Cybersecurity Saturday

The FEHBlog hopes that his readers enjoyed the 400th Thanksgiving holiday.

Congress will be in session for the next two weeks. Cyberscoop brings us up to date on the legislative effort to include a data breach and ransomware reporting provision in the must pass National Defense Authorization Act bill for the current federal fiscal year.

As we enter our country’s major holiday season, Tech Republic reports that “An alert issued Monday [November 22] by the Cybersecurity and Infrastructure Security Agency [CISA] and the FBI urged organizations to be on guard for ransomware attacks that take advantage of worker downtime during Thanksgiving [etc.].”

In the alert, CISA stressed that neither it nor the FBI have identified any specific threats that might occur on or around Thanksgiving. But with or without advanced warning, organizations need to be prepared for attacks designed to take advantage of the holiday.

ISACA offers an expert column on using zero trust and XDR to stop ransomware. The FEHBlog has linked to several columns on zero trust but he had not heard of XDR. It turns out that

XDR brings together information about possible attack elements (e.g., indicators of compromise [IoCs]) with logs of network traffic, quirky endpoint behavior, cloud and Software-as a-Service (SaaS) service requests, and server events for analysis. The power of XDR is that it goes beyond security information and event management (SIEM) which aggregates log data to include correlation, analysis and machine learning (ML)-augmented modelling. This forms the basis for an effective response.

By deploying an XDR solution (which can detect many attack elements) with a zero trust-enabled architecture (which hardens infrastructure against malicious attacks), one can substantially improve survivability against ransomware. So, deploy an IAM tool. Use multifactor authentication (MFA), at least for high-privilege accounts. Segment the network. And put an XDR tool in place for the security operations center (SOC). You will have a much calmer, more predictable, less eventful day-to-day work experience.

Because Bleeping Computer’s The Week in Ramsomware was not published Thanksgiving week, here is a Health IT Security overview of cybersecurity issues affecting the healthcare sector.

Thanksgiving Wrap Up

From the Delta variant mandate front, Federal News Network reports that

The federal government is at 96.5% compliance with the Biden administration’s COVID-19 vaccination mandate for employees and contractors, including civilian and military personnel.

Monday was the deadline to get vaccinated, and as of yesterday, the U.S. Agency for International Development, the departments of Commerce, Transportation, the Office of Personnel Management and the Small Business Administration all have at least 99% compliance with the mandate among employees. That includes the percentage of agency employees covered by a vaccination requirement with at least one dose of a COVID-19 vaccination, or a pending or approved exception or extension. Again, that’s for compliance — when it comes to actual vaccination or employees with at least one dose of a COVID vaccine, the compliance rates hovered between 86.1% and 97.8%.

That’s good news.

In Delta variant testing news, David Leonhardt in the New York Times Mornings column brings us a handy guide rapid COVID tests which are will work hand in glove with the Merck early COVID treatment pill that the Food and Drug Administration will consider for emergency use authorization next week.

The Covid tests that you take in a doctor’s office or testing center are usually PCR tests, which are designed to identify whether you have any amount of the Covid virus. They can sometimes come back positive even if you had the virus weeks earlier and have not been infectious for a long time.

The rapid tests — also known as antigen tests — are designed to tell whether you are infectious. That’s why they are such a powerful public-health tool. They can prevent somebody with the virus from spreading it to others.

“For too long, people thought of testing as an extra and not the core, and it needs to be thought of as the core,” Mara Aspinall, a professor at Arizona State University and former biotechnology executive, told Kaiser Health News.

The most widely available antigen test seems to be BinaxNOW, from Abbott. You should also feel comfortable using QuickVue, Ellume and Flowflex, among others. If you search for one of these tests online and a website points you to a different brand, do some research. Others can be very expensive.

Both CVS and Walgreens have search engines that let you find tests for sale near you. I recommend calling the store to confirm it still has them in stock — and then immediately going to buy it. A store may limit you to buying one test pack at a time. * * *

The F.D.A. approved three more tests this week, and the Biden administration continues to spend more to expand their availability.

By Christmas and New Year, tests should be easier to find than they are this week.

Fingers crossed.

In other news

After months of speculation, President Biden on Wednesday announced his intent to nominate the acting director of the Office of Management and Budget—currently Deputy Director Shalanda Young—to become the permanent leader. He also announced his pick to replace Young as deputy director. 

Young, a veteran of the House Appropriations Committee, has been serving as acting OMB director since the end of March when she was confirmed as deputy director, which followed the withdrawal of Neera Tanden’s nomination for the top job. Lawmakers from both parties immediately called on the administration to tap Young for the director role. 

Nani Coloretti, who the president will formally nominate as OMB deputy director, is currently a senior vice president at the Urban Institute. She has previously served in senior roles at the Housing and Urban Development and Treasury departments and Consumer Financial Protection Bureau. * * *

OMB’s role in advancing the administration’s priorities is critical. It manages the federal budget process, regulatory matters, procurement and management of the federal workforce (as demonstrated in the outline of the president’s management agenda released last week), including the return to office process and implementation of the coronavirus vaccine mandate.

Young is currently on maternity leave, so Jason Miller, OMB deputy director for management, is handling the day-to-day responsibilities. While the clock ran out earlier this month for some acting positions under the 1998 Federal Vacancies Reform Act, there is no time limit for acting OMB directors. 

  • Healthcare Dive provides an overview of third quarter financial reports from non-profit healthcare facilities, such as the Cleveland Clinic.

Nonprofit giant Cleveland Clinic posted operating revenue of $3.1 billion in the third quarter, up 13% year over year as net patient revenue swelled on an influx of patient activity. The Ohio academic medical center’s topline was also helped by higher outpatient pharmacy revenue, as utilization of outpatient and specialty drugs increased.

However, pandemic pressures weighed heavily on nonprofits in the quarter ended Sept. 30, as spending drove down operating incomes for systems like Providence HealthCommonSpirit and Kaiser Permanente, which shelled out more on overtime and staffing agencies, pharmaceuticals and medical supplies to respond to increased volumes.

The trend was common but not universal: Minnesota-based Mayo Clinic is an outlier, reporting a robust operating margin of 8% as revenue growth kept well above costs.

Cleveland Clinic operates 19 hospitals and a number of outpatient and ambulatory surgery centers, along with physician offices. Its network is most concentrated in northeast Ohio and Florida, though the system also operates centers in Toronto, Las Vegas and Abu Dhabi.

Have a wonderful Thanksgiving holiday.

Tuesday’s Tidbits

Photo by Patrick Fore on Unsplash

From the Delta variant front, David Leonhardt in the New York Times Mornings column tries to place the pre-Thanksgiving increase in COVID cases in perspective. He encourages readers to recognize that it’s the cadre over 65 and particularly those in their 80’s and 90’s who are threatened by COVID.

Covid is the threat on many of our minds. But for most people under 65, the virus may present less risk than a car trip to visit relatives this week.

The situation is more frightening for older people, especially those in their 80s and 90s. For the oldest age groups, Covid presents a real risk even after vaccination. It appears to be more dangerous than a typical flu and much more dangerous than time spent riding in a vehicle, based on C.D.C. data.

As a result, older Americans need protection during a surge. (The same is also true of a small percentage of younger people with specific vulnerabilities to Covid, like organ-transplant recipients.) The most effective way to protect vulnerable people is through vaccination — not only of them but also of others who might infect them [e.g., initial vaccinations for children beginning at age 5 and young teenagers and boosters for fully vaccinated adults, after two months for the Johnson & Johnson vaccine and six months for the mRNA vaccines.]

STAT News reminds us that the FDA will consider granting emergency use authorization to the Merck anti-viral pill for treating early COVID next Tuesday. However,

[C]linical trials for both the Pfizer and Merck antivirals focused on unvaccinated people with at least one risk factor for developing severe Covid-19. Trial data, as disclosed by the drug companies, shows them to be remarkably effective: No patient in either study died after being treated with a course of antivirals.

But it might be difficult to get the drugs outside a clinical trial setting. Depending on the particular patient, it could involve four individual steps: recognizing symptoms, receiving a positive Covid-19 test result, being prescribed an antiviral by a doctor, and picking up the pills at a nearby pharmacy.

Each step could prove difficult, Gaffney said, beginning with the challenge of recognizing symptoms during winter, when early signs of Covid-19 might be easily written off as a cold, flu, or allergies. Even if patients do quickly suspect they have Covid, diagnostic tests are still sometimes hard to come by. Many of the patients who test positive won’t have primary care physicians. And perhaps worst: The antivirals are ideally taken just three days after symptom onset, meaning the four-step process can’t face any setbacks.

Of all the challenges patients will face when seeking the antiviral treatments, the lack of access to efficient testing is by far the largest. * * *

[Céline] Gounder, a physician and NYU professor who served on President Biden’s Covid advisory board in the months before his inauguration] suggested that some immunocompromised people, for instance, should be prescribed the antivirals preemptively, if they’re exposed to Covid but haven’t tested positive — eliminating a potentially burdensome step. * * *

Ideally, though, people who live outside congregate settings would be able to access the same level of service at retail pharmacies. Other fixes, Gounder suggested, could include issuing a “standing order” for the drugs — essentially, allowing an entire city or state’s population to receive the drugs without a prescription.

In other words, we are close to having a Flonase for COVID.

From the Delta variant vaccine mandate front, the Wall Street Journal reports that

The Biden administration on Tuesday filed an emergency court motion that seeks the immediate reinstatement of its rules requiring many employers to ensure their workers are vaccinated or tested weekly for Covid-19.

The Justice Department filed the request with the Sixth U.S. Circuit Court of Appeals in Cincinnati, which last week was designated as the court that would decide legal challenges filed around the country to the vaccine-or-testing rules.

The Occupational Safety and Health Administration earlier this month formally issued the requirements, which apply to businesses with 100 or more employees. The rules cover roughly 84 million workers and are scheduled to take effect Jan. 4.

Also because the government contractor mandate requires contractors to verify its employees’ COVID vaccination status with supporting documents, the Society for Human Resource Management offers guidance on how employers can recognize fake vaccination cards.

From the tidbits department —

  • The Federal Times informs us that “Legislation introduced in the House Tuesday would not only establish credentials necessary for all future Office of Personnel Management directors, but also formally dictate the agency’s role in leading human resources through data-driven and modern policy. Under the bill, introduced by Rep. Gerry Connolly, D-Va., a nominee for OPM director would have to have prior human capital experience and be chosen without regard for political affiliation.”

The [independent dispute] system chosen by the Biden administration was expected to push insurance premiums down by 0.5% to 1%, the Congressional Budget Office estimated.

“Everyone has to give a little to get to a good place,” [HHS Secretary] Becerra said. “That sweet spot, I hope, is one where patients … are extracted from that food fight [between out of network providers and health plans]. And if there continues to be a food fight, the arbitration process will help settle it in a way that is efficient, but it also will lead to lower costs.”

  • The International Foundation of Employee Benefit Plans provides its insights into the new proposed rule on ACA reporting referenced in yesterday’s FEHBlog post. The proposed rule would provide:

— An Automatic 30-Day Extension of Deadline for Furnishing Statements Under Sections 6055 and 6056

— An Alternative Manner of Furnishing Statements Under Section 6055 During Taxable Years When the Individual Shared Responsibility Payment is Zero

Under the proposed alternative manner of furnishing, the reporting entity must post a clear and conspicuous notice on the entity’s website stating that responsible individuals may receive a copy of their statement upon request. The notice must include an email address, a physical address to which a request may be sent, and a telephone number that responsible individuals may use to contact a reporting entity with any questions.

The public comment period on this IRS proposed rule ends in roughly sixty days.

  • Govexec offers a helpful to-do list for the ongoing Federal Benefits Open Season from Nov. 8-Dec. 13
  1. Use the plan comparison tools available at OPM’s website and Checkbook’s Guide to Federal Health Plans to compare the top three or four health plan options for you and your family’s needs.
  2. Register to attend a virtual health fair hosted by the Federal Long Term Care Insurance Program. There will be live chat days on Nov. 12, Nov. 19, Dec. 1, and Dec. 8. 
  3. The National Active and Retired Federal Employees Association’s Federal Benefits Institute will have a variety of resources available during open season, including a live webinar series. 

Monday Roundup

Photo by Sven Read on UnsplashFr

From the Delta variant front, STAT News informs us that

Pfizer and BioNTech announced Monday that their Covid-19 vaccine was 100% efficacious in preventing infections in 12- to 15-year-olds, measured from seven days to four months after administration of the second dose of the vaccine.

The companies said the new data — a longer-term analysis of a Phase 3 trial conducted in 2,228 participants — will form the basis of an application to the Food and Drug Administration for an extension of their Covid-19 vaccine license to cover youths in the age group. 

“These are the first and only disclosed longer-term data demonstrating the safety and efficacy of a Covid- 19 vaccine in individuals 12 to 15 years of age,” Ugur Sahin, CEO and co-founder of BioNTech, said in a statement. “The growing body of data we have compiled from clinical trials and real-world surveillance to date strengthen the base of evidence supporting the strong efficacy and favorable safety profile of our Covid-19 vaccine across adolescent and adult populations.”

Astra-Zeneca announced late last week that

New data from the AZD7442 COVID-19 PROVENT prevention and TACKLE outpatient treatment Phase III trials both showed robust efficacy from a one-time intramuscular (IM) dose of the long-acting antibody (LAAB) combination.

In an analysis of the ongoing PROVENT trial evaluating a median six months of participant follow-up, one 300mg IM dose of AZD7442 reduced the risk of developing symptomatic COVID-19 compared to placebo by 83%.

About 2% of the global population is considered at increased risk of an inadequate response to a COVID-19 vaccine.This includes people with blood cancers or other cancers being treated with chemotherapy, patients on dialysis, those taking medications after an organ transplant or who are taking immunosuppressive drugs for conditions including multiple sclerosis and rheumatoid arthritis.2-6

The AZD7442 PROVENT trial is the first Phase III trial prospectively designed to evaluate a monoclonal antibody for pre-exposure prophylaxis of symptomatic COVID-19, with targeted inclusion of high-risk and immunocompromised participants. More than 75% of PROVENT participants at baseline had co-morbidities that put them at high risk for severe COVID-19 if they were to become infected, including people who are immunocompromised and may have a reduced immune response to vaccination.

There were no cases of severe COVID-19 or COVID-19-related deaths in those treated with  AZD7442 at either the primary or six-month analyses. In the placebo arm, there were two additional cases of severe COVID-19 at the six-month assessment, for a total of five cases of severe COVID-19 and two COVID-related deaths.

Developing new early treatment options is encouraging news. Kaiser Health News reminds us that the success of these new early anti-viral treatments hinges on widespread availability of inexpensive at home COVID tests.

From the Delta variant vaccine mandate front, Federal News Network tells us that

More than 90% of federal employees have received at least one dose of the COVID-19 vaccine by the president’s deadline, a senior administration official said Monday.

Most of those employees are fully vaccinated, the Biden administration said. All told, some 95% of employees have taken steps to comply with the Biden administration’s federal vaccine mandate by the Nov. 22 deadline — a figure that includes partially and fully vaccinated employees, as well as those who have a medical or religious exception pending or approved.

“Critically, the Nov. 22 deadline is not an end point; we continue to see more and more federal employees providing their information and getting their shots,” the administration official said in an email.

Agencies will continue to collect information, as well as requests for exceptions “due to documented medical necessities” in the coming days, the White House said.

The Office of Management and Budget will release a more detailed breakdown of vaccination rates within individual agencies on Wednesday.

The Society for Human Resource Management offers an article about the role of boosters in employer sponsored vaccination programs:

All U.S. adults are now eligible to receive a COVID-19 vaccine booster, so long as a certain number of months have passed since their last dose. As employers revise their vaccination policies, they may be wondering if they should require workers to get an extra jab to be considered “fully vaccinated.” Here’s what employment law attorneys had to say. 

At least for now, employment law attorneys recommend that businesses hold off on mandating booster shots.

“At this point, I think it is probably too soon to make those updates,” said Jim Hermon, an attorney with Dykema in Detroit. 

John Thomas Jr., an attorney with McGuireWoods in Tysons, Va., noted that employers are focused on helping their employees get over the hurdle of initial vaccination. “Some geographic areas—and some industries—are still struggling to reach a critical mass of people willing to get the shot in the first place.”  * * *

Although it may be too soon for many employers to add booster shots to their vaccination policies, attorneys said workplace leaders can start planning now. 

“I think it is company-specific,” said Katherine Dudley Helms, an attorney with Ogletree Deakins in Columbia, S.C. Some workplaces have seen a high percentage of employees get vaccinated, she said, so it might make sense to add the boosters to their recommendations as the shots are authorized. 

On the other hand, she noted, if the workforce vaccination rate is low or vaccination has been a battle for the employer, it may be wiser to try to focus on raising the rate of initial vaccination rather than adding the booster on top of that. Even with this approach, she said, an employer can certainly support and encourage employees who are eligible and wish to get the booster shot.

“My experience is that those who do not mandate vaccinations are preparing policies and practical plans for the likelihood that they may become mandatory either because of federal requirements or because the timing is right,” Helms observed.

Just as with the initial vaccinations, she said, employers should let workers know if the company will pay for the costs associated with getting the booster, including the time spent getting the shot. Employers should also address how time off will be treated if employees have a reaction.

From the Rx coverage from, Med City News reports on Walgreen’s new strategy. “The company launched a new health division, and has doubled down on its plans to open primary care clinics with VillageMD. It faces big competitors in CVS and Walmart, and it’ll take time to see if its new strategy pays off.” Walgreen’s, of course, is not alone in this endeavor.

Neal Batra and David Betts, who have studied consumers’ thoughts on healthcare for Deloitte, said people are primarily looking for three things: meaningful interactions with their provider, visits that make economic sense, and convenience. Booking a visit a month out to spend 10 minutes with a doctor ticks none of these boxes.

“We’ve believed for a long time that this [retail approach taken by Walgreen’s, CVS Health and Walmart, among others] is the direction that consumer healthcare will go. What we see now is that playing out,” said Betts, who leads the public health transformation effort for Deloitte Consulting.

The pandemic, in some ways, accelerated that. People didn’t want to sit in busy waiting rooms, and were more open to other care modalities, like telehealth. Pharmacy chains were also given big contracts for Covid-19 testing and vaccines, driving more people to their stores.

Batra, a principal in Deloitte’s Life Sciences and Health Care practice, said “it’s super logical” for retailers to look at primary care, because it involves routine visits and engagement points.

“It’s a very natural place to enter,” he said. “Are you going to see some of these models continue what we would call an upmarket march to go after more and more complex aspects of primary care, or even dip their toe into specific therapy areas that are more specialized? It remains to be seen, but our expectation is yes.”

For example, pharmacies could offer blood-pressure measurements, and blood-glucose testing for people with prediabetes or diabetes. For retailers, the cost of doing this would be relatively low, while the value for patients would be high.

From the ACA front, the Internal Revenue Service today released a proposed rule on ACA reporting by insurers and self-funded employers, Forms 1095 and 1096. The FEHBlog still needs to review it. The reporting which was developed to support enforcement of the ACA’s tax penalties for failure to carry minimum essential coverage are a mysterious component of the zeroed out penalty world that has existed for three years. The handful of states and DC which have adopted individual mandates can use the IRS forms.

Weekend Update

Photo by Tomasz Filipek on Unsplash

Congress is on a State/District work break this week, which includes the Thanksgiving holiday.

Before leaving town the House of Representatives passed its own version of the social and climate spending budget reconciliation bill (H.R. 5376). The Society for Human Resource Management reports that the wide-ranging House bill

contains several provisions affecting employer-sponsored benefits. Two of the most important—a new paid-leave program and a modification of the “firewall” that has prevented employees from receiving premium tax credits to subsidize buying health plans on the Affordable Care Act (ACA) marketplace—are highlighted [in the article], along with other provisions effecting retirement savings plans and new penalties for labor law violations.

The SHRM article also notes that the bill “faces an uncertain future in the U.S. Senate.”

Meanwhile Roll Call reports that the Senate will continue next week its work on the must pass National Defense Authorization Act.

From the Delta variant front, the Wall Street Journal reports today that

Spotty U.S. data have clouded the view of just how many fully vaccinated people are getting Covid-19, landing in hospitals and dying. The Centers for Disease Control and Prevention doesn’t publish a running tally on raw breakthrough numbers. The Journal reviewed medical-record data for a total of more than 21 million fully vaccinated people, and an array of state reports, to compile its analysis. In particular, people with diabetes, chronic lung disease, kidney disease and compromised immune systems were at risk of serious outcomes from breakthrough cases, the data show. * * *

The likelihood of having a breakthrough infection was still low, though confirmed infections were more common for people with these illnesses. About 1.5% of roughly 110,000 people with chronic kidney disease had one, for example. But Truveta found about a quarter of breakthrough patients with chronic kidney disease wound up hospitalized. The likelihood of hospitalizations for people with breakthrough cases but without underlying health problems was about 7.5%.

Breakthrough deaths are hitting older people the hardest, amplifying a well-worn pandemic pattern. Exclusive data the Journal reviewed from the Epic Health Research Network, which analyzes data from the medical-record software company Epic Systems Corp., shows about 80% of breakthrough deaths among the vaccinated are in people ages 65 and older. The data included records for 19.5 million fully vaccinated people. Among all Covid-19 deaths this year, that age group represents closer to 69%, according to the CDC.

The Epic Health Research Network data also point to more severe breakthrough cases in the most vulnerable patients, who were identified using a federal measure of social and economic factors. “This is magnifying underlying health disparities that we’re seeing,” said Harvard T.H. Chan School of Public Health researcher Thomas Tsai, co-author of a study that found the most-vulnerable communities had twice the odds of hospitals with ICUs near capacity than the least-vulnerable areas, using the same federal measure.

From the substance use front, The New York Times reports today

Fentanyl is the third wave of an opioid epidemic that began in the 1990s with prescription pills, followed by exploding heroin use.

Now communities are struggling under an onslaught of fentanyl. The reasons are multilayered: As pharmaceutical companies have tightened the tap on prescription pain pills following a raft of legal losses for their role in causing the opioid epidemic, the pills have become scarce on the black market. Addicts have turned to fentanyl for their fix.

To profit off the situation, cartels and small-time manufacturers have flooded in caches of imitation pills — fentanyl tablets mimicking prescription brands. In September, the United States Drug Enforcement Administration issued a public safety alert: More than 40 percent of black-market prescription pills contain lethal amounts of fentanyl.

“Like a wolf in sheep’s clothing, these pills are lethal,” Ray Donovan, then the D.E.A’.s special agent in charge of the New York division, said in a statement.

The article concludes

In Suffolk County, [on Long Island] Odette R. Hall, the chief medical examiner, is using the new mass spectrometer to dig through deaths, to figure out whether fentanyl or its analogues were to blame — or, she fears, whatever novel drug is coming next.

“Whatever is happening on the street,” Dr. Hall said, “is always going to be a step ahead.”

From the Alzheimer’s Disease front and given all of the understandably negative news of the Biogen drug Aduhelm, Boston’s Brigham and Women’s Hospital announced last week that their researchers were

set to begin a clinical trial that will test the safety and efficacy of a new vaccine delivered nasally intended to prevent and slow the progression of Alzheimer’s disease (AD). The trial represents the culmination of nearly 20 years of research led by Howard L. Weiner, MD, co-director of the Ann Romney Center for Neurologic Diseases at the Brigham.

“The launch of the first human trial of a nasal vaccine for Alzheimer’s is a remarkable milestone,” said Weiner. “Over the last two decades, we’ve amassed preclinical evidence suggesting the potential of this nasal vaccine for AD. If clinical trials in humans show that the vaccine is safe and effective, this could represent a nontoxic treatment for people with Alzheimer’s, and it could also be given early to help prevent Alzheimer’s in people at risk.” 

The vaccine uses the immune modulator Protollin, an investigational intranasal agent that stimulates the immune system. Protollin is composed of proteins derived from bacteria and has been used safely in humans as an adjuvant for other vaccines. Protollin is designed to activate white blood cells found in the lymph nodes on the sides and back of the neck to migrate to the brain and trigger clearance of beta amyloid plaques — one of the hallmarks of AD. I-Mab Biopharma (I-Mab) and Jiangsu Nhwa Pharmaceutical (NHWA) are responsible for the development, manufacturing and commercialization of Protollin.

“For 20 years, there has been growing evidence that the immune system plays a key role in eliminating beta amyloid. This vaccine harnesses a novel arm of the immune system to treat AD,” said Tanuja Chitnis, MD, professor of Neurology at the Brigham and principal investigator of the trial. “Research in this area has paved the way for us to pursue a whole new avenue for potentially treating not only AD, but also other neurodegenerative diseases.”

Fingers and toes crossed on this one.

Reminder — The Federal Benefits Open Season ends on December 13, 2021, three weeks from tomorrow.

Cybersecurity Saturday

From Capitol Hill, the Hill informs us that

The Senate is eyeing the annual defense bill as a vehicle to attach critical provisions to improve the nation’s cybersecurity following a devastating year in which major attacks left the government flat-footed.  

The [bipartisan] amendment [to the National Defense Authorization Act] would give critical infrastructure groups, nonprofit organizations, state and local governments, and certain businesses 24 hours to report ransomware attack payments. It also includes language to update the Federal Information Security Modernization Act (FISMA) to clarify the roles of key agencies in responding to cyber incidents, another key bipartisan priority. 

“It’s got broad bipartisan support, and we are hoping to get it in this package,” Peters told The Hill Wednesday. “Of course, we’ve got negotiations and then the House, and we’ve been working with our House counterparts too.”

The House already approved its version of the 2022 NDAA in September, including a raft of measures in the defense package intended to strengthen the nation’s cybersecurity.

Cyberscoop provides more breach notice news

Banks must report major cybersecurity incidents to federal officials within 36 hours under a rule that U.S. financial regulators finalized on Thursday.

Beginning in May 2022, financial executives will need to be more forthcoming about computer system failures and interruptions, such as ransomware or denial-of-service attacks that have the potential to disrupt customers’ ability to access their accounts, or impact the larger financial system. * * *

The final approval comes as Congress weighs broader reporting rules for critical infrastructure owners and operators, and as the Transportation Security Administration has begun imposing reporting requirements on leading pipeline, rail and air transport companies.

The 36-hour timeline for banks falls between the leading proposals on Capitol Hill at around 72 hours, and the TSA rules at 12 hours.

OPM allows FEHB carriers a 24 hour period to notify the agency about a breach or security incident.

On the advanced persistent threat front, Health IT Security reports that

US cyber officials along with allies from Australia and the UK issued an advisory warning the healthcare and transportation sectors about an Iranian government-sponsored advanced persistent threat (APT) group that has been exploiting Microsoft Exchange ProxyShell and Fortinet vulnerabilities. * * *

The FBI, CISA, ACSC, and NCSC recommend that organizations using Microsoft Exchange or Fortinet stay cautious and look for the following signs of suspicious activity:

— Search for IOCs. Collect known-bad IOCs and search for them in network and host artifacts. 

— Investigate exposed Microsoft Exchange servers (both patched and unpatched) for compromise. 

— Investigate changes to Remote Desktop Protocol (RDP), firewall, and Windows Remote Management (WinRM) configurations that may allow attackers to maintain persistent access. 

— Review domain controllers, servers, workstations, and active directories for new or unrecognized user accounts.

— Review Task Scheduler for unrecognized scheduled tasks. Additionally, manually review operating-system defined or recognized scheduled tasks for unrecognized “actions” (for example, review the steps each scheduled task is expected to perform).

Review antivirus logs for indications they were unexpectedly turned off.

Look for WinRAR and FileZilla in unexpected locations. 

To mitigate risk, the FBI, CISA, NCSC, and ACSC urged organizations to patch and update operating systems, evaluate and update blocklists and allowlists, and implement backup and restoration policies. In addition, organizations should implement network segmentation, work to secure all user accounts, implement multi-factor authentication, secure remote access, and use strong passwords.

For more information, see CISA’s assessment and overview of the ongoing Iranian cyber threat. 

Also on the prevention front CISA announced that

The White House, via Executive Order (EO) 14028: Improving the Nation’s Cybersecurity, tasked CISA, as the operational lead for federal cybersecurity, to “develop a standard set of operational procedures (i.e., playbook) to be used in planning and conducting cybersecurity vulnerability and incident response activity” for federal civilian agency information systems. In response, today, CISA published the Federal Government Cybersecurity Incident and Vulnerability Response Playbooks. The playbooks provide federal civilian executive branch (FCEB) agencies with operational procedures for planning and conducting cybersecurity incident and vulnerability response activities. The playbooks provide illustrated decision trees and detail each step for both incident and vulnerability response.  
FCEB agencies should use the playbooks to shape their overall defensive cyber operations. The playbooks apply to information systems used or operated by an FCEB agency, a contractor of the agency, or another organization on behalf of the agency. CISA encourages agencies to review the playbooks and CISA’s webpage on EO 14028 for more information.  
Although CISA created the playbooks for FCEB agencies, we encourage critical infrastructure entities; state, local, territorial, and tribal government organizations; and private sector organizations to review them to benchmark their own vulnerability and incident response practices.

CISA also updated its known exploited vulnerabilities catalog.

And of course, here is a link that the Bleeping Computer’s The Week in Ransomware.

While last week was full of arrests and law enforcement actions, this week has been much quieter, with mostly new research released.

Security firms released reports on the types of cryptomixers used by ransomware gangs, a detailed report on Conti, and how Russian ransomware gangs are starting to work with Chinese hackers.

ZDnet adds that “Ransomware is now a giant black hole that is sucking in all other forms of cybercrime
File-encrypting malware is where the money is — and that’s changing the whole online crime ecosystem.”

Friday Stats and More

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 weekly chart of new COVID cases:

Here is a link to the CDC’s weekly chart of new COVID hospital admissions which trended up by 5.4% from last week. However, the FEHBlog’s weekly chart of new COVID deaths has begun to trend down again.

Here’s FEHBlog’s weekly chart of new COVID vaccinations distributed and administered.

The vaccinations administered line continues to trend up. The CDC’s COVID vaccinations site now displays vaccinations administered to the age 5 to 11 group. Nearly 70% of the over age 12 population is fully vaccinated, and 97.5% of the age 65+ population has received at least one dose of the COVID vaccine. That’s impressive.

In Delta variant booster news, the CDC informs us that over one quarter of the age 50+ has received the booster. AHIP informs us that

Today the Food and Drug Administration (FDA) amended the emergency use authorizations (EUA) for both the Moderna and Pfizer-BioNTech COVID-19 vaccines, authorizing use of a single booster dose for all individuals 18 years of age and older after completion of primary vaccination with any FDA-authorized or approved COVID-19 vaccine. This amendment expands the use of booster doses of both vaccines to include all adults at least six months after completion of the primary vaccination series of the Moderna COVID-19 Vaccine or Pfizer-BioNTech COVID-19 Vaccine or at least two months after completion of primary vaccination with the Janssen COVID-19 Vaccine.

The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) also met today to discuss further clinical recommendations on the use of COVID-19 vaccine booster doses for adults. After reviewing the most recent safety and efficacy data of the Pfizer and Moderna booster doses, which showed the vaccines to be safe, the Committee unanimously (11-0) voted in favor of authorizing:

— A single COVID-19 vaccine booster dose is recommended for persons aged 18 and olderwho received an mRNA COVID vaccine primary series based on individual benefits and risks, at least 6 months after the primary series, under the FDA’s Emergency Use Authorization (EUA).

— A single COVID vaccine booster dose is recommended for persons aged 50 and older who received an mRNA COVID vaccine, at least 6 months after the primary series, under the FDA’s EUA.

Any FDA-approved or authorized COVID-19 vaccine can be used for a booster dose, regardless of vaccine received for a primary series.

The committee emphasized that the top priority continues to be vaccination of the unvaccinated, and that potential side effects of vaccination, such as incidence of myocarditis and pericarditis, need continual monitoring as more data becomes available.

Medscape adds that

Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky, MD, signed off on a recommendation Friday evening to let all US adults get a COVID-19 booster shot.

The endorsement, following a unanimous vote by a panel of CDC advisors earlier in the day backing a third dose of a Moderna or Pfizer mRNA COVID vaccine, now means everyone over the age of 18 is eligible for a booster.

According the ACA FAQ 50, health plans now must covered vaccines administered to the expanded group.

Here is a link to the CDC’s weekly interpretation of its COVID statistics.

In other news / the “more”:

  • The Department of Health and Human Services announced today that “Today, the Biden-Harris Administration unveiled details about the establishment of a new federal advisory committee, the Ground Ambulance and Patient Billing (GAPB) Advisory Committee. As mandated through the No Surprises Act, the GAPB Advisory Committee will be charged with providing recommendations to the Secretaries of Health and Human Services (HHS), Labor, and Treasury on ways to protect consumers from exorbitant charges and balance billing when using ground ambulance services. * * * Learn more about the GAPB Advisory Committee and the Federal Register Notice – PDF.”
  • Beckers Hospital News reports that “Insurers need more evidence of the clinical benefit of Biogen’s controversial Alzheimer’s drug Aduhelm before they start paying for it, Bloomberg reported Nov. 18. Bloomberg surveyed 25 of the nation’s largest insurers, and none of them deemed the drug “medically necessary.” Most indicated they view the drug as experimental and said they needed to see more evidence on the drug’s ability to slow cognitive decline.”
  • Govexec tells us that “About 90% of NASA employees have received at least one dose of a COVID-19 vaccination, according to agency data, but about 1,150 workers are seeking an exemption to President Biden’s governmentwide mandate.”
  • mHealth Intelligence informs us that “The number of outpatient visits after hospital discharges remained stable during the COVID-19 pandemic but telehealth use for these visits increased, suggesting that telehealth was a substitute for in-person care rather than an addition, a study published in JAMA Health Forum revealed.”
  • The Wall Street Journal provides an overview of currently available and near future COVID treatments.

Thursday Miscellany

OPM Headquarters a/k/a the Theodore Roosevelt Building

The FEHBlog discovered OPM’s Agency Financial Report for the 2021 fiscal year, dated November 2020, on its website tonight. The most interesting discussion of the FEHB begins at page 125, the start of OPM’s response to the Inspector General’s top management challenges paper.

From the Delta variant vaccine front, Politico reports tonight that

The Food and Drug Administration on Friday is expected to authorize Moderna’s Covid-19 booster shot for all adults — a move that would come in tandem with the clearance of Pfizer-BioNtech’s booster for widespread use, two people with knowledge of the matter told POLITICO.

The decision comes just days after Moderna officially asked the FDA to green-light its booster for Americans 18 and older, and reflects the administration’s growing unease over the recent rise in Covid-19 cases across the nation.

The FDA had previously planned to authorize Pfizer’s booster shot this week, enabling the government to roll out shots to millions more people ahead of the Thanksgiving holiday.

But after Moderna filed a similar request on Wednesday, officials began debating whether to speed that authorization along as well, the people with knowledge of the matter said.

The FDA declined to comment.

From the Open Season front, Govexec discusses how to get the biggest bang for your buck in dental benefits if you are a federal or postal employee / annuitant.

From the telehealth front, Fierce Healthcare informs us that

In a report from Quest Diagnostics released Monday, 67% of the over 500 primary care physicians surveyed said they fear they missed signs of drug abuse in their patients during the pandemic.

And nearly all of them were prescribing those often-misused drugs—a whopping 97% reported prescribing opioids within 6 months of taking the survey.

Their concerns extend beyond the pandemic into telemedicine use today. Only 50% of physicians said they were confident they could recognize signs of drug misuse during telehealth visits, a far cry from the 91% that said the same of in-person patient interactions.

From the Rx coverage front, the Wall Street Journal reports that

CVS Health Corp. said Thursday it will close 900 stores over the next three years, nearly 10% of its U.S. locations, while adding more health services at remaining locations.

The largest U.S. pharmacy chain said it would close 300 stores a year while adding primary-care offices at certain sites as well as converting more stores into so-called health hubs with offerings such as diagnostic testing, mental-health services and hearing exams.

“The company has been evaluating changes in population, consumer buying patterns and future health needs to ensure it has the right kinds of stores in the right locations for consumers and for the business,” CVS said in a statement.

A CVS spokesman said the company doesn’t yet have a list of which stores are closing, a process that will begin early next year. 

From the strategy front, Federal News Network tells us that

The Biden administration on Thursday laid out the vision for its President’s Management Agenda, detailing three broad goals and four values that will drive a multi-year, multi-faceted effort throughout the government.

The initial vision is a roadmap that explains how the administration will build capacity within government agencies to make good on the president’s broader agenda, Jason Miller, deputy director for management at the Office of Management and Budget, said.

“The how matters. This president has been clear from day one that how we do things shapes what we can do,” Miller told reporters Wednesday evening.

To that end, the Biden administration said values of equity, dignity, accountability and results would drive its PMA priorities. Each priority has multiple underlying strategies.

Those priorities are:

Strengthening and empowering the federal workforce

Delivering excellent, equitable and secure federal services and customer experiences

Managing the business of government to “build back better”

“This simple, yet powerful three-part approach builds on lessons learned across administrations, while also repairing damage done over time to the federal government, by strengthening its capacity to deliver results,” Miller said.

The administration wanted to keep the PMA simple, and it explicitly wanted to avoid setting “dozens and dozens of new initiatives,” Miller added.

Meritalk adds

The Office of Personnel Management (OPM) and the Office of Management and Budget (OMB) are set to release their four-year strategic plan later this month, according to OPM Director Kiran Ahuja, who previewed what the Federal government can expect to see in that plan.

During an FCW event today, Ahuja said the four-year strategic plan is currently “in OMB’s hands and will be released fairly soon.” Ahuja also said the plan will focus on rebuilding the Federal workforce.

“We have an opportunity to remake it, both in the early career talent that we need to bring in, as well as the importance of professional development opportunities,” Ahuja said.

She went on to say the plan will also focus on the Federal workforce becoming “the model employer,” through both telework and remote work flexibilities, as well as “a whole range of efforts,” including providing support to the Federal workforce and leaning in to “a hybrid work environment and being an example there.”

It seems like yesterday that OPM released its last four year plan in 2018.

Midweek Update

Photo by Josh Mills on Unsplash

From the Delta variant vaccine front, the New York Times reports

The Food and Drug Administration is aiming to authorize booster doses of Pfizer-BioNTech’s coronavirus vaccine for all adults as early as Thursday, a move that would expand the number of Americans eligible for additional shots by tens of millions, according to people familiar with the agency’s plans.

The Centers for Disease Control and Prevention’s independent committee of vaccine experts has scheduled a meeting for Friday to discuss data on the booster dose’s efficacy and safety. If both the F.D.A. and the C.D.C. sign off this week, they will have acted strikingly quickly — a little more than a week after Pfizer asked for authorization of boosters for everyone 18 and older.

Under that scenario, any adult who received a second dose of the vaccine at least six months earlier would be officially eligible to get a booster as soon as this weekend. The F.D.A. is expected to rule without consulting its own expert panel, which has met frequently during the pandemic to review vaccine data and make a recommendation ahead of a regulatory decision.

Moderna is expected to soon submit its own request for the F.D.A. to broaden eligibility for its booster. But for now, every adult could get the Pfizer booster, according to people familiar with the planning.

From the Delta variant research front, the National Institutes of Health has announced that

Lung autopsy and plasma samples from people who died of COVID-19 have provided a clearer picture of how the SARS-CoV-2 virus spreads and damages lung tissue. Scientists at the National Institutes of Health and their collaborators say the information, published in Science Translational Medicine, could help predict severe and prolonged COVID-19 cases, particularly among high-risk people, and inform effective treatments.

From the Delta variant vaccine mandate front, Govexec tells us that

The White House will not back down from next week’s deadline for virtually all federal employees to prove they are vaccinated against COVID-19, despite calls for a delay.  The federal workforce has until Nov. 22 to provide documentation demonstrating they are inoculated or to request an exemption under an executive order issued by President Biden. 

From the opioid epidemic front, the Washington Post informs us that

The U.S. drug epidemic reached another terrible milestone Wednesday when the government announced that more than 100,000 people had died of overdoses between April 2020 and April 2021. It is the first time that drug-related deaths have reached six figures in any 12-month period. * * *

The new data shows there are now more overdose deaths from the illegal synthetic opioid fentanyl than there were overdose deaths from all drugs in 2016.

Fentanyl is many times more powerful than morphine, leading to more frequent fatal overdoses. It is increasingly laced into other drugs, such as cocaine, and counterfeit pills, killing some who consume it unknowingly.

During the worst of the pandemic, more users were alone, reducing the chances that other users or bystanders could call first responders in the event of an overdose, experts have said. * * *

The number of opioid prescriptions issued by health-care providers has declined sharply as the crisis continues.

Addiction preys on young and middle-aged adults, who make up the bulk of those with drug-related substance use disorder.

Compounding the problem is the fact as related by Sam Quinones in his recent book the Least of Us that while a lethal dose of heroin takes about 15 minutes to kill a person, a lethal dose of fentanyl will take a minute or two to do so. That’s hardly enough time to administer naloxone which can pull people back from the brink of death. The FEHBlog wishes that Pfizer and Merck could develop a pill to cure substance abuse.

From the Open Season front, Reg Jones in Fedweek offers thoughts on how to use the ongoing federal benefits open season to the readers’ advantage.

From the No Surprises Act front, Healthcare Dive reports that

A key sticking point [stemming from the tri-agencies’ independent dispute resolution interim final rule] is the arbitration process, and how the qualifying payment amount (QPA) — determined by a plan’s median in-network contracted rate for a geographic area — is used to arrive at rates for out-of-network providers.

The Association of Air Medical Services filed a lawsuit in federal [district] court [for the District of Columbia, No. 1:21-cv-03031] challenging the rules Tuesday, claiming reliance on a QPA strays from Congress’ intent when passing the law that “no single statutory factor receives special weight” in the arbitration process.

As the FEHBlog previously noted, the Texas Medical Association has filed a similar lawsuit in the Lone Star State.

Encouragingly, Healthcare Dive adds that

The rules guiding the arbitration process are a form of consumer protection, 63 organizations representing patients, consumers, unions and employers said in a Tuesday letter.

An over reliance on out-of-network charges, particularly among Wall Street-backed providers, extracts maximum costs from patients, employers and health systems, thus driving up premiums and contributing to ever-rising healthcare spending in America, they said.

“As outlined in the interim final rule, it is only by reinforcing the QPA as the overriding and primary factor for determining final payment that the No Surprises Act can achieve the $17 billion in cost savings outlined by the Congressional Budget Office,” the groups wrote.


Also from the NSA front, the tri-agencies and OPM released an interim final rule implementing NSA Section 204’s burdensome yet aggregated prescription drug and healthcare cost reporting requirements imposed on health plans. The accompanying fact sheet explains

Summary of the November 17, 2021 IFC

This IFC requires plans and issuers in the group and individual markets to submit certain information on prescription drug and other health care spending to the Departments annually, including:

General information regarding the plan or coverage;

Enrollment and premium information, including average monthly premiums paid by employees versus employers; 

Total health care spending, broken down by type of cost (hospital care; primary care; specialty care; prescription drugs; and other medical costs, including wellness services), including prescription drug spending by enrollees versus employers and issuers;

The 50 most frequently dispensed brand prescription drugs;

The 50 costliest prescription drugs by total annual spending;

The 50 prescription drugs with the greatest increase in plan or coverage expenditures from the previous year; 

Prescription drug rebates, fees, and other remuneration paid by drug manufacturers to the plan or issuer in each therapeutic class of drugs, as well as for each of the 25 drugs that yielded the highest amount of rebates; and 

The impact of prescription drug rebates, fees, and other remuneration on premiums and out-of-pocket costs.

The IFC provides that plan sponsors, issuers, and FEHB carriers generally will be required to submit this information aggregated at the state/market level, rather than separately for each plan. To ensure that the Departments and OPM are able to conduct meaningful data analysis and identify prescription drug trends, the IFC further provides uniform standards and definitions, including for identifying prescription drugs regardless of the dosage strength, package size, or mode of delivery.

Applicability Date and Comment Period

The CAA requires plans and issuers to begin submitting the required information to the Departments by December 27, 2021, and to submit this information by June 1 of each year thereafter. However, the Departments have announced that they will exercise discretion to provide temporary deferral of enforcement with regard to the December 27, 2021 and June 1, 2022 deadlines, and that they will not initiate enforcement action against a plan or issuer that submits the required information for 2020 and 2021 by December 27, 2022. OPM also will allow its FEHB carriers to report information for 2020 and 2021 by December 27, 2022.

Comments on this IFC are due at 5 p.m. on January 24, 2022.

Before long, health plans, and especially FEHB carriers, will be spending most of their time reporting data to the government.

Tuesday’s Tidbits

Photo by Patrick Fore on Unsplash

From Capitol Hill, we learn that “U.S. Reps. Diana DeGette (D-CO) and Fred Upton (R-MI) today introduced their highly anticipated, bipartisan Cures 2.0 legislation that some leading health care organizations are calling a potential “game changer” in how the U.S. conducts biomedical research going forward.” Here’s a link\ to a Fierce Healthcare article on the bill.

From the Food and Drug Administration front —

  • The Wall Street Journal reports that “Pfizer said it asked U.S. health regulators to authorize its oral Covid-19 drug for use in high-risk patients, putting the pill on a path that could make it available for people to take at home by the end of the year.  Clearance from the U.S. Food and Drug Administration would give patients and doctors an easy-to-use treatment to keep people out of the hospital early in the course of the disease.” Moreover, “Pfizer Inc. is licensing its experimental Covid-19 antiviral to a global health organization in an effort to make the pill more readily available to people in low- and middle-income countries. Under the licensing agreement, the United Nations-backed Medicines Patent Pool will work with other drugmakers to manufacture the pill for use in 95 countries, including in sub-Saharan Africa, Pfizer and the nonprofit said Tuesday.”
  • The agency announced that authorizing “marketing of EaseVRx, a prescription-use immersive virtual reality (VR) system that uses cognitive behavioral therapy and other behavioral methods to help with pain reduction in patients 18 years of age and older with diagnosed chronic lower back pain. “Millions of adults in the United States are living with chronic lower back pain that can affect multiple aspects of their daily life,” said Christopher M. Loftus, M.D., acting director of the Office of Neurological and Physical Medicine Devices in the FDA’s Center for Devices and Radiological Health. “Pain reduction is a crucial component of living with chronic lower back pain. Today’s authorization offers a treatment option for pain reduction that does not include opioid pain medications when used alongside other treatment methods for chronic lower back pain.”

From the Delta variant vaccine mandate front, Reason informs us that

The ping-pong ball has been drawn, and the U.S. Court of Appeals for the Sixth Circuit is the winner. All of the various state, industry, and union challenges to the Occupational Safety and Health Administration’s Emergency Temporary Standard (ETS) mandating large employers to require vaccination or regular testing and masking of employees will be consolidated into a single proceeding in the Sixth Circuit.

Given that challenges had been filed in all twelve regional circuits, and there are over three-dozen parties, this will be one bear of a case. Red states and employer groups initially filed in the more conservative circuits, including the Fifth Circuit which issued a stay on Friday, arguing that OSHA’s action was unlawful. Blue states and progressive groups responded by filing challenges in more liberal circuits, alleging that OSHA’s ETS is too lax. Each side was trying to increase the chances that the case would be consolidated on favorable turf by increasing the number of favorable circuits in the lottery draw.

Today the Labor Department referred the case to the Joint Panel on Multidistrict Litigation which conducted the lottery. The Sixth Circuit’s case presenting the legality of the OSHA ETS is Kentucky v. OSHA, No 21-4031. Bloomberg adds that “Although the Fifth Circuit temporarily halted the rule before the case was transferred, the Sixth Circuit will have the authority to modify or lift that order.” The case ultimately is expected to be resolved at the Supreme Court.

From the Centers for Disease Control front

  • The CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) has created a website full of “the links to access select information from NCCDPHP on health equity and racial/ethnic disparities.”
  • The CDC also has made available a pre-diabetes risk test for consumer use along with suggestions on how to deal with this condition.

From the federal employee benefits front, Federal News Network informs us

Some same-sex spouses of deceased federal employees and retirees will have another shot at earning survivor benefits from the federal government, the Office of Personnel Management announced this week.

A new notice, scheduled for publication in the Federal Register Wednesday, describes how widows or widowers who meet a specific set of criteria can apply for federal survivor benefits that they were previously ineligible for or, in some cases, denied.

OPM also has created an online “support center” for federal retirees. Check it out.

From the prescription drug pricing front, Healthcare Dive tells us that

Price hikes taken last year by AbbVie on its anti-inflammatory drug Humira increased U.S. healthcare spending by $1.4 billion, an amount unsupported by evidence showing any new health benefits, the Institute for Clinical and Economic Review said in a new report.

Humira, which treats rheumatoid arthritis and other diseases, was one of nine high-cost drugs singled out by ICER for large price increases without corresponding data proving greater effectiveness or new clinical uses.

Humira’s net price rose 9.6% in 2020, the watchdog group said in its report. The increase in net price, which reflects what insurers pay after rebates, actually exceeded AbbVie’s hike to the drug’s list price, a reversal of what usually happens during negotiations with drugmakers.

STAT news adds that

The findings, which appear amid ongoing national turmoil over the cost of prescription drugs, mark the third time that ICER has attempted to identify price hikes on big-selling drugs for which no new clinical evidence was offered. The exercise has underscored a debate over the value of medicines and the extent to which price hikes occur beyond medical inflation, even after rebates are counted.

At the same time, however, ICER also noted that overall net prices for prescription drugs in the U.S. market declined in the past several years, and even wholesale price increases have not exceeded the broader inflation rate. This helped restrain health insurance premiums, which benefited patients, although not necessarily in relation to specific medications.

Finally an intriguing telehealth tidbit from mHealth Intelligence

The number of outpatient visits after hospital discharges remained stable during the COVID-19 pandemic but telehealth use for these visits increased, suggesting that telehealth was a substitute for in-person care rather than an addition, a study published in JAMA Health Forum revealed.