About health insurance
Prescription Drug and Health Care Spending Interim Final Rule with Request for Comments: “On November 17, 2021, the Department of Health and Human Services (HHS), together with the Department of Labor (DOL) and the Department of the Treasury (collectively, the Departments), as well as the Office of Personnel Management (OPM), released an interim final rule with request for comments (IFC), entitled ‘Prescription Drug and Health Care Spending’…
This IFC requires plans and issuers in the group and individual markets to submit certain information on prescription drug and other health care spending to the Departments annually, including:
General information regarding the plan or coverage;
Enrollment and premium information, including average monthly premiums paid by employees versus employers;
Total health care spending, broken down by type of cost (hospital care; primary care; specialty care; prescription drugs; and other medical costs, including wellness services), including prescription drug spending by enrollees versus employers and issuers;
The 50 most frequently dispensed brand prescription drugs;
The 50 costliest prescription drugs by total annual spending;
The 50 prescription drugs with the greatest increase in plan or coverage expenditures from the previous year;
Prescription drug rebates, fees, and other remuneration paid by drug manufacturers to the plan or issuer in each therapeutic class of drugs, as well as for each of the 25 drugs that yielded the highest amount of rebates; and
The impact of prescription drug rebates, fees, and other remuneration on premiums and out-of-pocket costs.”
URAC unveils new health plan accreditation programs: “URAC, a leading national health care accreditor, announced… that it has launched its new and improved health plan accreditation suite to serve health plans of all sizes. The new programs give health plans a choice for their accreditation.” This site provides an example of criteria.
Biden’s HHS Delays Drug Rule Allowing Multiple Price Points: “The Department of Health and Human Services delayed by six months provisions of a Medicaid drug contract rule that lets manufacturers offer states different prices for the same products.
Drug companies currently offer the same low price to all state Medicaid plans, which is commonly referred to as a drug’s ‘best price.’ The Trump-era rule could allow companies to offer different discounts to different states without forcing drugmakers to lower the price for everyone. However, lawyers said it would have been an administrative nightmare to enforce because the policy wasn’t clear.”
Medicare AEP[Annual Enrollment Period] :Half-Time Report: Although enrollment is continuing, the document is worth a quick read. Among the findings: “While $0 premium plans account for approximately 59% of all Medicare Advantage plans available for 2022, they account for 88% of all Medicare Advantage plans selected at eHealth during the first half of the current Annual Enrollment Period.”
Medicare funding cuts could limit Texans' physician options by two-thirds: “Should the proposed cut go through, the Texas Medical Association said it expects two-thirds of the state's physicians would be forced to stop accepting Medicare patients.
The move also would make 59 percent of physicians consider opting out of Medicare entirely, 42 percent stop treating current Medicare patients and 43 percent consider retirement.”
About the public’s health
Majority of Physicians Worry Signs of Addiction Were Missed During Pandemic, Finds New Quest Diagnostics Health Trends® Report: “First-of-its-kind study reveals nearly three in four physicians believe telehealth visits limit the ability to determine if patients are at risk for or are already misusing prescription drugs
Four in five physicians say a lack of drug testing during the pandemic put more people at risk for undetected drug misuse or use disorders
76% expect deaths from drug overdose will continue to rise even as the pandemic subsides”
State of Lung Cancer 2021 Report: “While the disease remains the leading cause of cancer deaths among both women and men, over the past five years, the survival rate has increased by 14.5% nationally to 23.7% yet remains significantly lower among communities of color at 20% and Black Americans at 18%.”
2021’s Most Overweight & Obese States in America: At the “top” are West Virginia and Mississippi. See the article for the several criteria used in the rankings.
About Covid-19
Moderna requests emergency authorization for booster dose for all adults: “Moderna has submitted a request to the Food and Drug Administration (FDA) to authorize booster doses of its coronavirus vaccine for all adults, seeking to expand the number of people eligible for a third shot.”
OSHA suspends enforcement of COVID-19 vaccine mandate for businesses: “The Occupational Safety and Health Administration (OSHA) is suspending enforcement of the Biden administration’s COVID-19 vaccine mandate for large private businesses after a federal appeals court upheld a stay on it last week.”
Mutation Linked to Remdesivir Resistance Found in Covid Patient: “Yale University scientists said resistance to Gilead Sciences' antiviral Veklury (remdesivir) was found in coronavirus samples collected from an immune-compromised patient treated with the drug for a persistent COVID-19 infection, reported Bloomberg.
Similar mutations causing resistance have been generated in lab studies, but had not yet been reported in patients treated with the injectable medicine, the researchers noted.
’While the finding is limited to a single case and requires confirmation of its generalizability in larger patient populations, it suggests that [Veklury] can impart selective pressure,’ they said in a study released on the medRxiv pre-print server.”
Aetna sues COVID-19 testing company, alleging fraud: “Aetna is taking a group of related radiology companies to court and accusing them of charging at least $580,000 for unauthorized COVID-19 testing.”
According to Aetna, in spring of 2020, RP and Vestibular Diagnostics’ Open MRI opened two new companies (Universal and Integrated Wellness) as Covid-19 diagnostic facilities. Among the complaints: Aetna “claimed that the laboratory misrepresented the type of testing performed and charged a sample processing fee that only applies to PCR testing. The complaint alleges that clinicians have also escalated the claims, and some bills predate the establishment of the new company.”
COVID-19 vaccination coverage among hospital-based healthcare personnel [HCP] reported through the Department of Health and Human Services Unified Hospital Data Surveillance System, United States, January 20, 2021-September 15, 2021: “As of September 15, 2021, among 3,357,348 HCP in 2,086 facilities included in this analysis, 70.0% were fully vaccinated…
COVID-19 vaccine coverage was highest in HCP working in children's hospitals.”
About pharma
CVS to close about 900 stores over next three years, as it shifts to digital strategy: “CVS Health said Thursday that it will close about 900 stores over the next three years, as it adjusts to shoppers who are buying more online.
Shares rose 2.81% to close at $95.34. With the day’s gains, CVS shares are up about 40% this year, bringing its market value to $125.81 billion.
The company announced in a news release that it will focus more of its efforts on digital growth and turning its stores into destinations that offer a range of health-care services, from flu shots to diagnostic tests.
Store closures will begin in spring 2022. The company said it plans to close about 300 per year.”
EMA panel signals negative trend vote on Biogen, Eisai's Aduhelm: “Biogen and Eisai said Wednesday that the European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) issued a "negative trend vote" on a filing seeking approval of Aduhelm (aducanumab) for the treatment of Alzheimer's disease. The CHMP is expected to adopt a formal opinion on the application for the anti-amyloid antibody at its meeting next month.”
Cassava slumps on report of SEC probe: “Shares in Cassava Sciences fell as much as 25% on Wednesday after The Wall Street Journal, citing unnamed sources, said the company is facing scrutiny by the US Securities and Exchange Commission (SEC) amid allegations it manipulated data for its experimental Alzheimer's disease drug simufilam….
The allegations surfaced earlier this year when a citizen's petition asked the FDA to suspend two clinical trials of simufilam. The petition was filed by lawyer Jordan Thomas on behalf of two physicians who dispute Cassava's clinical biomarker data as well as the integrity of its western blot analysis.”
Merck & Co.'s oral PCSK9 inhibitor yields 'encouraging' early results: “Two early studies unveiled Monday at the American Heart Association's (AHA) Scientific Sessions indicate that Merck & Co.'s oral PCSK9 inhibitor MK-0616 was safe and effective at reducing high LDL cholesterol levels. The results set up the groundwork for a potential rivalry down the road with other drugs in the class, including Amgen's Repatha (evolocumab), Sanofi and Regeneron Pharmaceuticals' Praluent (alirocumab) and Novartis' long-lasting siRNA therapy Leqvio (inclisiran), all of which are currently available only by injection.”
If this drug is eventually proved to be effective, the cost of production and administration will decrease, and (depending on pricing) sales could increase dramatically.
About healthcare systems
CommonSpirit eyes sale of 14 hospitals: “Chicago-based CommonSpirit Health is in discussions to negotiate an affiliation agreement to transfer ownership of 14 Midwest hospitals, according to financial documents released Nov. 16.
CommonSpirit said it is currently working toward an agreement with an undisclosed third party to transfer ownership of 13 critical access hospitals and one full-service tertiary hospital along with their associated clinics and home health operations. The hospitals are in North Dakota and Minnesota.”
Henry Ford Health operating income drops to $6.5M through Q3: “Henry Ford Health System, a five-hospital system based in Detroit, Mich., saw a net income of $152.5 million in the nine months ended Sept. 30, a 50.6 percent drop from the same period in 2020, according to its quarterly financial report released Nov. 15…
Total expenses in the nine months ended Sept. 30 reached $5.1 billion, a 10.5 percent increase from the same period in 2020. Henry Ford Health System saw expenses increase across several categories, including labor and supplies. Salaries, wages and employee benefits increased by $162 million year over year.”