On June 24th, 2022, the Supreme Court ruled 5 to 4 in favor of overturning Roe v. Wade, leaving the issues of abortion to each state's discretion. Individual state regulations vary and are constantly shifting; some states had trigger laws in place limiting all forms of abortion, others are passing legislation protecting the right to choose, and many are still undecided. As these decisions take shape, they have turned the United States into a patchwork quilt of differing healthcare regulations with employers left scrambling to navigate the evolving landscape.
With an estimated 1 in 4 women getting an abortion in their lifetime, employers are quickly trying to understand how the ruling may affect their teams and what systems they can put in place to support their employees. Externally, companies continue to hit the headlines for making strides to ensure their employees have access to abortion care. Internally, they are figuring out just what that will entail. Regardless of specifics, guiding their employees through a dynamic healthcare ecosystem is top of mind right now.
So, where do employers start? Even before the ruling, the complexity of healthcare was difficult to navigate; now helping members find care has become even more nuanced. Care navigation can guide your team through a post-Roe v. Wade America, giving anyone seeking abortion care the latest information for their state and the access to expert clinical guidance to understand their options throughout their entire care journey.
Why access to real-time information is key to abortion care after the ruling.
The recent ruling has necessitated increased communication around benefits between employers and employees. When the memo was first leaked, HR and benefits advisors knew that they needed to address changes to coverage options, but the uncertainty made it difficult to implement specifics. Now that the ruling is set, updates to benefit design will require employer communication to be more descriptive and updated more frequently. With open enrollment still a few months away for most employers, they will need to have a strategy in place to communicate these off-cycle benefit updates.
Employers who have care navigation in place should lean on their partners. First, care navigation solutions should be the source of truth on the latest laws and regulations, available to answer questions on the minds of HR and benefits leaders. Next, they can act as an effective delivery method to communicate general updates to offerings, whether it’s through their apps, by email to members, or through telephonic outreach. Finally, and most critically, care navigation solutions allow employees to connect with clinical health guides who can provide specific, one-to-one guidance when they need help with personal issues, answering their questions and getting them to the care they need. For instance, some employees may have questions on abortive care, while others may need information on contraceptives or IVF, all situations which health guides are prepared to discuss and quarterback for them. Care navigation allows employees to feel confident that they’re not only equipped with the necessary and relevant information, but have a personalized healthcare advocate managing their entire care journey.
Managing medical tourism and interstate travel benefits.
Medical tourism is the moniker generally applied when an individual travels out of the country to receive care that they cannot afford or cannot access in their home country. However, the division of reproductive rights along state lines means that domestic medical tourism will likely increase as companies will have to manage travel benefits for those seeking abortive services prohibited in their state.
While travel benefits may seem easy to provide (they are projected to function in the same way that travel benefits for out-of-state specialized surgeries like knee replacements do), the logistics of caring for an individual after the initial procedure or providing medical or pharmacy services back in the home state of the employee remain in question. To help support employees through the entire care journey, employers must understand the guidelines set by state legislation. For example, members are asking, “will travel benefits help cover my recommended pelvic exam a month after the initial procedure?”
A care navigation solution can play a major part in accessing and communicating the latest available information, keeping employees up-to-date with personalized outreach from health guides who have a comprehensive understanding of changing regulations. Care navigation can help employers communicate changes like updated access to interstate travel benefits or information on state-to-state policies, while also getting members to the best care possible. After a procedure, health guides can follow up with employees to answer their questions and ensure they don’t have outstanding care gaps.
How PBMs with pharmacy navigation can support employees dealing with restrictions on banned medications.
Medical abortions are performed by taking two medicines, mifepristone and misoprostol. Today, they account for 54% of abortions in the U.S. Prior to the ruling, many states had already enacted some regulation that added specific requirements (like counseling) for patients seeking abortion pills. Since the ruling, there has been a lot of uncertainty around the future of access to these medications in states with abortion laws in place, heightening the importance of PBMs with navigation pharmacy solutions.
PBMs with pharmacy navigation provide immense value in simplifying member access to necessary medication. Pharmacy guides work directly with members around changing policies, keeping them up-to-date on regulations surrounding different drugs and what is covered under their plan. If a medication is prohibited in their state, pharmacy guides will explore all alternative options, coordinating access between providers and pharmacies. By providing members with an expert that knows their formulary and is advocating on their behalf, employers can feel confident that the health of their teams is prioritized, and their employees feel cared for.
Outside of limiting access to abortion medications, the ruling affected medications that cause abortions as a side effect. These drugs are often necessary for the treatment of other chronic conditions, creating a complexity for patients who aren’t seeking an abortion. Alternative treatments can cost up to a thousand times more, putting massive financial pressure on a member with no other options. As regulations develop, pharmacy guides can help members understand if their access to life-saving medications is in jeopardy, educating them on their options and guiding them to alternate solutions during a vulnerable period.
How Rightway helps employees navigate change post-Roe v. Wade.
The interplay of medical and pharmacy care in the Roe v. Wade ruling illustrates why supporting employees across medical and pharmacy navigation is key to transforming their healthcare experience. The fact is, managing abortion care in a post Roe v. Wade environment is just the latest example; employees are simultaneously managing medical and pharmacy care every day. Having a single source to turn to is critical as members manage their healthcare in a dynamic and evolving future. As employees continue to lean on their employers for support, prioritizing their healthcare experience becomes a main component of a benefits strategy that intentionally prioritizes the moments that matter.
The last two years have presented new healthcare challenges for employers and their teams. Whether it’s Covid-19, Roe v. Wade, or the emerging Monkeypox epidemic, Rightway helps you and your team navigate a shifting landscape, providing real-time information from experts, communicating changing benefits, and directly supporting your employees. We recently hosted two sessions outlining changes post Roe v. Wade: a town hall to provide key information for employers and a Q+A for members. Additionally, we’ve compiled answers to the most frequent questions we’ve been receiving from our clients and members.
Interested in learning how Rightway can further help? Get in touch.