Friday Stats and More

Congress

Friday Stats and More

David Ermer–CDC, Congress, COVID-19, COVID-19 vaccine, Electronic health records, No Surprises Act, U.S. Healthcare, Uncategorized–

Based on the Centers for Disease Control’s Covid Data Tracker and using Thursday as the first day of the week, here is the FEHBlog’s updated weekly chart of new Covid cases:

Not quite as low as we were in early July but very much moving in the right direction. So is the FEHBlog’s updated weekly chart of new Covid deaths, which is considered a lagging indicator.

The epidemiologists have a keen eye out for new worrisome variants. For example, for other troubling variants, Becker’s Hospital News tells us about a relatively new combination of Delta and Omicron known as Deltacron.

The recombinant variant appears unlikely to spread as easily as delta or omicron, William Lee, PhD, vice president of science at Helix, told USA Today. “We have not seen any change in the epidemiology with this recombinant,” WHO COVID-19 technical lead Maria Van Kerkhove, PhD, said of deltacron during a March 9 media briefing. “We haven’t seen any change in severity. But there are many studies that are underway.” 

Here’s the FEHBlog’s weekly chart of Covid vaccinations distributed and administered from the start of the Covid vaccination era in late 2020 until the week ended this past Wednesday.

It is noteworthy that this week, the percentage of Americans aged 18 and older who are fully vaccinated (two doses of mRNA vaccine) cracked 75%. The same cadre is closing in on being 50% boostered. The most at risk, over age 65 cadre is 89% fully vaccinated and 66.7% boostered.

The American Hospital Association adds

In a study of 1,364 children aged 5-15, two doses of the Pfizer COVID-19 vaccine reduced the risk of omicron infection by 31% in those under 12 and 59% in older children, the Centers for Disease Control and Prevention reported today. CDC said the study reinforces the importance of vaccination to keep children and teens protected from severe disease, noting that another recent study found the vaccine 92%-94% effective against COVID-19 hospitalization in adolescents during the delta surge and 74% effective against hospitalization in younger children during omicron.

Here’s a link to the CDC’s weekly review of its Covid statistics. This week’s issue focuses on protecting folks at high risk for Covid, such as the immunocompromised.

Who is most likely to become very sick or die from COVID-19?  Your chances increase with age and underlying medical conditions like cancer, diabetes, heart conditions, dementia, and obesity, particularly if you’re not up to date on vaccinations. People with weakened immune systems,* some disabilities, some mental health conditions, and some chronic diseases are also at higher risk. A lot of people might not know they’re at risk for severe illness—review the list to find out if you could be.

Here’s a link to the CDC’s weekly Fluview report, which states that flu activity is increasing in “most of the country.” In this regard, the American Medical Association inform us

Healio (3/10, Downey, Gallagher) reports “interim estimates published Thursday in” the CDC’s Morbidity and Mortality Weekly Report “indicate that this season’s influenza vaccine has not been effective.” Based on the data “from more than 3,600 children and adults,” researchers “estimated that the vaccine has been 16% effective against mild or moderate influenza caused by the predominant circulating virus, influenza A(H3N2), with a 95% confidence interval…that suggests vaccination ‘did not significantly reduce the risk of outpatient medically attended illness’ caused by H3N2.”

From Capitol Hill and closing the loop on Thursday’s post, the Senate did pass the fiscal year 2022 omnibus appropriations act Thursday night. Roll Call reports

On a 68-31 vote, the Senate passed the 2,700-page, $1.5 trillion omnibus containing all 12 fiscal 2022 spending bills, $13.6 billion in supplemental appropriations to address the crisis in Ukraine and a lengthy list of unrelated measures fortunate enough to ride on the must-pass vehicle. 

From the No Surprises Act front, the FEHBlog had been concerned that the federal regulators were giving up on using the Qualified Payment Amount as a rebuttable presumption in NSA arbitrations which would help tremendously to control out of network benefit and plan legal costs. The FEHBlog therefore was encouraged to find that the federal government has filed a brief with the federal district court for the District of Columbia defending that position in a case raising the same issue. An oral argument on this issue will be heard by District Judge Richard Leon on March 21, 2022, at 3 pm. The FEHBlog will keep an eye on this and the other federal cases raising this issue.

From the electronic health record front, MedCity News interviews the CEO of Epic Systems at the Vive conference. The interview covers interoperability, artificial intelligence and other timely topics.

From the opioid epidemic front, STAT News reports

It was in the mid-2010s, the researchers heard, when “tranq dope” — opioids that contained the veterinary tranquilizer xylazine — took off in Philadelphia. But now, in some places across the U.S., it was appearing in 1 in 5 overdose deaths. A recent study also found the powerful synthetic opioid fentanyl in nearly every xylazine-involved death as well, indicating it wasn’t just the tranquilizer causing these overdoses. Experts are still trying to understand the risks of xylazine, but they’re worried because the drug is not an opioid but acts as a sedative, which can increase the risk of a fatal overdose. It might also make it harder to reverse those overdoses with naloxone, which is designed to work on opioids. STAT’s Andrew Joseph has more on how adulterated — and in turn, increasingly dangerous — the U.S. drug supply has become.

Rur roh.

Thursday Miscellany

David Ermer–CDC, Congress, COVID-19, Federal employment benefits, OPM, Telehealth, U.S. Healthcare–

From Capitol Hill, the Hill reports

The Senate has locked in a deal to quickly pass a massive government funding bill that includes $13.6 billion in Ukraine aid.

The agreement, announced by Senate Majority Leader Charles Schumer (D-N.Y.), puts the funding bill on a glide path to pass on Thursday night, capping off hours of would-they-won’t-they drama. 

Mazaal tov to Congress.

Also on Capitol Hill today, the Senate Homeland Security and Governmental Affairs Committee held a confirmation hearing for Krista Boyd, the President’s nominee to serve as OPM Inspector General. Fedweek notes that “Ms. Boyd is a senior staff member of the House Oversight and Reform Committee with long experience on Capitol Hill in federal workplace matters.”

From the Omicron front, Becker’s Hospital Review informs us “The rate of new COVID-19 cases involving the omicron subvariant BA.2 appears to be slowing in the U.S., according to variant proportion estimates from the CDC.”

Also, the Justice Department announced “Effective immediately, Associate Deputy Attorney General Kevin Chambers will serve as the Director for COVID-19 Fraud Enforcement.”

From the litigation front, Reuters reports “The judge overseeing Purdue Pharma’s bankruptcy on Wednesday approved a $6 billion opioid settlement funded by its Sackler family owners, overruling objections from the Department of Justice and 20 states that opposed the deal.”

From the healthcare business front

Healthcare Dive tells us

Anthem plans to change its name to Elevance Health, if the move is approved by shareholders, the company said Thursday.

The new name is meant to reflect the company’s offerings beyond traditional health insurance. “Elevance Health’s companies will serve people across the entire care journey, connecting them to the care, support, and resources they need to lead healthy lives,” Anthem CEO Gail Boudreaux said in a statement.

Elevance was chosen as a combination of the words “elevate” and “advance.” There will not be any changes to leadership or organizational structure accompanying the new name.

If approved, the Elevance name will start being used at the end of the second quarter of this year. Anthem Blue Cross and Blue Shield plans will still use the Anthem name.

From the telehealth front, Healthcare Dive reports

[Virtual care vendor] Amwell and LG Electronics are teaming up to jointly develop new digital health devices and tools, starting with hospital care in the U.S., the companies announced Wednesday.

South Korea-based LG, which manufactures a wide range of devices from refrigerators to computer monitors, already provides smart TVs for inpatient rooms.

Now, through the partnership, LG will also create devices that can host services from Amwell’s virtual care platform, Converge.

PYMTS.com reports this electronic health records news from the Vive conference being held in Miami

Electronic health records containing some of the most guarded personal data about people are making headlines again as a consortium of players join forces to create a universal single sign-in, allowing patients secure access to unified health data via digital identity.

Coming out of the ViVE health technology conference happening this week in Miami Beach, the effort is led by consumer-directed healthcare advocacy group the CARIN Alliance, working together with the Department of Health and Human Services (HHS) and other stakeholders.

On Tuesday (Mar. 8), Politico reported that HHS “is working with several health systems, insurers and health tech groups to roll out a single way for patients to log in and access their medical records across multiple systems. The launch later this month will set up a test environment for integrating the technology, said Ryan Howells, principal at Leavitt Partners and program manager at the CARIN Alliance, which is spearheading the efforts.”

CARIN is working with the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services (CMS), which will act as “government observers.”

From the FEHB front, benefits consultant Tammy Flanagan writes in Govexec about the Postal Service Health Benefits Program which will launch in 2025 as part of the Postal Reform Act of 2022. She observes

The version of the postal bill that eventually passed balances the risk pools, and the Office of Personnel Management now estimates premiums should go down for postal and non-postal employees and retirees alike.

The new law keeps all postal workers in FEHB, in their own group. All workers will be able to keep their current plans and avail themselves of the annual open season to choose other options within FEHB. 

Future postal retirees will be required to enroll in Medicare A and B at 65. Retiree health coverage will then become a combination of Medicare and FEHB. 

The question now is whether that requirement will eventually be extended to all federal employees, and what effect that would have on the premiums retirees pay. If that happens, at least federal employees will face one less tough decision at the time of retirement.

The FEHBlog expects that PSHBP premiums will be materially lower than FEHB premiums because PSHBP will accept Medicare funding for prescription drug benefits in the form of Part D EGWPs. Federal law has permitted the FEHB to offer premium-reducing Part D EGWPs for nearly twenty years. Nevertheless, OPM and a string of Administrations from George W. Bush to Joe Biden have refused to implement that law. Implementing that law in 2005 when it first took effect likely would have avoided the balkanization of the FEHB that we will soon experience with the PSHBP.

The FEHBlog does not expect the FEHB to adopt the mandatory Part B approach being taken by the PSHBP. Fewer retiring federal employees are picking up Part B because of the income-adjusted Part B premiums. As basic and income-adjusted Part B premiums continue to climb and climb, the FEHBlog expects that the PSHBP will liberalize, and then do away with, mandatory Part B. Meanwhile, the PSHBP’s undoubtedly favorable experience with Medicare funding of prescription drugs will lead OPM to allow FEHB the same opportunity.

With both branches of the Program using Part D EGWPs and integrated Medicare Advantage plans, everyone will enjoy reasonable premiums for high-quality healthcare. That in turn could lead to a reunion of the two branches. Hopefully, the PSHBP will be a relatively brief experiment that leaves the FEHB Program stronger.

The saving grace of the FEHB Program is that everyone in a plan option pays the same premium and the premiums are pooled to cover all plan option enrollees. That’s the bedrock principle of group health insurance that the FEHB Program has shown to work.

Midweek Update

David Ermer–CMS, Congress, Rx coverage, U.S. Healthcare–
Photo by Josh Mills on Unsplash

From Capitol Hill, overnight, the FY 2022 onmnibus appropriations bill language was released. The bill is over twenty one hundred pages long. The American Hospital Association has taken the time to summarize the bill’s healthcare provisions. Federal News Network discusses the bill’s federal workforce provisions. The Wall Street Journal notes

Democratic House leaders said they would remove a contentious $15.6 billion Covid-19 aid provision from the omnibus spending bill to try to get it over the finish line, after angry rank-and-file members rejected clawing back states’ unused coronavirus money to fund the proposal.

The decision to drop the Covid-19 aid was a dramatic setback for both House Speaker Nancy Pelosi (D., Calif.), who negotiated the plan, and President Biden, whose administration originally asked for $22.5 billion for Covid-19 aid and now will get nothing from the bill.

The House of Representative currently is considering the bill and a fourth continuing resolution that would last the four days beyond March 11 that the Senate needs to pass the bill. The House is expected to vote on the bill around 9:15 pm ET. Passage of the bill and the brief continuing resolution is expected.

From the Rx coverage front, Fierce Healthcare informs us

Amazon Pharmacy is partnering with Blue Plans in five states and Prime Therapeutics to tackle the affordability of prescription medications.

The online retail giant’s pharmacy arm is rolling out a prescription discount savings card that’s available to some Blue Plans members.

Integrating this discount card pricing into the shopping experience lets eligible customers compare their co-pay or discount price upfront and then apply purchases for eligible medications to the out-of-pocket maximums and deductibles associated with their insurance plan, according to Nworah Ayogu, M.D., chief medical officer for Amazon Pharmacy. * * *

Eligible plans now include Horizon Blue Cross Blue Shield of New Jersey, Blue Cross Blue Shield of Nebraska, Blue Cross Blue Shield of Alabama, Florida Blue and Blue Cross and Blue Shield of Kansas. 

From the miscellany department —

  • The National Committee for Quality Assurance has created a health equity website.
  • America’s Health Insurance Plans celebrated International Womens’ Day yesterday with remarks from healthcare leaders on how health plans can improve healthcare for women.
  • The Centers for Medicare and Medicaid Services issued new guidance for group health plans on submitting a valid documented defense to Medicare overpayment recovery demands.

Senate passes the Postal Reform Act of 2022

David Ermer–Congress, COVID treatment, COVID vaccine mandate, COVID-19, COVID-19 vaccine, HSA, U.S. Healthcare–
Photo by Michele Orallo on Unsplash

From Capitol Hill, Federal News Network reports

A long-awaited reform bill that would save the Postal Service more than $100 billion (H.R. 3076) is headed to President Joe Biden’s desk.

The Senate on Tuesday passed the Postal Service Reform Act, which would, among other things, eliminate a 2006 mandate from Congress to pre-fund retiree health benefits.

Postmaster General Louis DeJoy supports the bill, as do postal unions and associations, who say it will address USPS’s long-term financial challenges.

The bill will create a Postal Service Health Benefits Program (PSHBP) within the FEHBP effective January 1, 2025. A recently added feature of the bill creates a transitional Open Season in the fall of 2024. Any Postal employee or annuitant who fails to switch to a PSHBP plan will be added to the rolls of their current carrier’s PSHBP plan. However, the non-selecting Postal employees and annuitants whose current carrier is not participating in the PSHBP will wind up on the rolls of the PSHBP option with the lowest premium that is not a high deductible health plan and does not charge membership dues.

Another new feature of the bill requires the Postal Service to create a Health Benefits Education Program in mid-2023. That HBEP will include ACA navigators. It will be interesting to see, for example, whether the ACA Navigators can hold down the number of non-selecting Postal employees and annuitants in the transitional Open Season.

P.S. For fun, the FEHBlog reviewed the summary of H.R. 3076’s earliest antecedent which was S. 1789 from the 112th Congress titled the 21st Century Postal Service Act of 2012. According to the bill’s summary, this first shot also called for an HBEP. The 2022 twist is the ACA navigator feature in H.R. 3076. More accurately, the FEHBlog should describe these folks as ACA-like navigators.

For perspective on this clarification, NPR Shots discusses the good works of patient navigators in the State of Delaware. These folks have been improving the rates of cancer screenings in underserved communities which in turn has lower cancer mortality rates.

Also from Capitol Hill, Roll Call informs us

Congressional leaders spent Tuesday afternoon negotiating potential late add-ons to the fiscal 2022 omnibus spending bill, including cybersecurity legislation and a bipartisan deal to revive lapsed Violence Against Women Act authorities, with an eye on releasing final text later that day. 

“Republicans and Democrats are very, very close to finalizing the agreement,” Senate Majority Leader Charles E. Schumer, D-N.Y., told reporters Tuesday after Democrats’ early afternoon caucus lunch. “I expect there will be text released in a few hours. And we’re working very hard on a few last-minute issues: cyber and VAWA.”

The schedule leaders are eying would have the House vote on the omnibus Wednesday morning and the Senate clear the measure before stopgap funding expires at midnight Friday. GOP objections to a unanimous consent agreement to speed consideration in the Senate could delay final passage into the weekend, lawmakers warned, but both sides expect the process to be complete in time to avoid a partial government shutdown when federal agencies open Monday.

The Hill adds

Lawmakers say they are close to an agreement to provide billions in new coronavirus relief, set to be tied to a massive government funding bill [which step would improve its chances of passage]. 

Congress is expected to include at least $15 billion in response to the Biden administration’s request for new funding for COVID-19 vaccines, treatments and testing.

Also from Capitol Hill, Congressional Research Service released a report on Health Reimbursement Arrangements, a tool which the Internal Revenue Service created in the early 2000s shortly before Congress added high deductible plans with health savings account to the toolbox in the Medicare Modernization Act of 2003. Nevertheless, HRAs remain handy tools for designing employer sponsored health plans such as those in the FEHBP.

From the Omicron front, the Department of Health and Human Services released a fact sheet about the Administration’s new test to treat program which is launching on a limited basis this week. Here’s a link to the fact sheet. It is evident that these sites will not be using a health department standing order to dispense the Covid medication. Instead

Are pharmacists themselves able to prescribe the oral antiviral pills (Paxlovid and Molnupiravir)?

No. The Test to Treat initiative includes sites that have health care providers available to provide timely and thorough assessment and discussion relevant to oral antiviral treatment option(s) , consistent with FDA requirements regarding these drugs. The Test to Treat initiative does not change existing requirements for a qualified health care provider to write the prescription.

NPR Shots offers more information on the program here.

Biden administration officials say [in the fact sheet] they’ll be launching a “one-stop shop” website later this month, where people will be able to find test-to-treat locations, along with sites where they can get free masks, tests and vaccines.

The test to treat program comes at a time when coronavirus cases are falling steeply in the U.S., and the supply of Pfizer’s Paxlovid pill is ramping up. These are good trends, but it’s not a time to be complacent, says Dr. James Hildreth, president and CEO of Meharry Medical College: “The virus is not done with us yet, right? And, if we do have another surge, having a system like this in place could have a huge impact on controlling it.” 

Hildreth says the program holds a lot of promise — so long as it expands its outreach to rural communities, indigenous groups, and other marginalized high-risk people that need it the most.

The National Institutes of Health discusses an NIH funded research finding that the immune response from Covid vaccines improves for months after vaccination.

Govexec tells us “A federal appeals court on Tuesday appeared open to reinstating President Biden’s COVID-19 vaccine mandate, suggesting a lower court’s pause may have been overly broad.” Govexec based its view on the oral argument held before a panel of judges from the U.S. Court of Appeals for the Fifth Circuit in case calling into question the nationwide scope of the injunction created by the district court. The panel should issue its decision later this month.

Fierce Healthcare reports from the inaugural Vive conference being held this week in Miami, Florida. For example

Two key topics have dominated the industry conversation amid the COVID-19 pandemic: health equity and the role of technology.

But these are not distinct entities, insurance executives said Monday at the inaugural ViVE Conference in Miami, and it’s necessary to find the intersection, or “techquity.” It’s critical, they argued, that technology be viewed through an equity lens to ensure that access is fair and that the tools on offer are working for a diverse array of patients.

The national conversation about disparities, however, has helped enshrine equity as a key part of the technology conversation, said U. Michael Currie, senior vice president and chief health equity officer at Optum and UnitedHealth Group, on a panel at the conference.

and

Health tech veteran Jennifer Schneider, M.D., helped build up chronic condition management startup Livongo, then helped lead the company through a massive IPO and the industry’s largest merger with Teladoc.

Schneider and other Livongo veterans are reuniting and taking on their next challenge—improving rural healthcare.

The executive team, including Amar Kendale, former chief product officer at Livongo, and Bimal Shah, M.D., former chief medical officer at Livongo, announced Monday the launch of Homeward, a startup focused on improving access to high-quality, affordable primary and specialty care in rural communities.

Monday Roundup

David Ermer–CDC, Congress, COVID-19, COVID-19 vaccine, Telehealth, U.S. Healthcare–
Photo by Sven Read on Unsplash

From Capitol Hill, the Senate late this afternoon agreed by a 74-17 vote to end debate on the Postal Reform Act of 2022 (H.R. 3076). “The Senate stands in recess until 10:30 am on Tuesday, March 8, 2022.  Following Leader remarks, the Senate will resume consideration of Calendar #273, H.R. 3076, Postal Service Reform Act, post-cloture.” The time for the final Senate vote on H.R. 3076 is yet to be determined. Senate passage, which requires a simple majority vote, is assured.

Federal News Network calls attention to the fact that a month ago today the White House issued a statement of administration policy on H.R. 3076 which reads in pertinent part

H.R. 3076 would also establish a new, separate Postal Service Health Benefits Program (PSHBP)
within the existing Federal Employees Health Benefits Program (FEHBP), that integratesPostal
employees and annuitants into Medicare. Making these changes would improve the Postal
Service’s long-run financial outlook, without sacrificing quality, affordable healthcoverage for
Postal employees and retirees. The Administration is mindful that these reforms wouldimpose
administrative burdens on the Office of Personnel Management and FEHBP, and further,that
there could be potential challenges with operationalizing Medicare integration and withensuring
ongoing funding to support administration of the new PSHPB. The Administration looks
forward to working with Congress to ensure that the goals of H.R. 3076 are met in anefficient,
equitable, and cost-effective manner, while safeguarding the continued stability of the FEHBP

Roll Call reports

Top appropriators and congressional leaders are aiming to wrap up omnibus negotiations within 24 hours so they can file the massive spending package in the House on Tuesday, vote on it in that chamber Wednesday and get it through the Senate before Friday at midnight when stopgap funding expires.

While so-called open items remained, there was confidence on both sides of the aisle that talks were going well enough on the massive, long-overdue package that a fourth continuing resolution for the fiscal year that began Oct. 1 wouldn’t be necessary. 

From the Omicron front, STAT News informs us

A new report released Monday charts a path for the transition out of the Covid-19 pandemic, one that outlines both how the country can deal with the challenge of endemic Covid disease and how to prepare for future biosecurity threats.

The report plots a course to what its authors call the “next normal” — living with the SARS-CoV-2 virus as a continuing threat that needs to be managed. Doing so will require improvements on a number of fronts, from better surveillance for Covid and other pathogens to keeping tabs on how taxed hospitals are; and from efforts to address the air quality in buildings to continued investment in antiviral drugs and better vaccines. The authors also call for offering people sick with respiratory symptoms easy access to testing and, if they are positive for Covid or influenza, a quick prescription for the relevant antiviral drug.

The 136-page report was written by nearly two dozen experts, a number of whom have advised the Biden administration on its Covid-19 policies. Thirty other experts contributed to the report, entitled “Getting to and Sustaining the Next Normal: A Roadmap to Living with Covid.”

Helpful. Speaking of which, the Centers for Disease Control offers advice on how to prepare children and teens for Covid vaccination.

From the healthcare cost front, Healthcare Dive reports

Higher-priced emergency care was associated with lower mortality in hospital markets with less hospital concentration, but survival rates were similar for low- and high-priced hospitals in more concentrated markets, according to a working paper released last week from the nonprofit National Bureau of Economic Research.

The researchers determined that additional spending on quality improvements at expensive hospitals in unconcentrated markets is potentially cost-effective. 

However, they found no evidence of better outcomes among patients admitted for emergency care to pricier hospitals in markets with less competition, despite substantially higher costs. “In these concentrated markets, high prices likely reflect patients’ lack of alternative options, not hospital quality,” the study said.

From the healthcare business front, Fierce Healthcare tells us

GoodRx is scooping up vitaCare Prescription Services from TherapeuticsMD to beef up its growing pharma manufacturer solutions business.

VitaCare is a technology and services platform designed to make the complex process of filling prescriptions simple, cost-effective and stress-free for patients. 

In recent months, the COVID-19 pandemic has highlighted the value of pharmaceutical companies being able to connect directly with patients, according to TherapeuticsMD in its latest earnings release. This in combination with the rise of interest and investment in other hub service and pharmacy services companies has driven outside interest in vitaCare both from pharmaceutical companies seeking to utilize vitaCare for their products and from potential partners or sponsors seeking to acquire a controlling interest in vitaCare.

GoodRx has agreed to acquire vitaCare for $150 million in cash, with an additional $7 million consideration contingent upon vitaCare’s financial performance through 2023, according to the companies.

The transaction is expected to close in mid-2022.

From the telehealth from, HR Tech shares large employer tips on how to promote employee use of telehealth or as its now called virtual care.

March is Women’s History Month, and the Veterans Administration gives us a chance to virtually meet several VA oncologists, some of the women who are making cancer history.

Weekend Update

David Ermer–Congress, COVID treatment, COVID-19 vaccine, Telehealth, U.S. Healthcare–
Thanks to ACK15 for sharing their work on Unsplash.

From Capitol Hill, the House of Representatives and the Senate will be in session this week for Committee business and floor voting. Of note, the Senate will continue its voting process on the Postal Reform Act of 2022 (H.R. 3076) at 5:30 pm ET tomorrow. The continuing resolution funding the the federal government expires after 11:59 pm on Friday March 11.

The Wall Street Journal notes “House Democrats set to be in Philadelphia starting Wednesday for a long-planned retreat, negotiators need to make progress quickly.” The Journal’s article adds “Some aides and lawmakers of both parties said that the chances of passing an omnibus spending measure this week had increased, in part because a fiscal 2022 measure would include financing for Ukraine and Eastern European allies and give the military flexibility for any related needs.”

From the Omicron front —

  • The New York Times reports on the difficulties encountered in the distributing the Evusheld antibiotic treatment that shields immunocompromised Americans who cannot receive a Covid vaccination. According to the article, immunocompromised Americans represent 3% of the population.
  • The Wall Street Journal informs us

Novavax Inc.’s long-awaited Covid-19 vaccine is moving toward U.S. authorization after the company said it resolved manufacturing problems that had held up its application. 

Clearance in the U.S. isn’t imminent because the Food and Drug Administration must sort through a large amount of study data from several countries, a person familiar with the matter said. A decision is getting closer, however, since Novavax formally submitted an authorization request in late January.

If the shot is rolled out in the U.S., it could boost vaccination efforts that have flagged among the hesitant, according to Novavax and doctors.

  • The Journal also tells us

Vaccination campaigns have lagged behind in much of the developing world, as many countries struggle to distribute shots outside major urban areas. In Asia, countries like India, Indonesia and the Philippines have fully vaccinated half their populations. That is higher than the 13% of people living in Africa who are vaccinated, with 4% immunized in Nigeria, the continent’s most populous country. Latin America has done better. Many countries, including Brazil and Peru, have vaccinated more than 70% of their people.

Natural immunity, which refers to antibodies acquired through infection, was widespread in Indonesia when Omicron arrived. One study from October to December of roughly 20,000 Indonesians found that 74% of unvaccinated Indonesians had protective antibodies, according to Pandu Riono, a University of Indonesia epidemiologist who worked with government researchers on the study.

Based in part on the results, Mr. Riono and his colleagues estimate that 70% of Indonesians had been infected with Covid-19 as of December, far higher than the 34% of Americans who had been infected by then, according to a survey by the U.S. Centers for Disease Control and Prevention.

From the federal employment front, Federal News Network offers a transcript of an interview between Federal News Network reporter Tom Temin and American University professor Bob Tobias about the demographic characteristics of federal employees. For example, “74% of the workforce, federal workforce is 40 or older, versus 54% in the private sector.” Unquestionably, the experience of the federal employee population benefits all of us, but older workforce also impacts FEHB premiums.

From the telehealth front, Fierce Healthcare reports

Striking the balance between virtual and in-person care is a key trend to watch heading into the rest of 2022, according to a new survey from Evernorth.

Ipsos surveyed 3,000 consumers, 575 human resources professionals and 58 health plan leaders on behalf on the Cigna subsidiary. The report underscores patients’ growing comfort with virtual care and telemedicine in the wake of COVID-19, with 75% saying they agree more care will be provided virtually; 57% of those surveyed said they used virtual care over the last year.

However, consumers are not enthusiastic about virtual options in all settings, according to the survey. While 35% of those surveyed said they were satisfied with their experience in virtual primary care, just 11% said the same about behavioral health care. Nineteen percent said they were satisfied with virtual care for specialty services, while 5% said the same for physical therapy and 6% for nutrition and diet services.

While satisfaction with virtual behavioral health care was mixed in the survey, a growing number of people are seeking behavioral health services in virtual settings.

Boom!

From the strategery front, Becker’s ASC News discusses the 2022 growth strategies of Optum’s three business divisions:

  • Optum Health, the healthcare provider division which includes physician groups and ambulatory surgery centers
  • Optum Insight, which houses the data analytics platforms designed to connect clinical, administrative and financial data, and
  • Optum Rx, a pharmacy benefits and care services business.

Friday Stats and More

David Ermer–CDC, Congress, COVID-19, COVID-19 vaccine, U.S. Healthcare–

Based on the Centers for Disease Control’s Covid Data Tracker and using Thursday as the first day of the week, here is the FEHBlog’s latest weekly chart of new Covid cases

The American Hospital Association informs us

The Centers for Disease Control and Prevention yesterday said more than 90% of the U.S. population now lives in a county with a low or medium COVID-19 Community Level, a new CDC measure for communities considering whether to require face coverings in public indoor settings. The agency plans to update the county data every Thursday going forward.

Becker’s Hospital Review adds

Cases of the highly transmissible omicron subvariant appear to be doubling every week in the U.S., but there isn’t clear evidence BA.2 will cause another major surge, epidemiologist Michael Osterholm, PhD, told Becker’s March 2. * * *

Cases will likely continue to drop over time, Dr. Osterholm said, adding he is hopeful cases will reach or fall below levels not seen since last June, when the nation’s new case average fell below 12,000. 

It’s worth noting that the FEHBlog weekly chart of new cases found above begins with the low point Dr. Osterholm references, new cases under 12,000 and new deaths under 1,000.

Here’s the FEHBlog’s weekly chart of new COVID deaths

Here’s the FEHBlog’s weekly chart of Covid vaccinations distributed and administered from the 51st week of 2020 through the 9th week of 2022

From the Covid vaccine front, Bloomberg informs us

Parents still hesitating to get their kids vaccinated may be reassured by reporting that shows Covid inoculations protected children and teenagers from severe disease, even after the rise of the immune-evasive omicron variant.

Omicron came to the U.S. late last year armed with some 30 mutations in its spike protein that make it less recognizable to immune antibodies. Afterward, vaccine protection against infection and urgent care visits declined for 5- to 17-year-olds who’d received primary inoculations, according to U.S. Centers for Disease Control and Prevention data released Tuesday. However, vaccinated children and teens were still less likely to get infected than their unvaccinated peers, the agency said in its Morbidity and Mortality Weekly Report.

The CDC released recommendations last week saying that schools in areas of low and moderate risk can drop indoor mask mandates, the first update to its guidance on the topic since July — and the new findings may add confidence in moves to relax social  measures as infections fall across the U.S. But many parents have been slow to get shots for their kids since the vaccine was recommended in November, and vaccinations among kids ages 5 to 11 have fallen to their lowest levels since the shots were first cleared.

While kids generally don’t get as sick as adults from the coronavirus, clearing a vaccine for elementary school-age children marked a major milestone in the pandemic. It provided peace of mind for many concerned parents, allowing kids to resume activities that had been on hold since the virus first began spreading in the U.S.

Pfizer and BioNTech’s is the only shot that has been authorized for use in U.S. children and teens. The CDC looked at vaccine protection against infection, urgent care visits, hospitalization, and death among vaccinated children ages 5 through 11 and adolescents ages 12 through 17 before and during the omicron surge.

That’s solid information for health plans to share with their members.

Here’s a link to the CDC’s Weekly Review of its Covid statistics. Beckers Hospital Review saves you time by breaking down those stats at this link.

The CDC’s weekly FluView tells us “Sporadic influenza activity continues across the country. In some areas, influenza activity is increasing.”

From Capitol Hill, Roll Call informs us

Negotiations over an omnibus spending package remained far from complete Thursday as the late arrival of a White House supplemental funding request threw a wrench in the talks. 

The White House on Thursday formally asked lawmakers to attach to the fiscal 2022 spending package $32.5 billion in emergency funds for government response efforts to the ongoing COVID-19 pandemic and Russian war with Ukraine. 

The long-awaited details from the administration on its justification for the extra spending, on top of the roughly $1.5 trillion expected to be appropriated for the current fiscal year, come barely a week before stopgap funding expires March 11. 

To pass the omnibus before that deadline, Senate Appropriations ranking member Richard C. Shelby, R-Ala., said lawmakers need to get a final deal by Tuesday — and even that may be too late to avoid the need for another short-term continuing resolution. 

“We made good progress this week. But we make progress and we’re stalled,” he said. “And we can’t afford to stall this weekend. If we do, we’re headed for a CR.”

From the SOTU front, AHIP released AHIP President Matt Eyles’s comments on the President’s address.

From the health equity front, Mercer Consulting released a report finding a surprising gender gap in employer-sponsored health benefits continues to exist.

Thursday Miscellany

David Ermer–Congress, COVID treatment, COVID-19, COVID-19 testing, Mental health care, Rx coverage, U.S. Healthcare–
Photo by Josh Mills on Unsplash

From Capitol Hill, the Senate has adjourned until Monday March 7 after setting another cloture vote on the Postal Reform Act of 2022 (HR 3076) for Monday at 5:30 pm. While the FEHBlog is not a Senate procedure expert, it appears that another cloture vote is required because a minor Senate amendment was filed after the first cloture vote. Postal reform must be getting real because the Wall Street Journal posted an account of the decade-long effort to pass this legislation today.

From the Omicron front, the FEHBlog’s favorite part of the President’s new strategy was explained by the White House Covid czar yesterday:

Pfizer’s pill {Paxlovid] is a gamechanger — 90 percent effective at keeping people out of the hospital.

We collaborated with Pfizer to accelerate development of the pill.  And we’ve ordered 20 million courses.

As the President announced last night, Pfizer worked overtime to further accelerate delivery.  This month alone — the month of March — we’ll have 1 million of these treatment courses available.  And in April, that number will more than double.

To ensure these lifesaving treatments are easily accessible, the President’s Plan launches a new “Test to Treat” initiative to provide individuals access to testing and treatment for free, all in one stop. 

Hundreds of one-stop sites will open across the country this month, located at local pharmacy clinics, community health centers, long-term care facilities, and veterans’ health centers.

Marketwatch adds today that “CVS Health Corp., the Walgreens Boots Alliance Inc., and Walmart Inc. said they will participate in the test-to-treat initiative, a new program that allows someone who has tested positive for the virus to get antiviral pills during the same visit at no cost.”

Covid treatment costs were astronomical because care principally was given in hospitals and other healthcare facilities, creating a major burden on the healthcare system. Facilitating the use of Flonase for Covid will avoid the vast majority of those hospitalizations, thereby lowering healthcare costs.

Speaking of testing, the Wall Street Journal reports that

Manufacturers are developing new types of at-home tests, including for flu and strep throat, aimed at consumers who are increasingly monitoring and managing their own health through fitness apps and smartwatches.

Boulder, Colo.-based fertility company MFB Fertility Inc. received clearance from the U.S. Food and Drug Administration in February 2020 for its Proov test, designed to help women measure their hormone levels and to know when in a given month they are most likely to become pregnant. A typical kit includes 20 testing strips, allowing a woman to test daily, which the company said would be tough to achieve through visits to a doctor’s office.

Amy Beckley, the company’s chief executive, said the rise of at-home Covid-19 tests over the past year has made it much easier for people to understand her product.

“All of a sudden, home diagnostics and home testing became a thing,” she said.

Mobihealth News reported last June

The U.S. Air Force has inked a $1.3 million deal with MFB Fertility in order to provide military members and their partners the former’s home fertility tests.

The Air Force’s AFWERX office will invest in Proov, an at-home ovulation test with FDA clearance. The test works by measuring Pregnanediol Glucuronide (PdG), the urine metabolite of progesterone, which is released by the ovary after ovulation. High levels of PdG over multiple days can confirm that successful ovulation took place.

The contract will provide free Proov kits to Air Force couples upon request and connect them to fertility specialists.

Two cool innovations.

From the healthcare policy front —

  • The White House released a fact sheet on steps underway to address the Nation’s opioid epidemic.
  • The Associated Press reports on the President’s mental healthcare policy proposals made in Tuesday’s State of the Union address. For example, under the President’s plan, “Health insurance plans would have to cover three mental health visits a year at no added cost to patients.” I suggest that the Administration consider the fact that most employers offer employee assistance plans that already offer two or three free mental health therapy visits. The overcomplicated federal mental health parity law fails to look at the big picture.

From the diabetes front —

  • The AMA offers six tips for screening patients for pre-diabetes. Many of the tips also could be applied by health plan case managers and coaches.
  • The American Diabetes Association delves into the relationship between diabetes and kidney disease.

From the litigation front, Reuters reports

The Sackler family owners of Purdue Pharma LP reached a deal with a group of attorneys general to pay up to $6 billion in cash to resolve widespread litigation alleging that they fueled the U.S. opioid epidemic, bringing the OxyContin maker closer to exiting bankruptcy.

The attorneys general for eight states and the District of Columbia, who had blocked a previous settlement that included a $4.3 billion cash payment, announced the deal after weeks of mediation with the Sacklers.

The family agreed to pay at least $5.5 billion in cash, which will be used for abating a crisis that has led to nearly 500,000 U.S. opioid overdose deaths over two decades.

The value of the deal could grow as the family members sell additional assets.

U.S. Bankruptcy Judge Robert Drain must approve the deal, which protects the Sacklers from civil lawsuits. Purdue requested a March 9 hearing for Drain to review the agreement.

From the Rx coverage front, Biopharma Dive reports

Civica is making plans to offer three versions of insulin that can be sold at dramatically lower prices than today’s alternatives, targeting a need highlighted by President Joe Biden during this week’s State of the Union Address.

The nonprofit company, created by hospital systems and philanthropies to address drug shortages, said Wednesday it will recommend pricing of no more than $30 for the vials it produces. Name-brand versions can currently cost 10 times that amount at cash prices.

Civica announced an ambitious timeline, projecting that the first product — designed to be interchangeable with Sanofi’s Lantus — would be available as soon as early 2024. The company also aims to manufacture cheaper versions of Eli Lilly’s Humalog and Novo Nordisk’s Novolog, in both vials and pre-filled pens.

Also the Institute for Clinical and Economic Review (“ICER”) announced

it will assess the comparative clinical effectiveness and value of subcutaneous semaglutide (Wegovy, Novo Nordisk), phentermine / topiramate (Qsymia, Vivus Pharmaceuticals), liraglutide (Saxenda, Novo Nordisk), and naltrexone/bupropion (Contrave, Currax Pharma) for the treatment of obesity. 

The assessment will be publicly discussed during a meeting of the New England Comparative Effectiveness Public Advisory Council (New England CEPAC) in September 2022, where the independent evidence review panel will deliberate and vote on evidence presented in ICER’s report.

ICER’s website provides timelines of key posting dates and public comment periods for this assessment.

Midweek Update

David Ermer–Congress, COVID-19, Rx coverage, U.S. Healthcare–

From Capitol Hill, the Senate press gallery informs us “The Senate will convene Thursday at 10:00 am and resume the postal reform bill, which ML Schumer filed cloture on this evening.” It’s worth noting that yesterday “Amendment SA 4955 [was] proposed by Senator Schumer for Senator Peters. (consideration: CR S872; text: CR S872) To modify the deadline for the initial report on the operations and financial condition of the United States Postal Service.” The FEHBlog did not expect any amendments to be offered. Nevertheless, the bill appears on track to passage soon.

From the State of the Union address department

  • Healthcare Dive discusses the President’s healthcare policy proposals.
  • The Society for Human Resources Management discusses the President’s employment policy proposals.

From the Omicron front, the Administration announced a new Covid strategy today. Beckers Hospital Review lists eight highlights from the new strategy. The Wall Street Journal adds

The plan underscores the administration’s shifting focus from responding to the pandemic crisis to a new normal that focuses on managing the disease. But the road map, the result of weeks of work with advisers, state leaders and public health experts, relies heavily on Congress approving billions of dollars in new Covid-19 relief funding.

In other healthcare policy news

  • EHR Intelligence tells us

The Sequoia Project’s Emergency Preparedness Information Workgroup (EPIW) has published a free whitepaper that outlines public health recommendations based on lessons learned from COVID-19 response efforts.

The workgroup of public health, emergency preparedness, and response experts met over several months to create the Pandemic Response Insights and Recommendations whitepaper.

EPIW members created a SWOT (strengths, weaknesses, opportunities, threats) analysis of the COVID-19 response. They then consolidated this data into 17 recommendations to help local, state, and federal stakeholders prepare for a more coordinated national response to the next public health emergency.

  • The Food and Drug Administration issued “three final guidances to industry regarding cancer clinical trials that parallel the goals of President Biden’s recently announced effort to renew and build upon his 2016 Cancer Moonshot initiative to facilitate continued advancement in cancer prevention, detection, research, and patient care.”
  • The HHS Office for Civil Rights published guidance on gender-affirming care, civil rights, and patient privacy. The underlying policy as explained in the guidance is as follows:

The Department of Health & Human Services (HHS) stands with transgender and gender nonconforming youth and their families—and the significant majority of expert medical associations—in unequivocally stating that gender affirming care for minors, when medically appropriate and necessary, improves their physical and mental health. Attempts to restrict, challenge, or falsely characterize this potentially lifesaving care as abuse is dangerous. Such attempts block parents from making critical health care decisions for their children, create a chilling effect on health care providers who are necessary to provide care for these youth, and ultimately negatively impact the health and well-being of transgender and gender nonconforming youth.

On the Rx coverage front, Beckers Hospital Review informs us “Annual spending on pharmaceutical products has skyrocketed since 2010, though out-of-pocket costs have fallen, according to a Feb. 28 report from ValuePenguin.”

From the truth is stranger than fiction department, Govexec reports

The panel tasked with enforcing [federal] civil service protections has regained a governing quorum after the Senate approved two of President Biden’s three nominees on Tuesday, putting an end to five years of dysfunction. 

Both Tristan Leavitt and Raymond Limon won unanimous support in Senate voice votes, giving the Merit Systems Protection Board confirmed members of its central panel for the first time since 2019. The board needs at least two of its three slots filled to have a quorum and hear appeals, which has not occurred since January 2017. Cathy Harris, Biden’s third and final nominee for the board, is still awaiting a vote in the Senate. 

The quasi-judicial agency has a backlog of more than 3,500 cases pending before its central board, which the nominees have pledged to quickly address through an expedited process. Regional administrative judges at MSPB have continued to hear cases of alleged violations of prohibited personnel practices by federal agencies, but agencies or individuals that have sought further appeal to the board’s presidentially appointed, Senate-confirmed central panel have seen their causes languish—in some instances, for years.  

Tuesday’s Tidbits

David Ermer–Congress, COVID-19, COVID-19 testing, COVID-19 vaccine, OPM, SCOTUS, Telehealth, U.S. Healthcare, Uncategorized–

From Capitol Hill, the Senate approved a motion to proceed to a vote on the Postal Reform Act of 2022 (HR 3076) by a voice vote. This vote suggests to the FEHBlog that the Senate will approve the bill this week.

Roll Call discusses the status of the Consolidated Appropriations Act for Fiscal Year 2022. Congress has a week and half to finish cobbling together this law before it needs a fourth continuing resolution.

From the Omicron vaccine front, the American Hospital Association tells us

The Centers for Disease Control and Prevention today released a study examining the effectiveness of the Pfizer COVID-19 vaccine at preventing emergency department and urgent care visits by children aged 5-11 and 12-17. Among children aged 5-11, effectiveness 14-67 days after dose 2 (the longest interval in this age group) was 46%, significantly lower than overall estimates for adolescents aged 12-17. However, most encounters among children aged 5-11 occurred during omicron predominance, when the vaccine’s effectiveness also significantly declined for adolescents, suggesting that the lower effectiveness for children aged 5-11 was likely driven by the predominant variant rather than differences in effectiveness across age groups, the authors said. During omicron predominance, there was no evidence 2 doses protected adolescents after 150 days; however, a booster dose restored effectiveness to 81% in this age group, the authors said.

Another study released today by the CDC looks at reactions to the Pfizer booster in adolescents aged 12-17, which were generally mild to moderate and transient. Myocarditis was less frequently reported after a booster dose than a second primary dose, the authors said.

From the Omicron masking and testing front —

Federal agencies can relax their mask and testing protocols in the wake of new public health guidance. 

The Centers for Disease Control and Prevention’s released on Friday a “new framework” that “moves beyond just looking at cases and test positivity to evaluate factors that reflect the severity of disease, including hospitalizations and hospital capacity, and helps to determine whether the level of COVID-19 and severe disease are low, medium, or high in a community,” Dr. Rochelle Walensky, the agency’s director, said on a call with reporters. Guidance from the Biden administration’s Safer Federal Workforce Task Force on Monday reflects this new framework. 

“This document provides federal agencies with initial implementation guidance they should follow in utilizing the CDC’s COVID-19 Community Levels to determine the appropriate mask-wearing and screening testing requirements for each federal facility at a given time,” said the guidance. 

Nearly half of the 500 million free COVID-19 tests the Biden administration recently made available to the public still have not been claimed as virus cases plummet and people feel less urgency to test.

Wild demand swings have been a subplot in the pandemic, from vaccines to hand sanitizer, along with tests. On the first day of the White House test giveaway in January, COVIDtests.gov received over 45 million orders. Now officials say fewer than 100,000 orders a day are coming in for the packages of four free rapid tests per household, delivered by the U.S. Postal Service.

It would be a good idea for the federal government to tell health plans to refer their members to the federal site if they are interested in receiving test kits.

To sum it up from the Omicron front, check out the lead article from the NIH Director’s blog titled “How Covid immunity holds up over time.”

From the tidbits department —

  • The CDC discusses the unholy connection between diabetes and chronic kidney disease.
  • Fierce Healthcare discusses telehealth provider Amwell’s fourth quarter results.
  • Beckers Payer Issues notes

UnitedHealth Group is beginning to act on its November promise to shore up its sustainability efforts by halting its mailing paper of prior authorization and clinical decisions to providers, according to a Feb. 25 post on the California Medical Association website. 

The first move — a nationwide shift to digital clinical decision letters — is effective March 4 for most UnitedHealthcare Medicare Advantage and commercial plan members. Instead of receiving a mail appeal decision, providers can view the decisions digitally immediately after they are made. 

President Joe Biden is calling for more federal employees to return to the office, saying “significant progress” fighting the COVID-19 pandemic has made it safer to do so.

Ahead of his State of the Union address, Biden issued a letter Tuesday thanking the federal workforce for its “tireless work this past year” confronting the pandemic and leading economic recovery efforts.

A return to the office, however, doesn’t necessarily mean a return to the pre-pandemic status quo.

Biden urged agencies to “build on the innovations and technologies that we put to work serving the American people throughout the pandemic, making our government more efficient, resilient, and effective.”

Good luck, OPM.