COVID-19 Cost-Sharing Quickly Becoming Reality for Consumers

August 24, 2021 - FDA’s full approval of the Pfizer-BioNTech vaccine will have implications for mandates alongside the financial motivation coming from more payers regarding cost-sharing for COVID-19 treatments and hospitalizations.

FDA Gives Full Approval to Pfizer-BioNTech COVID-19 Vaccine

FDA has granted full approval to Pfizer and BioNTech’s COVID-19 vaccine for individuals 16 years of age and older. The vaccine, previously known as the Pfizer-BioNTech COVID-19 Vaccine, will now be marketed as Comirnaty. Comirnaty is the first COVID-19 vaccine to be fully FDA approved.

“As the first FDA-approved COVID-19 vaccine, the public can be very confident that this vaccine meets the high standards for safety, effectiveness, and manufacturing quality the FDA requires of an approved product,” Acting FDA Commissioner Janet Woodcock, MD, said in the announcement.

In December 2020, FDA issued the first emergency use authorization for a COVID-19 vaccine to Pfizer and BioNTech, allowing for distribution across the country. The vaccine continues to be available under the emergency use authorization, including for individuals 12 through 15 years of age and for the administration of a third dose in certain immunocompromised individuals. READ MORE

Private Payers No Longer Waiving COVID-19 Cost-Sharing

Now that vaccines are readily available to all American adults, private payers have stopped waiving cost-sharing for COVID-19 hospitalizations, according to a Peterson-Kaiser Family Foundation Health System Tracker brief.

Experts analyzed the two largest private payers in each state and Washington DC and found that 72 percent of those largest payers have ended cost-sharing waivers for COVID-19 treatment. Nearly half of the 102 payers included in the analysis had stopped covering out-of-pocket treatment costs by April 2021, when most adults became eligible to receive the vaccine. More than 20 percent of the payers stated that they will phase out the waivers by the end of 2021, with ten percent ending the waivers by the end of October, the month in which the public health emergency is set to expire.

The results used data gathered between January and July 2021. More than one in three employers with 50 or more employees reported that their largest health plans waived cost-sharing for COVID-19 treatment. The larger the company, the higher the probability that it would cover out-of-pocket treatment costs. READ MORE

New Johns Hopkins EHR Tool Supports Telehealth Adoption

Researchers at Johns Hopkins Medicine have developed a new process to measure digital literacy integrated into the Baltimore-based health system’s Epic electronic health record to ensure that every patient in one of the health system’s many connected health programs is given access to help if they need it.

The researchers used surveys from patients and their families and interviews with clinical and front desk staff to determine how often someone needed help adapting to new technology. Working with colleagues in IT and ambulatory operations, the team came up with a “video visit technical risk score,” a color-coded rating system that would identify those in need of help. The score was based on factors such as familiarity with the health system’s online patient portal and past experiences with online services, even phone calls, all charted in the EHR.

While the pilot saw some success in helping patients understand the technology, it did create an easier method of identifying who might need help, and it helped health system staff improve their workflows for onboarding patients into a telehealth program. READ MORE

10% of Adults Delayed Care in Spring Due to COVID-19

One in ten nonelderly adults delayed care in spring 2021 due to COVID-19 concerns, according to a new report from the Robert Wood Johnson Foundation. Latinx and Black adults delayed care at higher rates than White adults, and low-income individuals and those with chronic conditions reported high rates of unmet healthcare needs.

Researchers analyzed results from the Urban Institute’s April 2021 Health Reform Monitoring Survey, which fielded responses from over 9,000 US adults. Adults ages 18 to 64 reported delaying at least one type of care in the past 30 days because of COVID-19 exposure concerns.

About 16.2 percent of Latinx adults and 13.3 percent of Black adults delayed care due to fear of virus exposure, compared to 8.7 percent of White adults. Additionally, 14.9 percent of adults with incomes below 250 percent of the federal poverty level were more likely to postpone care compared to higher-income individuals. READ MORE

Predictive Model Helps Reduce MRI False Positives

According to a study from the Radiological Society of North America, prediction models based on clinical characteristics and imaging findings could reduce the number of false positives in MRI breast cancer screenings.

Researchers used data from the Dense Tissue and Early Breast Neoplasm Screening (DENSE) trial, which evaluated the effectiveness of screening with mammography and MRI versus mammography alone in participants aged 50 to 75.

Of the 454 women with positive MRI results in a first supplemental round of screenings, 79 were diagnosed with breast cancer, indicating that 375 women had false-positive results. According to the researchers, the full prediction model could have prevented 45.5 percent false-positive recalls and 21.3 percent benign biopsies. READ MORE­­­