kevin

Texas: Friday Health Plans Bails; Another ~230K Enrollees Will Have To Pick A Different Day Of The Week

It was just four days ago that Bright Healthcare, which had been aggressively expanding their individual market coverage area footprint as recently as a year ago, suddenly announced that they were doing a complete 180 and instead pulling out of virtually the entire individual & small group markets nationally starting in January 2023.

This shouldn’t have been as much of a surprise as people thought, however; Bright had already announced back in April of this year that they were pulling out of five states, and healthcare analyst Ari Gottlieb had written an impressively-researched post about the warning signs surrounding Bright’s plight back in August, which I expanded upon here at the time.

In any event, Tuesday’s announcement by Bright that they were pulling out the other nine states they’re currently operating in means that nearly a million ACA individual market enrollees will either be automatically shifted to different insurance policies via different carriers or they’ll have to log into their accounts and actively pick a different policy themselves. This represents upwards of 8% of all on-exchange individual market enrollees nationally, including an estimated ~262,000 in Texas alone.

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aetna medicare solution

WOW! Great news: Formulary enhancements for 2023

Starting in 2023, many of the top medications taken by Aetna Medicare members will be on a lower drug tier, Tiers 1 and 2. In fact, nearly 300 drugs are moving to a lower drug tier.

 

This includes drugs for asthma, depression, anxiety, and more. And many drugs for high blood pressure and high cholesterol are already on Tiers 1 and 2.

What’s the big deal?

These formulary updates may help members save on prescription costs.

For example, some of the Tier 3 drugs moving to Tier 2 include:

  • a) ALBUTEROL SULFATE HFA (asthma, COPD)
  • b) ESCITALOPRAM OXALATE (depression, anxiety)
  • c) CELECOXIB (pain relief, inflammation)
  • d) BUPROPION HYDROCHLORIDE ER (XL) (depression, smoking cessation)

Other fun facts

  • a) We’ve down-tiered nearly 300 drugs across each of our formularies: B2:         294; B4/B4+: 279; B5: 278 
  • b) Improved the volume of Tier 1 and 2 drugs on our MAPD formularies by           45% (compared with 2022) 
  • c) Nearly 8 in 10 members will continue to have access to $0/$0 Tier 1 and         2 copay structure 
  • d) Added ~10 new drugs to MAPD formularies including popular drugs such      as:
    •      i) Eligard (prostate cancer)
    •      ii) Gemtesa (overactive bladder)
    •      iii) Lantus (diabetes)*
    •      iiiv) Toujeo (diabetes)*
    •      v) Truxima (biosimilar, rheumatoid arthritis)
    •  

 *Drug already on B5+ in 2022

Great news! CMS announces Medicare Part B premium reductions!

According to an update released by CMS on September 27, 2023: The standard monthly premium for Medicare Part B decreases to $164.90 in 2023, compared to $170.10 in 2022, a decrease of $5.20. The annual deductible for Medicare Part B beneficiaries decreases from $233 to $226 in 2023. The Medicare Part B monthly adjustment amount is income-related and the total premiums for fully insured Part B beneficiaries in 2023 are shown below.

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WE’RE AVAILABLE BY EMAIL (SUPPORT@EPROASSOCIATES.COM) OR BY PHONE (1-888-500-2578).