Access to Some High-Cost Drugs Is Improving in Marketplace Plans, According to Report
Marketplace plans were less likely to place entire categories of drugs that treat complex diseases in the highest cost-sharing tiers in 2016 compared to previous years, according to a report from the consulting firm Avalere. The report, which analyzed silver plans' formularies across 20 medicine classes, also found that fewer plans this year are applying coinsurance above 40% for all drugs in a single class, though a small portion of plans still apply high coinsurance rates for all branded drugs in a class. Half of the plans reviewed placed all antiangiogenics—drugs used to treat cancer—in the highest cost-sharing tiers, making it the class of drug most frequently placed in the highest tier. Nearly one-third of silver plans placed multiple sclerosis drugs on the highest tier, a 14-percentage-point reduction from 2015. The report notes that CMS has discouraged plans from placing all drugs used to treat a condition in the highest tier without considering the medication's cost, and California has passed legislation preventing plans from placing all drugs for a condition on the highest tier beginning in 2017.
Premium Increases May Result in Increased Financial Assistance and Marketplace Enrollment, Report Finds
Significant increases in benchmark premiums may increase Marketplace enrollment by raising the premium assistance threshold to higher income levels, according to a new report from the actuarial consulting firm Milliman. States relying on HealthCare.gov that had significant premium increases for their benchmark plans between 2015 and 2016 had higher enrollment among those who qualify for financial assistance, compared to states with premium decreases or moderate increases. Changes in enrollment between 2015 and 2016 varied less between states among those eligible for premium tax credits in both years. Not surprisingly, the report also found that states that expand Medicaid or establish Basic Health Plans (BHP) are likely to see a decrease in Marketplace enrollment as expansion and BHP enrollees switch from Marketplace plans.
Kentucky: Report Highlights State's ACA Implementation Successes
Kentucky's uninsured rate has been cut in half—to 8%—and Medicaid enrollment has nearly doubled since 2013, according to a report by the Kaiser Family Foundation that describes the State's ACA implementation as one of the most successful in the nation. The report credits Kentucky's ACA successes to: strong and engaged leadership; a high-functioning, integrated eligibility system for Medicaid and Marketplace determinations; broad outreach and enrollment efforts; State-specific branding; and strong access to care for Medicaid beneficiaries (access to care for qualified health plan enrollees has varied by plan). The report also highlights the State's lower-than-anticipated care costs for the Medicaid expansion population and overall cost savings generated by expansion. Additionally, the report reviews ongoing changes and potential implications, including the transition from kynect, the State-based Marketplace, to HealthCare.gov, and Governor Matt Bevin's (R) plan to make changes to the Medicaid expansion through a waiver. The report comes amid the troubled rollout of Benefind, the State's new online enrollment system for Medicaid and other public assistance programs, and the Legislature'sfailed efforts to preserve the Medicaid expansion and kynect.
Nevada: Exchange to Continue Using Federal Platform
Nevada's Silver State Health Exchange will continue to use the HealthCare.gov platform to sell qualified health plans in 2017, accordingto the Nevada Appeal. Executive Director Bruce Gilbert said the exchange, a State-based Exchange on the federal platform (SBE-FP), may consider other options for 2018. Gilbert had previously said he expected the federal government's proposed 3% user fee on SBE-FP issuers—which has since been reduced to 1.5% for 2017—would encourage states to pursue private sector alternatives to the federal platform.