The Henry J. Kaiser Family Foundation

Dive Brief:An expensive weight loss drug could become one of Medicares costliest medications, even if the majority of patients are ineligible for coverage, according to a study published Monday in the Annals of Internal Medicine.The analysis found 3.6 million people are likely to be eligible for treatment with semaglutide, a GLP-1 drug thats approved as Wegovy to treat obesity and reduce heart risk. More liberal definitions of eligibility could increase that number to 15.2 million people.If all newly eligible patients received semaglutide, spending in Medicares Part D prescription drug benefit could increase by $34 billion to $145 billion each year, according to the study. Even if the government narrowly defined eligibility, federal spending on the medicine could still exceed $10 billion annually.Dive Insight:New GLP-1 drugs have shown great promise at treating obesity, a condition that affects a large proportion of American adults and contributes to a range of other health conditions. More recent testing has shown semaglutide, and a rival drug from Eli Lilly, hold notably other benefits.In March, U.S. regulators approved Wegovy for expanded use reducing heart attack risk in people with cardiovascular disease and who are obese or overweight.But Wegovy and drugs like it are costly and, at least for weight loss, people need to take them chronically potentially putting strain on insurers should significant numbers of people receive treatment.Employers, who provide health insurance coverage for the majority of Americans younger than 65 years, have already been sounding alarms over the drugs contribution to rising healthcare expenses.A report published last week by the Business Group on Health estimates large employers are preparing for a 7.8% spike in healthcare costs next year, largely due to increased spending on pharmaceuticals like GLP-1s.Meanwhile, Medicare spending on GLP-1 drugs has already accelerated. Gross spending on the medications rose from $57 million in 2018 to $5.7 billion in 2022, even though the program only covered three GLP-1 medications for diabetes at that time, according to an analysis by health policy research firm KFF.But now more Medicare beneficiaries may be able to access semaglutide. This spring, the Centers for Medicare and Medicaid Services said it would cover the costs of Novo Nordisks Wegovy for some people with a history of heart disease. (Medicare is currently prohibited for covering medicines only for obesity.)The new research aims to estimate how much covering semaglutide could cost Medicare, depending on how the program defines patients with established cardiovascular disease.While more than 14% of Medicare-eligible adults would be highly likely to be covered for semaglutide, more liberal definitions of established cardiovascular disease could increase that proportion up to nearly 61%, according to the study.Still, access to the drug could be impacted by other factors, like out-of-pocket costs, drug shortages, utilization management strategies and formulary placement, the researchers wrote. For example, if the medication is put on a specialty tier, Medicare Part D drug plans could charge 25% to 33% of the medications retail cost.But even with low usage rates, the medication could potentially become one of the largest drivers of Medicare spending without near-term budget controls, according to the study.Only 1 in 7 Medicare beneficiaries with elevated BMI are likely eligible for semaglutide if established cardiovascular disease is narrowly defined, researchers found. Even then, costs to Medicare could still exceed $10 billion each year.In this conservative coverage scenario, that means most beneficiaries with elevated BMI and cardiovascular risk would remain ineligible for semaglutide, yet the medication could still potentially become one of the costliest drugs to Medicare, lead author Alexander Chaitoff said in a statement. '

佛罗里达州棕榈滩花园 2023年3月29日 /美通社/ -- 第15届 Healthcare Revolution （医疗保健革命）年会（2023年5月23日）已经启动；这是医疗保健领域思想领袖、自筹资金雇主、经纪人和医疗保健领域领导者的最大盛会；本次大会的讨论发人深省且富有洞察力，主要专注于自筹资金雇主如何利用医疗旅游以其当前医疗保健支出的一小部分为他们的员工实现良好的医疗保健结果。 今年的Healthcare Revolution的讨论主要关于：美国梦因医疗保健成本不断上升和不可持续性所导致的失败、以及雇主如何把握医疗旅游带来的无穷机会。 为美国人提供的美国医疗保健现在已成为一种奢侈品，且许多人都无法享受。过去，医疗保健方面的大部分坏账都来自没有保险的人。现在，在美国，58%的坏账来自有保险但无法支付免赔额、共同保险额和自付费用的人员的医疗保健费用。2022年凯撒家庭基金会的 医疗保健债务调查 发现：10个成年人中有八个有医疗保健债务，而在没有医疗保健债务的成年人中，50%的人员报告说，他们因为前12个月的费用原因跳过或推迟了治疗。 雇主和员工都在为支付医疗保健费用而苦苦挣扎。 根据KFF进行的"2022雇主健康福利调查"，雇主出资的家庭保险年度保费已达到22,463美元，其中员工支付$6,106，其余则由雇主支付。这比2012的年度保费（当时雇主出资的家庭健康保险年保费为16,351英镑）增加了40%以上。 但是，随着通货膨胀消耗了员工的收入，医疗保健成本对大多数美国家庭来说已经变得过于昂贵，许多家庭都不开处方，也不进行治疗，或者完全避免医疗，以防止陷入财务债务。 这些令人不安的数据每个月都在恶化，自筹资金雇主必须掌握主动权，并决定如何让医疗保健支出获得最佳结果。今年的会议将改变游戏规则，为在美国支离破碎医疗保健系统中苦苦挣扎的医疗支付者一条通往彼岸的道路。 Healthcare Revolution汇集了一些自筹资金的医疗保健和福利领域最著名的领导者。 向专注于医疗旅游和药房旅游并大获成功的自筹资金雇主学习，了解这如何导致每年节省数百万美元的巨额成本，并改善员工的护理效果。 案例研究将由将员工送到国外购买昂贵的医疗程序和处方药的雇主提交，其员工现在更愿意在国外而不是在当地获得世界一流的快速医疗服务。 今年的雇主嘉宾将帮助打破阻碍进一步采用这个福利的障碍和反对意见。雇主和员工福利顾问将获得一个明确的路线图，说明如何实施医疗旅游，为员工提供激励（免除免赔额、共同保险额、自付费用），并为员工提供数千现金，同时使员工免于医疗债务，且其成本仅为美国的一小部分。 此外，您还将从韩国、哥斯达黎加和巴拿马等多个医疗旅游目的地的医疗保健领导者那里了解到，他们正在通过突破性的创新改变医疗保健，推动医学艺术和科学的发展。 Healthcare Revolution将首次创造一个由自筹资金雇主、员工福利顾问、保险公司、TPA和计划出资方等独家受众组成的最大的网络，以了解医疗旅游所拥有的无穷机会。 "雇主和员工是一个转折点。但什么都不管用了。是时候发展和接受医疗旅游等新解决方案了"，全球医疗资源和医疗旅游协会首席执行官Jonathan Edelheit表示。 我们的演讲嘉宾将打破围绕医疗旅游的成见，教育参与者如何看清反对医疗旅游目的地的宣传，并证实各种事实如何清楚地表明，医疗旅游正在扩大医疗保健，并为参与其中的美国自筹资金雇主节省成本。 立即在 www.healthcarerevolution.com 上免费注册 先睹 为快了解今年的演讲嘉宾 Tim Isenhower Tim Isenhower是我们的演讲嘉宾之一，他是HSM Solutions的福利总监，与HSM合作并管理其自筹资金保险计划近三十年。从上世纪90年代到今天，他一直管理着一个自我保险健康计划；这为他提供了一个打破常规的机会，让他有机会大胆考虑降低医疗成本的计划，包括直接签约、现场诊所和医疗旅游，因此成为提供医疗旅游的自筹资金公司的先驱之一。 Ray Bowman 博士 Ray Bowman博士目前是MarineMax的高级副总裁，负责人才和团队发展；MarineMax是全球最大的游艇零售商，业务遍及三十个州和三个大洲。他在MarineMax负责监督所有高管培训，并负责发现，个性化和扩展所有与健康计划相关的福利。此外，他还是MaxHealthPlan Solutions（MHS）倡议的主席；该倡议基于他制定的MarineMax创新医疗保健计划。MHS为希望控制健康计划成本同时提高员工福利的自筹资金公司提供免费咨询。 Wade Larson 博士 Wade Larson博士是Wagstaff，Inc.首席人力资源官，也是Optimal Talent Dynamics的总裁；Optimal Talent Dynamics是一个专注于领导力、医疗保健和人力资源成功的咨询集团。Wade博士 已与数百家组织和成千上万的个人合作，担任领导职位和员工顾问，以改进流程并优化绩效。作为一名国际演说家、作家、培训师和兼职教授，Larson认为，医疗保健改革属于个人范畴，因此，他要求领导者改变其组织和社区，以实现医疗保健战略的成功。 警告！！ 这项计划不适合对美国支离破碎的医疗保健系统感到满意的雇主、保险公司和商业领袖，也适合那些喜欢费率上涨、保费飙升和让其员工支付自付费用的人士；并且，其也不适合那些过于胆小、不敢带头做出改变且无法看到医疗保健成本具体变化的商业领袖和经纪商。这项计划只适合那些准备好跨越未知领域、冒险前行、取得无与伦比成果的人。 立即在 www.healthcarerevolution.com 上免费注册 关于 Medical Tourism Association Medical Tourism Association （MTA）是一家非营利组织，致力于打破障碍，提供可负担的、透明的和世界级的医疗服务 MTA成立于2007年，在推动医疗旅游行业采用最佳实践的同时，继续提高人们对该行业的认识。MTA的目标是让行业利益相关者更容易建立联系和开展业务，无论是医疗保健提供者、转介机构（买方）还是医疗游客。MTA很自豪能够与韩国、迪拜、华盛顿特区、佛罗里达州和阿布扎比等该行业的领先品牌合作，并帮助推出这些品牌。我们与各国政府、医疗保健提供者、保险公司和其他利益相关者合作，从项目的概念到启动和整体商业化。

Average annual premiums in 2022 reached $7,911 for single coverage and $22,463 for family coverage, a new survey showed. This is only a slight increase from last year at $7,739 and $22,221, respectively. But that modest rise in premiums likely won’t last. The Kaiser Family Foundation (KFF) report, released Thursday, included 2,188 non-federal public and private firms that responded to the entire survey. It included another 2,917 firms that responded to one question about offering coverage. The survey found that the increase is less than the 8% increase in inflation and less than the 6.7% increase in employees’ wages in the last year. “Employer costs for this year were largely set last year, before inflation became a major economic concern and after the Covid-19 pandemic led to a temporary slowdown in utilization of health care services,” according to a KFF news release. But inflation and the tight labor market may cause these premiums to rise in 2023, said KFF President and CEO Drew Altman in a statement. “Employers are already concerned about what they pay for health premiums, but this could be the calm before the storm, as recent inflation suggests that larger increases are imminent,” Altman said. “Given the tight labor market and rising wages, it will be tough for employers to shift costs onto workers when costs spike.” Other key findings from the survey include: Employees of small employers, or those that have less than 200 workers, pay more in healthcare costs than those of large employers. For family premiums, workers at small companies pay $7,556 toward premiums, compared with $5,580 for workers at big companies. For single coverage, small firm workers and large firm workers pay about the same toward their premiums. However, the average single deductible is $2,543 for workers at small firms and $1,493 for workers at large firms. About half, or 48%, of large employers, reported an increase in the number of employees using mental health services. Additionally, 29% of workers are requesting family leave because of mental health problems. Substance use is a concern for many large employers. About 14% said they’ve seen an increase in the number of workers accessing substance use services. Another 43% said they are at least somewhat concerned by the rise of substance use conditions. About 27% of large employers added mental health providers to their network, but 30% still said their network doesn’t have enough. Another 47% said telehealth is a vital way to increase access to mental health services. “Many large employers are struggling to add enough mental health and substance use providers to meet their workers’ growing needs,” said Gary Claxton, a KFF senior vice president, in the news release. “Most consider telemedicine to be an important part of the solution.” Getty images, utah778