The COVID-19 pandemic has spurred—and aggravated—a range of mental health and substance use issues in the United States. In this episode of Critical Point, Milliman’s Stoddard Davenport discusses the rising demand for mental health services and how different populations are being affected. Stoddard also highlights recent statistics on the topic and what the road ahead may look like for mental health in America.
To listen to other episodes of Critical Point, click here.
Pharmacy Briefing is a monthly summary of select U.S. Food and Drug Administration (FDA) approvals and launches, treatment guidelines and research updates, and other newsworthy events that have the potential to impact commercial drug utilization or costs.
The Supreme Court upholds Arkansas Act 900 regulating PBM practices
Drug manufacturers implement annual price increases
Employers consider whether to mandate COVID-19 vaccinations
Employers may consider public safety, the benefits of a safer work environment, and the concerns of those who worry about the safety of the vaccine before exercising the legal right to mandate vaccination.
COVID-19 has had a financially debilitating effect on many medical practices. Some practices are not expected to survive. The impact has been felt by physicians as well as other healthcare entities and led to severe declines in fee-for-service revenue. The pandemic also caused the Center for Medicare and Medicaid Innovation to make adjustments to its Direct Contracting (DC) program. DC adjustments include adding a second cohort that begins January 2022, providing a capitation payment glide path, and increasing physician capitation choices.
These changes create an opportunity for organizations considering becoming Direct Contracting Entities (DCEs) to attract physicians who may not have been interested in the program previously. The application window for the second cohort of DCEs opens in March 2021. In this brief, Milliman’s Coleen Young, Hugh Larson, and Annie Man discuss DC and the impact of COVID-19 on physicians.
Amazon Pharmacy, the tech giant’s latest venture into healthcare, launched a mail-order pharmacy in November 2020. The venture provides mail prescription delivery for all patients, as well as the additional benefits of two-day prescription delivery and discounted medication prices for Amazon Prime members through the Prime Rx program. Patients can have providers send prescriptions directly to Amazon or Amazon can contact the provider on the patient’s behalf. Amazon Pharmacy complements Amazon PillPack, which sorts medications into small, individual packages based on the date and time of day they are to be taken.
Effectively, Amazon is joining the existing pharmacy supply chain. Amazon Pharmacy works with pharmacy benefit managers to ensure its mail-order pharmacy service is included in pharmacy networks when prescriptions are filled with insurance. When insurance is not used, Amazon offers Prime members discounted pricing through its mail-order pharmacy or at participating retail locations.
In this paper, Milliman professionals discuss whether Amazon Pharmacy will disrupt, conform, or lay the groundwork for future transformation in the pharmacy industry.
The COVID-19 crisis and the enforced lockdowns and shelter-in-place orders worldwide have accelerated the relevance and usage of telehealth, which has major implications for health insurers. The usage of telehealth has been limited historically. For example, 92% of U.S. consumers reported that they were not using telehealth prior to the onset of the COVID-19 pandemic.
In this paper, Milliman professionals examine the current status of telehealth in major geographic markets, including the U.S., Europe, and Asia. They develop a framework for telehealth with its key market participants, including a typology of models of virtual care. They also explore insurer proposition design and cost containment.
The U.S. Food and Drug Administration recently granted emergency approval for the Pfizer COVID-19 vaccine and approval of the Moderna vaccine followed shortly. In November, Pfizer and BioNTech announced a successful Phase 3 study of a vaccine against COVID-19 with an efficacy of over 90%. Days later, Moderna made a similar announcement with the development of a vaccine having an efficacy of nearly 95%. These announcements were met with renewed hope that life will soon return to pre-pandemic normalcy.
Employers have become increasingly anxious to see a return to normal business practices after months of disruption due to COVID-19. The vaccines offer hope that businesses will be able to prepare to roll out plans to return to pre-pandemic practices in the near future. In this paper, Milliman’s Les Kartchner and Brent Jensen present considerations for employers as these new vaccines are made available.
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