Morning Consult Health: UnitedHealthcare to Cut Back on Use of Prior Authorization Process
 

Health

Essential health care industry news & intel to start your day.
March 29, 2023
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Today’s Top News

  • UnitedHealth Group Inc.’s UnitedHealthcare, the nation’s largest health insurer, is expected to announce plans today to reduce the number of prior authorization requirements for a list of medical procedures and devices. Prior authorization paperwork is a common complaint of doctors and patients, and other top insurers like Cigna Group and CVS Health Corp.’s Aetna are also considering ways to reduce or simplify the process. (The Wall Street Journal)
  • In a letter to Health and Human Services Secretary Xavier Becerra and Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure, Sen. Elizabeth Warren (D-Mass) criticized health insurers that manage Medicare Advantage plans for raising beneficiaries’ health costs and urged the Biden administration to limit payments to the companies. Warren’s letter, which states that private insurers have a “long history of exploiting the government out of billions of dollars,” is the latest shot from Congress regarding the MA program and follows proposed payment rate cuts that the industry has criticized. (Bloomberg)
  • The Food and Drug Administration scheduled a May advisory meeting to discuss if HRA Pharma’s birth control pill Opill should be available over the counter, an approval that would be the first of its kind from the agency. FDA advisers originally planned to review the drug in November of last year, but the date was pushed back to review additional information. (NBC News)
  • The Biden administration warned Congress that the stockpile of medicines for protecting against public health threats is underfunded by approximately $35 billion, leaving the country vulnerable to potential future emergencies. HHS estimates that the United States will need $64 billion over the next five years to adequately prepare for threats like COVID-19 and nuclear attacks, meaning that funding levels set by Congress last year underfund the National Institutes of Health, Administration for Strategic Preparedness and Response and FDA by billions of dollars. (CBS News)

Worth watching today:

  • Two House meetings:
    • House Appropriations Committee hearing: “Fiscal Year 2024 Request for the Food and Drug Administration.” FDA Commissioner Robert Califf is scheduled to testify.
    • House Natural Resources Committee’s Indian and Insular Affairs Subcommittee hearing: “Challenges and Opportunities for Improving Healthcare Delivery in Tribal Communities.”
  • Senate Finance Committee’s Health Care Subcommittee hearing: “An Oral Health Crisis: Identifying and Addressing Health Disparities.”
  • Axios event: “What’s Next Summit.” Speakers include CVS Chief Executive Karen Lynch and Arati Prabhakar, director of the White House Office for Science and Technology Policy.
  • The Hill’s “Disability Summit,” featuring Reps. Mike Bost (R-Ill.) and Debbie Dingell (D-Mich.) and Day Al-Mohamed, director of the White House Domestic Policy Council Disability Policy.
  • AHIP’s 2023 AHIP/OPM FEHB Carrier Virtual Conference begins, featuring a keynote session with Rachel Levine, assistant secretary of health for HHS.
 

Chart Review

 
 

What Else You Need to Know

Coronavirus
 

WHO revises COVID-19 vaccine recommendations for Omicron-era

Reuters

The World Health Organization has tailored its COVID-19 vaccination recommendations for a new phase of the pandemic, suggesting that healthy children and adolescents may not necessarily need a shot but older, high-risk groups should get a booster between 6 to 12 months after their last vaccine.

 

Millions poised to lose Medicaid as pandemic coverage protections end

Amy Goldstein, The Washington Post

States will begin this week to sever an anticipated 15 million low-income Americans from Medicaid rolls that ballooned during the pandemic.

 

Lawmakers debate who to blame for COVID school closures: Teachers unions or Trump?

Lexi Lonas, The Hill

House members spent a Tuesday hearing debating who to blame for school closures amid the COVID-19 pandemic, with Republicans deriding the influence of teacher’s unions and Democrats blasting the Trump administration.

 
General
 

Republicans press Becerra on gender-affirming care, reproductive rights

Sarah Owermohle, Stat News

GOP members of the House Appropriations Committee repeatedly interrogated Health and Human Services Secretary Xavier Becerra about issues like gender-affirming care, reproductive rights, and migrant children at the border, continuing a theme laid out by two Senate committees last week as Becerra embarks on a committee tour to sell President Biden’s proposed 2024 budget.

 

Dem AGs clash with Biden admin over abortion pill restrictions

Alice Miranda Ollstein, Politico

The Biden administration is fighting a Democratic-led effort to make abortion pills more accessible even as it simultaneously opposes a GOP-led effort to ban the drugs nationwide.

 

WHO to consider adding obesity drugs to ‘essential’ medicines list

Jennifer Rigby, Reuters

Drugs that combat obesity could for the first time be included on the World Health Organization’s “essential medicines list,” used to guide government purchasing decisions in low- and middle-income countries, the U.N. agency told Reuters. A panel of advisers to the WHO will review new requests for drugs to be included next month, with an updated essential medicines list due in September.

 

A new flu is spilling over from cows to people in the U.S. How worried should we be?

Michaeleen Doucleff, NPR News

Pigs and goats likely catch it too. It’s been found in humans’ noses in the southwest— and in the air at airports and at chicken farms in Malaysia.

 

The Incredible Challenge of Counting Every Global Birth and Death

Jeneen Interlandi, The New York Times Magazine

In rural Colombia, as in many parts of the world, tallying births and deaths is one of the most desperately needed public-health measures. It’s a lot harder than it sounds.

 

Over-the-Counter Narcan Could Save More Lives. But Price and Stigma Are Obstacles.

Jan Hoffman, The New York Times

The Food and Drug Administration is expected this week to allow the overdose-reversal medication to be sold without a prescription, a step toward making it a common emergency tool.

 

Government to step up efforts to monitor health of East Palestine residents, first responders

Brenda Goodman, CNN

Almost two months after a train carrying hazardous materials derailed in the town of East Palestine, Ohio, the state Department of Health is preparing to offer blood and urine testing and physical exams to first responders who rushed to fight the blaze. The testing is set to start within the next two weeks and will be the first step in a long-term effort to monitor the health of responders to the accident, according to an email obtained by CNN.

 

The simple intervention that may keep Black moms healthier

Priyanka Dayal McCluskey, WBUR

Studies show that Black people are more than twice as likely as white people to experience severe pregnancy-related complications, and nearly three times as likely to have a pregnancy-related death. The U.S. has the worst maternal mortality rate of high-income countries in the world — and the numbers are climbing. New federal data shows maternal deaths spiked 40% in 2021.

 

GOP lawmakers expand gender-affirming care restrictions to adults

Oriana González, Axios

Legislators in Kansas, Oklahoma, South Carolina and Texas have introduced bills barring health providers from offering care such as hormone treatments or surgery to people as old as 26.

 

Abortion ‘Chaos State’ Erupts as Dueling Attorneys General Clash

Allie Reed, Bloomberg Law

Top law enforcement officers in red and blue states are leaning on never-before-tested legal strategies to probe the boundaries of reproductive restrictions nationwide since the Supreme Court overturned the constitutional right to an abortion.

 

New Maryland provider opening in post-Roe ‘abortion desert’

Leah Willingham, The Associated Press

The Women’s Health Center of Maryland in Cumberland, roughly 5 miles (8 kilometers) from West Virginia, will open its doors in June — a year after the U.S. Supreme Court overturned federal abortion protections — to provide abortions to patients across central Appalachia, a region clinic operators say is an “abortion desert.”

 

The Horrifying Epidemic of Teen-Age Fentanyl Deaths in a Texas County

Rachel Monroe, The New Yorker

Students have overdosed during class, in bathrooms, and in an elementary-school parking lot.

 
Payers
 

Current and former CMMI chiefs reflect on past, future of agency

Paige Minemyer, Fierce Healthcare

The ViVE Conference this week convened three past and present leaders at CMMI to discuss the agency’s history and how it’s poised for the future. Current CMMI Director Liz Fowler, Ph.D., was joined by her predecessors Brad Smith, the founder of Russell Street Ventures, and Adam Boehler, the founder of Rubicon Founders.

 

End Delay of Drug Price Transparency Rule, Employer Group Urges

Sara Hansard, Bloomberg Law

An employer group wants the Biden administration to move ahead with requirements making detailed drug price information public as momentum grows behind the issue. A public policy think tank is also suing to hurry the process, while a House panel is holding a hearing Tuesday on making prices easier to find and track.

 

Hospitals Would See Medicaid Funds Slashed If Hill Fails to Act

Ganny Belloni, Bloomberg Law

Over $8 billion in federal funding for safety net hospitals will be cut starting Oct. 1 unless Congress postpones or delays the latest reduction in Medicaid Disproportionate Share Hospital payments.

 

Texas declares Friday Health Plans insolvent, seizes assets

Nona Tepper, Modern Healthcare

The Lone Star State’s insurance commissioner has seized the Friday Health Plans’ assets and is charged with liquidating its local property, technology, bank accounts and other valuables to pay outstanding claims, according to a liquidation order issued Thursday.

 
Providers
 

Hospital groups aim to blunt effort to reverse ACA ban on physician-owned hospitals

Robert King, Fierce Healthcare

The analysis released Tuesday by the American Hospital Association and Federation of American Hospitals is part of a general effort by the groups to keep in place a ban on physician-owned hospitals passed alongside the Affordable Care Act back in 2010. But critics say the hospital industry wants to stifle competition as the industry becomes more consolidated.

 

Hospitals Are Increasingly Crowded With Kids Who Tried to Harm Themselves, Study Finds

Ellen Barry, The New York Times

Hospitalizations for pediatric suicidal behavior increased by 163 percent over an 11-year period, an analysis of millions of hospital admissions in the United States found.

 

Hospitals feel congressional heat over compliance with price transparency rule

Robert King, Fierce Healthcare

Several members of the House Energy & Commerce Committee’s health subcommittee asked experts on Tuesday on how to get more hospitals in line with the rule that requires them to share pricing data on certain shoppable services. Lawmakers found a hodgepodge of responses to the law, which requires hospitals to put data online in an easy-to-understand format so consumers can price shop.

 

Progress Check on Hospital Price Transparency

Michelle Andrews, Kaiser Health News

Hospitals are facing mixed reviews regarding their efforts to comply with a federal requirement that they post information about prices related to nearly every health care service they provide.

 

Nurses Make House Calls to Treat ‘Tranq’ Wounds for Users at Society’s Edge

Alyssa Schukar and Julie Wernau, The Wall Street Journal

The Drug Enforcement Administration said about a quarter of seized fentanyl powder last year contained xylazine. Once largely contained to the Philadelphia region and Puerto Rico, xylazine has been found in illicit drugs in 48 states.

 

With travel nurses making $150 an hour, hospital systems are forced to innovate

Bertha Coombs, CNBC

As hospitals have turned to travel nurses to ease staffing shortages during the pandemic, contract labor expenses have risen more than 250% over the past three years. The national average pay for travel nurses was $150 an hour in early 2022, which analysts say tempted more nurses to leave staff jobs, increasing turnover and exacerbating shortages.

 

‘We’ve had to be creative’: How a major health system eased its labor shortage

Katie Clarey, HR Dive

By the summer of 2021, turnover had reached 30%. The organization implemented new staffing models, tweaked upskilling efforts and invested in greater staff support, and turnover is now down by half.

 
Pharma, Biotech and Devices
 

Pressure is building on pharma and biotech companies to take climate action

Betsy Ladyzhets, Stat News

Globally, large public biotech and pharmaceutical companies are responsible for more than 200 million metric tons of carbon dioxide and equivalent emissions, according to estimates from one 2022 report. The bulk of those emissions are tied to companies’ products and supply chains, which can be hard to measure.

 

House committee chair requests info from FDA on funding for trials involving ‘viral manipulation’

Paul Schloesser, Endpoints News

Republican members of Congress want FDA Commissioner Robert Califf and his agency to provide more information on the research FDA has funded that manipulates certain viruses like the SARS-CoV-2 virus — after the FDA confirmed that certain studies it funded involved viral manipulation, but in standard ways that are common in molecular biology.

 

Regeneron bets on ‘Treg’ cell therapy with Sonoma deal

Ben Fidler, BioPharma Dive

Regeneron is paying Sonoma $75 million upfront, $30 million of which is in the form of an equity investment, and could broaden the deal to include a fifth indication. Sonoma, meanwhile, is keeping rights to its other programs, including a rheumatoid arthritis treatment in preclinical testing.

 

Shortage of monkeys for early-stage research jeopardizes timelines for developing some drugs

Ed Silverman and Damian Garde, Stat News

In recent weeks, the U.S Fish & Wildlife Service began denying company requests to import long-tailed macaques from Cambodia in the wake of a federal investigation into a smuggling ring. Meanwhile, the cost of these monkeys, when they can be obtained, has jumped to more than $25,000 each, compared with $10,000 or less three years ago.

 

Viking joins obesity drug development race with early study data

Jonathan Gardner, BioPharma Dive

An injection being developed by biotechnology company Viking Therapeutics for obesity helped adults enrolled in a small clinical trial lose up to 8% of their body weight, the company said Tuesday. If successful, the shot could compete with drugs from Novo Nordisk, Eli Lilly and others.

 
Health Technology
 

Medical device companies now need to prove to FDA they’re protected against cyber attacks

Lizzy Lawrence, Stat News

The law, which goes into effect Wednesday, explicitly states that companies cannot sell their connected medical devices without first showing the Food and Drug Administration a solid cybersecurity plan. It also gives the FDA $5 million to see a higher security standard through.

 

Examining ChatGPT’s earliest foray into healthcare

Brock E.W. Turner, Digital Health Business and Technology

There is a lot of hype around AI in healthcare and a rush of digital health companies seeking to cash in. But experts are unsure how generative AI applications like ChatGPT and GPT-4 will influence clinical diagnosis and decision making. Most say the first wave of adoption will take place in areas where there are administrative redundancies.

 
Morning Consult