FEHBlog

Weekend update

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

The U.S. House of Representatives and the Senate again will be engaged in Committee business and floor voting this week. According to the Hill, the House leadership is aiming to vote on the massive social spending / budget reconciliation bill next Sunday October 31. “We have 90 percent of the bill agreed to and written. We just have some of the last decisions to be made,” [Speaker Nancy] Pelosi said on CNN’s “State of the Union.”

From the Delta variant front —

  • Bloomberg reports that “Top U.S. health officials signaled confidence that children ages 5 to 11 will begin getting Covid-19 vaccines by early November. The Pfizer vaccines will likely be given at pediatricians’ offices rather than at pharmacies or large sites.”
  • Medpage Today informs us that “The CDC has begun to provide weekly data on COVID-19 cases and deaths by vaccination status, illustrating the stark differences between those who have received the shots and those who haven’t — and even revealing some differences [among] vaccines.”
  • Precision Vaccinations discusses the likely evolution of the fully vaccinated against COVID definition in our country.

From the healthcare business front —

  • Healthcare Dive tells us that Lyft named Buck Poropatich as its new head of healthcare, according to an email statement sent Friday. Poropatich joined the company in 2019 and previously served as the director of healthcare strategy. * * * The ride-hailing giant wants to continue capitalizing on non-emergency medical transportation, and Poropatich has been instrumental in that expansion, along with finding new use cases in the sector, Lyft said.”
  • Fierce Healthcare reports that “Consumer genetic testing company 23andMe plans to buy Lemonaid Health, a virtual care and pharmacy provider, to integrate its personalized genetics service more deeply into primary care. 23andMe, which went public in June via a merger with Richard Branson’s blank check company, will pay $400 million for Lemonaid Health, with 25% of the purchase price in cash and the rest in shares of 23andMe. The acquisition is expected to close by the end of 2021. The acquisition adds Lemonaid Health’s telemedicine and prescription drug delivery services to 23andMe’s consumer business.”
  • Health Dive also lets us know that “Oak Street Health, a value-based primary care network for seniors, has acquired virtual specialty provider RubiconMD for $130 million, integrating specialty care into its existing care model. New-York based RubiconMD offers a platform providing access to medical specialists across 230 specialties, including cardiology, nephrology and pulmonology. The deal, announced Thursday, comes as major U.S. clinical networks increasingly build out their suite of services to jockey for employer and payer clients in the increasingly competitive space.”
  • Mobihealth News reports that “Virtual addiction treatment Workit Health raised $118 million in Series C funding led by Insight Partners. Other investors participating in the round include CVS Health Ventures, FirstMark Capital, BCBS Venture Fund, and 3L Capital. ‘Workit is at the forefront of massive acceleration in telemedicine adoption, which is key to solving the overdose crisis that was exacerbated by COVID-19. The risk factors associated with substance use have dramatically increased,’ Lisa McLaughlin, Workit Health’s co-CEO, said in a statement.  ‘This latest funding round helps us grow our relationship-based, telehealth-first, value-based approach into new regions that are in desperate need of simple and trusted solutions like Workit.’

Last Friday, the FEHBlog spoke with a group of federal annuitants at a client’s membership conference. Suffice it to say the FEHBlog thinks it is important for plans to promote OPM’s FEHB Fast Facts on FEHB and Medicare on their websites.

Last Thursday, the FEHBlog post about an OPM edit to Section 3 of the 2022 FEHB Significant Events Changes benefit administration letter. The FEHBlog noticed that he unintentionally cut off the copy of the edited section of the BAL. For that reason, here is a link to a complete copy of the revised BAL. Lo siento readers.

Cybersecurity Saturday

David Ermer–Cybersecurity–

Security Week reported yesterday that

The global fight against ransomware took a new twist this week with the United States leading a law enforcement effort to hack back and disrupt the extortion group behind the Colonial Pipeline cyberattack.

SecurityWeek has confirmed a Reuters report that the Tor servers associated with the REvil ransomware gang were seized in what was described as a “multi-country” hack-back operation that remains active.

Bleeping Computer discusses this ransomware development and others in its weekly update.

The Wall Street Journal adds that

A criminal organization believed to have built the software that shut down a U.S. fuel pipeline has set up a fake company to recruit potential employees, according to researchers at the intelligence firm Recorded Future and Microsoft Corp. MSFT -0.51%

The fake company is using the name Bastion Secure, according to the researchers. On a professional-looking website, the company says it sells cybersecurity services. But the site’s operator is a well-known hacking group called Fin7, Recorded Future and Microsoft say.

Fin7 is believed to have hacked hundreds of businesses, stolen more than 20 million customer records and written the software used in a hack that disrupted gasoline delivery in parts of the Southeastern U.S., federal prosecutors and researchers say.

From the prevention front:

The American Hospital Association has summarized the recent HC3 vulnerability news of interest to the health sector.

CISA has released a presentation on blockchain for the healthcare sector.

Security Week discusses efforts underway to fill encryption gaps.

The Society for Human Resources Management offers an article on reducing cybersecurity risks in hybrid (remote and office) work:

A Tessian survey found that 88 percent of data breaches involved human error.

And in a hybrid work environment, employees may pay less heed to the rules or simply be more likely to make mistakes since they’re not in a formal office, especially if they’re juggling family and other demands. In the Tessian survey, 43 percent of employees said they have made mistakes at work that compromised cybersecurity; 58 percent admitted having sent a company e-mail to the wrong person, often because they were distracted or tired.

“Every CISO [chief information security officer] I’ve spoken to is wondering what work-from-home means in terms of security, when there is zero distance between the office, the living room and the kitchen,” says Robert Holmes, Proofpoint’s vice president and general manager of email fraud defense.

To that end, executives would do well to encourage more cooperation between the technology side of the house and the people side. “This is an area where there’s a huge opportunity for the CHRO [chief human resource officer] and the CISO to have a strong relationship,” [Deloitte cyber leader Emily] Mossberg says. First, they can team up on training programs to increase security awareness. Second, the CISO can help HR strengthen practices, processes and systems to ensure the security of employee data in distributed work environments.

Friday Stats and More

David Ermer–COVID-19, COVID-19 vaccine, Medicare–

Using the CDC’s COVID Data Tracker and using Wednesday as the last day of the week, here is the FEHBlog’s chart of weekly new COVID cases for this year:

New cases continue to fall as do new COVID hospital admissions. What’s more, new weekly COVID deaths, a lagging indicator are trending down now too.

Finally, here’s the FEHBlog’s chart of weekly new COVID vaccinations distributed and administered from the 51st week of 2020 through the 42nd week of 2021:

Over two thirds of the vaccination eligible U.S. population (age 12 and older) is fully vaccinated. Medscape adds that

Pfizer says its vaccine for children is 90% effective at preventing COVID-19 infections.

The Pfizer vaccine for kids ages 5 to 11 is 10 micrograms, roughly one-third of the dose given to adolescents and adults. * * *

The vaccine effectiveness data comes from a study of more than 2,000 kids ages 5 to 11. Two-thirds of the children were randomly assigned to receive a child-sized dose of the Pfizer-BioNTech vaccine, while the other third was sorted into the placebo group.

According to the company’s analysis of its own studies, side effects seen in the study were nearly all mild. The most common side effect reported was pain at the site of the shot. Kids in the group that received the vaccine also had fatigue, headaches, fever, and chills at higher rates than were seen in the placebo group. These were most common after the second dose. Some skin reactions were seen in the study, like itching and rashes, but these were mostly mild and went away within a few days.

Kids also could have swollen lymph nodes after their vaccinations, as adults sometimes do, but these reactions were temporary.

One child developed a tic, a recurring involuntary muscle twitch or vocal sound, that came one week after their second dose of the vaccine. It was judged by study investigators to be related to the vaccine. The company says it was going away by the time the study was being published.

Reassuringly, no cases of heart inflammation called myocarditis were found in the study. Myocarditis is rare and temporary, but it requires hospital care. The highest rates of myocarditis are seen in males younger than 30. That group has a risk of about 11 cases for every 100,000 doses given, according to a recent study in the New England Journal of Medicine.

Also, here are links to the Health and Human Services Department’s new COMBAT COVID website (catchy!) and the CDC’s interpretation of this week’s COVID statistics.

The CDC’s most recent Flu View (October 16) sums it up as follows: Seasonal influenza activity in the United States remains low. Just like last year so far.

In other news, CNBC informs us that

The standard Medicare Part B premium is projected to be $158.50 per month [in 2022], up from $148.50 this year. However, the rates for next year have not been officially announced. * * *

People with incomes above certain levels will pay more for Medicare Part B coverage. This is known as the Income-Related Monthly Adjustment Amount, or IRMAA.

A new table for Medicare Part B premiums for 2022 has also not yet been released. However, this year’s IRMAA rates will likely be reasonably close, Elsasser said.

Both Social Security and SSI beneficiaries will be notified by mail in December as to what their benefit payments will be next year. That information will also be available online through personal My Social Security accounts.

New benefit amounts for 2022 will not be calculated for those covered by Medicare until after the premiums for next year are announced. Medicare changes for 2022 will be available at Medicare.gov.

Thursday Miscellany

David Ermer–Congress, COVID-19, COVID-19 vaccine, Federal employment benefits, HIPAA Privacy and Security Rules, OPM, U.S. Healthcare–
Photo by Josh Mills on Unsplash

From the Delta variant front, AHIP informs us that

Today, the Center for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) convened its final day of a scheduled meeting to discuss and vote on recommendations for booster doses of the Moderna and Janssen (Johnson & Johnson) COVID-19 vaccines, and to review data from the National Institutes of Health on mix-and-match booster doses.

The Committee unanimously voted (15-0) to approve the use of a single COVID-19 vaccine booster dose as follows:

1. Single booster dose of Moderna COVID-19 vaccine to be administered at least 6 months after completion of the primary series for individuals:

2. Single booster dose of the Janssen COVID-19 vaccine to be administered at least 2 months after completion of the primary regimen to individuals 18 years and older

3. Use of each of the available COVID-19 vaccines can be used as a heterologous (or “mix and match”) booster dose in eligible individuals following completion of primary vaccination with a different available COVID-19 vaccine

Data presented by Moderna showed a slow decline in neutralizing antibodies generated from the primary series over time.  Data from Janssen showed lower overall vaccine effectiveness compared to those who received an mRNA vaccine, and that evidence is not sufficient to determine if vaccine effectiveness is waning.

ACIP evaluated the benefits and risks of a booster dose for both the Moderna mRNA vaccine and for the Janssen vaccine.  The booster dose for the Moderna vaccine is half the dosage of the primary series shots, while those receiving a Janssen booster will receive the same dosage as the primary series.  CDC recommends that people receiving a booster dose receive the same vaccine as the primary series unless unavailable or another product is preferred.  Today’s vote created the pathway for heterologous booster doses for all vaccines, following FDA authorization yesterday.

The Committee also reviewed updates on the safety of all approved COVID-19 vaccines regarding incidences of myocarditis, pericarditis, and thrombocytopenia (TTS) and found no increased rates of these serious adverse events following additional booster doses of the vaccines. The data indicated that serious side effects for all vaccines are extremely rare. More research needs to be done on the safety of heterologous vaccine administration.

The final stop for these recommendations is the CDC Director Rochelle Walensky. The Wall Street Journal reports that Dr. Walensky approved the Committee’s recommendations this evening.

STAT News points out

When the [COVID] shots arrived late last year, the message from health officials was simple: Get vaccinated when you become eligible, and get whichever jab is offered to you. But with boosters becoming available for select groups of people, and a lower-dose shot for young children expected shortly, the campaign is moving from a simple set of instructions to more of a messy flow chart for people organizing and delivering the jabs. * * *

Sorting all this out will fall to pharmacies, immunization programs, pediatricians, and vaccine administrators, many already stretched thin, who will also have to track inventory and try to minimize waste. It will be a quick turnaround, as well: As soon as the CDC checks the final box for boosters with its recommendations, people will start demanding them.

Under ACA FAQ 50 issued October 4, 2021, health plans must immediately begin to cover administration of these boosters without member cost-sharing.

From the vaccine mandate front, Federal News Network reports that

A memo released by the Defense Department states that civilian [employees] will ultimately be fired from their jobs if they are not fully vaccinated. DoD wants all of its civilians to get the shot and go through the required waiting period for antibodies to flourish by Nov. 22.

DoD civilians who refuse to get the shot will go through “progressive enforcement actions,” the first of which is a five-day counseling and education period.

If an employee is still recalcitrant, they will be suspended without pay for less than 14 days. If the refusal continues, DoD will then terminate the employee for “failing to follow a direct order.”

The memo states that DoD will designate officials to handle the disciplinary process and “ensure consistent application of disciplinary measures.”

There are some exceptions to the rule. DoD will provide waivers to those who cannot get the vaccine due to medical conditions or for religious reasons. Further guidance will be available soon on the exceptions and DoD is currently not taking any action on exemption requests.

From the FEHB Open Season front, OPM made the following edit to its FEHB 2022 Significant Events chart:

StateFEHB CarrierPlan NameTerminatingOptions (endof 2021)TerminatingCodes (end of2021)Automatic EnrollmentOption and Codes for2022
IndianaHumana Health Plan,Inc.Humana Health Plan,Inc.HighLouisvilleMetropolitan areaMH1, MH3, MH2StandardLouisville Metropolitanarea – MH4, MH6, MH5
IndianaHumana Health Plan of Ohio, Inc.Humana Health Plan of Ohio, IncHighA61, A63, A62BasicW61,W63,W62
KentuckyHumana Health Plan of Ohio, Inc.Humana Health Plan of Ohio, Inc.HighA61, A63, A62Basic W61,W63,W62

From the federal employment benefits front, Reg Jones in Fedweek discusses death benefits available to surviving beneficiaries following a federal annuitant’s post-retirement death.

From the HLTH2.0 conference, Healthcare Dive provides more Amazon Health news and Fierce Healthcare discusses how to attract younger health plan members.

From the the Capitol Hill front, Healthcare IT News explains that why this may be the year that Congress finally restores funding for a HIPAA patient identification number. Fingers crossed.

Midweek update

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

From the Delta variant front —

The Boston Globe informs us that

U.S. regulators on Wednesday signed off on extending COVID-19 boosters to Americans who got the Moderna or Johnson & Johnson vaccine and said anyone eligible for an extra dose can get a brand different from the one they received initially. * * *

Specifically, the FDA authorized a third Moderna shot for seniors and others at high risk from COVID-19 because of their health problems, jobs or living conditions — six months after their last shot. One big change: Moderna’s booster will be half the dose that’s used for the first two shots, based on company data showing that was plenty to rev up immunity again.

For J&J’s single-shot vaccine, the FDA said all U.S. recipients, no matter their age, could get a second dose at least two months following their initial vaccination.

The FDA rulings differ because the vaccines are made differently, with different dosing schedules — and the J&J vaccine has consistently shown a lower level of effectiveness than either of the two-shot Moderna and Pfizer vaccines.

As for mixing and matching, the FDA said it’s OK to use any brand for the booster regardless of which vaccination people got first. The interchangeability of the shots is expected to speed the booster campaign, particularly in nursing homes and other institutional settings where residents have received different shots over time. * * *

The Food and Drug Administration’s decisions mark a big step toward expanding the U.S. booster campaign, which began with extra doses of the Pfizer vaccine last month. But before more people roll up their sleeves, the Centers for Disease Control and Prevention will consult an expert panel Thursday before finalizing official recommendations for who should get boosters and when.

The Wall Street Journal adds that

A panel of outside experts at the FDA is scheduled to review the data [on Pfizer’s modified COVID mRNA vaccine for children ages 5 to 11] Tuesday. Although the agency doesn’t have to follow the group’s recommendation, it typically does. The CDC’s independent advisory committee will meet on Nov. 2-3 to consider the vaccine. 

The White House said the administration has been coordinating with state and local leaders on plans to distribute the vaccines. If authorized, young children would receive two injections of the vaccine, three weeks apart, just like adolescents and adults do but at a lower dosage.

Mr. Zients said the doses will be shipped with all the supplies necessary to administer the shots, including smaller needles. The vaccines will also be shipped in smaller packages containing about 100 doses each, the White House said, and can be stored for up to 10 weeks at standard refrigeration temperatures and for 6 months at ultracold temperatures. * * *

[Furthermore,] the Biden administration is preparing to distribute shots to children at doctors’ offices, pharmacies and schools should federal regulators clear the inoculations for kids ages 5-11.

Also, Govexec reminds us that the Veterans Administration is acting as the guinea pig agency for the President’s vaccine mandate for federal employees. The VA initiated a mandate program while the President was still in the vaccination screening program stage so its discipline deadlines are occurring earlier.

The Veterans Affairs Department has begun disciplining employees who have not proven that they are vaccinated against COVID-19, sending an untold number into counseling following a deadline to turn over their documentation. 

Just 70% of the 380,000 employees at the Veterans Health Administration met the Oct. 18 deadline to show proof of vaccination, VA Secretary Denis McDonough said on Wednesday, leaving 114,000 workers who have yet to do so. VA previously reported that 88% of their health care workforce had said they were vaccinated, but that was based on data from self-reported “attestation forms.” Under stricter guidance the Biden administration has rolled out, VA employees must now submit paperwork to actually demonstrate that they have been inoculated.

From the third quarter financial results department —

Healthcare Dive reports that

  • Anthem’s medical costs during the third quarter beat Wall Street expectations despite the wave of COVID-19 hospitalizations and cases that were fueled by the delta variant during the quarter. The medical cost results are likely to ease investor fears, SVB Leerink analysts said in a Wednesday note.
  • On top of that, Anthem increased medical membership by nearly 6% over the prior-year quarter, ending the period with 45.1 million members. The largest membership gains were recorded in its government book of business, a continuing trend throughout the pandemic.
  • Anthem generated a $1.5 billion profit for the third quarter, a dramatic leap from the prior-year period when net income was $222 million. The payer again hiked its outlook for the remainder of the year on the results released Wednesday.

STAT News tells us that

Biogen made just $300,000 from the Alzheimer’s disease treatment Aduhelm in the first full quarter since its approval, a number far below Wall Street’s expectations and the company’s internal goals.

Aduhelm’s third-quarter sales, disclosed Wednesday, are nowhere near the roughly $14 million analyst consensus estimate, calculated by the investment bank Cowen. Last month, STAT reported that only about 100 patients had received a dose of Aduhelm between its June approval and Sept. 11. The final revenue number suggests Biogen failed to accelerate the drug’s commercial launch.

Also from the Rx coverage front, Fierce Healthcare informs us that

Express Scripts will prefer the first Food and Drug Administration-approved interchangeable biosimilar product, a move it says will lead to millions in savings.

Semglee, which was developed by Viatris, was approved by the FDA in late July. Express Scripts will move the product to its National Preferred Formulary, which reaches 28 million members. By making the change, the pharmacy benefit manager estimates it could achieve $20 million in savings in 2022.

In addition, Express Scripts said Sanofi’s biologic insulin injection Lantus will be excluded from its National Preferred Formulary.

From the reports and studies front

  • The CMS Center for Medicare and Medicaid Innovation issued a strategic plan for its second decade.
  • NCQA and Grantmakers in Health released a valuable report on how federal action is needed to improve race and ethnicity data in federal public health programs such as Medicare and Medicaid.

Tuesday’s Tidbits

David Ermer–Congress, COVID-19, COVID-19 vaccine, Rx coverage, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

From the Delta variant front —

  • The Centers for Disease Control reported today on a study finding that “Among hospitalized U.S. patients aged 12–18 years, vaccine effectiveness of 2 doses of Pfizer-BioNTech vaccine against COVID-19 hospitalization during June–September 2021, was 93% (95% confidence interval = 83%–97%).”
  • The Wall Street Journal tells us that General Electric Co., Union Pacific Corp. and other large U.S. employers are imposing Covid-19 vaccine mandates for their workers to comply with a Dec. 8 deadline set by the Biden administration for companies that are federal contractors. The FEHBlog expects that these companies understandably are taking this approach without prodding from the government contracting officers in order to avoid the OSHA vaccination screening program.
  • David Leonhardt in this morning’s New York Times, wrote about the death of General Colin Powell, who was a great American leader. He points out that

Colin Powell’s death at 84 underscores the continuing risk that Covid-19 presents to older people — even if they are fully vaccinated, as Powell was. For vaccinated Americans in their 70s and 80s, Covid remains more dangerous on average than many other everyday risks, including falls, choking, gunshot wounds or vehicle accidents. * * *

If cases return to their low levels of the spring and early summer, deaths among older adults will probably plummet as well. 

He also encourage older folks to get the COVID booster, which is happening, and the country to expand rapid COVID tests. He concludes

For most Americans, vaccination makes the risk of a serious form of Covid extremely rare. And for children, Covid tends to be mild even without vaccination. But until caseloads decline more, the situation remains frightening for many older people.

From Capitol Hill, the Federal New Network discusses the Senate Budget Committee’s release of the majority’s appropriations bills yesterday.

For federal employees, the draft bills from Senate Democrats are noticeably silent on a pay raise for civilian workers next year.

In their silence, Senate appropriators have essentially deferred to the plan President Joe Biden presented to Congressearlier this year. That plan called for a 2.2% across-the-board pay increase for federal employees, with an additional 0.5% in locality adjustments to total, on average, a 2.7% raise for 2022.

Neither the House nor Senate appears interested in legislating their own federal pay raise for civilian employees next year, making Biden’s planned 2.7% increase all the more likely.

From the waste front, UPI reports that

Medicare spent nearly $600 million over a three-year period to pay for cancer care involving four drugs later found to provide no clinical benefit for some forms of the disease for which the Food and Drug Administration approved them, an analysis published Monday by JAMA Internal Medicine found.

More than $170 million of this spending was for products voluntarily withdrawn by their manufacturers after clinical trials showed that they did not improve overall survival in people with various types of cancer, including breast and lung as well as liver and urinary tract cancers, the data showed.

From the over the counter front, Healthcare Dive reports that

  • “FDA proposed a rule creating a new category of over-the-counter hearing aids, allowing the products to be sold directly to consumers in stores and online without a medical exam or being fitted by an audiologist.
  • “The agency’s proposal is meant to increase competition in the lucrative hearing aid market and improve access to the high-cost technology for millions of Americans through a safe, effective and more affordable OTC alternative. While the rule, if finalized, would more clearly define prescription hearing aids, FDA said it would not change the classification of existing device types.
  • “A Cowen analyst said in a Tuesday note the FDA’s proposed rule would effectively allow consumer electronics manufacturers to get into the hearing aid space that has been dominated by companies such as ReSound, Sonova and William Demant. The Wall Street Journal reported last week that Apple is studying ways to make its AirPods into a health device, including for enhancing hearing.”

Competition is good.

It’s worth noting that in contrast to FEHB and employer sponsored coverage generally, Medicare Part B rarely requires prior authorization for any prescribed course of treatment.

From the tidbits department, Fierce Healthcare is offering a series of articles from the ongoing HLTH 2.0 conference

Monday Roundup

David Ermer–COVID-19, COVID-19 vaccine, Federal employment benefits, Telehealth, U.S. Healthcare–
Photo by Sven Read on Unsplash

From the Delta variant front, Health Magazine informs us that “Former FDA Chief Scott Gottlieb, MD, calls for research into UK Surge of New Delta Plus Variant, AY.4.2 While not yet singled out as a concern in the US, the new Delta subtype prompted a reminder that the world needs ‘robust systems’ to identify up-and-coming threats.” Ruh roh?

The Wall Street Journal reports that

The Food and Drug Administration [FDA] is moving to soon allow people to receive booster shots that are different from their first Covid-19 vaccine doses, people familiar with the matter said. 

The FDA won’t recommend any booster over the others but will permit people to get a booster shot that is different from the shot they first received, one of the people familiar with the matter said.

The FDA is seeking to authorize mixing and matching as soon as this week, the people familiar with the matter said. The FDA is also expected to approve Moderna Inc. and Johnson & Johnson boosters this week, according to a person familiar with the matter.

If you find the last sentence somewhat confusing, at this point, only the FDA’s vaccine advisory committee has approved the Moderna and Johnson & Johnson boosters. The acting FDA commissioner Janet Woodcock has to act on that guidance. Once Dr. Woodcock acts then her decision moves to the Centers for Disease Control for its decision.

The FEHBlog noticed today that the Office of Management and Budget’s Office of Information and Regulatory Affairs has held twenty five stakeholder listening sessions so far on the OSHA vaccination screening program rule that will apply to businesses with 100 or more employees. The rule arrived at OIRA last Tuesday October 12. The large number of listening sessions suggests to the FEHBlog that OIRA wants to wrap up its work expeditiously. The OIRA approved rule will be published in the Federal Register.

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

The Office of Personnel Management has proposed expanding eligibility for the Federal Employees Dental and Vision Insurance Program (FEDVIP) to include certain temporary and seasonal workers, among others.

OPM will publish a draft rule Tuesday in the Federal Register, which will describe several recommended FEDVIP changes, including new clarifications and provisions designed to make it easier for certain employees to alter their enrollment with the program outside of the traditional open season window.

Federal employees on temporary, seasonal or intermittent schedules — specifically those who work 130 hours a month for at least 90 days — [plus seasonal firefighters] would become eligible to enroll in FEDVIP under OPM’s draft policy.

OPM expanded eligibility for the Federal Employees Health Benefits Program (FEHBP) to this group back in 2014, and the agency’s proposed rule would simply allow temporary and seasonal workers to enroll in FEDVIP as well.

[T]o give [the 86,000] federal and USPS workers on temporary, seasonal and intermittent schedules a chance to enroll for the first time in FEDVIP, OPM envisions giving newly eligible employees a 60-day window after the date that it finalizes this new policy.

The preamble to the proposed rule notes that “As of August 3, 2021, FEDVIP has 5.4 million enrollees with approximately 7.3 million covered individuals.” The FEHB Program’s enrollment is evenly split between 2 million employed enrollees and 2 million retired enrollees plus 4 million eligible family members for a grand total of eight million. The FEHBlog understands why they are more enrollees in FEDVIP because Congress recently added certain TRICARE eligible folks to the FEDVIP program. But why does FEDVIP have the only half the number of eligible family members found in the FEHB Program? Does the FEHB Program offer adequate dental coverage for children? The FEHBlog has never explored that angle.

OPM has bulked up the family member status information and documentation found on its FEHB eligibility website.

From the Rx coverage front, the FDA today approved for marketing “the first interchangeable biosimilar product to treat certain inflammatory diseases. Cyltezo (adalimumab-adbm), originally approved in August 2017, is both biosimilar to, and interchangeable with (may be substituted for),  its reference product Humira (adalimumab) for Cyltezo’s approved uses.” Humira is a blockbuster drug which suggests big health system savings from this action. However, STAT News adds that those savings will not be realizable until June 2023 due to a Humira patent settlement. Furthermore

The FDA approved a biosimilar version that will only be available in low-dose concentrations. But three years ago, AbbVie began shifting patients to high-dose concentrations of Humira, which contain fewer excipients that often cause burning and discomfort when the medicine is injected. In fact, high-dose concentrations now account for 80% of the market, according to Bernstein analyst Ronny Gal.

The situation “is not so straightforward,” Evercore ISI analyst Josh Schimmer wrote in an investor note.

In its view, however, Boehringer Ingelheim believes Cyltezo should be considered to have the same “strength” as the corresponding original concentration and high-concentration versions of Humira, because they contain the same total drug content per container.

Nothing is simple when it comes to specialty drugs.

From the benefit design front, STAT News tells us that

The pandemic prompted a mad dash to figure out how to deliver health care virtually. As the dust settles, UnitedHealthcare, the country’s largest insurer, is laying the foundation for the future with a health plan built primarily around telemedicine services designed to be more affordable and accessible.

Called NavigateNOW, the new virtual-first plan will offer care for common services without a copay, including both in-person and virtual primary and behavioral health care, virtual urgent care, and most generic medications. UnitedHealthcare said plan premiums will be about 15% cheaper. The new offering, announced Monday, comes as both legacy insurers and startups are beginning to offer new flavors of health plans that combine conventional and digital services to offer a hybrid kind of care.

NavigateNOW enrollees will have 24-hour access to a virtual health team that includes primary, behavioral, and urgent care through UnitedHealth Group subsidiary Optum, which will also provide in-person care when necessary. Unlike some competitors, United will use its homegrown technology infrastructure to deliver the virtual care.

On a related note Healthcare Dive reports that

Seven months after announcing plans to merge, virtual care company Doctor on Demand and clinical navigator Grand Rounds are launching a new brand for their combined company: Included Health.

The name is meant to stress how the entity offers mental and behavioral healthcare, primary care, chronic care, specialty care, care for LGBTQ individuals and patient navigation tools all under the same roof, Included President Robin Glass and Chief Medical Officer Ian Tong told Healthcare Dive.

The inspiration for the rebrand came from Included Health, a care navigation platform for the LGBTQ community, which Doctor on Demand and Grand Rounds acquired in May in a bid to strengthen their offerings for the underserved population. Included, which covers just under 100 million members, declined to share how much it is investing in the rebrand.

Weekend update

David Ermer–Congress, Rx coverage, Telehealth, U.S. Healthcare–

Both the U.S. House of Representatives and the Senate will be engaged in Committee business and floor voting this coming week.

From the telehealth front —

Fierce Healthcare discusses the state of the telehealth marketplace.

“Ten years ago, Doctor On Demand, MDLive and Amwell had the market onto themselves. Largely, in part, due to pandemic, but also with reimbursement policy changes and innovation and an emerging tech side of the market, this has all driven new entrants to what you think of as the classic telehealth space,” Jeff Becker, principal healthcare analyst at CB Insights, told Fierce Healthcare.

The competition is “coming from everywhere,” Becker said, noting that the incumbent telehealth players traditionally generated revenue from one-off urgent care, low-acuity care and primary care visits handled virtually.

“Now you have Heal and DispatchHealth sending clinicians to your house or workplace to compete for that same urgent care book of business. You have Forward and One Medical with direct primary care and they, with a lot of venture backing, are competing for that one-off primary care, urgent care telehealth book of business,” he said.

There are also startups providing remote patient monitoring and virtual chronic disease management with a focus on specialty conditions, such as Monogram Health for chronic kidney disease patients and Hinge Health, which focuses on musculoskeletal pain. And there are digital health companies like Hims & Hers and Ro that offer prescription drug delivery and telehealth visits.

  • What’s more, on Friday October 15, Walmart, which also is engaged in the telehealth market, and Transcarent, which sells in the digital marketplace,

announced they would be working together as go-to-market partners for self-insured employers across the country. The agreement allows Transcarent, which offers employees and their dependents a new, different, and better health and care experience, to share Walmart’s everyday low-cost on pharmaceuticals and other services with self-insured employers and their employees for the first time.

The collaboration makes it easier for millions of employees and the families of self-insured employers to access high-value care – no matter where they live – at affordable prices. This new offering will allow employers of all sizes to leverage Walmart’s healthcare size and scale to more easily provide their employees convenient care and cost-effective health and wellness options.

  • mHealth Intelligence further informs us that

Several large health systems have formed a coalition to support strategies that use telehealth and remote patient monitoring to provide acute care for patients at home.

The Advanced Care at Home Coalition builds on both the surge in remote patient monitoring [RPM] programs during the pandemic and the Acute Hospital at Home Program, launched in late 2020 by the Centers for Medicare & Medicaid Services. That program, which now involves more than 100 hospitals and health systems across the country, offers CMS waivers for a home-based care management plan to treat patients who would otherwise require hospitalizations for a broad range of acute conditions, including asthma, congestive heart failure, pneumonia and chronic obstructive pulmonary disease (COPD). Treatment plans combine RPM and telehealth with in-person care.

The coalition was launched by the Mayo Clinic, Medically Home and Kaiser Permanente, and includes Adventist Health, ChristianaCare, Geisinger Health, Integris, Johns Hopkins Medicine, Michigan Medicine (the University of Michigan), Novant Health, ProMedica, the Sharp Rees-Stealy Medical Group, UNC Health and UnityPoint Health.

From the Rx coverage front, this coming Saturday October 23 is the latest Drug Enforcement Administration National Rx Take Back Day allowing consumers to conveniently and safely dispose of unused prescription and over the counter drugs.

From the medical research front, Health Payer Intelligence tells us that

Using predictive analytics, University of Chicago researchers have developed a method to determine an eventual diagnosis of autism spectrum disorder (ASD) in young children. The new computational approach gathers data using diagnostic codes from previous doctor’s visits, eliminating the need for blood work or procedures to make a diagnosis.

According to researchers, this method reportedly reduced the number of false-positive ASD diagnoses produced by traditional screening methods by half. ASD can be diagnosed as early as two years old. However, false positives flagged by the initial screens commonly used today can delay confirming a true diagnosis.

With the importance of early intervention and the limited number of trained professionals, tools that can potentially reduce the number of patients required to undergo the lengthy, multistep process to receive an official positive diagnosis can significantly impact patient care.

Cybersecurity Saturday

David Ermer–Cybersecurity–

Tech Republic reports on a White House sponsored “virtual ransomware summit this week with over 30 countries in attendance—although a few notable nations were excluded, such as China, Russia and North Korea. Australia, Brazil, Canada, France, Germany, India, Japan, United Arab Emirates and the United Kingdom were among the attendees.”

Cyberscoop adds that

Nations must better clamp down on money laundering in order to disrupt ransomware gangs’ illicit financial transactions, according to a statement Thursday from more than 30 countries that participated in two days of White House meetings focused on slowing hackers and digital extortion.

The joint statement also included commitments to other methods of countering ransomware, such as encouraging cyber hygiene practices to the private sector, collaborating across law enforcement and national security agencies and using diplomatic pressure against nations that harbor cybercriminals. 

Bleeping Computer’s This Week in Ransomware discusses the summit and more.

ZDNet reports that

More than $5 billion in bitcoin transactions has been tied to the top ten ransomware variants, according to a report released by the US Treasury on Friday. 

The department’s Financial Crimes Enforcement Network (FinCen) and Office of Foreign Assets Control (OFAC) released two reports illustrating just how lucrative cybercrime related to ransomware has become for the gangs behind them. Parts of the report are based on suspicious activity reports (SAR) financial services firms filed to the US government.

FinCen said the total value of suspicious activity reported in ransomware-related SARs during the first six months of 2021 was $590 million, which exceeds the $416 million reported for all of 2020.

Finally at this week’s CISA summit event marking Cybersecurity Awareness Week, the Acting U.S. Assistant Attorney General for the Civil Division Brian M. Boyton spoke about the Department’s Civil Cyber-fraud Initiative which leverages the False Claims Act to” identify, pursue and deter cyber vulnerabilities and incidents that arise with government contracts and grants and that put sensitive information and critical government systems at risk.”

We have identified at least three common cybersecurity failures that are prime candidates for potential False Claims Act enforcement through this initiative. 

First, the False Claims Act is a natural fit to pursue knowing failures to comply with cybersecurity standards. When government agencies acquire cyber products and services, they often require contractors and grantees to meet specific contract terms, which are often based on uniform contracting language or agency-specific requirements. For example, cybersecurity standards may require contractors to take measures to protect government data, to restrict non-U.S. citizen employees from accessing systems or to avoid using components from certain foreign countries. The knowing failure to meet these cybersecurity standards deprives the government of what it bargained for. 

Second, False Claims Act liability may be based on the knowing misrepresentation of security controls and practices. In seeking a government contract, or performing under it, companies often make representations to the government about their products, services, and cybersecurity practices. These representations may be about a system security plan detailing the security controls it has in place, the company’s practices for monitoring its systems for breaches, or password and access requirements. Misreporting about these practices may cause the government to choose a contractor who should not have received the contract in the first place. Or it could cause the government to structure a contract differently than it otherwise would have. Knowing misrepresentations of this kind also deprive the government of what it paid for and violate the False Claims Act.   

Finally, the knowing failure to timely report suspected breaches is another way a company may run afoul of the Act. Government contracts for cyber products, as well as for other goods and services, often require the timely reporting of cyber incidents that could threaten the security of agency information and systems. Prompt reporting by contractors often is crucial for agencies to respond to a breach, remediate the vulnerability and limit the resulting harm. 

At bottom, the department’s Civil Cyber-Fraud Initiative will hold accountable entities or individuals that put U.S. information or systems at risk.     

Friday Stats and More

David Ermer–COVID-19, COVID-19 vaccine–

Based on the Centers for Disease Control’s COVID Data tracker, the FEHBlog offers his 2021 chart of new weekly COVID cases using Wednesday as the last day of week:

Here is a link to the CDC’s chart of weekly new COVID hospitalizations which also is trending down:

The FEHBlog also offers his 2021 chart of new weekly COVID deaths, a lagging indicator, that at worst has plateaued for now.

Finally the FEHBlog offers his chart of new weekly COVID vaccinations distributed and administered over 51st week of 2020 through the 41st week of 2021 which end last Wednesday October 13.

As of today, 66.5% of vaccination eligible Americans (age 12 and older) and 84.3% of Americans over age 65 are fully vaccinated. Moreover, 13.4% of the over age 65 cadre have received a booster.

Here is a link to the CDC’s weekly interpretation of current COVID statistics. Also today the HHS Secretary renewed the COVID national public health emergency for another 90 days into January 2022, and the CDC issued its first FluView for the current flu season – “Seasonal influenza activity in the United States remains low.”

Also from the Delta variant front, AHIP informs us

Today, the Food and Drug Administration (FDA) Vaccine and Related Biological Products Advisory Committee (VRBPAC) voted to unanimously (19-0) endorse emergency use authorization for an additional, booster dose of the Johnson & Johnson (J&J) COVID-19 vaccine for adults 18 and older at least 2 months after the primary single-dose vaccine.

The Committee discussed the sustained durability and vaccine effectiveness (VE) of the single-dose J&J vaccine against severe disease and hospitalization. Data from J&J demonstrated that an additional dose of the J&J vaccine given at 2-6 months following the primary dose was safe, well-tolerated, and could increase protection against symptomatic COVID-19.

The Advisory Committee additionally reviewed data from the National Institutes of Health (NIH) on the use of heterologous booster doses following a primary series of the currently authorized or approved COVID-19 vaccines, e.g. administering an mRNA COVID-19 vaccine to recipients of the J&J adenoviral-based COVID-19 vaccine.  Heterologous boosters proved to be more effective at boosting antibody titers in study participants than homologous boosters, though the response differed depending on formulation of the primary series and booster.  It should be noted, though, that the NIH study was not designed to compare across boosters, as the study did not control for patient characteristics across booster options, among other factors.

The American Medical Association (AMA) has not yet announced updates to the Current Procedural Terminology® (CPT) COVID-19 vaccine and vaccine administration code set to account for authorization of the Johnson & Johnson additional dose. AHIP will keep members apprised of coding developments as they are announced via the AMA’s CPT COVID-19 landing page.

The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) will meet to discuss recommending the Moderna and Johnson & Johnson vaccine boosters on October 20-21.

For an insightful perspective on the FDA Advisory Committee’s work, check out David Leonhardt’s column in today’s New York Times. He accurately predicted that Committee would punt on the booster mix and match question.

The Wall Street Journal reports

The Food and Drug Administration is delaying a decision on authorizing ModernaInc.’s MRNA -2.31% Covid-19 vaccine for adolescents to assess whether the shot may lead to heightened risk of a rare inflammatory heart condition, according to people familiar with the matter.

After four Nordic countries strengthened their stances against giving Moderna vaccines to younger adults last week, the FDA has been taking another look at the risk of the condition, known as myocarditis, among younger men who took Moderna’s vaccine, especially compared with those who received the vaccine from Pfizer Inc. PFE -0.43% and BioNTech SE, BNTX -1.06% the people said.

So far, the regulators haven’t determined whether there is an elevated risk, the people said. The delay could be several weeks, but the timing is unclear, one of the people said.