Every year, the Kaiser Family Foundation (KFF) issues a report on employer-based health insurance. This year’s report was issued on Wednesday. It is truly a treasure trove of information on all aspects of the commercial insurance market and is a must-read. You can read the executive summary, but far more impactful is to look at the excellent Figures.
I also recommend the following article to get a big-picture overview of this study:
Health Benefits In 2023: Premiums Increase With Inflation And Employer Coverage In The Wake Of Dobbs
About Covid-19
Serotonin reduction in post-acute sequelae of viral infection “Highlights
Long COVID is associated with reduced circulating serotonin levels
Serotonin depletion is driven by viral RNA-induced type I interferons (IFNs)
IFNs reduce serotonin through diminished tryptophan uptake and hypercoagulability
Peripheral serotonin deficiency impairs cognition via reduced vagal signaling”
HHS pledges to keep Paxlovid available as it transitions to commercial market “HHS announced …an agreement with Pfizer to ensure continued access to the antiviral Paxlovid for the next few years as it prepares to transition the drug into the commercial market.”
And in a related story: Pfizer to price COVID treatment Paxlovid at $1,390 per course “Pfizer on Wednesday said it will set the U.S. price for its COVID-19 antiviral treatment Paxlovid at nearly $1,400 per five-day course when it moves to commercial sales after government stocks run out, more than double what the government currently pays for it.
The new list price, which does not include rebates and other discounts to insurers and pharmacy benefit managers, is $1,390 per course, Pfizer said in an emailed statement. The U.S. government paid around $530 per course for Paxlovid it has made available to Americans at no cost.”
U.S. halts collection on some past-due covid loans, sparking federal probes “The U.S. government has halted some efforts to collect an estimated $62 billion in past-due pandemic loans made to small businesses, concluding that aggressive attempts to recover the money — a portion of which may have been lost to fraud — could cost more than simply writing off the debt.”
About health insurance/insurers
Reducing Hospital Costs Without Hurting Patients “Policymakers have multiple options for reducing Medicare and Medicaid expenses without harming patients. Implementing site-neutral payment for ambulatory care services, equalizing the tax treatment of hospital investments, reforming GME payments, and addressing Medicaid provider taxes over time all would produce significant savings. Policymakers will likely deploy some of these savings to improve the Medicare program; they should prioritize improving the physician office fee schedule through a routinized inflation update and supporting GNE. Policymakers should ask the advisors to Congress—the CBO, the Joint Committee on Taxation, and (as necessary) the CMS Office of Actuary—to estimate the impacts of these changes on taxpayers, beneficiaries, and to the Medicare Trust Fund(s).”
And in a related article from the Urban Institute: Post-Acute Care and Medicare Solvency: Reducing Excessive PAC Payments Can Promote Financial Stability One of the largest Medicare expenses is Post Acute Care services. This analysis offers ways to reduce those costs.
Annual window to shop for Medicare Advantage plans returns on Sunday “During the enrollment period, which ends Dec. 7, people will have the opportunity to choose between traditional Medicare and privately run Medicare Advantage plans in their area, as well as prescription drug plans.
But research shows that most people don’t bother shopping.”
Elevance Health braces for $500M hit to bonus revenue amid MA star ratings drop “CEO Gail Boudreaux said on the insurer's third-quarter earnings call on Wednesday that Elevance Health is bracing for a $500 million loss to its quality bonus revenue following offsets from contract provisions thanks to the star ratings decline. The company's performance on consumer surveys was subpar, and it also felt the sting in the way the Centers for Medicare & Medicaid Services is applying new statistical methodology, she said.”
In a related article: Elevance Health boosts guidance as it posts $1.3B in Q3 profit “The insurer reported $1.6 billion in profit for the third quarter of 2022, making for a nearly 20% decline year over year.”
Fewer Medicare Advantage plans snag 5-star ratings for 2024 “CMS' overall average star ratings declined slightly for Medicare Advantage plans for plan year 2024.
CMS published its star ratings for Medicare Advantage and part D standalone plans Oct. 13. The average Medicare Advantage star rating for 2024 is 4.04, down from 4.14 in 2023. Around 74 percent of Medicare Advantage enrollees will be in a plan rated four stars or higher in 2024, up from 72 percent in 2023.”
Humana has highest customer satisfaction among health insurers “Health insurance satisfaction surges 4% to a record-high score of 76 (out of 100), with customer engagement points like call centers and websites improving 5% year over year, according to the American Customer Satisfaction Index (ACSI®) Insurance and Health Care Study 2022-2023. Meanwhile, hospitals improve 4%, reaching their highest score (74) since 2018.”
Many payers expect IRA to have negative impact on Part D plans “Changes to the Medicare Part D program—including capping insulin copays and out-of-pocket spending and eliminating the 5% coinsurance requirement for the catastrophic phase—from the Inflation Reduction Act (IRA) could negatively impact payers, according to a survey of health plans.”
About hospitals and healthcare systems
Downgrades outpace upgrades in Q3 and trend will continue, Fitch says “Nonprofit health system and hospital downgrades outnumbered upgrades by a ratio of 3-to-1 in the third quarter, Fitch said in an Oct. 18 public finance report.
And such a trend is likely to continue for the foreseeable future as staffing costs remain elevated amid tighter operating margins, according to the report.”
Henry Ford Health, Ascension Michigan unveil plans to form $10.5B joint venture “Henry Ford Health is coming together with several of Ascension Michigan’s hospitals and other facilities to form a joint venture with over $10.5 billion in annual operating revenue, the organizations announced Wednesday.
The deal, which is expected to close in summer 2024 pending federal and state regulatory reviews, includes all of Henry Ford’s acute care hospitals, related facilities and assets, including its Health Alliance Plan.”
About pharma
Rite Aid files for bankruptcy, names new CEO “Rite Aid is filing for Chapter 11 bankruptcy protection and has a new CEO to lead it through the turnaround, the U.S. drugstore chain announced Oct. 15.
The Philadelphia-based company, which has 2,100 stores across the U.S., named Jeffrey Stein as its CEO, chief restructuring officer and a member of its board of directors, effective immediately. He replaces Elizabeth Burr, who has served as interim CEO since January 2023 after Heyward Donigan abruptly resigned. Ms. Burr will remain director of the Rite Aid board.
Rite Aid is reporting that it has secured $3.45 billion from lenders to fund operations throughout the bankruptcy process. The largest creditor is McKesson Corp. with trade-payable claims of approximately $667.6 million, according to Bloomberg.”
CVS, Walgreens and Rite Aid are closing thousands of stores. Here’s why Among the reasons: “Researchers find pharmacy closures lead to health risks such as older adults failing to take medication…
[Also] pharmacies at greatest risk for closures are those with a large customer base on public insurance, which have lower reimbursement rates than private plans, as well as independent pharmacies.”
EU and UK regulators warn fake diabetes drug found at wholesalers “EU and UK regulators have warned fake versions of the diabetes drug Ozempic — often used for weight loss — have been discovered at wholesalers… The pre-filled injection pens are falsely labelled as the drug sold by the Denmark-based Novo Nordisk and were discovered as fakes because of inactive serial numbers. The pens came from suppliers in Austria and Germany and appear to be 1mg doses with authentic German packaging, although it is a different shape and shade of blue to the originals.”
Mayo, Lifepoint sue Bristol Myers Squibb over cancer drug cost “Mayo Clinic and Lifepoint Health are suing Bristol Myers Squibb and its subsidiary, Celgene, alleging the companies inflated the price of the cancer drug Revlimid by paying other drugmakers to keep their generic versions off the market…
The practice, known as ‘pay-for-delay’ or ‘reverse payments,’ has faced scrutiny from the Federal Trade Commission and insurance plans, which claim they cause consumers to overpay for medications.”
Alignment Healthcare, Walgreens launch co-branded Medicare Advantage plans “The plans will be offered in 10 counties across Arizona, California, Florida and Texas beginning Jan. 1 and include $0 premiums. The partners expect that the new plans will reach 1.6 million potential MA enrollees, according to an announcement.
Members who select the co-branded plans can use over-the-counter benefits at Walgreens' stores or online through a mail-order provider. They will also have access to a $0 copayment on more than 10,000 prescriptions at Walgreens or other in-network pharmacies.”
Johnson & Johnson, riding high after Kenvue spinoff, touts new launches as Stelara cliff nears “The company's top drug by sales, the immunology giant Stelara, generated $2.86 billion during the quarter, a 17% increase from the same period last year. The drug is expected to face its first biosimilar competition in 2025, so J&J is busy getting ready for the looming patent cliff.
To that end, the company is making progress on the launches of CAR-T drug Carvykti, novel antidepressant Spravato and cancer launch Tecvayli…”
Merck & Co. shells out $4 billion upfront in mega ADC pact with Daiichi Sankyo “Merck & Co. has agreed to pay Daiichi Sankyo $4 billion upfront, in a deal potentially worth as much as $22 billion, to advance three of the Japanese drugmaker's antibody-drug conjugate (ADCs) candidates across multiple cancer types. As part of the deal, the companies will jointly develop and commercialise patritumab deruxtecan, ifinatamab deruxtecan and raludotatug deruxtecan globally, except for Japan where Daiichi Sankyo has exclusive rights.”
BioNTech expects €900-million charge after Pfizer’s COVID vaccine write-offs “BioNTech said Monday it will likely record a charge of €900 million ($949 million) in the third quarter related to the COVID-19 vaccine Comirnaty after partner Pfizer announced that inventory write-offs will cost it $5.5 billion. Pfizer's charges primarily relate to the oral antiviral treatment Paxlovid (nirmatrelvir/ritonavir), but also include $900 million of inventory write-offs for Comirnaty.”
And in a related article with the same message: Pfizer targets $3.5 billion in cost cuts amid weakening COVID product sales
Comment: This charge was predictable as COVID has become more endemic. Manufacturers of the vaccines will still make money, just not as much as during the pandemic. The key to increased profitability is using the mRNA technology for other vaccines/treatments.
Walgreens inks new clinical trial deal “As part of its new clinical trials business, Walgreens Boots Alliance has teamed up with the Cardiovascular Research Foundation to find patients for a clinical trial that aims to study the prevalence of valvular heart disease in older Americans, the organizations announced Wednesday.
Deerfield-based Walgreens, which has about 9,000 stores in the U.S., says it will leverage its national presence to help identify and reach potential participants. The study has already begun, with top-line results expected to be released in 2025, Walgreens said in a statement.”
Walgreens to settle Rite Aid investors' merger claims for $192 million “Walgreens Boots Alliance has agreed to pay $192.5 million to settle a class action lawsuit by investors in Rite Aid who accused Walgreens of misleading them in 2017 about scrutiny of the two drugstore chain operators' then-pending merger.”
Walgreens, CVS workers plan nationwide strike “Pharmacy employees at Walgreens and CVS are in talks to organize nationwide walkouts and protests in late October, people familiar with the matter told CNBC.
CVS pharmacy employees in Kansas City called out of work in late September to protest heavy workloads and understaffing. Executives at the pharmacy chain met with the workers, who returned to work after CVS agreed to pay overtime, increase staffing and curb the amount of vaccination appointments.”
Israeli drugmaker Teva loses appeal against EU fine -EU court ruling “The General Court of the European Union ruled on Wednesday that Israeli drugmaker Teva and Cephalon must pay a 60.5 million euro fine by the European Commission for delaying the market entry of a cheaper generic version of Cephalon’s drug for sleep disorders that Teva sought to challenge in court.”
GoodRx, Sanofi to offer insulin for $35, regardless of insurance, at select pharmacies “All Americans with a valid prescription, regardless of their insurance status, can use GoodRx at more than 70,000 retail pharmacies to access a 30-day supply of Lantus for $35. Patients can visit GoodRx.com/lantus to access the coupon, redeemable at any pharmacy that accepts GoodRx including CVS, Walgreens and Walmart.”
State Drug Pricing Boards Tee Up New Front in Pharma Legal Fight “A wave of state boards aiming to set limits on what health plans pay for prescription drugs is likely to trigger lawsuits from drugmakers, policy analysts and lobbying groups say, as the industry also fights government price-setting policy at the federal level.
The Michigan Senate voted Oct. 4 to pass a package of bills… that would create an independent board to evaluate the impact of prescription drug costs on patients in the state, and to establish upper payment limits on some of the most expensive products. The legislation, if enacted, would make Michigan the ninth state to establish a prescription drug affordability board (PDAB), and the sixth with the ability to set payment limits.”
About the public’s health
Influenza Vaccine for 2023-2024 Each year, The Medical Letter covers recommendations for flu shots. This issue has always been my go-to source of information and is open to all for access.
Living alone and cancer mortality by race/ethnicity and socioeconomic status among US working-age adults “Compared to adults living with others, adults living alone were at a higher risk of cancer death in the age-adjusted model (HR, 1.32; 95% CI, 1.25–1.39) and after additional adjustments for multiple sociodemographic characteristics and cancer risk factors (HR, 1.10; 95% CI, 1.04–1.16). Age-adjusted models stratified by sex, poverty level, and educational attainment showed similar associations between living alone and cancer mortality, but the association was stronger among non-Hispanic White adults (HR, 1.33; 95% CI, 1.25–1.42) than non-Hispanic Black adults (HR, 1.18; 95% CI, 1.05–1.32; p value for difference < .05) and did not exist in other racial/ethnic groups.”
Having a college degrees somewhat attenuated the findings.
Red meat intake and risk of type 2 diabetes in a prospective cohort study of United States females and males “Intakes of total, processed, and unprocessed red meat were positively and approximately linearly associated with higher risks of T2D. Comparing the highest to the lowest quintiles, hazard ratios (HR) were 1.62 (95% confidence interval [CI]: 1.53, 1.71) for total red meat, 1.51 (95% CI: 1.44, 1.58) for processed red meat, and 1.40 (95% CI: 1.33, 1.47) for unprocessed red meat. The percentage lower risk of T2D associated with substituting 1 serving/d of nuts and legumes for total red meat was 30% (HR = 0.70, 95% CI: 0.66, 0.74), for processed red meat was 41% (HR = 0.59, 95% CI: 0.55, 0.64), and for unprocessed red meat was 29% (HR = 0.71, 95% CI: 0.67, 0.75); Substituting 1 serving/d of dairy for total, processed, or unprocessed red meat was also associated with significantly lower risk of T2D. The observed associations became stronger after we calibrated dietary intakes to intakes assessed by weighed diet records.”
Race and Ethnicity and Prehospital Use of Opioid or Ketamine Analgesia in Acute Traumatic Injury “In this cohort study of over 4.7 million patient encounters across the US during a 3-year period (2019-2021), among patients with acute traumatic injuries, patients from minoritized racial and ethnic groups were less likely to have a pain score recorded. Among patients with a high pain score, Black patients were significantly less likely to receive analgesia when compared with White patients.”
FDA takes ‘momentous’ step toward banning menthol cigarettes and flavored cigars “The US Food and Drug Administration took a ‘momentous’ step Monday toward banning menthol in cigarettes and banning flavored cigars, proposing a rule that public health experts say could save hundreds of thousands of lives…
The agency has sent the rule to the White House Office of Management and Budget for final review, the last regulatory step before the rule becomes final.”
Expanding PrEP Coverage in the United States to Achieve EHE Goals “Overall in 2022, 36% of the 1.2 million people who could benefit from PrEP were prescribed it, compared to 23% in 2019, the year that EHE [Ending the HIV Epidemic] was announced. Today’s data also show progress in increasing PrEP uptake in virtually all EHE jurisdictions, despite the unprecedented public health challenges funding recipients faced during this period with the COVID-19 pandemic and outbreaks of mpox, which consumed considerable resources as EHE efforts were just getting underway.”
Kids' Use of Cannabis and Tobacco Rose From 2021 to 2022 “In 2021, 11% of respondents reported exclusive use of tobacco, 10.8% reported simultaneous use of tobacco and cannabis, 3.4% reported exclusive use of cannabis, and 74% reported no cannabis or tobacco use, while in 2022, there was an increase in use in all three smoker groups:
13.6% reported use of both tobacco and cannabis
11.7% reported use of tobacco alone
4.1% reported use of cannabis alone
Respondents who reported using neither cannabis or tobacco declined to 70.6%”
About healthcare IT
Telemedicine Versus In-Person Primary Care: Treatment and Follow-up Visits “In-person return visits were somewhat higher after telemedicine compared with in-person primary care visits but varied by specific clinical condition.”
Private Health Data Still Being Exposed to Big Tech, Report Says “Despite recent efforts to address the issue, medical-related websites continue to be mined for data including personal medical information, in an apparent violation of patients’ privacy rights, according to a new study.
Some of the most common tracking pixels were from Alphabet Inc.’s Google, Microsoft Corp., Meta Platforms Inc. and ByteDance, the parent company of TikTok, according to a report by the cybersecurity company Feroot Security.”
Hacked to Pieces? The Effects of Ransomware Attacks on Hospitals and Patients “In this paper, we provide the first empirical evidence on the effect of ransomware attacks on hospital operations and health outcomes. We find that ransomware attacks immediately affect hospital operations - causing large reductions in ER, inpatient, and outpatient hospital volume and even larger reductions in Medicare revenue for care provided…
We find a marginally statistically significant (P=0.07) differential increase in in-hospital mortality of 0.77 percentage points for patients of ransomware-attacked hospitals who are hospitalized at the time of the attack. Compared to the in-hospital mortality rate of patients discharged in the five weeks prior to attack, this represents a 20.7% relative increase in in-hospital mortality. We find no similar increase for 30-day mortality, nor for 30-day readmissions.”
Supreme Court takes up fight over Biden administration’s online misinformation fight “The Biden administration can continue its efforts to fight misinformation on social media, the Supreme Court said on Friday in an order agreeing to pause a lower court order and hear the case later this term.
Justices Samuel Alito, Clarence Thomas, and Neil Gorsuch publicly dissented from the ruling, calling the government’s misinformation efforts a coordinated federal campaign against disfavored views on important published issues.”
Comment: One of the main reasons the Biden administration wants clearance to fight online misinformation is because of the non-scientific and harmful comments about public health measures, e.g., Covid-19 immunizations and harmful medications.
Carta Healthcare survey results indicate that education around AI may improve consumer trust “The survey finds that on average, three out of four Americans do not trust AI in a healthcare setting. Nearly four out of five patients in the U.S. report not knowing if their provider is using AI; in reality, 100% of healthcare providers are using AI, and have been for a long time. This discrepancy illustrates the public’s misperception of the use of this technology, which is made evident by the 43% of respondents who admit there are limitations in their understanding of AI.”
About healthcare personnel
Doctors Unionize at Big Health Care System “The doctors, roughly 400 primary and urgent-care providers across more than 50 clinics operated by the Allina Health System, appear to be the largest group of unionized private-sector physicians in the United States. More than 150 nurse practitioners and physician assistants at the clinics were also eligible to vote and will be members of the union, which will be represented by a local of the Service Employees International Union.”
Comment: In addition to nurses and pharmacists, physicians are now going on strike. Those who want more of a British healthcare system are starting to get their wish.
Kaiser pharmacy workers continue 3-week strike, approve to double it “As hundreds of pharmacy workers for Kaiser Permanente continue striking for up to three weeks in Oregon and Southwest Washington, their union approved another strike that could last almost four more weeks.”
Addressing the healthcare staffing shortage Lots of valuable information in this survey. For example, from 2021-2022, more than 71,000 left the workforce—about 20,000 of whom were primary care physicians.
About health technology
CMS is removing PET scan restrictions for Alzheimer's patients “The Centers for Medicare & Medicaid Services (CMS) has decided to remove the national coverage determination (NCD) that limits patients’ ability to qualify for new drugs, giving people with Alzheimer’s disease symptoms a better path to treating the condition.
The policy means amyloid PET scans will no longer be limited and will give patients a better chance of being prescribed a drug like Eisai's Leqembi, which clears beta amyloid proteins from the brain to slow the advances of Alzheimer’s.”
GE HealthCare and Novo Nordisk to Collaborate to Advance Novel Non-invasive Treatment for Type 2 Diabetes and Obesity with Ultrasound “GE HealthCare … announced a collaboration with Novo Nordisk to further advance the clinical and product development of peripheral focused ultrasound (PFUS). This is a novel technology that has potential to specifically regulate metabolic function in the body using ultrasound that may support the treatment of chronic diseases such as type 2 diabetes and obesity.
PFUS is a non-invasive type of bioelectronic medicine that uses ultrasound to activate the nervous system to stimulate a response that may be able to treat disease. Pre-clinical proof of concept and initial early-stage clinical research suggests that it may impact glucose metabolism in people with diabetes via personalized ultrasound stimulation of nerve pathways.”
About healthcare finance
For-profit hospital M&As: 9 deals involving HCA, CHS and Tenet FYI
17 latest healthcare bankruptcies FYI
Thermo Fisher to absorb proteomics player Olink in $3.1B deal “Thermo Fisher Scientific is putting down a premium to extend its reach in protein research. It has moved to acquire Olink, a Swedish provider of proteomics analysis equipment and services for tracking down and developing biomarkers.
Through a deal pegged at $3.1 billion, Thermo Fisher has signed on to pay $26 for each of Olink’s Nasdaq shares—for a price that comes to about 74% above the company’s previous closing value. The transaction includes the absorption of $143 million in Olink’s net cash, alongside the company’s international operations in Boston, Tokyo and Shanghai.”
Pfizer secures unconditional EU antitrust nod for Seagen buy “The EU announced that it has unconditionally approved Pfizer's pending $43-billion acquisition of antibody-drug conjugate (ADC) developer Seagen. In a statement on Thursday, the European Commission said it concluded that the transaction would not raise competition concerns, nor is it like to have a negative impact on prices.”