Thursday Miscellany

Rx coverage

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.

Interesting Ideas

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

Health Payer Intelligence reports that CIGNA and SCAN Health Plan are teaming up to reach out to Medicare Advantage members in an effort to help them with senior loneliness during the great hunkering. SCAN’s “employees are calling on seniors, starting with the most at-risk and isolated. During their birthday and welcome calls, SCAN’s Senior Advocates—individuals who are both members and SCAN Health Plan employees—listen for potential social determinants of health needs.” What a great approach for FEHB plans to follow.

STATNews discusses the value of using chest CT scans to reliably reliably supplement other forms of COVID-19 testing in our country.

STATNews also has developed a new electronic dashboard to gauge the readiness of rural counties in the U.S. to deal with the COVID-19 emergency or other pandemics. The developers are seeking public comment on the dashboard. This dashboard should have benefits beyond the current emergency.

Healthcare Dive reports that

The Centers for Disease Control and Prevention is working to automate generation and transmission of COVID-19 case reports to deliver data put in provider EHRs directly to public health agencies.

For providers that don’t have EHRs with the ability to electronically send case reports, CDC is creating a FHIR-based app [called eCR Now] to connect COVID-19 electronic case reporting (eCR) to existing health IT infrastructure to confirm cases and route the data to appropriate end users. The goal is to give public health officials a more accurate, timely picture of the pandemic.

The FEHBlog is quite a fan of the FHIR API.

This is the time of the year when the Drug Enforcement Administration (DEA) hold events that allow citizens to safely dispose of unused prescription drugs. Obviously these events are not being held this April. The DEA has creates a website on safe householder disposal of unused prescription drugs. It’s good information for health plans to share with members.

Person using a laptop

Thursday Miscellany

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

As the FEHBlog discussed COVID-19 death rates yesterday, it’s only meet and right to post STAT’s story which seeks to put COVID-19 death projections into perspective.

On the flip side, STAT reports on Pfizer’s decision to accelerate by three months human testing on a potential treatment for COVID-19 and local WTOP news reports on COVID-19 vaccine development efforts by a company in the Maryland suburbs of D.C., Novovax. Best of luck.

Healthleaders Media discusses a Guidehouse study finding

A major factor hampering the financial situation for rural providers is the migration of patients to care options outside of the community, with over 75% of patients bypassing local hospitals to receive care elsewhere. These levels are much higher compared to the outmigration patterns of suburban and urban patients.

More than 350 rural hospitals [one in four], accounting for $8.3 billion in total patient revenue, are at the greatest financial risk of closure, according to Guidehouse. The five states most likely to be impacted by hospital closures include Tennessee, Oklahoma, Mississippi, Alabama, and Kansas, according to the analysis.

Guidehouse adds that “Of these hospitals, 81%, or 287 hospitals, are considered highly essential to the health and economic well-being of their communities.” What is really troubling about this study is that it was conducted before the COVID-19 emergency which must be exacerbating these financial problems.

The Centers for Medicare and Medicaid Services today issued additional guidance loosening the regulatory reins on healthcare providers so that “so that hospitals, clinics, and other healthcare facilities can boost their frontline medical staffs” necessary to treat COVID-19 patients and others. Among other steps,

Doctors can now directly care for patients at rural hospitals, across state lines if necessary, via phone, radio, or online communication, without having to be physically present. Remotely located physicians, coordinating with nurse practitioners at rural facilities, will provide staffs at such facilities additional flexibility to meet the needs of their patients.

Similarly, the HHS Office for Civil Rights which enforces the HIPAA Privacy and Security Rules promised not to impose HIPAA penalties on good faith rule violations that occur at COVID-19 testing sites.

Drug Channels offers an interesting take on the CMS actuary’s recent healthcare spending projections for the U.S. Adam Fein observes that ” The coronavirus is upending our healthcare system and putting enormous pressure on hospitals. Despite increased costs of treatment, I expect that spending [that CMS estimated before the COVID-19 emergency] will be lower than the CMS projections.”

On the technology front, the federal government’s cybersecurity authorities released a detailed alert on a variety of cyberscams that have arisen during the COVID-19 emergency.

Friday Stats and More

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

The number of COVID-19 cases continues to grow along with the COVID-19 death rate (number of deaths over number of cases per the CDC). The FEHBlog’s statistics are drawn from the CDC’s now daily Cases in United States Summary.

Cause3/203/274/3
Travel2907121388
Person to Person31013264325
Uncategorized984283318233,566
Total Cases10,44285,356239,279
Total Deaths 15012465442
Death Rate1.44%1.46%2.27%

For context, the CDC’s latest Fluview “estimates that so far this season there have been at least 39 million flu illnesses, 400,000 hospitalizations and 24,000 deaths from flu.” That represents a death rate of less than one tenth of one percent (0.06%). Fortunately this flu season appears to be subsiding. The CDC additionally “estimates that influenza has resulted in between 9 million – 45 million illnesses, between 140,000 – 810,000 hospitalizations and between 12,000 – 61,000 deaths annually since 2010.”

The FEHBlog has wondered where is the light at the end of the COVID-19 tunnel. He now appreciates the fact that we haven’t made it half way through the tunnel. Hang in there.

Not surprisingly but regrettably Govexec.com reports that thousands of federal employees have contracted COVID-19 and attempts to provide a numerical breakdown by agency.

In more upbeat news, MedCity News informs us that

The Food and Drug Administration has given an emergency use authorization to a test for Covid-19 that detects whether a person is infected through the use of antibodies. The FDA granted the authorization to Research Triangle Park, North Carolina-based Cellex, for the qSARS-CoV-2 IgG/IgM Rapid Test, according to a letter from FDA chief scientist Denise Hinton, sent Wednesday to Cellex CEO James Li. The test is designed to produce results in 15-20 minutes.

The advantage of antibody tests is that they not only are less likely to produce false-negative results, but can also be used to detect past infections, meaning that they can be used to determine if a patient without symptoms has previously had Covid-19 and could thus be immune to it. It could also be used to indicate stage of infection and estimate time since exposure. Nevertheless, according to the primer, a limitation to antibody testing is that the body’s immune response to SARS-CoV-2 is slow.

The Labor Department continues to add to its list of now 78 FAQs on the FFCRA’s COVID-19 paid sick leave law which took effect on April 1 while the U.S. Supreme Court cancelled its April oral arguments which would have occurred at the end of this month.