CENTER UPDATE | AUGUST 2024

In this Issue:

  • The Latest on Braidwood v. Becerra
  • An Efficient Approach to Expand Equitable Access to Anti-Obesity Medications
  • EHR Nudge May Reduce Unnecessary Breast Cancer Biopsies
  • Out-of-Pocket Costs Substantial for Men with Abnormal Prostate Cancer Screening
  • Nearly Half of Patients Miss or Avoid Care Due to Cost, Appointment Scheduling
  • Pre-Deductible Coverage and Receipt of Telemental Health Services
  • Affording Healthcare Has Been More of a Struggle Since 2022
  • Patient Out-of-Pocket Costs for Type 2 Diabetes When Aging into Medicare
  • New Paper Evaluates Impacts of IRA on Medicare Part D
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The Latest on Braidwood v. Becerra

The U.S. Court of Appeals for the Fifth Circuit issued a decision in Braidwood Management v. Becerra on June 21, ruling that the appointment process of USPSTF members was unconstitutional. The decision puts many free preventive benefits at risk, including cancer screenings, immunizations, and maternal health services. While the immediate coverage remains unchanged, the case will likely face extended litigation, with potential appeals to higher courts.

An Efficient Approach to Expand Equitable Access to Anti-Obesity Medications

A new editorial discusses the promise of new anti-obesity medications (AOMs) like GLP-1 receptor agonists, which offer substantial weight loss and secondary health benefits, but face challenges such as adverse effects, high costs, and coverage restrictions. Authors argue that efficient allocation and equitable access to AOMs are crucial, and propose a strategy focusing on maximizing health benefits per dollar spent, particularly by differentiating between active weight loss and maintenance phases.

EHR Nudge May Reduce Unnecessary Breast Cancer Biopsies

A study in JAMA Surgery found that the rate of unnecessary, lower-value sentinel lymph node biopsies (SLNB) decreased among older women with early stage, node-negative breast cancer, if their surgeon received a “nudge” through the electronic health record (EHR) before counseling them on surgical management of their disease. A summary of the study notes that the nudge includes adding an EHR column to flag eligible patients, and a reminder to consider not using an SLNB after reviewing core biopsy pathology and ultrasound results.

Out-of-Pocket Costs Are Substantial and Rising for Men with Abnormal Prostate Cancer Screening

New research reveals rising out-of-pocket costs for additional diagnostic tests following elevated PSA screening results, impacting over 3 million U.S. privately insured men. More than 75% faced substantial costs, which have increased significantly over the past decade. The American Cancer Society and researchers urge insurers and policymakers to provide full coverage for all diagnostic steps after an abnormal PSA test to reduce patients’ financial burden.

Nearly Half of Patients Miss or Avoid Healthcare Due to Cost, Appointment Scheduling

The 2024 National Consumer Healthcare Survey explored what factors drive patients to choose and stay with providers. Among the findings, nearly 48% of patients said they missed or avoided healthcare in the last year. The top three reasons were high costs, no available appointments at a convenient time, or that they couldn’t get an appointment soon enough.

Pre-Deductible Coverage and Receipt of Telemental Health Visits

A recent study examined the impact of reintroducing cost-sharing on telemental health visits during the COVID-19 pandemic. It found that patients with reintroduced cost-sharing had 1.5 fewer visits per patient, and an 11.7% reduction in the proportion of patients having any visits. These results suggest that ending the exemption for telehealth cost-sharing could decrease mental health service use and potentially worsen clinical outcomes.

Affording Healthcare Has Been More of A Struggle Since 2022

A recent survey by West Health and Gallup reveals that only 55% of U.S. adults can easily access and afford quality healthcare – a six percent drop since 2022. Adults aged 50 and older have experienced a steeper decline in healthcare affordability, and Black and Hispanic adults face higher levels of cost desperation. As healthcare affordability declines, nearly one-third of Americans are now worried about affording prescription drugs in the next year.

Patient Out-of-Pocket Costs for Type 2 Diabetes Medications when Aging into Medicare

A recent cohort study of individuals with type 2 diabetes (T2D) revealed that out-of-pocket costs for T2D medications significantly increased upon reaching age 65, with average quarterly costs rising by $23.04 and the 95th percentile costs by $56.36, after adjusting for changes in utilization. Utilization slightly decreased by 5.3%, but there was an increased use of costlier medications like insulin.

New Paper Evaluates Impacts of the Inflation Reduction Act (IRA) on Medicare Part D

A new paper, published by the University of Michigan V-BID Center, focuses on the impacts of the IRA’s annual out-of-pocket spending cap and the Medicare Drug Price Negotiation Program (MDPNP). While the IRA aims to reduce costs and improve access to medications, particularly through removing cost-sharing for certain preventive services, concerns arise regarding unintended consequences of the MDPNP. These include potential restrictions on drug formularies by Part D plans, which could limit treatment options for beneficiaries with conditions like diabetes and atrial fibrillation. Monitoring and addressing these impacts are crucial to ensure equitable access to necessary medications under Medicare.

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