Monday Roundup

David Ermer–COVID-19, COVID-19 vaccine–
Photo by Sven Read on Unsplash

The light at the end of the COVID-19 tunnel got brighter this morning when prescription drug manufacturer Moderna announced strong efficacy results from its COVID-19 vaccine which, like the Pfizer vaccine, is based on messenger RNA technology. Healthcare Dive explains

The results are from an early look at a clinical trial of 30,000 volunteers recruited at nearly 90 hospitals and clinics across the country. An independent committee overseeing the trial found Moderna’s vaccine was 94.5% effective at preventing COVID-19 compared to a placebo. Their analysis was based on 95 cases of COVID-19, 90 of which occurred in participants given the placebo versus just five among those who received the vaccine. Crucially, while 11 participants given the placebo developed severe COVID-19, there were no such cases in vaccinated individuals, suggesting inoculation protects against the worst symptoms of the disease.

According to its announcement, Moderna will be seeking emergency use authorization from the Food and Drug Administration next month. The company’s request for FDA approval will follow in the first quarter of 2021. What’s more per Healthcare Dive

Pfizer and BioNTech’s shot has to be transported and stored at minus 70 degrees Celsius, or about 94 degrees Fahrenheit. Once thawed, doses can be stored for five days at temperatures between 2 and 8 degrees Celsius. Those limitations may make it difficult for community clinics and pharmacies to store and administer the shot.

Moderna’s vaccine, by comparison, must be stored and shipped at minus 20 degrees Celsius. The company said Monday new data indicate the vaccine can be refrigerated at between 2 and 8 degrees Celsius for up to 30 days, longer than the 7-day stability Moderna previously disclosed and an advantage that could permit broader use.

Moderna also is participating in the federal government’s Operation Warp Speed which will facilitate vaccine manufacturing and distribution.

Moderna’s CEO explained on Fox Business this morning that its vaccine will be available to people at 18 and older once EUA is obtained. Moderna plans to test the vaccine on younger teenagers next year in an effort to achieve FDA approval for using the vaccine on the younger group before the 2021 school year starts.

The Wall Street Journal’s most popular article today is titled “As Covid-19 Surges, the Big Unknown Is Where People Are Getting Infected.” That’s a question that has cross the FEHBlog’s mind more than once.

Jay Varma, senior adviser for public health in the New York City mayor’s office, said 10% of the city’s infections are due to travel, 5% from gatherings, and another 5% from institutional settings such as nursing homes. “The vast majority of the remainder—somewhere probably around 50% or more—we don’t have a way to directly attribute their source of infection,” Mr. Varma said. “And that’s a concern.”

The upshot of the article is that public health authorities in the U.S. need to engage in better contact tracing.

[M]ost contact-tracing systems set up to investigate infections haven’t been identifying enough contacts to map how the virus spreads. And whatever data they generate isn’t always being mined to inform how to craft more discriminating lockdowns. Asian nations that have used contact tracing successfully to control the disease interview 10 or more contacts for each case. In the U.S., France, the U.K. and Spain, tracers are identifying fewer than four contacts for each case, according to government data.

America’s Health Insurance Plans (“AHIP”) today properly criticizes Congress for opening to door to provider price gouging for out of network COVID-19 tests by conditioning health plan coverage simply on posting prices online.

In October 2020, AHIP conducted a second survey of health insurance providers in the commercial market to gather information on prices charged by out-of-network providers for diagnostic, antibody, and antigen tests for COVID-19.1 The survey found that almost a quarter (23%) of all claims for COVID-19 tests were from out-of-network test providers. And many out-of-network test providers charged prices for COVID-19 tests that far exceeded the average cost of in-network tests ($130).

Everyone should be able to get the COVID-19 tests they need, whether they have health insurance coverage or not. To stop price gouging:
• Congress should make the financial investment needed to ensure that Americans have access to all necessary COVID-19 testing.
• Congress should eliminate the ability for price gouging to occur by setting a reasonable market-based pricing benchmark for tests delivered out of network.
• Policymakers should accelerate the availability of consumer-friendly, rapid, and accurate tests that lower costs and mitigate the capacity and supply constraints of providers and labs.
• The Administration should ensure that all available COVID-19 tests, both manufacturer-developed and laboratory-developed, meet appropriate standards for accuracy.

Amen to that.

AHIP also offers a useful infographic on how health plan premiums spent by breaking a dollar into its component expenditures.

Highlights from the research include:

  • Medication and medical services accounted for 81.6 cents of the health care premium dollar.
  • 21.5 cents are used to pay for prescription drugs.
  • 19 cents are used to pay for in-patient hospital costs, while 19.8 cents are used to pay for out-patient hospital costs.
  • 12.1 cents are used to pay for doctors’ visits.
  • 4.6 cents are used to pay for federal, state, and local taxes.
  • 2.4 cents are used to pay for the prevention of fraud, waste, and abuse.
  • Only 3 cents of every health care dollar go toward health insurance provider profits.

Performing this breakdown on a dollar of FEHBP premiums is complicated by the fact that the FEHBP has a large cadre of Medicare prime annuitants, over 70% of whom also carry both Medicare Parts A and B. For these folks, Medicare pays the bulk of their hospital and doctors expenses while the FEHBP pays their prescription expenses.

Consequently raw FEHBP prescription drug spending is overstated and FEHBP hospital and doctors visits spending is understated. In the final analysis, if you take into account this Medicare cost shifting, the FEHB and AHIP dollar breakdowns should be in rough alignment, with one caveat. For experience rated plans, e.g., Blue Cross FEP and GEHA, which cover the majority of FEHB enrollees, less than one cent of every health care dollar go toward gross profit under OPM’s rules.