About health insurers
Cigna to offer $500 incentive for members who switch to a biosimilar drug: “Under the new Shared Savings Program, members will be offered a one-time $500 debit card for healthcare services or medications if they make the decision to switch to a biosimilar…
The program will be made available first to eligible patients taking Remicade, a brand-name biologic that treats a number of inflammatory conditions such as Crohn's disease and psoriasis. Remicade infusion costs can vary, but Cigna claims data suggest the average regimen costs $30,000 per year, with expenses growing depending on the site of administration.”
Bipartisan bill requires Medicare to cover breakthrough devices after approval from FDA: “The legislation, introduced in the House on Wednesday, would require Medicare to cover all breakthrough products approved by FDA for four years. During that time, the Centers for Medicare & Medicaid Services (CMS) would determine whether coverage should be permanent. Sometimes it can take CMS up to three years after a device is approved to grant a national coverage determination that ensures Medicare reimbursement.”
Blues plans banking on Sempre Health's gamified approach to slash medication costs: “Sempre Health has locked up another $15 million in financing as it looks to expand the company’s program to trim costs for behavioral health medication and cut skyrocketing healthcare system losses when patients skip their medications.
The series B funding was led by the Blue Venture Fund—a collaboration of Blue Cross Blue Shield companies, the Blue Cross Blue Shield Association and Sandbox, to which 35 BCBS companies have committed more than $890 million across four funds…
The company provides a mobile text-based platform to insurers to offer large prescription copay discounts to members for filling their prescriptions on time.”
UnitedHealth to be investigated by Mississippi state auditor for overbilling Medicaid: “The Mississippi State Auditor's Office is investigating OptumRX, UnitedHealth Group's pharmacy benefits manager, for allegedly overbilling the state's Medicaid program for prescription drugs…
The investigation comes one week after Mississippi Attorney General Lynn Fitch announced a $55 million settlement with Centene, a payer also accused of overbilling Medicaid for prescriptions.”
Humana, Mom's Meals food delivery pilot boosts members' quality of life: study: “Here’s how it works: fully prepared, refrigerated meals across the nation are provided by Mom’s Meals, which also caters to the Medicaid, Medicare and individual markets.
By the time the year-long program wound down, some 86% of the participating members concurred: the home delivery of diabetes-friendly meals was paramount to their overall well-being, according to results released Monday.”
Express Scripts sues US for $43M: ”Express Scripts, the pharmacy benefit management arm of Cigna, filed a lawsuit June 22 against the United States, alleging that the Internal Revenue Service refused to pay the company $43 million in tax returns.
According to the suit, the IRS erroneously denied Express Scripts' deductions and refused to refund the PBM more than $18 million in 2010 and nearly $25 million in 2011.”
About Covid-19
Officials note ‘likely association’ between Covid-19 vaccines and rare heart condition in young people: “…younger groups, particularly men under 30, have higher rates of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the lining around the heart) following vaccination with the shots from Moderna or Pfizer-BioNTech. Most cases have occurred soon after the second shot of the two-dose regimens.” However: Top federal health officials, professional groups say COVID-19 vaccines safe for adolescents: “The joint statement from more than a dozen federal and professional groups on Wednesday followed a meeting of the Centers for Disease Control and Prevention's vaccine advisory panel regarding reports of heart inflammation in young adults after use of either the Moderna or Pfizer-BioNTech vaccine.
’The facts are clear: this is an extremely rare side effect, and only an exceedingly small number of people will experience it after vaccination. Importantly, for the young people who do, most cases are mild, and individuals recover often on their own or with minimal treatment,’ the groups said.”
But, still: Pfizer, Moderna shots get new FDA safety warning: “The FDA will add a warning about rare instances of heart inflammation to the information sheets for the mRNA vaccines from Pfizer-BioNTech and Moderna.”
Recovery of deleted deep sequencing data sheds more light on the early Wuhan SARS-CoV-2 epidemic: [This article has not been formally peer reviewed.] This story is all over today’s media. The data implications do not seem to support the theory that the virus was caused by a lab leak. But it certainly adds to the credibility challenges to Chinese transparency. Here is the Abstract:
”The origin and early spread of SARS-CoV-2 remains shrouded in mystery. Here I identify a data set containing SARS-CoV-2 sequences from early in the Wuhan epidemic that has been deleted from the NIH's Sequence Read Archive. I recover the deleted files from the Google Cloud, and reconstruct partial sequences of 13 early epidemic viruses. Phylogenetic analysis of these sequences in the context of carefully annotated existing data suggests that the Huanan Seafood Market sequences that are the focus of the joint WHO-China report are not fully representative of the viruses in Wuhan early in the epidemic. Instead, the progenitor of known SARS-CoV-2 sequences likely contained three mutations relative to the market viruses that made it more similar to SARS-CoV-2's bat coronavirus relatives.” Here is further analysis of the findings:
Claim that Chinese team hid early SARS-CoV-2 sequences to stymie origin hunt sparks furor
Covid Illness Anxiety Plummets Amid Some Unease Over Low Vax Rate: Highlights from Monmouth Poll: “Worries about a family member getting seriously ill from the coronavirus have plunged to an all-time low. Currently, 42% of the American public expresses concern about this happening. In prior polls since the pandemic started, that number ranged between 67% and 83%. Even more telling, the number who say they are very concerned about a serious illness in their family from Covid has dropped to 23% from 40% in March, after hitting a pandemic-era high of 60% in January. Prior to that, the number of adults who said they were very concerned ranged from 37% to 50% in polls taken throughout 2020.”
CDC group says there isn’t enough data yet to recommend Covid booster shots: “A booster shot of a Covid-19 vaccine may only be necessary for those most at risk of severe disease, according to a CDC vaccine safety group.
Residents of long-term care facilities, elderly people, health-care personnel and immunocompromised people may need boosters sooner.
The CDC working group said there currently isn’t enough data to recommend a booster shot in the general population.”
About the public’s health
Declines in Births by Month: United States, 2020: “The number of births declined in both the first and second 6 months of 2020 compared with 2019 for nearly all race and Hispanic-origin groups, with larger declines in the second half of 2020 compared with the first half of the year.”
The Pandemic Led To The Biggest Drop In U.S. Life Expectancy Since WWII, Study Finds: “A new study estimates that life expectancy in the U.S. decreased by nearly two years between 2018 and 2020, largely due to the COVID-19 pandemic. And the declines were most pronounced among minority groups, including Black and Hispanic people.” The decline is the largest since WWII.
Association of Meal and Snack Patterns With Mortality of All‐Cause, Cardiovascular Disease, and Cancer: The US National Health and Nutrition Examination Survey, 2003 to 2014: This study concludes it is not just what you eat, but when you eat it: “Fruit‐snack after breakfast, fruit‐lunch, vegetable‐dinner, and dairy‐snack after dinner was associated with lower mortality risks of CVD, cancer, and all‐cause; whereas Western‐lunch and starchy‐snack after main meals had greater CVD and all‐cause mortalities.”
About pharma
Viatris scores a win in long-running EpiPen antitrust lawsuit, but patent settlement charge : heads to trial: “Viatris, the newly-formed company that combined Mylan and Pfizer's Upjohn unit late last year, said it's "pleased" with the Kansas District Court's decision to rule in favor of the company's summary judgement motion in the case…
The judge's latest ruling dismissed all claims related to the Racketeer Influenced and Corrupt Organizations Act, including charges against the company's former CEO Heather Bresch, Viatris said. The court also dismissed the charge that Mylan prevented competition through rebate arrangements with PBMs.
However, one claim related to patent settlements between Pfizer, which manufactured EpiPen, and Israeli drugmaker Teva remains outstanding and will go to trial, a Viatris spokesperson said. In the case, the plaintiffs claimed the companies abused "sham" patent litigation to forestall Teva's generic version from entering the market.”
Lilly to file for accelerated FDA approval of Alzheimer's drug after Aduhelm OK opens the floodgates: “Lilly plans to file for accelerated approval of its Alzheimer’s disease prospect donanemab later this year, a therapy the company once thought would need boat loads more data to get over the regulatory finish line.”
In a related story: Point32Health challenges Aduhelm, threatens coverage for 1.1M members: “Point32Health may not cover Biogen's new Alzheimer's treatment, Aduhelm, for its commercial members unless the price is reduced.
Point32Health CMO Michael Sherman, MD, told The Boston Globe that the drugmaker was favoring ‘excessive corporate profits’ with the $56,000 price tag over patient interests. Dr. Sherman believes the price of the treatment should be closer to $5,600, 10 percent of the current cost.”
Medicare Spent $2.1 Billion On Discarded Drugs From 2017 to 2019: “Our analysis of data provided by the Centers for Medicare and Medicaid Services (CMS) shows that more than $2.1 billion was wasted on discarded units of drugs from 2017 to 2019.
The majority of this wasted taxpayer money was spent on unused units of chemotherapy and cancer-treating drugs that were thrown away and unavailable for treating other patients in need of the drugs.
Most of this medication and financial waste is due to single-dose vials or containers of medications that include higher doses than are necessary to treat the average patient.” Emphases in the original.
Novartis bets on data, digital technologies to tackle global health challenges: “Novartis announced a collaboration Wednesday with Hewlett Packard that aims to accelerate the use of data and digital technologies in the Swiss drugmaker's global health initiatives, with the goal being to bolster access to healthcare and medicines. Financial terms were not disclosed, but the companies said they plan to start by developing a disease surveillance solution for dengue fever, initially focusing on India…
The initiative will concentrate on three ‘enablers’ of global health; namely identifying and integrating complex data sources related to health, applying artificial intelligence, machine learning and geo-spatial analytics to these data, and expanding access to technology in remote and underserved settings.”
About healthcare IT
It took a pandemic, but the US finally has (some) centralized medical data: “At the beginning of the pandemic, a group of researchers funded by the US National Institutes of Health, or NIH, realized that many questions about covid-19 would be impossible to answer without breaking down barriers to data sharing. So they developed a framework for combining actual patient records from different institutions in a way that could be both private and useful.
The result is the National COVID Cohort Collaborative (N3C), which collects medical records from millions of patients around the country, cleans them, and then grants access to groups studying everything from when to use a ventilator to how covid affects menstrual cycles…
The database is now one of the largest collections of covid records in the world, with 6.3 million patient records from 56 institutions and counting, including records from 2.1 million patients with the virus. Most records go back to 2018, and contributing organizations have pledged to keep updating them for five years. That makes N3C not just one of the most useful resources for studying the disease today, but one of the most promising ways to study long covid.”
Efficacy of Smartphone Active and Passive Virtual Reality [VR] Distraction vs Standard Care on Burn Pain Among Pediatric Patients: A fascinating use for VR: “In this randomized clinical trial that included 90 pediatric patients with burns, participants in the active VR group had significantly lower scores for overall pain compared with participants in the standard care group and for worst pain compared with participants in the passive VR group and the control group.”
Regenstrief study shows EHRs underperforming for primary care: “The study traces the roots of the challenge to the fact that many EHRs were initially designed for specialists and hospitals – without much attention to the specific needs of primary care physicians, ‘whose effective decision-making is grounded in perception and comprehension of a patient's dynamic situation.’
For example, they note, an outpatient doc's choice to stop a patient's use of a particular medication will usually be informed by trends in that patient's blood pressure or cholesterol numbers, or other medications taken over the course of a month – all holistic information with implications for the patient's future health trajectory, but data that isn't always readily seen on a single EHR screen…
Instead, she said, ‘current EHRs are overloading primary care physicians with information in disparate files and folders rather than presenting comprehensive, actionable data in a context that gives meaning.’”
ONC Health IT Framework for Advancing SDOH Data Use and Interoperability: “ONC focuses on four key areas with respect to how health IT can be used to help achieve this: standards and data; infrastructure; policy; and, implementation.” Check the press release for more details.