Midweek Update

David Ermer–Congress, COVID-19, Government Contracting, Rx coverage, U.S. Healthcare–
Photo by Manasvita S on Unsplash

In news from our Nation’s capital

  • Yesterday the House Appropriations Committee approved for House floor consideration the Fiscal Year 2022 Financial Services and General Government appropriations bill which includes OPM and FEHB Program funding. The vote was 33-24. Govexec adds that the Committee action “endorses President Biden’s proposal to give civilian federal employees an average 2.7% pay raise in 2022, despite efforts by some Democrats to provide a bigger increase.”
  • Amy Howe informs us that tomorrow will be the last day of the U.S. Supreme Court’s October 2020 term and the two remaining decisions are politically significant.
  • The Society for Human Resource Management reports that ​”The Equal Employment Opportunity Commission (EEOC) has extended the deadline for filing the EEO-1 form from July 19 to Aug. 23. Businesses with 100 or more employees and some federal contractors with at least 50 employees must submit an annual EEO-1 form, which asks for information from the previous year about the number of employees who worked for the business, sorted by job category, race, ethnicity and gender. The EEOC did not collect such data in 2020 due to the coronavirus crisis. Covered employers now have until the new deadline to submit both their 2019 and 2020 data.”
  • The Office of Management and Budget’s Office of Information and Regulatory Affairs has completed its work on HHS’s first interim final rule on implementing the No Surprises Act. Next step will be the Federal Register’s public inspection list.

From the COVID-19 front

  • The Centers for Disease Control has improved its COVID-19 data tracker website. Check out this fascinating new chart on the value of the COVID-19 vaccines.
  • The Wall Street Journal reports that “People who became infected with Covid-19 after getting a messenger RNA vaccine [Pfizer or Moderna] carried less virus and had shorter cases than unvaccinated people who became infected, a study by government health researchers found. * * * “Even when people get vaccinated and did get infected, they were less likely to have an illness that causes a fever,” said Mark Thompson, an epidemiologist at the U.S. Centers for Disease Control and Prevention who helped lead the study.”
  • The American Hospital Association informs us that “The Moderna COVID-19 vaccine produces neutralizing antibody titers against the Delta variant, although fewer than against the ancestral strain of the virus, the company announced yesterday. * * * “These new data are encouraging and reinforce our belief that the Moderna COVID-19 Vaccine should remain protective against newly detected variants,” said CEO Stéphane Bancel.

From the Aduhelm front, STAT News tells us that
A majority of U.S. physicians disagree with the Food and Drug Administration’s approval of the Alzheimer’s drug from Biogen (BIIB) and believe the medicine should not be routinely used, according to a new survey from STAT and Medscape. Nearly two-thirds of the 200 primary care physicians and neurologists polled find the trial data unclear when it comes to benefits and risks of the drug. Consequently, only a small minority of these doctors think the medicine should be given to patients with early-onset Alzheimer’s.

The controversial new Alzheimer’s drug would only be cost effective if priced between $3,000 and $8,400, an 85% to 95% discount off the $56,000 list price, due to “insufficient” evidence the drug benefits patients, STAT says, citing a revised analysis. The assessment by the Institute for Clinical and Economic Review is very similar to an evaluation issued a month ago, before the FDA approved the medicine and issued a broad label. But Biogen has pledged to promote the drug only to a more specific patient population and the FDA is requiring fewer costly MRI scans to monitor patient safety.

With regard to the physician survey and with all due respect to that fine profession, the FEHBlog expects that the “If you build it they will come” principle could apply to Aduhelm.

In other healthcare news

  • Barron’s reports that “The nation’s largest retailer is now selling the first private-label insulin at prices more than 50% lower than brand names of the diabetes drug, which can cost thousands of dollars a year. Walmart pharmacies began filling prescriptions this week for the discount chain’s ReliOn NovoLog brand of insulin in vials and injector pens. The drug, made by major supplier Novo Nordisk (NVO), will be available by mid-July at the company’s Sam’s Club wholesale stores. “We know many people with diabetes struggle to manage the financial burden of this condition, and we are focused on helping by providing affordable solutions,” Cheryl Pegus, executive vice president of Walmart Health & Wellness, announced Tuesday.” 
  • Medscape informs us that “Families with private health insurance pay around $3,000 for newborn delivery and hospitalization, while adding neonatal intensive care can push the bill closer to $5,000, based on a retrospective look at almost 400,000 episodes. The findings suggest that privately insured families need prenatal financial counseling, as well as screening for financial hardship after delivery, reported lead author Kao-Ping Chua, MD, PhD, assistant professor and health policy researcher in the department of pediatrics and the Susan B. Meister Child Health Evaluation and Research Center at the University of Michigan, Ann Arbor, and colleagues. “Concern is growing regarding the high and rising financial burden of childbirth for privately insured families,” the investigators wrote in Pediatrics.”  Health plans may want to take a gander at their own members out of pocket spending on maternity care.
  • Employee Benefit News inquires whether a “subscription model can fix primary care.” The subscription model is offered by direct primary care companies like One Medical. According to the EBN article,

The appeal of these companies has grown as employers increasingly seek to address a shortage of high-quality primary care and reduce spending on the health of their workforce, said Ellen Kelsay, CEO and president of the Business Group on Health, which represents large employers.

Studies show a strong correlation between access to primary care and lower spending on expensive medical services such as ER visits, surgeries and hospital admissions. Yet in the United States, primary care accounts for only around 5% to 7% of total health spending, compared with 14% in the 36 member nations of the Organization for Economic Cooperation and Development.

The big bet of One Medical and companies like it is that greater spending on primary care will fatten their bottom lines while reducing overall health costs for their clients. [One Medical works with health plans as well as self-funded employers and patients.]