Weekend Update

Rx coverage

Weekend Update

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

The House and Senate will be conducting legislative and committee business this week preceding the Fourth of July holiday. Of note, on Tuesday at 10 am the Senate Health Education Labor and Pensions Committee will hold a hearing on ways to return to work and school safely following the great hunkering down.

The Supreme Court has thirteen more opinions to release before its summer break. The Court is expected to release opinions on Monday, Tuesday, and Wednesday this week, all at 10 am.

On the COVID-19 front —

  • Fierce Healthcare discusses how the Walgreen’s Pharmacy chain has leveraged its partnership with Microsoft and other technology companies to better respond to the COVID-19 emergency.
  • A few weeks ago, the Journal podcast offered a fascinating show on the Hertz bankruptcy. It’s worth a 17 minute long listen. The story highlights how a strong balance sheet helps companies weather storms like the COVID-19 emergency. Becker’s Hospital Review identifies 14 well known health systems in this favorable situation, including Kaiser Permanente. It’s not an exclusive list.
  • Healthcare Dive reports on the significant adverse financial impact that the COVID-19 emergency has had on primary care practices in the U.S. Surprisingly that article does not note that these practices have been eligible for Payroll Protection loans and federal grants. The government deserves credit for trying to soften the blow to this critical sector of our health care system. Tuesday June 30 is the deadline for applying for a PPP loan.

On the human nature front, the Wall Street Journal reports that COVID-19 first responders have been relaxing by playing a boardgame called Pandemic.

Midweek update

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

Fierce Healthcare reports on PriceWaterhouseCooper’s three tier approach to estimating 2021 health care costs. Of course, the variable is impact of the COVID-19 emergency. The Goldilocks increase is estimated at 6%.

Fierce Pharma informs us that Gilead’s as yet unpriced remdesivir treatment for severe COVID-19 has gained stiff competition for a “low-cost [drug called] dexamethasone.”

According to results just published on preprint site medRxiv, dexamethasone treatment led to a 35% reduction in death rate among patients on invasive mechanical ventilation and 20% for those receiving oxygen without invasive ventilation.

Because of that showing, clinical experts told ICER that dexamethasone could soon become the new standard of care throughout the U.S., “and that the relative benefits of remdesivir will now be judged to be most pertinent as an adjunct to dexamethasone treatment,” the organization noted in its new analysis. In the ACTT-1 trial, the death rate for remdesivir among severe patients were reduced to 7.7% from 13% for placebo, a difference that was not statistically significant.

Both drugs remain under study.

Smartbrief offers four innovative approaches for payers in the post hunkering down world. The FEHBlog’s favorites approach is as follows:

Humana Vice President Caraline Coats defined whole person care through the lens her company’s Bold Goal initiative uses: Primary care, social determinants of health, pharmacy, home health and behavioral health. Their work strives to help members in targeted communities enjoy more Healthy Days per month – when they feel physically and mentally well. A lot of their progress comes down to taking the time to ask members the right questions, and then having the ability to act on what is learned.

In an industry built around episodic care, “whole-person care is really different,” Coats said, and it is still being defined. So, her team’s work looks a lot like vetting of clinical interventions: rigorous testing, followed by publication of results so others may learn, too. Among their recent promising experiments is a partnership with Mom’s Meals to meet the needs of certain members with diabetes and a program with Papa (which provides companionship and help with everyday tasks) that measurably brought down loneliness scores among participants.

Meanwhile Blue Cross and Blue Shield of North Carolina is offering monetary support to primary care practices in that State. That’s quite a helping hand. Bravo.

On the technology front —

  • Anthem, the large Blue Cross licensee, is now an Alexa skill. Currently

Using the Anthem Skill, you can:

Order your digital member ID card.
Access your health savings account (HSA) or health reimbursement account (HRA) balance.
Check your progress toward meeting your medical plan’s deductible and out-of-pocket maximum.
Schedule a call with someone from our Member Services team.
Refill, renew and check the order status of any home delivery prescription medicines.
Find out how close you are to reaching your dental plan’s deductible and annual maximum.
Use the glossary to learn what a health care term means.

  • STAT News has an interesting article about about how North Dakota is testing a contacts app with COVID-19 patients. The app was developed by a Microsoft engineer for use with North Dakota football games. Unfortunately, however, according to the article:

While apps can’t replace health care workers, they may be used to bolster their efforts — so long as enough people use them. So far, though, that hasn’t gone as planned: Early excitement over cutting-edge technology has given way to a largely lackluster role for contact tracing apps. Many states have opted against adopting the tools as part of their arsenal. And the handful of states that are launching such apps — including North Dakota — haven’t seen them gain much traction.

Tuesday Tidbits

David Ermer–ACA, CDC, Congress, COVID-19, Medicare, Rx coverage, Uncategorized–

At today’s House Energy and Commerce Committee hearing on the COVID-19 emergency, Dr. Fauci, according to the Wall Street Journal, remarked that “he is ‘cautiously optimistic’ that a successful vaccine could be produced around the end of 2020. ‘I believe it will be when and not if,’ he said.” Amen to that. Here’s a link to today’s Senate Health Education Labor and Pension Committee’s hearing on the same topic.

The Labor Department’s Employee Benefit Security Administration issued a wide-ranging set of frequently asked questions on the health plan related provisions of the Families First Coronavirus Response Act and the CARES Act. Check it out.

Reuters reports on a sobering CMS study of the COVID-19 emergency on Medicare beneficiaries. ““The disparities in the data reflect longstanding challenges facing minority communities and low income older adults,” said Seema Verma, administrator of the Centers for Medicare & Medicaid Services (CMS).”

MedCity News informs us that “Clinical development will soon begin for an inhaled version of a [Gilead] antiviral drug {remdesivir} used to treat Covid-19 that is currently available only to hospitalized patients in intravenous form.” That’s a pro move.

Drug Channels offers its annual study of 2019 PBM drug spending reports.

The PBMs’ data highlight key trends about drug spending:
— For 2019, CVS and Express Scripts reported overall changes in drug spending that were in the low single digits. Prime reported mid-single-digit growth in overall drug spending.
— Spending growth on traditional drugs declined by mid-single digits for the third consecutive year. This decline came from deeper commercial rebates on brand-name drugs, ongoing deflation in generic drugs, and a small increase in the generic dispensing rates.
— The results for CVS and Express Scripts were comparable. For CVS Caremark’s commercial clients, net drug prices for traditional drugs declined by -6.3%, while utilization grew by 1.5%. For Express Scripts’ commercial clients, net drug prices for traditional drugs declined by -6.4%, while utilization grew by 1.4%.

In legal news

  • It was no surprise to learn from Politico that LGBTQ advocates already have brought a lawsuit against the Department of Health and Human Services (“HHS”) “over its rollback of LGBTQ patient protections, arguing that last week’s Supreme Court decision extending workplace legal protections to gay and transgender employees invalidates the new rules.” That should be a rollover win for the plaintiffs.
  • It was a pleasant surprise to learn that the U.S. District Court for the District of Columbia today ruled in favor of an HHS rule requiring hospital to disclose real prices, e.g, negotiated prices with health plans, for their services just like retail stores. The FEHBlog expects that this rule will lead to more and better (e.g., quality based) competition among hospitals. But first the decision will need to be affirmed by the Court of Appeals.

Thursday Miscellany

David Ermer–COVID-19, Electronic health records, Rx coverage–

The Centers for Disease Control updated their guidance on how COVID-19 spreads earlier this week. Here’s the main takeaways from the FEHBlog’s standpoint:

COVID-19 is thought to spread mainly through close contact from person-to-person. * * * Some people without symptoms may be able to spread the virus. The virus that causes COVID-19 is spreading very easily and sustainably between people. Information from the ongoing COVID-19 pandemic suggests that this virus is spreading more efficiently than influenza, but not as efficiently as measles, which is highly contagious. In general, the more closely a person interacts with others and the longer that interaction, the higher the risk of COVID-19 spread.

Check it out.

Healthcare Dive reports

The Trump administration on Wednesday proposed changes to how drugmakers can report their prices to Medicaid, seeking to make it easier for pharmaceutical companies and insurers to enter into contracts that tie payment to patient outcomes. Typically, drug contracts are linked to the volume of product sold, providing for larger manufacturer rebates the more a product is prescribed and covered by an insurer. Increasingly, however, drugmakers and insurers have been exploring alternative approaches centered on some measure of a medicine’s value.

Why is this relevant to the FEHBP? “The Medicaid best price policy requires drug manufacturers to give Medicaid programs the best price among nearly all purchasers [Medicare Part D is excepted].” So for example, if a prescription drug manufacturer cuts a deal for value based drug pricing, the VBD pricing cannot drop below the Medicaid price. If the manufacturer can cut the same deal with Medicaid under this proposed rule, then everyone benefits. This is a proposed rule that won’t go into effect until later this year at best.

Fierce Healthcare reports that

Health Care Service Corp., which owns and operates Blue Cross plans in five states, has tapped Epic to develop a data exchange platform between health plans and providers. HCSC health plans will be able to exchange medical information with health providers in its networks that use Epic’s electronic health record (EHR) software. The contract is one of the first of its kind between Epic and a large insurer, according to the companies.

Given the importance of clinical data in government and large employer healthcare quality programs imposed on health plans, including OPM’s Plan Performance Assessment, this certainly won’t be the last such deal.

Weekend update

David Ermer–Congress, Rx coverage, SCOTUS, Telehealth–

The Senate is engaged in legislative and committee business this week. Last week the Senate passed by unanimous consent a bill (S. 279) to amend the FEHB and FEGLI Acts for the purpose of extending coverage to employees of Indian tribal grant schools. This bill would close a gap created by the Affordable Care Act which generally extended coverage under these programs to Indian tribal employees. There are 128 tribal grant schools in the U.S.

The House of Representatives is engaged in committee business this week. That body is next scheduled to hold votes over the period June 30 through July 2.

The Supreme Court continues this week to release the remaining opinions from its October 2019 term. The Hill includes an article discussing the seven opinions that are expected to be politically controversial.

In other news Fierce Healthcare reports

  • “A top Department of Health and Human Services (HHS) official acknowledged [last week] that telehealth is here to stay after an explosion of use due to COVID-19 but hedged on whether new regulatory flexibility on reimbursement is going to stick around.” The permanent flexibility depends largely on Congress and state regulators, and
  • “OptumRx researchers are highlighting three more drug products that payers should be keeping an eye on in 2020″ — Roche’s Risdiplam, NS Pharma’s Viltolarsen, and Immunomedic’s Trodelvy.

Midweek update

David Ermer–Congress, Rx coverage, Telehealth–

NBC News reports that Wednesday evening, the Senate passed by unanimous consent a House passed bill to improve the Payment Protection Program that the CARES Act created to help small businesses with liquidity issues created by the great hunkering down.

UPI provides helpful context around the new Medicare program to control Medicare beneficiary out of pocket costs for insulin.

“Among commercially insured patients, high insulin prices do not necessarily translate to high out-of-pocket costs,” study co-author Dr. Amir Meiri, a research fellow with the Harvard Medical School Department of Population Medicine and a practicing internist, told UPI.

For these patients, “insulin out-of-pocket costs are generally lower than expected and declining, except among patients in high-deductible health plans with health savings accounts, who must pay for the full cost of medications — including insulin — until they reach their deductible,” Meiri said.

The time period for the study was 2007-16. Last year, the Internal Revenue Service pursuant to an executive order issued a ruling permitting coverage of insulin before the high deductible.

A friend of the FEHBlog called to his attention this 21st century, FDA approved digital stethoscope that could revolutionize care at home. Fierce Healthcare quotes Cambia Health’s chief medical officer who notes ““Telehealth as always been a benefit,” she said. “I think physicians now know that their patients want to use telehealth.”

Weekend update

David Ermer–CDC, Congress, COVID-19, COVID-19 testing, OPM, Rx coverage, SCOTUS–

The House of Representatives and the Senate both will be in session on Capitol Hill this coming week, Of note from an FEHBP perspective is that Senate Homeland Security and Governmental Affairs Committee has scheduled a confirmation hearing for the President’s nominee for OPM Inspection General, Craig E. Leen, for Tuesday June 2 at 2:30 pm. Mr. Leen currently is Director of the Office of Federal Contract Compliance Programs (OFCCP) at the U.S. Department of Labor. The FEHBlog plans to tune in.

The Supreme Court heads into the home stretch of its October 2019 term tomorrow. The Court has 25 decisions left to issue before adjourning for the summer according to the Scotusblog.

OPM released more COVID-19 guidance last Friday. This guidance concerns preparedness for returning to OPM facilities.

Fierce Healthcare brings us up to date on COVID-19 testing at home options. The latest product receiving FDA approval is offered by Quest Diagnostics a/k/a Quest Labs.

The FEHBlog ran across on Twitter today this May 24 column from Reason senior editor Jacob Sillum.

According to the Centers for Disease Control and Prevention (CDC), the current “best estimate” for the fatality rate among Americans with COVID-19 symptoms is 0.4 percent. The CDC also estimates that 35 percent of people infected by the COVID-19 virus never develop symptoms. Those numbers imply that the virus kills less than 0.3 percent of people infected by it.

The FEHBlog also found this reassuring (at least to the FEHBlog) Science News article on COVID-19 mutations.

[C]oronavirus mutations are guaranteed to pop up over the coming months — and experts will continue to track them. “The data will tell us whether we need to worry, and in what way we need to worry,” [Louise] Moncla[, an evolutionary epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle] says. “Everyone should take a deep breath and realize that this is exactly what we’ve always expected to happen, and we don’t necessarily need to be concerned.”

Person using a laptop

Thursday Miscellany

David Ermer–COVID-19, OPM, Rx coverage–

A few posts ago, the FEHBlog favorably mentioned the National COVID-19 Convalescent Plasma Project. “Researchers hope transfusions of antibody-rich plasma from recovered Covid-19 patients can help neutralize the coronavirus in patients who are sick.” Today the Wall Street Journal reports that

A [Phase 2] study of thousands of Covid-19 patients who received blood plasma transfusions from recovered patients indicates the experimental therapy appears to be safe, paving the way for future studies and clinical trials.

A team of researchers at Mayo Clinic, Michigan State University and Johns Hopkins University examined health outcomes of 5,000 hospitalized patients around the U.S. who received convalescent plasma treatment, and found the transfusions resulted in few serious side effects and there wasn’t an excessive mortality rate.

Let’s go.

In other upbeat news, the Wall Street Journal reports that “More patients are turning to mail or courier to get their prescription drugs during coronavirus lockdowns, a shift from the traditional visit with a pharmacist that is expected to endure after the pandemic subsides.” Mail order delivery of maintenance medications is known to create a cost savings for health plans and their members.

Health Payer Intelligence discusses a fascinating PriceWaterHouseCoopers healthcare consumer survey conducted during the great hunkering down. The survey’s “results signal that US businesses could play an even bigger role in protecting the health of their workers, that the health system likely will make more room for telehealth and other forms of virtual care, and that the American consumer may take a more active role in managing health and participating in a system that is being remade.”

In other news —

  • The FEHBlog ran across this American Medical Association website of its COVID-19 resources.
  • Fierce Healthcare calls to our attention the Medscape Physician Compensation Report 2020. “Primary care docs brought in about $243,000, up 2.5% from $237,000 reported a year earlier. Specialists earned about $346,000 on average, up 1.5% from the $341,000 they made a year earlier.”
  • OPM issued additional COVID-19 guidance to federal agencies today. It’s not FEHBP related.

Monday Mishmash

David Ermer–COVID-19, Medicare, Rx coverage–

Today, the Centers for Medicare and Medicare Services released its proposed rule describing changes to its Medicare Part A prospective payment system (“PPS”) changes for the federal fiscal year beginning October 1, 2020. This PPS applies to acute and long term inpatient care. Fierce Healthcare explains that the changes represent “an approximately 1.6% increase to inpatient hospital stay payments” that will add about $2.1 billion to Medicare spending next fiscal year.

A friend of the FEHBlog recommended a book called “Together: The Healing Power of Connection in a Sometimes Lonely World” written by former U.S. Surgeon General Vivek Murthy. It seems like a perfect read for the great hunkering down. The FEHBlog will let you know.

In other news:

  • Fierce Healthcare also discusses how CVS Health has adapted its specialty pharmacy to the COVID-19 emergency. According to the article, CVS Specialty is making greater use of digital tools, e.g., “a 30% increase in March alone in encounter volume through CVS Specialty’s secure messaging tool, which allows [their] pharmacists to text members directly to discuss their medications.”
  • The Wall Street Journal reports that “Atul Gawande is in advanced discussions to step down as chief executive and take on a less operational role as chairman of Haven, the health-care venture backed by Amazon.com Inc., Berkshire Hathaway Inc., and JPMorgan Chase JPM , according to people with knowledge of the matter.” Haven was the big new thing is 2018 when Dr. Gawande came aboard.
  • The HHS Office of Inspector General announced the availability of two “toolkits and the accompanying code can be used to analyze claims data for prescription drugs and identify patients who may be misusing or abusing prescription opioids and may be in need of additional case management or other followup. These toolkits and accompanying code can also be used to answer research questions about opioid utilization.”

Weekend update

David Ermer–Congress, COVID-19, HIPAA Privacy and Security Rules, Rx coverage–

Happy Mother’s Day.

Just like last week, the Senate will be in session this week while the House continues to fully hunker down. The Hill discusses five factors influencing when the House will return to Capitol Hill. It’s funny that the article does not list the Presidential election as a sixth factor. (Even the FEHBlog is entitled to have an occasional “DJT” moment. Lo siento.)

The FEHBlog forgot last Thursday to provide a link to the Senate Health Education Labor and Pension Committees “shark tank” on new tests for COVID-19. Here you go. This Committee will be holding a hearing on how to pull out of the great hunkering down on Tuesday.

For the past two months, the FEHBlog has been tracking a simplified infection fatality rate (IFR) for COVID-19 based on the CDC’s statistics. The FEHBlog is not an epidimeologist but he figured things would be looking up if the rate plateaued. The FEHBlog’s statistics do show the IFR increase slowing down over the past month. In any event, here’s a new Health Affairs article on the COVID-19 IFR for your information.

CIGNA’s PBM Express Scripts has created a program called ParachuteRX which offers reasonably priced prescription drugs to the uninsured. Cool.

The FEHBlog has been a fan of genetics-based personalized medicine. It therefore was sobering for the FEHBlog to read in the Wall Street Journal that the popular focus on personalized medicine has detracted from public health efforts. The article explains that

the first national initiative launched to try to treat today’s severely ill patients is the National Covid-19 Convalescent Plasma Project. The project originated with a small nucleus of people who, it turns out, have been prominent critics of personalized medicine over the years, including Arturo Casadevall of Johns Hopkins University, Michael Joyner of the Mayo Clinic and Nigel Paneth of Michigan State University.

The idea of using antibody-rich plasma from recovered patients to try to neutralize a virus in those who are ill was first used more than 100 years ago. The project is designed to buy time and save lives until a vaccine can be developed and deployed or more targeted therapies can be identified and tested. It also offers a real-world test case for ideas that had largely been confined to academic journals and debates between scientists.

Indeed the FEHBlog learned in the Great Influenza book that small scale efforts to use this antibody approach found success in the 1918-19 pandemic. It’s encouraging to read that a large scale effort is underway now. In the aftermath of the great hunkering down, a Goldilocks compromise must be reached between personalized medicine and public health efforts.

Finally, Health IT Security does a good job putting the government’s COVID-19 related flexibilities with regard to enforcing the HIPAA Privacy Rule into focus.