Dr. Tom Weigel: What Blue Cross VT Members can Expect with the End of the Federal Public Health Emergency

woman receiving a flu shot

This is commentary by Dr. Tom Weigel, Chief Medical Officer for Blue Cross and Blue Shield of Vermont, sharing upcoming changes to health plan benefits with the end of the COVID-19 Public Health Emergency.

With the end of the Public Health Emergency (PHE) on May 11, 2023 we are taking stock of our COVID-19 response, assessing the benefits that have been made permanent, and ending certain pandemic-specific policies. Blue Cross and Blue Shield of Vermont will delay changes to our members’ coverage until July 1, 2023.

During the pandemic, Blue Cross and Blue Shield of Vermont paid for Covid testing and medications, administering vaccines, and both in-patient and out-patient treatments from our members’ capital reserves. This reflects our promise to members that these funds exist for their protection in unforeseen circumstances. Now that the PHE is ending, and COVID-19 is becoming endemic, its treatment, testing and vaccinations will shift to a similar coverage model for that of any other respiratory virus. 

As a state, we have learned a tremendous amount about how to communicate remotely during the pandemic. One of the greatest transformations in health care access that came to the forefront during the pandemic is the widespread adoption of telemedicine. Prior to the pandemic, telehealth was rarely used by either providers or patients. Fewer than 1% of our members’ health care claims were from telehealth visits in 2019. Now, three years later, our members routinely access their providers via telehealth modalities including video calls, telephone check-ups, and electronic opinions from specialists. During the pandemic we sought to quickly broaden access to telehealth services for members who were struggling with provider wait times. With the ending of the PHE, these services will still be available to our members, but as of July 1, members who use AmWell will have cost-share for their visits as we work to normalize telehealth within the scope of all patient care. 

COVID-19 vaccines and tests became a regular topic of conversation in homes across the state during the pandemic. The support that our state government provided all of us was profound. Our clinical team worked side by side with the Vermont Department of Health at vaccination sites, and our regulatory, member, and provider services teams worked around the clock with a single-minded focus to implement hundreds of changes to ensure our members could receive the care they need. 

Among the policy and regulatory changes implemented with our state partners was the elimination of cost-share for testing, vaccinations and Covid treatments. Vermont was lauded for its pandemic response, and Vermonters stepped up in record numbers, rolling up their sleeves to get vaccinated. As the pandemic becomes endemic and COVID-19 is now grouped among the dreaded winter viruses with flu, RSV and the inevitable stomach bug, the COVID-19 vaccines will continue to be covered as preventative care, and testing in a provider’s office with be covered with cost share similar to that of other virus testing. Over the counter antigen tests will no longer be a covered benefit. There are some oral Covid therapeutic medicines that will be covered with member cost share, and others that, as of February, were moved to investigational status by the FDA that will not be covered by the member’s health plan.

Our pharmacies offer a critical point of care, and we support a bill currently moving through the Vermont Legislature that will extend some pharmacist provisions around vaccinations and testing that were normalized during the pandemic. During the height of the pandemic when Vermonters were encouraged to stay at home whenever possible, we supported a policy to allow early refills on prescriptions. Now that mail order and in-person has normalized, we advocated to return to a 30-day supply over our concerns about the impact of wasted prescriptions on our waterways and environment, as well as the cost impact to premiums of unused prescriptions. 

As the PHE ends and we reflect on how Vermonters have looked out for one another over these past three years, what is abundantly clear is how profoundly caring our neighbors are. We are proud to be a part of the fabric of Vermont.