As COVID-19 Recedes, Payers Face Changed Coverage Landscape

There will never be a return to a pre-pandemic normal in terms of what health insurers, self-insured employers and other payers must cover, but they will in some ways be less burdened as COVID-19 recedes, according to Jeff Levin-Scherz, M.D., the population health leader for health and benefits in North America at Willis Towers Watson.

He told Fierce Healthcare that telehealth won’t have the same reach as it did during the pandemic because individuals using the technology will have to interact with a provider in the same state. In addition, the mental health landscape has changed radically, with the prevalence of major symptoms of anxiety or depression tripling since 2019, according to WTW.

Levin-Scherz noted that the telehealth tracking company Fair Health says half of the telehealth interactions going on presently in the country involve mental health or substance use disorders.

“I think there are a couple of reasons for that,” said Levin-Scherz. “One is there’s an enormous shortage of mental health providers. Another is that the needs have just skyrocketed. Also, in many instances, people with mental health issues would prefer not to see somebody in person. There are good reasons why we’re seeing mental health delivered via virtual care.”

One coverage mandate that Levin-Scherz said he’s glad will stay in place allows providers to prescribe opioid use disorder medications such as suboxone until November 2024 for individuals already utilizing telemedicine for that purpose and until November of this year for those who aren’t.

“That, at least for the moment, is not changing,” said Levin-Scherz.

Employers and health plans do not have to cover COVID-19 home tests, which is in keeping with payers not having to pay for any over-the-counter tests or medications.

“If people go get a lab test, they pay for it,” said Levin-Scherz. “If people get a home pregnancy test, it is not covered by insurance. And so, the tests are going to be more like a pregnancy test. You don’t expect your insurance to cover it. The cost of home COVID test in the U.K. is between $1 and $2 whereas here it’s $12. When these over-the-counter tests are no longer covered, we’ll probably see the cost go down.”

COVID-19 vaccinations must still be covered without charge by employer-sponsored health insurance, said Levin-Scherz. But most employers outside of healthcare have already discontinued the vaccine mandates.

That’s because vaccination a year or more ago provides little protection against bringing COVID-19 to the workplace now.

“It also takes a lot of work to track it,” Levin-Scherz said. “Most employers will remove their COVID vaccine mandates, and I think that that’s probably a good idea.”

Employers will no longer be required to waive cost sharing on COVID-19 medications such as Paxlovid. The federal government continues to supply the medication now, so employer-sponsored health insurance is only responsible for administration fees, although the employer plans will also have to start paying for the drug itself when the federal supply runs out, according to WTW.

Many employers made improvements in their offices to mitigate the spread of COVID-19 and other respiratory illnesses. For instance, they improved airflow, and they may have to make even more improvements. Last Friday, the Centers for Disease Control and Prevention upgraded guidelines on airflow, saying that air ventilation should produce five air changes an hour.

And, though the agency has encouraged better airflow in the past, this is the first time it’s ever set a goal.

“I think that this is a really good first step,” said Levin-Scherz. “It turns out that clean indoor air doesn’t just prevent COVID transmission, but influenza transmission and also prevents RSV transmission. Also, there’s evidence that people actually are more productive and more able to get their job done when there are more air exchanges and the air is cleaner.”


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