About Covid-19
Omicron may be less severe than delta, early reports suggest: “New data from South Africa suggests the omicron COVID-19 variant may cause less severe infections than delta, though more research is needed to confirm this finding.”
CMS suspends enforcement of COVID-19 vaccination mandate: “CMS has suspended implementation and enforcement of its COVID-19 vaccination mandate for healthcare workers pending developments in litigation, the agency said in a Dec. 2 memorandum.”
FDA authorizes Lilly antibody treatment for use in children, including newborns: “The treatment is a combination of two monoclonal antibodies, bamlanivimab and etesevimab, administered together through intravenous infusion. It was previously authorized for pediatric patients 12 years of age and older weighing at least 88 pounds.
The treatment is now authorized for all pediatric patients who have a positive COVID-19 test or who have been exposed to someone with COVID-19, who are at high risk for progression to severe COVID-19, including hospitalization or death.
The US is averaging more than 100,000 new Covid-19 cases a day, the highest level in two months: “For the first time in two months, the US is averaging more than 100,000 new Covid-19 cases each day, shortly after millions of Americans traveled for the Thanksgiving holiday.
The seven-day moving average of new cases was 121,437 as of Saturday, according to data from Johns Hopkins University (JHU). Prior to this week, the US last topped the 100,000-cases-a-day mark in early October.
Also on the rise is the number of Covid-19 deaths, with a seven-day average of 1,651 people dying from the virus each day as of Saturday, the JHU data showed. Average daily deaths haven't been this high in more than a month.”
Coronavirus vaccine demand grows in U.S. amid omicron variant concerns, booster eligibility expansion: “Health-care providers administered 2.18 million doses of coronavirus vaccines on Thursday, according to the Centers for Disease Control and Prevention — the ‘highest single-day total since May,’ the White House said. According to the latest CDC report, over the week ending on Thursday, the average number of daily administered vaccine doses reported to the agency was 22 percent higher than the previous week…
The increased demand for coronavirus vaccines is largely driven by demand for booster doses, CDC data shows.”
It Would Cost $50 Billion to Vaccinate the World, OECD Says: “That’s the amount needed to vaccinate the world, a measure that’s key to ending the pandemic and tackling the imbalances ‘plaguing the recovery,’ according to OECD Chief Economist Laurence Boone.
‘When you balance things out, $10 trillion for supporting the economy going through the pandemic compared with a tiny $50 billion to bring the vaccine to the entire world population, that looks completely disproportionate,’ she told Bloomberg Television in an interview Wednesday. The first number is the amount spent by Group of 20 countries to mitigating the economic impact of Covid-19.”
New York City Announces Vaccine Mandate for Private Employers: “Mr. de Blasio said the aggressive measure, which takes effect Dec. 27 and which he described as the first of its kind in the nation, was needed as a ‘pre-emptive strike’ to stall another wave of coronavirus cases and help reduce transmission during the winter months and holiday gatherings.”
Novavax to Develop Omicron-Specific COVID-19 Shot: “Novavax is throwing two punches at Omicron, the new COVID-19 variant that’s sparking fresh waves of travel restrictions: evaluating how well its lead COVID-19 vaccine candidate NVX-CoV2373 targets the new variant and creating a new vaccine made specifically to target the highly mutated virus….
The current vaccine (known as Covavax outside the U.S.), which is yet to be authorized in the U.S…”
U.S. to not reimburse private health insurers for covering at-home COVID test costs: “‘The Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act require coverage of diagnostic testing for COVID-19 without any cost-sharing requirements during the public health emergency,’ the White House official said.
’The Departments of Health and Human Services, Labor and the Treasury will clarify that coverage of over-the-counter COVID-19 tests is generally subject to those provisions,’ the official added.”
Pfizer accused of funding anti-AstraZeneca information: “US drugmaker Pfizer, the world’s dominant Covid vaccine maker, has been accused of funding educational presentations that said its UK rival AstraZeneca was ineffective and even dangerous for some members of the population.”
About pharma
Express Scripts launches new prescription discount card solution: “Through the new Right Price offering, a member who is eligible for savings through a discount card will automatically see those savings applied at the pharmacy counter. Matt Perlberg, senior vice president of supply chain at Express Scripts, told Fierce Healthcare that the pharmacy benefit manager most often sees these discounts come into play for members who have yet to meet their deductible.
For about 2% of claims, members who are purchasing generic drugs but have not yet met the deductible may find these coupon cards lead to a lower price than their drug benefits, Perlberg said.”
Drug prices slashed over 60% on average to get on China's bulk-buying list: What happens when a country uses its purchasing power to buy pharmaceuticals?
“Chinese authorities said Friday that the National Reimbursement Drug List (NRDL) has been updated, with pharmaceutical firms agreeing to cut prices by an average of 62% for 67 branded medicines that have no generic equivalents in the country. Meanwhile, seven drugs that do have generic versions were also included, for a total of 74 additions to the centralised procurement scheme this time around, while 11 medicines of low clinical value were removed, according to the National Healthcare Security Administration (NHSA).
The latest average discount marks a record for the bulk-buying programme, which negotiated average cuts of 61% for 70 drugs in 2019, and of 51% on 119 drugs in 2020. For the 2021 edition, new listings include Eli Lilly's psoriasis treatment Taltz (ixekizumab) and Johnson & Johnson's multiple myeloma drug Darzalex (daratumumab), the latter of which saw its annual cost reduced from CNY1 million ($157,000) to under CNY300,000 ($47,000) per year under the scheme.”
Understanding the Evolving Business Models and Revenue of Pharmacy Benefit Managers:
“KEY FINDINGS:
Overall, gross profit (defined as revenue minus the cost of goods sold) increased by 12%, from $25 billion in 2017 to $28 billion in 2019.
Between 2017 and 2019, PBMs adapted their business model to rely more on revenue collected through fees assessed on manufacturers and payers and gross profit on prescriptions filled through affiliated mail order and specialty pharmacies, while shifting away from a dependence on retained rebates.”
An important caveat to the above research: “It is notable that available financial data proved insufficient to fully describe the source of nearly 40% of PBMs’ total gross profit. Exploration of all publicly available data, an extensive review of the literature and our survey of industry insiders cast little light
onto specific gross profit derived from a variety of PBM business practices that include, but may not
be limited to, spread pricing, pharmacy fees and clawbacks, fees collected from payers, and other non-administrative fees collected from manufacturers.” [Emphasis in the original.]
BD finalizes name and leadership for its billion-dollar diabetes spinoff: “BD has settled on a new name for its new company, the independent spinout that will house its billion-dollar diabetes care business.
Embecta is set to launch as its own, publicly traded brand in the second quarter of 2022 after almost a century of supplying a portfolio of insulin pens and syringes under the BD banner. The diabetes division contributed about 6% of the company’s revenues in the 2020 fiscal year, or nearly $1.1 billion, by serving about 30 million users worldwide.”
About the public’s health
Immune system-stimulating nanoparticle could lead to more powerful vaccines: “Researchers from MIT, the La Jolla Institute for Immunology, and other institutions have now designed a new nanoparticle adjuvant that may be more potent than others now in use. Studies in mice showed that it significantly improved antibody production following vaccination against HIV, diphtheria, and influenza…
The researchers now hope to incorporate the adjuvant into an HIV vaccine that is currently being tested in clinical trials, in hopes of improving its performance.”
Association of Prenatal Care Services, Maternal Morbidity, and Perinatal Mortality With the Advanced Maternal Age Cutoff of 35 Years: “In this cross-sectional study, the AMA [advanced maternal age] designation at age 35 years was associated with an increase in receipt of prenatal monitoring and a small decrease in perinatal mortality, suggesting that the AMA designation may be associated with clinical decision-making, with individuals just older than 35 years receiving more prenatal monitoring. These results suggest that increases in prenatal care services stemming from the AMA designation may have important benefits for fetal and infant survival for patients in this age range.”
About health insurance
CMS Provides Guidance on Good Faith Estimates for No Surprises Act: “CMS has released 11 documents to help providers comply with the No Surprises Act’s requirement that providers give patients a ‘good faith estimate’ of expected charges.
The No Surprises Act was passed as part of the Consolidated Appropriations Act, 2021. The Act will prohibit surprise medical billing in most healthcare situations starting Jan. 1, 2022. As part of No Surprises Act compliance, providers and facilities will need to be able to inform patients, both orally and in writing, of a cost estimate if they are not enrolled in a plan or are covered by a federal healthcare program, or who are not seeking to file a claim with their insurance for care. This ‘good faith estimate,’ as the Act calls it, must be given upon request or at the time of scheduling.
Included in the documents released by CMS is a template for providers and healthcare facilities to use to deliver good faith estimates under the No Surprises Act.“
An Analysis of Medicare Accountable Care Organization Expense Reports: The objective of the study was to ” understand the investments that Medicare Shared Savings Program accountable care organizations (ACOs) in the ACO Investment Model (AIM) made to participate in the program and the costs that they incurred as a result of their efforts to lower spending and improve quality…
AIM ACOs reported expenses of $264.8 million over the 3 performance years (2016-2018). The majority of the $264.8 million in expenditures was incurred for personnel (55.5%), followed by infrastructure (22.3%), management firm expenses (15.3%), and internal programs and systems (6.9%). The dominant identifiable ACO strategy was care coordination and management, accounting for 52.9% of related ACO expenses…
Efforts to change clinician practice patterns, alter the way patients access the health care system, and institute other practice redesigns were not primary targets for investment.”
The Medicare Advantage Quality Bonus Program Has Not Improved Plan Quality: “In 2012 Medicare introduced the quality bonus program, linking financial bonuses to commercial insurers’ quality performance in Medicare Advantage (MA). Despite large investments in the program, evidence of its effectiveness is limited…
We observed no consistent differential improvement in quality for MA versus commercial enrollees under the quality bonus program. Program participation was associated with significant quality improvements among MA beneficiaries on four measures, significant declines on four other measures, and no significant change in overall quality performance (+0.6 percentage points). Together, these results suggest that the quality bonus program did not produce the intended improvement in overall quality performance of MA plans.”
About hospitals and health systems
Physician Compensation In Physician-Owned And Hospital-Owned Practices: “Among physician practices overall, vertical integration with hospitals or health systems was associated with, on average, 0.8 percent lower income compared with independent physicians after multivariable adjustment. In analyses by physician specialty, vertical integration of physician practices with hospitals or health systems was associated with lower income for nonsurgical specialists, no difference in income for primary care physicians, and slightly higher income for surgical specialists. Although vertical integration of physician practices is a rapidly growing trend, physicians might not directly benefit financially.”
Trinity Health's operating income doubles: “Trinity Health reported higher revenue and operating income in the three months ending Sept. 30 than in the same period a year earlier, according to financial documents released Dec. 3….
Trinity also reported higher expenses…
After factoring in investments and other nonoperating items totaling $164.87 million, Trinity posted a net income of $378.83 million in the first quarter of fiscal year 2022, down from $771.87 million a year earlier.”