CENTER UPDATE | FebrUARY 2025

In this Issue:

  • Trump Administration Backs ACA Preventive Coverage Mandate
  • Medicare Advantage Enrollees Say They Value Their Plans Extra Benefits
  • Rising Coinsurance Rates Drive Up Medicare Beneficiaries’ Drug Costs
  • How Hospitals Can Cut Wasteful Pre-Surgery Testing
  • Use of Copay Adjustment Programs Reaches New High
  • NC Teachers, State Employees Voice Frustration Over State Health Plan
  • Employer-Sponsored Mental Health Benefits Show Strong ROI
  • 2025 V-BID Summit

Trump Administration Backs ACA Preventive Coverage Mandate

In a brief filed with the Supreme Court, the Trump administration plans to defend the ACA mandate that requires insurers to cover certain preventive services for health plan members without cost-sharing. The Braidwood v Becerra case is expected to be argued in the spring, with a decision anticipated by June, potentially impacting nationwide health insurance coverage policies.

Medicare Advantage Enrollees Say They Value Their Plans Extra Benefits, But Many Don't Use Them

Medicare Advantage enrollment has grown due to its coverage of extra services like dental, vision, and hearing care, which traditional Medicare lacks. A new Commonwealth Fund report examines how much beneficiaries value these supplemental benefits and their usage rates. The study found that about 80% of Medicare beneficiaries consider these benefits important, with Black and Hispanic individuals, lower-income people, and those with functional limitations valuing them the most. However, only 40% of Medicare Advantage enrollees reported using some of the most common supplemental benefits.

Rising Coinsurance Rates Drive Up Medicare Beneficiaries' Drug Costs

A recent study from the Schaeffer Center, published in JAMA, reveals a sharp rise in Medicare drug plans using coinsurance for preferred brand-name drugs—jumping from 10% in 2020 to 72% in 2024. While rebates and discounts have also grown, they primarily benefit pharmacy benefit managers and insurers rather than consumers. As a result, costs for widely used medications like Eliquis, Xarelto, and Ozempic have more than doubled, with Eliquis users seeing an increase from $47 to $102.

How Hospitals Can Cut Wasteful Pre-Surgery Testing

A new study highlights how hospitals can reduce unnecessary preoperative testing while maintaining patient safety. Researchers focused on four common tests in low-risk patients undergoing outpatient procedures, reducing unnecessary testing rates from 37% to 14% and overall testing from 51% to 27%. The intervention, which involved clinician education and decision-support tools, ensured that patients who truly needed tests continued to receive them without impacting surgical outcomes. The success of this initiative has led to a statewide expansion, with 16 Michigan hospitals now working to implement similar improvements.

Use of Copay Adjustment Programs Reaches New High

A new analysis estimates that commercial insurance plans and affiliated vendors received ~$6.5 billion of manufacturers’ copay support funds last year — funds that are meant to ease the financial burden on patients. According to data from 35 PBMs and payers representing 121 million covered lives, 47% and 43% of beneficiaries are enrolled in plans with copay maximizers and accumulators, respectively.

Use of Copay Adjustment Programs NC Teachers, State Employees Voice Frustration Over State Health PlanNew High

A survey published this week by the nonprofit United States of Care found that 80 percent of N.C. residents believe the state’s health costs are higher than they need to be, with nearly 75 percent saying they’ve taken steps to reduce out-of-pocket medical costs — such as delaying going to the doctor or skipping a medical test or procedure — that could negatively affect their health.

Employer-Sponsored Mental Health Benefits Show Strong ROI

A new JAMA study found that employer-sponsored mental health programs can lead to significant medical cost savings. In a cohort study of nearly 14,000 employees and dependents, every $100 invested in a behavioral health benefit resulted in a $190 reduction in medical claims costs. The program, which provided fast access to psychotherapy, medication management, and digital resources, led to an average savings of $1,070 per participant in the first year.

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