12.6: The percentage of high schoolers who reported they used tobacco products in 2023, down from 16.5% in 2022 according to the CDC’s National Youth Tobacco Survey. E-cigarette usage also decreased from 14.1% to 10%. The trend mimics a similar drop in length of stay for SUD cases in hospitals, down from 10.1 to about 7.5 from ’21 to ’22 according to one commercial plan. The trends are promising but given the potential for so many high costs and recurrence in SUD, the “work is far from over” according to experts at the CDC.
GLP Changing Employer Policies: More union plans are starting to cover the weight loss drugs and for more than just those with type 2 diabetes. Policies set to roll out in 2024 are part of an effort by unions and self-insured employers to recruit and retain employees. The coverage expansion of what is a $10-16K a year medicine is noteworthy and perhaps the market disrupter of the year. Pre-authorization is required and will remain in place for foreseeable future, but the medicine has potential to have a ripple effect, on cardiovascular disease prevalence and management, potentially depression and anxiety and maybe on pain and productivity. One national union health plan we interviewed last week spent $150K on GLP-1s alone in 2022 for a small group of its members, compared to the $1.6M it spent overall for weight loss, an $840K increase vs. 2021. There are many new GLP-1 drugs in the pipeline, so plans expect to see use increase year over year. “The big question is ‘to what end,’” said utilization analyst Wendy Abraham on our conference call November 10th. “Down the road, we may work it out so that members may also need to enroll in a program of counseling since these drugs may be lifetime usage.”
Home Care Victory: BCBS in Massachusetts will remove 14,000 prior authorization requirements for home care services beginning January 1. The payer says this is in response to capacity-related stress hospitals in the state are facing, which is not unique to Massachusetts.
Point For MA: A recent study by Harvard and Inovalon comparing outcomes data for Medicare beneficiaries found that MA members had lower rates of high-risk medication use, fewer avoidable hospitalizations and fewer hospital readmissions overall. Past studies on this topic found more modest differences across the two populations but Harvard and Inovalon said their study used a larger sample and a broader set of quality measures than those studies.
Instantaneous Meal: Instacart Health has signed a partnership with Mount Sinai Solutions, the employer arm of the New York City-based health system, to offer $110 in fresh grocery stipends for post-op and post-partum patients. The program will launch in early 2024 and includes the creation of a virtual storefront with local and national grocers through Instacart. Like we predicted back in 2014 when we suggested grocery delivery service Peapod ought to add nutritionists and partner with healthcare insurers and hospitals, nearly a decade later the grocery delivery service Instacart continues to make a move into healthcare. Its health division started working with WellCare of Kentucky and digital health company, Good Measures, to make food prescription programs available for Medicaid members. Good Measures’ dietitians work with members to create a nutrition plan for them, which is accessible via Instacart. For low-income consumers, Instacart allows people to use their Temporary Assistance for Needy Families benefits as well as Supplemental Nutrition Assistance Program assistance funds.
Insulin Access: Optum Rx is moving 8 insulins to preferred formulary status which means they will be available with the lowest out-of-pocket costs for commercial members whose health plans use the pharmacy benefit manager beginning in January 2024. The insulins are currently either on tier 3 or not covered at all, which leads to access issues and higher costs for patients. The PBM says that, in 2024, 98% of all their customers will have access to insulin for $35 or less a month. In related news, BCBS of Massachusetts recently removed prior authorization requirements for continuous glucose monitoring and supplies for Type 1 diabetes.
Reproductive Policy Change: The White House announced the nation’s first initiative for women’s health research, led by First Lady Jill Biden. The initiative will target both reproductive health care research, perimenopause, and menopause. These topics, along with the exploration of increasing payer focus on women’s health, were explored in our recent women’s health whitepaper read here.
Extra Point (From The Archives): Phil Collins’ people were on the rotary phone 42 years ago to call my dad of all people to help the Genesis pop legend tape the ankle he rolled in time for his show on a cold November Friday night at the Hartford Civic Center Mall. Dad, who was an athletic trainer and tennis coach at the University of Hartford for nearly four decades, treated Phil like any student-athlete. Collins offered dad a pair of front row seats to hear him belt out his “In The Air Tonight” number, his #1 hit back in 1981. I wanted to go desperately, but Dad picked my sister and while I was bummed at the time (okay, I was mad), I get it now. Flash forward to four years ago at Madison Square Garden in New York. Collins, now almost 70, hobbled on stage with a wobbly cane and a broken foot and admitted to the sold out crowd he probably wasn’t going to be skipping around stage or beating the drums, that his ‘messed up’ foot, bad back and a number of other health issues would keep him stationary, but, against all odds, he was going to sing a few songs…His teenage son played drums and my bride and I, neither having ever seen Phil in concert, sang “Follow You Follow Me” like we were still 10 years old next to the scratchy record player in our parents’ living rooms. It is remarkable how pain, injury, surgery and anxiety don’t have to mean you stop. You just have to get some help and adjust. I think back to that night when the phone rang and how my mom dropped the receiver on dad’s foot and nearly choked my sister with the phone coil as she frantically, if not excitedly, stretched the phone over to dad’s ear….I think back to how dad showed me the next morning how he taped Phil’s ankle like an artist in his own right, and I wonder if the pop star would remember that moment. If he’d remember dad.