About Covid-19
Pfizer asks FDA to clear updated COVID shot for kids under 5 “Pfizer is asking U.S. regulators to authorize its updated COVID-19 vaccine for children under age 5 — not as a booster but part of their initial shots.
Children ages 6 months through 4 years already are supposed to get three extra-small doses of the original Pfizer COVID-19 vaccine — each a tenth of the amount adults receive — as their primary series. If the Food and Drug Administration agrees, a dose of Pfizer’s bivalent omicron-targeting vaccine would be substituted for their third shot.”
US Won’t Back 2022 Patent Waivers for Covid Tests and Treatments “The US won’t agree to waive intellectual-property protections for Covid-19 treatments and tests this year -- aligning with developed-nation peers and delaying prospects for a World Trade Organization accord aimed at boosting global access to life-saving medicines.
On Tuesday, US Trade Representative Katherine Tai said the agency needs more information about the market dynamics for Covid diagnostics and therapeutics, and plans to ask the US International Trade Commission to launch an investigation into the matter.”
About health insurance/insurers
Association of Medicare Advantage vs Traditional Medicare With 30-Day Mortality Among Patients With Acute Myocardial Infarction “Among Medicare beneficiaries with acute MI, enrollment in Medicare Advantage, compared with traditional Medicare, was significantly associated with modestly lower rates of 30-day mortality in 2009, and the difference was no longer statistically significant by 2018. These findings, considered with other outcomes, may provide insight into differences in treatment and outcomes by Medicare insurance type.”
And in a related editorial: How Much of an “Advantage” Is Medicare Advantage? This commentary provides a thoughtful analysis of differences between MA and FFS Medicare.
Association Between Individual Primary Care Physician Merit-based Incentive Payment System Score and Measures of Process and Patient Outcomes “Question Are higher scores for primary care physicians in the Medicare Merit-based Incentive Payment System (MIPS) associated with better performance on a broad range of clinical process and patient outcome measures?
Findings In this cross-sectional observational study of 80 246 primary care physicians, MIPS scores were inconsistently related to performance on process and outcome measures, and physicians caring for more medically complex and socially vulnerable patients were more likely to receive low MIPS scores, even when they delivered relatively high-quality care.
Meaning The MIPS program may not accurately capture the quality of care that primary care physicians provide.”
And in an accompanying editorial: Pay for PerformanceWhen Slogans Overtake Science in Health Policy: “In sum, theory and evidence tell us that quality of care is not as contractible through the payment system as the emphasis in policy would suggest. Talk of a fix that attaches stronger incentives to just the right measures—measures that somehow encompass what is valued and are impervious to the problems discussed above—is vague and fanciful. At some point, the slogans overtook the science, derailing a national conversation about quality improvement that will need to get back on track for progress to be made.”
The entire article is worth reading.
9 Medicare Advantage plans audited for upcoding by OIG in the last 6 months FYI
The Impact of the COVID-19 Public Health Emergency Expiration on All Types of Health Coverage “Key Findings
18 million people could lose Medicaid coverage when the COVID-19 public health emergency (PHE) ends, according to a new analysis.
While many who are currently enrolled in Medicaid will transition to other coverage options, nearly 4 million people (3.8M) will become completely uninsured.
19 states will see their uninsurance rates spike by more than 20 percent.
3.2 million children will transition from Medicaid to separate Children’s Health Insurance Program (CHIP) health plans.”
About hospitals and healthcare systems
Financial updates from 23 health systems: CommonSpirit, Tenet and more FYI
About pharma
Cigna’s PBM Express Scripts Latest To Put Less Pricey Biosimilars Of Abbvie’s Humira On Preferred Drug List “Cigna’s pharmacy benefit manager Express Scripts Monday said it will put ‘multiple’ biosimilar versions of Abbvie’s expensive rheumatoid arthritis drug Humira in the ‘same position as the brand’ on the PBM’s formulary in 2023.
Humira, approved by the U.S. Food and Drug Administration 20 years ago, has for years now been one of the nation’s most costly drugs generating more than $20 billion in sales for its maker, Abbvie in 2021 alone. Cigna and Express Scripts said Humira, which treats inflammatory and skin conditions, is one of the most widely used specialty medications.”
About the public’s health
Rising flu cases drive up U.S. hospitalizations, CDC says “The United States is experiencing the highest levels of hospitalizations from influenza that it has seen in a decade for this time of year, the head of the U.S. Centers for Disease Control and Prevention (CDC) said on Monday, adding that 14 children have died so far this flu season.
CDC Director Rochelle Walensky added that U.S. hospital systems also continue to be stressed with a high number of patients with other respiratory illnesses such as respiratory syncytial virus (RSV) and COVID-19.
There have been at least 8.7 million illnesses, 78,000 hospitalizations, and 4,500 deaths from flu so far this season, according to CDC estimates. It urged people to get vaccinated.”
mRNA vaccines take the sting out of malaria infection—and transmission “After nearly four decades of development, the world finally has a malaria vaccine. The first large-scale rollout of GlaxoSmithKline’s RTS,S, or Mosquirix, kicked off at the end of November.
And more are on the way. In September, Oxford researchers reported promising phase 2 results for R21/Matrix-M, which bumps up the efficacy rate against infection from Mosquinix’s 35% to as high as 80%. COVID-19 vaccine-maker BioNTech is working on its own version, too.”
About health technology
Apple scores victory in dispute over heart monitoring technologies in Apple Watch “The U.S. Patent and Trademark Office’s Patent Trial and Appeal Board, or PTAB, on Tuesday ruled that three AliveCor patents covering heart monitoring technologies for wearable devices were unpatentable. AliveCor alleged in federal court and before the International Trade Commission that Apple had copied the technologies with its Apple Watch, and over the summer an ITC judge found that Apple had infringed on two of three patents AliveCor asserted in its complaint.”
About healthcare finance
Centene completes sale of Magellan Rx to Prime Therapeutics “Centene has completed its $1.35 billion divestiture of Magellan Rx to Prime Therapeutics.
The move adds Magellan's specialty drug management capabilities to Prime Therapeutics' suite of pharmacy benefit management tools, allowing it to enhance its collection of solutions. Prime is collectively owned by 19 Blues plans and affiliates.
Magellan Rx also brings 1.7 million new PBM members into the fold…”