5 trending topics in health care policy for 2024

1. Changes to prior authorizations

Recently finalized and starting in 2027, the Centers for Medicare and Medicaid Services (CMS) will require some insurers to use an electronic prior authorization process as part of the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). One aspect of the rule will be implemented in 2026: Expedited prior authorization requests will need responses within 72 hours and standard requests within seven days from MAOs, state Medicaid and CHIP FFS programs, and Medicaid managed care plans and CHIP managed care entities. The goal of the rule is to alleviate the burden on providers and reduce administrative costs. But a key issue is that while payors are required to build this functionality, providers are not required to use it. Will providers continue to fax and use other manual processes? If so, the goals of rule may be defeated. Many states are also looking at reforms to the prior authorization process to reduce administrative complexity, though some raise concerns about eliminating important utilization management tools.

2. Prescription drug costs

From a July 2023 poll, it was reported that one in four adults taking prescription drugs find difficulty in affording their medication, with spending on prescription drugs rapidly increasing over the past three decades. While the Inflation Reduction Act includes measures to improve prescription drug spending for Medicare members that will be implemented over the next few years, reducing prescription drug costs for other groups as well continues to be a topic of discussion.

3. Eligibility for weight-loss drugs

Initially approved for treating diabetes by the Food and Drug Administration (FDA) in 2017, Ozempic and similar medications have gained popularity in the past year or so as a weight-loss drug with fast results. And while it’s not uncommon for doctors to prescribe a medication for something other than its intended use, the demand has caused a worldwide shortage for these medications—something that’s particularly detrimental to those taking these medications for diabetes. The shortage is likely to continue through 2024.

Some employers plan to cover the GLP-1 drugs for weight-loss to make their benefit packages more appealing to employees and to keep a healthier workforce, but cost could be a concern. Medications like Ozempic can cost around $1,000 per month and are not typically intended for short term use, which would keep the cost high over time, especially the more employees opt to use it (and for those who use it who aren’t covered at all by their employers). As the price of Ozempic has already risen in 2024, the year is likely to bring more conversations around cost, keeping up with the demand, eligibility versus intended use.

4. Guidelines on artificial intelligence (AI) usage

AI is prevalent in nearly every industry, offering many benefits to its adoption. In health care, AI can help to support health care providers in making better decisions, offer medical advice for patients, reduce paperwork and speed up innovative discoveries. However, concerns surrounding security, compliance and patient privacy, are important to take into consideration.

An Executive Order from President Biden has already been issued on the “safe, secure and trustworthy development” of AI and the National Association of Insurance Commissioners recently issued a Model Bulletin on the use of AI and appropriate safeguards and governance structures that must be considered when deploying AI.

5. Changes to behavioral health care

With a growing demand over the past few years, there’s been a need to improve access to behavioral health care services. At the end of 2023, CMS finalized policies that will help to promote access this year and beyond for eligible Medicare members.

For instance, prior to these policies, marriage and family therapists and mental health counselors were not able to enroll as Medicare providers. Now, as long as they meet the requirements, they’ll be able to enroll as a Medicare provider, which will help to bring more access to members. Medicare Advantage members will also have access to many of these newly enrolled providers for therapy and substance use disorder treatments.

It was also recently announced by the Biden administration that policies put into place during the pandemic for patients to receive opioid addiction treatment will stay in place permanently. This will allow patients to take home doses of the opioid addiction treatment methadone and start addiction treatment medication through telehealth. In 2023, a proposed rule by the Departments of Labor and Health and Human Services was also released to strengthen enforcement of the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) and improve a patient’s ability to access mental health and substance use disorder care.