Medicare will cap patients’ spending on drugs — but not hospital or doctor bills

The good news for people on Medicare: By 2025, they’ll pay no more than $2,000 a year for their drugs. But the news isn’t so good for the 35 million people enrolled in traditional Medicare covering hospital, outpatient, home health, and nursing home care. They’re still exposed to potentially unlimited costs if they become seriously ill and don’t have supplemental coverage. “Many people don’t know that traditional Medicare does not have a cap on catastrophic out-of-pocket expenses, because most insurance does,” Cristina Boccuti of the research firm West Health, told STAT’s Bob Herman.

Medicare’s annual enrollment ends Dec. 7. At least 1 in 5 people who choose Medicare Advantage — the alternative operated by health insurance companies — say they choose it because of its out-of-pocket limits, according to a new Commonwealth Fund survey. But Medicare policy experts say there’s momentum to establish a cap for all services. Read more.

Your job can be hazardous to your health, surgeon general’s report says

All that quiet quitting amid the Great Resignation signals a deeper disconnect between the U.S. workplace and Americans’ mental health and well-being, a new report from the U.S. Surgeon General says, citing endless hours, unpaid leave, and chronic stress. While the surgeon general’s office has typically promoted solutions to more traditional public health problems such as the opioid epidemic or low rates of Covid vaccination, this effort draws attention to less clinical contributors to ill health, from racism to bullying to powerlessness at work.

Employers will need to change the way they operate, the report says, starting with protecting employees from physical and psychological harms and paying a living wage. “As we recover from the worst of the pandemic, we have an opportunity and the power to make workplaces engines for mental health and well-being,” Surgeon General Vivek Murthy said in a statement. I have more here.

Vast majority of adolescents who start gender-affirming care continue as adults, study says

Some U.S. state legislatures are weighing whether to make gender-affirming care a crime, focusing on banning it for children under 18. A new study from the Netherlands, which in 1998 became the first country to offer a protocol for young people with gender dysphoria, sheds light on what happens after they start taking hormones. The vast majority (704 out of 720, or 98%) of adolescents who used puberty-suppressing treatment before 18 and then gender-affirming hormones have continued taking the hormones as adults, the researchers found.

Gender dysphoria — discomfort at the gap between gender identity and sex assigned at birth — prompts the treatments, and the study counters critics' claims that many people who undergo the treatments as teens later regret doing so. The authors believe this study is the first to examine not just taking gender-affirming hormones, for which other research has shown 74.4% of people continue, but also puberty suppression. “Our findings could help guide the public and legal debate,” they write in Lancet Child and Adolescent Health.

Closer look: To improve clinical trials, support family caregivers, experts say

(BEN MARGOT/AP)

America’s 53 million family caregivers play a vital role in an under-resourced health care workforce, geriatrician Sharon Inouye of Harvard and Jason Resendez of the National Alliance for Caregiving write in a STAT First Opinion. But there’s more they could do if the clinical trial enterprise engaged them in recruiting and supporting people for research studies who are older, disabled, or have Alzheimer’s disease, cancer, or other chronic medical conditions. “Engaged and committed caregivers can be key not only to getting people into clinical trials but to keeping them in trials for all the follow-up visits, interviews, and procedures, which typically can last for several years,” they write.

That means treating caregivers as partners, they say, “making efforts to incorporate patient and caregiver perspectives into the earliest phases of research, including the development of research questions, study protocol designs, and data collection strategies.” Read more on how that might work.

Stem cell studies offer clues about PTSD

Some people exposed to traumatic events develop PTSD afterward, but some don’t. Researchers studying environmental as well as genetic factors now have a new tool to figure out why a minority of trauma survivors continue to suffer. Researchers writing in Nature Neuroscience report success in deriving neurons from human induced pluripotent stem cells created from combat veterans’ skin biopsies, which they compared in lab dishes to similarly obtained neurons from people without trauma exposure.

They found that neurons from veterans with PTSD were hypersensitive to hydrocortisone, a synthetic version of the stress hormone cortisol that is key in the “fight-or-flight” response. From there, the scientists identified the specific gene networks that respond differently after exposure to the stress hormone. The researchers hope their work might allow “drug screening in a dish” to find therapies for the syndrome.

CDC report urges bivalent boosters for people with weakened immunity

People whose immunity is compromised by certain diseases or treatments for them — cancer, organ or stem cell transplants, auto-immune diseases — have gained much less protection against Covid-19 from vaccination than the rest of the world. A new CDC study documents how vaccines and boosters held up from December 2021 through August 20, in their ability to prevent hospital stays. Among immunocompromised people who got the recommended three primary doses of an mRNA vaccine, protection rose from 36% after two doses to 67% after three doses during the Omicron BA.1’s predominance. With later variants circulating, protection dipped to 32%, but rose again to 43% after a fourth booster dose.

Protection may have waned over time, the researchers say, and new bivalent boosters targeting BA.4 and BA.5 variants might be helpful. They also recommend treatment with antivirals or prophylactic Evusheld — with the caveat that recent research shows its effectiveness against Omicron sublineages might be reduced. And masks.

What we're reading

An autistic teen needed mental health help. He spent weeks in an ER instead, Washington Post
Covid-19 vaccines should be among regular immunizations, CDC advisers say, Wall Street Journal
How one pharma insider sees the drug pricing reform law: the impact will 'vary by product and by company,' STAT
Seeking to protect groundwater, N.H. looks to regulate PFAS contamination in soil, New Hampshire Public Radio
Novartis agrees to license a best-selling cancer drug to dozens of low- and middle-income countries, STAT