About health insurance
Justice Department Reports Record Number of Health Fraud Cases: “The Justice Department opened a record number of False Claims Act cases last year involving allegations of health-care fraud, and it’s zeroing in now on those who misuse electronic health records, contribute to the opioid epidemic, abuse senior citizens, manipulate Medicare’s managed care program, and improperly claim Covid-19 relief funds.
‘The department also opened over 900 new matters, including 580 new health fraud matters,’ Michael Granston, deputy assistant attorney general for the DOJ’s commercial litigation branch, said Tuesday during the American Health Law Association’s annual meeting.”
Special Affordable Care Act subsidies available for unemployed Americans starting July 1: “The benefit, part of the Democrats’ $1.9 trillion rescue package enacted in March, allows anyone who receives or is approved to receive unemployment compensation during the year to select policies for as little as $0 a month in premiums and with little cost-sharing requirements, after federal assistance.
The subsidies are tied to the benchmark silver plan, so those who pick higher-level policies might have to pay a premium. The same goes for those who live in states that require plans to cover additional benefits, such as abortion, that are beyond the law’s essential health benefits.”
Without Extension of ARPA Benefits, Americans Could Face Higher Premiums in Exchanges: “Included in ARPA [American Rescue Plan Act], signed into law by President Biden on March 11, 2021, is a temporary increase in exchange premium tax credits for people already eligible for assistance under the Affordable Care Act (ACA). The law also extends eligibility to people with incomes over 400% of the federal poverty level (FPL), for 2021 and 2022. Under these provisions, approximately 18 million Americans now have access to lower-premium exchange plans – and approximately 8 million are newly eligible for lower premiums. Enhanced APRA tax credits are estimated to save current exchange enrollees an average of 25 percent of current premiums after subsidies. These ARPA tax credit enhancements are set to expire on December 31, 2022.”
The article has examples of what would happen if the Act is not extended.
California hospital beats suit over ER fee nondisclosure: “A California hospital was properly dismissed from a lawsuit alleging it violated state consumer protection laws by failing to disclose emergency room visit fees before treatment, a state appellate court ruled June 29.”
Hospital chargemaster prices for generics up to 6,000% more than pharmacies, research finds: “Chargemaster prices for generic drugs in hospitals can be 6,000 percent higher than the price of the same drug in a pharmacy, according to an analysis by GoodRx, a pharmacy discount company.
GoodRx analyzed chargemaster prices for 12 common generic drugs at 16 geographically diverse hospitals across the U.S. and compared the prices to cash prices at pharmacies. The company said cash prices are readily available and provide a good benchmark for the ‘fair’ price consumers should pay for a generic drug.”
33 Million Persons of All Ages Uninsured in 2019: “In 2019, 33.0 million (10.2 percent) persons of all ages were uninsured, according to a study published online June 29 in the National Health Statistics Reports, a publication from the U.S. Centers for Disease Control and Prevention.”
The problem with these data is that they are old. For example, 2019 figures do not take into account more recent Medicaid expansions and ACA enrollments.
Humana Ranked No. 1 Among Health Insurers for Customer Experience: “Humana ranked No. 1 among Health Insurers for customer experience (CX) quality in Forrester’s proprietary 2021 US CX Index™ survey… Along with this notable recognition, Humana also ranked the highest on clear communications and providing transparent prices, rates and fees amongst health insurers.”
About Covid-19
CureVac, the latest experimental coronavirus vaccine, proves just 48 percent effective overall, a disappointing result: “The company emphasizes that in people 60 and younger, vaccine was 77 percent effective against moderate to severe disease.”
Moderna's COVID-19 vaccine shows promise against Delta variant in lab study: “The study was conducted on blood serum from eight participants obtained one week after they received the second dose of the vaccine, mRNA-1273.”
Hepatitis C Antivirals May Fight SARS-CoV-2: “Sofosbuvir/ledipasvir (Harvoni) and nitazoxanide (Alinia) both appeared to clear SARS-CoV-2, the virus that causes COVID-19 in a preliminary trial, said Mohamed Medhat, lecturer in the department of gastroenterology and tropical medicine at Assiut University Hospitals in Assiut, Egypt.
Sofosbuvir/ledipasvir was particularly efficacious, said Medhat, who reported the results at the International Liver Congress 2021.”
Respiratory risk, not death, increased for adults with obesity in ICU with COVID-19: “In the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID), researchers analyzed the records of adults admitted to the ICU with COVID-19 at 68 U.S. hospitals. Although having a higher BMI was associated with a higher risk for acute respiratory distress syndrome and acute kidney injury requiring renal replacement therapy, there was no increased risk for mortality observed.”
This research offers different results than past studies, including lack of some previously reported inflammatory biomarkers associated with obesity.
About pharma
Takeda, Endo reaped 'many hundreds of millions' through Amitiza pay-for-delay deal, lawsuit claims: “For years, branded drugmakers have used settlements with generics companies to extend market exclusivity. These ‘pay-for-delay’ deals are often criticized as anti-competitive, and now Takeda and Endo are facing scrutiny for their prior accord.
A patent settlement between Takeda and Par Pharmaceutical—now part of Endo—in 2014 delayed generics to Japanese pharma’s constipation drug Amitiza and broke antitrust law, a new proposed class-action lawsuit claims.”
BIOTECHNOLOGY UPDATE: From the OECD, this monograph is an international perspective that includes different biotech sectors, such as health, agriculture and biofuels.
Sanofi commits €400 million annually to new mRNA vaccine unit: “According to Sanofi, [its] new research centre will look at developing mRNA vaccines beyond the coronavirus pandemic, bringing them into routine use against diseases with high unmet need. The company indicated that it expects to have a minimum of six clinical candidates by 2025.”
About healthcare IT
CMS interoperability rule becomes enforced June 30: 6 things to know: The article is a reminder that enforcement of this provision is starting and has some useful highlights.
About diagnostic devices
Philips and the Spanish National Center for Cardiovascular Research (CNIC) collaborate on a new ultra-fast cardiac MRI protocol for research purposes with the aim of benefitting clinical practice in the future: “Reducing the procedure time for full evaluation of heart anatomy and function from about one hour down to a few minutes, this new technique has the potential to increase patient access to precision diagnosis, improve patient comfort due to shorter scan times, and lower the cost of care…
The new technique (called ‘Enhanced SENSE by Static Outer-volume Subtraction (ESSOS)) makes use of the fact that during a breath-hold, everything within the patient’s chest remains static, except their beating heart. After an initial image of the static part (outer volume) has been captured this MRI data is temporarily removed. The MRI signal of the beating heart can now more easily be subtracted from subsequent scan data, allowing up to four times faster acquisition of a 3D image of the heart. This results in a net acceleration factor of up to 32. Once the dynamic information of the beating heart is reconstructed, the static outer volume images are added back to generate a full 3D cardiac image showing heart anatomy and function, and allowing review from different views with good image resolution. If needed, a second contrast-enhanced isotropic 3D single breath-hold scan can reveal the extent of damage to the patient’s heart muscle.”