Providers urged to screen for vaping illnesses, but flu season could complicate efforts

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Ingrid Stiver Senior Manager, Health Research Institute, PwC US September 13, 2019

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Healthcare providers across the country may need to update their screening policies for patients with respiratory symptoms to align with new CDC emergency guidance, issued after more than 25 states reported cases of lung illnesses and deaths potentially associated with the use of vaping products.

The CDC has asked clinicians to immediately report suspected cases of lung illness associated with e-cigarettes to their state or local health department for investigation and is urging consumers to consider not using e-cigarette products. However, identification of respiratory problems could soon be complicated by the onset of the typical flu season in October, which likely will result in more patients with respiratory symptoms.

Providers will need to consider whether to continue to follow prior CDC guidance on e-cigarettes, which states that they have the potential to benefit adult smokers if used as a complete substitute for cigarettes and other smoked tobacco products, or to urge their patients to stop using these products.

The string of illnesses is especially concerning as the rate of vaping among teens has increased in recent years. The most recent Monitoring the Future survey on teen drug use, funded by the National Institutes of Health and conducted by the University of Michigan, shows that the rates of teenagers vaping nicotine doubled between 2017 and 2018. One in five 12th graders said they had vaped nicotine in the past month in the 2018 survey. Past-month rates of vaping marijuana also increased among teenagers between 2017 and 2018 but remain lower than rates of nicotine vaping.

HRI impact analysis

Over time, payers could see increased claims costs from the vaping illness, especially in those states where the illness is concentrated, such as Illinois and Wisconsin. However, it is too soon to know whether the cases of vaping illness exist in sufficient quantity or expense to influence premium rates charged to all consumers purchasing commercial products such as individual and group plans, or how it will affect the bottom line of payers running managed Medicaid or CHIP programs or Medicare Advantage plans.

Payers could respond by increasing rates for e-cigarette users on Affordable Care Act (ACA)-compliant individual and small group plans starting in 2021. Under the ACA, health insurers can charge higher premiums to tobacco users – up to 1.5 times that of non-tobacco users. The final rule addressing how to set premium rates for tobacco vs. non-tobacco users states that “tobacco includes all tobacco products” but does not address whether this would include e-cigarettes. Further definitions and interpretations have been left up to the states and the health insurers, with some health insurers charging e-cigarette users a premium surcharge and others not. Recent increases in the rates of vaping as well as the suspected vaping-related illness may lead more insurers to assess a surcharge on those using e-cigarettes.

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Trine K. Tsouderos

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