Sam Farmer’s Post

U.S. employers are bracing for the largest increase in health insurance costs in a decade next year, according forecasts from healthcare consultants. (The good news is that workers may be somewhat spared this time around in a still-tight labor market.) Benefit consultants from Mercer, Aon and Unity Willis Towers Watson see employer healthcare costs jumping 5.4% to 8.5% in 2024 due to medical inflation, soaring demand for costly weight-loss drugs and wider availability of high-priced gene therapies.

Found's recent excerpt from an additional CNBC article about insurance coverage and some promising new data from Novo Nordisk. "Meanwhile, more health insurers are pulling back on coverage. A July survey by Found, a company that provides obesity-care services to 200,000 people, showed that 69% of its patient population does not have insurance coverage for GLP-1 drugs to treat diabetes or weight loss. The results represent a 50% decline in coverage since December 2022." This excerpt links back to our Fierce Healthcare story a few weeks back surrounding the GLP-1s coverage decline. In that article Found CEO Sarah Jones Simmer shares how the current coverage trends are “likely the result of irresponsible prescribing for recreational reasons, causing the pendulum to swing ‘all the way in the other direction,’ and it's leading to patients who have genuine medical need struggling to access these therapies.” Link to the Fierce Healthcare story in the comments. https://lnkd.in/g-J-qctw

The healthcare policy landscape in the US is changing, potentially impacting those seeking weight loss treatments. While Obamacare plans currently do not cover weight loss drugs, the government is considering altering this policy. High out-of-pocket costs for medications like Saxenda and Wegovy are a significant burden for individuals, costing over $1,300 a month. Additionally, treating obesity-related conditions is a strain on healthcare spending. Proposed changes to health insurance rules for 2025 may influence the coverage of weight loss drugs under Obamacare, with ongoing discussions shaping the outcomes. There are gaps in insurance coverage, particularly for treatments like weight loss drugs, which could be addressed by their potential inclusion in Obamacare plans. However, challenges persist, including the financial burden on individuals and state budget constraints. As the healthcare landscape evolves, monitoring these developments is crucial for understanding their impact on healthcare coverage.

As semaglutide and tirzepatide become an increasingly common treatment for obesity, health insurance companies and plan sponsors face an important decision about whether to cover them. In MedPage Today Genevieve Friedman, Brighton Health Plan Solutions' Nancy Klotz, MD, MBA, FACP discusses these weight-loss drugs, including their potential to improve members’ long-term health among certain populations. https://lnkd.in/eyYBz_Dx

Attention to those with chronic conditions! Prescription Assistance Advocates can help you obtain your necessary medications. We act as a bridge between you, your doctor, and pharmaceutical companies to provide free or low-cost medicines for conditions like diabetes, high blood pressure, cholesterol, respiratory illness, and mental health. Our services offer a 90 to 120-day supply of medications without any limit on the number of medications covered. We help those with or without insurance or inadequate prescription coverage, including those who fall into the “donut hole” or coverage gap of Medicare Part D. To qualify, you'll need a state-issued photo ID or driver's license, social security card, proof of income, and a prescribing physician. Our Medication Assistance program provides resources to help those without health insurance and limited or no prescription coverage obtain their prescription medication for free or almost free. The best part? You don't need an advocate! If you need assistance with costly medications, you can ask your doctor for alternatives like generic medications and other medication treatments that could be more affordable. The doctor's office could also complete applications for assistance and send them directly to pharmaceutical companies for you. Don't let the cost of medication hold you back from proper treatment. If you live in Texas near Bexar or Comal counties, contact a Prescription Assistance Advocate today at PH: (210) 227-0170 for assistance.

U.S. employers may face the largest increase in health insurance costs in a decade next year. According to healthcare consultants, employer healthcare costs are expected to rise between 5.4% to 8.5% in 2024 due to medical inflation, increased demand for weight-loss drugs, and wider availability of high-priced gene therapies. However, there is good news for workers. In the current tight labor market, workers may be spared the brunt of these costs.

Understanding SDoH in Predicting Sepsis Readmission A study analyzed data from 35 U.S. hospitals (2017-2021) to compare social determinants of health (SDoH) with traditional clinical factors in predicting 30-day readmission after sepsis hospitalization. Out of 271,428 patients, 8,909 had a prior sepsis hospitalization, and 21% experienced unplanned readmission within 30 days. Economic constraints, transportation issues, and inability to afford follow-up care significantly increased readmission risk, as did living in high-poverty areas with low health insurance coverage. Conversely, having a primary care provider and health insurance reduced readmission odds. The study concluded that SDoH are powerful predictors of unplanned readmission, and incorporating them with clinical factors could enhance prediction models. https://lnkd.in/gs8asU3g

🔵 **Older Adults Advocate for Medicare and Insurance Coverage of Obesity Drugs** A recent poll by the University of Michigan reveals a strong opinion among US adults aged 50-80 on the coverage of weight-loss drugs. The data suggests an overwhelming support for health insurance and Medicare to cover FDA-approved prescription weight-loss drugs. Key Insights: - **83%** agree that health insurance should cover these medications. - **76%** believe Medicare should also provide coverage. - **63%** of overweight respondents are interested in taking these medications. However, the willingness to pay higher Medicare premiums for this coverage is limited, with only 30% in favor. The poll highlights the high awareness of injectable GLP-1 receptor agonists, such as Ozempic and Wegovy, especially in managing obesity and diabetes. Yet, the coverage for these drugs is inconsistent, with Medicare and some private plans having restrictions despite their potential benefits. 🔵 **Call for Comprehensive Coverage** The American Medical Association urges insurers to cover evidence-based weight-loss medications. With the increasing demand and awareness, it's essential for those affected to discuss their options with healthcare providers. The University of Michigan's study, conducted from July to August 2023, reflects the opinions of a diverse group of 2,657 adults and brings to light the need for more inclusive healthcare policies. 📌 _What are your thoughts on this? Should Medicare and health insurance cover weight-loss drugs? Share your views below! #Healthcare #Medicare #ObesityManagement #PatientAdvocacy #PublicHealth Read the full paper here >>> http://bit.ly/3vsvp6w

New GoodRx data shows how vertically-integrated health plans and their #PBMs are increasing barriers for premium-paying customers to access prescribed treatments: ⛈ plans are increasing copays, coinsurance, & deductibles, ⛈ plans are adding new restrictions to "covered" treatments. How are plans cost-shifting to customers via more complexity and restrictions? ❌ Plans "cover" just 54% of prescribed drugs. ❌ 50% of Part D drugs have some form of admin restriction. ❌ 25% of Americans have at least one drug that their insurance doesn’t cover. What are premiums for anyway? https://lnkd.in/ePhqMqYf

I guess this article is timely with Babylon Health today announcing a not un-expected end to the Company by starting bankruptcy proceedings. The question of what success model to use to commercialise digital health product remains a question that continues to challenge the industry. At Peach Health we also see the approach discussed in this article, which is to sell a virtual / hybrid healthcare service and not the digital product itself, as the right path to follow. The few successful digital health players that have reached sizeable sales (Livongo, Hinge Health and Omada) have followed this model. Of course in the US the other big success driver for these companies was a focus on the employer insurance market. #digitalhealth #digitalhealthcare #digitaltherapeutics