Medicare Drug Plans Are Getting Better Next Year. Some Will Also Cost More.

By Susan Jaffe - When Pam McClure learned she’d save nearly $4,000 on her prescription drugs next year, she said, “it sounded too good to be true.” She and her husband are both retired and live on a “very strict” budget in central North Dakota. Read Full Article… 

HVBA Article Summary

1. Out-of-Pocket Cost Cap: Starting in 2025, Medicare beneficiaries will have their out-of-pocket prescription drug costs capped at $2,000 annually, providing significant financial relief for millions of Americans, particularly those with chronic conditions like diabetes.

2. Premium Increases and Plan Adjustments: While the average Medicare drug plan premium has seen a slight decrease, many insurers are increasing premiums significantly, with some plans experiencing more than a tenfold increase. This has raised concerns among beneficiaries about maintaining affordable coverage.

3. Comprehensive Changes Under the IRA: The Inflation Reduction Act introduces sweeping reforms to Medicare's drug benefits, including capping insulin copayments at $35 and allowing Medicare to negotiate drug prices, aiming to lower overall medication costs and enhance the affordability of necessary treatments for seniors.

Bringing back medical underwriting? Views clash on coverage for pre-existing conditions

By Allison Bell - Researchers at RAND have discovered a factor that could help shore up the Affordable Care Act and limit use of commercial insurance to solve some social problems: Many Americans think some everyday forms of health-related underwriting are unfair. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Decline in Support for Traditional Rating Factors: The study reveals that fewer than 30% of U.S. adults support using traditional health insurance rating factors—such as gender, age, race, prior health issues, genetic traits, or environmental exposure—to determine premiums, highlighting a significant shift in public attitudes over the past two decades.

2. Current ACA Framework and Age-based Premiums: While the Affordable Care Act has largely eliminated medical underwriting, it still allows insurers to adjust premiums based on age. This aspect of the pricing framework appears to conflict with public sentiment, as many participants oppose other risk-based factors.

3. Support for Lifestyle-related Pricing: More than 60% of survey respondents are in favor of higher premiums for individuals who engage in risky behaviors, such as heavy drinking, smoking, or illegal drug use. Additionally, about 45% support charging higher rates for individuals who are obese, indicating a nuanced view on the justification for varying insurance costs based on personal health choices.

Reimagining US employer health benefits with innovative plan designs

By McKinsey & Company - Despite inflation cooling off in the United States, the country’s health insurance leaders are still feeling the strain of the recent 40-year-high inflation.¹ Commercial healthcare costs are expected to rise by 9 to 10 percent annually between 2024 and 2026. Read Full Article… 

HVBA Article Summary

1. Rising Costs and Employer Demand: Employers are facing healthcare cost increases two to three times higher than in recent years, prompting two-thirds to consider switching carriers for better cost and member experience.

2. Innovation as a Necessity: Payers that don’t innovate risk losing members, with an estimated 12 million expected to shift to innovative health products by 2030, emphasizing savings and enhanced member engagement.

3. Emergence of Alternative Plans: New plan designs, like alternative cost-sharing and pooled risk products, are emerging to encourage cost-effective provider choices, driving significant savings for employers and members. Payers must adapt their strategies accordingly.

Mental health of U.S. workers is nearing an all-time low with finances largely to blame

By Lucy Peterson - The mental and physical well being of American workers is nearing an all-time low amidst violent wars in the Middle East and Ukraine, high inflation and a contentious political environment. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Decline in Mental Health: The Guardian's study reveals a significant decline in U.S. workers' overall well-being, with 24% reporting increased anxiety and depression over the past two years. Despite a return to a new normal post-COVID-19, only 34% of workers feel they maintain a healthy work/life balance.

2. Need for Support and Resources: Many workers, particularly Gen Z, single parents, and caregivers, report low mental health satisfaction and express a pressing need for mental health resources. However, less than one-third strongly agree that their employers provide adequate support, with nearly 25% indicating they lack access to mental health resources but desire them.

3. Financial Stress as a Major Factor: Financial concerns have emerged as the primary source of stress for 48% of workers, up from 37% in 2021. Key stressors include worries about emergency savings, retirement funds, and household debt. The study emphasizes the interconnectedness of financial and mental wellness, suggesting that addressing these intersections is crucial for improving overall well-being.

More Evidence Ties Semaglutide to Reduced Alzheimer’s Risk

By Megan Brooks - A new study provides real-world evidence to support the potential repurposing of glucagon-like peptide 1 receptor agonists (GLP-1 RAs), used to treat type 2 diabetes and obesity, for prevention of Alzheimer’s disease (AD). Read Full Article… 

HVBA Article Summary

1. Efficacy of Semaglutide: Adults with type 2 diabetes prescribed the GLP-1 RA semaglutide demonstrated a significantly lower risk of developing Alzheimer's disease (AD) compared to those taking other antidiabetic medications, with a hazard ratio indicating a 40%-70% reduced risk of first-time AD diagnosis.

2. Supporting Evidence: The study, utilizing real-world data from over 1 million electronic health records, aligns with previous findings showing that GLP-1 RAs may offer neuroprotective benefits, including reduced beta-amyloid deposition and improved cognitive functions in animal models.

3. Need for Further Research: While the results are promising, experts emphasize the necessity for large-scale clinical trials to determine semaglutide's specific effects on Alzheimer's risk, highlighting that managing diabetes alone may also contribute to better brain health.

Workplace benefits: How to help workers understand and use them

By Susan Rupe - A disconnect exists between what workplace benefits employers offer their workers and how workers understand and use these benefits. Read Full Article…

HVBA Article Summary

1. Understanding Employee Needs: Todd Katz emphasizes that many employees are not fully aware of their benefits or how to utilize them effectively. Despite employers’ efforts to provide a variety of wellness and voluntary benefit options, research indicates a gap in employee satisfaction and understanding, largely due to time constraints and ineffective tools for navigating benefits.

2. Personalized Tools for Benefits Selection: MetLife’s Upwise tool aims to address the challenges employees face in selecting the right benefits. By allowing employees to take a secure survey that tailors recommendations based on their unique health and financial situations, Upwise provides personalized guidance and education on how to access and utilize employer-sponsored benefits.

3. Diverse Benefits for a Diverse Workforce: As workplaces grow more diverse, employers are encouraged to offer a range of voluntary benefits that cater to various employee needs. Key trends include mental health resources, maternity benefits, and legal services, reflecting the different priorities of employees at various life stages. Employers and benefits brokers must focus on ensuring that these offerings are effectively communicated and utilized to enhance overall employee satisfaction.

Can Restricting Carbohydrates Cut the Need for Medication in T2D?

By Miriam E. Tucker - Eating a low-carbohydrate diet can help preserve beta-cell function in people with mild type 2 diabetes (T2D), potentially allowing some to achieve target glucose levels without medication, new research suggests. Read Full Article…

HVBA Article Summary

1. Study Findings on Diet and Beta-Cell Function: A 12-week study found that a low-carbohydrate diet (9% of calories) significantly improved C-peptide levels and beta-cell function in individuals with Type 2 Diabetes, particularly among African American participants.

2. Potential for Non-Medication Management: Research author Marian L. Yurchishin indicated that a carbohydrate-restricted diet could help some patients with mild T2D improve beta-cell function without medication, but it shouldn't replace medical therapy for those with more severe conditions.

3. Concerns Over Sustainability and Dietary Balance: Critics like Alison B. Evert questioned the long-term sustainability of a low-carbohydrate diet, noting its high fat content and the study's controlled conditions do not reflect typical dietary habits.