Last Week in Healthcare Reform: December 13th, 2021

A new study looks at the impact of high drug prices on consumers; meanwhile, PBMs continue to focus on keeping drugs affordable; hospitals in Wisconsin are increasingly going after patients for unpaid bills; and, more Medicare Advantage plans offer supplemental benefits.

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Week in Review

High Rx Prices: As highlighted in last week’s Health Action Network newsletter, rising prescription drug prices continue to exact a heavy toll on our overall healthcare spending. Now, a new study puts a finer point on the impact that high drug prices have had on consumers and patients. According to the analysis performed by Urban Institute researchers, prior to the coronavirus pandemic, nearly 13 million adults in the U.S. delayed or did not get needed prescription drugs as a result of costs, including 2.3 million elderly Medicare beneficiaries and 1.1 million Medicaid enrollees. Further, more than one-quarter of those enrolled in Medicare (25.4 percent) and over 5 percent of adults with private insurance spent more than 1 percent of their household incomes on their individual out-of-pocket prescription drug costs.  

PBMs’ Value: Meanwhile, there’s been a lot of noise directed at pharmacy benefit managers (PBMs) recently. With all the attention increasingly being paid to the issue of out-of-control drug prices, it really shouldn’t come as any surprise that Big Pharma would be interested in deflecting blame. But, despite their efforts, the fact remains that, ultimately, no one but these drugmakers bears the responsibility for their pricing decisions. Regardless, it’s still helpful to be reminded of the work that PBMs actually do protecting access to affordable, quality, life-saving medicines on behalf of more than 266 million Americans. For instance, by negotiating directly with manufacturers, PBMs are able to save an average of $962 per patient, per year. Additionally, PBMs coordinate care with the entirety of a patient’s healthcare team to prevent potentially hazardous interactions and to keep people safe. And, by expanding access to at-home mail delivery, PBMs are able to save consumers a trip to the pharmacy.

Wisconsin Hospitals: A new analysis reveals a significant uptick in the number of lawsuits Wisconsin hospitals are bringing against patients for unpaid bills. Performed jointly by Yale and Stanford Universities and published in Health Affairs, researchers discovered that the rate of medical debt collection lawsuits in the state increased by 37 percent between 2001 and 2018, rising from 1.12 cases per 1000 Wisconsin residents to 1.53 cases. And, by 2018, more than half of hospital lawsuits resulted in wage garnishments, having increased 27 percent over that same period. The analysis also uncovered racial and economic disparities in the lawsuits, with Black patients and lower-income patients in rural areas being disproportionately affected.

MA Benefits: A growing number of Medicare Advantage (MA) plans now offer supplemental benefits, according to recently released data from the Better Medicare Alliance. Heading into next year, the number of MA plans making at least one of five recently expanded supplemental benefits available to beneficiaries – including adult day health services, home-based palliative care, in-home support services, caregiver support, and therapeutic massage – went up by 43 percent. Further, the number of these plans now offering more than one of these benefits also increased 15 percent. With 29.5 million beneficiaries projected to enroll in the program over the coming year, more MA plans are broadening their supplemental offerings to include a growing focus on health-related social needs.

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