CENTER UPDATE | April 2021

This update features literature items, media reports, and events supporting continued
momentum for multiple V-BID Center initiatives throughout late March and early April.

Insurers Test Re-Enacting Cost-Sharing for COVID-19 Treatment

Three of the nation’s Blue Cross and Blue Shield affiliates have re-enacted cost-sharing for COVID-19 treatment. While the CARES Act mandates insurers cover all medically necessary testing and vaccine costs, commercial insurers are not required to fully cover treatment costs. Insurers should implement a value-based benefit design for COVID-19 care and eliminate cost-sharing to prevent patients from not seeking out necessary treatment due to cost.

Out-of-Pocket Spending for Influenza Hospitalizations in Medicare Advantage

In an analysis of elderly Medicare Advantage patients, the mean out-of-pocket spending for influenza hospitalizations was almost $1,000. These findings indicate the potential magnitude of patient cost-sharing if cost-sharing waivers for COVID-19 hospitalizations are allowed to expire. Cost-sharing waivers should be swiftly, generously, and continually implemented to allow patients to receive necessary COVID-19 care.

Survey: Americans Struggle to Afford Medications As COVID-19 Hits Savings and Insurance Coverage

The COVID-19 pandemic has made it harder for people to afford health care by draining their savings and changing their insurance coverage status. A GoodRx survey indicates one in three Americans saw their out-of-pocket medication costs rise in 2020, and 40% of respondents indicated difficulty affording their prescription medications. Many patients have to choose between taking their mediation or incurring more debt.

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How Does Cost-Sharing Impact Spending Growth and Cost-Effective Treatments? Evidence from Deductibles

Research has shown that high-deductible health plans can have an immediate impact on health care spending, but medium- and long-term effects on spending growth remain unknown. A new working paper finds that HDHPs have a limited effect on spending growth, and are not associated with significantly lower growth in spending on highly cost-effective medicines.

High Out-of-Pocket Costs Lead to Financial Concerns, Lifestyle Changes for Seniors

Results from a survey conducted by the PAN Foundation indicate that 4 in 10 seniors on Medicare are worried about the price they pay for prescription drugs. 75% of Medicare seniors cannot afford to pay more than $200 for their prescription drugs each month, and some have had to make lifestyle chances to afford medications. Click here to review additional survey findings.

Spending and Out-of-Pocket Prices for Brand-Name Drugs Among Commercially Insured Individuals in Massachusetts

A cross-sectional study of data from the Massachusetts All-Payer Claims Database revealed that while nearly 43% of patient spending was for drugs in the highest price quartile, more than half of patient spending was for drugs in the second and third price quartiles. Policies to reduce the highest drug prices may not necessarily address the source of patients’ high out-of-pocket costs.

The Impact of Social Determinants of Health on Medication Adherence: a Systematic Review and Meta-Analysis

A systematic review of literature on the relationship between social determinants of health and medication adherence found that experiences of food insecurity and housing instability both significantly impacted odds of medication adherence. Additionally, overall adverse social determinants were significantly associated with lower medication adherence.

Online Advertising Increased New Hampshire Residents' Use of Provider Price Tool But Not Use of Lower-Price Providers

Price transparency tools, which are intended to facilitate price shopping and reduce patient spending, are underused. An online advertising campaign to increase awareness of a price transparency website in New Hampshire increased visits to the site, but did not translate to increased use of lower-price providers. Structural factors appear to limit consumers’ ability to use health care price information.

A Few Hundred Dollars Makes a Difference in Use of Long-Lasting Birth Control

After the Affordable Care Act’s no-cost preventive services provision took effect, women in high-deductible health plans opted for long-acting reversible contraceptives more frequently than women in other health plans. Women who faced the highest costs before the ACA mandate increased their use of LARC methods the most following cost-sharing elimination, highlighting the impact out-of-pocket costs have on contraceptive choice.

"Incredibly Concerning" Lawsuit Threatens No-Charge Preventive Care for Millions

A lawsuit challenging provisions of the Affordable Care Act that require insurers to provide first-dollar coverage of select preventive services has been approved to proceed by a U.S. district judge in Texas. If these provisions are overturned, Americans may experience challenges affording high-value preventive care, such as cancer screenings, contraceptives, vaccines, tobacco cessation treatment, and HIV prevention drugs.

How Payers Can Identify, Reduce Low-Value Care Spending Patterns

Identifying and eliminating low-value care will be crucial to improving overall health care spending and patient outcomes. To meaningfully reduce low-value care spending, a concerted and deliberate effort among payers and other stakeholders will be needed. Learn more from this recent feature of the V-BID Center’s work on low-value care.

Survey Finds Majority of Employers Support Drug and Hospital Pricing Reform

A survey from the National Alliance of Healthcare Purchaser Coalitions finds that about two-thirds of employers have either implemented or are considering implementing value-based insurance design strategies, and 55% of employers are avoiding increasing employee cost-sharing to mitigate cost increases.

Savvy Employers Alter Status Quo to Address Drugs, Deductibles and Disincentives for Treatment

In 2019, the IRS issued guidance allowing HDHPs with health savings accounts to cover an expanded list of preventive services and medications before patients meet their plan’s annual out-of-pocket deductible. In concordance with the guidance, one in five employers waived some cost-sharing for prescription drugs in 2020 to encourage employees with chronic illnesses to adhere to their treatment plan.

Recent Webinar: Virtual V-BID Summit 2021 - 20 Years of Impact & Innovation

On Wednesday, March 10th, over 600 participants attended the 2021 V-BID Summit. The webinar featured a roster of leaders from across the health care spectrum to celebrate the 20th anniversary of the first V-BID publication and discuss the future of value-based insurance design. Click here to view a webinar recording!

Please Help Support the V-BID Center

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.

V-BID Center Update: Insurers Re-Instating Cost-Sharing for COVID-19 Care; Lawsuit Against ACA Preventive Service Provisions