3 healthcare trends that payers should be aware of in 2024

Explore new analyses and payer-specific advice on GLP-1 drugs, the clinical journey of cancer patients, and upcoming price transparency mandates.

The healthcare industry has seen a significant transformation over the years and there’s been a lot to keep track of. The pandemic ignited a shift in technology trends, delayed preventive cancer screenings, introduced new federal price transparency regulations, and sparked high demand for new weight loss drugs.

To help health plans and employers prepare for the year ahead, our team conducted analyses on topics we have recently been hearing about from our clients – GLP-1 drugs, cancer, and price transparency. We leveraged the MarketScan by Merative closed claims database to dig into the data behind the headlines and summarized some key findings below. Read on, or watch our deep dive for a walkthrough of all the research and our advice for how payers can better manage and measure these top-of-mind healthcare trends.

GLP-1s and weight loss drugs

GLP-1 medications, like Victoza and Trulicity, have been on the market for over a decade. However, in recent years several highly effective products have repositioned GLP-1s as a standard of treatment for diabetes and expanded their focus towards weight loss. These new medications, like Ozempic, Mounjaro, and Wegovy, quickly grew in popularity and have left payers to manage a significant increase in utilization and spend. For example, from 2013-2023, the MarketScan data found that GLP-1 utilization has grown from 4.8 patients per 1000 to 55.3 patients per 1000 – a CAGR of 25%. Meanwhile, GLP-1 spend has grown from $13 PMPY to $265 PMPY – a CAGR of 32%.

From limiting off-label utilization to integrating wellness initiatives, payers are struggling to understand how to best control costs, support their populations, and measure ROI. Join our Senior Pharmacy Analytic Advisor, Katherine Shanahan, as she walks through the following industry questions:

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Clinical journey of cancer patients

Preventative care can considerably impact cancer diagnoses rates. This was most apparent during the COVID-19 pandemic, which caused delays in cancer diagnosis. Patients also saw delays in treatment of cancer due to health care setting closures, disruptions in employment and health insurance, and fear of COVID-19 exposure.

In 2024, The American Cancer Society estimates over 2 million new cancer cases in the United States and found more people are being diagnosed with cancer than ever before, and at an earlier age. Using MarketScan data to drill into cancer prevalence across all types of cancer, we found in the year leading up to the pandemic, all types of cancer saw a consistent increase. From April 2020–March 2021, skin cancer rates almost doubled, with breast and prostate cancer experiencing significant increases. In the following year, rates slightly decreased, but every type (except lung cancer) remained higher than pre-COVID rates.

Understanding factors at the community level is key to identifying patterns and to reducing health equity barriers. By combining the CDC’s Social Vulnerability Index, publicly available data, with claims data analysts can better understand cancer rates across areas of higher poverty. In our analysis, we found lower rates of breast and skin cancer in areas of highest poverty. In these areas you will find higher levels of unemployment, a struggle to put food on the table, and to pay everyday bills; thus, leading to postponed preventive care and the opportunity for early diagnosis.

Health plans and employers play a critical role in helping engage members to be an advocate for themselves with preventive care and by working together to reduce barriers. Hear from our Senior Healthcare Analytic Advisor, Brandi Hodor, as she answers the following:

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Price transparency regulations

The journey to increased price transparency has been years in the making, with the most recent milestone being the No Surprises Act. To promote price transparency for patients, new policies have been put in place to help protect patients financially, provide standardized public rate information with machine readable files (MRFs), minimize unnecessary administrative burdens, and provide self-service shopping tools for members.

This July will mark two years since the Transparency in Coverage rule and the enforcement of the payer requirement to post the in-network, and out-of-network allowed amount files. It’s anticipated CMS will provide updates on schema enhancements and clarifications on required standards, such as prescription drug MRFs, now that the Departments have ended their enforcement discretion.

Through these actions, CMS is making significant advancements towards price transparency. Payers have a great opportunity to leverage MRFs in price negotiations and in their member engagement initiatives – if you have the right plan in place. Listen as our Healthcare Reform Strategist, Bryan Briegel, reviews upcoming mandates and answers the following:

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