Among people who filled at least one insulin prescription, 14.1% reached catastrophic health spending — out-of-pocket medical spending greater than 40% of a household’s remaining income after subsistence needs are met — and almost two-thirds of them were Medicare beneficiaries, according to a recent Health Affairs study.

The study was based on data from the Medical Expenditure Panel Survey in 2017 and 2018. Among the respondents who filled at least one insulin prescription, 41.1% were covered by Medicare and 35.7% by private insurance. Median annual out-of-pocket spending on insulin was $97.72, while people with Medicare coverage and private insurance paid much more than Medicaid enrollees.

Although the prediabetes prevalence rate increased by 4.8 percentage points between 2010 and 2020, access to the National Diabetes Prevention Program remained limited, with only 3% of people with prediabetes participating in the program, according to a recent Health Affairs study. The researchers estimated 13.5% prevalence of diagnosed prediabetes and 30% of potentially undiagnosed prediabetes in 2020, using two national surveys.

The National Diabetes Prevention Program — an intensive 12-month, group-based, lifestyle intervention to prevent or delay type 2 diabetes — remained underused and undersupplied. Only 5% of patients diagnosed with prediabetes were referred to such a program. In general, men were more likely to be referred but less likely to participate than women.

In 2022, the majority of plan sponsors used a drug benefit consultant while designing their drug benefit programs, according to Pharmaceutical Strategies Group’s 2022 “Trends in Drug Benefit Design Report,” sponsored by Rx Savings Solutions. The report, which is based on surveys of 153 individuals representing employers, union/Taft-Hartley plans and health plans that covered an estimated 35.1 million lives, also revealed an increasing focus on member satisfaction.

Medicare Advantage members can experience markedly different outcomes in measures related to prescription drugs based on race and/or ethnicity that ultimately impact their overall quality of care, according to the CMS Office of Minority Health’s latest report on health disparities in MA. The report, “Disparities in Health Care in Medicare Advantage by Race, Ethnicity, and Sex,” was funded by CMS and conducted by RAND Health Care’s Quality Measurement and Improvement Program. The report authors studied both the 2021 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and the 2021 Healthcare Effectiveness Data and Information Set (HEDIS), highlighting disparities in several clinical areas. In addition to the prescription drug measures illustrated in the graphics below, the report also covered other clinical care measures such as cancer screening rates and patient experience measures including the ease of getting medical appointments and customer service experiences.

Over 70% of employers with 500 or more employees are planning to enhance their benefit programs in 2023, with increasing emphasis on health care affordability, work and life balance and women’s reproductive health, according to Mercer’s “Health & Benefit Strategies for 2023 Report.” The report, which is based on surveys of 708 organizations with a focus on the 451 large employers, also found that health benefit strategies are becoming less about reducing health care costs but more about supporting the emotional, physical, social and financial well-being of employees.

In 2022, the majority of plan sponsors used a drug benefit consultant while designing their drug benefit programs, according to Pharmaceutical Strategies Group’s 2022 “Trends in Drug Benefit Design Report,” sponsored by Rx Savings Solutions. The report, which is based on surveys of 153 individuals representing employers, union/Taft-Hartley plans and health plans that covered an estimated 35.1 million lives, also revealed an increasing focus on member satisfaction.

About 18.3% of in-network claims were denied by non-group qualified health plans (QHPs) offered on HealthCare.gov in 2020, according to a recent Kaiser Family Foundation analysis. Among the 144 issuers in HealthCare.gov states with complete data on claims received and denied, 52 of them had a denial rate between 10% and 19%. In 2020, the majority of denials (72%) were classified as “all other reasons,” while one in five of the roughly 765,000 medical necessity denials involved behavioral health services. In addition, of the more than 42 million denied claims in 2020, marketplace enrollees appealed fewer than 61,000 claims — a 0.1% appeal rate — and insurers upheld 63% of denials that were appealed.

Here’s how major health insurers’ stock performed in June 2022. UnitedHealth Group had the highest closing stock price among major commercial insurers as of June 30, 2022, at $513.63. Molina Healthcare, Inc. had the highest closing stock price among major Medicaid insurers at $279.61.

The proportion of open abortion facilities that accept any type of health insurance declined from 89% in 2017 to 80% in 2019 and 2020, while median patient self-pay charges for abortion are going up, according to a study published in Health Affairs in April. The South has the lowest percentage of health insurance acceptance, yet the Midwest saw the largest decrease over the four years, from 88% in 2017 to 75% in 2020.

CMS recently approved Maine, Minnesota, New Mexico and Washington, D.C., to offer 12 months of postpartum coverage through Medicaid and Children’s Health Insurance Program (CHIP) extensions, adding an additional 15,000 enrollees annually with extended coverage from 60 days to 12 months after pregnancy. In total, nearly 253,000 people in 14 states and D.C. have gained such access as a result of the American Rescue Plan Act (ARPA).

Starting on April 1, states were able to apply “to extend Medicaid postpartum coverage to 12 months via a state plan amendment,” according to the Kaiser Family Foundation. So far, Connecticut, Indiana, Kansas, Maryland, Massachusetts, North Carolina, Pennsylvania, Washington and West Virginia have also submitted the extension proposals.