A Biden administration proposal would prohibit health discrimination based on sexual orientation and gender identity; hepatitis cases in children may result from 2 viruses causing liver inflammation; Court of Appeals rules against Pfizer’s effort to directly pay copays for their heart failure medications.
Proposal Would Protect Health Coverage for Gay, Transgender Patients
The Biden administration has announced that it will enshrine antidiscrimination protections for people of all sexual orientations and gender identities in the Affordable Care Act (ACA), which would reverse a policy adopted by the HHS during the Trump administration. The original language of the ACA prohibited discrimination on the basis of race, color, national origin, sex, age, and disability. However, the definition of “sex” has changed in the successive presidencies, with the Obama administration defining it as including gender identity, the Trump administration removing that wording, and the Biden administration defining sex to be sexual orientation and gender identity.
Study Investigates Possible Viral Cause to Pediatric Hepatitis
Research on the origin of global hepatitis cases in children hypothesizes that the cases were an effect of a pair of viruses working to trigger liver inflammation in children with a certain genetic susceptibility. Adenovirus 41 had previously been scrutinized when it was found in two-thirds of cases in the United Kingdom and half of cases in the United States. However, a second virus, adeno-associated virus 2, was also found in high levels in 25 of the 26 children with a hepatitis diagnosis. This link may help explain the uptick in hepatitis cases among children, as the United Kingdom has seen 263 cases this year.
Pfizer Loses US Appeals Court Ruling
The 2nd US Circuit Court of Appeals unanimously rejected Pfizer’s appeal to an antikickback law, agreeing with a lower-court ruling that determined that Pfizer’s Direct Copay Assistance Program violated a ban on knowingly or willfully providing financial support to induce federally reimbursable drug purchases, even if not done with that intent. Pfizer claims this antikickback law prevents them from helping patients with heart failure, including individuals with low incomes, to afford medicine that can cost $225,000 per year. The government, however, said that a ruling in Pfizer’s favor would leave Medicare on the hook for the drug prices.
Navigating Sport-Related Neurospine Injuries, Surgery, and Managed Care
February 25th 2025On this episode of Managed Care Cast, we speak with Arthur L. Jenkins III, MD, FACS, CEO of Jenkins NeuroSpine, to explore the intersection of advanced surgical care for sport-related neurospine injuries and managed care systems.
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Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
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