About health insurance
Analysis of Medicare Advantage [MA] Plans’ Supplemental Benefits and Variation by County: This research letter provides a needed update on MA plans’ use of these benefits. In summary: “New supplemental benefits can be a tool to address MA beneficiaries’ health and social needs. However, only a relatively small proportion of MA plans (10.1%) are taking advantage of the most complex benefits.”
CMS Supports Modernizing Enrollment on State-Based Exchanges: “Twenty states with state-based exchanges are eligible to receive CMS grant funding, with each awardee receiving approximately $1.3 million…
As many as 21 cooperative agreement grants will be available to applicants. States that operate their exchanges on the federal health insurance marketplace website may still be eligible to apply.
CMS highlighted that these funds could go towards speeding up the eligibility determination process which assess whether individuals qualify for premium tax credits and cost-sharing reductions.
However, the funds may be used in a wide variety of ways to improve Affordable Care Act marketplace enrollment processes.”
4th Circ. revives dummy-code lawsuit against Aetna, Optum: “A federal appeals court on Tuesday reversed a ruling for Aetna Inc and OptumHealth Care Solutions, reviving a potential class action alleging that they agreed to use a ‘dummy code’ to disguise unbillable administrative fees as billable medical treatment.”
The case deals with a self-insured plan Aetna administered and for which it used Optum to subcontract certain services.
Time to pursue patient-centered payment models designed by doctors: A statement from the new AMA president. He makes many good points, however, if fully implemented, there would be an increased fragmentation in the healthcare system (hard to believe that is possible). Further, many of his recommendations would be implemented in a risk-based system, like Medicare Advantage plans that partner with physicians.
Blues plans team up to back new pharmacy solutions company, Evio: “Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Michigan, Blue Shield of California, Highmark Health and Independence Blue Cross are backing Evio, according to an announcementreleased Tuesday.
The new company aims to establish outcomes-based arrangements with drugmakers, especially for high-cost therapies. In addition, Evio aims to collect and provide real-world evidence for medications to ensure the right product is getting to the right patient.
Evio will initially focus on providing these services to five founding health plans, according to the announcement. The plans collectively cover more than 20 million members nationwide.”
About hospitals and health systems
HCA to sell $2.4B in debt: “HCA Healthcare plans to offer two batches of senior notes worth nearly $2.4 billion to repay a portion of nearly $2.6 billion in senior secured term loans.”
Select Medical's latest deals amp up operations in acute care, outpatient clinics: “Select Medical Corporation announced a handful of new acquisitions and joint venture partnerships that will add seven long-term acute care hospitals and eight outpatient clinics to its already impressive collection of post-acute care facilities.
The company, which operates critical illness recovery, rehabilitation and occupational health locations across 46 states, said it expects the deals to close in the back half of 2021 pending regulatory approval.”
Hemmed In at Home, Nonprofit Hospitals Look for Profits Abroad: A good review of pros and cons of this strategy with examples.
About pharma
Calif. Jury Clears CVS In $121M Drug Overcharge Trial: “A California federal jury on Wednesday cleared CVS Pharmacy Inc. of claims by multiple classes of insured drug buyers that the pharmacy chain overcharged them by more than $121 million for generic drugs, in violation of multiple state consumer protection statutes, according to CVS and attorneys for the classes. After deliberating for less than a day, a unanimous jury cleared CVS of allegations brought by insured drug buyers from six states that the national pharmacy chain unfairly overcharged them for prescriptions under the company's now-defunct nationwide discount program called Health Savings Pass.”
Congress needs to fix the broken market for antibiotic development: “Unlike blockbuster cancer therapies or drugs that people take for years to control high blood pressure, antibiotics must be used judiciously to preserve their effectiveness. And their use is typically discontinued as soon as an infection is cured. That’s one reason antibiotics have not provided a strong return on investment for pharmaceutical companies. From 2014 to 2016, drug companies made more than $8 billion on cancer drugs, but lost $100 million on antibiotics. This poor return on investment also discourages private investment in new antibiotics. In 2019, investors poured $9.7 billion into oncology research, but committed only $132 million to antibiotics research.”
The article calls on Congress to “pass the Pioneering Antimicrobial Subscriptions To End Upsurging Resistance Act of 2021, also known as the PASTEUR Act, to stimulate the development of new drugs to fight deadly bacterial infections.”
Senior Democrat outlines new drug pricing plan as talks drag on: Here are the major points of Sen. Widen’s proposal.
CVS cut 72 drugs with 'hyperinflated' prices from its formulary last year: “Posaconazole, an antifungal medication, is priced at $4,500 for a 30-day supply—while an alternative, fluconazole, costs less than $14.
This is an example of a growing trend: medications, including many generics, with ‘hyperinflated’ prices, experts at CVS Caremark say. The pharmacy benefit manager giant culled 72 such drugs from its formulary in 2020 alone, leading to savings of $1.2 billion compared to 2018.”
Teva reaches $925K settlement with Mississippi in price-fixing case—and it hopes other states will follow suit: “The case dates back to 2019 when Mississippi, along with 43 other states, sued 20 generic drugmakers for divvying up markets and setting prices, the lawsuit alleged at the time. Investigations identified over 100 affected drugs for various maladies, including treatments for multiple sclerosis, HIV, ADHD and cancer, they claimed.
In some cases, price hikes that stemmed from backroom conversations were above 1,000%, former Connecticut Attorney General William Tong, who has led the investigation, said at the time.”
AI drug discovery start-up Insilico raises more than $255m: “Insilico, an artificial intelligence-based drug-discovery platform preparing to trial its first treatment in humans, has raised more than $255m from investors including Warburg Pincus and Sequoia Capital China.
The Hong Kong-based start-up has 16 programmes in development, about half of which are for cancer and one of which is a potential antiviral for Covid-19. It plans to enter clinical trials this year with a novel drug for idiopathic pulmonary fibrosis, which scars the lungs, after discovering and validating the candidate in lab experiments in under 18 months.”
About medical devices
Masimo’s Radius Tº Wearable Thermometer Gets FDA 510(k) Clearance: “Masimo’s wearable, wireless thermometer branded Radius Tº has received 510(k) clearance from the FDA for both prescription and over-the-counter use in patients age five years and up.
Using a proprietary algorithm, Radius Tº provides continuous body temperature measurements that are approximations of sublingual temperatures captured from an oral probe.”
Portable dialysis machine maker Quanta lands $245M to boost U.S. reach: “After starting off 2021 with an FDA clearance for its portable dialysis machine, Quanta Dialysis Technologies has now raised a massive $245 million venture capital round to help roll out its next-generation device to both acute and chronic care settings.
The proceeds will also scale up the U.K.-based company’s operations internationally, with a special focus on boosting its U.S. manufacturing, sales and customer service divisions—in addition to setting the stage for a new clinical trial aimed at garnering an FDA green light for at-home use of its portable dialysis device.
Quanta’s SC+ hemodialysis machine is small enough to fit on top of a cart or tabletop and is currently cleared for use by healthcare professionals in hospitals and skilled nursing facilities.”
About the public’s health
Biden officials aim for the stars with new NIH research arm to push bold, risky biomedical ideas: “After the success of bringing COVID-19 vaccines to the masses in less than a year, U.S. officials are wondering how those lessons can be applied to spur breakthroughs across medicine.
President Biden is proposing a new research agency to sit within the National Institutes of Health, called the Advanced Research Projects Agency for Health (ARPA-H). It would be modeled after the Defense Advanced Research Projects Agency, or DARPA, which has led breakthroughs for the Department of Defense for more than 60 years.
The NIH requested an initial $6.5 billion in funding “to develop breakthroughs—to prevent, detect, and treat diseases like Alzheimer’s, diabetes, and cancer,” according to a paper from several NIH and White House officials published Tuesday in the journal Science.”
Radiology advocates update breast cancer screening guidance to reflect higher risk for minority women: “Breast cancer still looms as the second leading cause of cancer deaths, and two leading imaging groups say women should begin undergoing annual mammograms at age 40, particularly minority populations…
Minority women are 72% more likely to be diagnosed with breast cancer before they turn 50, and 58% more likely to suffer from an advanced stage of disease under the age of 50 compared to non-Hispanic white women. Such groups, which includes Hispanic, American Indian, Asian and non-Hispanic Black individuals among others, are also 127% more likely to die from breast cancer by their 50th birthday.”
Blood, Testing Supply Shortage To Persist Through 2021: “There has been at least a 10% increase in blood transfusions as patients resume care they deferred during the COVID-19 pandemic, many of whom are sicker.. Donations are also down, which have delayed some non-urgent procedures…
More than a third of community blood centers across the country reported having a one-day supply or less, according to America’s Blood Centers’ daily update from 59 community blood centers.”