Today's News and Commentary

About COVID-19

Hackers altered Moderna, Pfizer data from EU before posting online to undermine public's trust in vaccines: “Hackers who leaked the European Medicines Agency's COVID-19 vaccine data from Moderna and Pfizer manipulated the information before publishing it online, the EMA announced Jan. 15. 
In an update on the cyberattack, the EMA said the leaked documents included internal and confidential emails about the COVID-19 vaccine evaluation process and that ‘some of the correspondence has been manipulated by the perpetrators prior to publication in a way which could undermine trust in vaccines.’” 

US approaches 400,000 coronavirus deaths: “The US recorded 1.5 million new Covid-19 cases in the past seven days, according to the most recent data from Johns Hopkins University, an 11% drop from the previous week. Cases declined in 35 states week-over-week, and 18 states saw a drop in the number of deaths.
But with a longer range view, last week's apparent improvement falls much closer to average. Over the past month, the number of new Covid-19 cases recorded each day has ranged from nearly 101,000 to more than 302,000; over the past seven days, new cases averaged about 218,000 daily.”

Emergence of SARS-CoV-2 B.1.1.7 Lineage — United States, December 29, 2020–January 12, 2021: “A more highly transmissible variant of SARS-CoV-2, B.1.1.7, has been detected in start highlight12end highlight U.S. states…
The increased transmissibility of the B.1.1.7 variant warrants universal and increased compliance with mitigation strategies, including distancing and masking. Higher vaccination coverage might need to be achieved to protect the public. Genomic sequence analysis through the National SARS-CoV-2 Strain Surveillance program will enable a targeted approach to identifying variants of concern in the United States.”

Biden pledges to build scores of new vaccine sites and prioritize older Americans: “President-elect Joe Biden pledged to put Americans 65 and older near the front of the line for coronavirus vaccines and to expand the number of vaccination sites to quickly make up for the Trump administration's bungled response.
Biden vowed to use available supplies more efficiently and equitably to supercharge the effort to get shots into arms after Trump’s promise to vaccinate 20 million people before Jan. 1 fell far short.”

Israel trades Pfizer doses for medical data in vaccine blitz: “After sprinting ahead in the race to inoculate its population against the coronavirus, Israel has struck a deal with Pfizer, promising to share vast troves of medical data with the international drug giant in exchange for the continued flow of its hard-to-get vaccine.”

The Trump administration bailed out prominent anti-vaccine groups during a pandemic: “Five prominent anti-vaccine organizations that have been known to spread misleading information about the coronavirus received more than $850,000 in loans from the federal Paycheck Protection Program, raising questions about why the government is giving money to groups actively opposing its agenda and seeking to undermine public health during a critical period.
The groups that received the loans are the National Vaccine Information Center, Mercola Health Resources, the Informed Consent Action Network, the Children’s Health Defense and the Tenpenny Integrative Medical Center, according to the Center for Countering Digital Hate, an advocacy group based in the United Kingdom that fights misinformation and conducted the research using public documents. The group relied on data released in early December by the Small Business Administration in response to a lawsuit from The Washington Post and other news organizations.”

Previous coronavirus infection may offer less protection from new variant: “Previous infection with the coronavirus may offer less protection against the new variant first identified in South Africa, scientists said on Monday, although they hope that vaccines will still work.
Studies also found that the new variant binds more strongly and readily to human cells. That helps explain why it seems to be spreading around 50% quicker than previous versions, leading South African epidemiologist Salim Abdool Karim said.”

Key Capital COVID-19 Oral Pill Vaccine Records 90% Reduction in Virus Infectivity in Early Study: “The preliminary tests conducted by a leading Asian research institute have shown safety and a 90% reduction on virus infectivity in mammalian cells following exposure to the active vaccine. This laboratory testing highlights the vaccine methodology and ability to inactivate and/or prevent viral infection and its potential for oral mucosal administration.”

WHO cites human behavior more than variants as virus spreads: “The World Health Organization's emergencies chief said Friday that the impact of new variants of COVID-19 in places like Britain, South Africa and Brazil remains to be seen, citing human behavior for some recent rises in infection counts.”

Panel: China, WHO should have acted quicker to stop pandemic: “A panel of experts commissioned by the World Health Organization has criticized China and other countries for not moving to stem the initial outbreak of the coronavirus earlier and questioned whether the U.N. health agency should have labeled it a pandemic sooner.
In a report issued to the media Monday, the panel led by former Liberian President Ellen Johnson Sirleaf and former New Zealand Prime Minister Helen Clark said there were ‘lost opportunities’ to adopt basic public health measures as early as possible.” Here is the full preliminary WHO report.

About healthcare IT

Health Insurer Pays $5.1 Million to Settle Data Breach Affecting Over 9.3 Million People: “Excellus Health Plan, Inc. has agreed to pay $5.1 million to the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) and to implement a corrective action plan to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules related to a breach affecting over 9.3 million people.  Excellus Health Plan is a New York health services corporation that provides health insurance coverage to over 1.5 million people in Upstate and Western New York.
On September 9, 2015, Excellus Health Plan filed a breach report stating that cyber-attackers had gained unauthorized access to its information technology systems.”
It is still amazing how long these actions take.

A look inside Anthem's new digital incubator: “As healthcare continues to evolve, legacy players are aiming to be the first to gain access to the latest innovations.
At Anthem, that effort has meant launching its own Digital Incubator, which pairs financial backing with mentorship and opportunities for partnerships with universities and corporations…
For [example], the incubator hosts challenges for would-be innovators to compete for prizes while developing solutions targeting key health issues. This week, ADI opened applications for community health challenges, with specific focus areas targeting health literacy, food insecurity and medication adherence…
In addition, ADI has entrepreneurs in residence who are given the opportunity to work alongside the payer's leadership and other executives, including through one-on-one mentorship.”

So long, fax machines? CMS finalizes rule aimed at streamlining prior authorizations, improving data sharing: “The Trump administration finalized a rule aimed at improving the sharing of healthcare data between payers and providers and streamlining prior authorization.
The rule, released Friday (PDF) by the Centers for Medicare & Medicaid Services (CMS), requires payers in certain government programs to build application programming interfaces (APIs) for data exchange and prior authorization. It tackles a common complaint from providers that prior authorization has increased in use among plans and takes up too much time away from patients.
Officials said the final rule also builds on efforts to drive interoperability and empower patients by promoting secure electronic access to health data.”

Health benefits platform Accolade is buying telehealth startup 2nd.MD for $460M:”Accolade plans to pay $460 million to acquire 2nd.MD, a company that helps patients get expert medical opinions via video or phone.
The deal will create the most comprehensive, integrated healthcare navigation experience in the industry, Accolade officials said.
By adding 2nd.MD's services, Accolade will help employers address the urgent medical needs that face employees in 2021.”

UnitedHealthcare Expands Access to Virtual Care, Including a New Virtual Primary Care Offering: “To help improve access to local care providers, UnitedHealthcare has updated a policy to help encourage the use of virtual care and enable eligible members to meet with their physicians virtually. Effective Jan. 1, the policy applies to fully insured and self-insured employer plans and will continue to reimburse local primary care physicians, specialists and select therapy providers for administering certain care through telehealth as an alternative to in-person visits.
The new Virtual Primary Care service, which is designed to make it easier for people to establish and maintain a relationship with a primary care physician, is currently available for members enrolled in certain employer-sponsored fully insured or self-funded health plans in 11 states. The service, offered in collaboration with a national telehealth provider group, is expected to be expanded to more states in 2021 and is part of a broader UnitedHealthcare effort to help enable members to use technology to access care.”

New computational tool reliably differentiates between cancer and normal cells from single-cell RNA-sequencing data: “n an effort to address a major challenge when analyzing large single-cell RNA-sequencing datasets, researchers from The University of Texas MD Anderson Cancer Center have developed a new computational technique to accurately differentiate between data from cancer cells and the variety of normal cells found within tumor samples. The work was published today in Nature Biotechnology.
The new tool, dubbed CopyKAT (copy number karyotyping of aneuploid tumors), allows researchers to more easily examine the complex data obtained from large single-cell RNA-sequencing experiments, which deliver gene expression data from many thousands of individual cells.”

About pharma

The top 10 largest biopharma M&A deals in 2020: The article has details bout each of the ten deals.

Ineos gives Oxford £100m to set up antibiotic research institute: “Oxford university has received £100m, its largest donation for science, from chemicals group Ineos to set up an antibiotics research institute to counter the growing threat from deadly superbugs. The gift from the UK’s largest private company will help tackle antimicrobial resistance, which scientists estimate kills at least 750,000 people worldwide a year and could lead to as many as 10m deaths annually by 2050 unless a new generation of drugs is found.”

Rite Aid Must Face Trial For Inflated Drug Price Claims: “A Delaware Superior Court judge on Friday sent toward trial some litigation claims filed by a group of health insurance and pharmacy benefit companies asserting Rite Aid charged the companies too much for prescriptions included in the drugstore chain's discount drug card program.”

About health insurance

CMS issues changes to Medicare Advantage and Part D meant to improve coverage, access: “The Centers for Medicare and Medicaid Services issued a final rule Friday that will require Part D plans to offer a real-time benefit-comparison tool starting January 1, 2023…
The changes are generally effective for the 2022 plan year and will potentially lower enrollee cost sharing on some of the most expensive prescription drugs, CMS said. The final rule will allow enrollees to know in advance and compare their out-of-pocket payments for different prescription drugs.”
Part D plans already have a total annual cost computation (on the medicare.gov website) so it is not clear how this rule would be of benefit.

Kemp, Trump proposal to block ACA shopping website draws legal fight: “Advocates for the federal health insurance program known as Obamacare filed a lawsuit Thursday challenging Georgia’s plan to block access to coverage through the program’s online marketplace.
The federal lawsuit argues that in allowing Georgia to ignore certain provisions of the Affordable Care Act, the Trump administration was illegally attempting to gut the law, which has withstood repeated challenges in Congress and the courts.”

Insurers ordered to give up claims data for FTC study of healthcare mergers and acquisitions: Another use of insurance data: “The Federal Trade Commission sent orders to six health insurers for claims data to help it study the effect of hospital acquisitions of physician groups. 
This study is part of a broader initiative announced by the FTC to revamp its merger retrospective program and better equip the agency to challenge healthcare mergers.
The FTC sent orders to Aetna, Anthem, UnitedHealthcare, Cigna, Florida Blue and Health Care Service Corp. The orders ask the insurers to provide patient-level claims data for inpatient, outpatient and physician services.”

A breakdown of 14 recent CMS actions: A good summary of each of these actions.

About the public’s health

HHS finalizes rule that imposes term limits for career federal scientists: “Health and Human Services published a final rule that institutes term limits top career government scientists.
The agency’s final rule issued late Friday imposes five-year terms for policy level directors across the entirety of HHS’ divisions that include the Health Resources and Services Administration and Food and Drug Administration centers…
The first term for these agency directors will start ending on staggered dates in December 2021 and the rule would affect 66 career scientists.
HHS said that the scientists will not be fired or have their pay reduced under the rule but instead would be appointed somewhere else in the agency.”
Look for the Biden administration to reverse this rule.

Today's News and Commentary

Here is a Summary of this week’s annual JP Morgan Conference

About the public’s health

Biden unveils $1.9 trillion relief package: 10 things to know: This article is a good, concise summary of last night’s speech by the President-elect. For more details, see: Biden’s $1.9 trillion Covid relief plan calls for stimulus checks, unemployment support and more

Ex-FDA chief David Kessler to lead COVID-19 vaccine efforts as head of Operation Warp Speed: The rumor of the appointment has been confirmed.

SIU researchers discover new, dominant variant of US COVID-19 virus: “A team led by a researcher at Southern Illinois University Carbondale has discovered a new variant of the COVID-19 virus that is specific to and dominant in the United States, adding to the growing list of mutations such as those discovered in the United Kingdom and South Africa. It might be more easily transmissible than other variants, and its impact on vaccines is uncertain.”

CDC warns highly transmissible coronavirus variant to become dominant in U.S.: “The highly contagious variant of the coronavirus first seen in the United Kingdom will become the dominant strain in the United States within about two months, its rapid spread heightening the urgency of getting people vaccinated, the Centers for Disease Control and Prevention predicted Friday in its most sobering warning yet about mutations in the virus.
In every scenario explored by the CDC, the U.K. strain, which British researchers estimate is roughly 50 percent more transmissible than the more common coronavirus strain, will account for a majority of cases in the United States by some point in March.”

Comparison of Saliva and Nasopharyngeal Swab Nucleic Acid Amplification Testing [NAAT] for Detection of SARS-CoV-2: “In the primary analysis, the saliva NAAT pooled sensitivity was 83.2% (95% credible interval [CrI], 74.7%-91.4%) and the pooled specificity was 99.2% (95% CrI, 98.2%-99.8%). The nasopharyngeal swab NAAT had a sensitivity of 84.8% (95% CrI, 76.8%-92.4%) and a specificity of 98.9% (95% CrI, 97.4%-99.8%). Results were similar in secondary analyses.
These results suggest that saliva NAAT diagnostic accuracy is similar to that of nasopharyngeal swab NAAT, especially in the ambulatory setting. These findings support larger-scale research on the use of saliva NAAT as an alternative to nasopharyngeal swabs.”

SARS-CoV-2 serological tests can generate false positive results for samples from patients with chronic inflammatory diseases: “The majority of the verified serological assays were sensitive to interfering antibodies in samples from patients with chronic inflammatory diseases and therefore may have poor specificity in this context. For these patients, the risk of false positivity should be considered when interpreting results of the SARS-CoV-2 serological assays.” The problem was most pronounced in sero-positive rheumatoid arthritis.

Dollar General Will Pay Workers to Get a Covid-19 Vaccine: The problem with this strategy is that some people perceive the vaccine is dangerous if someone is offering to pay them to get it.

Companies scramble to expand coronavirus vaccine supply: Finally, some good news: “Production of the two coronavirus vaccines authorized in the United States is accelerating, even as companies with experimental vaccines nearing the end of trials struggle to meet ambitious manufacturing targets.
That means the United States should have 200 million doses each from the companies with authorized shots, Pfizer-BioNTech and Moderna — enough to guarantee that more than 70 percent of adults will be able to get the two-shot vaccination by the end of July.”
However: Vaccine reserve was already exhausted when Trump administration vowed to release it, dashing hopes of expanded access

Matching Sinopharm, fellow Chinese biotech Sinovac sees 78% COVID-19 vaccine efficacy: “A little over a week after Sinopharm nabbed the world’s first full approval from Chinese regulators on a 79% efficacy showing for its COVID-19 vax, fellow Chinese native Sinovac, using similar tech, has shown pretty much the same numbers.”

Under the Gun: We need to remember another pandemic. “Over 30,000 Americans die every year of firearm-related injuries, and this number is continuing to rise. In 2017 approximately 40,000 died from a gun injury, a 2.9% increase from 2016. In comparison, deaths related to motor vehicle collisions have fallen, decreasing from one year to the next. Firearm-related deaths now outnumber motor-vehicle deaths for the first time in some states. In the past, the approach to gun violence and other crimes focused on increased law enforcement presence and policing. Public health interventions focused on improving social support for hard-hit communities were rare.”


About healthcare IT

CVS Health launches Symphony™ to support senior safety at home and enhance caregiver peace of mind: “The center of the Symphony ecosystem is the voice-activated Smart Hub which enables hands-free calls with caregivers or emergency responders, while also monitoring motion, temperature, and air quality within the home.
Symphony features a free app for caregivers that provides alerts for falls or other emergencies and assists with facilitating care coordination. Additionally, smart algorithms within the app track and alert caregivers when normal conditions, such as average room temperature or air quality, are disrupted, suggesting when the caregiver may want to check in with their loved one.”

About pharma

The era of bipartisan work on lowering drug prices might be over: The Democrats have always wanted direct negotiations with manufacturers, while Republicans preferred marketplace solutions (like competition). This issue is a perfect example of a shared goal whose accomplishment is deadlocked by tactical differences.

Eli Lilly chips $30M into VC fund aimed at minority-owned healthcare companies: ”The company invested $30 million in Unseen Capital Health Fund, a venture fund aimed at supporting founders of early-stage healthcare companies who are Black or of other racial minorities, Lilly announced on Friday. In addition to identifying, funding and supporting minority-led businesses, the fund will also target companies working on solutions for marginalized communities.
Unseen Capital is already investing in companies and plans to top out its fund at $100 million.”

How a gene linked to the circadian clock could point to new prostate cancer treatments: ”Studies have shown that disruptions in circadian rhythms caused by chronic sleep deprivation and other lifestyle-related issues are linked to an increased incidence of some cancers, including prostate cancer.
Researchers at Sidney Kimmel Cancer - Jefferson Health (SKCC) analyzed that connection and landed on a circadian clock gene that seems to play a major role in prostate cancer progression. They believe their findings could inspire new treatments that target the gene, which is called CRY1, they reportedin the journal Nature Communications.”

Trump administration will let nearly all doctors prescribe addiction medicine buprenorphine: “The change will allow almost all physicians to prescribe the addiction drug buprenorphine, regardless of whether they’ve obtained a government waiver. Previously, doctors had to undergo an eight-hour training and receive the license, known as the “X-waiver,” before they could prescribe buprenorphine. For years, addiction treatment advocates have argued that tight buprenorphine regulations prevent thousands of doctors from providing high-quality addiction care.”

Evaluation of Aspirin Use With Cancer Incidence and Survival Among Older Adults in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: “In the current study, any aspirin use and aspirin use at least 3 times/week was associated with improved bladder and breast cancer survival. Associations between aspirin use and incidence of any of the investigated cancers or between aspirin use and esophageal, gastric, pancreatic, or uterine cancer survival were not observed.”

About health insurance

CMS Axes MFAR For Good: “CMS on Thursday officially killed its controversial Medicaid fiscal accountability regulation after putting it on ice in September. The Trump administration proposed the rule in November 2019 because it worried that states were gaming the state-federal Medicaid financing system to collect additional federal dollars. But a wide range of stakeholders opposed the rule, including providers, state regulators and governors, patient advocacy groups and some members of Congress. That's because it would have ramped up federal oversight of how states fund their Medicaid programs and possibly led to significant funding cuts.”

CMS finalizes changes to marketplace, payment notice for 2022: “In a final rule [to be published in the Federal Register January 19] released today, for 2022, the Centers for Medicare and Medicaid Services will reduce the user fee for qualified health plans sold through a federally-facilitated exchange from 3% to 2.25% of premium. This is an additional reduction beyond the 0.5 percentage point reduction in the user fee rate included in the 2020 payment notice.
CMS also is finalizing a reduction in the user fee for issuers offering plans through state-based exchanges that use the federal platform from 2.25% to 1.75% of premium. In years past, including 2020 and 2021, this provision has been key to reducing insurance premiums to deliver an 8% average premium reduction across states with exchanges using HealthCare.gov since the 2018 coverage year. 
CMS expects to continue reviewing comments and finalizing other proposed policies in a second final rule to be published at a later date.“

DOJ recovers $1.8B from healthcare false claims cases: 4 things to know: “The Department of Justice obtained more than $2.2 billion in fraud and false claims settlements and judgements in fiscal year 2020, and the bulk of those recoveries came from matters that involved the healthcare industry.”

MedPAC to recommend 2% payment boost for hospitals next year: “The commission said it wants to give the payment boost to both acute-care and long-term care hospitals. The 2 percent payment increase will result in about a $750 million to $2 billion increase in acute-care hospital spending for Medicare and about $50 million for long-term care hospitals.  
MedPAC also plans to recommend no change to the payment rate for physicians in 2022 and a 5 percent decrease for home health firms and inpatient rehabilitation centers.”
These recommendations are advisory ,so they are highly subject to lobbying and other political pressures.

About healthcare quality

Information Sharing Practices Between US Hospitals and Skilled Nursing Facilities to Support Care Transitions: “In this study, US SNFs reported significant shortcomings in the completeness, timeliness, and usability of information provided by hospitals to support patient transitions. These shortcomings are likely associated with a suboptimal transition experience. Shared clinicians represent a potential strategy to improve information sharing but are costly. New payment models such as accountable care organizations may offer a more scalable approach but were only associated with more timely sharing.”
This study found what many clinicians already knew from experience.

About healthcare marketing

NRC Health 2021 Healthcare Consumer Trends Report: Interesting consumer insights across several topics. For example, one interesting finding was: “Year over year, indifference to brands is increasing among healthcare consumers, with percentages of consumers who stated ‘no preference’ increasing from 31% in 2018 to 36% this year. This means that more than a third of consumers currently show no particular preference for a healthcare brand.
As may be expected, the pandemic has only exacerbated these trends. In the wake of COVID-19, 45% of consumers report that they have already changed their healthcare brand preference, and 62% expect their brand preferences to change once the pandemic has ended.” [Emphases in the original]

Today's News and Commentary

About health insurance

Open Enrollment sign-ups for 2021 match 2020's total, says CMS: “The Centers for Medicare and Medicaid Services has released the final weekly enrollment snapshot that shows about 8.3 million people selected individual market plans through the marketplaces using the federal platform during the 2021 Open Enrollment Period. 
This total enrollment is nearly the same as enrollments during the 2020 open enrollment period, despite the fact that New Jersey and Pennsylvania transitioned to state-based exchange platforms starting with the 2021 open enrollment period. As a result of their transition, selections in New Jersey and Pennsylvania are not included in the snapshot. 
After removing these states from the total plan selection totals in the 2020 open enrollment period and comparing year-over-year trends, the results show plan selections this year increased by 7% from 2020, despite a decline in new consumers. Also, for the fourth straight year, the consumer satisfaction rate at the call center remained high – averaging over 90% – throughout the entire stretch.”

35 Next Gen ACOs achieved savings, bonuses in 2019: “The 37 ACOs participating in the model reduced Medicare spending by $558.6 million in 2019, according to the data, and just two of the 37 failed to meet benchmarks and achieve savings.
Based on the data, the 37 ACOs earned a combined $461.9 million in incentive payments from CMS for meeting financial and quality targets. However, taking into account the unearned quality withholds, CMS will pay $354.5 million to the ACOs. 
This means the program resulted in $204 million in direct savings to Medicare after accounting for the incentive payments.”

About the public’s health

Renewal of Determination That A Public Health Emergency Exists: HHS Secretary Azar renewed the declaration of a public health emergency.

HHS launches COVID-19 antibody treatment locator tool: “The U.S. Department of Health and Human Services has launched a treatment locator to help patients and providers find monoclonal antibody therapeutics for COVID-19.
Housed at HHS' Protect Public Data Hub, the tool displays locations that have received shipments of therapeutics under the U.S. Food and Drug Administration authority within the past several weeks.”

Covid infection shown to provide as much immunity as vaccines: ”People who have already contracted coronavirus are as protected against reinfection as those who have received the best Covid-19 vaccines, according to a survey of 20,000 UK healthcare workers, the largest study in the world so far…
prior infection provided at least 83 per cent protection against reinfection. It gave better than 94 per cent protection against symptomatic Covid-19, matching the figures for the most effective Covid-19 vaccines.”
Note that there is a difference between measuring antibody levels and assessing reinfection rates.

Early study shows J&J's one-dose COVID-19 vaccine triggered antibodies in all participants: “As previously reported, neutralising antibody titers against COVID-19 were detected in over 90% of participants after a single vaccination at day 29. The new data showed that among younger adults aged 18 to 55 years, this increased to 100% at day 57, regardless of vaccine dose or age group, while titers then remained stable until at least day 71, which is currently the latest available time point in the ongoing study. Meanwhile, a second dose of Ad26.COV2.S provided an increase in the titer by a factor of 2.6 to 2.9, researchers said. Johnson & Johnson noted that data on durability of immune responses in trial participants aged over 65 years after day 29 will be shared in late January.”

Scientists find antibody that blocks dengue virus: “A team of researchers led by the University of California, Berkeley and the University of Michigan has discovered an antibody that blocks the spread within the body of the dengue virus, a mosquito-borne pathogen that infects between 50 and 100 million people a year. The virus causes what is known as dengue fever, symptoms of which include fever, vomiting and muscle aches, and can lead to more serious illnesses, and even death…
Currently, there are no effective treatments or vaccines for the dengue virus.”
Aside from its potential humanitarian benefits, commercial implications are huge.

DxTerity Offers COVID-19 Tests For Sale on Amazon: “DxTerity's SARS-CoV-2 PCR-based test is the first at-home saliva test to receive Emergency Use Authorization (EUA) by the FDA for symptomatic and asymptomatic testing.” This saliva sample mail-in test costs $110.

About pharma

Drugmakers sue HHS over 340B advisory opinion in feud over contract pharmacy access: “Drug companies AstraZeneca, Eli Lilly and Sanofi filed separate lawsuits seeking to preserve their ability to restrict offering 340B-discounted drugs to contract pharmacies.
The lawsuits, filed Tuesday in different federal courts, seek to get rid of an advisory opinion filed by the Department of Health and Human Services’ (HHS') general counsel that says drug companies must offer 340B drugs to contract pharmacies, which are third-party entities that dispense drugs on behalf of hospitals participating in the program.”

Boehringer partners with Google to bring quantum computing to biopharma R&D: “The three-year pharmaceutical project is the first of its type for Google’s Quantum AI division, and will be co-led by a new Quantum Lab at Boehringer—forming one part of the company’s digital transformation strategy alongside investments in machine learning and data science, as well as digitally powered biomarkers and therapeutics.”

Walgreens announces creation of new tech startup aimed at developing comprehensive patient platform: “Walgreens is establishing a tech-enabled healthcare startup with the goal of creating a new patient platform that blends physical and digital tools, company leadership said…
The startup will put together a customer engagement platform that includes a personalization engine.”

Woodcock to serve as acting FDA commissioner, Sharfstein a contender for top FDA job: “David Kessler is out of the running for nomination as FDA commissioner, leaving Joshua Sharfstein as a front-runner to lead FDA, sources briefed by the Biden transition team told BioCentury. While the list of candidates had narrowed to Kessler and Sharfstein, the delay in naming a candidate for the position could be a sign that other names are being considered. 
Janet Woodcock is expected to be named acting FDA commissioner, according to the sources, who spoke on condition of anonymity. “

He’s in! Shark Tank’s Mark Cuban launches generics maker promising ‘radically’ low-cost drugs: “Cuban has launched a new company, Mark Cuban Cost Plus Drugs, which has a plan to offer low-cost rivals to overpriced generic drugs. The company is launching with one product: albendazole, an antiparasitic. It will charge $20 per tablet, a steep discount to its current average cash price of $225, according to the company’s website.
Cuban’s plan is to disclose the cost of development and distribution for each of its products and then add a 15% margin to land on a wholesale price.”
About healthcare IT

Online therapy app Talkspace to go public in $1.4B deal with blank check firm: “Online therapy app Talkspace plans to go public through a merger with SPAC Hudson Executive Investment Corp. The combined company will operate as Talkspace and intends to be listed on the Nasdaq under the symbol "TALK."
The deal values Talkspace—which connects users with licensed therapists via video chat or text—at $1.4 billion, including debt. The deal will provide the company with $250 million in cash to be used as growth capital, the companies announced Wednesday.”

FDA Releases Action Plan for AI, Machine Learning Medical Software: “The FDA has released its first artificial intelligence and machine learning action plan, a multi-step approach designed to advance the agency’s management of advanced medical software.
The Artificial Intelligence/Machine Learning (AI/ML)-Based Software as a Medical Device (SaMD) Action Plan is a response to stakeholder feedback on the FDA’s 2019 regulatory framework for AI and ML-based medical products.”

Google finalizes $2.1B Fitbit acquisition: 5 details: The deal, announced in November of 2019, was completed today. The article has some details.

Today's News and Commentary

About healthcare devices

Medicare Coverage of Innovative Technology (MCIT) and Definition of “Reasonable and Necessary”: “This final rule establishes a Medicare coverage pathway to provide Medicare beneficiaries nationwide with faster access to new, innovative medical devices designated as breakthrough by the Food and Drug Administration (FDA). The Medicare Coverage of Innovative Technology (MCIT) pathway will result in 4 years of national Medicare coverage starting on the date of FDA market authorization or a manufacturer chosen date within 2 years thereafter. This rule also implements regulatory standards to be used in making reasonable and necessary determinations under section 1862(a)(1)(A) of the Social Security Act (the Act) for items and services that are furnished under Part A and Part B.
DATES: This final rule is effective on March 15, 2021.”

About healthcare systems

Tenet aims to acquire 25 to 40 surgical centers in 2021 as pivot away from urgent care continues: “Tenet Healthcare plans to spend $150 million to acquire between 25 to 40 ambulatory surgery centers in 2021 as the hospital system continues its pivot to more higher acuity facilities and away from urgent care.”
Very interesting move, considering elective surgery volumes have been down the past year due to COVID-19 concerns. Does this action also signal health systems’ cooling to physician practice acquisition?

Aspirus Health to buy Ascension hospitals, clinics in Wisconsin – Modern Healthcare: ”Ascension will divest seven hospitals, 21 doctor clinics and a medical transport firm in northern and central Wisconsin. Ascension owns 24 hospital campuses and greater than 100 healthcare services throughout the state.
Wausau, Wis.-based Aspirus employs 8,700 staff at 10 hospitals in Michigan’s Higher Peninsula and Wisconsin.”

8 health systems opening hospitals: The article details which systems are opening hospitals. What is interesting is that they have gone ahead with those openings in the face of declining use due to COVID-19.

Cleveland Clinic CEO and President Tom Mihaljevic, M.D., Announces New Mission Statement in State of the Clinic Address: “‘Our mission has served the community for generations, yet our role has evolved with the passage of time,’ Dr. Mihaljevic said in a virtual address to Cleveland Clinic caregivers worldwide. ‘As stewards of this organization, we carry out the will of our founders to reach for higher and nobler ends. So today, I am privileged to unveil our new mission statement for the next 100 years. “Caring for life, researching for health and educating those who serve.[emphasis added]” It stays true to our past, encompasses the present and outlines the future.’”
The announcement highlights the fact that a mission statement is a “living” document that needs to be periodically reevaluated.

About the public’s health

US has suffered its worst day ever for Covid-19 deaths: “The US reported its highest daily number of Covid-19 deaths on Tuesday with more than 4,320 fatalities attributed to the virus.
It marked the second time -- both this month and since the pandemic's start -- that the US reported more than 4,000 Covid-19 deaths in a single day.
Over the past week, the US has averaged more than 3,300 deaths every day, a jump of more than 217% from mid-November.” Despite these numbers: As pandemic worsens, most US states resist restrictions: “As the U.S. goes through the most lethal phase of the coronavirus outbreak yet, governors and local officials in hard-hit parts of the country are showing little willingness to impose any new restrictions on businesses to stop the spread.” The article gives examples of restriction avoidance.

The 10 most under-reported humanitarian crises of 2020: It is important to remember other public health problems in the age of the COVID-19 pandemic. These problems will remain after widespread vaccinations.

Justices say women must obtain abortion pill in person: “The Supreme Court ordered Tuesday that women must visit a doctor’s office, hospital or clinic in person to obtain an abortion pill during the COVID-19 pandemic, though similar rules for other drugs have been suspended during the public health emergency.” The vote was as expected. No opinion was written but the Chief Justice deferred to FDA “experts” on this issue. However, these “expert” opinions may be politically motivated. The Biden administration can reverse the requirement (and probably will).

Cancer Statistics, 2021: This annual report (from the American Cancer Society) is the best information on cancer statistics. Among the overall findings: “After increasing for most of the 20th century, the cancer death rate has fallen continuously from its peak in 1991 through 2018, for a total decline of 31%, because of reductions in smoking and improvements in early detection and treatment. This translates to 3.2 million fewer cancer deaths than would have occurred if peak rates had persisted. Long‐term declines in mortality for the 4 leading cancers have halted for prostate cancer and slowed for breast and colorectal cancers, but accelerated for lung cancer, which accounted for almost one‐half of the total mortality decline from 2014 to 2018.”

Accelerometer measured physical activity [PA] and the incidence of cardiovascular disease: Evidence from the UK Biobank cohort study: “In this study, we found no evidence of a threshold for the inverse association between objectively measured moderate, vigorous, and total PA with CVD. Our findings suggest that PA is not only associated with lower risk for of CVD, but the greatest benefit is seen for those who are active at the highest level.[emphasis added]”

Innovative biopharmaceutical industry comment on COVID-19 vaccines dosing strategies and recommend following the science: Acknowledging the uncontrolled pandemic and relative vaccine shortage, a number of industry organizations are warning that spacing of vaccine administration should follow the scientific data.

Youth Vaping Triples Odds for Adult Smoking: “A new study finds that teens who start vaping are three times more likely to smoke cigarettes in adulthood than those who never started with electronic cigarettes.
Although the number of teens who start smoking cigarettes in high school has declined, vaping has soared. From 2016 to 2019, the number of cigarette smokers among U.S. high school seniors dropped from 28% to 22%, but e-cigarette use increased from 39% to 46%, the researchers found.”

Scientists develop breakthrough COVID-19 antibody test: “Scientists at the University of Denver's (DU) Knoebel Institute for Healthy Aging, in collaboration with two other research entities, have developed and tested a new and highly sensitive antibody test for COVID-19 that is so accurate, it can predict if a patient will experience ‘mild’ COVID symptoms verses more ‘severe’ symptoms.
The test has received an Emergency Use Authorization from the U.S. Food & Drug Administration (FDA).”

A COVID-19 treatment candidate that fuses tiny antibodies from llamas and alpacas shows promise: “By fusing two nanobodies selected from a llama and an alpaca that were immunized with SARS-CoV-2—the novel coronavirus behind COVID-19—the researchers were able to synthesize nanobodies that can simultaneously attack multiple sites of the virus’s spike protein, according to a new study published in Science. The tiny antibodies also fought mutated variants of the virus, the team showed in lab dishes.
A company called Dioscure Therapeutics has spun off from the University of Bonn with plans to bring its lead COVID-19 candidates, DIOS-202 and DIOS-203, into clinical trials this year.”

Hospitals to Report Covid-19 Vaccination Data: “The Health and Human Services Department will start collecting hospital data on how many health-care personnel and patients have gotten Covid-19 vaccines amid a faltering national push to widely and quickly immunize the public.
The agency on Tuesday unveiled the change that asks hospitals to report once a week on progress immunizing health-care personnel and patients. Data won’t initially be made public for individual hospitals, according to senior HHS officials. HHS expects to make the data public after verifying its quality, they said.”

US to require negative Covid-19 test for international air travellers: “The Centers for Disease Control and Prevention will require the test result from January 26. After landing, the CDC recommends travellers take a test three to five days later and remain at home for seven days. Airlines will have to deny boarding to visitors who do not have a negative test result from the previous three days — or documentation that proves they have recovered from the disease.”

Two articles about the efficacy of vaccines:
Chinese vaccine efficacy lower than originally thought in Brazil trials: “Brazilian health officials say a Chinese coronavirus vaccine has demonstrated an overall efficacy rate of 50 per cent, far lower than originally indicated in a blow to one of the Latin American nation’s hopes for defeating the pandemic.”
Australian scientists cast doubt on Oxford/AstraZeneca vaccine: “A group of Australian scientists has called on the government to review its Covid-19 immunisation strategy over concerns that the Oxford/AstraZeneca vaccine was not effective enough to generate herd immunity.”

Johnson & Johnson Expects Vaccine Results Soon but Lags in Production: “Johnson & Johnson expects to release critical results from its Covid-19 vaccine trial in as little as two weeks — a potential boon in the effort to protect Americans from the coronavirus — but most likely won’t be able to provide as many doses this spring as it promised the federal government because of unanticipated manufacturing delays…
Unlike those products, which require two doses, Johnson & Johnson’s could need just one, greatly simplifying logistics for local health departments and clinics struggling to get shots in arms. What’s more, its vaccine can stay stable in a refrigerator for months, whereas the others have to be frozen.”

Operation Warp Speed chief resigns at Biden team’s request, will stay through transition, sources say: “Operation Warp Speed chief advisor Dr. Moncef Slaoui has submitted his resignation at the request of the incoming Biden team under a plan that would see him stay in the role for a month to help with the transition, according to two people familiar with the situation.”

In 'nasty parting shot,' HHS finalizes rule axing LGBTQ nondiscrimination protections:”With little more than a week left to the Trump administration, the Department of Health and Human Services has finalized a rule permitting social-service providers that receive government funds to discriminate based on sexual orientation and gender identity.”
Another policy that a Biden administration will reverse.

Moderna, Uber partner to support uptake of COVID-19 vaccines:”The two companies will work together initially to provide accessible, credible information on vaccine safety through Uber’s in-app messaging, the organizations announced Tuesday.
The two companies will also work with public health and other organizations to identify additional opportunities to support ongoing efforts to broaden access to COVID-19 vaccines.
Uber and Moderna said they are evaluating other options, including incorporating ride scheduling directly into the immunization appointment process, and possibly integrating with vaccine providers’ systems to text reminders and enable patients to book rides in advance of their first or second immunization appointments.”

Immunological characteristics govern the transition of COVID-19 to endemicity: “We are currently faced with the question of how the CoV-2 severity may change in the years ahead. Our analysis of immunological and epidemiological data on endemic human coronaviruses (HCoVs) shows that infection-blocking immunity wanes rapidly, but disease-reducing immunity is long-lived. Our model, incorporating these components of immunity, recapitulates both the current severity of CoV-2 and the benign nature of HCoVs, suggesting that once the endemic phase is reached and primary exposure is in childhood, CoV-2 may be no more virulent than the common cold. We predict a different outcome for an emergent coronavirus that causes severe disease in children. These results reinforce the importance of behavioral containment during pandemic vaccine rollout, while prompting us to evaluate scenarios for continuing vaccination in the endemic phase.”

About pharma

PCMA sues Trump administration over rebate rule:”The Pharmaceutical Care Management Association has filed suit against the Trump administration in an effort to block the recently finalized rebate rule…
In the complaint (PDF), PCMA warns that the rule would lead to higher premiums in Medicare Part D and reflects an ‘erratic and highly irregular administrative process’ in which the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) did not effectively coordinate.”

Health Canada approves Lundbeck's (Pr)VYEPTI (eptinezumab)--the first and only intravenous preventive treatment for migraine: This article is a reminder of the different time frames for drug approvals among countries; the FDA approved this drug last February.

GSK Strikes $224 Million Pact with Eligo for Acne Gene Therapy: “Eligo said its Eligobiotics technology can ‘precisely modify the composition of the skin’s microbiome to treat or reduce the risk of developing moderate-to-severe acne.’” This treatment is a new way to treat acne and should be watched.

New Bayer drugs will not bridge revenue gap, says pharma head: “Potential new blockbuster drugs from German pharma giant Bayer will not be enough to offset a fall in revenues when its two best-sellers go off patent, the group’s head of pharma has told the Financial Times.
Stefan Oelrich, who joined the company in 2018 from rival Sanofi, said Bayer would soon launch up to three new drugs with annual sales potential of €1bn. However, he acknowledged this would not compensate for the effects of the forthcoming patent expiry on both the blood thinner Xarelto and the eye treatment Eylea, which will start this year in stages globally, saying that this was ‘mathematically impossible.’”

About healthcare IT

Biogen teams up with Apple to see whether iPhones can spot cognitive decline: “The study will enroll adults young and old, using the devices to track subtle changes in a person’s movements and interactions that, over time, may add up and correlate with the earliest signs of cognitive impairment.”

Teladoc to pilot CGMs in Type 2 diabetes as Dexcom eyes new growth market: ”Teladoc Health will launch a pilot demonstration of Dexcom’s wearable, continuous glucose monitoring systems in patients with Type 2 diabetes—picking up the torch from the devicemaker’s partnership with Livongo following its $18.5 billion acquisition last year.
The project will start by supplying the blood sugar sensors at no cost to certain members of Teladoc and Livongo’s diabetes program before expanding the pilot’s reach throughout the course of the year.
The goal is to improve outcomes and healthy glucose levels among people with Type 2 diabetes, by providing them with the same real-time recommendations for lifestyle decisions,  visual data and personal trends offered to people with Type 1 diabetes.”

Evaluation of Internet-Based Crowdsourced Fundraising to Cover Health Care Costs in the United States: “From May 2010 through December 2018, more than $10 billion was sought through online medical fundraisers in the US, with more than $3 billion raised. Cancer represented the most common medical condition for which funding was sought, followed by trauma/injury.”

AdventHealth meets CMS quality metrics, saves money with digital health platform: “Through the app, enrolled patients received regular reminders to complete their medication check-ins, submitted photos of themselves taking their medications and received personalized bonus incentives in the form of messages of encouragement from family and friends.”
The “pilot saw a 57% reduction in readmissions for high-risk patients, taking their readmissions from 19% to 8%, ultimately saving the health system $183,000 in care costs.”

Cerner wants to build a $1B data business as it expands reach into pharma market: “Building on its acquisition of clinical research company Kantar Health, health IT giant Cerner is setting its sights on building a $1 billion data business for the healthcare and life sciences industries.
Cerner announced plans in December to acquire the health division of Kantar Group, which provides data, analytics and research to the life sciences industry, for $375 million.
The company is looking to create a leading data insights and clinical research platform and wants to harness data to improve the safety, efficiency, and efficacy of clinical research across life sciences, pharmaceuticals, and health care at large.”

Trump administration to invest $8M in broadband for rural telehealth access: “The Health Resources and Services Administration (HRSA), part of the Department of Health and Human Services, awarded the funding to the Telehealth Broadband Pilot (TBP) program. That program will assess the broadband capacity available to rural health care providers and patient communities to improve their access to telehealth services.”

athenahealth and Humana Collaborate to Improve Healthcare Outcomes for its Members: “The collaboration utilizes intelligence from Humana to empower providers to proactively address patient needs within the native EHR workflows – facilitating care management discussions between providers and patients, making it easier for providers to transition to value-based care programs, and supporting quality program performance goals such as Medicare Advantage Star Ratings…
By marrying patients’ medical records with insights from their health plan data, athenahealth and Humana will integrate supplemental and clinical data in real time to give providers the necessary insights to spot potential time-sensitive gaps in patient care. For instance, patients with diabetes can become overwhelmed with numerous annual appointments including blood pressure screenings, blood sugar control tests, eye exams, and medication reviews. Automatic appointment alerts generated by Humana’s data can help providers stay on top of diabetes management – thereby improving diabetic patients’ healthcare experiences and closing care gaps.”

About health regulation

New rule makes it harder for HHS to penalize guidance violations: “HHS officials bolstered President Donald Trump's deregulation agenda on Tuesday, signing off on a rule that makes it more difficult for regulators to go after individuals and organizations for not following standards laid out in guidance documents. The rule effectively bans the department from penalizing individuals and organizations for noncompliance with a standard or practice if HHS only announced it in a guidance document. It also lays out a substantial process HHS must follow to carry out civil enforcement actions for potential violations. HHS said the rule is necessary to ensure fairness.”

Today's News and Commentary

About healthcare regulation

U.S. health agency mandates review of regulations every 10 years: “The outgoing Trump administration has finalized a rule that will require all new regulations by agencies under the Department of Health and Human Services to be reviewed for relevance every 10 years or face automatic expiration. The department, however, will now have five years to review all existing regulations, instead of the two-year timeline proposed earlier.”

About pharma

Fujifilm Pays $2 Billion to Establish U.S. Cell-Culture Manufacturing Plant: “Fujifilm is investing $2 billion in a high-output U.S. cell-culture manufacturing plant to speed the expansion of its biopharmaceutical contract development and manufacturing organization business.
Scheduled to be operational in 2025, the facility will produce antibodies, recombinant proteins, gene therapies and vaccines, and it will have automated fill-finish and assembly, packing and labeling capabilities.”

Lilly's donanemab slows clinical decline in Alzheimer's disease study: “Eli Lilly said Monday that donanemab, an experimental antibody targeting N3pG-amyloid beta, significantly slowed decline on a composite measure of cognition and daily function in patients with early symptomatic Alzheimer's disease compared to placebo, meeting the primary endpoint of the Phase II TRAILBLAZER-ALZ trial…
Top-line results demonstrated that donanemab slowed decline on the iADRS by 32% relative to placebo. Eli Lilly also noted that the drug led to "consistent improvements" on all pre-specified secondary goals measuring cognition and function compared to placebo, although statistical significance was not achieved on every measure. Key secondary measures included change from baseline to week 76 on the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog13), ADCS-iADL, Mini Mental State Examination (MMSE) score, and Clinical Dementia Rating Scale Sum of Boxes (CDR-SB) scores, as well as brain amyloid and tau deposition.”

Miller School Leads Groundbreaking Trial Treating Severe COVID-19 with Mesenchymal Stem Cells: “The paper describes findings from 24 patients hospitalized at UHealth Tower or UM/Jackson Memorial Hospital with COVID-19 who developed severe acute respiratory distress syndrome. Each received two infusions given days apart of either mesenchymal stem cells or a placebo.
It was a double-blind study…
Researchers found the treatment was safe, with no infusion-related serious adverse events.
Patient survival at one month was 91% in the stem cell treated group versus 42% in the control group. Among patients younger than 85 years old, 100% of those treated with mesenchymal stem cells survived at one month.”

Sanofi acquires immunotherapy biotech Kymab: “French drugmaker Sanofi has announced a deal of up to $1.45bn to buy UK biotech Kymab and confirmed it is studying the possibility of helping manufacture rival Covid-19 vaccines after delays in developing its own jab…
Cambridge-based Kymab is studying the use of a new monoclonal antibody drug known as KY1005 for the treatment of eczema, a skin condition.”

About diagnostics

Abbott Earns FDA OK for Handheld Concussion Blood Test: “Abbott Laboratories has received the FDA’s 510(k) marketing clearance for a test that helps evaluate mild traumatic brain injuries, also known as concussions, using a handheld device.
The blood test is run on the company’s handheld i-STAT Alinity device, producing a result within 15 minutes after the patient’s blood plasma sample is inserted.
The diagnostic assesses plasma samples for biomarkers UCH-L1 and GFAP, two proteins that are seen after a concussion or head trauma.”
This device could be a blockbuster for use on the sports field. But it would be better to prevent injuries in the first place.

About the public’s health

Trump administration reverses stance, will no longer hold back second shots of coronavirus vaccine: “The Trump administration will announce sweeping changes to its vaccination rollout on Tuesday, including making many more doses of the coronavirus vaccine available and urging states to provide shots to anyone 65 and older. The steps are an effort to speed up a delayed and disjointed rollout.
The changes are a sharp departure from the administration’s previous strategy, and they come just days after President-elect Joe Biden announced plans to release nearly all the vaccine supply. Biden is expected to provide a detailed blueprint on reinvigorating the rollout later this week.”

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine — United States, December 14–23, 2020: “During December 14–23, 2020, monitoring by the Vaccine Adverse Event Reporting System detected 21 cases of anaphylaxis after administration of a reported 1,893,360 first doses of the Pfizer-BioNTech COVID-19 vaccine (11.1 cases per million doses); 71% of these occurred within 15 minutes of vaccination.”

Record low flu cases show how COVID-19 is more contagious and 'less forgiving,' experts say: “As COVID-19 raged last year, the seasonal flu all but vanished, according to data from the U.S. Centers for Disease Control and Prevention.
During the 2019 flu season from Sept. 29 to Dec. 28, the CDC reported more than 65,000 cases of influenza nationwide. During the same period this flu season, the agency reported 1,016 cases.
Health experts said that high vaccination rates against the flu – combined with social distancing, mask-wearing and hand-washing employed to stop the spread of the coronavirus – played a huge role in preventing influenza transmission.”

Trial of COVID-19 blood plasma finds no benefit in severely ill patients: “The decision by the REMAP-CAP trial leaders came after an initial analysis of more than 900 severely ill trial participants in intensive care showed that treatment with the product - an antibody-rich plasma taken from people who have recovered from the pandemic disease - did not improve outcomes.”

Hospitals say syringes supplied by feds waste vaccine doses: “Pharmacists discovered early in the U.S. vaccination push that the standard five-dose vials of the vaccine from Pfizer and its German partner BioNTech often contained enough material for six or even seven shots
But some syringes distributed by Operation Warp Speed, the federal Covid-19 vaccine program, aren’t efficient enough to extract a sixth dose, according to hospital lobbyists. They say the issue appears to stem from supply chain problems that have troubled the nation’s pandemic response from the start.”

2021 Global Mayors Challenge: “Bloomberg Philanthropies has launched an innovation competition that will identify and accelerate the most ambitious ideas developed by cities in response to COVID-19. The competition will select 50 finalists that represent the world’s leading urban innovations to emerge from the pandemic. Fifteen grand-prize winners will receive $1 million each and robust multi-year support to implement and spread their breakthrough ideas.”

Health Workers’ Antibody Levels Wane After SARS-CoV-2 Infection: Another reason to vaccinate those who had the infection. “Most people who are infected with SARS-CoV-2 develop antibodies to the virus within 2 to 3 weeks. But how long those antibodies last is unclear. To learn more, the Influenza Vaccine Effectiveness in the Critically Ill Network, a group of academic centers studying both influenza and coronavirus disease 2019 (COVID-19), enrolled 3248 health care workers in a seroprevalence study. All worked directly with patients who had COVID-19 at 13 medical centers throughout the US.
Six percent, or 194, of participants had detectable antibodies to SARS-CoV-2 based on enzyme-linked immunosorbent assay test results. About 80% of these antibody-positive health care workers returned for a second antibody test 2 months later.
At the second test, SARS-CoV-2 antibodies had declined in about 94% of those who initially were seropositive. About 28% no longer tested positive for antibodies. Roughly 1 in 5 individuals who had COVID-19 symptoms fell below the threshold for seropositivity at the second test, as did nearly half of participants who were asymptomatic. Older adults and those with lower antibody levels on the initial test were more likely to seroconvert by the second test.
The results suggest that studies using seropositivity as a proxy for previous infection are likely to underestimate the true prevalence of infections, the authors cautioned. They also suggested that the window for collecting convalescent plasma to use as a potential treatment for COVID-19 is narrow.”
About healthcare IT

VA, Fitbit help support Veteran health and wellness during COVID-19 pandemic: “The U.S. Department of Veterans Affairs (VA) announced today a new initiative with Fitbit that will provide eligible Veterans, caregivers and VA staff with access to Fitbit programs and services to help manage stress, improve sleep and increase physical activity during the COVID-19 pandemic.
The initiative will be focused on participants who currently use Fitbit devices.
VA has contracted with Fitbit to initially provide 10,000 eligible Veterans, caregivers and VA staff a one-year free membership to Fitbit Premium. This includes access to guided programs, hundreds of workouts, mindfulness content, a wellness report and a health metrics dashboard. Participants will also have access to Fitbit Health Coaching, one-on-one coaching and guidance from a certified health coach or licensed health professional.”

At all-virtual CES, the spotlight is on touchless tech, robot companions — and smart bathrooms: The annual consumer tech conference is coincident with the JPM conference. This article explains some interesting healthcare applications presented at this virtual show.

About healthcare devices

HHS Moves to End Oversight of Some Gloves, Masks, Ventilators:”Seven types of surgical and examination gloves won’t require FDA oversight anymore, the HHS said Monday in a move to permanently cut regulatory requirements that were initially curtailed during the pandemic.
These gloves are considered class one medical devices, the lowest risk label for medical products the Food and Drug Administration oversees. They’ll now be permanently excluded from the FDA’s medical device regulatory scheme. 
In addition, the Department of Health and Human Services is proposing that certain sterilizers, digital imaging software, face masks, and ventilators be excluded from FDA review.”

About health insurance

Atrius Health, state's largest independent physician group, is in acquisition talks: “The nation’s largest employer of primary-care physicians is in talks to acquire the largest independent doctor group in Massachusetts, a decision that would further cement the national group’s presence in the Bay State. 
Optum, the for-profit health provider arm of UnitedHealth Group, has signed a memorandum of understanding to acquire Atrius Health, a nonprofit that counts 715 physicians across 30 locations in Massachusetts, sources tell the Boston Business Journal.”

Payers Kick Off 2021 Investments in Social Determinants of Health: The article gives many examples of payer partnerships with local organizations.

About healthcare systems

2020 M&A in Review: COVID-19 as Catalyst for Transformation: From Kaufman, Hall & Associates: “In the face of these pressures, it is remarkable that M&A activity for the year stayed within the historic range of activity seen over the past 10 years…”
The anticipated trends for 2021 will compell “healthcare organizations to:

Focus on core business strengths and assess the long-term viability of non-core assets, aligning as needed with partners that offer complementary, innovative, or otherwise unrepresented capabilities Build partnerships to address gaps in the healthcare infrastructure exposed or intensified by the virus, including collaborative partnerships with non-traditional partners

Strengthen intellectual capital resources to be nimbler and more flexible in dealing with the current crisis and in pivoting to new modes of providing care more efficiently, effectively, or uniquely relative to other legacy providers and potential new market entrants”

Today's News and Commentary

A bit of whimsy to start your week:

His Vaccine Story Inspired His Father To Write A Disney Classic

Today is the start of the 4-day annual JP Morgan Healthcare Conference. Obviously, this year it is virtual. Here are some highlights for today:
Novartis' Cosentyx growth, Bristol's M&A shopping list, Vertex's beyond-CF ambitions

Microsoft signs on to Verily, Broad Institute’s Terra open research platform

Sanofi grabs a British biotech, Regeneron hopes for FDA hold lift, Bluebird puts its eggs in two baskets, and more

About health insurance

CMS approves first block grant waiver, giving Tennessee ability to remake Medicaid program: “The Trump administration has approved a federal waiver to enable Tennessee to convert its Medicaid program into a block grant, the first waiver of its kind to be cleared.
It remains unclear whether the waiver, approved Friday by the Centers for Medicare & Medicaid Services (CMS), will survive under President-elect Joe Biden’s administration set to start in a few weeks.
The waiver, which will last for a 10-year period, would create a budgetary cap for federal spending based on recent historical spending and enrollment in Medicaid in the state."

CMS Issues New Roadmap for States to Address the Social Determinants of Health to Improve Outcomes, Lower Costs, Support State Value-Based Care Strategies: This statement clarifies opportunities for states to provide services that would otherwise not be eligible for federal matching. The CMS letter to state health officials provides more details. From that latter document is the statement: “States have flexibility to design an array of services to address SDOH. However, the services and supports that states can cover tend to fall within several categories of services, including housing-related services and supports, non-medical transportation, home-delivered meals, educational services, employment, community integration and social supports, and case management.”
An example of one opinion is:  “Federal financial participation is not available to state Medicaid programs for room and board (except in certain medical institutions ). However, federal financial participation is generally available under certain federal authorities for housing-related supports and services that promote health and community integration, including home accessibility modifications, one-time community transition costs, and housing and tenancy supports, including pre-tenancy services and tenancy sustaining services.”

HHS Announces Plans to Expand the Home Health Value-Based Purchasing Model: “The U.S. Department of Health and Human Services (HHS) announced Friday that it is expanding the Home Health Value-Based Purchasing (HHVBP) Model. First implemented in 2016, the HHVBP Model is currently active in just nine states: Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska and Tennessee.
HHS Secretary Alex Azar has already signed off on an expansion, the department noted. Friday’s announcement did not specify the extent of the expansion, but clarified that HHS would execute the implementation through rulemaking no earlier than Jan. 1, 2022.”

How 2020 Has Changed Employee Benefits: “Artemis Health conducted a research study surveying over 300 benefits leaders at companies with 5,000 or more employees to see exactly how their goals, motivations, and challenges have changed in 2020.”
Among the findings:
78% of benefits leaders are prioritizing well-being
Mental health will be a key 2021 priority
2/3 of organizations will be investing in benefits data

About the public’s health

Biden to unveil trillions in pandemic economic relief spending next week: “He said the proposal includes relief for state and local governments grappling with the pandemic, as well as new support for people who lost their jobs or cannot afford rent.
Biden also called for raising the minimum wage to $15, a campaign promise, and for sending out $2,000 in direct cash payments. Democrats sought those cash payouts in the last relief bill, passed in December, but only were able to get Republicans to agree to $600.”

6-month consequences of COVID-19 in patients discharged from hospital: a cohort study: This Chinese study published in The Lancet may or may not reflect a clinical pattern elsewhere. Given that caveat, the results showed: “At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery.”
The implication is that, in addition to acute care, chronic services will be needed to care for large populations—exacerbating a personnel shortage.

No evidence homegrown variant is fueling coronavirus surge in the US, CDC says: “There is no evidence the United States has a homegrown variant of coronavirus that's fueling the recent increased spread of the virus, the US Centers for Disease Control and Prevention said Friday
The White House Coronavirus Task Force told states last week ‘there may be a USA variant that has evolved here, in addition to the UK variant that is already spreading in our communities,’ according to reports obtained by CNN.
But the CDC said there was no evidence of that yet.”

Interim recommendations for use of the Pfizer–BioNTech COVID-19 vaccine, BNT162b2, under Emergency Use Listing: From the WHO: “Countries experiencing exceptional epidemiological circumstances may consider delaying for a short period the administration of the second dose as a pragmatic approach to maximizing the number of individuals benefiting from a first dose while vaccine supply continues to increase. WHO’s recommendation at present is that the interval between doses may be extended up to 42 days (6 weeks), on the basis of currently available clinical trial data.”
The document is an update on recommendations. This 6-week delay recommendation is new.

About healthcare systems

ER operator Adeptus, formerly one of DFW's fastest-growing companies, files for bankruptcy: “Adeptus Health LLC, the operator of a network of independent emergency rooms and once considered one of the fastest-growing companies in Dallas-Fort Worth, filed for voluntary Chapter 7 bankruptcy protection Dec. 18 in the Northern District of Texas.
The Irving-based company listed assets of roughly $6.8 million and debts of about $278.2 million. The filing's largest creditor was listed as Deerfield Partners LP with an outstanding claim of over $209.9 million.
Chapter 7 bankruptcy protection typically provides for the liquidation of a business’ assets to satisfy creditor claims…
The company filed for an initial public offering in 2015 and debuted at $22 a share. Within a year, the stock price hit $100 and Adeptus’ market cap neared $1 billion, according to a story in The Texas Lawbook.
In April 2017, however, the ER operator filed for Chapter 11 bankruptcy protection in the Northern District of Texas.”
During the COVID-19 pandemic, hospitals have been hurting because of a decrease in elective procedures and ancillary charges. Physicians’ offices are likewise hurting because patients are not coming in for followup visits and minor illnesses. However, why should urgent care centers be failing? They are alternatives to hospital ERs for non-emergent illnesses. Details behind the bankruptcy filing would be interesting for a case study.

CommonSpirit to sell 14 hospitals to Essentia Health: “Fourteen hospitals owned by Chicago-based CommonSpirit Health could join Duluth, Minn.-based Essentia Health as early as this summer.
Under a letter of intent announced Jan. 8, CommonSpirit-owned facilities operating under the CHI Health brand in North Dakota and Minnesota would join Essentia Health. The deal includes a full-service tertiary hospital in Bismarck, N.D., and 13 critical access hospitals. Additionally, all CHI Health associated clinics and living communities would join Essentia Health.”

Today's News and Commentary

About the public’s health

US sees five deadliest days since Covid-19 pandemic's start in last two weeks: “In just less than two weeks, the US recorded its five deadliest days since the Covid-19 pandemic's start -- with more than 4,000 virus-related deaths reported Thursday.
The nation's total Covid-19 death toll has now climbed to more than 365,300, according to data from Johns Hopkins University. And another nearly 115,000 people could lose their lives over the next four weeks, according to projections from the University of Washington's Institute for Health Metrics and Evaluation.”

Pfizer vaccine appears to neutralize a key mutation of Covid variants found in UK, South Africa: “The research, published Thursday on preprint server bioRxiv and not yet peer-reviewed, suggested the Pfizer-BioNTech vaccine worked to neutralize the so-called N501Y mutation.
The N501Y mutation has been reported in the more infectious variants. It is altering an amino acid within six key residues in the receptor-binding domain — a key part of the spike protein that the virus uses to gain entry into cells within the body.”

Biden says he will release all available coronavirus vaccine before second doses are administered: “President-elect Joe Biden announced Friday that he plans to release all available coronavirus vaccine after he takes office. The move breaks with the Trump administration, which has favored holding half the vaccine in reserve to ensure people receive their second doses. It would greatly expand the number of Americans who could soon get their first shot, but risks depleting reserves needed for follow-up shots.”

FDA warns new coronavirus variant could trigger false negatives among gold-standard tests: “The FDA is alerting healthcare professionals that mutations in the novel coronavirus’s genetic code—such as the type powering the fast-spreading variant identified in the U.K.—can trigger false negative results in gold-standard COVID-19 tests.
Accuracy can suffer if the alterations occur within the specific region of the virus’s RNA used by molecular diagnostics to line up a positive result, which may vary product to product, the agency said.
While FDA staff said they believe these risks are low, the agency listed three currently authorized tests—Thermo Fisher’s TaqPath combo kit, Mesa Biotech’s hand-held Accula test and Applied DNA Sciences’ Linea assay—that may be compromised by genetic variants.”

California hospitals prepping for grim COVID-19 choices: “California hospitals struggling with a skyrocketing coronavirus surge are trying to prepare for the possibility that they may have to ration care for lack of staff and beds — and hoping they don't have to make that choice.
The state avoided surging cases for months, but now the virus is raging out of control there and across the nation in the wake of Thanksgiving holiday gatherings that authorities say vastly spread infections. Only Arizona tops California in cases per resident.
The state this week ordered hospitals in the hardest-hit areas to delay many elective surgeries in order to free up space.”

UPDATED Coronavirus tracker: 86% of mild COVID-19 cases include loss of smell, study finds: “A new study of 2,500 patients in 18 European hospitals with COVID-19 finds that loss of smell is a symptom 86% of the time for mild cases of the virus.
Sense of smell typically reappeared within 18 to 21 days, according to the study in the Journal of Internal Medicine, though about 5% of those studies had not recovered their sense of smell six months out from recovery.”

Post-infection coronavirus immunity usually robust after 8 months, study shows: “The human body typically retains a robust immune response to the coronavirus for at least eight months after an infection, and potentially much longer, researchers said in a study published in the journal Science. About 90 percent of the patients studied showed lingering, stable immunity, the study found.”

Labcorp to help CDC track COVID-19 mutations as new strain spreads in U.S.: “The Centers for Disease Control and Prevention has tapped Labcorp to help conduct a large-scale genomic study tracking new mutations in the COVID-19 virus—after a fast-spreading variant, first identified in the U.K., has recently surfaced on U.S. shores.
The public health agency plans to collect random samples from across the country, to provide a baseline that will enable national and state-level surveillance programs to hone in on emerging cases. 
With the addition of Labcorp’s facilities, the CDC said it aims to more than double the number of genomic samples sequenced per week.”

U.S. DEPARTMENT OF LABOR’S OSHA ANNOUNCES $3,930,381 IN CORONAVIRUS VIOLATIONS: “Since the start of the coronavirus pandemic through Dec. 31, 2020, the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) has issued citations arising from 300 inspections for violations relating to coronavirus, resulting in proposed penalties totaling $3,930,381. 
OSHA inspections have resulted in the agency citing employers for violations, including failures to:

Arthritis drugs found to reduce risk of death in severe Covid-19 cases: “The immunosuppressants tocilizumab and sarilumab, were found to reduce stays in intensive care by at least seven days on average, according to data released by the UK government-backed Remap-cap study, conducted by researchers at Imperial College London and Utrecht university in the Netherlands…
These are the first immune-modulating drugs found to have an effect on outcomes of hospitalised Covid-19 patients, adding to positive results from the cheap and plentiful steroid dexamethasone.”

The Best Evidence for How to Overcome COVID Vaccine Fears: This article is an excellent review of the headline’s topic. It identifies more reluctant groups and explains strategies to increase immunization rates. For example: “Research shows that {the intervention]… with the biggest proved impact… is to make the desired action—in this case, vaccination—the default. A 2010 study at Rutgers University showed that informing people that a dose of flu vaccine was waiting for them at a specified time and place (although the appointment could be changed) boosted their vaccination rate by 36 percent, compared with a control group that was e-mailed a Web link to schedule their own appointment. In other words, opt out works better than opt in.”

About health insurance

The Affordable Care Act Reduced Income Inequality In The US: “We found that the ACA reduced income inequality and that the decrease was much larger in states that expanded Medicaid than in states that did not. We also decomposed the effect of the ACA on inequality by race/ethnicity, age, and family educational attainment. The ACA reduced inequality both across groups and within these groups. With efforts to repeal the ACA—specifically, California v. Texas—having shifted from Congress to the courts, it remains important to consider the consequences of fully repealing the ACA, which would likely reverse reduced inequality observed under the law.”

How 3 Major Payers Extended Temporary COVID-19 Benefits into 2021: The article provides information on what Aetna, BC/BS companies and Cigna are doing.

Health Care Company Indicted for Labor Market Collusion: “A federal grand jury returned a two-count indictment charging Surgical Care Affiliates LLC and its related entity (collectively SCA), which own and operate outpatient medical care centers across the country, for agreeing with competitors not to solicit senior-level employees, the Department of Justice announced today. These are the Antitrust Division’s first charges in this ongoing investigation into employee allocation agreements.”
SCA is a division of Optum, part of UnitedHealth Group.

Illinois Is the Nation's First State to Extend Health Coverage to Undocumented Seniors: “Healthy Illinois pushed state lawmakers to offer health benefits to all low-income immigrants. But the legislature opted instead for a smaller program that covers people 65 and older who are undocumented or have been legal permanent residents, also known as green card holders, for less than five years. (These groups don't typically qualify for government health insurance.) Participants must have an income at or below the federal poverty level, which is $12,670 for an individual or $17,240 for a couple. It covers services like hospital and doctor visits, prescription drugs, and dental and vision care (though not stays in nursing facilities), at no cost to the patient.
The new policy continues a trend of expanding government health coverage to undocumented immigrants.”
Other countries (like France) cover undocumented residents in order to deliver optimum public health.

Hospitals Lose Fight Over Uncompensated Care Reimbursements:”The Affordable Care Act bars hospitals from challenging HHS Secretary Alex M. Azar II’s calculation of adjustments to Medicare reimbursements for uncompensated care provided to low-income Americans, a federal court in Washington said.
The Health and Human Services Department’s Provider Reimbursement Review Board lacked jurisdiction to consider the hospitals’ objections to their payments, and thus properly dismissed their request for review, the U.S. District Court for the District of Columbia said Thursday.”

Physician Fee Schedule Update: The “Consolidated Appropriations Act, 2021 modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS):

  • Provided a 3.75% increase in MPFS payments for CY 2021

  • Suspended the 2% payment adjustment (sequestration) through March 31, 2021

  • Reinstated the 1.0 floor on the work Geographic Practice Cost Index through CY 2023

  • Delayed implementation of the inherent complexity add-on code for evaluation and management services (G2211) until CY 2024

CMS has recalculated the MPFS payment rates and conversion factor to reflect these changes. The revised MPFS conversion factor for CY 2021 is 34.8931.”

Telehealth Claim Lines Increase 3,060 Percent Nationally When Comparing October 2019 to October 2020: “Telehealth claim lines increased 3,060 percent nationally from October 2019 to October 2020, rising from 0.18 percent of medical claim lines in October 2019 to 5.61 percent in October 2020, according to new data from FAIR Health's Monthly Telehealth Regional Tracker. From month to month, coinciding with a surge in COVID-19 cases in October, the telehealth share of medical claim lines rose 10.6 percent nationally, from 5.07 percent in September 2020 to 5.61 percent in October 2020. The data represent the privately insured population, excluding Medicare and Medicaid.
Trends in the four US census regions (Midwest, Northeast, South and West) were similar to those in the nation as a whole. In each region, there were large percent increases in volume of claim lines from October 2019 to October 2020, and smaller increases from September 2020 to October 2020.”

Today's News and Commentary

With the two seat Democratic victory in Georgia, that party now has majority control of the Senate (with VP Harris as the tie-breaker). But it is unlikely Democrats can get the 60 votes needed to break a filibuster to pass major legislation. Only reconciliation bills (which affect finances) can be passed if all Democrats vote together. Given this narrow margin, the media are recommending several things that could be done with respect to health care; but they have forgotten one important change- adding back a “tax” on the uninsured. That measure would make any Supreme Court decision to invalidate the ACA moot.

About pharma

Early High-Titer Plasma Therapy to Prevent Severe Covid-19 in Older Adults: “Early administration of high-titer convalescent plasma against SARS-CoV-2 to mildly ill infected older adults reduced the progression of Covid-19.” The full article is available from the NEJM.

Trump Signs Bill Allowing FDA Seizure Of Counterfeits: “President Donald Trump on Tuesday signed the Safeguarding Therapeutics Act, a bipartisan bill that would give the U. S. Food and Drug Administration the authority to seize counterfeit medical devices and products, including vaccines…
Under the act, the U. S. Department of Health Human Services will set regulations that allow the manufacturer of an alleged counterfeit product to challenge the decision before the products are destroyed. During this time, the department will store the products at the manufacturer's costs.”

FDA extends immunodeficiency drug's shelf life as pandemic exacerbates shortages: “The FDA has stretched the expiration date of 42 existing lots of Octapharma’s subcutaneous immune deficiency drug cutaquig and granted a 12-month shelf life extension on future lots stored at 36 degrees to 46 degrees Fahrenheit. The drug was previously cleared to last 24 months when refrigerated.”
This article is a reminder that many medications can be kept past the printed expiration date if stored properly.

Walgreens shares rise after its earnings top estimates, fueled by higher drug sales: “Walgreens said its U.S. pharmacy sales picked up in the fiscal first quarter, despite less foot traffic, lower sales of cough, cold and flu medications, and fewer new prescriptions as people skipped the doctor’s office and socially distanced during the Covid pandemic.”

New drug form may help treat osteoporosis, calcium-related disorders: “Purdue University innovators developed a stabilized form of human calcitonin, which is a peptide drug already used for people with osteoporosis. Researchers at Purdue created a prodrug form of the peptide hormone to increase its effectiveness as an osteoporosis treatment.
In humans, calcitonin is the hormone responsible for normal calcium homeostasis. When prescribed to osteoporosis patients, calcitonin inhibits bone resorption, resulting in increased bone mass.
Unfortunately, human calcitonin undergoes fibrillation in aqueous solution, leading to reduced efficacy when used as a therapeutic. As a substitute, osteoporosis patients are prescribed salmon calcitonin…
To decrease the fibrillation propensity and increase the therapeutic benefit of human calcitonin, Purdue researchers phosphorylated specific amino acid residues.”

About the public’s health

U.S. Is Blind to Contagious New Virus Variant, Scientists Warn: “The United States has no large-scale, nationwide system for checking coronavirus genomes for new mutations, including the ones carried by the new variant. About 1.4 million people test positive for the virus each week, but researchers are only doing genome sequencing — a method that can definitively spot the new variant — on fewer than 3,000 of those weekly samples. And that work is done by a patchwork of academic, state and commercial laboratories.
Scientists say that a national surveillance program would be able to determine just how widespread the new variant is and help contain emerging hot spots, extending the crucial window of time in which vulnerable people across the country could get vaccinated. That would cost several hundred million dollars or more.”

CureVac and Bayer join forces on COVID-19 vaccine candidate CVnCoV: “Bayer has signed a collaboration and services agreement with CureVac N.V…., a biopharmaceutical company developing a new class of transformative medicines based on messenger ribonucleic acid (mRNA). Under the terms of the agreement, Bayer will support the further development, supply and key territory operations of CureVac´s COVID-19 vaccine candidate CVnCoV. To this end, Bayer will contribute its expertise and established infrastructure in areas such as clinical operations, regulatory affairs, pharmacovigilance, medical information, supply chain performance as well as support in selected countries.”

HPV Vaccination Campaign for Young Adults and Health Care Providers Launches from HHS’ Office on Women’s Health: The HPV VAX NOW campaign was announced yesterday. Its aim is to increase HPV vaccination rates.

Swansea University developing world’s first COVID-19 ‘smart-patch’ vaccine that will measure effectiveness: “The research, from the Institute for Innovative Materials, Processing and Numerical Technologies (IMPACT), will produce the vaccine through the use of microneedles (MNs) to create a ‘smart-patch’. This device will simultaneously measure a patient’s inflammatory response to the vaccination by monitoring biomarkers in the skin…
Microneedles provide a safe and effective method to deliver vaccines with added attributes of requiring lower vaccine doses, permitting low-cost manufacturing, and enabling simple distribution and administration. A microneedle delivery patch is easy to apply and minimally invasive – combined with the proposed measurement capabilities, this new vaccine system would enable a personalised vaccination approach…
The primary goal of this project is to create a prototype of smart vaccine delivery device that can not only deliver the COVID-19 vaccine transdermally but also monitor biomarkers in the skin compartment in a minimally invasive way, offering real-time information on the efficacy of the vaccination. The new method would change the way in which vaccine efficacy trials are performed from a statistical assessment to a scientific measurement of patient inflammatory response to vaccination.”

Pfizer, BioNTech Make Offer to South Africa to Price COVID-19 Vaccine at $10 Per Dose: “The price is about half of what the U.S. and EU negotiated with the companies, but the South African government is reportedly pressing for an even lower price.”
This article raises the question of wealthy nations subsidizing costs in developing countries.

Kaiser Permanente data key to nation’s COVID-19 vaccine surveillance strategy: “Kaiser Permanente’s Vaccine Study Center…, part of the Kaiser Permanente Northern California Division of Research, was chosen by the Centers for Disease Control and Prevention (CDC) to carry out a Rapid Cycle Analysis (RCA) through CDC’s Vaccine Safety Datalink (VSD) network. Organizations that share data through the network include 5 Kaiser Permanente regions, HealthPartners in Minneapolis, and the Marshfield Clinic in Wisconsin.
The surveillance involves casting a wide net through electronic patient records, searching for specific potential adverse health effects, such as strokes or anaphylaxis (severe allergic reaction). Eight health care institutions that participate in the VSD share weekly data reports on the selected diagnoses and data analysts search for any possible connection with a COVID-19 vaccination.
Kaiser Permanente’s Vaccine Study Center has been evaluating vaccines for more than 30 years and carrying out rapid response studies through the Datalink for more than a decade…”

People without symptoms spread virus in more than half of cases, CDC model finds: “Fifty-nine percent of all transmission came from people without symptoms, under the model’s baseline scenario. That includes 35 percent of new cases from people who infect others before they show symptoms and 24 percent that come from people who never develop symptoms at all.”

About health insurance

Best Health Insurance Companies For 2021: Kaiser tops the national list of ranking by consumers. You can also view rankings by state.

What Is The Value Of A Star When Choosing A Provider For Total Joint Replacement? A Discrete Choice Experiment: “We conducted a discrete choice experiment in an outpatient setting (an academic joint arthroplasty practice) to study trade-offs that patients are willing to make in choosing a provider for a hypothetical total joint arthroplasty. Two hundred consecutive new patients presenting for hip or knee pain in 2018 were included. The average patient was willing to pay $2,607 and $3,152 extra for an additional hospital or physician star, respectively, and an extra $11.45 to not travel an extra mile for arthroplasty care. History of prior surgery and prior experience with rating systems reduced the relative value of an incremental star by $539.25 and $934.50, respectively.”

Comparison of Utilization, Costs, and Quality of Medicaid vs Subsidized Private Health Insurance for Low-Income Adults: “Public coverage through Medicaid was associated with more ED visits and fewer office visits than private Marketplace coverage, which may reflect barriers to outpatient care or lower cost-sharing barriers to ED care in Medicaid. Results suggest that Medicaid coverage was substantially less costly to beneficiaries and society than private coverage, with mixed results on health care quality.”
An ongoing coverage question is whether Medicaid-eligible people should be insured through that program or through subsidized private insurance. This research starts to shed some light on the answer.

Today's News and Commentary

About the public’s health

WHO recommends two doses of Pfizer COVID-19 vaccine within 21-28 days: “People should get two doses of the Pfizer and BioNTech vaccine within 21-28 days, the World Health Organization said on Tuesday, as many countries struggled to administer the jabs that can ward off the COVID-19 virus.”

Studies to see if Moderna COVID-19 vaccine doses can be halved may take two months:”Scientists at the National Institutes of Health and Moderna Inc may take about two months to determine whether doses of the company’s COVID-19 vaccine can be halved to double the supply of the shots in the U.S., according to the agency.”

Estimation of US SARS-CoV-2 Infections, Symptomatic Infections, Hospitalizations, and Deaths Using Seroprevalence Surveys: “The SARS-CoV-2 disease burden may be much larger than reported COVID-19 cases owing to underreporting. Even after adjusting for underreporting, a substantial gap remains between the estimated proportion of the population infected and the proportion infected required to reach herd immunity. Additional seroprevalence surveys are needed to monitor the pandemic, including after the introduction of safe and efficacious vaccines.”

WHO team blocked from entering China to study origins of coronavirus: “The World Health Organization said that China has blocked the arrival of a team investigating the origins of the coronavirus pandemic, in a rare rebuke from the UN agency. 
WHO Director-General Tedros Adhanom Ghebreyesus said two scientists on the United Nations team had already left their home countries for Wuhan when they were told that Chinese officials had not approved the necessary permissions to enter the country.
The arrangements had been jointly agreed with China in advance.”

US passes 21 million coronavirus cases and more than 130,000 people are in hospitals: “On a day the United States registered another record for Covid-19 patients in hospitals, the country passed 21 million cases of the coronavirus, according to Johns Hopkins University.
The US, with 21,007,694 cases as of Tuesday evening, has almost as many as the next three nations -- India, Brazil and Russia -- have combined.
The US has added 1 million cases in the past four days.
That's as the record number of hospital patients Tuesday topped 131,200, according to the Covid Tracking Project.”

Trump administration speeds up plan to deliver Covid shots in pharmacies: “Within the next two weeks, Operation Warp Speed, the federal government’s vaccine accelerator, estimates 3,000 to 6,000 pharmacies could begin administering Covid-19 shots, according to a senior HHS official. The administration announced in November that it would work with major pharmacy chains and independent community pharmacies to distribute vaccines but didn't lay out a timetable.”

About pharma

AmerisourceBergen to Buy Alliance Healthcare From Walgreens Boots for $6.5 Billion: “AmerisourceBergen Corp. on Wednesday said it agreed to buy the majority of Walgreens Boots Alliance Inc.'s Alliance Healthcare businesses for about $6.5 billion.
Amerisource, a Valley Forge, Pa., provider of pharmaceutical products, said it would pay $6.275 billion in cash and issue 2 million shares to Walgreens in exchange for European pharmaceutical wholesaler Alliance.
Amerisource said the deal extends its distribution presence and its global platform of higher-margin manufacturer services. Walgreens, based in Deerfield, Ill., said it plans to increase its focus on expanding its core retail pharmacy businesses.
Amerisource and Walgreens also agreed to extend and expand their U.S. commercial agreements through 2029. Walgreens currently owns a roughly 28% stake in Amerisource, according to FactSet.”

GoodRx: 589 drugs have already seen price hikes in 2021: “Since the start of the year, nearly 600 drugs have seen price hikes, according to new data from GoodRx.
So far in January, 589 drugs have had price increases, with an average jump of 4.2%. Of those, 582 are branded products and seven are generics, GoodRx found.”

CMS names an e-prescribing standard for prior authorization to expedite access to medications: “The Centers for Medicare and Medicaid Services has issued a final rule that, for the first time, is requiring that Part D prescription drug plans support a new electronic prior authorization transaction standard for their Part D e-prescribing programs.
This new electronic prior authorization standard is intended to allow prescribers to see that a drug is subject to prior authorization while they are prescribing it. This is meant to ensure that there are secure electronic transactions between prescribers and Part D plan sponsors, and that patients will not experience delays when picking up their prescriptions. 
CMS will begin enforcing the requirements of this rule on January 1, 2022, although Part D sponsors may choose to implement the new transaction standard earlier. CMS said the action is part of its efforts to strengthen Medicare.”

Many health plans now must cover full cost of expensive HIV prevention drugs: “Starting this month, most people with private insurance will no longer have to decide whether they can afford to protect themselves against HIV. Most health plans must begin to cover the drugs without charging consumers anything out-of-pocket (some plans already began doing so last year).
Drugs in this category—Truvada, Descovy and, newly available, a generic version of Truvada—received an “A” recommendation by the U.S. Preventive Services Task Force. Under the Affordable Care Act, preventive services that receive an ‘A’ or ‘B’ rating by the task force, a group of medical experts in prevention and primary care, must be covered by most private health plans without making members share the cost, usually through copayments or deductibles. Only plans that are grandfathered under the health law are exempt.”
For additional information on this ACA requirement, see: Affordable Care Act preventive items and services.

About hospitals and health systems

115 hospitals sue HHS over Medicare payment calculation: “A group of 115 hospitals sued HHS in an attempt to prevent the department from retroactively changing how it calculates Medicare Part A disproportionate share hospital payments for patients who were enrolled in Medicare Advantage plans under Part C of the Medicare Act.
The federal lawsuit was filed Jan. 4 by a coalition of Nashville, Tenn.-based HCA Healthcare and Irving, Texas-based Christus Health hospitals. The hospitals are states including California, Colorado, Utah and Florida. 
The hospitals' lawsuit concerns a 2004 Medicare policy change that included a new methodology for allocating Medicare Part C days in the disproportionate share hospital calculation formula. 
The U.S. Court of Appeals has ruled against HHS in several different actions brought by hospitals challenging the 2004 policy. The U.S. Supreme Court also recently upheld the appeals court decision, according to the complaint. 
Despite those court rulings, HHS proposed in August 2020 to readopt the calculation policy and apply it retroactively.  
In the lawsuit, the hospitals argue that HHS is disregarding the court decisions.”

CHI Franciscan, Virginia Mason officially merge: 5 things to know: “CHI Franciscan and Virginia Mason officially formed an 11-hospital health system Jan. 5. The system, Virginia Mason Franciscan Health, will be part of Chicago-based CommonSpirit Health.”

Tenet, Methodist Le Bonheur call off sale of 2 hospitals after FTC's lawsuit: “Tenet Healthcare and Methodist Le Bonheur agreed to call off Methodist’s $250 million acquisition of two Memphis-area hospitals after the sale triggered a lawsuit from the Federal Trade Commission.”

About health insurance

UnitedHealth Group's Optum to buy Change Healthcare for $13B: “UnitedHealth Group's Optum unit has agreed to buy Change Healthcare for $7.84 billion in cash plus about $5 billion in debt, the companies said on Wednesday.
The acquisition will strengthen the insurer's portfolio of healthcare technology services and capabilities.
Change Healthcare will join with OptumInsight to provide software and data analytics, technology-enabled services and research, advisory and revenue cycle management offerings, the companies said in a press release.”


Today's News and Commentary

500th Issue

About health insurance

Centene Signs Definitive Agreement to Acquire Magellan Health: ”Centene Corporation… and Magellan Health, Inc… announced that they have entered into a definitive merger agreement under which Centene will acquire Magellan Health for $95per share in cash for a total enterprise value of $2.2 billion. The transaction, which was unanimously approved by the Boards of Directors of both companies, will broaden and deepen Centene's whole health capabilities and establish a leading behavioral health platform.”
Magellan has been used by a number of insurers for behavioral health services. Now we will need to see if others insurers will still contract with the company.

Tufts Health Plan and Harvard Pilgrim Health Care officially come together: ”Harvard Pilgrim Health Care and Tufts Health Plan announced their organizations have formally combined, effective January 1, 2021, having received all regulatory approvals.”
The partners claim: “Over time, more than $100 million in savings is anticipated through administrative synergies which will go directly to mitigating premium increases and member out-of-pocket burden.”

9th Circ. Revives Insurance Rule For Green Card Seekers: “The Ninth Circuit has revived President Donald Trump's proclamation requiring green card applicants to prove they will have access to health insurance, prompting a sharp dissent from one judge who slammed the order as an "unprecedented exercise of unilateral Executive power. ‘Leaning on the U. S. Supreme Court's ruling upholding the president's controversial travel ban, the federal appeals court held Thursday in a split decision that the Trump administration's rationale behind the proclamation — namely, that uninsured immigrants would cost the U. S. financially — was "adequate" to permit the entry bar.’”

Insurer Refuses to Keep Envision Clinicians in Their Network: “UnitedHealthcare has decided not to renew its longstanding partnership with Envision Healthcare in the midst of a national health crisis. This means Envision’s clinicians will not be part of United’s insurance plans starting January 1, 2021.
United’s decision comes at a time when Envision’s 25,000 clinicians have cared for approximately one out of every 10 hospitalized COVID-19 patients. Although Envision does not balance bill patients, it cannot prevent patients from receiving higher surprise bills from United, including bills related to COVID-19 care. While United waives patient cost sharing for in-network COVID-19-related care, United’s cost-sharing waiver does not apply to all out-of-network in-patient COVID-19 costs3. United’s COVID-19 coverage means that one in 10 patients who go to an emergency room may face a surprise gap in coverage.” United says that it was paying Envision’s physicians considerably above its median rates.

About the public’s health

A final EPA rollback under Trump curbs use of health studies: Under the guise of transparency, the Trump administration says that unless all study data is available for review, it will be barred from consideration for policy decisions. The problem is that many public health studies use data that has been “scrubbed” of personal identities; those studies will no longer be eligible for inclusion in those policy decisions.

Association of Cigarette and Electronic Cigarette Use Patterns With Levels of Inflammatory and Oxidative Stress Biomarkers Among US Adults: “In this nationally representative population study of adults, we observed no difference in inflammatory and oxidative stress biomarkers between exclusive e-ciga- rette users and nonusers (no cigarettes or vaping), and levels were lower in exclusive e-cigarette users relative to exclusive smokers. These findings are consistent with recent population studies of inflammatory biomarker4 and toxicant exposure5 in users of e-cigarettes and ciga- rettes and highlight the importance of completely re- placing cigarette smoking with e-cigarettes or quitting the use of both products for cigarette smokers to derive potential health benefits.”

About the public’s health

LA County Paramedics Told Not To Transport Some Patients With Low Chance Of Survival: ”Paramedics in Southern California are being told to conserve oxygen and not to bring patients to the hospital who have little chance of survival as Los Angeles County grapples with a new wave of COVID-19 patients that is expected to get worse in the coming days.
The Los Angeles County Emergency Medical Services Agency issued a directive Monday that ambulance crews should administer supplemental oxygen only to patients whose oxygen saturation levels fall below 90%.
In a separate memo from the county's EMS Agency, paramedic crews have been told not to transfer patients who experience cardiac arrest unless spontaneous circulation can be restored on the scene.”
This real-life case should provoke discussions of medical ethics.

BioNTech says no data to support delayed vaccine booster shot: “BioNTech and partner Pfizer warned on Monday that they had no evidence that their jointly developed vaccine will continue to protect against COVID-19 if the booster shot is given later than tested in trials.”

8 recently launched healthcare marketing campaigns: All are COVID-19 related.

How Eight Covid-19 Vaccines Work: I believe this article from the NY Times is open access. It is a great summary with graphics.

About pharma

PhRMA Denied Early Win In Drug Pricing Law Case: “A California federal judge has refused to grant the Pharmaceutical Research and Manufacturers of America's bid to permanently block a state drug pricing law, shooting down the trade group's bid for an early win on its First Amendment and commerce clause claims. In a Dec. 30 decision, District Judge Morrison C. England Jr. denied PhRMA's motion that sought summary judgment on its First Amendment free speech and commerce clause allegations and also sought a permanent injunction against Senate Bill 17.”

Pfizer Introduces New Logo Playing Up Role in Drug Creation: “The logo, 18 months in the making, replaces the oval, pill-like shape that had enclosed the Pfizer name since 1948 with a helix design to the left of the company name. It retains current elements, including the name, font and blue color. The company is promoting the new design with an ad campaign.”

Feds tell pharma companies to pony up 340B discounts, but it's unclear whether they will: “The HHS’ new advisory opinion doesn’t carry the force of law, but instead communicates the agency’s views on the issue. Drugmakers, for their part, either say they're reviewing the opinion or plan to stick to their own new policies.”

About healthcare philanthropy

15 largest gifts to healthcare organizations in 2020: Read the article for details.

Today's News and Commentary

About health insurance

Haven, the Amazon-Berkshire-JPMorgan venture to disrupt healthcare, is disbanding after 3 years: Haven, the joint venture formed by three of America’s most powerful companies to lower costs and improve outcomes in health care, is disbanding after three years, CNBC has learned exclusively.
The company began informing employees Monday that it will shut down by the end of next month, according to people with direct knowledge of the matter…
One key issue facing Haven was that while the firm came up with ideas, each of the three founding companies executed their own projects separately with their own employees, obviating the need for the joint venture to begin with, according to the people, who declined to be identified speaking about the matter.”

About hospitals and health systems

Hospitals Say They Will Publish Previously Secret Prices: Just a reminder: “As of Jan. 1, hospitals will be required to publish the prices negotiated privately with each payer for 300 common services for easy use by consumers, and make public the same information for all their procedures in a format that can be read and analyzed by computers.” Check hospital websites to see if they comply. For example, Partners in Boston has listed prices for a couple years; but their pdf. is dated 2018.

About the public’s health

A new mandate highlights costs, benefits of making all scientific articles free to read: “In 2018, a group of mostly European funders sent shock waves through the world of scientific publishing by proposing an unprecedented rule: The scientists they funded would be required to make journal articles developed with their support immediately free to read when published.
The new requirement, which takes effect starting this month, seeks to upend decades of tradition in scientific publishing, whereby scientists publish their research in journals for free and publishers make money by charging universities and other institutions for subscriptions. Advocates of the new scheme, called Plan S (the “S” stands for the intended “shock” to the status quo), hope to destroy subscription paywalls and speed scientific progress by allowing findings to be shared more freely. It’s part of a larger shift in scientific communication that began more than 20 years ago and has recently picked up steam.
Scientists have several ways to comply with Plan S, including by paying publishers a fee to make an article freely available on a journal website, or depositing the article in a free public repository where anyone can download it. The mandate is the first by an international coalition of funders, which now includes 17 agencies and six foundations, including the Wellcome Trust and Howard Hughes Medical Institute, two of the world’s largest funders of biomedical research.”
Read this article from Science for more information. It is truly a revolutionary move.

U.S. distributes over 13.07 million doses of COVID-19 vaccines; 4.2 million administered -CDC: “The U.S. Centers for Disease Control and Prevention said it had administered 4,225,756 first doses of COVID-19 vaccines in the country as of Saturday morning and distributed 13,071,925 doses.”

Coronavirus: BMJ urges NYT to correct vaccine 'mixing' article:The editor of the British Medical Journal has asked the New York Times to correct an article that says UK guidelines allow two Covid-19 vaccines to be mixed.[Bold in original]
The US publication reported that UK health officials would allow patients to be given a second dose that is a different vaccine to their first…
Dr Mary Ramsay, Public Health England's head of immunisations, said: ‘We do not recommend mixing the Covid-19 vaccines - if your first dose is the Pfizer vaccine you should not be given the AstraZeneca vaccine for your second dose and vice versa.’”

Vaping combined with smoking is likely as harmful as smoking cigarettes alone:

  • “Participants who vaped exclusively showed a similar inflammatory and oxidative stress profile as people who did not smoke cigarettes or use e-cigarettes.

  • Participants who smoked exclusively and those who used cigarettes and e-cigarettes had higher levels across all biomarkers assessed compared to participants who did not use cigarettes or e-cigarettes.

  • Compared to participants who smoked exclusively, those who vaped exclusively had significantly lower levels of almost all inflammatory and oxidative stress biomarkers. However, participants who used cigarettes and e-cigarettes had levels of all inflammatory and oxidative stress biomarkers comparable to those who smoked exclusively.”


CDC hopes to double the number of coronavirus samples checked for new mutations: “The US Centers for Disease Control and Prevention hopes to more than double the number of coronavirus genomes sequenced to watch for new mutations in the US over the next two weeks, a top official said Sunday.
The CDC is now sequencing about 3,000 samples a week and hopes to more than double that to about 6,500 per week, according to Dr. Gregory Armstrong, director of the Office of Advanced Molecular Detection at the CDC's National Center for Emerging and Zoonotic Infectious Diseases.”

Pfizer and BioNTech to offer COVID vaccine to volunteers who got placebo: “Pfizer Inc and its partner BioNTech Se plan to give volunteers who received a placebo in its COVID-19 vaccine trial an option to receive a first dose of the vaccine by March 1, 2021, while staying within the study.
The trial's Vaccine Transition Option allows all participants aged 16 or older the choice to discover whether they were given the placebo, ‘and for participants who learn they received the placebo, to have the option to receive the investigational vaccine while staying in the study,’ the companies said on their website here for trial participants.”

Feds may cut Moderna vaccine doses in half so more people get shots, Warp Speed adviser says: “The federal government is in talks with Moderna about giving half the recommended dose of the company's Covid-19 shot to speed up immunization efforts, the head of the Trump administration's vaccine rollout said on Sunday.
Operation Warp Speed chief adviser Moncef Slaoui said there is evidence that two half doses in people between the ages of 18 and 55 gives ‘identical immune response’ to the recommended one hundred microgram dose, but said the final decision will rest with the FDA.”

About healthcare IT

10 biggest patient data breaches in 2020: Wonder why patients don’t trust healthcare IT systems with their data? “In 2020, 527 healthcare organizations reported to HHS more than 21 million individuals being affected by data breaches.” Recall that smaller breaches need not be reported. And in a related article: Nearly 4M health records breached in December

Allscripts Closes Previously Announced Sale of CarePort Health Business: “On December 31, 2020, Allscripts… closed the previously announced sale of its CarePort Health business to WellSky® Corporation for $1.35 billion. CarePort solutions assist hundreds of hospitals and thousands of post-acute care providers to efficiently coordinate and transition patients through different settings of care.”

About pharma

Italy’s Angelini to buy Swiss biotech group for $1bn: “Italy’s Angelini Pharma has agreed to buy emerging Swiss biotech company Arvelle Therapeutics for up to $960m as it aims to become a leading European player in the treatment of central nervous system and mental diseases. Angelini will pay private-equity backed Arvelle an initial $610m in cash and another $350m following the European Medicines Agency’s approval of a drug for the treatment of epilepsy, which is expected this year, and certain revenue targets.”

Today's News and Commentary

TODAY’ TOP STORY:

Canadian healthcare providers can now practice in Michigan: Michigan Gov. Gretchen Whitmer signed a bill this week to immediately permit reciprocity in licenses, registrations and certifications for Canadian healthcare professionals in Michigan. 
Canadian healthcare professionals can apply for reciprocity as long as they meet the educational, examination and billing requirements of Michigan law. The allowance had been in effect for Canadian health professionals from 2002 until it was allowed to expire in 2012.”
This type of legislation is unique in the US. Reciprocity among states is easing. In the EU, movement of physician across borders is legislated. But a state recognizing another country’s professionals like this is refreshing.

About pharma

HHS Releases Advisory Opinion Clarifying that 340B Discounts Apply to Contract Pharmacies: “On Wednesday, the HHS Office of the General Counsel released an advisory opinion concluding that drug manufacturers are required to deliver discounts under the 340B Drug Pricing Program (340B Program) on covered outpatient drugs when contract pharmacies are acting as agents of 340B covered entities.
The 340B Program requires drug manufacturers (in exchange for coverage of drugs under Medicaid) to offer substantial discounts to "covered entities," which include safety net hospitals, community health centers, and other institutions that serve vulnerable populations. Estimates suggest that discounts in the 340B Program can range between 25 and 50 percent and that approximately $30 billion of drugs are sold to covered entities each year, representing almost 6 percent of prescription drugs sold in the United States.”

About the public’s health

What Can Be Learned From Differing Rates of Suicide Among Groups: “In data released in 2017, the rate for white Americans was around 19 per 100,000, and it was about 7.1 for both Hispanics and Asian-Americans/Pacific Islanders, and 6.6 for Black Americans, according to the Centers for Disease Control and Prevention.” The article discusses multiple reasons for this discrepancy, especially social support (including religious affiliation).

Discovery of Virus Variant in Colorado and California Alarms Scientists: The virus variant hits a second state.

About health insurance

Obamacare, in Its First Big Test as Safety Net, Is Holding Up So Far: “Final government estimates of the uninsured rate are months away, but at least one survey, from the research group the Commonwealth Fund, shows the share of Americans without coverage was holding steady through the spring. The Affordable Care Act is a crucial reason for that.”

‘Blown away’: Spokane Valley church raising money to help pay off millions in medical debt: “Valley Real Life in Spokane Valley is raising money to help buy off outstanding medical debt owed by those in need in the Pacific Northwest. The church has partnered with a New York-based nonprofit called RIP Medical Debt, which leverages donations to purchase – and then forgive – qualifying debt portfolios for pennies on the dollar.
With still a few weeks left in the church’s fundraising campaign, Valley Real Life Church has raised enough to erase upward of $21 million in debt for struggling individuals and families.”
Charitable purchases of healthcare debt at large discounts has been around for several years and is a great use of those funds.

About medical groups

In 2019, Medical Groups Generated a Profit; Health System-Affiliated Groups a Loss, According to New Survey: “The survey shows the overall median profit/investment (P/I) per provider in 2019 to be -$22,028, an improvement from -$57,426 in 2018. For health system-affiliated medical groups, the overall median loss per provider (also known as ‘investment per provider’) in 2019 was -$163,994 in 2019, slightly better than -$165,050 seen in 2018. For independent medical groups, the profit per provider increased to $12,434 in 2019 from $5,200 in 2018.
The survey also measures median profit/investment (P/I) per physician. This metric includes financial performance divided by number of physicians only, whereas the per provider metric includes advanced practice providers (APPs) in the count of ‘providers.’ In 2019, the overall median per physician was -$32,985, a significant improvement from -$98,840 in 2018. For health system-affiliated medical groups, the overall median loss/investment per physician in 2019 was -$278,505 in 2019, a decline from the -$225,261 seen in 2018. For independent medical groups, the profit per provider increased to $16,603 in 2019 from $6,296 in 2018….
The numbers alone are not necessarily indicative of system-affiliated groups performing worse than independent groups,” said Fred Horton, M.H.A., AMGA Consulting president. “One reason for these divergent trends is that revenue generated from ancillary services, such as scans and lab work, is reflected in the bottom line of independent medical groups, but generally does not accrue to the bottom line of groups affiliated with a system. Another reason is that certain expenses are exclusive to system-affiliated medical groups, for example, system office allocations and centralized service expense allocations. Because of these nuances, we analyze compensation and production alignment, staffing ratios, and general volume-adjusted metrics to make a more apples-to-apples comparison.”
The results and explanations are complex, but they make one wonder whether the system affiliation promises that enticed physicians to affiliate are worth it.
A couple other considerations:
Hospitals affiliated groups can bill more because they can charge facility fees.
The groups that affiliated may have ben distressed and the independent groups did not affiliate because they were profitable.

Today's News and Commentary

About hospitals and health systems

U.S. appeals court upholds Trump health care price disclosure rule: “The 2-0 decision by the U.S. Court of Appeals for the District of Columbia Circuit is a victory for President Donald Trump’s effort to make health care pricing more transparent so patients can be better informed when deciding on treatment.
The American Hospital Association and other hospital groups had challenged the rule, which was issued in November 2019 and is scheduled to take effect on Jan. 1, 2021.”

New Jersey may be the first state to impose per-bed fees on nonprofit hospitals for municipal services: “New Jersey lawmakers approved an unusual measure last week that requires many nonprofit hospitals to pay per-bed fees to their local governments, while preserving their increasingly contested property-tax exemptions.
The legislation, which requires hospitals to pay a fee of $3 a day for each licensed bed, is in response to a landmark 2015 New Jersey Tax Court ruling involving Morristown Medical Center that “the operation and function of nonprofit hospitals do not meet the criteria for property tax exemption” under state law. A 300-bed hospital subject to the fee would pay $328,500 a year.”

About the public’s health

Coronavirus updates: Vaccinations lag as hospitalizations hit record levels: “Although officials projected that the United States would be able to vaccinate 20 million people by the end of December, the Centers for Disease Control and Prevention reported that 11.4 million doses had been sent to states and only about 2.1 million people had received the vaccine’s first dose.”

You’re Infected With the Coronavirus. But How Infected?: “Dozens of research papers published over the past few months found that people whose bodies were teeming with the coronavirus more often became seriously ill and more likely to die, compared with those who carried much less virus and were more likely to emerge relatively unscathed… data on viral load — or at least a rough approximation of it — is readily available, built into results from the P.C.R. tests that most labs use to diagnose a coronavirus infection.”

1st reported US case of COVID-19 variant found in Colorado: “The first reported U.S. case of the COVID-19 variant that’s been seen in the United Kingdom has been discovered in Colorado, Gov. Jared Polis announced Tuesday, adding urgency to efforts to vaccinate Americans. 
The variant was found in a man in his 20s who is in isolation southeast of Denver in Elbert County and has no travel history, state health officials said.”

New US dietary guidelines include babies and toddlers for first time: “The United States Department of Agriculture and the Department of Health and Human Services issued new dietary guidelines, which include recommendations for babies and toddlers for the first time…
Despite this expanded guidance including early life stages, the guidance doesn't follow quantitative recommendations in two key areas -- alcohol and sugar intake -- addressed by an advisory committee's scientific report.”
More politics and lobbying win out at the expense of the public’s health.

Philips, BioIntelliSense and University of Colorado receive U.S. Department of Defense funding for early COVID-19 detection:
Cambridge, MA
 – “Royal Philips… and BioIntelliSense, Inc., a continuous health monitoring and clinical intelligence company, today announced they have been selected by the U.S. Army Medical Research and Development Command (USAMRDC) to receive nearly USD 2.8 million from the U.S. Department of Defense (DoD) through a Medical Technology Enterprise Consortium (MTEC) award to validate BioIntelliSense’s FDA-cleared BioSticker device for the early detection of COVID-19 symptoms. The goal of the award is to accelerate the use of wearable diagnostics for the benefit of military and public health through the early identification and containment of pre-symptomatic COVID-19 cases.
Working with the University of Colorado Anschutz Medical Campus, the clinical study will consist of 2,500 eligible participants with a recent, known COVID-19 exposure and/or a person experiencing early COVID-19 symptoms.”

Regional Variation in Active Surveillance for Low-Risk Prostate Cancer in the US: “In this cohort study of 79 825 men from the Surveillance, Epidemiology, and End Results (SEER) Prostate with Watchful Waiting database, variations across SEER regions appeared to explain 17% of the observed differences in use of active surveillance after adjustment for sociodemographic characteristics and county health resources. Other factors, such as Black race, county-level socioeconomic factors, and specialist densities did not show an association, although Hispanic ethnicity showed a negative association with surveillance use.”
Local area variations have been studied in this country for the past 50 years. Unfortunately they still persist. Health system characteristics, physician practice styles and patient treatment preferences have been shown to be the reasons for the variations.

About healthcare IT

VA's digital health project faces new scrutiny from union, groups inside agency: The saga continues…:
”The Department of Veterans Affairs' $16 billion medical records modernization project is facing new scrutiny just a month after a much-touted software rollout at a VA facility in Spokane, Wash.
One of the department’s unions says it didn't get advance warning the new system would be activated at a VA facility in Las Vegas. Meanwhile, groups within the department are questioning the technical capabilities of the project and who’s managing it. And internal reviews are raising concerns about some important, data-sharing technical capabilities, along with its management structure.”

About health insurance

CPT E/M Office Revisions Level of Medical Decision Making (MDM): A reminder that these coding changes start January 1. This chart from the AMA is really helpful in explaining the decision criteria,

2012-2018 Data on Physician Compensation Methods: Upswing in Compensation through the Combination of Salary and Bonus: An interesting survey of how physician compensation has changed over a few years. “The percentage of physicians who were paid by a single method dropped to 42.7% in 2018 from 51.8% in 2012, with salary and compensation based on productivity being the two most prominent payment methods.”

About pharma

Pfizer Forges Potential $4.2 Billion Deal to Distribute Myovant Sciences’ Orgovyx: “Pfizer is expanding further into oncology thanks to a deal with Myovant Sciences, under which the two companies will cooperate on developing and commercializing Myovant’s newly approved prostate cancer drug Orgovyx (relugolix). Myovant will receive up to $4.2 billion, including an upfront payment of $650 million.”
This drug was previously mentioned in this blog as a once-daily oral treatment for advanced prostate cancer.

Today's News and Commentary

About the public’s health

First case of highly infectious coronavirus variant detected in Colorado: “Colorado officials on Tuesday reported the first known case in the United States of a person infected with the coronavirus variant that has been circulating rapidly across much of the United Kingdom and has led to a lockdown of much of southern England.
Scientists believe the variant is more transmissible but does not make people sicker.”

About pharma

FDA Takes Further Steps to Confront Opioid Crisis Through Risk Evaluation and Mitigation Strategy Programs: “ In particular, this program has been strengthened to:  

  • Require that prescribers document a patient’s opioid tolerance with each prescription of a TIRF medicine for outpatient use;

  • Require outpatient pharmacies dispensing TIRF [transmucosal immediate-release fentanyl] medicines to document and verify a patient’s opioid tolerance before dispensing;

  • Require inpatient pharmacies to develop internal policies and procedures to verify opioid tolerance in patients who require TIRF medicines while hospitalized; and

  • Require a new patient registry for use, along with other data sources, to monitor for accidental exposure, misuse, abuse, addiction, and overdose.”

About healthcare providers

The Doctor Will See You Once You Sign This Binding Arbitration Agreement: The article explains this change is due to rising malpractice litigation expenses and the increasing trend of venture capital firms owning practices.

About healthcare financing

Private equity pushes into healthcare: 7 latest deals: A good review of what has happened this month.

FDA actions in December

7 recent drug, device approvals: The headline speaks for itself.

Today's News and Commentary

Trump Signs Pandemic Relief Bill After Unemployment Aid Lapses: “The legislative package will provide billions of dollars for the distribution of vaccines, funds for schools, small businesses, hospitals and American families, and money needed to keep the government open for the remainder of the fiscal year. The enactment came less than 48 hours before the government would have shut down and just days before an eviction moratorium and other critical pandemic relief provisions were set to expire.
But it also came after two critical unemployment programs lapsed, guaranteeing a delay in benefits for millions of unemployed Americans.”

About the public’s health

COVID-19 Vaccination Considerations for Persons with Underlying Medical Conditions:From the CDC: “Adults of any age with certain underlying medical conditions are at increased risk for severe illness from the virus that causes COVID-19. mRNA COVID-19 vaccines may be administered to people with underlying medical conditions provided they have not had a severe allergic reaction to any of the ingredients in the vaccine.” The article details recommendations for some high risk groups.

Novavax starts late-stage trial of COVID-19 vaccine in United States: “Novavax Inc has begun a large late-stage study of its experimental COVID-19 vaccine in the United States, the drug developer said on Monday, after delaying the trial twice due to issues in scaling up the manufacturing process.
It will enroll up to 30,000 volunteers across about 115 sites in the United States and Mexico, with two-thirds of them receiving the shot 21 days apart and the rest getting placebo, the company said.”

Biden will invoke Defense Production Act to boost Covid vaccine production, advisor says: “President-elect Joe Biden plans to invoke the Defense Production Act after he takes office next month to boost production of Covid vaccines, a member of his Covid-19 advisory team said.
The wartime production law allows the president to compel companies to prioritize manufacturing for national security purposes.”

Oxford/AstraZeneca Covid vaccine to be approved by UK within days: “The Oxford/AstraZeneca vaccine is seen as game-changing within Whitehall, as its low price and ease of storage will allow the government to vaccinate people more quickly. The BioNTech/Pfizer vaccine, which was approved earlier this month, must be kept at minus 70C and can be moved only four times within a cold chain before being used…
The Oxford vaccine was designed with access in mind. AstraZeneca has pledged to sell it at cost to developing nations in perpetuity. Its ease of storage, with a long-term shelf life protected at conventional refrigeration temperatures, has galvanised hopes that it can be used by much of the developing world.”

Comparing Health Outcomes of Privileged US Citizens With Those of Average Residents of Other Developed Countries: The study should have been done long ago. Policy makers are often arguing that we need to bring the US population up to the “best care in the world” that is enjoyed by our richest citizens. It looks like that goal only gets us half way. The entire article is worth a read. Here are some highlights:
“The health outcomes of privileged White US citizens for 6 health outcomes are better than those for average US citizens; however, the health outcomes of privileged White US citizens for infant mortality, maternal mortality, and AMI [heart attack] are not consistently better than the outcomes of average residents in many other developed countries…
Privileged White US citizens appear to have the best outcome in the world for breast cancer. That outcome is very likely due to the high rate of mammogram screening in the US, which is associated with higher rates of diagnosis of small cancers.However, if undetected, most of these small cancers would not have progressed to large cancers and caused death…
Our results suggest—but do not prove—that health outcomes depend on the system of care, rather than the performance of individual physicians or hospitals.”

About health insurance

Duke Health, Geisinger sue HHS over Medicare payments: “The hospitals' lawsuit takes issue with a Medicare policy change, adopted in 2004, that included a new methodology for allocating Medicare Part C days in the disproportionate share hospital formula. The appeals court has ruled against HHS in three actions challenging its attempts to apply its Part C days policy to deny DSH payments to hospitals. However, the hospitals argue that HHS is disregarding those decisions and a decision by the U.S. Supreme Court.”

Florida physician pleads guilty to $29M fraud: How does our healthcare system let such practices happen in the first place?
“As part of his plea deal, Dr. deGraft-Johnson acknowledged consistently performing two invasive diagnostic angiography procedures on hundreds of patients, whether medically necessary or not. When the patients returned for follow-up office visits, Dr. deGraft-Johnson submitted fraudulent claims to their insurance companies stating he performed atherectomies during the appointments. Using this scheme, the physician admitted he claimed to have performed more than 3,000 of these surgical procedures to clear blockages in arteries in as many as 845 of his patients' legs. 
In court documents released in February, prosecutors provided several examples of Dr. deGraft-Johnson's fraud. In one case, he claimed to have done 14 procedures during a seven-hour period. Prosecutors said the procedures would have taken roughly 28 hours…”

CMS Holds Back Medicaid Rebate Reporting Policy for Two Years: ”The policy will require drugmakers to report discounts to CMS that do not help patients and instead lower costs for health insurers and pharmacy benefit managers (PBMs). It is intended to help ensure that patients see lower out-of-pocket costs through cost-sharing assistance, including copayment assistance cards provided by pharma companies.
CMS said that it is delaying the policy for two years (January 2023) to give manufacturers, insurance companies and PBMs time to make any necessary changes to the reporting systems used to offer discounts in patient assistance programs.”

Today's News and Commentary

About the public’s health

The U.S. has vaccinated just 1 million people out of a goal of 20 million for December: The headline speaks for itself.

A side-by-side comparison of the Pfizer/BioNTech and Moderna vaccines: The “bottom line” is: similar efficacy in trials.
Compared to the Pfizer/BioNTech product, the Moderna vaccine doesn’t have as extreme cold storage needs, requires more than 3 times the dose, and the second dose is given 28 days after the first one (compared to 21 days).

About pharma

Federal judge blocks Trump administration drug pricing rule: “A federal judge on Wednesday blocked a last-minute Trump administration rule aimed at lowering drug prices as of next week.
The rule, scheduled to take effect on Jan. 1, would have tied reimbursements for 50 drugs by Medicare, a U.S. government insurance program, to the lowest prices paid by certain other countries. U.S. District Judge Catherine Blake in Maryland ruled that the administration had rushed the rule without giving the public a chance to comment, in violation of federal law.”

Merck Announces Supply Agreement with U.S. Government for Initial Doses of Investigational Biological Therapy for the Treatment of Patients with Severe and Critical COVID-19: “ Merck… announced it has entered into an agreement with the United States Government to support [$356 million] the development, manufacture and initial distribution of an investigational biological therapeutic (CD24Fc, to be named MK-7110) upon approval or Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA). Merck acquired MK-7110 through the acquisition of OncoImmune, a privately held, clinical-stage biopharmaceutical company…
In September 2020, OncoImmune reported topline findings from an interim efficacy analysis of a Phase 3 study evaluating MK-7110 for the treatment of patients with severe and critical COVID-19. An interim analysis of data from 203 participants (75% of the planned enrollment) indicated that hospitalized patients with COVID-19 treated with a single dose of MK-7110 showed a 60% higher probability of improvement in clinical status compared to placebo, as defined by the protocol. The risk of death or respiratory failure was reduced by more than 50%. The study is ongoing.”

About healthcare quality

New Measures Under Consideration Mark a Milestone for CMS’s Reimagined Quality Strategy to Increase Digital Innovation and Reduce Burden: “ The Centers for Medicare & Medicaid Services… unveiled its 2020 list of quality and efficiency measures under consideration… Every year, CMS evaluates all measures in its programs, proposing to remove those that have become less relevant and proposing new measures that may be more meaningful based on review by external health care experts. This year, almost all of the measures proposed would be collected digitally, meaning information comes from claims and other electronic sources, and would not require doctors to retrieve data manually.”
Read the posting for an explanation of the 20 measures CMS chose.

About healthcare systems

Tenet, Methodist Le Bonheur abandon $350M deal after FTC challenge: “The organizations called off the deal less than two months after the Federal Trade Commission filed a complaintseeking a temporary restraining order and preliminary injunction to stop the transaction pending an administrative trial, which was slated to begin May 18. The Tennessee attorney general's office joined the FTC's complaint.”

Today's News and Commentary

About the public’s health

Trump throws Covid relief bill in doubt by asking Congress to amend it: After being absent in Congressional discussions over the past number of months, the President now says the relief bill should be amended to increase the amounts paid from $600 to $2000 per individual ($4000 per couple). He did not use the word “veto” in his statements, possibly because both houses of Congress have more than enough votes to override it. The Democrats had pushed for more relief while Republicans wanted a smaller amount. One problem is that Congress has adjourned for a winter break and would need to be recalled.

Pfizer and BioNTech to Supply the U.S. with 100 Million Additional Doses of COVID-19 Vaccine: “Consistent with the original agreement announced in July 2020, the U.S. government will pay $1.95 billion for the additional 100 million doses.“ In a related story: The inside story behind Pfizer and BioNTech's new vaccine brand name, Comirnaty: “The name is coined from Covid-19 immunity, and then embeds the mRNA in the middle, which is the platform technology, and as a whole the name is meant to evoke the word community…”

Here's Your COVID Vaccine Rumor Roundup: This article is an excellent explanation debunking the major myths about the COVID vaccines.
And in a related article: The Anti-Vaxx Playbook: “This report, The Anti-Vaxx Playbook, is based on in-depth analysis of speeches and presentations by leading digital anti-vaccine advocates at a meeting they recently held in private over three days; investigation of private anti-vaccine digital spaces; and other intelligence gathered by our researchers. It reveals how anti-vaccine networks are systematically planning to suppress uptake of the Coronavirus vaccine by exploiting digital platforms.
These malignant actors have developed their strategic understanding over years of advocacy and practice. Their strategy is simple. Exploit social media algorithms’ predilection for controversial and engaging content to hammer home three key messages - Covid isn’t dangerous; vaccines are dangerous; and mistrust of doctors, scientists and public health authorities. Despite the variety of styles, tones and themes employed by the anti-vaccine movement, every meme they share is in service to one of these three messages.”
You should read the Executive Summary on page 6.

CDC says new UK strain of coronavirus could 'already be in the United States': However, experts believe the current vaccines should be effective against the mutation.

Lyft, Anthem, JPMorgan Chase and United Way Launch Universal Vaccine Access Campaign: “Lyft, Inc… today announced the launch of a nationwide campaign to support universal access to the coronavirus vaccine. The goal of this effort is to provide 60 million rides to and from vaccination sites for low-income, uninsured, and at-risk communities, when the vaccine becomes available. Corporate partners JPMorgan Chase and Anthem Inc. and community partner United Way will be working alongside Lyft to lead the effort, with many other business, healthcare and technology partners preparing to join the campaign as vaccines become available in the coming weeks.”

About pharma

Takeda offloads heart and metabolism drugs to 3-month-old Chinese firm for $322M: “Takeda has already exceeded the product sell-off goal it set alongside its Shire merger, but the Japanese pharma shows no sign of slowing down.
After making several geography-specific divestitures in different regions of the world, Takeda has turned to China. The company said Monday it agreed to offload some cardiovascular and metabolic drugs in the Chinese mainland to local firm Hasten Biopharmaceutic for $322 million.
The deal covers five drugs, including hypertension med Ebrantil (urapidil); the whole portfolio generated $109.5 million in sales for the fiscal year ended in March.”

Report Shows Prescription Opioid Use in US Declined by 60% From 2011 Peak: “Decreases in prescription opioid volume over the past 9 years have been driven by changes in clinical use, regulatory, and reimbursement policies, and in progressively more restrictive legislation enacted since 2012, according to the report. Further, the declines have been greatest in the highest doses of prescription opioids, or 90 morphine milligrams equivalents per day, which present the highest risk of opioid use disorder.”

U.S. sues Walmart saying pharmacies fueled opioid crisis, retailer rejects allegations: “In a civil lawsuit in U.S. District Court in Delaware, the government said Walmart failed to take its gatekeeping duties as a pharmacy seriously, allegations the company rejected.”

Global investors inject momentum into Hong Kong’s biotech craze: “International investors including BlackRock and Fidelity are anchoring a boom in Hong Kong biotech listings, with Chinese healthcare companies raising a record $21.1bn from share offerings in the city this year. Hong Kong is seeking to supplant New York’s Nasdaq as the world’s largest biotech fundraising centre by 2025. The rush of interest from western investors follows reforms two years ago that allowed biotech groups with no revenue to go public in the Asia finance hub for the first time.”

About health insurance

H.R.1418 - Competitive Health Insurance Reform Act of 2020: An Act: To restore the application of the Federal antitrust laws to the business of health insurance to protect competition and consumers.
Amendment To McCarran-Ferguson Act.—Section 3 of the Act of March 9, 1945 (15 U.S.C. 1013), commonly known as the McCarran-Ferguson Act…” The law awaits presidential signature.

The McCarran-Ferguson Act is one of the cornerstones of the insurance industry. It provides these companies with limited anti-trust protections and gives states the authority to regulate, tax and license them. With intense consolidation of many health insurance companies, this amendment restores federal ability to prosecute under antitrust provisions of the Sherman and Clayton Acts. The law was obviously opposed by health insurance trade group AHIP, but also by the National Association of Insurance Commissioners.

[For more details see pages 236 and 237 of the U.S. Healthcare System book.]

Congress extends Medicare coverage of immunosuppressive drugs for kidney transplant: “The US Senate passed the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act as part of a broad year-end legislative package, extending Medicare coverage of life-saving immunosuppressive medications for the life of the kidney transplant.
An estimated 375 adult kidney transplant recipients lose their transplant every year due to a lack of coverage of immunosuppressive medications after the prior 36-month Medicare coverage period…
The legislation ensures that Medicare covers the cost of immunosuppressive drugs if no other coverage is available. A non-partisan Congressional Budget Office analysis estimated the legislation will save Medicare more than $400,000,000 over the course of 10 years by averting a return of transplant patients to hemodialysis.”

Today's News and Commentary

The final version of the COVID-19 relief bill has been published. Below are some of the healthcare-specific provisions, summarized by the MGMA. The legislation:

  • Temporarily suspends the 2% Medicare sequestration from Jan. 1 through March 31, 2021;

  • Increases Medicare payments across the board for CY 2021 from what was finalized in the 2021 Physician Fee Schedule (PFS) by adding $3 billion into the PFS and delaying payment of HCPCS add-on code G2211 for three years;

  • Freezes the 2020 qualifying participant thresholds required to achieve alternative payment model (APM) benefits such as the 5% lump sum bonus through 2023;

  • Delays the start date for the mandatory radiation oncology APM from July 1, 2021 until Jan. 1, 2022;

  • Extends the work geographic index floor under the Medicare program through Dec. 31, 2023;

  • Expands access to mental health services furnished through telehealth past the expiration of the COVID-19 public health emergency; and

  • Provides for the creation of 1,000 new Medicare-funded graduate medical education (GME) residency positions.

The surprise billing provision was discussed in yesterday’s blog.

About hospitals and healthcare systems

Monitoring for Hospital Price Transparency: A reminder that on January 1 CMS will start to monitor hospitals for compliance with price transparency.

Philadelphia health system merger clears latest FTC challenge: The merger is back on… “An appellate court on Dec. 21 denied the Federal Trade Commission's latest attempt to block a merger between Philadelphia-based Jefferson Health and Einstein Healthcare Network.”

Texas hospital pays $48M to settle false claims allegations: “Prosecutors allege that the hospital, which is partially physician-owned, and its subsidiary THHBP Management submitted claims to Medicare that resulted from illegal physician referrals and kickbacks.
In particular, prosecutors said the hospital violated Stark Law and the Anti-Kickback Statute by requiring physician owners to meet a 48 patient-contact requirement to maintain ownership in the hospital.”

About the public’s health

Johnson & Johnson Takes Big Step Forward With Its Vaccine Trial, Has Potential to Be Single Shot: “Johnson & Johnson took a big step forward this week as they announced their phase 3 trials are now fully enrolled with 45,000 people.” The vaccine does not require very low shipping/storage temperatures and, if proven effective, will require only one dose. It works by incorporating double stranded DNA in a modified adenovirus. The virus infects cells and releases the DNA, which causes manufacture of SARS CoV-2 spike proteins. These proteins provoke an immune response. See: How the Johnson & Johnson Vaccine Works for helpful graphics of tis process.

Trends in Overweight and Obesity Self-awareness Among Adults With Overweight or Obesity in the United States, 1999 to 2016: “Among study participants…, 33.5% were overweight and 34.5% were obese, although 41.3% of persons who were overweight and 9.7% of persons who were obese did not consider themselves to be overweight…
Among persons with obesity, being aware of their obesity… and health professionals' recommendation on losing weight… were independently associated with attempts to lose weight after adjustment for all [other] factors…[such as demographics, income and insurance status].”
Like many other conditions, self-realization of the problem is the first step toward successful treatment. That problem requires a different approach than just assuring compliance with treatment.

About pharma

FDA approves Riabni, third biosimilar to Rituxan: “The list price for rituximab-arrx in the United States will be $716.80 per 100 mg, or $3,584 for a 500-mg single-dose vial. This is 23.7% lower than the list price of its reference product, according to an Amgen press release.” This article is a reminder that biosimilars sell at a lower discount percentage than do generic small molecules.

Biogen Will Settle for $22 Million Over Alleged Drugs Kickback Scheme: “Biogen has agreed to a $22 million settlement to resolve allegations that donations it made to charities were kickbacks to Medicare patients for out-of-pocket costs associated with its multiple sclerosis medications.”

Myovant Sciences’ Oral Therapy for Advanced Prostate Cancer Wins FDA Approval: “A form of androgen deprivation therapy, Orgovyx lowers hormone levels that enable prostate cancer cells to grow. Unlike other treatments in this class, the drug doesn’t have to be injected or implanted under the skin.” Price was not available, but since it is taken orally, it will lower administration costs.

About health insurance

CMS Says 8.2M Americans Enrolled on ACA Federal Exchange for 2021: “The enrollment level is only slightly lower than the 2020 open enrollment season’s 8.3 million enrollment, even though there are fewer states on the federal exchange. Year-over-year plan selection trends rose by 6.6 percent from 2020, similar to its increase from 2019 (6.3 percent).
This year, New Jersey and Pennsylvania joined 12 states and the District of Columbia in shifting to a state-based platform for their state-based exchanges.”

Establishing Minimum Standards in Medicaid State Drug Utilization Review (DUR) and Supporting Value-Based Purchasing (VBP) for Drugs Covered in Medicaid, Revising Medicaid Drug Rebate and Third Party Liability (TPL) Requirements (CMS 2482-F) Final Reg: “This final rule advances CMS’ efforts to support state flexibility to enter value-based purchasing arrangements (VBPs) with drug manufacturers for innovative, and sometimes costly drugs therapies, and to provide manufacturers with regulatory flexibility to enter into VBPs with commercial payers, which will benefit Medicaid programs. It also creates minimum standards in state Medicaid DUR programs designed to reduce opioid-related fraud, misuse and abuse.

This final rule also revises regulations regarding:  

  • How manufacturers should calculate the average manufacturer price (AMP) of a brand name drug when there is also a sale of an authorized generic;

  • How manufacturers should include the discount or rebates provided as part of their patient assistance programs in the calculation of ‘best price’ and AMP, including when they are impacted by pharmacy benefit managers (PBM) accumulator programs;

  • State and manufacturer reporting requirements to the Medicaid Drug Rebate Program (MDRP);

  • The definition of a CMS-authorized supplemental rebate agreement, to clarify that the rebates under such arrangements for MCO claims must be paid to the state;

  • The definition of line extension, new formulation, oral solid dosage form, single source drug, multiple source drug, and innovator multiple source drug for purposes of the MDRP; and,

  • Coordination of benefits (COB) and TPL rules related to the special treatment of certain types of care and payment in Medicaid and Children’s Health Insurance Program (CHIP).”

Two Owners of New York Pharmacies Charged in $30 Million Covid-19 Health Care Fraud and Money Laundering Scheme: “An indictment was unsealed in federal court in Brooklyn… charging the two owners of over a dozen pharmacies in New York City and on Long Island, for their roles in a $30 million health care fraud and money laundering scheme in which they exploited emergency codes and edits in the Medicare system that went into effect due to the COVID-19 pandemic in order to submit fraudulent claims for expensive cancer drugs that were never provided, ordered or authorized by medical professionals.”

Oscar Health gearing up to go public: “The startup health insurer filed a draft registration statement on Form S-1 with the Securities and Exchange Commission (SEC). A potential initial public offering will undergo an SEC review…
Oscar's individual and family plans as well as small group and Medicare Advantage coverage will be available across 18 states and 286 counties next year. About 420,000 members were enrolled in its plans as of Sept. 30.”
About healthcare quality

Unnecessary C-sections are a problem in the US. Will publicizing hospital rates change that?: “The Joint Commission… plans to start publicly reporting next year on hospitals with high cesarean section birth rates. The news comes a few weeks after the Department of Health and Human Services unveiled an action plan to improve maternal health, which included reducing low-risk C-section delivery rate by 25%.
Since 1985, the World Health Organization has considered the ideal rate for C-section births to be between 10% to 15%.
However, the Centers for Disease Control and Prevention reports more than 31% of all deliveries in the U.S. were by C-section in 2018. Tricia Elliott, director of Quality Measurement at TJC, says some U.S. hospitals report C-section rates as high as 60%…
High C-section rates are not the problem, said Dr. William Grobman, professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine. The problem is variation between hospitals – low C-section rates in some and high rates in others – with no improved outcome for mother and baby.”





Today's News and Commentary

About the public’s health

First shipments of Moderna vaccine roll out, a new weapon in U.S. Covid-19 response: The headline speaks for itself. The vaccine received emergency use authorization late Friday.

Congress seals agreement on $900 billion COVID relief bill: Lots in the bill for economic relief and funding unrelated to the COVID-19 pandemic. As far as health-related provisions, “$22 billion would help states and local governments with COVID-19-related health expenses like testing and vaccines.”

Surprise medical bill prevention included in year-end legislative package: “The measure uses a process known as arbitration to determine how much the insurer will pay the doctor, a shift from earlier versions that would have set the payment rate based on the median rate in that geographic area. 
The latest version moves even further towards doctors and hospitals by banning the arbiter from considering the lower payment rates paid by the Medicare and Medicaid programs.”

Panel: People over 75, essential workers next for vaccines: Even before everyone in the first tier is vaccinated, the CDC recommends “that people 75 and older and essential workers like firefighters, teachers and grocery store workers should be next in line for COVID-19 shots…”

UK says new coronavirus strain is more infectious, but vaccines should still work: The headline speaks for itself. This story is an update of previous reports about the UK from which 40 countries have banned travel.

Federal guidance enables employers to mandate workers get COVID-19 vaccine: This story was previously reported; the guidance comes from the Equal Employment Opportunity Commission. It is a reminder now that more vaccines are on the way.

CVS, Walgreens begin distributing vaccine in long-term care facilities: “Walgreens said its pharmacists would begin giving the shots at nursing homes and assisted living facilities in Ohio, Connecticut and Florida while CVS said it'd give the shots at centers in Ohio and Connecticut.”

COVID-19 Community Profile Report: CNBC calls this report “the most comprehensive data report made public by the federal government since the virus began to spread across the U.S. about nine months ago.”

About healthcare IT

IBM links with Salesforce to offer digital COVID-19 vaccine passports: “Big Blue’s health pass app, which debuted earlier this year, aims to provide individual, sharable health credentials following test results, vaccinations and temperature checks through an encrypted digital wallet on a smartphone…
Now, IBM is working with Salesforce to help employers deliver wellness surveys to employees and customers through its Work.com platform, as well as perform contract tracing and schedule coronavirus test or vaccine appointments.”

The Solarwinds breach — What do CIOs need to do now?: A good summary of the implications of the breach for this major supplier of network security and management software.

About pharma

Agios offloads oncology unit to Servier in $1.8B deal, zeroes in on genetically defined diseases: “Agios Pharmaceuticals’ roots are in cancer drug development, but it’s passing that baton to Servier as it doubles down on its programs in genetically defined diseases, including a drug it’s developing for noncancerous blood diseases.”

Today's News and Commentary

About the public’s health

Some states say Pfizer vaccine allotments cut for next week: “In recent days, governors and health leaders in more than a dozen states have said the federal government has told them that next week’s shipment of the Pfizer-BioNTech vaccine will be less than originally projected.
[For example,] California, where an explosion in cases is straining intensive care units to the breaking point, will receive 160,000 fewer vaccine doses than state officials had anticipated next week — a roughly 40% reduction.”

Federal guidance enables employers to mandate workers get COVID-19 vaccine: “New guidance from the Equal Employment Opportunity Commission allows employers to require workers to get COVID-19 vaccinations, which has major implications for providers…
The guidance applies to all employers and details what procedures a company can take if a person has a health reason why they can’t get the vaccine or has closely held religious objections.
If a worker can’t get the vaccine due to a disability, then employers should conduct an individual assessment on whether the worker poses a direct threat to the health and safety of others in the workplace.”

Increase in Fatal Drug Overdoses Across the United States Driven by Synthetic Opioids Before and During the COVID-19 Pandemic: This CDC report is a reminder that the opioid crisis is still with us and getting worse.

About health insurance

CMS to allow managed care organizations to participate in direct contracting: “The model, announced Thursday by the Centers for Medicare & Medicaid Services (CMS), will allow Medicaid managed care organizations (MCOs) to participate in the global and professional options in the agency’s direct contracting model, which offers voluntary risk-sharing agreements with providers.”

The Coming Crisis For The Medicare Trust Fund: “The Congressional Budget Office (CBO) now projects that the trust fund will be exhausted in 2024, a little more than three years from now, which is the nearest the fund has come to exhaustion in the 55 years of its existence.”

About pharma

REGN-COV2, a Neutralizing Antibody Cocktail, in Outpatients with Covid-19: “In this ongoing, double-blind, phase 1–3 trial involving nonhospitalized patients with Covid-19, we investigated two fully human, neutralizing monoclonal antibod- ies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein, used in a combined cocktail (REGN-COV2) to reduce the risk of the emer- gence of treatment-resistant mutant virus…
In this interim analysis, the REGN-COV2 antibody cocktail reduced viral load, with a greater effect in patients whose immune response had not yet been initi- ated or who had a high viral load at baseline. Safety outcomes were similar in the combined REGN-COV2 dose groups and the placebo group. (Funded by Regeneron Pharmaceuticals and the Biomedical and Advanced Research and Development Authority of the Department of Health and Human Services…)”

About hospitals and healthcare systems

Tenet to Sell Urgent Care Platform to FastMed: “Tenet Healthcare… and FastMed Urgent Care announced today that they have entered into a definitive agreement under which FastMed will purchase Tenet’s urgent care platform [all 87 facilities], which is operated under the CareSpot and MedPost brands and managed by Tenet’s United Surgical Partners International (USPI) subsidiary.” The divestiture is unusual as hospitals/systems have been expanding their urgent care outpatient facilities.

About healthcare IT

Philips puts down $2.8B for BioTelemetry and its wearable heart monitors: “BioTelemetry, alongside its artificial intelligence-based analytics and other services, helps remotely monitor and diagnose at least 1 million cardiac patients each year. It’s a business that brought in $439 million in sales in 2019, and one that Philips expects to grow by more than 20% in the next four years—especially as the COVID-19 pandemic continues to push patients away from clinics and hospitals and toward telehealth solutions.”