By David Wild

Chris Sloan, Avalere

With the COVID-19 pandemic derailing nearly every aspect of health care, experts are speculating that the ongoing crisis will reshape everything from drug pricing reform initiatives to universal health care policy debates and insurance accessibility.

Health Care Reform

By the time Congress gets to proposed health care reform, the political landscape may be very different from what it is today, potentially with a different president, noted Chris Sloan, an associate principal at Avalere, a health care consulting firm in Washington, D.C.

“Assuming the focus remains on COVID-19, the next opportunity for major health care policy reform might not be before 2021,” Mr. Sloan said during a recent Avalere podcast. If former Vice President Joe Biden wins the election, his health care proposals will look “very different than some Republican priorities, when it comes to Medicare drug pricing negotiations, for example,” he said.


Drug Supply Chain Weaknesses

Although some initiatives are stalling due to the COVID-19 crisis, others will be prioritized because of their relevance to the current pandemic, experts believe. For example, shortages of health care supplies and a recent shutdown of pharmaceutical manufacturers in Baddi, India—a key drug manufacturing hub—likely will accelerate initiatives to fix vulnerabilities in the drug supply chain and reduce dependence on China and India, said Melissa Andel, the vice president of health policy for Applied Policy. “In fact, the third phase of the stimulus package that Congress passed during the COVID-19 crisis included a pretty significant increase in funding that could be used by manufacturers to repatriate some of their activities back from overseas into the United States.”

Medicare for All

The argument in favor of a Medicare-for-all system could be bolstered in light of an increasing number of unemployed and uninsured individuals and “negative health care experiences,” such as surprise hospital bills for COVID-19 treatment, Ms. Andel noted. However, not all agree with that assessment. According to Mr. Sloan, personal views on the topic of universal health insurance “are so heavily entrenched that even a global pandemic isn’t going to sway many people’s minds.


“What I do think we may see are some state-specific efforts to widen the availability of patient health care safety nets, like Medicaid,” he said. “Losing commercial insurance coverage in New York is very different than losing it in Texas, where Medicaid is limited, so some states with less generous social programs may be pressured to expand these programs.”


Access to Care

Health care stakeholders are keeping a close eye on how much the pandemic affects health care utilization both now and after it resolves, Mr. Sloan noted. With most clinic appointments, tests and elective procedures postponed, pharmaceutical manufacturers, insurers and payors are trying to preserve as much access as possible to treatments and are encouraging adherence to medications. “Everyone has an incentive to avoid a spike in new diagnoses and complications and a wave of uncontrolled medical costs after COVID-19 subsides,” he said.


One way stakeholders have been addressing some of the gaps in care is through the use of telehealth, which saw a nearly 1,600% surge in claims at the height of the COVID-19 pandemic, according to IQVIA data presented by Doug Long, MBA, the vice president of industry relations for the firm, during a separate seminar (see “Pandemic Shakes Up Rx Marketplace”). These claims are being reimbursed widely, according to Mr. Sloan. Because it facilitates access to care for underserved populations, telehealth likely will continue to be paid for and used more frequently even after the pandemic is resolved, he suggested. (For more details on telepharmacy reimbursement, see “Be Prepared, Be Innovative and Be Safe!”.)

The financial effects of current and future changes in health care utilization are keeping health plan managers up at night, Matt Kazan, a senior health policy advisor at Avalere Health, noted during the podcast. “They’re looking at how the unanticipated costs of treatment for members who develop COVID-19 weigh against any savings from reduced utilization of health care services during this time,” he said.


The chronic care gap Mr. Kazan pointed to is underscored by IQVIA data: As the COVID-19 pandemic took hold at the end of March, medical claims for diagnostic visits in physician offices and institutions plunged by 63.2% and 72%, respectively, according to Mr. Long.

When Care Returns

Once the health care system reopens, another set of costs will start to be felt, Mr. Kazan noted. When that happens, he explained, clinic visits, elective procedures and tests presumably will resume, and patients will start treatments for new diagnoses that had been missed during the height of the pandemic. The problem is that the increased utilization “[will come] right when plans are setting their premiums for 2021,” he said. “It’s yet to be seen how all of these costs will affect the price of insurance.”

Along with the loss of insurance that tens of millions of newly unemployed Americans are facing, possible higher premiums, Mr. Kazan noted, would place health insurance further out of reach for many.

–Co-posted with Specialty Pharmacy Continuum