CENTER UPDATE | JUNE 2021
This update features policy developments, literature items, media reports, and events supporting continued
momentum for multiple V-BID Center initiatives throughout June.
Utilization Impact of Cost-Sharing Elimination for Preventive Care Services: A Rapid Review
In a new rapid review conducted by members of the V-BID Center, the majority of included articles concluded that cost-sharing elimination, such as Section 2713 of the Affordable Care Act, leads to increased use of preventive services. Low-socioeconomic groups and those who experience the greatest financial barriers to care appear to benefit the most from cost-sharing elimination.
The Next Major Challenge to the Affordable Care Act
While the Supreme Court recently upheld the Affordable Care Act, a new case challenging the law’s guarantee of zero-dollar coverage for preventive services has already been filed. If Section 2713 is overturned, insurers could require enrollees to pay out-of-pocket for high-value preventive care, including contraception, HIV pre-exposure prophylaxis, cancer screenings, and COVID-19 vaccines.
HHS Secretary Becerra: COVID-19 Vaccines and Testing Must be Free for Patients
In early June, Secretary of Health and Human Services Xavier Becerra released a letter to insurers and providers reminding them that COVID-19 vaccines and testing must be provided with no out-of-pocket cost. As cost-sharing can deter patients from receiving necessary care, offering testing and vaccines with no additional cost is essential for managing the COVID-19 pandemic.
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Podcast: Value-Based Insurance Design & the Digital Front Door
On a new episode of the Bright Spots in Healthcare podcast, V-BID Center Director Mark Fendrick discusses the evolution of V-BID and why designing health benefit plans to reduce financial barriers to high-value clinical services is the answer to lowering health care costs in our country. Other topics include the differences between V-BID and value-based care; incorporating digital into V-BID; and the challenges of V-BID and how to overcome them.
Podcast: Timing Out-of-Pocket Spending in Health Care is Challenging
Although most commercially-insured people have several health care encounters throughout the year, research indicates their out-of-pocket spending is mostly concentrated within short time intervals. Learn more about how the timing of cost-sharing could be leading to higher health care spending from this episode of the Health Podyssey podcast.
Podcast: Enhancing Access and Affordability to Essential Clinical Services
During a recent episode of the Outcomes Rocket podcast, V-BID Center Director Mark Fendrick shares his insights on high-value and low-value services, the importance of a system that incentivizes routine care, and the role of V-BID in the COVID-19 pandemic.
Association of Copay Elimination With Medication Adherence and Total Cost
Elimination of copays for drugs to treat chronic illnesses was associated with increases in medication adherence and reductions in overall spending for commercially-insured Louisiana residents. Flexible benefit designs that eliminate copays for patients with chronic illnesses may improve adherence and reduce the total cost of care.
Black Medicare Beneficiaries are More Likely than White Beneficiaries to Experience Cost-Related Problems
A new Kaiser Family Foundation analysis finds that enrollees in Medicare Advantage do not generally experience greater protection against cost-related problems than beneficiaries in traditional Medicare with supplemental coverage. Among people with Medicare, Black beneficiaries are more likely than White beneficiaries to have cost-related problems with their health care, with racial disparities persisting across Medicare types.
Association of Branded Prescription Drug Rebates and Patient Out-of-Pocket Costs in a Nationally Representative Sample
A cross-sectional study of estimated rebates for branded drugs determined that increased rebate sizes were associated with increased out-of-pocket costs for Medicare beneficiaries, commercially-insured patients, and the uninsured. These results emphasize the need for policy solutions that decouple list prices and out-of-pocket costs.
Coverage Satisfaction, Cost-Reducing Behavior, and Nonadherence Among Medicare-Enrolled Type 2 Diabetics
New research suggests that medication nonadherence among Medicare beneficiaries with type 2 diabetes is associated with dissatisfaction with the amount paid for medications and cost-reducing behavior. Interventions that lower medication costs for Medicare beneficiaries, such as the Medicare Part D Senior Savings Model, may improve adherence.
Mean Out-of-Pocket Spending Exceeds $3,000 for Childbirth Episodes
From 2016 to 2019, the mean out-of-pocket cost for a childbirth episode of care was $3,068, according to a new study. While nearly all episodes had some form of out-of-pocket cost, 17.1% of episodes had out-of-pocket costs that exceeded $5,000, and 1% of episodes had costs that exceeded $10,000. Just under 30% of episodes were covered by high-deductible health plans.
Characterizing Patient Assistance Program Use and Patient Responsiveness To Specialty Drug Price for Multiple Sclerosis
A program that promotes adherence to specialty drugs via facilitated patient assistance programs was found to reduce patient out-of-pocket costs but had no effect on utilization. Payers should consider embracing patient assistance programs to remove financial barriers to necessary medications, but use tools other than cost-sharing to influence medication adherence.
Aligning to Drive Value: Using Data, Relying on Evidence, and Building on Trust
The Washington Health Alliance recently released a white paper summarizing the products of their initiative to inform and motivate purchaser action to improve the value of care for plan participants. Data analysis identified several high- and low-value improvement opportunities for purchasers, such as improved treatment of low back pain through non-opioid pain management alternatives.
Woman Hit with Nearly $2,000 Unexpected Bill for Colon Cancer Screening
Cologuard, a popular home test to screen for colon cancer, has come with an unexpected bill for some patients, leading to fears that these patients may put off life-saving treatment. Under the Affordable Care Act, only routine screening tests are covered with no cost-sharing, meaning follow-up colonoscopies after a positive Cologuard test may have an associated out-of-pocket cost.
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As a non-profit entity, the V-BID Center relies on fundraising to support our research, education, and policy efforts. Please help us continue our work by donating here. We truly appreciate your consideration.