This is Jacob Emerson with the Becker's Payer Issues podcast. Here's your biweekly industry news briefing for September 9th. The Biden administration has finalized new requirements for health plans to strengthen mental health parity laws for 175,000,000 Americans. Payers and employer sponsored plans have been required to cover mental health and substance use benefits the same as they would for medical benefits under the Mental Health Parity and Addiction Equity Act of 2008.
Though that law was further strengthened in 2020, mental health care access is still fragmented and difficult to access for many nationwide. The new rule, introduced back in July of 2023, will require plans to analyze the outcomes of their mental health coverage policies, including network size, out of network payment policies, and prior authorization requirements. The new rule clarifies that plans cannot have more restrictive prior authorization standards or narrower networks
for mental health service. The administration is also closing a loophole in the 2,008 act that excluded non federal government health plans from parity standards, such as health plans from states for their employees. Parts of the new policy go into effect in 2025 and others in 2026. The insurance industry has pushed back against the rule change, with AHIP saying it will not achieve the goals of increasing access to mental health care or substance use disorder treatment.
Well, interest in Cigna's GLP one management program is, quote, through the roof. That's according to CEO David Cordani. He said September 5th that clients are looking at how you how do you ex balance how do you balance expanding access, but in a more sustainable way. In March, Cigna launched Encircle RX, which is a program to help employers manage the cost of GLP 1 drugs. The program grew to more than 2,000,000 enrollees
in its 1st 6 months. Mister Pordani said that around 50% of the large employers served by Evernorth, Cigna's health services business, cover GLP 1 drugs for weight loss. A small percentage of Cigna Healthcare's clients, the company's insurance benefits business, have opted to cover the cost of the drugs for their employees. Cigna works with employers of all sizes. Mister Cordoni said that the topic is front
of mind for everybody, not just investors. On one hand, it represents a example of pharmacological innovation that brings new services and new programs. And on the other hand, it hits an affordability challenge. Mister Cordani said the coverage for the drugs is ticking upwards at a slow pace, growing in single digit percentages. LaSalle of Blue Cross and Blue Shield of Louisiana is completely off the table, according to the company's new CEO, Brian Kamerlinck.
In February, BCBS Louisiana tabled plans to be acquired by Elevance Health. That sale faced scrutiny from local physicians and state officials. Mister Cammerlink was appointed CEO in May in the wake of the scrapped deal. He told local media that there are no plans to pursue a sale under his watch. He said, quote, we're focused on Louisiana, and we're focused on being independent.
We're going to work with our local providers, brokers, and community members, which includes the Louisiana legislature, to remain independent as long as we can. The company has implemented a number of changes since he assumed the CEO role, including rebranding as Louisiana Blue, appointing new senior executives, and introducing a new organizational structure. Well, GLP one medication costs are one factor contributing to tighter margins in the Medicaid space.
That's according to executives at Centene. On September 4th, the company's CFO, Drew Asher, said Medicaid redeterminations are continuing to put pressure on the company's Medicaid business. The company lowered its Medicaid membership expectations for the year from 13,600,000 to 13,000,000. The lower membership guidance led to the largest one day drop in Centene's share price in a year. The pressure is largely driven by redeterminations, but individual changes by states also play a
role. He said either there's a new program or the state has done something wonky with the pharmacy benefits or where the whether they've carved out a single PBM or added GLP ones, we have to get paid for that. According to data from the Robert Wood Johnson Foundation, 13 states cover GLP one drugs for weight loss indications through Medicaid. Utilization is also rising in the behavioral health space, a trend that Centene has observed over
the last 2 years. Now as of August 23rd, more than 25,000,000 Medicaid enrollees have been disenrolled from that program through the redeterminations process. Other insurers have said that beneficiaries have remained in Medicaid that that have remained in Medicaid tend to have more health needs driving up costs in the program for those that have remained and not been disenrolled. Well, 50 insurers are looking to lower premiums on an ACA marketplace in 2025.
Next year, 324 insurers are offering ACA coverage across all 50 states in Washington DC. And among them, the median proposed premium increase is 7%. That's similar to this year. The proposed rates are preliminary, and they could change during rate review processes, but states are currently finalizing those rates. In their rate processes, but states are currently finalizing those rates. In their rate filings, insurers mentioned inflation and the increasing usage of weight loss and other specialty
drugs as trends that are influencing premiums. Lingering COVID 19 costs and Medicaid redeterminations are having little effect. The company that's asking for the the lowest ACA premium drop in 2025 or or the company that is asking for the largest decrease in price, that's gonna go to Centene's subsidiary in Delaware, which is asking for 14% lower premiums in 2025. In terms of percent lower premiums in 2025.
In terms of who's gonna see the biggest raises for ACA premiums in 2025, that's largely New York state residents. Seeing some of those largest increases, EmblemHealth in New York requested a 51% increase, Highmark's subsidiaries in New York requested a 30% increase, Metro Plus Health requested 28%, and Independent Health requested 27%, and Oscar Health in in New York City requested a 25% increase.
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