This is Jacob Emerson with Becker payer issues
podcast.
Here's your bi weekly industry news briefing for
May 20 second.
Well, a new study from the Blue Cross
Blue Shield
Association published May 20 first is found that
a majority of patient taking weight loss drugs,
discontinue use of their medication before reaching a
clinically meaningful health benefit it. That study was
conducted by the data arm of the association,
Blue Health Intelligence,
and it's based on national pharmacy and medical
claims data from nearly a hundred and 70000
commercial insurance members, the largest study of its
kind to date. Members included in that study
were prescribed Go or Sa between July 20
14 and December 20 23,
and they had at least 6 months of
continuous enrollment before and after they began taking
Gl ones. High Patients taking those drugs should
complete at least 12 weeks of continuous treatment
and to achieve weight loss that will positively
impact their health.
Bc sa, Vp of clinical affairs said that
when patients take medication, they wanted to be
safe and effective. The study shows, most people
are unlike to see lasting benefits and that
unfortunately, weight loss isn't as simple as filling
a prescription.
Now, in that study, it really found that
58 percent of patients discontinued Gl 1 use
before reaching a clinically meaningful health benefit.
30 percent of patients
continued use of weight loss drugs within the
first month of treatment.
A majority of Gl 1 prescriptions came from
a primary care provider,
patients who received a prescription from an endo
or obesity medicine specialist or more likely to
stick with treatment.
Patients who saw their physician more often, regardless
of specialty. We're more likely to continue with
treatment.
Patients ages 18 to 34 were more likely
to drop out of treatment. Sooner.
Gender had no effect on dropout rates in
the first 12 weeks and patients with coexist
conditions such as peripheral vascular disease or diabetes,
Particularly those with 3 or more similar conditions
were more likely to continue traits
Well, 2 states have recently signed prior
authorization reform bills into law In Oklahoma, a
bill signed, will require prior authorization procedures to
be published on websites available to patients and
provider.
This bill goes into a effect on January
first.
Those with chronic conditions must be notified no
less than 60 days prior to changes that
will affect them. If a prior authorization is
denied, appeals must be reviewed by providers of
the same or similar specialties.
Payers must respond to urgent requests within 72
hours and within 7 days for non urgent
request.
And in Vermont, the governor Phil Scott has
signed a bill to reform the prior authorization
process in the state. That legislation aligns prior
auth with Medicaid and claim edits With Medicare.
It also allows patients and providers to ask
for exemptions to step therapy, and requires payers
to decide prior authorization hospitalizations within 24 hours
for urgent situations and 2 business days for
non urgent care. It also directs the state's
Department of Financial Regulation to prohibit prior author
requirements for certain medications and services
and require insurers to collect cost sharing amounts
from patients.
Bc of Vermont had raised concerns that the
legislation would cause insurance rates to rise between
5 and 7 percent. The governor said that
to alleviate to pay concerns, he is directing
the State's Department of Financial Regulation, and the
agency of human services to jointly study the
effects of the bill on health outcomes, costs,
and insurance rates They are to report back
to him on the findings.
That study will also include a cost impact
analysis of prior authorization laws in other states.
To evaluate whether they have been successful in
improving outcomes or reducing health care costs by
reducing burdens for providers
The governor's also requesting that the Green Mountain
care board uses its authority to identify cost
savings associated with reduced administrative burdens and to
which ensure those savings pass all the way
through to state residents in the form of
lower costs,
that legislation goes into effect in January 20
25.
Well Opt rx has unveiled a new pricing
trend on May twentieth, following an industry wide
trend of increasing transparency on medication costs.
The pharmacy benefits pricing offering called Opt
clear trend guarantee
combines guarantees into a single per member cost
and will offer drug benefit plan sponsors greater
predictability of pharmacy spend. It's to help manage
total lowest net cost. The company said the
new pricing model, which will be available in
January 20 25.
Builds upon its cost made clear payment solutions
that feature cost plus pricing with lower ingredient
cost. Clear trident and guarantee is an alternative
that combines resale, home delivery,
specialty drug and rebate components into 1 per
member value based model.
Opt, the third largest Pb with its handling
of 22 percent of Us
prescription claims in 20 23
is jumping into a popular trend.
Following the increasing disruption status of Mark Cuban
cost plus drugs pricing model. The nation's largest
Pb are now offering similar services,
as consumers demand more transparency and federal investigators
probe the industry.
And finally, employer adoption of Ic is up
29 percent since 20 23. That's according to
a may report from the Hr council.
Or individual coverage health reimbursement arrangements
allowing employers to offer a defined tax advantage
contribution used to reimburse premiums
for an individual health plan purchase by employee
on their state's Aca exchange.
Now
Adoption grew 29 percent year over year between
20 23 and 24.
Ic 84 percent among employers with 50 or
more employer employees.
Among employers surveyed, 83 percent were not able
to offer health benefits until they offered an
ic or qualifying small employer Hr. 17 percent
of employers switched from traditional group coverage.
The number of employees offered to defined contribution
health benefits now exceeds 200000 people, and that
figure does not include dependence. So some estimates
have said that more than 500000
people may Nationwide
enrolled. 25 percent of employees choose silver plans,
34 percent choose bronze and 35 percent choose
gold,
The top metro areas for Ic adoption in
ranking order are New York City, Atlanta, Los
Angeles,
the San Francisco Bay Area and the twin
cities in Minute. Soda. If you like the
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