Consumer Engagement

Stand-Alone PDP Market Is Poised for Disruption, Experts Predict

The stand-alone Prescription Drug Plan (PDP) market — which was already in decline — is poised to take even more hits due to regulatory and legislative changes that are taking effect in 2024 and beyond, according to industry observers. Indeed, one expert who analyzed data from CMS’s 2024 Medicare Advantage and Part D “landscape files” predicts that “a lot of people are faced with pretty significant premium increases” next year.

There’s a complicated calculus driving that trend, explains Tom Kornfield, a senior consultant at Avalere Health. But both he and equities analyst George Hill agree that the Inflation Reduction Act of 2022 (IRA) is a major factor.

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Intermountain, Mark Cuban Cost Plus Drug Co. Strike Online Generics Deal

Mark Cuban Cost Plus Drug Co. and Select Health, the managed care arm of Utah-based nonprofit health system Intermountain Health, on Sept. 19 struck a deal to provide Select Health members with what a press release called “direct access” to Cost Plus’ online generics pharmacy. Select Health tells AIS Health, a division of MMIT, that members’ level of access to Cost Plus depends on their plan design and plan sponsor: Some members may be able to count any purchases made through Cost Plus toward their annual deductible and out-of-pocket maximum.

Intermountain, which owns its own PBM, Scripius, is just the latest notable regional player to partner with Cost Plus on generics. The deal comes shortly after the much discussed move by Blue Shield of California to unbundle its PBM contracts. (As part of Blue Shield’s new strategy, Cost Plus will manage retail pharmacy pricing and payment for the insurer.)

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Reports of Cold Calling, False Promises Puts Medicare Marketers on Alert

As Medicare Advantage insurers prepare for the Oct. 1 start of Annual Election Period (AEP) marketing, they face an increased level of scrutiny as CMS implements various provisions aimed at curbing misleading and aggressive marketing practices. But new research suggests that some of the marketing misconduct of years past could rear its ugly head again this fall, prompting industry experts to question whether CMS should take additional steps or if action from Congress is needed.

Released on Sept. 12, the Commonwealth Fund’s survey of seniors’ experiences during the last week of the 2023 AEP tells the familiar tale of Medicare beneficiaries inundated with marketing messages during open enrollment. Nearly all seniors saw or received some form of plan marketing — ranging from phone calls to television advertisements — and more than three-quarters reported seeing television or online ads once daily. Additionally, 73% received phone calls at least once a week, and 30% reported receiving at least seven calls in a week. And despite CMS rules barring marketers from calling beneficiaries unless they’ve agreed to be contacted or requested the call, 74% of all respondents reported receiving an unsolicited call from a plan or plan representative.

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Researchers Take Closer Look at Virtual Mental Health Care Boom

Now that the COVID-19 public health emergency has ended, the health care system — including insurers — are grappling with how to proceed in the “new normal” amid shifted habits and utilization patterns. To that end, two new studies offer insights into the implications of patients’ growing use of telehealth for mental health care services.

“The COVID-19 pandemic has caused massive amounts of changes in health care delivery, but then also in terms of how individuals are dealing with the pandemic. There’s been extensive research about how anxiety has increased or [how] other mental health disorders have increased,” observes Jonathan Cantor, Ph.D., a policy researcher at RAND Corp. With that in mind, Cantor and his fellow researchers sought to build on a previous study and measure how both telehealth and in-person mental health utilization and spending has changed from 2019 to 2022.

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MA Insurers Turn Up the Heat With Pre-AEP Awareness, Messaging Campaigns

Medicare Advantage insurers can’t share the juicy details of their new plan offerings until Oct. 1, but they are taking steps to prime the market and help boost enrollment during the 2024 Annual Election Period (AEP) with “preheat” strategies. Such efforts are often used to create or reinforce brand awareness in the month or two leading up to the AEP, and some insurers are shifting more dollars to this channel as consumer switching is expected to rise again this year, marketing experts tell AIS Health, a division of MMIT. (Warning: The following article contains an abnormal amount of marketing lingo.)

“Before AEP starts, ‘market warming’ with mail and DRTV [direct response television] continues to pay off. In fact, many say that if a plan misses pre-AEP market outreach, they’ve missed most of the available leads for the period. For some plans, these early leads represent over half of all AEP volume,” says Lindsay Resnick, executive vice president with Wunderman Thompson Health. However, such efforts are successful only if the plans’ “sales funnel” and call center are prepared to handle high call volumes and if they have a “lead nurturing” process in place to optimize the value of these leads, he advises. For example, “responder non-converters” (i.e., those who have responded in the past but did not become members) tend to convert at higher rates, he notes.

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Consumers Could Use More Help Choosing Individual Market Plans, Study Suggests

A survey of people enrolled in Affordable Care Act marketplace plans in California found that 28% had difficulty paying their premiums in 2021, according to a study published last month in Health Affairs. While that is an improvement from 40% in a similar sample of enrollees in 2017, Vicki Fung, Ph.D., the study’s lead author, tells AIS Health that more could be done to help people choose affordable coverage and determine whether they are eligible for cost-sharing subsidies.

Fung notes that health insurers could help people with consumers’ decisions, including coordinating with agents and brokers that insurers work with and steering people who are eligible for generous subsidies toward purchasing a similar plan via the ACA exchange rather than off-marketplace.

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Preventive Services Recommendation May Not Increase Injectable PrEP Access

A federal panel of medical experts on Aug. 22 recommended that pre-exposure prophylaxis be prescribed to people at increased risk of HIV infection, and included long-lasting, physician-administered injectable forms of PrEP in its guidance. However, a leading vaccine expert says the decision by the U.S. Preventive Services Task Force (USPSTF) is unlikely to increase access to PrEP, especially given an ongoing conservative-led legal battle that threatens to overturn the preventive services mandate included in the Affordable Care Act.

USPSTF granted PrEP an “A” grade, its highest rating. In the rating, USPSTF experts “recommend[ed] that healthcare professionals prescribe PrEP to people at increased risk for HIV to help prevent HIV.” Notably, the new rating mentions injectable PrEP, Apretude (cabotegravir extended-release injectable suspension), which had not been included in USPSTF PrEP recommendations before. In a 2019 PrEP endorsement, the task force only mentioned oral PrEP.

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mPulse Infuses Behavioral Science Into Text-Based Outreach to Medicaid Members

As Medicaid managed care organizations look to assist states with ensuring enrollees maintain coverage throughout the redetermination process, text messaging is often seen an effective way to reach members whose only method of communication may be a smartphone. During an Aug. 9 webinar hosted by Medicaid Health Plans of America, mPulse Mobile Chief Marketing Officer Brendan McClure said the technology company has reached out to more than 7 million members this year on behalf of its Medicaid plan clients.

The engagement solutions provider divides its phone-based outreach efforts into two main categories:

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Medicaid MCOs Try Multiple Touchpoints to Boost Redetermination Awareness

Effective April 1, states were allowed to begin disenrolling people from Medicaid who no longer qualify after a multiyear pause during the COVID-19 public health emergency (PHE). Yet data from the federal government suggests many people are losing coverage for procedural reasons, and surveys show a concerning lack of awareness regarding the redetermination process. Medicaid managed care organizations say they are working to supplement outreach efforts from state and federal agencies and are trying a variety of tactics to activate impacted members, including text messaging and notifications at the pharmacy. Since the start of redeterminations, CMS has clarified that states may rely on MCOs to assist enrollees with completing and submitting renewal forms and even pay them for this type of work.

KFF estimates that at least 4.77 million Medicaid beneficiaries have been disenrolled as of Aug. 15, with three quarters of disenrollments occurring for procedural reasons. HHS had previously estimated that 8.2 million people will no longer qualify for Medicaid once redeterminations resumed and find other coverage, while 6.8 million Medicaid enrollees could lose coverage despite still being eligible.

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Capital Blue Cross, Other Payers Are Looking to Lower Costs Related to Diabetes

Since implementing diabetes-related programs in 2021, Capital Blue Cross said it has saved its members and their employers nearly $6 million in health care costs. Meanwhile, Humana Inc. has launched a diabetes self-management education and support (DSMES) program through its CenterWell Home Health subsidiary that has seen an uptick in usage among health plans. The initiatives are part of a growing trend among payers that recognize the health burden and huge costs associated with diabetes.

Kelly Brennan, Capital Blue Cross’s senior director of Health Promotion and Wellness, tells AIS Health that the insurer’s beneficiaries with diabetes often have other chronic conditions, “which can be expensive to manage, both for our members and for business leaders who rely upon us to provide strategic solutions that curb health care spending and ensure their employees can be their healthiest.”

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