About Covid-19
Highly immune evasive omicron XBB.1.5 variant is quickly becoming dominant in U.S. as it doubles weekly “KEY POINTS
The Covid omicron XBB.1.5 variant has nearly doubled in prevalence over the past week and now represents about 41% of new cases in the U.S., according to CDC data.
XBB.1.5 is highly immune evasive and appears to bind better to cells than other members of the XBB omicron subvariant family.
Scientists at Columbia University have warned that the rise of subvariants such as the XBB family could ‘result in a surge of breakthrough infections as well as re-infections.’”
About health insurance/insurers
CMS cracks down on Medicare Advantage TV marketing “CMS is cracking down on deceptive marketing practices and will no longer allow Medicare Advantage or Part D prescription drug plans to advertise on television without agency approval first.
The new policy is effective Jan. 1, 2023 and was discussed in an Oct. 19, 2022 memo from CMS to MA and Part D providers. The agency said it issued the new policy after reviewing thousands of beneficiary complaints regarding confusing, misleading or inaccurate information from plans — plan sponsors are also responsible for all marketing activities from brokers and third-party agencies….
To ensure compliance during the ongoing open enrollment period, CMS will review all marketing materials received during the period and target its oversight toward organizations with high rates of complaints. It will also monitor broker calls with potential enrollees and continue to ‘secret shop.’”
Medical bills heading to dispute resolution far more often than anticipated “Insurers and providers are overwhelming an arbitration system Congress set up to resolve billing disputes as part of the law to prevent surprise medical bills, according to CMS data…
Federal agencies estimated there would be 17,333 claims a year submitted to the independent dispute resolution process.
But, CMS data shows, there were more than 90,000 disputes initiated in less than six months.
Determining which disputes are eligible for review is taking longer than anticipated as well, CMS officials said in the report.”
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Cigna-HealthSpring of Tennessee, Inc. (Contract H4454) Submitted to CMS “With respect to the 10 high-risk groups covered by our audit, most of the selected diagnosis codes that Cigna submitted to CMS for use in CMS’s risk adjustment program did not comply with Federal requirements. For 195 of the 279 sampled enrollee-years, the medical records that Cigna provided did not support the diagnosis codes and resulted in $509,194 in overpayments.
As demonstrated by the errors found in our sample, Cigna’s policies and procedures to prevent, detect, and correct noncompliance with CMS’s program requirements, as mandated by Federal regulations, could be improved. On the basis of our sample results, we estimated that Cigna received at least
$5.9 million in overpayments for 2016 and 2017.”
This review is part of the OIG’s program to review appropriateness of coding for all MA plans. Read the article for proposed remedies.
About pharma
Novartis pays $245M to settle Exforge generic pay-for-delay lawsuit “Novartis has decided to end a classic generic pay-for-delay legal battle with a series of settlements.
The Swiss pharma will pay altogether $245 million in separate settlements with direct purchasers, indirect purchases and retailers who had accused the company of colluding with Endo’s Par Pharmaceutical to push back the launch of a generic version of Novartis’ high blood pressure med Exforge.”
Manufacturer Revenue on Inhalers After Expiration of Primary Patents, 2000-2021 “Manufacturers of brand-name inhalers listed many more secondary patents than primary patents with the FDA from 2000 to 2021 and earned substantially more revenue on inhalers after active ingredients went off patent compared with revenue generated when the primary patents remained active…
The current patent and regulatory system rewards minor changes to the delivery systems of existing molecules, diverting incentives for investments in new therapeutic breakthroughs.2 Regulators and lawmakers have begun to scrutinize patenting practices relating to drug-device combinations.5,6 Without substantial reform, patients and payers may continue spending large sums on inhaled products with active ingredients developed decades ago.”
96 drugs lost exclusivity in 2022 FYI
2022 drug approvals: After Aduhelm fiasco, FDA endorsements drop to 37 FYI
About healthcare personnel
The US doesn’t have enough infectious disease doctors — and the situation is about to get worse. “According to Association of American Medical Colleges data and a 2017 IDSA survey, ID doctors who care for patients make around $175,000 to $215,000 annually — which doesn’t go as far as you’d think given most US doctors’ are hundreds of thousands of dollars in educational debt. It’s also less than half of what some other specialties earn.”