There is no argument that the COVID-19 pandemic was a stressful and challenging time for all aspects of the healthcare delivery system in the United States and across the world. Fortunately, as of February 9, 2023, due to the virus mitigation efforts put into place over the past 3 years, we have seen a dramatic decrease in new COVID-19 cases (down 92%), hospitalizations, and deaths (both down by 80%). Moving forward, the Biden Administration looks to transition COVID-19 policies, including flexibilities enabled by the COVID-19 emergency declarations, into improving standards of care for patients, and therefore, will allow the Public Health Emergency (PHE) Act to expire on May 11, 2023.

As we move into this post-pandemic phase, it is important to consider how the end of the PHE will impact care delivery and patient care now that certain provisions that allowed for expanded, easier access to care may or may not remain in place. Many hospitals, providers, and caregivers continue to deal with the challenges of workforce shortages and financial pressures, cost increases for medications and equipment, supply chain issues, and sicker patients.

Many states, hospitals, and nursing homes have been operating under Medicare and Medicaid waivers permitting broad flexibilities that allowed for expanded facility capacity and relaxed training requirements for certain staff, including nursing aides. The Centers for Medicare & Medicaid Services (CMS) also allowed hospitals to make broader use of nurse practitioners and physician assistants in the care of Medicare patients. With the end of the Public Health Emergency (PHE), these facilities will be required to return to normal operations and meet CMS requirements that promote the safety and quality of care they provide. Those facilities may struggle to make these adjustments as they continue to deal with the shortage of health care providers and clinical and administrative support staff.

Changes to how providers have been able to evaluate and treat patients recovering from addiction and other mental disorders will come with the end of the PHE. In response to the pandemic, the Drug Enforcement Administration (DEA) approved for providers to prescribe certain controlled substances via telehealth, without conducting an in-person medical evaluation. With these provisions set to expire, addiction activists expressed concerns about the potential thousands of overdoses that could occur without the expanded access provisions. In response, the DEA has proposed regulations that would allow providers to prescribe a 30-day supply of schedule III-V non-narcotic controlled medications and buprenorphine for the treatment of opioid disorder, after a telemedicine consultation. As the US deals with a national epidemic of opioid addiction, these expanded access concessions can ensure patients with mental health and substance abuse disorders have access to the care that they need.

Additionally, the end of the Medicaid Continuous Coverage requirement on March 31, 2023, requires states to resume reviewing all Medicaid enrollees’ eligibility and begin ending coverage for those that are found ineligible over the next 12-14 months. It is estimated that close to 15 million people could lose their current Medicaid coverage if they no longer qualify or if they face administrative barriers during the renewal process even if they are still eligible. Health care providers/organizations that are currently treating chronically ill Medicaid beneficiaries may be faced with additional administrative strain as they will need to monitor coverage and eligibility for these patients and assist in finding alternative assistance if they lose their coverage. Most important will be the stress this will place on the individuals and families at risk of losing their coverage and navigating the process of finding alternative coverage through state and federal marketplaces/employers or being left without any health insurance coverage.

In response to these and other changes coming with the end of the PHE, payers—especially those with Medicare and Medicaid lines of business—will need to adjust their care delivery system processes to ensure compliance with requirements under the Department of Health and Human Services (HHS). We can expect payers to be prepared to address and mitigate the potential negative patient access considerations due to loss of Medicaid coverage. In turn, manufacturers need to understand the implications to payers, customers, and patients that need access to their medications. As these post-PHE changes are implemented, ramping up efforts to provide education on resources and programs that support patient access to care may prove to be beneficial.