This Week in Healthcare Reform: February 19th, 2021

The Administration opens up a special enrollment period on the exchanges; prices for more than 800 drugs went up in January; meanwhile, the growing incidence of pharmacy deserts makes affordable drugs that much more out-of-reach; and, the availability of supplemental benefits in Medicare Advantage plans is on the rise.

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Week in Review

Special Enrollment Period: With estimates that as many as 3 million people lost access to their employer-based health coverage between March and September of last year, the Centers for Medicare & Medicaid Services (CMS) opened up a special enrollment period on the Affordable Care Act’s (ACA) federally-facilitated insurance exchange marketplaces this past Monday.  Consumers in the 36 states that use the platform, as well as those in the 13 additional states and the District of Columbia that operate their own platforms, have until 15 May to enroll for health care coverage, with some variations.  CMS’ goal with the special enrollment period is to connect some of the 15 million uninsured people with their coverage options – in particular, the 9 million of whom qualify for ACA subsidies.

Rx Prices: As they have every year, pharmaceutical manufacturers kicked off January by raising prices on hundreds of drugs.  By the time the month ended and the smoke had cleared, drugmakers had raised prices on more than 800 medicines.  Further, those price increases averaged nearly 5 percent.  According to data compiled by GoodRx, those increases were the largest that had been seen in years.  A new analysis puts that data in further context, shining a spotlight on what turned out to be a banner year for the pharmaceutical industry.  Despite the uncertainty caused by the pandemic last year, drugmakers ended 2020 worth half a trillion dollars more than when the year started, owing in no small part to their having quietly raised prices throughout the year as the coronavirus public health crisis raged.

Pharmacy Deserts: Against that backdrop, the issue of access to life-saving medicines takes on even more urgency as consumers in already-vulnerable communities find themselves situated in what are known as ‘pharmacy deserts’, or areas without ready access to brick-and-mortar pharmacies, either because their local drugstores have closed or they don’t accept Medicaid.  While pharmacy deserts have been a going concern in rural areas for a while, they’re increasingly surfacing in urban settings now, such as Chicago.  Beyond the immediate issues presented by the growing lack of pharmacy options, these shortages also correspond to fewer clinical services, such as vaccinations, health screenings, and other medication management services.  Broadly speaking, this impacts a host of social health drivers.  More distressingly, however, is how pharmacy deserts are furthering the inequities that have complicated the distribution of the coronavirus vaccine.

MA Supplemental Benefits: Beneficiaries enrolled in Medicare Advantage (MA) plans are reporting higher-than-ever levels of satisfaction with the program.  In a recent poll from Morning Consult commissioned by the Better Medicare Alliance, seniors reported near-universal satisfaction with MA (98 percent), and with how the program has been handling the pandemic (also 98 percent).  Given Medicare Advantage’s focus on coordinated care and the supplemental benefits offered by many plans, it’s not hard to see why so many beneficiaries gravitate towards the program.  And, those numbers are likely to grow, as a separate analysis found that the number of MA plans offering these supplemental benefits is growing.


Of the many hard-learned lessons imparted by our evolving response to the COVID-19 crisis, perhaps none has been as important as that which speaks to the underlying resilience of our health care industry.

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