10 July 2022 |

Outside the Huddle #134

By workweek

The Outside the Huddle section of the Healthcare Huddle newsletter contains quick-hit summaries of need-to-know news in the healthcare industry.

Physicians to See Reimbursement Cuts in CY2023

CMS proposed a decrease to the Medicare Physician Fee Schedule next year, which will significantly cut physician reimbursement. Yes, even with inflation, CMS plans to cut reimbursement. CMS cites the expiration of the Protecting Medicare and American Farmers From Sequester Cuts Act, which increased Physician Fee Schedule reimbursements by 3% in 2022.

Biden Signs Abortion Protection Executive Order

Biden signed an abortion protection executive order tackling the following:

  • Safeguard access to abortion medication and emergency contraception.
  • Protect patient privacy.
  • Bolster legal options for those seeking abortion access.

Fortunately, we’re already seeing tech companies taking the privacy of consumers into their own hands. For example, Google announced it would automatically delete location history when users visit abortion clinics point.

Child and Teen Firearm Mortality in the U.S. and Peer Countries

KFF analyzed U.S. child and teen firearm mortality compared to similar peer nations. Their findings won’t surprise you:

We find that the United States is alone among peer nations in the number of child firearm deaths. In no other similarly large or wealthy country are firearm deaths in the top 4 causes of mortality let alone the number 1 cause of death among children.

Dems Try Again on Drug Prices

Democrats released an updated version of their drug pricing plan, allowing the Center for Medicaid and Medicare services to negotiate drug prices. Efforts to pass such legislation have been challenging, given pharma’s prominent lobbying role. With the November elections nearing, Democrats are pushing to fulfill their promise to lower prices. I doubt anything will succeed, unfortunately. It will be left to states to figure out, just like California.

FDA to Review Another Biogen Alzheimer’s Drug

Biogen (along with Eisai) is taking another stab at an Azheimer’s drug called lecanemab. Recall, Biogen’s recently approved drug, Aduhelm, was a controversial flop. Will lecanemab have a more favorable outcome? The FDA will decide on giving the drug accelerated approval by early next year. However, given that the FDA has already approved Aduhelm, a similar drug to lecanemab, I would expect the FDA to approve the new drug.

Pfizer is the Winner of the Pandemic

Yet, while patients may recoil at the need for repeated injections — two boosters are now recommended for people 50 and older — the requirement is gold for investors.

Pfizer earned a record-breaking $81.3B in revenue last year, thanks to its stronghold on the Covid-19 vaccine market and antiviral therapies. With a seemingly forever-mutating virus, Pfizer will likely post solid revenue earnings for the foreseeable future.

ACA Marketplace Claims Denials

ACA Marketplace insurers denied around 20% of insurance claims in 2020. There was large variation in average denial rates, ranging from 1% to 80%. About 70% of denied claims were due to problems like administrative/paperwork errors, although the data isn’t too clear. Perhaps most surprising for me is insurers upheld 60% of their initial denials.