About Covid-19
COVID shots should target XBB variants in 2023-24 campaign, US FDA staff say “COVID-19 vaccines being developed and manufactured for the 2023-2024 campaign should target one of the currently dominant XBB variants, the U.S. Food and Drug Administration's (FDA) staff reviewers said on Monday.
The comments were made in documents posted ahead of Thursday's meeting of a panel of FDA's independent experts, who are expected to make recommendations on what strain an updated COVID-19 booster should target.”
About health insurance/insurers
Medicaid Enrollment and Unwinding Tracker “At least 1,027,000 Medicaid enrollees have been disenrolled as of June 12, 2023, based on the most current data from 20 states. Another 1.5 million enrollees had their coverage renewed, though four of the 20 reporting states do not provide data on renewed enrollees. At least 2.5 million total renewals were completed across the 20 states. However, these data undercount the actual number of disenrollments because not all states have publicly available data on total disenrollments.
The median disenrollment rate is 40%, but there is wide variation across states ranging from 12% in Nebraska to 73% in Idaho.”
In a related piece: Letter to U.S. Governors from HHS Secretary Xavier Becerra on Medicaid Redeterminations “Given the high number of people losing coverage due to administrative processes, I urge you to review your state’s currently elected flexibilities and consider going further to take up existing and new policy options that we have offered to protect eligible individuals and families from procedural termination. I am pleased to announce several new options for states to consider adopting, such as allowing states to use their managed care plans to help beneficiaries complete these forms. These new options build on existing flexibilities we have already offered states, such as:
Spreading renewals for all populations out over 12 months, which will provide more time to run a smooth process and prevent systems from getting backlogged. A smooth process reduces burden not only on individuals and families, but also on state eligibility systems. Taking the time to do the process correctly will ensure those eligible for continued coverage do not experience a gap in care and those no longer eligible easily transition to other sources of coverage.
Maximizing the use of data sources, such as renewing individuals on the basis of their eligibility for other programs, such as the Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF). This will help reduce the need for some individuals to fill out and return a Medicaid renewal form.
Partnering with managed care plans and using data available from the United States Postal Service to update people’s contact information so that they actually receive the renewal forms states are sending out.
These are just a few of the options that help to maintain coverage for eligible people – there are many more, and we welcome the opportunity to provide technical assistance to implement these policies.
A full list of available state strategies is available here.”
Health Care Affordability Improved Between 2019 and 2022 Under Pandemic Health Coverage Policies “The share of adults reporting difficulty paying medical bills decreased from 18.7 percent to 15 percent from 2019 to 2022. The share of adults who reported forgoing needed medical care due to cost in the past year declined by more than 4.5 percent (18.5% to 13.9%). The share of Black and Hispanic adults reporting difficulty paying medical bills and forgoing needed medical care due to its cost fell sharply, reaching rates closer to those of White adults by 2022.”
CMS grows outreach of Part D Extra Help program ahead of 2024 expansion “The feds expanded eligibility for the Extra Help program as part of the Inflation Reduction Act, effective Jan. 1, 2024. Under the law, Medicare beneficiaries with limited resources and incomes of up to 150% of the federal poverty level can sign up for the full low-income subsidy.
That subsidy can be used to pay for Part D premiums as well as cost-sharing for medications. The Department of Health and Human Services (HHS) said in a fact sheet that 300,000 people currently enrolled in the program stand to benefit from the expansion, and they could save nearly $300 per year on average.
HHS estimates that up to 3 million seniors and people with disabilities could stand to benefit from Extra Help but are not currently enrolled."
Compromise struck to preserve Obamacare’s preventive care mandate “The agreement, which still needs approval from the 5th U.S. Circuit Court of Appeals, keeps coverage intact nationwide while the case proceeds. The Biden administration, in exchange, pledged not to enforce the mandate to cover HIV prevention drugs and other preventive care services against the employers and individual workers who sued claiming that doing so violated their religious beliefs. This means that even if the Affordable Care Act rules are upheld on appeal, the government can’t penalize the challengers for refusing to cover required services.”
About pharma
Not covering emerging Alzheimer's drugs could cost Medicare billions: study “Emerging Alzheimer’s disease medications come with high price tags, but researchers with the University of Chicago calculate that in the long run, it’s much less costly to cover these therapies for Medicare beneficiaries.
Providing coverage for these drugs would save the public payers between $13.1 billion and $545.6 billion in healthcare costs over the course of 17 years, according to the white paper…
Part of the additional costs under CMS’ current policy would stem from an increase in private and public healthcare spending by $6.8 billion to $284.5 billion, according to the study.
’For Medicare, the value lost ranges from $3.1 billion to $128 billion for CMS delay of 0 to 17 years, and for Medicaid the range is $1.3 billion to $54.1 billion,’ the white paper said. ‘Combining Medicare and Medicaid, the value lost to public insurance would range from $4.4 billion to $182.1 billion.’”
And in a related story: European Alzheimer's experts unconvinced by new Eisai, Biogen drug “Alzheimer's disease experts in Europe weighing potential use of a new drug from Eisai and Biogen say its ability to slow cognitive decline may not outweigh its health risks, or be worth the toll on scarce healthcare resources.”
Sanders vows to oppose NIH nominee until Biden produces drug-pricing plan “Sen. Bernie Sanders (I-Vt.), chairman of the Senate health panel, is vowing to not move forward with President Biden’s nominee to lead the National Institutes of Health — or any health nominee — until he receives the administration’s ‘comprehensive’ plan on lowering drug prices.”
Some Cancer Patients Must Travel Hundreds of Miles for Medication “Health emergency’s end means independent cancer doctors can’t send prescriptions directly to their Medicare patients…
The Centers for Medicare and Medicaid Services in September 2021 posted a list of frequently asked questions that said independent oncologists can dispense prescriptions only to a patient who is physically in the doctor’s office at the time.
Sending oral chemotherapy drugs by mail violates the Stark law, the agency said. The law bans doctors from making referrals of Medicare and Medicaid patients to other organizations or medical businesses where they have a financial stake. The restriction also applies to other independent practices, such as urology, that have an on-site dispensing pharmacy.”
These excuses for why patients need to get their medication from physicians’ offices seems specious: “But oncologists say that allowing Medicare patients to get cancer drugs from third-party specialty pharmacies doesn’t solve the problem, leads to waste and drives up costs. The pharmacies, they say, are often run by pharmacy-benefit managers that have lately been under fire from congressional lawmakers who assert they drive up prices. [Comment: But patients may pay more for drugs with PBMs. The article does not compare physician dispensed prices agains those obtained through the Part D plan.]
Many such pharmacies provide 90-day prescriptions, they say, and cancer patients often need shorter prescriptions because their treatment may change frequently in response to how a patient is responding. [Comment: PBMs can furnish any amount the physician orders. Also, the article did not say how many of these patients could not get these drugs from a local pharmacy. Nor did it comment on the fact that physicians were making a nice profit on selling these drugs.]
In a related article: Cancer drug shortage is complicating treatment, survey finds “The ongoing shortages of numerous oncology medications are causing delays in care for patients at cancer centers, according to a study from the National Comprehensive Cancer Network.”
About the public’s health
Reduced Stress-Related Neural Network Activity Mediates the Effect of Alcohol on Cardiovascular Risk “Chronic stress associates with major adverse cardiovascular events (MACE) via increased stress-related neural network activity (SNA). Light/moderate alcohol consumption (ACl/m) has been linked to lower MACE risk, but the mechanisms are unclear…
ACl/m associates with reduced MACE risk, in part, by lowering activity of an stress-related brain network known for its association with cardiovascular disease. Given alcohol’s potential health detriments, new interventions with similar effects on SNA are needed.”
Brain responses to nutrients are severely impaired and not reversed by weight loss in humans with obesity: a randomized crossover study “We show that intragastric glucose and lipid infusions induce orosensory-independent and preference-independent, nutrient-specific cerebral neuronal activity and striatal dopamine release in lean participants. In contrast, participants with obesity have severely impaired brain responses to post-ingestive nutrients. Importantly, the impaired neuronal responses are not restored after diet-induced weight loss. Impaired neuronal responses to nutritional signals may contribute to overeating and obesity, and ongoing resistance to post-ingestive nutrient signals after significant weight loss may in part explain the high rate of weight regain after successful weight loss.”
Comment: The article title is more understandable than the Abstract excerpt. What is important is that this study contributes to the literature that obesity has physiologic causes beyond behavioral ones.
AMA asks doctors to de-emphasize use of BMI in gauging health and obesity “A subcommittee of the AMA wrote in a report leading up to the vote that BMI doesn’t differentiate between fat and lean mass and doesn’t account for body fat location. Studies have shown that fat that accumulates around the abdomen may be more dangerous than fat that gathers in the legs and thighs, hence why waist circumference or the waist-to-hip ratio could be useful measurements.
Additionally, BMI cutoffs don’t appropriately represent risks across racial groups, the subcommittee wrote. For example studies have shown that Asian, Hispanic and Black people have a higher risk of developing type 2 diabetes at lower BMIs than white people.”
About healthcare IT
Suicide hotlines promise anonymity. Dozens of their websites send sensitive data to Facebook Great piece of investigative journalism. “Websites for mental health crisis resources across the country — which promise anonymity for visitors, many of whom are at a desperate moment in their lives — have been quietly sending sensitive visitor data to Facebook, The Markup has found.”
About healthcare personnel
29 physician specialties ranked by student debt burden “ The emergency medicine specialty has the highest percentage of physicians who are still paying off student debt, according to Medscape's ‘Physician Wealth & Debt Report’ published June 9.”
Comment: Post medical school debt is said to be one factor in specialty choice; however, this list does not seem to correlate low debt with higher paying specialties. For example, Plastic and General Surgery both have scores of 23% while Diabetes and endocrinology come is at 11 percent.