About COVID-19
High‐Resolution Agent‐Based Modeling of COVID‐19 Spreading in a Small Town: This simulation looks at effectiveness of targeted interventions versus generalized measures in controlling COVID-19. The model was based on New Rochelle, NY. The authors concluded:
“To illustrate the model's value in analyzing prospective ‘what‐if’ questions, we performed an immunization study in which we evaluated several vaccination strategies of future importance. In particular, we compared the impact of vaccination of select group of vulnerable individuals, including school employees, retirement home employees and residents, and the totality of the two thousand hospital employees in the town, a randomly selected group of 2000 individuals, and 20 000 randomly selected individuals out of the 80 000 people living in New Rochelle. Our results suggest that prioritizing vaccination of high‐risk individuals has a marginal effect on the count of COVID‐19 deaths. Predictably, a much more significant improvement is registered when a quarter of the town is vaccinated. Importantly, the benefits of the restrictive measures in place during the first wave greatly surpass those from any of these selective vaccination scenarios.” [Emphasis added]
Lilly's bamlanivimab cuts risk of COVID-19 by up to 80% at nursing homes: “Eli Lilly announced Thursday that in a Phase III study, bamlanivimab was shown to significantly reduce the risk of contracting symptomatic COVID-19 among residents and staff of long-term care facilities. The findings from the BLAZE-2 COVID-19 prevention trial suggest the risk was decreased by up to 80% in people administered the antibody therapy versus those in the same facility given placebo.”
Single Covid vaccine dose in Israel 'less effective than we thought': “Israel's coronavirus tsar Nachman Ash warned that a single dose of the Pfizer/BioNTech coronavirus vaccine may be providing less protection than originally hoped…
By contrast, those who had received their second dose of the Pfizer vaccine had a six- to 12-fold increase in antibodies, according to data released earlier this week by Sheba Medical Center in Tel Hashomer.
Pfizer itself says a single dose of its vaccine is about 52% effective, although some countries, including the UK, have delayed administering second doses in a bid to maximise the number of people given a first dose.”
Some states want to buy their own COVID vaccines. The Biden administration says no.: “The Biden administration is rejecting calls from some states to buy COVID-19 vaccine doses directly from Pfizer, as governors hunt for ways to supplement their limited supply of shots.
The divide on that question counts among the early pandemic challenges facing the 46th president, as his team tackles a nationwide vaccine effort that has progressed unevenly in the face of overwhelming demand.
‘We need to have a national approach to vaccinations, and must ensure states aren't competing against each other like they did with PPE, ventilators, and tests,’ spokesperson T.J. Ducklo said in a statement.”
Timing of second Covid vaccine doesn't need to be exact. Just get it, experts say.: “‘The second dose should be administered as close to the recommended interval as possible,’ the CDC said in an update to its website Thursday. ‘However, if it is not feasible to adhere to the recommended interval, the second dose of Pfizer-BioNTech and Moderna Covid-19 vaccines may be scheduled for administration up to 6 weeks (42 days) after the first dose.’”
New CDC director says Covid vaccine won't be in every pharmacy by late February: “The new director of the Centers for Disease Control and Prevention said Thursday that the Covid-19 vaccine would not be widely available by late February as the Trump administration previously said.”
Executive Order on Protecting Worker Health and Safety: No specific actions are in this order; it directs government agencies to study and come up with policies to protect workers from COVID-19. Particularly, it invokes OSHA protections.
About health insurance
ACO participation reaches new low as advocates press Biden for major changes: “The number of ACOs for 2021 is below the ACOs that started with the Trump administration in 2017 (480), according to new data from the Centers for Medicare & Medicaid Services, which oversees the program. ACO participation reached a record high of 561 in 2018 but has declined down to 518 in 2019 and 517 last year, federal data shows.
While participation in the program has shifted and declined over the years, ACOs still continue to generate savings for Medicare. The program generated $2.4 billion in gross savings for Medicare in 2019 compared with 1.7 billion in 2018…”
CMS Clarifies 2021 PFS [Physician Fee Schedule] Reimbursements for Remote Patient Monitoring: “In the final rule, to qualify for reimbursement under CPT codes 99457 and 99458, CMS mandated at least 20 minutes of interactive communication time between provider and patient over a calendar month, but that interactive communication couldn’t be part of the 20 minutes of RPM care. The agency has now clarified that “interactive communication” can include both in-person and connected health channels.”
MA Plans See 99% Member Satisfaction Among Non-White Members: “The results indicated that 98 percent of seniors on Medicare Advantage were satisfied with their health plan. Non-white Medicare Advantage beneficiaries expressed even higher satisfaction, with 99 percent reporting that they were satisfied with their coverage.
Similar percentages of members were satisfied with how their health plan managed the pandemic (98 percent) and the network of providers and healthcare systems available to them (97 percent).
The survey also asked which common supplemental health benefits the participants utilized. Vision care was most commonly used with 64 percent of Medicare Advantage members having used this supplemental benefit.”
Caveat: Medicare beneficiaries who choose MA plans are a self-selected group who seek such cost and benefit advantages compared to traditional Medicare with its enhanced freedom of choice.
UnitedHealthcare, Humana & more: 7 payers expanding telehealth strategies: The article is a good brief summary of where these companies stand on telehealth benefits, and hence, where the industry is going. One major trend coming out of the COVID-19 experience is making telehealth a permanent benefit.
9th Circ. Delays Public Charge Ruling As Justices Mull Case: “The Ninth Circuit permitted the U. S. Department of Homeland Security to implement the so-called public charge rule on Wednesday, saying it will delay the effective date of its ruling barring the policy while the U. S. Supreme Court considers the rule's legality. In a one-page order, the appeals court granted DHS' request that it stay its mandate halting enforcement of the Trump administration's public charge rule, which makes it more difficult for immigrants on or deemed likely to use certain public benefits to obtain green cards.”
Orange County insurance brokers help pay off more than $2.1M in medical debt for those in need: “More than 80 employees across the company have donated their own money to help erase more than $2.1 million worth of medical debt. It's for people who live at or below 200% of the poverty line in Orange County…
Through a partnership with the non-profit RIP Medical Debt, every $100 donated forgives $10,000 in medical debt.”
One of many such examples of RIP Medical Debt helping pay off medical bills.
About pharma
FDA approves 1st long-acting HIV drug combo, monthly shots: “U.S. regulators have approved the first long-acting drug combo for HIV, monthly shots that can replace the daily pills now used to control infection with the AIDS virus.
Thursday’s approval of the two-shot combo called Cabenuva is expected to make it easier for people to stay on track with their HIV medicines and to do so with more privacy. It’s a huge change from not long ago, when patients had to take multiple pills several times a day, carefully timed around meals..
Cabenuva combines rilpivirine, sold as Edurant by Johnson & Johnson’s Janssen unit, and a new drug — cabotegravir, from ViiV Healthcare. They’re packaged together and given as separate shots once a month. Dosing every two months also is being tested.”
HHS Freezes Rule Affecting Community Health Center’s 340B Drug Discounts: “The Biden administration implemented a regulatory rule freeze affecting all federal agency rules that had not gone into effect as of Jan. 20, 2021…
Pursuant to the regulatory rule freeze, the Department of Health and Human Services (HHS) has frozen a final rule that would have blocked community health centers (i.e., federally qualified health centers) from receiving future grant funding unless the health centers provided a complete pass-through of 340B discounts on insulin and epi-pens to low-income patients (the 340B Insulin Pass-Through Rule). Community health centers staunchly opposed the 340B Insulin Pass-Through Rule, arguing that it would have added significant bureaucratic obligations to centers’ operations while making a relatively minimal impact on the costs of drugs provided to center patients. The 340B Insulin Pass-Through Rule was slated to go into effect today, Jan. 22, 2021.
As a result of HHS’ freeze, the effective date of the 340B Insulin Pass-Through Rule has now been delayed until at least March 22, 2021. While there is currently no indication whether the Biden administration will ultimately rescind or revise the 340B Insulin Pass-Through Rule, the delay offers community health centers additional time to develop plans to comply with the 340B Insulin Pass-Through Rule.”
Insys Founder To Pay NJ $5M In Opioid Bribery Settlement: “Convicted Insys Therapeutics founder John N. Kapoor has agreed to pay New Jersey $5 million to resolve allegations that he orchestrated bribes to doctors in the state as part of a nationwide kickback scheme to boost sales of Insys' powerful opioid Subsys, the state's attorney general said Thursday. New Jersey Attorney General Gurbir S. Grewal said Thursday that the deal with Insys' 77-year-old founder Kapoor marks the first settlement the state has made in any civil lawsuit against people and corporations accused of fraudulently peddling opioids and that it does not resolve the claims against bankrupt Insys.”
About healthcare systems
Implementation of Newly Enacted Hospital Price Transparency: “ADVI Analytics explored the top 20 largest hospitals in the county (as determined by number of beds from Becker’s Hospital Review). We found the results varied greatly amongst the hospitals as some made the required information obvious on their websites while other seemingly buried the links. All of the top 20 hospitals published some type of pricing information but not all appeared to completely comply with the mandate and show information for 300 shoppable procedures. Other issues that we identified with the data included: data was not able to download in a useable format, hospitals did not provide HCPCS codes for services, and variability in hospitals’ terms for the pricing information. Among the data we analyzed, we found the price of code 99203 (Level 3 Evaluation and Management code), one of the most commonly billed services in Medicare, ranged from $200 to $1534. Another high-volume radiology code, 70450 (CT, head or brain, without contrast) ranged from $90 to $2,033.”
Hospitals mark up drug prices by 250% on average, analysis finds: “Hospitals mark up drug prices by 250 percent on average, according to an analysis from Ronny Gal, a senior research analyst at Bernstein.
Mr. Gal analyzed prices hospitals charge for drugs, with data disclosed as of Jan. 1. He found that hospitals mark up some drugs, such as Epogen, an anemia treatment, by as much as 533 percent compared to the average sales price. This incentivizes hospitals to use expensive branded products instead of biosimilars, he said…
Hospitals also charge a range of prices for the same drug, Mr. Gal said. The average variation is about 36 percent.”
Price gouging and cost shifting…