Below is a roundup of payer-centric news for the week of Feb. 26, 2024.
CVS, Walgreens to begin offering abortion pills
Abortion pill mifepristone will be sold at CVS and Walgreens stores this month, The New York Times first reported.
A Walgreens spokesperson said it will be available in New York, Pennsylvania, Massachusetts, California and Illinois.
"Today is an important milestone in ensuring access to mifepristone, a drug that has been approved by the Food and Drug Administration as safe and effective for more than 20 years," said the White House in a statement.
Illinois Governor J.B. Pritzker had expressed concern last year about Walgreens' decision to not sell the drug.
White House highlights Instacart
Food delivery service Instacart was praised by the White House for its work in offering grocery benefits to Medicare Advantage plans.
In October, the company rolled out co-branded plans to members to help seniors pay for groceries.
The White House also applauded its various food partnerships, including working with No Kid Hungry and Mercy Housing in California and Georgia, and a recent agreement with the Military Family Advisory Network.
Mississippi Republicans pass Medicaid expansion bill
Medicaid expansion passed in the Mississippi House to bipartisan support. The bill will head to the Senate.
Passed in a Republican-led House, the bill was voted through 98 to 20, according to news outlets. Just nine states have not yet passed Medicaid expansion, reports KFF.
If passed by the Senate, the expansion would take effect in January, even if the Centers for Medicare & Medicaid Services rejects the bill's work requirement, said law firm Balch & Bingham Partner Pepper Crutcher Jr. in published insights.
Payer investment in primary care has declined: report
Since 2019, investment in primary care has declined across all major payers, according to researchers from the American Academy of Family Physicians, funded by the Milbank Memorial Fund and the Physicians Foundation.
"This decline has been most pronounced for Medicare reimbursements for primary care services and providers, which have dropped by 15%," the report said.
While behavioral health has been prioritized and is sometimes included in the definition of primary care, the report noted that behavioral care is often not integrated with primary care.
In January, the Centers for Medicare & Medicaid Services announced a behavioral health model that weaves physical health needs into behavioral health organizations, a reversal of what usually occurs.
Molina loses Virginia contract
Insurer Molina Healthcare of Virginia was not awarded a contract from Virginia's Cardinal Care Managed Care program.
The current contract expires this summer. Molina said it would "evaluate next steps" in a news release.
Instead, the state will give contracts to Anthem HealthKeepers, Aetna Better Health of Virginia, Humana Healthy Horizons of Virginia, Sentara Health Plans and UnitedHealthcare of the Mid-Atlantic.
Lobby-funded study says MA rate cuts will be worse than expected
Medicare Advantage (MA) medical cost inflation will increase by 4% to 6% in 2025, and plans will need to conservatively account for a 2% increase, according to a report funded by Better Medicare Alliance.
The Centers for Medicare & Medicaid Services proposed to decrease MA payments in 2025 by 0.16% in January.
"As a result, Berkeley Research Group estimates the value of supplemental benefits or reductions to premiums and cost sharing could fall by $33 or more per beneficiary per month, on average," the report said. "Beneficiaries would experience this as an increase in their health care costs and/ or reduction in available benefits. This analysis does not include the impact of the changes in Part D from the Inflation Reduction Act (IRA) that likely will cause Part D premiums to increase."
The group said phase-in of the V28 risk adjustment model, star ratings changes and the increased growth factor lead to that conclusion.
HHS announces $37 million in behavioral health grants
Through the Substance Abuse and Mental Health Services Administration, the Department of Health and Human Services announced $36.9 million in funding opportunities for behavioral health services. The Centers for Medicare & Medicaid Services is also allowing states to expand the number of providers eligible for Medicaid funding.
Funding opportunities include $8.1 million for prevention technology transfer centers, $10 million for screening, brief intervention and referral to treatment and $5 million for community programs for outreach and intervention with youth at risk for psychosis.
Finally, guidance this week allows states to receive federal dollars for nurse advice lines, according to a news release.
Medical crowdfunding due to insurance inadequacies: survey
Crowdfunding for medical expenses is a growing way for patients to pay for costly bills. In a recent survey, 77% of people who decided to crowdfund or solicit donations felt their out-of-pocket expenses were too high or insurance wouldn't cover expenses.
While a majority of crowdfunders say they met their fundraising goals, it's a potentially worrisome sign that large-scale crowdfunding is needed for medical procedures. It found that 28% of people needed funds for a lifesaving surgery, while 14% were looking to afford ongoing treatment like chemotherapy.
A plurality of respondents said assisting people with crowdfunding goals is the right thing to do to help people.