Cancer Mortality Increasing for Americans Ages 35-44, While Decreasing for Older Age Groups

While national cancer mortality rates have been declining for many years, the variation in rate by age has changed in more recent years. From
2018 to 2022, malignant neoplasm deaths were up 5.0% for ages 35-44 — an age cohort that historically is less affected by many cancers as
reflected in current screening guidelines. Conversely, malignant neoplasm deaths have declined year-over-year for older age groups — ages
45-54 and 55-64

The Incidence of Early-Onset Cancer Has Been, and Will Likely Continue, Increasing

Rates of early-onset cancers are growing, especially for adults ages 30-39, for whom incidence increased by almost 20% between
2010 and 2019. Given that primary care volumes declined by 6.3% from 2021 to 2022, the likelihood of diagnosing early-onset
cancer has dropped and will likely manifest in later stage diagnosis and increased mortality.

Decline in Primary and Preventive Care Is Consistent Across Markets

Primary care utilization declined from 2021 to 2022, ranging from -7.8% (Miami, Chicago) to -4.1% (Washington, DC). This trend persists
despite large metropolitan markets having a larger footprint of new entrants (e.g., CVS) offering access to select primary care services.
Conversely, behavioral health utilization increased in nine of the ten markets, ranging from -1.9% (Miami) to 8.0% (Los Angeles).

Prescribing Volume for Certain Drug Classes Has Increased

While e-prescribing of antidepressants (-4.5%), stimulants (7.4%) and opioids (-24.3%) changed in 2022
from 2021, the share of total prescribing was higher for antidepressants (1.3%) and stimulants (11.2%) but
lower for opioids (-3.6%).

Behavioral Health Demand Varies by Condition, With Most Trending Upwards

Q4 2022 visit volumes for anxiety disorders (+44.9%), eating disorders (+41.0%), alcohol and substance
use disorders (+23.7%), depressive disorders (+18.6%) and bipolar disorders (+12.2%) have all
consistently trended upwards since Q1 2019

Primary Care Volumes Have Not Returned to Pre- Pandemic Levels

From 2019 to 2022, primary care volumes (-8.4%) declined, while women’s health volumes (+5.0%) and behavioral health
volumes (+20.1%) increased. The reduction in preventive care compounded by the increase in behavioral health demand and
constrained behavioral health provider supply will inevitably result in greater morbidity and mortality, as already evidenced by
increasing mortality in younger adults.

Cost Overtakes COVID-19 as Primary Driver of Delayed

In 2020, a greater share of consumers deferred care due to concerns about the pandemic than cost. However, in 2022, this
trend reversed, and the share of consumers who deferred care due to COVID-19 fell by 11 percentage points. Cost — both
of overall living and of healthcare services — has returned as the primary reason for deferring care.

Mortality Rate For Americans Under Age 40 Is Rising

Between 2018 and 2022, the mortality rate for Americans under age 40 increased in 42 states. These spikes are largely attributable to a marked increase in overdose deaths – the primary cause of death in 37 states for this age cohort in 2022.

Non-COVID Mortality Is Increasing in Younger Populations

Excess mortality among younger Americans — who represent most of the commercially insured market — is increasing. Between Q1 2020 and Q4 2022, non-COVID excess mortality for Americans aged 35-44 increased by 28 percentage points, peaking in Q3 2021 with a 35%-point increase above the baseline.