From Washington, DC,

• Healthcare Dive informs us,
  • “Providers and drugmakers are once again at odds over the 340B drug discount program: this time, over a rule finalized by the Biden administration on Thursday making changes to its dispute resolution process.
  • “The final rule, which will become effective in mid-June, is meant to make dispute resolution more accessible and efficient, according to the Health Resources and Services Administration, or HRSA, the agency that oversees 340B. Along with lowering barriers to enter the process, the rule requires parties to make a good faith effort to resolve disputes before bringing them to arbiters and creates an appeals process if either party doesn’t like the result.
  • “Provider groups the American Hospital Association and 340B Health said the rule should streamline the arbitration process and preserve the integrity of the controversial program. Meanwhile, pharmaceutical lobby PhRMA said the new process “panders to 340B hospitals” while ignoring drugmakers’ concerns.”

• KFF lets us know,
  • “Federal data from 2019 shows just 4% of potentially eligible enrollees participated in the program, a figure that appears to have held steady through 2023, according to a Mathematica analysis. About 12,000 physicians billed Medicare under the CCM mantle in 2021, according to the latest Medicare data analyzed by KFF Health News. (The Medicare data includes doctors who have annually billed CCM at least a dozen times.)
  • “By comparison, federal data shows about 1 million providers participate in Medicare.
  • Even as the strategy has largely failed to live up to its potential, thousands of physicians have boosted their annual pay by participating, and auxiliary for-profit businesses have sprung up to help doctors take advantage of the program. The federal data showed about 4,500 physicians received at least $100,000 each in CCM pay in 2021. * * *
  • “This program had potential to have a big impact,” said Kenneth Thorpe, an Emory University health policy expert on chronic diseases. “But I knew it was never going to work from the start because it was put together wrong.”
  • “He said most doctors’ offices are not set up for monitoring patients at home. “This is very time-intensive and not something physicians are used to doing or have time to do,” Thorpe said.”

• Reg Jones offers “A Refresher Course on FEGLI Life Insurance” in FedWeek.

From the public health and medical research front,

• The Centers for Disease Control reports today,
  • “The amount of respiratory illness (fever plus cough or sore throat) causing people to seek healthcare continues to decrease across most areas of the country. This week, 2 jurisdictions experienced high activity compared to 1 jurisdiction experiencing high activity the previous week. No jurisdictions experienced very high activity. 
  • “Nationally, emergency department visits with diagnosed influenza are decreasing. Emergency department visits with COVID-19 and RSV remain stable at low levels.  
  • “Nationally, COVID-19, influenza, and RSV test positivity decreased compared to the previous week. 
  • “Nationally, the COVID-19 wastewater viral activity level, which reflects both symptomatic and asymptomatic infections, remains low.” 

• The National Institutes of Health announced,
  • “Despite Food and Drug Administration (FDA)-approval of seven next-generation antibiotics to fight infections caused by resistant “gram-negative” bacteria, clinicians frequently continue to treat antibiotic-resistant infections with older generic antibiotics considered to be less effective and less safe, according to a study by researchers at the National Institutes of Health’s (NIH) Clinical Center. Researchers examined the factors influencing doctors’ preference for newer antibiotics over traditional generic agents to shed light on the decision-making processes among clinicians when treating patients with challenging bloodstream infections caused by gram-negative bacteria and significant comorbidities.
  • “The study revealed that at a considerable proportion of hospitals, particularly smaller facilities located in rural areas, staff were reluctant to adopt newer antibiotics. Researchers identified a large cost disparity between older and newer classes of antibiotics; the newer drugs can cost approximately six times more than the older medications, which could disincentivize prescribing.
  • “Researchers also highlight that next-gen agents are prescribed more often at hospitals where lab results that show the medications are effective against a patient’s bacterial infection are reported to prescribers. Scientists suggest that earlier and more widespread availability of such lab testing might improve use. Additionally, authors recommend that future public health policies and economic strategies on further development and use of similar antibiotics should be designed to identify and overcome additional barriers.
  • “Gram-negative bacteria are a class of bacteria resistant to multiple drugs and increasingly resistant to most antibiotics. According to the Centers for Disease Control and Prevention, they are able to find new paths of resistant and pass along genetic material that enables other bacteria to become drug resistant.”

• The American Hospital Association News adds,
  • “In clinical trials involving 220,000 patients at 59 HCA Healthcare hospitals, algorithm-driven computerized alerts helped clinicians better identify the appropriate antibiotic for 28% of patients with pneumonia and 17% of patients with urinary tract infections, according to studies funded by the Centers for Disease Control and Prevention published April 19 in JAMA. To reduce antibiotic resistance, physicians treating patients with a low risk for antibiotic-resistant bacteria were prompted to give standard-spectrum antibiotics.”In clinical trials involving 220,000 patients at 59 HCA Healthcare hospitals, algorithm-driven computerized alerts helped clinicians better identify the appropriate antibiotic for 28% of patients with pneumonia and 17% of patients with urinary tract infections, according to studies funded by the Centers for Disease Control and Prevention published April 19 in JAMA. To reduce antibiotic resistance, physicians treating patients with a low risk for antibiotic-resistant bacteria were prompted to give standard-spectrum antibiotics.
  • “Pneumonia and urinary tract infections are two of the most common infections requiring hospitalization and a major reason for overuse of broad-spectrum antibiotics,” said Sujan Reddy, M.D., medical officer in CDC’s Division of Healthcare Quality Promotion. “The INSPIRE trials have found a highly effective way to help physicians follow treatment recommendations to optimize antibiotic selection for each patient. These trials show the value of harnessing electronic health data to improve best practice.”

• Health IT Analytics tells us,
  • “Artificial intelligence (AI)-driven tools can improve the skin cancer diagnostic accuracy of clinicians, nurse practitioners and medical students, according to a study published last week in npj Digital Medicine.
  • “The researchers underscored that AI-based skin cancer diagnostic tools are developing rapidly, and these tools are likely to be deployed in clinical settings upon appropriate testing and successful validation.”

From the U.S. healthcare business front,

• Per BioPharma Dive,
  • “Alvotech and U.S. commercial partner Teva have signed a “long-term agreement” with an unspecified company to boost access to their biosimilar version of AbbVie’s blockbuster drug Humira, Alvotech said Friday. An Alvotech spokesperson declined to provide specifics.
  • “The deal comes seven weeks after the Food and Drug Administration approved Alvotech’s biosimilar, Simlandi, which the agency previously rejected multiple times. For patients to receive treatment, Alvotech and Teva must first cut deals with drug wholesalers, pharmacies and insurers that negotiate prices before agreeing to cover the therapy.
  • “CVS Health, whose pharmacy benefit manager is the country’s largest by prescription claims, removed Humira from its national formularyon April 1. Wall Street analysts have already reported substantial declines in Humira prescriptions over the last few weeks, when compared to the same period in 2023.”

• According to Beckers Hospital Review,
  • “Change Healthcare has reinstated 80% of the functionality for its claims, payment and pharmacy services following a February ransomware attack, the company said.
  • “Those three areas represent most of Change Healthcare’s customers and continue to be restored, according to an April 16 earnings call from parent company UnitedHealth Group.
  • “Now we’ve still got work to do,” said Roger Connor, CEO of OptumInsight, the UnitedHealth unit that includes Change, during the call. “We’ve got another set of products coming online … in the coming weeks, but pleased with that progress.”

• The AHA News reports,
  • “Patients went out-of-network 3.5 times more often to see a behavioral health clinician than a medical/surgical clinician in 2021, and up to 20 times more often for certain behavioral health visits, according to a new study by RTI International. For example, patients went out-of-network 8.9 times more often to see a psychiatrist, 10.6 times more often to see a psychologist, 6.2 times more often for acute behavioral inpatient care, and 19.9 times more often for sub-acute behavioral inpatient care.”

• The Wall Street Journal reports,
  • “Social media is displacing physicians as the trusted authorities on whether patients should take one of the medicines. People are not only deciding to take a weight-loss drug—called GLP-1s— based on posts by friends and influencers but sometimes also skipping their doctor to go with one mentioned online.
  • “The virtual word-of-mouth can come across as authentic and accessible. People say they appreciate the tips and support they get from other online users. But many influencers and friends on social media play up all the pounds a person lost while playing down side effects that can be nasty, such as painful headaches and bouts of vomiting. Some omit the risks altogether.
  • “Unlike company drug advertisements, social-media posts don’t have to describe a drug’s side effects, suggest other resources or tell people to speak with their doctors.”
• Ruh roh. This is why health plans are offering coaching services to these folks.