#6things That Happened in Health Policy This Week

6 Things That Happened in Health Policy This Week is produced by a mix of research assistants from the Healthcare Quality & Outcomes (HQO) Initiative at the Harvard T.H. Chan School of Public Health. In each edition we feature a variety of news articles, reports, and studies focused on U.S. health policy and health services research. This week’s edition includes contributions from Stephanie Caty (stephaniecaty), Yevgeniy Feyman (@YFeyman), Anthony Moccia (@Anthony_Moccia), and Kim Reimold (@KimReimold).

KHN: Report For State Insurance Commissioners Offers Options To Improve Drug Access

  • A forthcoming study from the National Association of Insurance Commissioners (NAIC) proposes state-level reforms that can make prescription drugs more affordable and accessible to patients.
  • Proposed reforms include:
    • Limiting cost-sharing tiers for prescription drugs. Typically, when insurers offer drug coverage, they do so along multiple levels requiring different levels of cost-sharing for different drugs. Some states, like New York and Vermont have restricted the number of tiers.
    • Requiring copay-only plans. Cost-sharing can come either as a flat copay (some dollar amount per prescription) or as a coinsurance (a percentage of the drug’s cost). Coinsurance can lead to high prices for consumers.
    • Prohibiting mid-year formulary changes. The formulary is a list of covered drugs for the insurance plan. Changing this formulary mid-year can affect drug coverage for patients who might be caught unaware.
  • The goal of these proposals is to help inform NAIC’s model law, the Health Carrier Prescription Drug Benefit Management Model Act, which was last updated in 2003.

Modern Healthcare: State Medicaid agencies could spend up to $5 million to cover mosquito repellent

  • Controversially, at least 6 state Medicaid agencies are planning on spending millions on mosquito repellent.
    • Officials from Texas projected that they could spend up to $12.6 million to support such efforts.
  • These projections surfaced after:
    • CMS agreed earlier this summer that states could cover repellents if prescribed by an authorized health professional.
    • A year of increasing repellent prices (Off Deep Woods spray is up 33 cents) and increasing repellent consumption (spent 12% more than last year).

While Georges Benjamin, executive director of the American Public Health Association, likened repellents to a medication (especially among low-income populations), UNC infectious diseases fellow Dr. Matt Collins thinks that widespread prevention will be costly and ineffective.

Vox: Big insurers have quit Obamacare. That means more shoppers only get one choice.

  • A new analysis from Vox estimates that there will be 687 counties with only one insurer in their Healthcare.gov marketplace in 2017, which is almost four times as many counties (182) as in 2016
  • Aetna and UnitedHealth have both left substantial parts, if not all of the market, and while there is some hope that smaller insurers will enter to replace them, this has not yet happened
  • While 1,152 out of the 2,601 counties using Healthcare.gov still have 3 or more insurers offering plans, this number had decreased substantially from 2016, when almost 70% of counties using Healthcare.gov had 3 or more insurer options
  • The analysis finds that competition in the markets varies significantly between states and within states; urban areas such as Detroit, Dallas and San Antonio, tend to have much greater competition while rural counties, including many in Arizona and Alabama, are more likely to have one or no insurers offering plans
  • Although there is the possibility for some fluctuation in the marketplaces in the next month before the insurers have to finalize coverage options, this is likely to be the least competitive year the marketplaces have seen

Washington Post: How emergency rooms treat poorer kids differently

  • Based on a study released by the National Bureau of Economic Research using hospital billings in New Jersey from 2006-2010, children with public insurance (Medicaid or the Children’s Health Insurance Program) are less likely to be admitted to the hospital from the emergency department than their privately insured counterparts
  • For children presenting to the ED with flu like symptoms, a publicly insured child is 10% less likely to be admitted to the hospital; for other conditions such as asthma or appendicitis, publicly insured children are 5% less likely to be admitted
  • During peak flu season, when hospital beds are in high demand, publicly insured children are 20% less likely to be admitted, suggesting that hospitals may be selecting patients based on potential profitability
  • When publicly insured children are admitted to the hospital, they incur more expenses than privately insured children, likely due to the fact that they must be sicker to be admitted
  • However , outcomes for publicly- and privately-insured children do not differ, which suggests that children may be hospitalized unnecessarily

The Hill: State officials under pressure to OK ObamaCare premium hikes

  • State insurance officials are feeling pressure to approve ObamaCare premium increases to ensure that insurers do not drop out of the market
    • In Tennessee three insurers in the state marketplace received approval for premium increases of 62%, 46% and 44%
    • Tennessee insurance commissioner, Julie Mix McPeak, acknowledged that her reasoning for approving premium increases was partly out of fear that insurers would leave the state marketplace
  • ObamaCare analyst Charles Gaba predicts that average approved premiums could increase to 27.6% over the next year
  • Most consumers will not feel the effect of increased premiums because of the ObamaCare subsidies that cap percent of income a person has to pay for premiums, but still about 15% of enrollees will have to pay full price
  • Senator John McCain, one of the most vocal senators on the topic, claims that Arizona residents will be left with “more expensive and less accessible health care”

NYT: Mylan to Offer Some Patients Aid on Cost of EpiPens

  • EpiPen prices rise to $600 for a pack of 2 from around $100 in 2007, this price increase comes during a time with no therapeutically equivalent competitor available
  • In response to the controversy, Mylan said it would lower out-of-pocket costs to some consumers
    • Offering financial assistance with co-payments for patients with commercial insurance and expand the number of uninsured patients eligible for free EpiPens
  • Breakdown of costs based on insurance coverage:
    • Commercially Insured
      • Largest group of EpiPen Users
      • Responsible for co-payments
      • Mylan is offering a coupon up to 300$ that can be obtained from prescribing physician or the EpiPen website
      • Depending upon a patients co-pay the most they will pay is half price
    • Uninsured Families
      • Accounting for only about 5 % of EpiPen users
      • Pay full price
      • Mylan will give uninsured patients with income below 400% the federal poverty level for free
      • Patients must apply for this every year and provide financial information and documents
    • Medicare or Medicaid families
      • These patients will most likely see no difference
      • Drug companies cannot provide assistance to this population because it is considered a kickback
      • Only foreseen issue is patients who enter the doughnut hole
      • Spokeswoman for Mylan claims said the “90% of Medicare and Medicaid patients have coverage for EpiPen”

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