CENTER UPDATE | March 2025

In this Issue:

  • Recap of the 2025 Virtual V-BID Summit
  • V-BID Models Advance Cost-Effective Care in Nigeria
  • Medicare Part D Reforms Drive Awareness but Beneficiaries Seek More Information
  • Low Premiums Often Come with High Deductibles
  • Rising Patient Costs Associated with Copay Accumulator and Maximizer Programs
  • Affordability of Job-Based Health Coverage for Workers
  • Why Women Pay More Out-of-Pocket Prescription Drug Costs

2025 Virtual V-BID Summit
"20 Years of Putting Patients First"

The 2025 Virtual V-BID Summit marked a significant milestone, celebrating 20 years of Value-Based Insurance Design (V-BID) with a focus on improving healthcare access, outcomes, and affordability. Leading experts and policymakers gathered to discuss the evolution of V-BID and its role in reshaping healthcare systems by aligning insurance benefits with the value of care provided, rather than costs. Key topics included innovative strategies for improving chronic disease management, reducing healthcare disparities, and enhancing patient-centered care. An AJMC article series highlights key discussions from summit sessions:

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V-BID Models Advance Cost-Effective Care in Nigeria

In Nigeria, Dr. Chidi N. Okoro is driving cost-effective care through value-based insurance design (V-BID) models. Dr. Okoro advocates for a personalized approach that prioritizes prevention and improved health outcomes, especially for chronic disease management. His work aligns closely with ongoing efforts in the U.S. to improve cost-effective care and enhance healthcare outcomes while reducing unnecessary costs.

Medicare Part D Reforms Drive Awareness but Beneficiaries Seek More Information

New reforms to Medicare Part D, including an annual cap on out-of-pocket prescription costs and the Medicare Prescription Payment Plan, were introduced under the Inflation Reduction Act. However, results of a national poll show that only 11% of beneficiaries feel very knowledgeable about the changes. The survey shows a 27% increase in awareness since June 2024, with 40% of respondents now familiar with the reforms. Additionally, 66% of beneficiaries expressed interest in learning more about the reforms.

Low Premiums Often Come with High Deductibles

A new issue brief highlights how low premiums in health insurance marketplaces often come with high deductibles, leading to potential financial strain for consumers. While low-cost plans may seem appealing, they frequently result in higher out-of-pocket costs when seeking care, undermining affordability. The report stresses the need for policymakers to consider both premiums and deductibles in efforts to make healthcare more accessible and equitable for all.

Rising Patient Costs Associated with Copay Accumulator and Maximizer Programs

Copay accumulator and maximizer programs, which prevent manufacturer copay assistance from counting toward a patient’s deductible or out-of-pocket maximum, have become a growing concern for patients who rely on these programs to afford medications. These strategies, used by insurers and pharmacy benefit managers, often lead to higher out-of-pocket costs, especially for those with chronic conditions. Despite increasing awareness, federal rulemaking to address these programs has been slow, leaving patients vulnerable to greater financial burdens.

Affordability of Job-Based Health Coverage for Workers

A new report from The Commonwealth Fund explores the affordability of employer-sponsored health coverage in the U.S., revealing that many workers struggle with rising premiums and out-of-pocket costs. The report highlights that while job-based insurance remains the primary coverage for many, the cost burden has grown, especially for those in lower-wage jobs or small businesses. Despite employer contributions, workers are increasingly paying higher deductibles and copayments, leading to reduced access to care

Why Women Pay More Out-of-Pocket Prescription Drug Costs

Research from GoodRx highlights a significant gender gap in prescription drug costs, with women spending more on medications than men, even after accounting for health conditions. The study found that women face higher out-of-pocket expenses due to a combination of factors, including more frequent prescriptions for chronic conditions and gender-specific health issues. This disparity is particularly pronounced for certain drug classes, like mental health and reproductive health medications.

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