What does the Great Unwinding mean for employer-based health plans?

The COVID-19 public health emergency has been extended through spring 2023. But when it eventually ends, it will trigger what many health industry observers call The Great Unwinding.

What The Great Unwinding will mean for group health plans was one topic discussed in a webinar held by Mercer last week.

Katharine Marshall, principal with Mercer’s Law and Policy Group, listed what group health plan sponsors must to do prepare for the end of the public health emergency.

1. Review plan coverage of COVID-19 testing and determine whether coverage terms will change when the public health emergency expires.
2. Review plan coverage of vaccines and determine whether coverage terms will change when the public health emergency expires.
3. Review whether expanded telehealth benefits must wind down.
4. Determine whether to make plan changes midyear or at year-end.
5. Prepare to update plan administrative processes.
6. Consider offering COVID-19 booster shots and flu shots through an on-site clinic or an employee assistance program.

In addition, she said, the federal government is expected to stop purchasing and distributing vaccines for free as early as January 2023. Pharmaceutical companies are expected to set new prices for the commercial market. Plans need time to fully negotiate costs with manufacturers, pharmacies and wholesalers. Administration oversight and action will be important to avoid inflated costs. A clear picture of frequency of vaccines and boosters will be key in supporting effective price negotiations.

The vaccine supply could be impacted as well, Marshall said. It is unclear whether manufacturers will have the incentive to produce sufficient quantities for future COVID-19 surges or for new, updated vaccines. It’s also uncertain how may vaccines local pharmacies will purchase, particularly in areas with low demand.

The federal government’s supply of antivirals is expected to be depleted, she said. Commercial insurance will take on more of the cost of these treatments and plan members who receive COVID-19 antiviral treatment may be subject to cost sharing.

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected]. Follow her on Twitter @INNsusan.

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Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].