Thursday Miscellany

COVID-19 vaccine

Thursday Miscellany

David Ermer–CMS, COVID-19, COVID-19 vaccine, Federal employment benefits, OPM, Patient safety, Telehealth, U.S. Healthcare–
Photo by Mel on Unsplash

Today the U.S. Office of Personnel Management released guidance to federal agencies on American Rescue Plan Act “provisions authorizing emergency paid leave (EPL) for covered Federal employees in specified qualifying circumstances through special funds.” The Federal News Network offers information on how federal employees can apply for EPL.

From the COVID-19 front, the Wall Street Journal reports that Astra-Zeneca now expects to file an emergency use application for its COVID-19 vaccine with the Food and Drug Administration in the middle of next month.

“One especially time-consuming task has been compiling British data from almost four months of vaccinations in the U.K., including efficacy, virus-transmission and safety statistics, people close to the process say. That has added to the complexity of AstraZeneca’s submission and is expected to lengthen any FDA review. Other shots that the FDA has authorized had large-scale human trial data but little or none from real-world rollouts outside of controlled studies.”

No good deed, etc.

From the patients safety front, the Leapfrog Group released its Spring 2021 hospital safety grades yesterday. The two hospitals closest in proximity to the FEHBlog’s residence are graded A and B. Beckers Hospital Review helpfully points out the 27 hospitals with straight A scores and F scores. Meanwhile, Healthcare Finance reports that

The Centers for Medicare and Medicaid Services on Wednesday released the overall hospital quality star ratings that now include new methodology in five measure groups.

CMS rated over 4,500 hospitals from one to five stars, with five representing the highest quality rating.

Of 4,586 hospitals, 13.5%, or 455 hospitals, received five stars; 988 received four stars; 1,018 received three stars; 690 received two stars; and 204 received one star.

For more than a quarter of hospitals, 1,181, no information was available.

This compares to January 2020 data, when of the 5,340 hospitals listed, 396 received five stars; 1,132 received four stars; 1,108 got three stars; 710 received two stars; and 226 got one star. Another 1,761 had no rating information available.

Furthermore, the Centers for Disease Control released a new study setting a “Baseline to Measure Quality of Antibiotic Prescribing in U.S. Hospitals.”

Since 2015, when the prescribing data were collected, CDC has been working diligently with partners like the American Hospital Association and others to implement stewardship efforts and programs in acute care.

CDC will continue building on this progress and important work in the coming years as a part of the newly released Combating Antibiotic-Resistant Bacteria National Action Plan. Good luck with that effort.

In healthcare business news:

  • Healthcare Dive informs us that ” Virtual care powerhouse Teladoc reported a wider-than-expected net loss in the first quarter, but beat Wall Street estimates on revenue with a topline of $454 million, up 151% year over year, driven by growth in specialty offerings and multi-product contracts. * * * CEO Jason Gorevic contended he is unworried about mounting competition in the lucrative telehealth space, banking the company’s heft and variety of clinical services will fend off entrenched rivals and new entrants like Amazon.”
  • Fierce Healthcare advises “Do not expect the Biden administration to pull away from price transparency even though the administration wants to pull a requirement for hospitals to post Medicare Advantage rates, experts say. The proposal included in a hospital inpatient payment rule released late Tuesday is more aimed at easing administrative burdens for hospitals still struggling due to the pandemic, several experts said. “The repeal of this requirement more falls into the bucket of easing hospitals’ burden as opposed to the agency’s stance on hospital price transparency,” said Caitlin Sheetz, head of analytics and a director for the consulting firm ADVI, in an interview with Fierce Healthcare.
  • Fierce Healthcare also reports that “Anthem has completed its acquisition of home health benefits manager MyNEXUS, the insurer announced Thursday morning. MyNEXUS offers comprehensive home-based nursing management to health insurers, providing integrated clinical services to some 1.7 million Medicare Advantage beneficiaries in 20 states. The company’s platforms largely automate the visit and authorization, which allows members to access care more quickly, according to the announcement. MyNEXUS will be folded into Anthem’s Diversified business group.”

In benefit design news, Health Payer Intelligence offers a thoughtful article describing key considerations for implementing diabetes management programs.

Midweek Update

David Ermer–CDC, Congress, COVID-19, COVID-19 testing, COVID-19 vaccine, Federal employment benefits, Medicare, U.S. Healthcare–
Photo by Mark Tegethoff on Unsplash

Govexec reports that at the Senate Homeland Security and Governmental Affairs Committee’s business meeting today, the Committee advanced to the Senate floor the nominations of Kiran Ahuja to be OPM Director along party lines and the three nominations of Postal Service Governors with bipartisan margins. The FEHBlog expects these nominations to be brought to the Senate floor next month.

From the COVID-19 front:

  • The Wall Street Journal informs us that “Vaccines appear to be starting to curb new Covid-19 infections in the U.S., a breakthrough that could help people return to more normal activities as infection worries fade, public-health officials say. By Tuesday, 37.3% of U.S. adults were fully vaccinated against Covid-19, with about 2.7 million shots each day. * * * With the U.S. recently averaging at least 50,000 new daily cases, the pandemic is far from over. But the U.S. is nearing a nationwide benchmark of having 40% of adults fully vaccinated, which many public-health experts call an important threshold where vaccinations gain an upper hand over the coronavirus, based on the experience from further-along nations such as Israel.”
  • Today the Centers for Disease Control released a report on the mRNA vaccines. Here are the highlights which support the Journal’s report particularly as over 2/3s of Americans over age 65 are fully vaccinated.

Clinical trials suggest high efficacy for COVID-19 vaccines, but evaluation of vaccine effectiveness against severe outcomes in real-world settings and in populations at high risk, including older adults, is needed.

What is added by this report?

In a multistate network of U.S. hospitals during January–March 2021, receipt of Pfizer-BioNTech or Moderna COVID-19 vaccines was 94% effective against COVID-19 hospitalization among fully vaccinated adults and 64% effective among partially vaccinated adults aged ≥65 years.

What are the implications for public health practice?

SARS-CoV-2 vaccines significantly reduce the risk for COVID-19–associated hospitalization in older adults and, in turn, might lead to commensurate reductions in post-COVID conditions and deaths.

  • The Wall Street Journal also reports that “Covid-19 tests for people to use to get quick results at home are finally becoming available to buy at pharmacies and retailers. Yet an obstacle might stand in the way of regular use: cost. * * * The U.S. Food and Drug Administration recently cleared over-the-counter sales of two of these rapid at-home screening tests, one from Abbott Laboratories and another from Quidel Corp. 

Major pharmacies recently said they plan to sell a two-pack of Abbott’s test for nearly $24, while Walmart says it will charge just under $20. The price for Quidel’s test hasn’t been released, though Quidel has indicated it will be less than $30 for a pair.

“Twenty-five dollars for a Covid test, I think most people would pay that once. But would they pay it every week or every two weeks?” says Zoe McLaren, a health economist and an associate professor in the School of Public Policy at the University of Maryland, Baltimore County. “It’s not designed to be a one-time cost.”

Dr. McLaren and medical-testing experts expressed hope that prices would drop if more companies get clearance to sell paper-strip tests. * * * Public-health authorities say they are glad to see the tests in stores, and the tests will be valuable tools for checking symptoms or for specific occasions, such as traveling or visiting relatives.

From the Medicare front

  • The Centers for Medicare and Medicaid Services released yesterday a proposed fiscal year 2022 Medicare Part A inpatient prospective payment system rule. “The proposed increase in operating payment rates for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users is approximately 2.8 percent. This reflects the projected hospital market basket update of 2.5 percent reduced by a 0.2 percentage point productivity adjustment and increased by a 0.5 percentage point adjustment required by legislation.”
  • Healthcare Dive provides its perspective on the proposal which evidently was well received by the hospital industry. “[T]he American Hospital Association applaud[ed] the provision that removes the requirement that hospitals report privately negotiated rates with Medicare Advantage payers on Medicare cost reports and another that repeals market-based weight methodology for determining payments.”

On the FEHB front

  • FedSmith advises that “Federal employees facing a future with children aging out of TRICARE should consider enrolling in an FEHB policy. This is because FEHB plans provide coverage for children in the family option up to age 26. Additionally, the family FEHB premium for the employee, spouse, and children may be less than the cost of the TYA option for one individual. FEHB employees who are eligible for TRICARE and interested in having their children covered in an FEHB plan have to enroll during Open Season. Federal employees with TRICARE also need to enroll in a plan at least a year ahead of retirement for the FEHB plan to be continue in retirement.” Interesting.

On the artificial intelligence front, Forbes lists its top 50 AI companies to watch. Enjoy.

Weekend update

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

Both of Houses of Congress are engaged in Committee business this week. The Senate Homeland Security and Governmental Affairs Committee will meet Wednesday morning to consider moving Kiran Ahuja’s OPM Director nomination to the Senate floor. The Senate will be engaged in floor business this week. Among other business items, the Senate will consider confirming Jason Miller to be OMB Deputy Director for Management. The President will address a joint session of Congress on Wednesday night.

From the COVID-19 front —

According to the CDC, over 1/3 of Americans over age 18 and over 2/3s of Americans over 65 are fully vaccinated against COVID-19. Bloomberg reports that “in the next few weeks, what the vaccine campaign is going to look like is going to change dramatically. The Biden administration is pursuing a strategy of abundance, which the White House has referred to as an “overwhelm the problem” approach. That means that there will likely still be widespread shipping of vaccines to pharmacies and health centers, inoculation clinics and mobile vaccine resources. But what’s likely to disappear are lines and scarcity.”

The FEHBlog has been looking for news that Pfizer and Moderna have applied for full Food and Drug Administration marketing approval for their vaccines. A San Diego television station reports on the implications of full marketing approval for these vaccines.

Companies want full approval for several reasons. Once the pandemic is no longer officially designated as an emergency, only fully approved products can remain on the market. And the stamp of approval from the FDA carries valuable credibility, [Dr. Sidney] Wolfe [co-founder of Public Citizen’s Health Research Group] said. “Aside from what benefit for marketing it does in this country, it will clearly have an international benefit,” he said.

The FEHBlog also understands that full marketing approval would allows the companies to distribute the vaccines directly to physicians’ offices.

Typically it takes the FDA about six months to review a licensure application for a high-priority drug. Pfizer said it expects to apply in the first half of 2021, and it expects a decision from the FDA in the second half of the year.

Another news source indicates that Moderna recently filed its licensure application with the FDA.

Good Housekeeping offers a timeline for when children will receive COVID-19 vaccines. Pfizer has applied to extend its COVID-19 vaccine’s emergency use authorization to people aged 12 to 15. However, the FEHBlog sees no FDA advisory committee scheduled to consider this request as yet.

From the artificial intelligence and telehealth fronts, the Wall Street Journal reports that

  • A journalist writes on her experience with telehealth over the past year.

For me, both in-person conversations and remote conversations have their unique advantages and disadvantages. Sometimes, eye contact or hands-on care is just what I need to feel confident in my doctor’s diagnosis or advice. But other times, there’s nothing like leveling the playing field with video or phone chat to make everything feel a bit more intimate and safer. One of the lessons we’ve learned from a year of remote everything is that in-person interactions have strengths that virtual conversations can’t quite match, and vice versa. Healthcare may be one more area where the future is hybrid.

It’s a reminder that health plans should focus their telehealth efforts on mental health services because people are comfortable with it and it extends the plan’s network.

  • In the other article three experts weigh in on whether artificial intelligence can replace human mental health therapists. Of course, the answer to that question is no. Nevertheless the experts’ responses on exciting uses of artificial intelligence in the mental health field is interesting, e.g., “In the near term, I am most excited about using AI to augment or guide therapists, such as giving feedback after the session or even providing tools to support self-reflection.” and

We can generate a vast amount of data about the brain from genetics, neuroimaging, cognitive assessments and now even smartphone signals. We can utilize AI to find patterns that may help us unlock why people develop mental illness, who responds best to certain treatments and who may need help immediately. Using new data combined with AI will likely help us unlock the potential of creating new personalized and even preventive treatments.

Encouraging.

From the federal employment front, the Federal Times informs us that “Even during the worst global pandemic of the century, increased demands on public jobs and a radical shift to predominantly remote work, federal employees are confident in their agencies’ ability to keep them safe and recognize their hard work, according to results of the [OPM] 2020 Federal Employee Viewpoint Survey.” Bravo.

Friday Stats and More

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

Based on the Centers for Disease Control’s COVID-19 Data Tracker website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 14th week of 2020 through 16th week of this year (beginning April 2, 2020, and ending April 21, 2021; using Thursday as the first day of the week in order to facilitate this weekly update):

and here is the CDC’s latest overall weekly hospitalization rate chart for COVID-19:

The FEHBlog has noticed that the new cases and deaths chart shows a flat line for new weekly deaths  because new cases greatly exceed new deaths. Accordingly here is a chart of new COVID-19 deaths over the period (April 2, 2020, through April 21, 2021):

Finally here is a COVID-19 vaccinations chart over the period December 17, 2020, through April 21, 2021 which also uses Thursday as the first day of the week:

The Hill reports this evening that

Johnson & Johnson coronavirus vaccinations should resume immediately, federal regulators said Friday.

The approval follows a recommendation from a federal advisory panel that the shot’s benefits outweigh its risks. 

States could start administering the shots in hours, if not days. There are about 9.5 million doses of the vaccine sitting on shelves across the country that could be deployed immediately.

The Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC), which had jointly recommended a nationwide pause 10 days ago, accepted the recommendation from CDC’s Advisory Committee on Immunization Practices.

The panel wants the FDA to add a warning label intended to make providers aware of the risk of a rare complication involving blood clots in women under the age of 50. 

Johnson & Johnson has already negotiated warning label language with FDA, a company official told the panel.

Medscape adds that “The recommended pause on April 13 in the rollout of the Janssen/Johnson and Johnson vaccine has not substantially deflated confidence in COVID-19 immunization, a new poll reveals.” Let’s go.

From Capitol Hill, Healthcare Dive reports that “The Senate Finance Committee split upon party lines in a Thursday vote on the nomination of Chiquita Brooks-LaSure, President Joe Biden’s pick to head the powerful agency overseeing Medicare and Medicaid, voting 14-14 to move to a full Senate vote without a recommendation for confirmation.” The FEHBlog expects that Ms. Brooks-LaSure will be confirmed next week.

Speaking of health equity, Econtalk currently features a fascinating discussion between host Russ Roberts, who recently became President of Jerusalem’s Shalem College, and Washington University Sociology Professor Mark Rank  “on the nature of poverty and the challenge of ending or reducing it.”

Fierce Healthcare offers interviews with healthcare experts on telehealth regulation and health equity.

Beckers points out how UnitedHealthcare plans to make Optum a $100 billion business and how Anthem’s IngenioRx PBM business keeps growing.

OPM Director Hearing / End of the Carrier Conference / Thursday Miscellany

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

The virtual OPM AHIP FEHB Carrier Conference ended today. For a good chunk of the conference, Kiran Ahuja, the President’s nominee for OPM Director contemporaneously had her confirmation hearing before the Senate Homeland and Government Security Committee. Here are the Federal Times, Govexec , and Federal News Network articles on that hearing which reportedly went smoothly for the nominee.

At the carrier conference today, the FEHBlog learned about the many things including the following:

  • The Blue Cross Blue Shield Association has released a strategy to help bring about healthcare equity. “The strategy is centered around improving racial health disparities in maternal health, behavioral health, diabetes, and cardiovascular conditions [by] “measuring racial health disparities, forming community and clinical partnerships, scaling effective programs, and influencing local and federal policy decisions.”
  • The American Pharmacists Association has produced a report on promising practices for pharmacist engagement in tobacco cessation interventions. 
  • OPM now has a list of documentation that enrollees must furnish to the employing office or the FEHB carrier to verify family member eligibility in FEHB.

Thanks OPM and AHIP for a great conference.

In Thursday Miscellany —

  • As promised here is a link to the Internal Revenue Service guidance making “tax credits [available to certain employers] for providing paid leave to employees who take time off related to COVID-19 vaccinations.
  • The AP reports on encouraging “new data reassuring for COVID-19 vaccination in pregnancy.”
  • The Secretary of Health and Human Services has extended the COVID-19 public health emergency for another 90 days from yesterday.
  • The American Hospital Association is touting Hospital-at-Home Innovation During COVID-19 and Beyond. “What was once a small but mighty contingent of health care systems providing “hospital-at-home” care before the pandemic has grown into a larger movement. With this model, hospitals across the country are “admitting” patients to their own homes for acute care with excellent results. As highlighted in AHA’s recent issue brief on hospital-at-home, patients receiving this care have a 20% reduction in mortality, were three times less likely to be admitted to an emergency department than usual care patients and have higher satisfaction with their care. And these results are achieved at a 25% lower cost of care.”
  • Fierce Healthcare reports that [Blue Cross licensee] Highmark Health and ChristianaCare are launching a new joint venture that aims to harness data to accelerate value-based, equitable care. The joint company, which has yet to be named, will take advantage of the strengths of both companies to drive toward more accessible and affordable care. Karen Hanlon, chief operating officer at Highmark Health, said on a call with reporters Wednesday that the venture aims to disrupt the traditional dynamic between payers and providers for greater collaboration.” Here’s hoping.
  • AHIMA reports that the ICD-10 coding authorities are considering releasing new codes for October 1, 2021 (as usual) and April 1, 2022 (special supplement.)

Midweek update

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

Today was the second day of the OPM AHIP FEHB Carrier Conference. One of the sessions concerned COVID-19 vaccination outreach to socially disadvantaged communities. The FEHBlog learned that Kaiser Permanente, which is the third largest FEHB plan carrier, has released a COVID-19 vaccination equity tookit and that Geisinger, a Pennsylanvia based FEHB plan carrier, has produced a Neighborly website chock full of community resources. A speaker referenced this New York Times article on the following topic: “Half of American adults have received at least one shot of the coronavirus vaccine. Now comes the hard part: persuading the other half to get it.”

In COVID-19 vaccine news from outside the carrier conference

  • The Society for Human Resource Management reports that “To encourage more widespread vaccinations, President Joe Biden has announced a paid leave tax credit to employers that provide full pay for any employee who takes time off to get a COVID-19 vaccination. The tax credit is available to organizations with fewer than 500 employees, and it also provides full pay for employees who take time to recover from the vaccination. The credit covers up to $511 per day for each vaccinated employee, and is funded by the American Rescue Plan.” The FEHBlog will post the implementing IRS notice tomorrow.
  • Fierce Pharma reports that “AstraZeneca is still planning to apply for emergency use authorization of its shot in the U.S., a company spokesman confirmed. * * * If going down that road yields an endorsement from the U.S., it could help boost the damaged reputation of the shot. Much of the world, especially poorer nations, are in dire need of vaccines and global demand is expected to extend into the next few years at least. In addition, the shot has a key advantage over its mRNA rivals––its lower price, which makes it particularly attractive to developing nations.”
  • Govexec reports that “State Department Spokesperson Ned Price said on Tuesday that the department had delivered vaccines to all of its posts abroad, as of Sunday.“ and “The Defense Department said on Tuesday it expects to start receiving 390,000 vaccine doses weekly, which is up from an average of 155,500 per week. “[Eighty-three] percent of vaccines received by the Defense Department have been administered, exceeding the U.S. average of 78%, and more than 28% of our total force is now vaccinated,” Pentagon Press Secretary John Kirby said during a briefing on Monday. 

There was a lot of carrier conference discussion about expensive yet curative cell and gene therapies. The FEHBlog ran across this recent MIT report on that topic.

Also the FEHBlog was overjoyed to hear from an OPM speaker that with any luck laterthis decade OPM will begin providing carriers with HIPAA 820 standard transactions that will allow them to reconcile premiums to headcount. The FEHBlog has been advocating this logical step for quite a while.

In other healthcare news —

  • Healthcare Dive informs us about Elizabeth Fowler’s first public address since taking the reins of the CMS Center for Medicare and Medicaid Innovation earlier this year. “‘In my view, we’re at a really critical juncture in the path to value-based care,’ Fowler said at the National Association of Accountable Care Organizations’ spring conference on Tuesday, asking stakeholders for patience as CMMI reviews paused models and outlines a path forward.”
  • Saturday is the Drug Enforcement Administration’s spring edition of National Prescription Drug Take Back Day. “National Prescription Drug Take Back Day is a safe, convenient, and responsible way to dispose of unused or expired prescription drugs at locations in communities throughout the country. The October 2020 Take Back Day brought in 985,392 pounds (492.7 tons) of medication. This is the largest amount ever collected in the program’s ten years!” You can find your nearest collection site here.

Monday Roundup

David Ermer–CDC, COVID-19, COVID-19 testing, COVID-19 vaccine, Federal employment benefits, HSA, OPM, Rx coverage, U.S. Healthcare–
Photo by Sven Read on Unsplash

Mondays have tended to be good news days for COVID-19 vaccines. As of today, over 50% of Americans over age 18 have received at least one dose of a COVID-19 vaccine.

Fierce Healthcare reports that

“CVS Pharmacy has begun stocking its virtual and in-store shelves nationwide with rapid tests for COVID-19—which can be purchased without a prescription and used by anyone regardless of whether or not they are showing symptoms—including three FDA-authorized diagnostics and sample collection kits produced by LabCorp, Ellume and Abbott.”

“Even as vaccines become more widely available, COVID-19 testing remains a critical tool to keep our communities safe,” Walgreens President John Standley said in a statement. Walgreens currently offers on-site testing at more than 5,500 of its pharmacies and plans to expand to 6,000 drive-thru sites by May, using Abbott’s ID NOW portable testing machines.

In addition, earlier this month CVS began offering COVID-19 antibody testing for $38 at 1,100 in-house clinics, using fingerstick blood samples to determine previous infections.

The U.S. Office of Personnel Management announced today that the agency

will allow [FSAFEDS] flexibilities permitted under the Consolidated Appropriations Act 2021 and the American Rescue Plan Act including allowing full carryover for a health care flexible spending account (HCFSA) and Limited Expense FSA (LEX FSA); extending the grace period for a dependent care flexible spending account (DCFSA); and permitting care for dependents through age 14 for 2020 and 2021 under a DCFSA. In addition, OPM is working with our FSAFEDS contractor, Health Equity, to offer a Special Enrollment/Election Period (SEP) in the near future.  This SEP will allow participants to increase or decrease their current elections for their DCFSA and/or their HCFSA.  In addition, the SEP will allow those who did not re-enroll for 2021 during Open Season in the Fall, the opportunity to enroll in a DCFSA and/or HCFSA for 2021.  Finally, OPM will allow DCFSA participants to increase their election during the Special Election Period to the new IRS maximum of $10,500 for 2021. 

All good news.

What’s more, the Wall Street Journal reported in its Saturday essay about the U.S. airline safety revolution.

Over the past 12 years, U.S. airlines have accomplished an astonishing feat: carrying more than eight billion passengers without a fatal crash.

Such numbers were once unimaginable, even among the most optimistic safety experts. But now, pilots for domestic carriers can expect to go through an entire career without experiencing a single engine malfunction or failure. Official statistics show that in recent years, the riskiest part of any airline trip in the U.S. is when aircraft wheels are on the ground, on runways or taxiways.

The achievements stem from a sweeping safety reassessment—a virtual revolution in thinking—sparked by a small band of senior federal regulators, top industry executives and pilots-union leaders after a series of high-profile fatal crashes in the mid-1990s. To combat common industry hazards, they teamed up to launch voluntary incident reporting programs with carriers sharing data and no punishment for airlines or aviators when mistakes were uncovered.

One wonders whether this successful strategy may be transferable to other pressing safety issues, such as patient safety. In this regard, a friend of the FEHBlog suggested check this Washington Post opinion piece written by a group of psychologists titled “We instinctively add on new features and fixes. Why don’t we subtract instead?
‘Less is more’ is a hard insight to act on, it turns out.” How true.

In other healthcare news —

  • The Kaiser Family Foundation informs us that

a relatively small number and share of drugs accounted for a disproportionate share of Medicare Part B and Part D prescription drug spending in 2019 (Figure 1).

— The 250 top-selling drugs in Medicare Part D with one manufacturer and no generic or biosimilar competition (7% of all Part D covered drugs) accounted for 60% of net total Part D spending.

— The top 50 drugs covered under Medicare Part B (8.5% of all Part B covered drugs) accounted for 80% of total Part B drug spending.

Some recent proposals to lower prescription drug prices have limited the number of drugs subject to price negotiation and international reference pricing. This analysis shows that Medicare Part D and Part B spending is highly concentrated among a relatively small share of covered drugs, mainly those without generic or biosimilar competitors. Focusing drug price negotiation or reference pricing on a subset of drugs that account for a disproportionate share of spending would be an efficient use of administrative resources . . . .

  • Employee Benefits News tells us

New research from Voya shows employees have a bias against HDHPs and the reason for that is as simple as marketing.

“One of the really interesting findings that we saw from the research about why there is that bias comes down to branding, pure and simple,” says Nate Black, vice president of consumer driven health for Voya Financial. “When we replaced the high deductible health plan name and called it something more generic, the share of people choosing high deductible health plans doubled. So just the name itself can have a really significant impact on how people think about what plan they should choose.”

Sixty-three percent of the people surveyed by Voya said they would choose the plan with the lowest deductible. As part of the study Voya designed an experiment asking participants to choose between a PPO and an HDHP. The experiment was set up in a way that the HDHP was always the optimal financial choice, despite this, 65% of those surveyed still chose the PPO plan.

Communicating the long term value of plans connected with health savings accounts is quite important.

  • Here’s a link to the CDC’s website on the Johnson & Johnson vaccine pause which explains

If you received the vaccine more than three weeks ago, the risk of developing a blood clot is likely very low at this time.

If you received the vaccine within the last three weeks, your risk of developing a blood clot is also very low and that risk will decrease over time.

Contact your healthcare provider and seek medical treatment urgently if you develop any of the following symptoms: severe headache, backache, new neurologic symptoms, severe abdominal pain, shortness of breath, leg swelling, tiny red spots on the skin (petechiae), or new or easy bruising.

If you experience any adverse events after vaccination, report them to v-safe and the Vaccine Adverse Event Reporting System

The FEHBlog enrolled in v-safe after his first Pfizer vaccination and the CDC has continued to inobtrusively check in weekly. The FEHBlog is happy to help out.

Weekend update

David Ermer–CDC, Congress, COVID-19, COVID-19 vaccine, Federal employment benefits, OPM–
Photo by Tomasz Filipek on Unsplash

Both Houses of Congress are working on floor and committee business this week. Here are links to the House floor schedule, the Senate floor schedule and the Committee business schedule. Nothing particularly interesting from an FEHBP standpoint.

In contrast, this week from Tuesday through Thursday, the U.S. Office of Personnel Management and America’s Health Insurance Plans will hold the annual FEHB carrier conference. This will be the longest conference in the FEHBlog’s memory.

In that regard, “The Alliance for Fertility Preservation (AFP) commends the U.S. Office of Personnel Management (OPM) for including coverage for fertility preservation in its annual call for benefit and rate proposals from Federal Employee Health Benefit (FEHB) Program carriers. This coverage would allow for fertility preservation services related to infertility caused by medical treatment (iatrogenic infertility).”

The AFP estimates that in the United States, approximately 160,000 people between ages 0-44 are diagnosed with cancer each year. Most of these patients will face treatments including chemotherapy, radiation, and/or surgery that can damage reproductive cells (eggs and sperm), reproductive organs, or impact the ability to carry a pregnancy. Because this damage treatment-based, it can affect patients with any type of cancer. Patients with other conditions requiring similar therapies are also at risk.

Fertility preservation is now considered part of the standard of care for age-eligible patients. Guidelines supporting fertility preservation have been issued by the relevant medical associations, including the American Society of Clinical Oncology (ASCO), the American Society for Reproductive Medicine (ASRM), and the American Medical Association (AMA).

This new benefit for 2022 is a carrier conference topic on Tuesday.

From the COVID-19 front, the FEHBlog and his wife attended the socially distanced and fan-masked Washington Nationals game this afternoon. Walking from the parking lot to Nationals Park, we walked by a CVS pharmacy which had a sign reading COVID-19 vaccinations available here. We went into the pharmacy, and the FEHBlog noticed a staff member at a table waiting to sign up people for the vaccine. The FEHBlog was so happy.

Health Payer Intelligence discusses how the Blue Cross Blue Shield plans are “aiming to be a community resource to ensure shots are administered. Reed Melton, vice president of clinical operations at the Blue Cross Blue Shield Association (BCBSA), told Fierce Healthcare that the group’s member plans are partnering with regional and community organizations to tackle vaccine hesitancy and support administration efforts. “We have a full-court press from Honolulu to San Juan,” Melton said.  At the national level, BCBSA has partnered with Feeding America to offer educational materials on COVID-19 vaccines to people at 200 food banks, which can reach 40 million Americans.”

Last week the Centers for Disease Control reported to providers of care about so-called vaccine breakthrough cases of COVID-19.

Vaccine breakthrough cases occur in only a small percentage of vaccinated persons. To date, no unexpected patterns have been identified in the case demographics or vaccine characteristics among people with reported vaccine breakthrough infections.COVID-19 vaccines are effective. CDC recommends that all eligible people get a COVID-19 vaccine as soon as one is available to them.

The Wall Street Journal reports today that

President Biden’s chief medical adviser said he expects Johnson & Johnson’s Covid-19 vaccine to return to use in the U.S. by Friday, after a pause because of concerns about blood clots in several patients. “I would be very surprised…if we don’t have a resumption in some form by Friday,” Dr. Anthony Fauci told CBS’s “Face the Nation,” echoing remarks he made on other networks Sunday.

The American Medical Association has shared information about what physicians should know about this blood clot issue.

Thursday Miscellany

David Ermer–CDC, Congress, COVID-19, COVID-19 vaccine, U.S. Healthcare–
Photo by Juliane Liebermann on Unsplash

From Capitol Hill, Govexec reports that yesterday, “a Senate panel advanced President Biden’s pick [Jason Miller] to be deputy director for management for the Office of Management and Budget to the full chamber. Today, Fierce Healthcare reports Chiquita Brooks-LaSure’s confirmation hearing to be Centers for Medicare Service administrator before the Senate Finance Committee. “The hearing didn’t highlight any major opposition from Republicans to her nomination, likely signaling her confirmation as the head of CMS.”

From the Johnson & Johnson vaccine pause front, Healthcare Dive discusses “What Happens Next, A call by regulators to stop J&J vaccinations won’t dramatically disrupt U.S. supply. But changes in labeling are possible, as is a renewed debate over vaccine hesitancy.” The Wall Street Journal adds that

A study by the University of Oxford found the risk of rare but sometimes-deadly blood clotting is roughly eight to 10 times greater in Covid-19 sufferers than among people who have received any of the first three Western-developed vaccines widely available. The study, involving vaccinations from Pfizer Inc. and BioNTech SE, another from Moderna Inc. and one from AstraZeneca PLC, adds to competing evidence related to blood clotting that regulators and governments may need to take into account as they weigh continued deployment of vaccines. 

While the Johnson & Johnson vaccine was not included in this study, the Astra-Zeneca vaccine uses the same adenovirus technology as the Johnson & Johnson vaccine.

In other COVID-19 vaccine news, the HHS Office of Inspector General issued a warning that provider must not charge patients for the COVID-19 vaccine.


OIG is aware of complaints by patients about charges by providers when getting their COVID-19 vaccines. Providers that charge impermissible fees must refund them and ensure that individuals are not charged fees for the COVID-19 vaccine or vaccine administration in the future. Consistent with the CDC Vaccination Program, providers are permitted to bill third-party payers (such as Medicare, Medicaid, the HRSA COVID-19 Uninsured Program, or a private insurer) for an administration fee, in accordance with the payer’s applicable billing rules.

In FEHB news, today the Office of Personnel Management issued a benefit administration letter to employing agencies and a letter to FEHB carriers instructing them to tighten up on the process of adding family members to an FEHBP enrollment. For the employing offices —

An employing office must require proof of family member eligibility for coverage through the FEHB Program for: 

• new employees during their initial opportunity to enroll (IOE) 

• employees requesting FEHB changes due to all other QLEs2 

Due to the large volume of transactions during the annual Federal Benefits Open Season, employing offices may, but are not required to, verify family member eligibility. 

When reviewing a new family member’s eligibility, employing offices may take this opportunity to verify the eligibility of family members currently enrolled who have not previously been verified. 

For the carriers — “Before adding a family member to an existing Self and Family enrollment, an FEHB Carrier must require that the enrollee provide proof of that family member’s eligibility for coverage through the FEHB Program.” In the middle of the last decade, OPM considered but never implemented an audit of family member eligibility records.

From the Centers for Disease Control reports front

  • Health Day informs us that “Emergency department visits were lower during December 2020 to January 2021 compared with prepandemic levels one year earlier, according to research published in the April 16 issue of the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. * * * The researchers found that after an initial decrease during March to April 2020, there was an increase in emergency department visits through July 2020, but at levels below those during 2019; during December 2020 to January 2021, there was a decrease of 25 percent in visits compared with prepandemic levels.”
  • The New York Times reports that

More than 87,000 Americans died of drug overdoses over the 12-month period that ended in September, according to preliminary federal data, eclipsing the toll from any year since the opioid epidemic began in the 1990s.

The surge represents an increasingly urgent public health crisis, one that has drawn less attention and fewer resources while the nation has battled the coronavirus pandemic. Deaths from overdoses started rising again in the months leading up to the coronavirus pandemic — after dropping slightly in 2018 for the first time in decades — and it is hard to gauge just how closely the two phenomena are linked. But the pandemic unquestionably exacerbated the trend, which grew much worse last spring: The biggest jump in overdose deaths took place in April and May, when fear and stress were rampant, job losses were multiplying and the strictest lockdown measures were in effect

That’s quite sad.

In other news —

  • Becker’s Hospital Review informs us that “UnitedHealth Group posted nearly $5 billion in profit for the first quarter of 2021 as its UnitedHealthcare and Optum businesses continue to grow.”
  • STAT News offers an interesting report on the burgeoning market for increasingly inexpensive continuous glucose monitors for folks with Diabetes I.

Glucose monitors are becoming the backbone of a new movement in consumer tech — one that so far is outpacing the evidence. “You kind of have this dichotomy with the perceived value of CGM,” said Susan Schembre, a researcher at the University of Arizona who has studied the use of CGMs in healthy people. “We have the consumers really driving the market on one end, and then the science kind of resisting it on the other.”

Eventually, the devices and the evidence will converge. Already, clinical CGMs have expanded from their initial patient population: Doctors regularly prescribe them to people who manage their type 2 diabetes with insulin, and sometimes to help type 2 patients tweak their habits and avoid going on medication. Manufacturers are planning for a future in which patients use the devices to both treat and prevent metabolic issues — dramatically increasing their market share. Consumer tech companies are looking for their slice of the pie.

Midweek Update

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

Bloomberg reports that

A Centers for Disease Control and Prevention panel ended discussion about the Johnson & Johnson vaccine without taking a vote, leaving it unclear how long the distribution of the shot will remain paused in the U.S. Some panel members advocated for a monthlong pause, while others were concerned about the effects of not having the J&J vaccine available, especially to the communities it was being targeted toward. As a result, distribution of the vaccine will remain halted at least until the panel meets next, perhaps in a week to 10 days.

The Wall Street Journal adds

The six cases [which resulted in the pause] exceed the background rate for the rare brain blood-clotting condition alone in women of this age group, said Tom Shimabukuro, a vaccine safety expert at the CDC who presented data on the cases. The illness the six women developed—cerebral venous sinus thrombosis, or CVST, combined with a low-platelet count—is even more rare, he said. 

The CDC issued an alert to healthcare providers Tuesday warning them to screen for the blood-clotting condition among patients who recently received the J&J vaccine and have severe headache or abdominal pain, shortness of breath, backache, leg swelling, new neurological symptoms or new or easy bruising. The condition requires a unique treatment, and healthcare providers shouldn’t give these patients the standard treatment, which involves using the anticoagulant heparin, the agency also warned. 

Notwithstanding yesterday’s supply disruption, 2.5 doses of the COVID-19 vaccines were administered yesterday according to the CDC. 47.6% of the U.S. population over age 18, and 79.6% of the U.S. population over age 65, have had at least one dose of the vaccines. 29.6% of the over age 18 population and 63% of the over 65 population are fully vaccinated.

On the artificial intelligence front, STAT News informs us that

Mayo Clinic [along with business partners] is forming a pair of companies to collect and analyze data from remote monitoring devices and diagnostic tools, a move that comes as part of a broader bid to harness patient data to deliver continuous care guided by artificial intelligence. The ultimate goal of the companies is to deliver more precise physiological information to patients and doctors around the clock, allowing them to make faster decisions to head off disease and deliver care without the usual morass of extra office visits and trips to the pharmacy.

Here’s hoping plus a link to the Mayo Clinic’s press release.

In other healthcare news, the Mayo Clinic also reminds us that “One in 5 Americans has a sexually transmitted infection,according to the Centers for Disease Control and Prevention (CDC). During Sexually Transmitted Diseases Awareness Week, April 12–17, the CDC encourages discussion, testing and help to remove the stigma surrounding sexually transmitted infections and diseases.”

The International Foundation of Employee Benefit Plans lets us know that

The number of organizations offering fertility benefits has increased over the past five years. According to the International Foundation of Employee Benefit Plans (Employee Benefits Survey: 2020 Results), 30% of U.S. organizations offer fertility benefits. Overall,

  • 24% cover fertility medications (8% covered in 2016, 14% in 2018)
  • 24% cover in vitro fertilization (IVF) treatments (13% in 2016, 17% in 2018)
  • 14% cover visits with counselors (e.g., geneticists, surrogacy, etc.) (4% in 2016, 8% in 2018)
  • 12% cover genetic testing to determine infertility issues (up slightly from 11% in 2018)
  • 11% cover non-IVF fertility treatments (6% in 2016, 11% in 2018).

In 2016, only 2% of organizations covered egg harvesting/freezing services. That jumped to 6% in 2018 and even higher in 2020, with 10% reporting that they cover the benefit.

Fierce Healthcare reports

As growing numbers of specialty drugs come through the development pipeline, employers are finding new strategies to manage the associated costs, a new report from Willis Towers Watson shows. Katie Asch, senior director and U.S. consulting pharmacy practice lead at WTW, told Fierce Healthcare that two-thirds of new drug approvals are for specialty drug products. In addition, these products are gaining approval for additional indications, Asch said. * * *

The WTW analysis groups potential solutions in financial and clinical responses, with financial options focusing on costs directly and clinical solutions focusing on utilization. For instance, utilization management tools like prior authorization can ensure patients are taking drugs appropriately, while copay assistance programs can manage individual costs.

In addition, according to the report, employers are finding ways to deploy multiple solutions in tandem. The insurer may offer a stop-loss program that can work well in tandem with advanced strategies for chronic care management, for example. “We’re seeing plans focus a bit more attention there if they have already pulled all the levers,” she said.

The report also highlights some drug products that are expected to get the Food and Drug Administration’s OK in the coming months. Ponesimod, a therapy for multiple sclerosis, is expected to be approved around March 18 and would cost between $60,000 and $80,000 per year.