telehealth

Specialty Pharmacy, Home Infusion Spaces Saw Myriad 2021 Changes

While the COVID-19 pandemic continued to impact the specialty pharmacy and home infusion spaces for the second straight year, other events also played a role. AIS Health spoke to some industry experts about 2021’s impact.

AIS Health: Looking back over the past year, what do you think were the most noteworthy occurrences within the specialty pharmacy industry, and why?

Dea Belazi, Pharm.D., M.P.H., president and CEO of AscellaHealth: Some of the noteworthy trends in SP have included the continued rise of the cost of specialty agents within health care expenditures, the continued emergence of ultra-high-cost specialty agents for rare and orphan diseases and the continued vertical integration of specialty pharmacies into health care organizations.

Medicaid MCOs Brace for Return of Churn, Other Challenges

As a condition of receiving enhanced federal funds during the COVID-19 public health emergency (PHE), states were required to take certain steps to ensure continuous Medicaid and CHIP coverage for most enrollees, leading to a nearly 18% jump in Medicaid enrollment. But with the latest PHE extension set to expire on Jan. 16, states will no longer receive such funds and will therefore no longer be required to maintain continuous coverage, although CMS has given them 12 months after the month in which the PHE ends to complete eligibility redeterminations. As a result, supporting states’ reverification efforts and ensuring that eligible members stay on the rolls or have a viable landing spot will be critical to Medicaid managed care organizations this year, industry experts tell AIS Health, a division of MMIT.

Payers, Plan Sponsors Hope for 2022 Telehealth, Drug Price Laws

Carriers and plan sponsors are taking stock of what federal policies deserve a fresh look as they work though tumultuous events like the pandemic and the telehealth boom. In the next year, major industry trade groups plan to push for policies including drug price reform and comprehensive telehealth regulation.

For the Alliance of Community Health Plans (ACHP), a trade group of nonprofit carriers, top priorities include changing Medicare Advantage risk adjustment rules to account for audio telehealth encounters, making some pandemic-era rules for telehealth permanent and passing drug price reforms. (ACHP also laid out more priorities in a Dec. 9 blog post.)

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CareFirst, Others Seek Behavioral Health Workforce Solutions

Since the start of the COVID-19 crisis, behavioral health issues have soared as an unprecedented number of patients seek ways to cope with anxiety, stress and despair. Yet despite the rising numbers, the industry faces an ongoing labor crunch.

More training and funding opportunities could help alleviate the burden that payers and affiliated provider groups are facing, according to a Dec. 8 webinar “Help Wanted: Addressing the Behavioral Health Workforce Shortage” led by CareFirst BlueCross BlueShield, which serves 3.5 million members throughout Maryland, Virginia and the District of Columbia.

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News Briefs: New Research Shows Rise in Telehealth Use Among Medicare Enrollees| Dec. 16, 2021

New statistics showing a rise in telehealth usage among Medicare beneficiaries during the pandemic make a strong case for permanently expanding telehealth coverage for Medicare patients. A new report from the HHS Assistant Secretary for Planning and Evaluation (ASPE) found that the number of FFS beneficiary telehealth visits rose from approximately 840,000 in 2019 to nearly 52.7 million in 2020, with the largest increase seen in behavioral health specialist visits. Black and rural beneficiaries demonstrated lower use of telehealth compared with white and urban beneficiaries, respectively. The report did not include results for Medicare Advantage members, since plans had discretion to offer telehealth prior to the pandemic, noted ASPE. Meanwhile, a new Medicare Telemedicine Data Snapshot from CMS showed that the number of Medicare beneficiaries (including MA enrollees) using telemedicine services between March 1, 2020, and Feb. 28, 2021, increased over 30 times the number of users from the prior year (March 2019 to February 2020). Dual eligibles had higher use of telehealth than those with just Medicare. “These latest numbers prove that when given the resources and opportunity to use telemedicine, many of these patients will opt to use the technology,” wrote Connected Nation, which seeks to fill broadband and digital technology gaps through partnerships across all sectors. “We would argue that among the critical needs is to expand not only access to broadband but also working to ensure it is affordable and that others understand both how to access the technology and how it can benefit them.”

Employer Plans in 2021: Premiums, Telemedicine Coverage Rise

The average annual premium for employer-sponsored health insurance increased 4% to $7,739 for single coverage and $22,221 for family coverage, respectively, this year, according to the Kaiser Family Foundation 2021 Employer Health Benefits Survey. In recent years, high-deductible plans with a savings option have been gaining popularity. About 22% of firms offered an HDHP/SO and 28% of covered workers were enrolled in such a plan in 2021, representing slight declines compared with previous years. Meanwhile, the COVID-19 pandemic has increased the use of telemedicine, as 95% of firms with 50 or more workers offered telemedicine coverage in their largest health plan, up from 85% last year. In addition, about 65% of firms with 50 or more workers made changes to enhance their telemedicine benefits after the beginning of the pandemic.

News Briefs: Becerra Defends No Surprises Act Regulation | Nov. 24, 2021

HHS Sec. Xavier Becerra is defending No Surprises Act-related regulations from growing criticism by providers and members of Congress, citing an HHS report on the cost and prevalence of surprise bills. Becerra said on Nov. 22 that providers who overcharge for services will simply have to change: “I don’t think when someone is overcharging, that it’s going to hurt the overcharger to now have to [accept] a fair price,” he told Kaiser Health News. “Those who are overcharging either have to tighten their belt and do it better, or they don’t last in the business. It’s not fair to say that we have to let someone gouge us in order for them to be in business.” The HHS report found that “surprise medical bills are relatively common among privately insured patients and can average more than $1,200 for services provided by anesthesiologists, $2,600 for surgical assistants, and $750 for childbirth-related care.” More than 150 members of Congress from both parties, many of them physicians, sent a letter to Becerra earlier this month protesting the latest rulemaking on the No Surprises Act. In addition, Texas’ largest provider organization filed suit to block the latest interim final rule.

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Frustration Grows Over ‘Relentless’ Employer Plan Premium Rise

The premium costs of employer-sponsored health plans increased by 4% this year, according to the Kaiser Family Foundation’s (KFF) annual Employer Health Benefits Survey. KFF analysts and health care purchasers alike say the annual growth rate in health care costs — employer plan premiums for a family have grown by 47% since 2011 and 283% since 1998, according to KFF — causes unsustainable financial strain for both employers and plan members.

KFF also identified several emerging trends in employer coverage driven by cost growth and the COVID-19 pandemic. Deductibles and other forms of member cost sharing have increased in recent years. The share of employees in high-deductible plans declined slightly in 2021, but accounted for roughly a quarter of employer enrollment, a similar figure to recent years. Employer insurance experts have mixed opinions on whether these trends will continue. Meanwhile, in response to the pandemic, firms expanded their telehealth offerings and behavioral health benefits this year.

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Employer Plans in 2021: Premiums, Telemedicine Coverage Rise

The average annual premium for employer-sponsored health insurance increased 4% to $7,739 for single coverage and $22,221 for family coverage, respectively, this year, according to the Kaiser Family Foundation 2021 Employer Health Benefits Survey. In recent years, high-deductible plans with a savings option have been gaining popularity. About 22% of firms offered an HDHP/SO and 28% of covered workers were enrolled in such a plan in 2021, representing slight declines compared with previous years. Meanwhile, the COVID-19 pandemic has increased the use of telemedicine, as 95% of firms with 50 or more workers offered telemedicine coverage in their largest health plan, up from 85% last year. In addition, about 65% of firms with 50 or more workers made changes to enhance their telemedicine benefits after the beginning of the pandemic.

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Medication Abortion Regulations, at a Glance

Medication abortion — which involves using two drugs, mifepristone and misoprostol — accounts for 54% of all pregnancy terminations before nine weeks of gestation in the U.S., according to a recent Kaiser Family Foundation analysis. The FDA’s Center for Drug Evaluation and Research exercised “enforcement discretion” of the Risk Evaluation and Mitigation Strategy requirement that asks prescribers to dispense mifepristone to patients in-person during the pandemic. This allows providers in 32 states and the District of Columbia that do not have laws that ban medication abortion to dispense mifepristone via telehealth. Currently, 18 states and D.C. allow both advance practice clinicians and medical doctors to dispense abortion pills.