Sunday, August 11, 2019

Weekend update

The FEHBlog is in the San Francisco airport waiting for his flight back to DC.  He enjoyed the American Bar Association meeting and side trips to the Napa Valley and Yosemite (spectacular).

While in San Francisco, the FEHBlog realized that he had a bacterial infection. He located and visited a walk in clinic. It turned out that treating this particular infection was outside the walk in clinic's scope so he had to visit an urgent care center, which he did. The FEHBlog got the antibiotic prescription that he needed and filled the prescription at Walgreen's, The FEHBlog was surprised by the distinction between walk in and urgent care centers. It strikes the FEHBlog that these types of rather arcane distinctions (from the patient's perspective at least) could push patients to the emergency room. Perhaps the FEHBlog should have checked with insurer first.

Congress remains on state work periods until after Labor Day. Congressional staff comes back early to work in DC on FY 2020 appropriations and big legislation such as S. 1895, the bipartisan bill to lower healthcare costs.

As you know, in the fourth quarter of 2018, CVS Health acquired Aetna, and Cigna acquired Express Scripts, The FEHBlog thought that both PBM / health insurer mergers made sense from a improving health care quality perspective. Healthcare Dive reports that CVS Health and Cigna each reported strong 2nd quarter 2019 earnings earlier this month.

The Boston Globe's STAT reports
The Trump administration finalized late Wednesday [in a Medicare national coverage decision] long-sought rules for when Medicare will cover CAR-T treatments, the cutting-edge, often curative therapies that harness patients’ own immune cells against their cancer. 
Under the new policy, Medicare will pay for CAR-T therapies so long as they’re administered in health care facilities that follow the Food and Drug Administration’s special safety rules, known as risk evaluation and mitigation strategies, or REMS. Medicare will also pay for CAR-T even when it’s used to treat conditions that aren’t FDA-approved. The two CAR-T treatments on the market, Gilead’s Yescarta and Novartis’ Kymriah, are approved to treat non-Hodgkin lymphoma and acute lymphoblastic leukemia, respectively. The policy is likely a positive development for hospitals . . . .

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