Gender-affirming care could be casualty of public health emergency's end | Wednesday, March 15, 2023
| | | | | | | Presented By HCA Healthcare | | | | Axios Vitals | | By Tina Reed · Mar 15, 2023 | | We're halfway through the week, Vitals readers. Today's newsletter is 812 words or a 3-minute read. Situational awareness: The Biden administration announced plans today to begin enforcing a provision of last year's Inflation Reduction Act that penalizes drug companies for raising prices on Medicare prescription drugs faster than inflation. - Starting April 1, Medicare recipients could see a drop in out-of-pocket costs for 27 drugs — including some used for cancer, rheumatoid arthritis and chronic kidney disease — by between $2 and $390, officials said.
| | | | | | 1 big thing: Unwinding of COVID emergency brings hurdles for gender-affirming care |  | | | Illustration: Allie Carl/Axios | | | | The end of the COVID-19 public health emergency could bring new barriers to trans men undergoing hormone therapy by eliminating telehealth prescribing of controlled substances including testosterone, Axios' Oriana Gonzalez writes. Why it matters: Requiring in-person visits to continue treatments could delay a patient's transition and reverse some of the changes their body underwent. The policy change doesn't affect estrogen, used in hormone therapy for trans women. Catch up fast: The PHE gave health providers the flexibility to prescribe certain drugs or chemicals considered to have a potential for abuse or becoming addictive without an in-person visit. - Testosterone has been grouped with synthetic hormones on the list since 1990, due to concerns around its misuse and reports about athletes using testosterone or steroids to enhance their performance.
State of play: The Drug Enforcement Agency and the HHS last month announced a proposed rule to loosen some of the in-person prescription requirements once the health emergency ends, in May. - Providers could make an initial 30-day prescription through telemedicine, but would then require an in-person visit.
Between the lines: That isn't enough for some lawmakers in Congress who are pressing the Biden administration to make the pandemic-era prescribing flexibilities permanent. The other side: Lawmakers in conservative-led states have considered or passed bans on gender-affirming care that address telemedicine. - Tennessee's recently enacted ban on gender-affirming care for trans minors specifically says that medical procedures administered via telehealth are prohibited.
- In Florida, lawmakers are considering a bill that would prohibit gender-affirming care via telemedicine by requiring that providers be "physically present" to provide treatment to an adult.
What's next: The DEA is accepting public comments on the rule through the end of March. Related: California law linked to more gender-affirming surgeries |     | | | | | | 2. Paxlovid not linked with COVID rebound, FDA says |  | | | Illustration: Shoshana Gordon/Axios | | | | Paxlovid isn't associated with COVID rebound, in which patients test positive or have symptoms days after a course of the drug is completed, Food and Drug Administration staff said in briefing documents released Tuesday, Axios' Sabrina Moreno writes. Why it matters: This is the first time the FDA has publicly discussed if the phenomenon is actually due to the antiviral — a question that's swirled around its use since Pfizer's drug was granted emergency use authorization in December 2021. The big picture: The documents were prepared ahead of a Thursday meeting of FDA advisers, who will vote on whether to give the pill full approval for patients at high risk of hospitalization or death. - FDA staff said that Pfizer's clinical trials support the notion that Paxlovid's benefits outweigh its risks.
| | | | | | | | 3. Hospital tax exemptions outpace charity |  | | | Illustration: Eniola Odetunde/Axios | | | | Nonprofit hospitals reaped almost $28 billion in tax exemptions from federal, state and local sources in 2020 while providing about $16 billion in charity care, according to a new Kaiser Family Foundation brief, Axios' Arielle Dreher writes. Why it matters: Federal law requires nonprofits to offer charity care in exchange for their tax-exempt status. But the sector has drawn fire for offering less uncompensated care relative to earnings, as well as for aggressive bill collection practices. By the numbers: The nearly $28 billion tax exemption is equivalent to about 43% of net income generated by nonprofit hospitals in 2020, per KFF. That year, facilities also collected $31.9 billion in federal disproportionate share payments, which are intended to partially offset the costs of charity care for low-income patients. - The value of tax exemptions for nonprofit hospitals has grown 41% from 2011 to 2020, the KFF brief found.
Yes, but: Some hospitals expanded their charity care policies during the pandemic to accommodate more patients, but vague criteria made it difficult to assess the practical effects. Share this story. | | | | | | | | A message from HCA Healthcare | | Shaping the future of medicine | | |  | | | | With Graduate Medical Education (GME) programs across the country, HCA Healthcare is preparing residents to be healthcare leaders. How it's done: Residents work alongside and learn from our experienced physicians as they improve access to high-quality healthcare. Read more of our stories. | | | | | | 4. Data du jour: Primary problems |  Data: FAIR Health; Note: Washington, D.C., and Hawaii's datasets were too small for analysis; Map: Thomas Oide/Axios Approximately 30% of all patients who received medical services between 2016 and 2022 did not see a primary care physician, a FAIR Health analysis provided first to Axios shows. Why it matters: Primary care providers are supposed to manage patients' day-to-day health needs and provide preventative care, and evidence shows it can drive down costs and improve outcomes, but many people are clearly getting their care elsewhere. The big picture: The report points to the geographic distribution of primary care providers around the country, which could be a factor in patients' accessing their care. - "Increasing the density of primary care providers in an area improves the detection and diagnosis of disease and reduces health disparities, the report's authors say, pointing to a study that correlated a higher density of providers compared to patients with increased life expectancy.
| | | | | | | | 5. Catch up quick | | 🔻 Novo Nordisk plans to slash insulin prices by up to 75%. (Wall Street Journal) 💪 Google flexes its health care AI muscle. (Axios) 💧 EPA moves to limit "forever chemicals" in drinking water. (Axi0s) 👉 A multi-state opioid settlement last year is now hindering patients' access to a wide array of drugs. (New York Times) 👀 A urologist wants to make his penis-enlargement implant as common as breast implants, but some men who've gotten it say it's left them deformed. (Insider) | | | | | | | | A message from HCA Healthcare | | What advancing health equity looks like | | |  | | | | HCA Healthcare provides high-quality care for every patient we serve. An example: Strategic collaborations, like the American Heart Association's "Getting to the Heart of Stroke" three-year initiative, enable us to improve health equity and access to care. See our impact. | | | | Have a news tip? Just reply to this email. Did someone forward this email? Subscribe here. Thanks for reading, and thanks to senior health care editor Adriel Bettelheim and senior copy editor Bryan McBournie for the edits. |  | | Dive deeper into the future of health care | | | | | | Axios thanks our partners for supporting our newsletters.
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