House passes slimmed-down spending bill to keep government open “PBM reform, doctor pay boost, and pediatric cancer measures were cut.”
About health insurance/insurers
Federal ACA marketplace enrollment lagging “New and returning sign-ups through healthcare.gov — the federal marketplace that serves 31 states — are well below last year’s rate. New enrollments were just over 730,000 in early December, compared with 1.5 million at the same time last year.”
New York health insurer, executive agree to up to $100 million settlement over Medicare fraud tied to improper diagnoses “A New York health insurer and one of its former executives have agreed to pay the Justice Department up to $100 million to resolve claims that they made their Medicare members appear sicker than they really were to get more money from the government.
The government’s lawsuit, filed in 2021, accused Independent Health, its now defunct subsidiary DxID, and DxID’s former CEO, Betsy Gaffney, of systematically scouring Medicare Advantage patients’ medical records for money-making diagnoses and pressuring doctors to sign off on them, resulting in Independent Health getting millions more from the government than it otherwise would have.”
About hospitals and healthcare systems
Financial Performance Gaps Between Critical Access Hospitals and Other Acute Care Hospitals “CAHs have unique financial pressures, particularly in the years following the COVID-19 pandemic. In this cross-sectional study, CAHs had lower overall operating margins but higher Medicare operating margins than other acute care hospitals. Operating margins for system-affiliated CAHs were 63% higher than for independent CAHs (4.4–percentage point absolute difference). Relative to independent hospitals, system-affiliated hospitals had higher commercial prices. Limitations of this study include use of financial metrics derived from CMS cost report data, rather than audited financial statements, and the lack of national hospital price data.”
About pharma
Judge blocks West Virginia's 340B contract pharmacy law “U.S. drugmakers have won a court order blocking a West Virginia law that would require them to offer discounts on drugs dispensed by third-party pharmacies that contract with hospitals and clinics serving low-income populations.”
FDA says Eli Lilly’s weight loss drug Zepbound is no longer in shortage “KEY POINTS
The Food and Drug Administration said the active ingredient in Eli Lilly’s weight loss drug Zepbound is no longer in shortage, a decision that will eventually bar compounding pharmacies from making unbranded versions of the injection.
But the FDA said it will provide a 60 to 90-day transition period where it will not take action against pharmacies for making compounded tirzepatide, which will give patients time to switch to the branded version.
It’s the latest in a high-stakes dispute between compounding pharmacies and the FDA over a shortage of tirzepatide, the active ingredient in Eli Lilly’s widely prescribed weight loss drug Zepbound and diabetes treatment Mounjaro.”
About the public’s health
Long COVID affects 8.4% of U.S. adults, with income and geography shaping impact “The study found that 8.4% of U.S. adults reported experiencing PCC, while 3.6% were currently experiencing symptoms characteristic of PCC. Among these individuals, 2.3% reported symptoms severe enough to limit daily activities. Women, bisexual individuals, and adults aged 35 to 64 had the highest reported rates of PCC and activity-limiting PCC.
Economic status was also observed to influence prevalence, with higher rates of PCC observed among individuals with lower family incomes. Rural residents also reported higher rates of both PCC and activity-limiting PCC compared to urban residents.
Additionally, the findings revealed significant racial and ethnic disparities, with Hispanic adults and non-Hispanic American Indian and Alaska Native adults experiencing higher rates than other groups. Conversely, non-Hispanic Asian adults reported the lowest prevalence.
Nearly 65% of those with current PCC indicated that their symptoms limited their daily activities, with “a little” or ‘a lot’ of interference in their ability to function. The prevalence of PCC and activity limitations showed clear trends based on urbanization, with rural populations consistently more affected.”
Review of US vaccine injury reimbursement program shows less than 3% of claims eligible for compensation “A report yesterday from the US Government Accountability Office (GAO) on federal response to medical countermeasure injury compensation claims—primarily about COVID and flu vaccines—reveals that, during the first few years of the COVID-19 pandemic, claims spiked to 27 times the typical number received, and less than 3% of the claims were eligible for compensation.
About half of the claims were related to COVID vaccination. The vast majority of money paid for claims, however—more than $6 million—was for harms tied to the H1N1 flu vaccine.”
About healthcare technology
Top health tech companies by VC funding: A look at 2024 and the past decade “According to Silicon Valley Bank, investment so far this year is hovering between $4 billion and $4.5 billion per quarter. Funding in the first eight months of 2024 has already exceeded investment totals from full-year 2019, SVB reported.
And it's perhaps no surprise that healthcare AI startups are driving the momentum this year. It was reported in October that generative AI startup Abridge is raising $250 million in new funding with a pre-money valuation of an eye-popping $2.5 billion.”
See the charts in the article.
Medline sets stage for blockbuster US IPO with confidential filing “Medline has confidentially filed for an initial public offering in the United States, paving the way for one of the major stock market flotations in 2025 that could value the medical supplies provider as high as $50 billion.
The company has not determined the size of the offering, it said on Thursday, but Reuters reported last month the stock sale could fetch $5 billion.”