This is Jacob Emerson with the Becker's Payer
Issues podcast.
Here's your biweekly industry news briefing for September
9th.
The Biden administration
has finalized new requirements for health plans to
strengthen mental health parity laws for 175,000,000
Americans.
Payers and employer sponsored plans have been required
to cover mental health and substance use benefits
the same as they would for medical benefits
under the Mental Health Parity and Addiction Equity
Act of 2008.
Though that law was further strengthened in 2020,
mental health care access is still fragmented and
difficult to access for many nationwide.
The new rule, introduced back in July of
2023,
will require plans to analyze the outcomes of
their mental health coverage policies, including network size,
out of network payment policies, and prior authorization
requirements.
The new rule clarifies that plans cannot have
more restrictive prior authorization standards or narrower networks
for mental health service. The administration is also
closing a loophole in the 2,008 act that
excluded non federal government health plans from parity
standards, such as health plans from states for
their employees.
Parts of the new policy go into effect
in 2025 and others in 2026.
The insurance industry has pushed back against the
rule change, with AHIP saying it will not
achieve the goals of increasing access to mental
health care or substance use disorder treatment.
Well, interest in Cigna's GLP one management program
is, quote, through the roof. That's according to
CEO David Cordani.
He said September 5th that clients are looking
at how you how do you ex balance
how do you balance expanding access, but in
a more sustainable way. In March, Cigna launched
Encircle RX, which is a program to help
employers manage the cost of GLP 1 drugs.
The program grew to more than 2,000,000 enrollees
in its 1st 6 months. Mister Pordani said
that around 50% of the large employers served
by Evernorth, Cigna's health services business, cover GLP
1 drugs for weight loss. A small percentage
of Cigna Healthcare's clients, the company's insurance benefits
business, have opted to cover the cost of
the drugs for their employees.
Cigna works with employers of all sizes.
Mister Cordoni said that the topic is front
of mind for everybody, not just investors. On
one hand, it represents a example of pharmacological
innovation that brings new services and new programs.
And on the other hand, it hits an
affordability
challenge.
Mister Cordani said the coverage for the drugs
is ticking upwards at a slow pace, growing
in single digit percentages.
LaSalle of Blue Cross and Blue Shield of
Louisiana
is completely off the table, according to the
company's new CEO, Brian Kamerlinck.
In February, BCBS Louisiana tabled plans to be
acquired by Elevance Health. That sale faced scrutiny
from local physicians and state officials.
Mister Cammerlink was appointed CEO in May in
the wake of the scrapped deal. He told
local media that there are no plans to
pursue a sale under his watch. He said,
quote, we're focused on Louisiana, and we're focused
on being independent.
We're going to work with our local providers,
brokers, and community members, which includes the Louisiana
legislature,
to remain independent as long as we can.
The company has implemented a number of changes
since he assumed the CEO role, including rebranding
as Louisiana Blue,
appointing new senior executives, and introducing a new
organizational
structure.
Well, GLP one medication costs are one factor
contributing to tighter margins in the Medicaid space.
That's according to executives at Centene.
On September 4th, the company's CFO, Drew Asher,
said Medicaid redeterminations
are continuing
to put pressure on the company's Medicaid business.
The company lowered its Medicaid membership expectations for
the year from 13,600,000
to 13,000,000.
The lower membership guidance led to the largest
one day drop in Centene's share price in
a year. The pressure is largely driven by
redeterminations,
but individual changes by states also play a
role. He said either there's a new program
or the state has done something wonky with
the pharmacy benefits
or where the whether they've carved out a
single PBM or added GLP ones, we have
to get paid for that.
According to data from the Robert Wood Johnson
Foundation, 13 states cover GLP one drugs for
weight loss indications through Medicaid.
Utilization is also rising in the behavioral health
space, a trend that Centene has observed over
the last 2 years. Now as of August
23rd, more than 25,000,000
Medicaid enrollees have been disenrolled
from that program through the redeterminations
process.
Other insurers have said that beneficiaries have remained
in Medicaid that that have remained in Medicaid
tend to have more health needs driving up
costs in the program for those that have
remained and not been disenrolled.
Well, 50 insurers are looking to lower premiums
on an ACA marketplace in 2025.
Next year, 324
insurers are offering ACA coverage across all 50
states in Washington DC. And among them, the
median proposed premium increase is 7%.
That's similar to this year. The proposed rates
are preliminary, and they could change during rate
review processes, but states are currently finalizing those
rates. In their rate
processes,
but states are currently finalizing those rates. In
their rate filings, insurers mentioned inflation and the
increasing usage of weight loss and other specialty
drugs as trends that are influencing premiums. Lingering
COVID 19 costs and Medicaid redeterminations
are having little effect.
The company that's asking for the
the lowest ACA premium drop in 2025 or
or the company that is asking for the
largest decrease in price, that's gonna go to
Centene's subsidiary in Delaware, which is asking for
14% lower premiums in 2025. In terms of
percent lower premiums in 2025.
In terms of
who's gonna see the biggest raises for ACA
premiums in 2025,
that's largely New York state residents.
Seeing some of those largest increases,
EmblemHealth in New York requested a 51% increase,
Highmark's subsidiaries in New York requested a 30%
increase,
Metro Plus Health requested 28%,
and Independent Health requested 27%,
and Oscar Health in in New York City
requested a 25%
increase.
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