The Sunshine Economy: Opioids, Obamacare And Transparency With Florida Blue's CEO

Dec 17, 2018

Florida's largest health insurer has seen a 45 percent drop in opioid prescriptions since it stopped paying for OxyContin.

It has been almost a year since Florida Blue announced that it would no longer provide prescription payments for the popular painkiller and would require advanced permission for any opioid prescription lasting longer than seven days.

It replaced OxyContnin in its drug plans with a different opioid, Xtampza. That drug is designed to be more difficult to crush, making it tougher to snort or inject.

"We've seen a 45 percent decrease in opioid prescriptions inside of our plans," says Florida Blue CEO Patrick Geraghty. "We know that we are not having it just be a trade-out."

Since 2010, legal sales of opioids in Florida have dropped dramatically. Last year, sales were a third of what they were at the beginning of the decade, according to a health policy research center affiliated with the University of Minnesota. It used opioid sales data from the Centers for Disease Control and Prevention and the drop off in Florida was the biggest in the United States. The data does not include this year.

"OxyContin is the most addictive of the opioids and, therefore, it was something that needed to be addressed and addressed quickly," says Geraghty.

The state of Florida is suing several opioid manufactuers including Purdue Pharma, Endo Pharmaceuticals and Teva Pharmceutical. The suit also targets drug distributors like AmeriSourceBergen, Cardinal Health and McKesson. In November, Attorney General Pam Bondi added pharmacies CVS and Walgreens to its lawsuit. Bondi claims the drugstores "failed in their duties" to "stop suspicious orders of opioids they received." The lawsuit does not name any health insurance companies.

Geraghty says Florida Blue has had no discussion with the AG's office regarding any possible legal action.

"Florida Blue is playing a role in solving the opioid crisis," he says.

Affordable Care Act

No state has had more Obamacare enrollees than Florida. In 2018, 1.7 million Floridians bought their health insurance through the Affordable Care Act.

On Friday in Texas, a federal judge ruled Obamacare unconstitutional because the individual mandate is no more. The ruling is expected to be appealed and the Centers for Medicare and Medicaid Services says it has no impact on current Obamacare plans or plans for 2019.

The recent federal court decision is still moving through the courts, and the exchanges are still open for business and we will continue with open enrollment. There is no impact to current coverage or coverage in a 2019 plan.

— Administrator Seema Verma (@SeemaCMS) December 15, 2018

For the first time in five years, no one faces a fine if they don’t have health insurance in the new year. A cornerstone of the Affordable Care Act was the individual mandate. It required almost everyone to have health insurance. If you didn’t get coverage, you faced a fine of at least $695, or 2.5 percent of one's income. For someone making $50,000 a year, that fine could be over $1,200.

But not in 2019.

In the tax bill approved in 2017, the individual mandate was repealed. Technically, the law reduces the fine for not getting health insurance to zero, effectively getting rid of the requirement.

WLRN spoke with Pat Geraghty, CEO of Florida Blue, the only health insurer to offer ACA plans in every Florida county, two weeks before the deadline to sign-up for coverage in 2019. That deadline was Dec. 15.

"So far, we are seeing great enthusiasm in our enrollments," Geraghty said. He said in the two weeks before the sign-up deadline, enrollment into Florida Blue plans was "ahead of pace."

One change, he said, is that more Floridians were shifting into Bronze-level health insurance plans. ACA policies are categorized by medals: bronze, silver, gold and platinum. The more precious the medal, the more the insurance plan pays, but the higher the monthly premium. Bronze plans carry a lower monthly cost, but also require the patient to be responsible for more of the cost of their care.

The ACA covers part of the monthly insurance premium depending upon income levels. Geraghty said Floridians who have to pay something for their coverage are increasingly opting for bronze-level plans. 

Florida Blue's average individual monthly premium for its ACA-complaint plans next year is $685, up 2.4 percent from 2018. The company requested an average increase of 10.5 percent, but state regulators okayed the lower amount.

"We offer plans in every different tier. Some of our competition don't offer the range of coverage that we do," Geraghty said. "We've got long experience in this market so we know how to price the various levels of benefit because we've been there every single year and we've operated in the black."

Florida Blue CEO Patrick Geraghty.
Credit courtesy: Florida Blue

Transparency

In 2016, a new law in Florida took effect requiring most health insurance companies to share cost information with the state. Specifically, the law means any company that provides health insurance to state workers or sells Medicaid Managed care insurance must share their medical claims data with a website. That data includes the numerical codes that identify what was done, what the doctor or hospital billed and what an insurance company actually paid.

The law affects about a dozen different health insurance companies in Florida. But, as of October, some insurers had not shared their information with the state, including the state’s largest health insurer -- Florida Blue.

But Geraghty said the company has worked out a deal to provide the pricing information. "I think we have reached agreement about the contribution of our information. So that should be something that I think will be handled going forward."

He said the company had privacy concerns and wanted to have "all the appropriate checks and balances" in place, though he declined to describe what those were in detail.

"We have all kinds of arrangements with doctors. We have all kinds of contracts with employers. There are lots of things that we need to do to assure the privacy of the people that are involved in our arrangements. It's really that process that we were protecting."