split among several prescriptions) without an in-person evaluation. Additional prescriptions require an in-person evaluation or must comply with other forms of telemedicine authorized under the Controlled Substances Act (CSA). – Pharmacist Identity Verification: Pharmacists must verify patient identity before filling prescriptions. Notably, the rule does not impact provider-patient relationships where a prior in-person medical evaluation has occurred. VETERANS AFFAIRS RULE This final rule, titled Continuity of Care via Telemedicine for Veterans Affairs Patients, authorizes Department of Veterans Affairs (VA) practitioners to prescribe controlled substances via telemedicine to VA patients without a prior in-person evaluation, provided another VA practitioner has conducted an in-person evaluation at any time. Conditions include: – Reviewing both the VA electronic health record (EHR) and the state PDMP where the patient is located. – If the VA EHR or PDMP is unavailable, prescriptions must be limited to a seven-day supply until the provider can review the required data. – This rule does not apply to non-VA-contracted practitioners or those providing care via the community care network (CCN). The DEA has indicated that while this rule is specific to VA practitioners due to their closed-system operation, it may consider extending similar authorities to non-VA providers in the future. Meanwhile, as noted previously, the DEA’s exemption from in-person requirements remains in place through December 31, 2025. SPECIAL REGISTRATION RULE (Proposed Rule) The DEA has also proposed a special registration rule to establish a framework for telemedicine prescribing of controlled substances. This rule introduces three types of special registrations: 1. Telemedicine Prescribing Registration: Allows qualified practitioners to prescribe Schedule III-V controlled substances. 2. Advanced Telemedicine Prescribing Registration: Allows specialized practitioners (e.g., psychiatrists, hospice physicians) to prescribe Schedule II-V controlled substances. 3. Telemedicine Platform Registration: Allows approved online telemedicine platforms to dispense Schedule II-V controlled substances through authorized providers. Registrants under this rule must use both audio and video components for telemedicine encounters and obtain a State Telemedicine Registration for each state in which they treat patients unless exempted. Prescriptions must be issued electronically through Electronic Prescribing for Controlled Substances (EPCS) after verifying patient identity. Additionally, providers must conduct a nationwide PDMP check, though this requirement will have a delayed implementation timeline of three years. Until then, PDMP checks will be required for the patient’s state, the provider’s state, and any states with reciprocity agreements. For Schedule II controlled substances, further restrictions apply, such as requiring the prescribing practitioner to be in the same state as the patient and limiting the proportion of Schedule II prescriptions issued via special registration telemedicine encounters to 50% of the practitioner’s total Schedule II prescriptions in a calendar month.  Finally, the proposed rule establishes specific regulations for online telemedicine platforms that facilitate prescribing. It defines “covered online telemedicine platforms” based on criteria such as promoting or advertising-controlled substance prescriptions, financial incentives tied to prescribing volume, exerting control over clinicians’ prescribing decisions, and controlling patient medical records or prescriptions. Hospitals, clinics, insurers, and local in-person medical practices are exempt from these platform classifications. The proposed Special Registration Rule was published in the Federal Register on January 17, 2025, and public comments will be accepted through March 18, 2025. Again, the general DEA in-person requirement waiver remains in effect until the end of 2025. However, it is possible that state professional requirements around prescribing may also apply in the meantime – please utilize CCHP’s Policy Finder tool to search by state and topic for additional information. For full details on all the recent federal prescribing rules, refer to the following DEA regulations: – Effective Date Delay, Comments due February 28:  Buprenorphine & VA Rule Delay Announcement and Comment Request – Final Rule (New effective date March 21): Expansion of Buprenorphine Treatment via Telemedicine Encounter – Final Rule (New effective date March 21): Continuity of Care via Telemedicine for Veterans Affairs Patients – Proposed Rule, Comments Due March 18, 2025: Special Registrations for Telemedicine and Limited State Telemedicine Registrations For more background on past DEA attempts to adopt permanent telehealth prescribing regulations, please access: – CCHP’s September 2024 Newsletter Article: DEA Prepares New Regulations for Telemedicine Prescribing of Controlled Substances – CCHP’s July 2024 Newsletter Article: Regulatory Crossroads: Past, Present and Potential Future – Telemedicine Controlled Substance Prescribing Amid Fraud Concerns  – CCHP Resource: Evolution of Telehealth Controlled Substance Prescribing Timeline.

Source: Center for Connected Health Policy, personal communication, February 25 2025