1 00:00:00,080 --> 00:00:02,399 This is Jacob Emerson with the Becker's Payer 2 00:00:02,399 --> 00:00:03,540 Issues podcast. 3 00:00:03,919 --> 00:00:07,299 Here's your biweekly industry news briefing for September 4 00:00:07,359 --> 00:00:07,859 9th. 5 00:00:08,559 --> 00:00:09,619 The Biden administration 6 00:00:09,919 --> 00:00:13,039 has finalized new requirements for health plans to 7 00:00:13,039 --> 00:00:16,024 strengthen mental health parity laws for 175,000,000 8 00:00:17,125 --> 00:00:17,625 Americans. 9 00:00:18,244 --> 00:00:21,125 Payers and employer sponsored plans have been required 10 00:00:21,125 --> 00:00:23,605 to cover mental health and substance use benefits 11 00:00:23,605 --> 00:00:25,464 the same as they would for medical benefits 12 00:00:25,765 --> 00:00:27,925 under the Mental Health Parity and Addiction Equity 13 00:00:27,925 --> 00:00:28,904 Act of 2008. 14 00:00:29,550 --> 00:00:32,210 Though that law was further strengthened in 2020, 15 00:00:32,750 --> 00:00:35,629 mental health care access is still fragmented and 16 00:00:35,629 --> 00:00:37,969 difficult to access for many nationwide. 17 00:00:38,829 --> 00:00:40,989 The new rule, introduced back in July of 18 00:00:40,989 --> 00:00:41,489 2023, 19 00:00:42,030 --> 00:00:44,909 will require plans to analyze the outcomes of 20 00:00:44,909 --> 00:00:48,005 their mental health coverage policies, including network size, 21 00:00:48,005 --> 00:00:50,745 out of network payment policies, and prior authorization 22 00:00:50,965 --> 00:00:51,465 requirements. 23 00:00:52,085 --> 00:00:54,804 The new rule clarifies that plans cannot have 24 00:00:54,804 --> 00:00:58,664 more restrictive prior authorization standards or narrower networks 25 00:00:58,885 --> 00:01:01,649 for mental health service. The administration is also 26 00:01:01,649 --> 00:01:04,450 closing a loophole in the 2,008 act that 27 00:01:04,450 --> 00:01:07,250 excluded non federal government health plans from parity 28 00:01:07,250 --> 00:01:10,049 standards, such as health plans from states for 29 00:01:10,049 --> 00:01:10,790 their employees. 30 00:01:11,329 --> 00:01:13,009 Parts of the new policy go into effect 31 00:01:13,009 --> 00:01:15,109 in 2025 and others in 2026. 32 00:01:15,965 --> 00:01:18,284 The insurance industry has pushed back against the 33 00:01:18,284 --> 00:01:20,525 rule change, with AHIP saying it will not 34 00:01:20,525 --> 00:01:23,005 achieve the goals of increasing access to mental 35 00:01:23,005 --> 00:01:25,984 health care or substance use disorder treatment. 36 00:01:26,765 --> 00:01:29,725 Well, interest in Cigna's GLP one management program 37 00:01:29,725 --> 00:01:32,520 is, quote, through the roof. That's according to 38 00:01:32,520 --> 00:01:33,739 CEO David Cordani. 39 00:01:34,520 --> 00:01:36,760 He said September 5th that clients are looking 40 00:01:36,760 --> 00:01:38,760 at how you how do you ex balance 41 00:01:39,000 --> 00:01:41,640 how do you balance expanding access, but in 42 00:01:41,640 --> 00:01:45,145 a more sustainable way. In March, Cigna launched 43 00:01:45,145 --> 00:01:47,704 Encircle RX, which is a program to help 44 00:01:47,704 --> 00:01:50,844 employers manage the cost of GLP 1 drugs. 45 00:01:51,145 --> 00:01:53,645 The program grew to more than 2,000,000 enrollees 46 00:01:53,704 --> 00:01:56,424 in its 1st 6 months. Mister Pordani said 47 00:01:56,424 --> 00:01:59,040 that around 50% of the large employers served 48 00:01:59,040 --> 00:02:02,640 by Evernorth, Cigna's health services business, cover GLP 49 00:02:02,640 --> 00:02:05,040 1 drugs for weight loss. A small percentage 50 00:02:05,040 --> 00:02:07,920 of Cigna Healthcare's clients, the company's insurance benefits 51 00:02:07,920 --> 00:02:10,159 business, have opted to cover the cost of 52 00:02:10,159 --> 00:02:11,539 the drugs for their employees. 53 00:02:11,995 --> 00:02:14,495 Cigna works with employers of all sizes. 54 00:02:14,955 --> 00:02:17,355 Mister Cordoni said that the topic is front 55 00:02:17,355 --> 00:02:19,594 of mind for everybody, not just investors. On 56 00:02:19,594 --> 00:02:22,014 one hand, it represents a example of pharmacological 57 00:02:22,395 --> 00:02:24,735 innovation that brings new services and new programs. 58 00:02:25,000 --> 00:02:26,919 And on the other hand, it hits an 59 00:02:26,919 --> 00:02:27,419 affordability 60 00:02:27,719 --> 00:02:28,219 challenge. 61 00:02:29,400 --> 00:02:31,639 Mister Cordani said the coverage for the drugs 62 00:02:31,639 --> 00:02:34,120 is ticking upwards at a slow pace, growing 63 00:02:34,120 --> 00:02:35,819 in single digit percentages. 64 00:02:37,094 --> 00:02:39,094 LaSalle of Blue Cross and Blue Shield of 65 00:02:39,094 --> 00:02:39,594 Louisiana 66 00:02:39,974 --> 00:02:42,455 is completely off the table, according to the 67 00:02:42,455 --> 00:02:44,474 company's new CEO, Brian Kamerlinck. 68 00:02:44,935 --> 00:02:48,455 In February, BCBS Louisiana tabled plans to be 69 00:02:48,455 --> 00:02:52,129 acquired by Elevance Health. That sale faced scrutiny 70 00:02:52,129 --> 00:02:54,469 from local physicians and state officials. 71 00:02:54,849 --> 00:02:57,330 Mister Cammerlink was appointed CEO in May in 72 00:02:57,330 --> 00:02:59,569 the wake of the scrapped deal. He told 73 00:02:59,569 --> 00:03:01,409 local media that there are no plans to 74 00:03:01,409 --> 00:03:03,925 pursue a sale under his watch. He said, 75 00:03:03,925 --> 00:03:06,324 quote, we're focused on Louisiana, and we're focused 76 00:03:06,324 --> 00:03:07,305 on being independent. 77 00:03:07,764 --> 00:03:09,444 We're going to work with our local providers, 78 00:03:09,444 --> 00:03:12,425 brokers, and community members, which includes the Louisiana 79 00:03:12,485 --> 00:03:12,985 legislature, 80 00:03:13,444 --> 00:03:16,104 to remain independent as long as we can. 81 00:03:16,405 --> 00:03:18,584 The company has implemented a number of changes 82 00:03:18,645 --> 00:03:21,280 since he assumed the CEO role, including rebranding 83 00:03:21,500 --> 00:03:22,879 as Louisiana Blue, 84 00:03:23,180 --> 00:03:26,860 appointing new senior executives, and introducing a new 85 00:03:26,860 --> 00:03:27,360 organizational 86 00:03:27,819 --> 00:03:28,319 structure. 87 00:03:29,740 --> 00:03:31,900 Well, GLP one medication costs are one factor 88 00:03:31,900 --> 00:03:34,935 contributing to tighter margins in the Medicaid space. 89 00:03:35,175 --> 00:03:37,594 That's according to executives at Centene. 90 00:03:38,055 --> 00:03:40,775 On September 4th, the company's CFO, Drew Asher, 91 00:03:40,775 --> 00:03:42,074 said Medicaid redeterminations 92 00:03:42,694 --> 00:03:43,354 are continuing 93 00:03:43,655 --> 00:03:46,314 to put pressure on the company's Medicaid business. 94 00:03:46,614 --> 00:03:49,655 The company lowered its Medicaid membership expectations for 95 00:03:49,655 --> 00:03:50,939 the year from 13,600,000 96 00:03:51,639 --> 00:03:52,459 to 13,000,000. 97 00:03:53,159 --> 00:03:55,159 The lower membership guidance led to the largest 98 00:03:55,159 --> 00:03:57,400 one day drop in Centene's share price in 99 00:03:57,400 --> 00:04:00,280 a year. The pressure is largely driven by 100 00:04:00,280 --> 00:04:00,780 redeterminations, 101 00:04:01,400 --> 00:04:03,879 but individual changes by states also play a 102 00:04:03,879 --> 00:04:06,114 role. He said either there's a new program 103 00:04:06,114 --> 00:04:08,275 or the state has done something wonky with 104 00:04:08,275 --> 00:04:09,414 the pharmacy benefits 105 00:04:09,715 --> 00:04:11,634 or where the whether they've carved out a 106 00:04:11,634 --> 00:04:14,275 single PBM or added GLP ones, we have 107 00:04:14,275 --> 00:04:15,495 to get paid for that. 108 00:04:15,794 --> 00:04:18,240 According to data from the Robert Wood Johnson 109 00:04:18,240 --> 00:04:21,040 Foundation, 13 states cover GLP one drugs for 110 00:04:21,040 --> 00:04:23,060 weight loss indications through Medicaid. 111 00:04:23,520 --> 00:04:26,080 Utilization is also rising in the behavioral health 112 00:04:26,080 --> 00:04:28,639 space, a trend that Centene has observed over 113 00:04:28,639 --> 00:04:30,975 the last 2 years. Now as of August 114 00:04:30,975 --> 00:04:32,435 23rd, more than 25,000,000 115 00:04:32,894 --> 00:04:34,754 Medicaid enrollees have been disenrolled 116 00:04:35,134 --> 00:04:37,074 from that program through the redeterminations 117 00:04:37,615 --> 00:04:38,115 process. 118 00:04:39,134 --> 00:04:41,535 Other insurers have said that beneficiaries have remained 119 00:04:41,535 --> 00:04:43,774 in Medicaid that that have remained in Medicaid 120 00:04:43,774 --> 00:04:46,330 tend to have more health needs driving up 121 00:04:46,330 --> 00:04:48,569 costs in the program for those that have 122 00:04:48,569 --> 00:04:50,750 remained and not been disenrolled. 123 00:04:52,889 --> 00:04:55,610 Well, 50 insurers are looking to lower premiums 124 00:04:55,610 --> 00:04:57,710 on an ACA marketplace in 2025. 125 00:04:58,644 --> 00:04:59,464 Next year, 324 126 00:05:00,245 --> 00:05:02,964 insurers are offering ACA coverage across all 50 127 00:05:02,964 --> 00:05:05,365 states in Washington DC. And among them, the 128 00:05:05,365 --> 00:05:07,865 median proposed premium increase is 7%. 129 00:05:08,404 --> 00:05:11,284 That's similar to this year. The proposed rates 130 00:05:11,284 --> 00:05:13,004 are preliminary, and they could change during rate 131 00:05:13,004 --> 00:05:13,164 review processes, but states are currently finalizing those 132 00:05:13,164 --> 00:05:13,784 rates. In their rate 133 00:05:14,240 --> 00:05:14,740 processes, 134 00:05:17,199 --> 00:05:17,740 but states are currently finalizing those rates. In 135 00:05:17,740 --> 00:05:18,826 their rate filings, insurers mentioned inflation and the 136 00:05:18,826 --> 00:05:19,680 increasing usage of weight loss and other specialty 137 00:05:19,680 --> 00:05:21,839 drugs as trends that are influencing premiums. Lingering 138 00:05:21,839 --> 00:05:24,339 COVID 19 costs and Medicaid redeterminations 139 00:05:28,805 --> 00:05:30,185 are having little effect. 140 00:05:30,645 --> 00:05:32,345 The company that's asking for the 141 00:05:33,205 --> 00:05:36,485 the lowest ACA premium drop in 2025 or 142 00:05:36,485 --> 00:05:38,004 or the company that is asking for the 143 00:05:38,004 --> 00:05:40,564 largest decrease in price, that's gonna go to 144 00:05:40,564 --> 00:05:43,151 Centene's subsidiary in Delaware, which is asking for 145 00:05:43,151 --> 00:05:44,185 14% lower premiums in 2025. In terms of 146 00:05:44,779 --> 00:05:46,879 percent lower premiums in 2025. 147 00:05:47,980 --> 00:05:48,960 In terms of 148 00:05:49,340 --> 00:05:52,060 who's gonna see the biggest raises for ACA 149 00:05:52,060 --> 00:05:53,199 premiums in 2025, 150 00:05:53,740 --> 00:05:56,000 that's largely New York state residents. 151 00:05:56,379 --> 00:05:58,080 Seeing some of those largest increases, 152 00:05:58,675 --> 00:06:01,735 EmblemHealth in New York requested a 51% increase, 153 00:06:01,954 --> 00:06:04,694 Highmark's subsidiaries in New York requested a 30% 154 00:06:04,754 --> 00:06:05,254 increase, 155 00:06:05,634 --> 00:06:07,975 Metro Plus Health requested 28%, 156 00:06:08,595 --> 00:06:10,854 and Independent Health requested 27%, 157 00:06:11,620 --> 00:06:13,800 and Oscar Health in in New York City 158 00:06:13,939 --> 00:06:15,399 requested a 25% 159 00:06:16,100 --> 00:06:16,600 increase. 160 00:06:17,220 --> 00:06:19,220 If you'd like the latest health insurance industry 161 00:06:19,220 --> 00:06:21,754 news delivered straight to your inbox every morning, 162 00:06:21,754 --> 00:06:24,574 subscribe to the Becker's payer issues e newsletter 163 00:06:24,794 --> 00:06:26,414 on our website at beckerspayer.com.