Weekend update

Congress

Weekend update

David Ermer–Congress, Medicare, Rx coverage, U.S. Healthcare–
Thanks to Alexandr Hovhannisyan for sharing their work on Unsplash.

The House of Representatives will be conducting Committee business this week and is not expected to resume floor voting until June 14. The Senate will be conducting Committee business and floor voting this week. Tomorrow the Senate will begin the voting process for confirmed President Biden’s nominee for Centers for Medicare and Medicaid Services Administrator, Chiquita Brooks-LaSure.

The Supreme Court will hold another opinion day tomorrow which may be the occasion for the release of the California v. Texas Affordable Care Act constitutionality decision. Lexology discusses the fallout from the Surpreme Court’s December 2020 opinion in Rutledge v. PCMA narrowing the scope of ERISA preemption with respect to prescription benefit manager law. State legislatures have jumped on the opportunity created by the Rutledge opinion.

In 2021 alone, at least eight states have enacted some sort of PBM reform legislation, including Alabama, Arizona, Arkansas, Mississippi, New York, North Dakota, West Virginia and Wisconsin. PBM reform regulation has passed both the state house and senate in Texas and is on its way to the governor. These bills run the gamut of regulating the PBM industry, from prohibiting PBMs from charging pharmacies fees during and after the claims adjudication process, prohibiting PBMs from reimbursing their own affiliated pharmacies at a higher level than independent pharmacies to banning PBM discrimination against pharmacies participating in the Federal 340B medication discount program. This trend is likely to continue with almost 100 bills introduced across 39 states similarly aimed at regulating the PBM industry

Cost curve up. ERISA decisions like this one impact FEHB preemption because courts have interpreted the two preemption laws as generally analogous in scope.

In other news and opinions:

  • Medpage Today offers an op-ed about the importance of primary care. The FEHBlog agrees that “Patients need support for mental and physical health all in one place” and accordingly health plans should encourage the use of primary care.
  • Fierce Healthcare reports that “There was a significant increase in pharmacy fraud and abuse under the pandemic, analysts at OptumRx say. The pharmacy benefit manager giant recovered $300 million in fraud, waste and abuse spend in 2020 and documented the largest ever increase in fraudulent claims, which were up 300% compared to 2019. In addition, Optum’s investigative audits led to an increase of 135% in fraud recoveries last year from 2019. The average audit recovery per case was also 70% higher in 2020 than in 2019, Optum found. Optum found the fraudulent behavior concentrated among independent pharmacies and rarely found similar activity among retail chains, [Optum analysts] said. Due to the findings, the PBM axed 112 pharmacies from its network.
  • Kaiser Health News informs us that “Colorado health officials so abhor the high costs associated with free-standing emergency rooms they’re offering to pay hospitals to shut the facilities down. The state wants hospitals to convert them to other purposes, such as providing primary care or mental health services. At least 500 free-standing ERs have set up in more than 20 states in the past decade. Colorado has 44, 34 owned by hospitals. The trend began a decade ago with hopes these stand-alone facilities would fill a need for ER care when no hospital was nearby and reduce congestion at hospital ERs. But that rarely happened. Instead, these emergency rooms — not physically connected to hospitals — generally set up in affluent suburban communities, often near hospitals that compete with the free-standing ERs’ owners. And they largely treated patients who did not need emergency care, but still billed them and their insurers at expensive ER rates, several studies have found.” Good luck Colorado as this approach also may reduce surprise billing issues.

Thursday Miscellany

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

Following up on yesterday’s post about the proposed Postal Service Health Benefits Program that Congress is considering, here is a link to the Senate Homeland Security and Governmental Affairs Committee’s press release on its companion bill to the House measure (HR 3706). The press release provides a link to the Senate bill for those interested.

The Office of Personnel Management issued a benefit administration letter to federal agencies “which provides guidance on the OPM implementation of FSAFEDS Program flexibilities offered under the Consolidated Appropriations Act 2021 and accompanying law and guidance.”

From the COVID-19 front, the American Hospital Association reports

FDA authorizes storing thawed Pfizer COVID-19 vaccine in refrigerator for up to 30 days before diluting. The Food and Drug Administration yesterday authorized storing thawed, undiluted vials of the Pfizer COVID-19 vaccine at refrigerator temperatures (35°F to 46°F) for up to 30 days after the company submitted data showing the vials can remain stable that long, up from the previously authorized five days. For details, see the updated fact sheet for health care providers administering the vaccine.
Peter Marks, M.D., director of FDA’s Center for Biologics Evaluation and Research, said the change should make it easier for vaccine providers such as doctors’ offices to administer the vaccine.
Once the thawed vials are diluted, providers must use them within six hours, a potential challenge for clinicians who lack sufficient demand for the vaccine during regular office visits.

That’s quite a conundrum. On the brighter side, Politico informs us

Emergent BioSolutions could resume manufacturing Johnson & Johnson’s Covid-19 vaccine within days, CEO Robert Kramer told a House [of Representatives] panel Wednesday. Restarting Emergent’s production of the J&J shot would revitalize efforts to get the single-dose vaccine to many Americans. The United States is currently relying entirely on vaccines from Pfizer and Moderna for its vaccination efforts; for the second straight week, the White House on Tuesday told state officials that the J&J vaccine was not available to order.

The American Medical Association adds that “The biggest impediment to getting more people fully vaccinated for COVID-19 is access, not vaccine hesitancy, according to Thomas R. Frieden, MD, MPH, former director of the Centers for Disease Control and Prevention during the Obama administration.” “We can make a lot of progress by making vaccination more convenient,” said Dr. Frieden, CEO of Resolve to Save Lives, an initiative to prevent epidemics and cardiovascular disease. “That’s really important. That means walk-in hours. That means easy locations, easy hours, supporting transportation and setting up pop-up sites outside of everywhere, from ballgames to bars to bowling alleys to shopping centers. We need to make it the default choice, basically, to get a vaccine.”

In healthcare business news,

  • Healthcare Dive lets us know that “Anthem and Epic on Wednesday announced a collaboration expanding bidirectional data exchange, in a bid to streamline administrative process like prior authorizations, a frequently cited pain point for providers, and give providers more real-time data on patient behaviors like medication adherence. The partnership will integrate Epic’s payer platform into Anthem’s operating system. The Indianapolis-based payer will also combine Epic’s information with other sources such as claims logs, health information exchanges and lab companies. Providers will also be notified of significant health events, such as when a patient is discharged, in an effort to improve follow-up care.” Awesome!
  • Fierce Healthcare reports that “While its joint venture with Amazon and Berkshire Hathaway, Haven, is no more, JPMorgan Chase is launching a new effort to address the cost and efficiency of employer-sponsored healthcare. Morgan Health will serve as a new business arm within the company that’s focused on these issues, the financial giant announced Thursday. Dan Mendelson will serve as CEO of Morgan Helth and report to Peter Scher, vice president of JPMorgan Chase. Mendelson is the founder and former CEO of Avalere Health.”

In healthcare news

  • The Associated Press informs us that “Screening and the HPV vaccine have led to drops in cervical cancers over the last two decades in the U.S., a new study finds, but the gains are offset by a rise in other tumors caused by the [HPV] virus. In the U.S., the HPV vaccine has been recommended since 2006 for girls at age 11 or 12, and since 2011 for boys the same age, and catch-up shots are recommended for anyone through age 26 who hasn’t been vaccinated. Experts agree it will take years to see the true impact because it can take decades for a chronic HPV infection to turn into cancer. What’s driving the HPV cancer trends is the youthful sexual behavior of baby boomers before the vaccine was out. The vaccine works best when given at younger ages before people are exposed to HPV through sexual activity, so it arrived too late for the boomers.
  • The Blue Cross Blue Shield Association reports that “Black women under the age of 24 are more likely to experience severe childbirth complications than white women over the age of 35 – an age group usually considered high risk, according to new data from the Blue Cross Blue Shield Association (BCBSA). Data shows the rates of childbirth complications have been increasing for women of color. In the last two years, the rate of Hispanic women with severe childbirth complications increased 19%. “There is an urgent maternal health crisis in our country,” said Kim Keck, president and CEO of BCBSA. “It is unconscionable that women of color face a greater risk of childbirth complications compared to white women. We must confront health disparities across the board to change the trajectory.” Amen to that.

Postal Reform Update and More

David Ermer–Congress, Federal employment benefits, U.S. Healthcare–

The Washington Post reports today that

A bipartisan group of senators [led by the Chair and Ranking Member of the Senate Homeland Security and Governmental Affairs Committee] introduced legislation Wednesday to lift significant financial burdens off the ailing U.S. Postal Service while tightening accountability requirements for mail delivery, a major stride for an agency that has tussled with its balance sheet and reputation for the better part of a year. The bill, identical to a version that has advanced in the House [H.R. 3706], would repeal $5 billion a year in mandatory retiree health-care expenses and require future postal retirees to enroll in Medicare[ via a Postal Service Health Benefits Program (“PSHBP’) within the FEHB Program]. Advocates say the measures would save the agency $30 billion over the next decade.

FedSmith recapitulates the key aspects of the PSHBP provisions in the House bill for us. FedSmith also helpfully shares NARFE’s comments on the House bill. However, FedSmith concludes that “What is not mentioned in the [House] bill, but a possibility that could impact the rest of the federal workforce is the possibility that this “reform” package could become just the first step in removing federal retirees from the FEHB.”

With all due respect to FedSmith, OPM, and presumably Congress, knows full well that removing retirees from the FEHB would discourage federal employees from opting for long term employment with the government. Currently, if a federal employee has at least five years of FEHB coverage preceding their civil service retirement, they carry FEHB coverage into retirement with the full government contribution.

FEHB coverage tops any Medicare supplement plan out there by a long shot. What’s more the dirty little secret of Medicare is that federal law does not prohibit Medicare supplement plans to impose pre-existing condition limitations on prospective members except when an individual becomes first eligible for Medicare. (Only four northeast states prohibit that practice.) For example, the FEHBlog lives in Maryland which allows Medicare supplement plans to impose pre-existing condition limitations. If the FEHBlog had picked a Medicare Advantage plan initially and later wanted to switch to traditional Medicare, his selection of Medicare supplement plans would be limited particularly he had encountered health problems.

In any event, annuitants with primary Medicare coverage are good FEHB risks who help control premiums for everyone. For those reasons, the FEHBlog does not foresee annuitants being removed from the FEHB. He would like to see OPM permit FEHB carriers to offer Medicare Part D prescription drug plan integration in their “traditional” plans because that Part D integration and not the Part A and B integration will generate the greatest savings for the PSHBP carriers. Congress already opened the door the FEHB integration with Medicare Part D In the Medicare Modernization Act of 2003 which created Part D.

Here are some other nuggets of interest:

  • Reg Jones continues his series on federal employee benefits in FedWeek. This week’s article concerns opportunities to enroll in or change coverage in federal employee benefit programs upon marriage.
  • The National Committee for Quality Assurance takes us on a trip along the road to health equity.
  • Healthcare Dive reports that “CommonSpirit Health and Essentia Health have called off a deal for Essentia to acquire 14 CommonSpirit facilities in North Dakota and Minnesota, the two Catholic systems announced Tuesday.”

Tuesday’s Tidbits

David Ermer–Congress, COVID-19, COVID-19 vaccine, Mental health care, Telehealth, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

Over 275 million doses of the COVID-19 vaccines have been administered in the United States and 47.5% of the U.S population has received at least one dose of COVID-19 vaccine ,and 37.5% of the total U.S. population has been fully vaccinated. The Wall Street Journal reports today that

Covid-19 vaccines are showing up in unlikely places—on public transportation, at churches and in factories. Shots are also being offered in restaurants, casinos and ballparks. These pop-up locations represent a bid by health advocates and community leaders to reach a group of unvaccinated individuals less likely to make headlines: the ambivalent.

From the American Medical Association front

  • The AMA continues to rail against health insurer requests for prior authorizations.
  • In contrast the AMA is now a fan of telehealth as long as health insurers pay adequately for it.

“Here are the top five services physicians surveyed say they want to offer after the COVID-19 pandemic has ended, along with the percentage who said they wanted to continue each service:

  • Chronic disease management—73%.
  • Medical management—64%.
  • Care coordination—60%.
  • Preventative care—53%.
  • Hospital or emergency department follow-up—48%.

“Physicians also identified what they anticipate to be the barriers to maintaining telehealth after the public health emergency. No. 1 on that list? About 73% of physicians worry there will be low—or no—payment.”

STAT News reports that the House Oversight and Reform Committee bludgeoned prescription drug manufacturer Abbvie’s CEO over its pricing practices particularly for its blockbuster drug Humira during a hearing held today.

Three powerful Democrats wrote to the Federal Trade Commission Tuesday urging them to investigate whether drug maker AbbVie violated the law in trying to keep cheaper versions of its blockbuster drug Humira off the market.

The surprise announcement came in the first minutes of a Tuesday hearing held by the House Oversight Committee investigating the company’s pricing practices. AbbVie’s CEO Richard Gonzalez is testifying.

“I sent a letter to the FTC today … asking for a formal inquiry into whether AbbVie’s anticompetitive practices violated the law,” said the committee’s chair, Rep. Carolyn Maloney (D-N.Y.). The letter was also signed by the chair of the House Judiciary Committee, Rep. Jerrold Nadler (D-N.Y), and the chair of that committee’s antitrust subcommittee, Rep. David Cicilline (D-R.I.).

From the tidbit front

  • The Internal Revenue Service released guidance for employers on the American Rescue Plan’s subsidization of COBRA continuation coverage for employees who lose their health coverage due to an involuntary termination or reduction in hours.
  • The Department of Health and Human Services announced that its “Substance Abuse and Mental Health Services Administration (SAMHSA) is distributing $3 billion in American Rescue Plan funding — the largest aggregate amount of funding to date for its mental health and substance use block grant programs. The Community Mental Health Services Block Grant (MHBG) Program and Substance Abuse Prevention and Treatment Block Grant Program (SABG) will disperse $1.5 billion each to states and territories (with the latter also awarding money to a tribe). This follows the March announcement of supplemental funding of nearly $2.5 billion for these programs.”
  • The U.S. Preventive Services Task Force released a new final recommendation that persons aged 45 through 49 should receive screening for colorectal cancer. This supplements USPSTF’s current recommendation that persons aged 50 to 75 received this testing. The new recommendation will become a mandate on FEHB carriers and other group health plans to provide in-network coverage with no member cost sharing for this service for the lower aged cadre beginning January 1, 2023.
  • In 2019 the FEHBlog heard a hospital system executive vociferously object to Medicare’s new site neutrality policy under which Medicare pays the same rate whether the service is rendered inpatient or outpatient. It occurred to the FEHBlog that this site neutrality rule may lower healthcare costs. Needless to say, a trade association lawsuit challenged the rule, and the government won before the U.S. Court of Appeals for the D.C. Circuit. Healthcare Dive reports that Justice Department is opposing the American Hospital Association’s petition for U.S. Supreme Court review of the D.C. Circuit ruling.

Weekend update

David Ermer–Congress, COVID-19, COVID-19 vaccine, Mental health care, OPM, Rx coverage, Telehealth, U.S. Healthcare, Uncategorized–

FEHBlog opening note — The FEHBlog goofed by posting this May 7 COVID-19 charts in the May 14 Friday Stats and More post. The FEHBlog corrected his error on Saturday after the Friday post email went out. You can check out the website if you want to see the May 14 charts which are encouraging. In contrast, check out the Wall Street Journal’s charts on the COVID-19 situation in India which is still struggling with virus. Whereas 37% of the U.S. population is fully vaccinated, less than 5% of the much larger and younger Indian population has reached that status. In this regard, the Rome (N.Y.) Sentinel offers an Excellus Blue Cross consulting pharmacist’s valuable guidance on why people in the age 18 to 34 bracket should received the COVID vaccination.

Q: Katie [Abbott, Pharm.D.], you are in that age group. Why did you choose to get vaccinated? 

I trust the science behind the vaccines and believe they will help bring us back to how life was before the pandemic.

Q: Some, or most cases of COVID-19 in younger people are not severe. Why would a younger person get vaccinated if younger people aren’t really dying from COVID-19?

The younger population may not be seeing as many severe cases or deaths, but they are still at high risk of long COVID. Long COVID is when those who have recovered from COVID-19 experience lasting effects, including a range of symptoms such as fatigue, brain fog, chest pain, shortness of breath, cough, joint or muscle pain, depression, anxiety, and so much more. Long COVID can develop weeks or months after infection. It can happen to anyone who has had COVID, even if they had mild or no symptoms. Getting the vaccine remains a safe way to protect yourself, along with your community, family members, and those who cannot be vaccinated.

Returning to the regular weekend update, both Congress will be in session this week for Committee work and House and Senate floor votes. The House Oversight and Reform Committee will hold its third recent hearing on prescription drug costs on Tuesday morning. It’s worth noting that although the House Oversight and Reform Committee approved the Postal Reform bill (HR 3076) last week, the House Energy and Commerce and Ways and Means Committees also have jurisdiction over the bill. So we don’t know right now, when the bill may reach the House floor.

In OPM news, the Federal Times reports that

In anticipation of more employees returning to the office and in the spirit of May’s Mental Health Awareness Month, the Office of Personnel Management issued a tip sheet for agency human resource staff to better support employees at a vulnerable time. * * * In addition to communicating with employees about the usual resources available to them – such as the Employee Assistance Program and mental health treatments offered through Federal Employee Health Benefit plans – OPM encouraged agency work-life coordinators and HR professionals to be as communicative as possible about office safety procedures and available work schedule adjustments to ease any potential employee anxiety.

In other healthcare news,

  • mHealth Intelligence discusses the work of University of West Virginia researchers who are seeking to determine the best mix of in-person and virtual care. “With telehealth use skyrocketing over the past year and a half due to the coronavirus pandemic, some have wondered if there’s a limit to its effectiveness. Is there a certain number of virtual visits that a patient – especially one with a chronic condition – should get, after which the technology outlasts its value? The answer, according the researchers at the University of West Virginia, is … uncertain.” While that outcome is surprising to the FEHBlog, the researchers have gone back to the drawing board.
  • Fierce Healthcare reports that “GoodRx, a telehealth and drug-pricing comparison software company, acquired competitor RxSaver for $50 million in cash. The company closed the deal in late April, GoodRx reported during its first-quarter 2021 earnings call Thursday. RxSaver, which was owned by Vericast Corp., the payment and marketing company controlled by billionaire Ronald Perelman, operates a price comparison platform to provide discount offerings through partnerships with pharmacy benefit managers (PBMs). The acquisition will expand GoodRx’s business capabilities and consumer reach, particularly with respect to its prescription offering, the company said in its first-quarter 2021 earnings report.”
  • Health Payer Intelligence informs us that ” To help combat racial care disparities in communities of color, Blue Shield of California (Blue Shield) provided $300,000 to 12 different nonprofit organizations in California that promote the mental health and well-being of youths in their communities.   This act supports the health equity strategy of Blue Cross Blue Shield Association (BCBSA), Blue Shield’s parent company, as it seeks to improve racial care disparities by collaborating with local community leaders. By contributing $25,000 to each organization, Blue Shield is providing opportunities for youths of color that can improve their mental health.”
  •  Healthcare Dive reports that “Piedmont Healthcare signed a non-binding letter of intent to acquire Augusta, Georgia-based University Health Care System, which operates three hospitals as well as skilled nursing facilities and urgent care clinics along Georgia’s eastern border with South Carolina. * * * Just last week, the 11-hospital system announced plans to buy four additional hospitals from HCA Healthcare for $950 million. The sale is expected to close in the third quarter of this year. The hospitals in the HCA deal circle the outskirts of the Atlanta region. * * * Altogether, the two most recent deals would give Piedmont a total of 18 hospitals in Georgia, in addition to more ancillary services.” Healthcare Dive adds that the two deals are likely to face regulatory scrutiny.

Thursday Miscellany

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

The FEHBlog enjoyed watching a love-fest of a Congressional business meeting this morning when the House Oversight and Reform Committee approved the Postal Reform Act, HR 3076, by a voice vote. Govexec reports on the proceedings and adds that the Senate has confirmed two Postal Service Board of Governors nominees. OPM Director nominee Kiran Ahuja had her confirmation hearing on the same day as these new Postal Governors. Her nomination should be considered on the Senate floor soon.

From the COVID-19 front

  • Bloomberg reports that ““Anyone who is fully vaccinated can participate in indoor or outdoor activities, large or small, without wearing a mask or physical distancing,” said CDC Director Rochelle Walensky. “If you are fully vaccinated [two weeks after two doses], you can start doing the things that you had stopped doing because of the pandemic. We have all longed for this moment when we can get back to some sense of normalcy.” Of course, “the CDC guidance spelled out ample exceptions, however, that signal the era of masks isn’t over yet. The agency still recommends fully vaccinated people wear masks on “all planes, buses, trains and other forms of public transportation,” as well as in health care settings, correctional facilities, homeless shelters, and where required by state and local governments, or businesses.”
  • Fierce Healthcare informs us that large pharmacy chains such as CVS Health, Rite Aide and Walgreen’s, are scheduling Pfizer vaccine appointments for young adolescents ages 12-15 following issuance of FDA and CDC approval over the last week.
  • Kaiser Health News reports that “Hispanics who have yet to receive a covid shot are about twice as likely as non-Hispanic whites or Blacks to say they’d like to get vaccinated as soon as possible, according to a survey released Thursday. The findings hint at fixable, though difficult, vaccine access problems for the population. One-third of unvaccinated Hispanics say they want the shots, compared with 17% of Blacks and 16% of whites, according to the survey released Thursday by KFF.” As of today, 59% of Americans over age 18 have received at least one dose of a COVID vaccine.
  • The Wall Street Journal reports that “Prominent scientists are calling for a deeper investigation into the origin of Covid-19, including the possibility that a laboratory accident released the new coronavirus that caused the pandemic. In a letter published Thursday in the journal Science, an international group of 18 biologists, immunologists and other scientists criticized the findings of a report released in March by a World Health Organization-led team into the pandemic’s origin and called for a more extensive evaluation of the two leading hypotheses: that the pandemic virus entered the human population and began spreading after escaping from a lab or after jumping to humans from infected animals.”
  • Govexec tells us that “The OPM Office of the Inspector General published a report analyzing the agency’s response to the coronavirus pandemic, finding officials fell short in a number of areas. In addition to failing to adequately inform employees of COVID-19 “incidents,” the agency failed to adequately document post-incident workplace cleaning or cleaning of “high contact” areas of its Washington, D.C., headquarters. The inspector general also said the agency needed more signage regarding social distancing and other ways to mitigate spread of the disease.” Who hasn’t fallen short at some point during these extraordinary circumstances? (Fortune Magazine suggests that New Zealand Prime Minister Jacinda Adern may be the exception that proves the rule.)

In other public health news,

  • The Centers for Disease Control offers the public a pre-diabetes risk test.
  • Health Payer Intelligence reports that “In response to the coronavirus pandemic’s influence on moms’ and caregivers’ stress levels, CVS Health and Aetna are taking steps to prioritize the mental well-being of individuals in these groups.” Bravo.

In healthcare business news, Healthcare Dive informs us that

  • Telehealth giant Amwell saw a rise in revenue and visits in the first quarter, but its growth is decelerating from 2020, bolstering market fears about the sustainability of the virtual care boom.
  • In quarterly results released aftermarket Wednesday, the Boston-based telehealth vendor beat Wall Street expectations on earnings but missed on revenue. Its topline was $57.6 million, up 7% year over year, spurred by subscription and digital revenue growth. In comparison, Amwell notched 34% year-over-year growth in the fourth quarter.
  • Similarly, Amwell’s total visits of 1.6 million were up 121% year over year, paling in comparison to the 351% growth seen in the fourth quarter.

Also from Healthcare Dive

  • Kaiser Permanente and Mayo Clinic are investing $100 million in a hospital-at-home company as the COVID-19 pandemic accelerates the push toward care settings outside a hospital’s four walls.
  • The investment is in Boston-based Medically Home, which has a virtual and physical delivery model allowing providers to shift acute care typically administered in a hospital to a patient’s home. Its software platform, called Cesia Continuum, integrates communications and monitoring for care teams.
  • The partnership will allow patients to be treated at home for infusions and conditions like cancer, infections and COVID-19, according to the companies’ announcement Thursday.

Midweek Update

David Ermer–CDC, Congress, COVID-19, COVID-19 vaccine, Medicare, OPM, Rx coverage, Telehealth–

Tomorrow morning the House Oversight and Reform Committee will mark up its bipartisan Postal Reform Act (H.R. 3076) and the Postal Improvement Act (HR 3077). H.R. 3076 would eliminate the Postal Service’s unique obligation to pre-fund the cost of FEHB coverage for its annuitants. It also would create a subprogram with the FEHB for postal service employees and annuitants that would be fully integrated with Medicare Parts A (hospital), B (professional services) and D (prescription drugs) for annuitants over age 65.

Existing FEHB plans largely receive the financial benefit of Medicare Parts A and B integration, but OPM does not permit FEHB plans to offer Medicare Part D integration known as EGWPs. The FEHBlog expects H.R. 3076’s mandatory use of Part D EGWPs in the subprogram will unleash a gusher of new benefit savings for subprogram plans. Fingers crossed that successful adoption of Part D EGWPs in this subprogram leads OPM to allow carriers to add them in existing FEHB too. However, as currently drafted, the subprogram would launch on January 1, 2023, which is aggressive timing in the FEHBlog’s view.

Today according to the Wall Street Journal

The Centers for Disease Control and Prevention recommended that 12- to 15-year-olds receive the Covid-19 vaccine from Pfizer Inc. and BioNTech SE, expanding the nation’s vaccination campaign. 

The CDC took the step after its vaccination advisory panel voted to recommend the shot at a meeting Wednesday after reviewing clinical trial data and other relevant information. The vote by the Advisory Committee on Immunization Practices, or ACIP, was 14-0, with one voting member recusing. * * *

Covid-19 cases are rising in adolescents, and as older Americans have gotten vaccinated, adolescents make up an increasing proportion of the overall U.S. case count, Sara Oliver, a CDC medical officer, said. Adolescents accounted for 9% of reported cases in April, a larger proportion than cases involving people 65 years and older as more adults have been vaccinated, she said.

According to the CARES Act of 2020, health plans, including FEHB plans, must begin to cover the Pfizer vaccine without member cost sharing for this age group no later than fifteen days from today, May 27, 2021. According to the Journal, “Pfizer anticipates asking the FDA in September to authorize its vaccine’s use in children 2 to 11 years old should ongoing studies prove positive. The company said It plans to make a similar request for children 6 months to 2 years of age in the fourth quarter.”

In Biden Administration news, the American Hospital Association reports that

Health and Human Services Secretary Xavier Becerra today swore in Andrea Palm as deputy secretary. Confirmed by the Senate yesterday, Palm previously served as secretary-designee of Wisconsin’s Department of Health Services and in several leadership roles at HHS during the Obama-Biden administration.  
“My focus will be on improving the lives and livelihoods of the American people: tackling the COVID-19 pandemic, efficiently and equitably distributing vaccines, expanding access to affordable health care, addressing the epidemic of substance use disorders, and improving mental health care,” she said. 
Biden’s nominee to serve as Centers for Medicare and Medicaid Services administrator, Chiquita Brooks-LaSure, today moved one-step closer to confirmation with the Senate voting 51-48 to discharge the nomination. The Senate could hold a final vote on her confirmation next week.  

STAT News informs us

  • “Telehealth companies, flush with cash after the Covid-19 pandemic spiked both demand and investment, are now embarking on massive lobbying efforts to secure their interests on Capitol Hill. The goal is clear: Lawmakers are weighing whether to permanently loosen regulations that were temporarily eased during the pandemic. Among other changes, providers have been allowed to practice in states where they are not licensed, and Medicare has been permitted to pay providers the same for virtual visits as in-person ones. Lobbyists for the rapidly growing industry are determined to keep those changes intact.” Watch for this result the big infrastructure bill.
  • Amazon’s objectives for its nascent pharmacy business are straightforward: “better selection, better convenience, and better prices,” according to TJ Parker, the vice president of pharmacy at the company.“ It really is the Amazon playbook,” he said during a Wednesday panel at STAT’s Health Tech Summit. * * * “Customers really want more Amazon and less pharmacy and so our work from here is to make pharmacy truly as seamless to us as amazon.com [is] for other categories,” Parker said. Among Amazon’s latest offerings: a new price-comparison tool for medications, which launched Tuesday. Now, when someone searches for a prescription drug on Amazon, Amazon Pharmacy’s price for a drug is listed alongside the cost for Prime members at other pharmacies like CVS, Walgreens, Walmart, and Costco.” Watch out GoodRx.

On a related note, the Drug Channels blog assesses how Cigna’s growing pharmacy platform expands its channel power.

Last week, Cigna released its earnings for the first quarter of 2021. I was struck by how quickly Cigna’s Express Scripts PBM business has increased revenues and prescriptions from its retail pharmacy network. Our second chart below highlights this growth. The businesses in Cigna’s Evernorth segment—especially Express Scripts, Ascent Health Services, and InsideRx—are already providing rebate negotiation, network management, and/or a sourcing platform for Prime Therapeutics, Kroger, Humana, GoodRx, and Amazon.”

Tuesday’s Tidbits

David Ermer–Congress, Federal employment benefits, HIPAA Privacy and Security Rules, Mental health care, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

The FEHBlog had been wondering what was going on with the Postal Reform bill that includes a new Postal Service Health Benefits Program. It turns out that the House Oversight and Reform Committee plans to mark up the latest draft of that bill on Thursday morning. The FEHBlog plans to tune in for this meeting.

In health equity developments —

  • The Wall Street Journal reports that “Ride-sharing companies Uber Technologies Inc. and Lyft Inc. will make all rides to and from vaccination sites free until July 4 under a new partnership with the White House. * * * While the companies were already providing free or discounted rides in some circumstances, the rides will now be free to anyone in the U.S. who is going to a vaccination site to get the shot, and Lyft and Uber will promote the rides to and from tens of thousands of vaccination sites through their apps. The feature will launch in the next two weeks and run until July 4.”
  • Health Leaders Media informs us about Horizon Blue Cross’s ongoing efforts to advance health equity in New Jersey in cooperation with healthcare and community organizations as well as solid data.
  • The American Medical Association released a “strategic plan to embed racial justice and advance health equity.” “With the input of many both inside and outside of AMA, this strategic plan serves as a three-year roadmap to plant the initial seeds for action and accountability to embed racial justice and advance health equity for years to come.”

In regulatory developments –

  • Professor Katie Keith in the Health Affairs blog provides background on yesterday HHS decision to “interpret Section 1557 and Title IX, which prohibit discrimination on the basis of sex, to include discrimination on the basis of sexual orientation and gender identity.”
  • Fierce Healthcare reports that “The Centers for Medicare & Medicaid Services has sent its first wave of warning letters out to hospitals breaking federal rules requiring them to disclose payer-negotiated prices, a spokesperson for the agency confirmed.”
  • Healthcare Dives discusses healthcare organization comments to HHS’s Office for Civil Rights on its proposed rule that would make generally helpful adjustments to the HIPAA Privacy Rule, in the FEHBlog’s opinion.

Miscellaneous tidbits —

  • Reg Jones discusses the Federal Employees Group Life Insurance Program in FedWeek.
  • The Society for Human Resources Management writes about “Supporting Mental Health in the Post-Pandemic Workplace.”
  • Health Payer Intelligence discusses Blue Cross of North Carolina’s successful effort to consolidate member experience data from across the company to boost member satisfaction.

Weekend update

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

Happy Mothers’ Day.

Congress will be engaged in Committee business and floor votes for the next two weeks. The Hill reports on what we can expect from Congress in the near term.

From the COVID-19 front, Bloomberg informs us that

The share of U.S. hospital beds occupied by Covid-19 patients fell to 5.37%, the lowest since Oct. 5, according to the U.S. Department of Health & Human Services. Michigan had the biggest percentage of beds occupied by Covid patients at 13.3% followed by Maryland at 10.8%, according to the latest HHS data, which reflect the situation on Thursday. Florida had 3,504 hospitalized Covid patients, the most of any state, followed by Texas with 3,080.

The U.S. added fewer than 35,000 cases on Saturday, sending the seven-day rolling average of new infections to the lowest since the end of September. While reporting often lags on weekends, the data collected by Johns Hopkins University and Bloomberg is the latest sign that the pandemic in America is easing.

Another 625 people nationwide died of Covid-19, bringing the toll to more than 581,000 since the outbreak began. Detroit and New York City had the most deaths per capita among major metro areas in the week through Wednesday, according to a Centers for Disease Control and Prevention report dated May 6.

According to the CDC’s website, nearly 7.5 million doses of COVID-19 vaccine were administered over the past three days. Approximately 43% of the U.S. population over age 18 and 71% of that population over age 65 is fully vaccinated against COVID-19. All of these facts are clearly related.

Govexec reports on the Postal Service’s first quarter 2021 financial results.

USPS lost just $82 million in the second quarter of fiscal 2021, a marked improvement over the same quarter the previous year. When excluding inflationary adjustments to the agency’s workers’ compensation liabilities that are outside of management’s control, however, the agency experienced $1.7 billion in losses from January through March compared to $1.9 billion in that period of fiscal 2020. 

Total revenue jumped 6% over the same period last year, led by a 34% spike in package business. The shift from regular mail—where plummeting volume persisted—to packages continued to add costs to the postal system, as packages entail additional personnel and transportation costs. * * *

The Postal Service’s costs jumped by 4% in the most recent quarter, which management attributed to package delivery and paid leave related to the pandemic. The agency’s total net loss of $82 million was down from $4.5 billion in the same period last year. 

Joe Corbett, the USPS chief financial officer, speculated the agency would break even by fiscal 2023 or fiscal 2024, provided DeJoy’s plan is implemented. USPS is relying in large part on Congress to pass reforms that would remove much of its liabilities for retiree health care costs from its balance sheets.  

Fredric Rolando, president of the National Association of Letters Carriers, said the postal revenue increases demonstrate those retiree health care reforms are the primary change needed.  The uptick in business drives home “how much the American people and their businesses rely on the essential work of the Postal Service,” Rolando said

If the the Postal Service’s healthcare reforms would save money and the Medicare Part D integration would create a gusher of savings, why not just apply those reforms across the entire FEHB which would avoid the additional administrative cost of creating a new Postal Service Health Benefits Program within the FEHB Program?

Weekend Update

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

This coming week, the House of Representatives is engaged in Committee business and the Senate is on a State work break.

From the COVID front, Bloomberg reports on a UK study finding that taking only one dose of the Pfizer OK may be sufficient for a person who has survived a COVID-19 infection but not for others.

The study appears to contrast with other research that has suggested the first dose of Pfizer’s shot provides a strong level of protection against Covid, including some variants. That’s in part because it examined the level of people’s immune responses, rather than real-world infection levels.

Still, the findings offer a warning for countries like the U.K., where the majority of vaccinated people have had only a single dose of inoculations like Pfizer’s that require two shots to offer full protection.

In other vaccination news, Precision Vaccinations explains that

The HPV vaccine was designed to prevent reproductive warts and cancers caused by the most common sexually transmitted infection in the United States. The FDA approved the vaccine for women in 2006 and expanded it to men in 2009.

Preventing cervical cancer was the primary focus at that time, so girls and women were more likely to hear about it from their pediatricians or OBGYNs. 

Yet oropharyngeal cancer, which occurs in the throat, tonsils, and back of the tongue, has now surpassed cervical cancer as the leading cancer caused by HPV.

Data indicates 80% of those diagnosed with oropharyngeal cancer are men.

“I don’t think that a lot of people, providers, and patients, are aware that this vaccine is a cancer-prevention vaccine for men as well as women,” Chen says. “But HPV-associated oropharyngeal cancer can impact anyone.”

“And there’s no good screening for it, which makes vaccination even more important.”

With respect to general preventive services, Fierce Healthcare informs us that

CVS Health is expanding its program to offer no-cost, community-based screenings to 14 more markets.

Project Health, which is now in its sixteenth year, offers a slew of free biometric screenings at CVS Pharmacy locations, including blood pressure, glucose levels and cholesterol. Patients can then meet with a nurse practitioner, who can provide additional guidance and referrals for treatment if needed.

New markets include Birmingham, Alabama; Phoenix; Jacksonville, Orlando and Tallahassee, Florida; Baton Rouge and New Orleans, Louisiana; Jackson, Mississippi; Charlotte, North Carolina; Cleveland, Ohio; Charleston and Columbia, South Carolina; and Knoxville and Memphis, Tennessee, CVS said in announcement provided first to Fierce Healthcare.

The program is also launching four new mobile units, CVS said, and anticipates providing 1,700 screening events across its 32 markets by the end of the year.

From the relevant history front, the Wall Street Journal’s Saturday Essay compares the 1957-58 flu pandemic with our current COVID-19 pandemic. In both cases, a rapidly developed vaccine was made available to the public.

From 1948 to 1957, Maurice Hilleman—born in Miles City, Mont., in 1919—was chief of the Department of Respiratory Diseases at the Army Medical Center (now the Walter Reed Army Institute of Research).

Early in his career, Hilleman had discovered the genetic changes that occur when the influenza virus mutates, known as “shift and drift.” It was this work that enabled him to recognize, when reading reports in the press of “glassy-eyed children” in Hong Kong, that the outbreak had the potential to become a disastrous pandemic. He and a colleague worked nine 14-hour days to confirm that this was a new and potentially deadly strain of flu.

Speed was of the essence, as in 2020. Hilleman was able to work directly with vaccine manufacturers, bypassing “the bureaucratic red tape,” as he put it. The Public Health Service released the first cultures of the Asian influenza virus to manufacturers even before Hilleman had finished his analysis. By the late summer, six companies were producing his vaccine.

It has become commonplace to describe the speed with which vaccines were devised for Covid-19 as unprecedented. But it was not. The first New York Times report of the outbreak in Hong Kong—three paragraphs on page 3—was on April 17, 1957. By July 26, little more than three months later, doctors at Fort Ord, Calif., began to inoculate recruits to the military.

Wait there’s more, according to his 2005 obituary, Dr. Hilleman invented vaccines for measles, mumps, rubella, Hepatitis A, Hepatitis B and pneumonia.

In closing here is an interesting Bloomberg interview with Shahid Jameel, director, Trivedi School of Biosciences, Ashoka University, which is located in the state of Haryana, India. The interview concerns the COVID-19 crisis in that country.

BG: What’s the biggest challenge now?

SJ: To bring things under control, you want to vaccinate more people on a daily basis than the number of new infections. Remember that a person who gets the first shot today will get the second shot in four to six weeks, and will need two more weeks to develop full immunity. So somebody who starts vaccination today will take two months to develop protective immunity.

This means the vaccination drive has to be sustained over months, many more doses daily than cases. Only then can we reverse the surge.

BG: Is the supply of vaccines sufficient to maintain that pace?

SJ: One of the critical errors we made was in vaccine procurement. In January, the government ordered only 11 million doses [from Serum Institute located in India]. Between Serum Institute and Bharat Biotech, we can currently produce roughly 90-100 million doses in a month. But they also have exports commitments, especially to the WHO’s COVAX program. 

Meanwhile, India has begun to accept vaccine registration from anyone aged 18 or older. In total, we’re talking about 800 million people, or 1.6 billion doses. It’s going to be a struggle.

The BBC offers more background on the Indian crisis. Needless to say, the world needs to help India.