The average annual premium for employer-sponsored health insurance in 2022 was $7,911 for single coverage and $22,463 for family coverage, similar to the average premiums last year, according to the Kaiser Family Foundation 2022 Employer Health Benefits Survey. On average, employees contributed 17% toward single coverage premiums and 28% toward family coverage premiums. Among employees at small firms, 33% of them chose a plan where the employer paid the entire premium for single coverage, compared with only 6% at large firms. Meanwhile, 31% of small firm workers were in a plan that required them to contribute more than half of the premium for family coverage.

Since the FDA’s approval of the first biosimilar — Zarxio (filgrastim-sndz) from Sandoz, a division of Novartis Pharmaceuticals Corp. — on March 6, 2015, the agency has approved almost 40 more agents via the 351(k) pathway established under the Biologics Price Competition and Innovation Act (BPCIA), itself part of the Affordable Care Act (ACA). Although not all of those agents have launched yet, and almost all of the ones that have are all professionally administered, industry experts say they expect to see more competition in the space, depending on interchangeability status, provider uptake and the impact of the Inflation Reduction Act.

Highmark Health recently implemented a medical policy stating the insurer will cover digital prescription therapeutics (DPTs) under certain circumstances. The decision is “incredibly significant for our industry,” Akili Interactive Labs chief executive and co-founder Eddie Martucci, Ph.D., writes in an email to AIS, a division of MMIT.

Highmark’s policy pertains to Akili’s EndeavorRx treatment for children with attention-deficit/hyperactivity disorder as well as the eight other FDA-approved DPTs, which are software-based therapies to treat medical and behavioral conditions. DPTs treat conditions such as substance use disorder, opioid use disorder, irritable bowel syndrome and chronic lower back pain.

More than 1,400 Medicare Advantage plans will offer at least one Expanded Primarily Health-Related Benefit (EPHRB) in the 2023 plan year, according to a new report from ATI Advisory. CMS in 2019 reinterpreted the definition of what constitutes as a “primary health-related” benefit, which allowed plans to offer a wider range of supplemental benefits such as adult day health services, support for caregivers of enrollees and therapeutic massage. The most commonly offered EPHRB is in-home support services, which is available in at least one plan in the majority of U.S. counties, according to ATI’s analysis. Two EPHRBs — in-home support services and support for caregivers — saw significant uptake from 2022 to 2023, growing 50% and 83%, respectively. An earlier analysis from ATI found that more than 30% of MA members are currently enrolled in a plan that offers at least one type of supplemental benefit, which includes both EPHRBs and Special Supplemental Benefits for the Chronically Ill.

Highmark Health recently implemented a medical policy stating the insurer will cover digital prescription therapeutics (DPTs) under certain circumstances. The decision is “incredibly significant for our industry,” Akili Interactive Labs chief executive and co-founder Eddie Martucci, Ph.D., writes in an email to AIS, a division of MMIT.

Highmark’s policy pertains to Akili’s EndeavorRx treatment for children with attention-deficit/hyperactivity disorder as well as the eight other FDA-approved DPTs, which are software-based therapies to treat medical and behavioral conditions. DPTs treat conditions such as substance use disorder, opioid use disorder, irritable bowel syndrome and chronic lower back pain.

When the 2023 open enrollment period for Affordable Care Act exchange plans officially begins on Nov. 1, health insurers will be offering plans in a market full of contrasts: where, for example, rising premiums are masked by enhanced subsidies, and where health plan competition is at its highest level but there’s fewer new-to-the market insurers than there were in 2022.

New regulatory changes are also taking effect in the 2023 plan year. Most notably, insurers will have to offer standardized plans alongside their other products for the first time since the Obama administration, and CMS will be evaluating plans for quantitative network adequacy standards.

While some state officials have had more success than others, most states struggle to enforce mental health parity requirements set by federal law, according to a new report from the Georgetown University Center for Health Insurance Reforms (CHIR) and the Robert Wood Johnson Foundation (RWJF). One of the report’s authors and a mental health patient advocate both say that states need more resources to enforce parity requirements.

State officials have the responsibility of enforcing federal statutes such as the Mental Health Parity and Addiction Equity Act (MHPAEA) in the individual and fully funded employer health plan markets. Many states also have their own parity statutes as well. However, as the report puts it, “federal and state regulators have found that enforcing the complex law is challenging. While insurers’ quantitative barriers to treatment such as cost-sharing or visit limits can be relatively straightforward for regulators to assess, certain ‘non-quantitative’ treatment limits [NQTLs], such as the use of prior authorization, provider reimbursement, and formulary design are much more difficult.”

As the Oct. 15 start date of the 2023 Medicare Annual Election Period (AEP) approached, insurers across the country this month unveiled new-and-improved benefits and major market expansions aimed at capturing share of the ever-growing Medicare Advantage market. And while Long Beach, Calif.-based SCAN Health Plan is offering enhanced benefits and pursuing new markets, it’s also gaining attention for launching a novel product specifically geared toward LGBTQ+ older adults. Company executives tell AIS Health, a division of MMIT, that the nonprofit insurer spent more than a year carefully shaping the product to ensure that it would meet the needs of the LGBTQ+ community, and it will continue to tweak the product as it gathers feedback from enrollees.

As CMS resumed normal Star Ratings calculations and gave greater weight to patient experience measures, the proportion of Medicare Advantage Prescription Drug (MA-PD) plans earning 4 stars or higher for 2023 saw a dramatic drop from 2022, according to newly released CMS data. In an AIS Health series on successful Star Ratings strategies, top performers highlight connecting the dots around medication adherence, maintaining a year-round focus on member experience, and helping members navigate and utilize their benefits as key priorities. And while member outreach is a critical part of those initiatives, successful plans are careful to avoid overcommunicating with members and creating message fatigue, sources tell AIS Health, a division of MMIT.

Medical costs are going up and employer plan sponsors are feeling the pressure, according to several recent surveys of health benefit purchasers. Large-group purchasers are pursuing a variety of strategies, including direct contracting and new coverage models, to offset rising medical costs and the anticipated impact of inflation on medical trend, while small-group participation seems to have grown in recent years and could see even more adoption through new coverage models.

Most surveys of plan sponsors found that purchasers, particularly large purchasers, expect medical trend around 6% next year: