A Thank Y cove ou T rageo Me was i m m be plrs em : en Th ted is st w ud hen he y was a lcondu th savct ing Fed t ig s u ac r he rcou ough 2 nt ( the HSA EB )- R eI l C igient ble he er fal ort R h p es lans earch on He were intral oduc th ed Benefits( I Fron nnova stitn, Sep ion (EB ulv Reda I C, R and HB I R ), w oebuc ith t k 2 he f 013) undi . Si ng m siuppor larly, tr of ec etnt he f res olea low rch ha ing o s f rgo ani und zat that ions w : A heon, B n the I lue Cr RS al os low s ed Cost of Select Preventive Services, 2019 B lue Shiem eld A ploye ssorci s a and he tion, Ial CtU h p BA lan , JP Mor s to covga ern C cerhas tain p e, Pfi reve zer nt, ive and PhR service MA. s out side HSA-eligible health plan deductibles, about three-quarters of them chose to do so, often without cost sharing (Fronstin and Percentage of Employer Savings October 20, 2022, #444 5 Fendrick 2021). Members Utilizing Percentage of From 20 Percent Total Cost Per User Service Total Cost Coinsurance References Breast Cancer Screening $332 10.00% 0.50% 0.11% G iven the current uncertainty surrounding the ACA’s preventive care coverage mandate, we examined the extent Cervical Cancer Screening $39 9% 0.10% 0.01% to which these health services impact costs. Accordingly, we conducted an analysis of claims data on over 2.4 Fronstin, P. (2002, July). Can "Consumerism" Slow the Rate of Health Benefit Cost Increases? EBRI Issue Brief The Impact of Covering Select Preventive Services on m illC ion olorenr ectao l lC lee anc se tro q uantify spending on five commonly used services and all prescription drug classes receiving no.247. Screening* $990 4% 0.70% 0.15% an “A” or “B” recommendation from the USPSTF. Employer Health Care Spending HPV Vaccination† $297 3% 0.10% 0.03% Fronstin, P., & Fendrick, A. M. (2021, October). Employer Uptake of Pre-Deductible Coverage for Preventive Notes: O ur findings demonstrate that the costs of covering select preventive services are very low (Figure 1). Moreover, When the Patient Protection and Affordable Care Act (ACA) passed in 2010, it included provisions requiring that HPV=Human Papillomavirus. Services in HSA-Eligible Health Plans. EBRI Issue Brief, no. 542. any reintroduction of patient cost sharing will have a minimal impac 1t on overall employer health care spending. If employers and health plans cover certain preventive services in full. These include services such as screenings * Not including facility fees, pathology, or anesthesia. employers imposed 20 percent cost sharing on these medications, employer spending would fall by 0.3 percent. ^ Not including sterilization. for cancer and other health conditions, vaccinations, and birth control. Plan sponsors have been prohibited from † Including administration. imposing any form of cost sharing (i.e., deductible, copayments, or coinsurance) on participants receiving these Fronstin, P., Sepulveda, M. J., & Roebuck, M. C. (2013, June). Consumer-Directed Health Plans Reduce The The case before the U.S. District Court for the Northern District of Texas challenged the requirement that services. However, a recent federal judicial opinion in Texas may put coverage of some of these preventive Long-Term Use Of Outpatient Physician Visits And Prescription Drugs. Health Affairs, 32(6), 1126- employers had to provide coverage for Pre-Exposure Prophylaxis (PrEP) medications that prevent human services with no out-of-pocket costs in jeopardy. On September 7, 2022, Judge Reed O’Connor of the U.S. 1134. i The mm Texa unodef s c ic ai se en m cy vi ay al rus so( rH aiIse V) q w ues ithou tions a t cob st out sha con ring tr.a T cept he c ive c ourtove conc rage lude . O d t urh an at al the ysi rs f equ ind ire s t mh eat nt tto o co tal ave verr P age rEP District Court for the Northern District of Texas found a key part of the preventive service provision spe drugs nd ivi ng p olaer tes u tse he r w fed as er $47 al R 0el , and 9 p igious Fr eree cent do m of R enr eso to llree ati s on A used s ct.om In ou e fo r an rm al of y si cont s of rac Pr eEP pti dr ves u, a gs, we ccount found ing f or tha 0t.7 the unconstitutional. Specifically, the decision refers to the part of the ACA that requires coverage without cost per cosc t ent on a p of ter ot-al pa spe tient nd b ias ng. is o If em f thes ple d oye rr ug s we s is r r e e tlo atiint vel rodu y hi ce gh 20 p at $er 13,8 cent 14 m per em b yea er c r.os Btut sha bec ring o ausen con so few trac enr epo ti lves lees , they sharing of preventive services to which the U.S. Preventive Services Task Force (USPTF) assigns a rating of “A” Norris, H. C., Richardson, H. M., Benoit, M.-A. C., Shrosbree, B., Smith, J. E., & Fendrick, A. M. (2021). w utoul ilize d r PrEP educ m e tedi heica r sp tion endi s (n ag by 0.14 p bout 0.17 pe errce cen ntt. o f all members), the total cost of these drugs accounts for only 0.41 2 or “B”. U The j tilizudge ation I rul med pac tt ha of t r C eco ostm -Shar menda ing El tions f imirn oat mi t on he US for P PS revent TF ar ive Ca e uncon re S ster itut viice onal s: A b R ecapi ause d R the T eview. ask Fo Med rc ica e ils percent of total spending. If, for example, employers imposed 20 percent cost sharing on patients for PrEP drugs, an independent, volunteer panel of national experts in prevention and evidence-based medicine whose members Care Research and Review, 1-23. em Wep ex loye pec r sp t th end e sp ing w ending ou lo d f n al otlhe by r pr les eve s tha ntin one ve ser -tv ent iceh s of re ce 1 iper ving cen a US t. PSTF “A” or “B” rating to be similarly low. ar e not appointed by the President and confirmed by the Senate, thereby violating the appointments clause. Moreover, certain recommended services do not impose incremental costs, as they are often provided as part of a r outine office visit, such as screening for hypertension, tobacco use, and unhealthy weight. This ruling has important clinical, equity, and cost implications, as preventive care is important for individuals Figure 1 and public health. The U.S. Department of Health and H ### um an Services has estimated that in 2020, 151.6 million Cost of “A” and “B” Rated Medications, 2019 E mployers could realize more measurable cost reductions if the addition of cost sharing reduced use of these 3 people had access to free preventive care under the ACA. This ACA provision is very popular, favored by 62 preventive services. However, imposing cost sharing for preventive services would reverse a growing movement 4 percent of Americans. A recent review reported that removing cost sharing boosts the use of preventive services, Percentage of Employer Savings among employers in recent years to expand coverage of clinically effective care without deductibles or copays which helps reduce disparities and save lives (Norris et al. 2021). Members Utilizing Percentage of From 20 Percent ( Fronstin and Fendrick 2021). It also could hamper intensifying efforts to reduce health disparities for lower- Total Cost Per User Service Total Cost Coinsurance income Americans, people of color, and the LGBTQ+ population. If this court decision is upheld and the coverage mandate of USPSTF “A”- and “B”-rated services is invalidated, HIV PrEP Medication $13,814 0.20% 0.40% 0.08% employers and health plans could impose some form of cost sharing for these preventive services. Yet, employers Statins (Ages 40–64) $151 8% 0.20% 0.04% Data and Methods may continue to provide these services at no cost to members for at least a few reasons, including: Breast Cancer Preventive Drugs (Ages 35–64) $237 1% 0.02% 0.00% ® We analyzed MarketScan pharmacy and medical claims data on a random sample of 2.4 million members 1. Employers may not want to cut benefits during a time when unemployment is low and recruitment Contraceptives $470 9% 0.70% 0.14% continuously enrolled during 2019 in a non-capitated private health plan (including employer-sponsored and retainment of workers is of concern. Total $454 17% 1.30% 0.30% and other commercial insurance). No further sample restrictions were applied. Therefore, the study cohort Notes: HIV=Human Immunodeficiency Virus; PrEP=Pre-Exposure Prophylaxis. included individuals under age 65, residing in all U.S. geographic regions, and enrolled in a variety of plan 2. Employers may believe that incentivizing their use reduces aggregate health spending in the long types. Using relevant procedure codes and financial fields from claims, we derived mean per-member per- term. year (PMPY) plan, member, and total cost measures for the “A”- and “B”-rated preventive services Other selected preventive services are similarly low cost. For instance, screening for breast cancer, cervical examined. We also captured the percentage of members with any utilization of each of the services, as well 3. There is precedent for covering these services without cost sharing in the absence of the ACA cancer, and colorectal cancer are perhaps the most well-known “A”- and “B”-rated preventive services. In 2019, as the share of total costs represented by each service. We replicated the analysis using 2020 data and found mandate. When health reimbursement arrangements (HRAs) were introduced in the early 2000s, some 10 percent of enrollees received breast cancer screening, 9 percent received cervical cancer screening, and 4 nearly identical results. employers provided first-dollar coverage for preventive services (Fronstin 2002). Comparable generous percent received colorectal cancer screening (Figure 2). (It is important to note that each of these cancer screenings are not performed annua lly for recommended patient populations). They account for 0.5 percent, 0.1 About EBRI: The Employee Benefit Research Institute is a private, nonpartisan, nonprofit research institute 1 per Grc an ent df,ath and 0. ered 7 pe health rce pn lan t o sf ar tot e n al o c t rost equ s, r ired es tp oec co tim ve pl ly y. with Fol lth ow is ip ng on rovisio the n. prior example, if employers were to based in Washington, DC, that focuses on health, savings, retirement, and economic security issues. EBRI does introduce 20 percent member cost sharing for these screenings, they would reduce their spending by 0.27 percent. not lobby and does not take policy positions. The work of EBRI is made possible by funding from its members 2 The USPTF is a group the Agency for Healthcare Research and Quality (AHRQ) has been authorized by the U.S. Congress and sponsors, which include a broad range of public, private, for-profit and nonprofit organizations. For more to convene since 1998. information go to www.ebri.org or connect with us on Twitter or LinkedIn. 3 https://aspe.hhs.gov/sites/default/files/documents/786fa55a84e7e3833961933124d70dd2/preventive-services-ib-2022.pdf. 5 Also see https://ahiporg-production.s3.amazonaws.com/documents/202109-AHIP_HDHP-Survey.pdf and https://www.irs.gov/pub/irs-drop/n-19-45.pdf. 4 https://www.kff.org/health-reform/poll-finding/kff-health-tracking-poll-july-2019/. EBRI’s on Twitter! @EBRI or http://twitter.com/EBRI EBRI blog: https://ebriorg.wordpress.com/ E E EB B BR R RI I I on on on T T Twitt witt witte e er r r: : : @ @ @E E EB B BR R RI I I o o or r r htt htt http:/ p:/ p://t /t /twit wit witter ter ter...c c com/ om/ om/E E EB B BR R RI I I B B Blog: log: log: htt htt https ps ps:/ :/ ://ebr /ebr /ebrio io ior r rg. g. g.wor wor wordp dp dpr r re e es s ss s s...c c com/ om/ om/ © 2022, Employee Benefit Research Institute, 901 D St. SW, Suite 802, Washington, DC 20024, 202/659-0670 www.ebri.org 2 3 4