California Will Begin Setting Aside 10% Of COVID-19 Vaccine Doses For Teachers

California to reserve 10% of vaccine first doses for teachers | The  Sacramento Bee

Source: NPR, by Rob Stein

California is planning to start setting aside 10% of the COVID-19 vaccine the state receives each week to vaccinate teachers, day care workers and other school employees in the hopes of getting more students back in the classroom.

“It must be done, and it must be done much sooner than the current path we are on. And we believe this will advance that cause,” Gov. Gavin Newsom said Friday as he announced the plan at an Oakland vaccination site.

The plan will begin March 1 by setting aside about 75,000 vaccine doses from the state’s current weekly allotment, Newsom said.

The vaccine will be used to inoculate “the ecosystem that is required to reopen our schools for in-person instruction,” including teachers, day care workers and other public school employees, such as bus drivers and cafeteria workers, Newsom said.

Most of the state’s large school districts have been teaching students remotely for most of the school year.

But 35 of California’s counties are already prioritizing vaccinating teachers and other educators.

“We want to operationalize that as a standard for all 58 counties in the state,” Newsom said

The announcement came a day after Newsom said a plan by Democrats in the state legislature aimed at opening schools by April 15 was not aggressive enough.

“While the Legislature’s proposal represents a step in the right direction, it doesn’t go far enough or fast enough,” Newsom said in a statement. “I look forward to building on the growing momentum to get our schools open and continuing discussions with the legislature to get our kids back in school as safely and quickly as possible.”

The issue of vaccinating teachers has become one of the most contentious issues as the nation grapples with the pandemic.

The Centers for Disease Control and Prevention’s new guidelines for how schools can safely offer in-person learning recommends vaccinating school staff, but does not require it. That has drawn criticism from powerful teachers’ unions.

A representative of the California Teachers Association described the 10% allotment as “an important step to ensuring teachers and school staff have access to the vaccine before opening schools and worksites for in-person instruction,” according to the Los Angeles Times.

Newsom has come under fire for how he has handled the pandemic, especially for imposing strict lockdowns.

Newsom says the state can begin setting aside vaccine doses because the Biden administration has begun providing more reliable projections for how much vaccine the state receives each week.

California has been hit particularly hard by the pandemic. But the move comes as the number of people getting infected by the coronavirus has finally started falling in the state, along with the number of people hospitalized with COVID-19 and dying from the disease.

‘The Problem Is Tomorrow’s Variants’: Renowned Bay Area Epidemiologist Predicts Prolonged Pandemic

Image result for ‘The Problem Is Tomorrow’s Variants’: Renowned Bay Area Epidemiologist Predicts Prolonged Pandemic images

Source: San Francisco Chronicle, by Aidin Vaziri

It will take years, not months, to gain the upper hand in the coronavirus pandemic — and it will require thinking well beyond our borders, says Dr. Larry Brilliant.

The 76-year-old Bay Area epidemiologist, who has worked to eradicate smallpox, polio and co-founded the Seva Foundation in Berkeley to combat blindness, has a unique perspective on the subject.

For years, Brilliant warned of a pandemic on the scale of the one we are living through. He even served as the senior technical adviser on the 2011 motion picture “Contagion,” filmed partly at the San Francisco 49ers old stadium, Candlestick Park — during which time he presciently predicted that epidemiologists would become rock stars and stadiums would become mass vaccination sites.

As the CEO of Pandefense Advisory, Brilliant has assisted in the global response to the coronavirus crisis over the past year. He has a broader view of the pandemic than most public health leaders and scientists, having invested his life’s work in anticipation of this very moment.

He is encouraged by dropping case counts, the rapid development and rollout of innovative new vaccines, the new science-driven leadership in the White House. But Brilliant is not here to reassure anyone that this will all be over soon.

“I think there’s a lot of good happening,” he said, speaking to The Chronicle by phone from his home in Mill Valley in a rare interview Friday. “I would prefer to think that things will get better, but the scientist in me worries we’re too perilously close to things going the other way.”

Brilliant, who moved to San Francisco in 1967 from his native Detroit, clearly remembers how he felt the moment he realized, in January 2020, that his predictions were about to come true. He was in a meeting with top epidemiologists and public health policy experts from around the world at the Flood Building in San Francisco when an alarming call came in. The Thai Health Ministry had identified a case of the novel coronavirus at one of its airports.

“Those of us who had been through MERS and SARS, we looked at each other and said, ‘This is going to really bad,’” Brilliant said. “We knew then that this was going to happen.”

As the first leader of Google’s philanthropy division, Brilliant is connected with tech leaders and public health officials worldwide. But in the former administration, he found his efforts stymied, and he was forced to watch from the sidelines as every opportunity to get the pandemic under control was ignored, dismissed and disparaged.

He feels renewed optimism with President Biden in charge, especially with a new federal COVID-19 response team that includes Andy Slavitt, the former acting chief of Medicare and Medicaid under the Obama administration; Vivek Murthy, the former U.S. surgeon general; and David Kessler, the former commissioner of the Food and Drug Administration.

“I think it’s going to be a very different attitude,” Brilliant said, praising Biden’s swift action in securing enough vaccine to deliver doses to every American by the end of the summer.

“We’ve got enough vaccine on order to vaccinate every man, woman and child in the United States,” he said. “We also have enough vaccine to help the rest of the world, which is important.”

He cautioned, however, that it will take a global effort to truly make an impact, especially to head off increasingly aggressive variants of the virus that could elude testing and vaccines.

Even if the United States gets most people vaccinated, it won’t be enough, he said: “Until everybody in the world is safe, no one is safe.”

The virus does not recognize borders, and variants such as those discovered in the U.K., Brazil and South Africa will continue to emerge until everyone is vaccinated, he predicted.

Brilliant, a longtime Grateful Dead doctor, laments that half the country still believes in an America First policy, and that kind of nationalism will create an “uphill battle” in the quest to wipe out the pandemic.

While he is confident that the vaccines in production now will be suitable to combat the variants in circulation, that picture could rapidly change.

“Today’s vaccines are good enough to stop today’s variants,” Brilliant said. “The problem is tomorrow’s variants. We’re just on the cusp.”

He thinks that the global picture of the pandemic is much more dire than the numbers show. There have been more than 100 million cases of COVID-19 reported since the start of the pandemic, according to data collected by Johns Hopkins University. Brilliant predicts the actual number of cases will top a billion, “without question.”

As government leaders rush to reopen the economy and schools while the pandemic continues to rage Brilliant urges caution.

“People are beginning to think, ‘Well, I can go hug my granddaughter,” he said, noting he rarely ventures out of the home he shares with his wife, Girija Brilliant. “The psychological letdowns people will have are going to be tremendous.”

He said the three surges we experienced last year may not have been surges at all but a portent of what is to come globally.

“There’s a nonzero probability that we’ll look back and all those three bumps will all together just be the first wave, and what’s coming next could be worse,” he said. “I think the future is really complicated.”

Brilliant, who said Thursday that he was set to receive his second vaccine dose with his wife on Valentine’s Day, said people should continue to follow public health protocols for now, including masking, physical distancing and staying home except for essential outings. He said not enough is known about the vaccines to be sure that even after people receive their shots, they will be unable to spread the virus.

“As a country, we’re still not vigilant enough,” he said. “When you meet the people who have long COVID, and a year after, they still wake up some night unable to breathe, they still have swollen toes, they still have difficulty focusing. … If I can use a technical medical definition, this is really a s—ty disease.”

California Aims To More Than Double Vaccination Rate In New Partnership With Blue Shield

Supplies of the Moderna vaccine are shown at a Fremont clinic. Vaccinations are inching up across the Bay Area.

Source: San Francisco Chronicle, by Erin Allday

California aims to vaccinate up to 3 million people a week by March 1 — more than double its current rate — under a distribution contract with Blue Shield that took effect Monday. The goal was set even as counties continued to face frustrating supply problems.

The partnership with Blue Shield is meant to repair what has so far been a bumpy, chaotic vaccination rollout in California, highlighted in the Bay Area this week by one major immunization site opening while two others closed because of vaccine shortages.

The Oakland Coliseum opens Tuesday morning as the largest vaccination site in Alameda County. The state began taking appointments for the clinic Sunday at — its online reservation platform. But across the bay, San Francisco public health officials said clinics at Moscone Center and City College of San Francisco would be shuttered for a week because the city had run out of vaccine. Similar closures have plagued vaccine sites in Southern California.

The auspicious opening and the disappointing closures are among the most obvious markers of the struggle to vaccinate people quickly and efficiently in California. Access to vaccine often has been fickle, and residents have expressed frustrated confusion over when and how they will be able to get their shots.

“It’s obviously confusing for people. It’s hard to tell what’s going on,” Dr. George Rutherford, an infectious disease expert with UCSF, said in an interview Monday. “But this is not about bad intentions. It’s not about anything but the vagaries of the supply system. All we can do is ask people to bear with us as the supply catches up with the demand.”

State officials have said that the collaboration with Blue Shield will streamline distribution, leaning on the expertise of one of California’s largest insurance providers. The 55-page contract states that Blue Shield cannot be paid more than $15 million for its participation, and it cannot profit off of its deal with the state. Details of the partnership were released Monday.

The state continues to be responsible for approving vaccine allocations to counties and certain large health care providers such as Kaiser Permanente, and determining how doses are divvied up. Blue Shield is tasked with developing a system for helping the state make those decisions and for managing distribution details.

Blue Shield’s distribution system must take into account not just how many people are served by counties and providers, but how quickly they are administering vaccines and how well they’re reaching disadvantaged communities.

The state and Blue Shield set a goal of building up capacity so California is able to vaccinate 3 million people a week by the end of this month and 4 million a week by the end of April. Whether they are able to administer that many shots depends on supply, which is not controlled by the state.

California currently vaccinates about 1.3 million people a week. The state had administered more than 6 million doses as of Monday, according to the state Department of Public Health.

Other goals relate to equal access to vaccinations. For 95% of the population, vaccines must be available within 30 minutes of travel time in urban areas and 60 minutes in rural areas, and there must be plans to vaccinate people who cannot leave their homes. The contract repeatedly references developing goals and metrics for getting vaccines to communities that have been most burdened by the coronavirus.

The Oakland Coliseum site, along with a similar operation at Cal State Los Angeles, are meant to resolve some of those equity issues. The Coliseum clinic is open to all Californians, not just residents of Alameda County, though they must meet current county vaccine eligibility to make an appointment. That group includes health care workers; anyone age 65 and older; and workers in education, emergency services, and food and agriculture industries.

Both sites will prioritize access for people who may have trouble getting vaccinated elsewhere, state and federal officials said. Equitable distribution of vaccines has been problematic. Latino and Black residents in particular are being vaccinated at much lower rates than white people, despite carrying a much heavier burden of illness.

“These sites have been set up to reach populations that generally have a harder time getting access to good medical care,” said Grady Joseph, assistant director of the Governor’s Office of Emergency Services, or Cal OES. “We are approaching both of these sites from a lens of equity. And making sure that individuals who historically have a tougher time accessing are at the front of the line.”

The Oakland Coliseum and Cal State Los Angeles sites were the first announced by the Biden administration this month as part of a plan to build 100 mass vaccination clinics across the country in the president’s first 100 days in office. The Oakland Coliseum site seeks to deliver 6,000 doses a day. Both sites are run by the Federal Emergency Management Agency and the state, through Cal OES.

Vaccine supplies for the Oakland site come directly from the federal government, not Alameda County’s allotment, and people do not have to be county residents to use the site. Other large vaccination clinics, including those in San Francisco that were temporarily shut down this week, rely on vaccine supply from county allotments, which have been notoriously inconsistent.

Mayor London Breed bemoaned the lack of vaccine supply on Twitter on Sunday, when she announced that the two San Francisco sites would be closed until at least the end of the week.

“I’m frustrated because we’ve shown that SF can administer shots as soon as they come in,” Breed wrote. “The only thing holding us back is a lack of supply, and I’m hoping that will change soon.”

Similarly, public health officials have had to pause vaccinations at several sites in Southern California, including Dodger Stadium last week. That site will reopen Tuesday, but only for people receiving their second doses, public health officials said. They said their ability to scale up the clinic is limited largely by vaccine supply.

“Our city has the tools, the infrastructure and the determination to vaccinate Angelenos swiftly and safely — we simply need more doses,” Los Angeles Mayor Eric Garcetti said in a statement Monday.

Rutherford said the supply issues are partly a holdover from the Trump administration, which overpromised how many doses would be made available to states. Vaccines arrived at about the promised levels for the first couple of weeks of the rollout in early December, then quickly fell short.

“Everybody is trying to do as good a job as we can, given all the circumstances,” Rutherford said.

California’s Smallest County Makes Big Vaccination Gains

Image result for California’s Smallest County Makes Big Vaccination Gains imagesSource: Kaiser Health News, by Hannah Norman

In the winter, the roughly three-hour drive from Alpine County’s main health clinic in Woodfords to the remote enclave of Bear Valley winds along snowy two-lane roads and over 8,000-foot mountain passes, circumventing the more direct route, which is closed for the season.

So to get a box of the frozen Moderna covid-19 vaccine to the ski resort hamlet of about 100 people, the clinic has enlisted the sheriff’s department.

“It’s unreasonable for our staff to drive there, give a bunch of vaccines and drive back, especially with weather where there will likely be chain controls,” said Dr. Richard Johnson, the county’s public health officer, explaining that drivers are often required to put chains on their tires for traction.

Alpine County, California’s least populated county, is home to just over 1,100 people, spread across communities nestled in the rugged Sierra Nevada mountain range and its foothills. The county, just south of Lake Tahoe on the Nevada state line, recorded only four new covid cases in the past two weeks.

In California’s major metropolises, like Los Angeles and the Bay Area, getting a covid vaccine means lining up behind tens of thousands of health care workers and nursing home residents who were prioritized for shots and are jockeying for a limited number of appointments.

But things are moving fast in Alpine County, which has no hospitals. It doesn’t even have a nursing home or other long-term care facility. Plus, a large portion of its population gets its vaccine supply from the national Indian Health Service. As of last week, the health department has administered just over 600 shots, finishing first doses for its entire health care staff and fire department, its EMTs and even its teachers.

State epidemiologist Dr. Erica Pan recently estimated it could take until June to vaccinate the roughly 6 million Californians age 65 and older.

But in Alpine County, Johnson hopes to finish the first round of shots for all older residents soon and continue second doses before moving on to more essential workers in education, child care, emergency services, food and agriculture. This includes many people who work in Alpine County but live elsewhere, like in South Lake Tahoe, noted Johnson.

“As a small county, we can do this sort of thing,” he said.

Rather than anti-vaccine and far-right protesters — like the ones who recently disrupted operations at the Dodger Stadium vaccine site in L.A. — snowstorms are the postponing factor here.

Composed of small tourist towns, ski resorts, national forests and Native American tribal land, Alpine County has a population density of about two people per square mile. According to the U.S. Census Bureau, 82.7% of its housing units are vacant at least part of the year — largely because many of them are second homes for winter skiers and summer hikers.

Across the nation, many rural health departments are crafting creative vaccine delivery strategies and finding success largely because they have a lot fewer people to vaccinate than urban areas.

Yet challenges persist in rural communities where residents remain wary of covid vaccines. More than one-third of rural Americans say they probably or definitely won’t get a covid vaccine, according to a recent KFF poll. (KHN is an editorially independent program of KFF.)

Vaccine hesitancy is an issue among the Washoe Tribe of Nevada and California, said Dr. Bela Toth, chief medical officer of the Washoe Tribal Health Center.

The Hung-A-Lel-Ti Community of the tribe is one-fourth of Alpine County’s population. Fewer than 300 people live on the community’s reservation, a remote 80 acres of high desert dotted by homes, a gymnasium and community and education centers. It’s one of five Washoe communities in the Lake Tahoe region; the rest are near Carson City and Gardnerville, Nevada.

The tribe receives its vaccines from the Indian Health Service, though uptake has been behind that of the rest of the county.

“We are a cross-border tribe, so there are always challenges,” Toth said.

The tribal health center, just over the Nevada line, hopes to vaccinate 100 to 200 people a week as eligibility expands, following its first successful drive-thru vaccination site last week, according to Toth. Before the drive-thru clinic, the health center had vaccinated just 123 people, mostly its health workers and some residents over age 75.

Alpine County has offered to help speed up the tribe’s vaccination pace, but Toth hopes to do it all in house, he said.

For the other residents of the county, Johnson, 74, keeps a tight logistical schedule, with appointments set every 15 minutes twice a week in Woodfords for residents of Markleeville, the county seat, and Kirkwood, home of a ski resort. All appointment requests ring into the “warm line,” and for 10 days at a time, Johnson is on phone duty. He answered more than 300 calls on his last shift, interviewing each person to determine eligibility.

A few dozen second-home owners from Kirkwood and Bear Valley have dialed in seeking vaccines, and it’s difficult to parse who spends months in the area and who rents their home out on Airbnb or Vrbo, Johnson said.

“I fully appreciate that the 75-year-olds who live in the Bay Area can’t get vaccines there, so we struggle with what’s our ethical obligation to them,” he added. “But if they’re coming back and forth from the Bay Area, they’re presenting a risk to our own staff by coming here and perhaps bringing something with them.”

Ultimately, Johnson decided to vaccinate eligible second-home owners who show electric bills or other proof of residence.

Two nurses and a crew of health care volunteers, many in their 70s, guide patients through the process of filling out paperwork, getting the shot and waiting 15 to 30 minutes while they’re monitored for allergic reactions.

“I feel so honored to be here,” said Kate Harvey, 73, a former nurse and longtime resident of Markleeville, who volunteered to greet patients at the clinic. As small-town charm demands, Harvey is also the wife of the previous public health officer, Dr. Richard Harvey, who was observing a just-vaccinated police officer in the next room.

Over the mountains in Bear Valley, a four-person team administers vaccines at the county’s second vaccination site, but only after the sheriff’s department makes the three-hour drive over mountain passes each week to drop off the frozen vials.

Last month, a storm dumped more than 6 feet of snow on the Sierra, making some roads impassable even for the most seasoned winter drivers.

Like many rural health providers, the county depends solely on Moderna’s vaccine, which is good for 30 days after it’s shipped and doesn’t require storage in an ultra-low-temperature freezer like the Pfizer-BioNTech alternative.

Managing the logistics wears on Johnson, as it does on many other health officials across the state. Every Tuesday night, he finds out from the state how many shots the county will be allocated for the week, never knowing what to expect more than a week ahead. So far, it’s been 100 or 200 doses a week.

But recent directives from the Biden administration have made him hopeful that more doses and advance notice are on the way.

“A vaccine in the freezer does no one any good,” Johnson said. “It must be in the arms of recipients as soon as possible.”

Pentagon Approves Over 1,000 Personnel to Help FEMA with COVID-19 Vaccines

Pentagon approves over 1,000 personnel to help FEMA with COVID-19 vaccines

Source: The Hill, by Ellen Mitchell

The Pentagon has authorized more than 1,000 active-duty service members to help the Federal Emergency Management Agency (FEMA) with its vaccination effort against COVID-19.

The 1,110 active-duty troops will be broken up into teams of 222 people to support five state vaccination sites, according to a Defense Department fact sheet released Friday.

White House coronavirus response coordinator Jeff Zients called the effort a “critical part of our all of government response.”

An initial group of 222 will be deployed to a site in California in the coming days, top Pentagon spokesperson John Kirby told reporters later on Friday.

“We expect that they’ll be able to get on site on or about the 15th of this month,” Kirby said, referring questions to FEMA as to the exact location.

The announcement comes after FEMA late last month asked the Pentagon to assist with President Biden’s goal to vaccinate 100 million people against the coronavirus in his first 100 days in office.

Among the possible solutions is sending up to 10,000 active-duty and National Guard forces to 100 vaccination sites across the country, though such a request is “still to be determined,” according to the Defense Department.

The teams approved thus far will be made up of personnel from across the military services, and include 80 vaccinators, 15 registered nurses, 57 clinical staff, 15 command and control and 55 general purpose, the fact sheet notes.

The Pentagon is still working with FEMA to determine what sites the other four teams will go to and in what order, Kirby said.

4 Vital Health Issues — Not Tied to Covid — That Congress Addressed in Massive Spending Bill

4 Vital Health Issues — Not Tied to Covid — That Congress Addressed in Massive  Spending Bill | Kaiser Health News

Source: Kaiser Health News, by Emmarie Huetteman

Late last month, before President Joe Biden took office and proposed his pandemic relief plan, Congress passed a nearly 5,600-page legislative package that provided some pandemic relief along with its more general allocations to fund the government in 2021.

While the $900 billion that lawmakers included for urgent pandemic relief got most of the attention, some even bigger changes for health care were buried in the other parts of that huge legislative package.

The bundle included a ban on surprise medical bills, for example — a problem that key lawmakers had been wrestling with for two years. Starting in 2022, because of the new law, patients generally will not pay more for out-of-network care in emergencies and at otherwise in-network facilities.

But surprise bills weren’t the only health care issue Congress addressed as it ended a tumultuous year. Lawmakers also answered pleas from strained health facilities in rural areas, agreed to cover the cost of training more new doctors, sought to strengthen efforts to equalize mental health coverage with that of physical medicine and instructed the federal government to collect data that could be used to rein in high medical bills.

Here are some details about those big changes Congress made in December.

Rural Hospitals Get a Boost

Throwing a lifeline to struggling rural health systems — and, it appears, a bone to an outgoing congressional committee chairman — lawmakers gave rural hospitals a way to get paid by Medicare for their services regardless of whether they have patients in beds.

The law creates a new category of provider, known as a “rural emergency hospital.” Starting in 2023, some hospitals will qualify for this designation by maintaining full-time emergency departments, among other criteria, without being required to provide in-patient care. The Department of Health and Human Services will determine how the program is implemented and which services are eligible.

Medicare, the federal insurance program that covers more than 61 million Americans 65 and older or with certain disabilities, currently does not reimburse hospitals for emergency or hospital outpatient services unless the hospital also offers in-patient care.

That requirement has exacerbated financial problems for rural hospitals, many of which balance serving communities with fewer patients — and less need for full in-patient services — with the need for emergency and outpatient services. One study last year found 120 rural hospital facilities had closed in the past 10 years, with more at risk.

Hospital groups have praised the change, which was introduced by Sen. Chuck Grassley (R-Iowa), who has championed rural health issues and ended his term as chairman of the Senate Finance Committee this month. “I worked to ensure rural America would not go overlooked,” he said in a statement.

Medicare Invests in More Doctors

Hoping to address a national shortage of doctors that has reached critical levels during the pandemic, Congress created an additional 1,000 residency positions over the next five years.

Medicare will fund the positions, which involve supervised training to medical school graduates going into specialties like emergency medicine and are distributed among hospitals most in need of personnel, including rural hospitals.

Critics like The Wall Street Journal’s editorial board have noted this is Congress’ attempt to fix a problem it created in the late 1990s, when lawmakers capped the number of Medicare-funded residency positions in the United States, fearing too many doctors would inflate the cost of Medicare.

While Medicare is not the only source of educational funding and hospitals may add their own residency slots as needed, Medicare generally will reimburse hospitals for the number of residents they had at the end of 1996. Among other consequences of that 1996 cap, most Medicare-funded residencies are clumped at Northeastern hospitals, a 2014 study showed.

In contrast to the 1,000 positions created as part of the stimulus package, one bipartisan proposal in 2019 that was never enacted would have added up to 15,000 positions over five years.

Strengthening Mental Health Parity

The legislative package strengthens protections for mental health coverage, requiring federal officials to study the limitations insurance companies place on coverage for mental health and substance use disorder treatments.

In 1996 Congress passed the first law barring health insurers from passing along more of the cost for mental health care to patients than they would for medical or surgical care. The Affordable Care Act, building on earlier laws, made mental health and substance use disorder treatments an “essential health benefit” — in other words, it required most health insurance plans to cover mental health care.

But enforcing that standard has been a challenge, in part because violations can be hard to spot and the system has often relied on patients to notice — and report — them.

In December, lawmakers approved a measure requiring insurers to analyze their coverage and provide their findings to state and federal officials upon request.

They also instructed federal officials to request the findings from at least 20 plans per year that may have violated mental health parity laws and tell insurers how to correct any problems they find — under penalty of having insurer violations reported to their customers if they do not comply.

The law requires federal officials to publish an annual report summarizing the analyses they collect.

More Transparency in Cost and Quality

Americans often do not know how much they will be expected to pay when they enter a doctor’s office, an ambulance or an emergency room.

Taking another modest step toward transparency, Congress banned so-called gag clauses in contracts between health insurers and providers.

Among other things, these sorts of “gag” restrictions previously have prevented insurers and group health plans from sharing with patients and others — such as employers — information about a provider’s prices or quality. The December legislation also prohibited insurers from agreeing to contracts that prevent them from getting access electronically to claims and other information from providers on behalf of the insurer’s enrollees.

In 2018, Congress banned gag clauses in contracts between pharmacies and insurers or pharmacy benefit managers. Those gag clauses had prevented pharmacists from sharing cost information with patients, like whether they could pay a lower price for a prescription by paying out-of-pocket rather than using their insurance coverage.

The proposal approved in December’s legislation came from a big, bipartisan package of health care cost fixes passed in 2019 by the Senate Health, Education, Labor and Pensions Committee, but not by the rest of Congress. The committee’s Republican chairman, Sen. Lamar Alexander of Tennessee, retired from Congress this month. His Democratic partner on that package, Sen. Patty Murray of Washington, will take over the chairmanship as Democrats assume control of the Senate and has vowed to focus on health care affordability.

Consumers First, a health consumer-focused alliance of health professionals, labor unions and others, led by Families USA, praised the ban. The change is “a significant step forward” to stop “the abusive practices from hospitals and health systems and other segments of the health care sector that are driving up health care costs and making health care unaffordable for our nation’s families, workers, and employers,” it said in a statement.

Biden Administration Announces Direct Vaccine Shipments To Pharmacies

Covid vaccines: Biden administration announces direct shipments to  pharmacies including Walgreens, CVS and Rite Aid - CNNPolitics

Source: CNN Politics, by Kevin Liptak, Sara Murray and Betsy Klein

The Biden administration announced Tuesday it will begin direct shipments of coronavirus vaccines to retail pharmacies next week, expanding points of access for Americans to receive shots as concerns about variants of the virus expand.

“Millions of Americans turn to their local pharmacies every day for their medicines, flu shots, and much more. And pharmacies are readily accessible in most communities, with most Americans living within five miles of a pharmacy,” White House Covid-19 response coordinator Jeff Zients said in a briefing.

The program, which will begin rolling out February 11, will start at about 6,500 stores that will receive a total of 1 million doses before eventually expanding, Zients said.

The administration also announced it is increasing the weekly allocation of vaccines going to states, tribes and territories by an additional 5%, bringing the weekly total of vaccines purchased per week a minimum of 10.5 million.

And Zients said the Federal Emergency Management Agency would fully reimburse states for the eligible services they have provided since the beginning of the pandemic in January 2020. The reimbursements will encompass personal protective equipment and the mobilization of the National Guard, Zients said, estimating the price tag will be between $3-5 billion.

In his briefing, Zients sought to manage expectations for the pharmacy rollout. He said both vaccine makers Pfizer and Moderna are stepping up production to provide the extra doses.

“In the early phase, many pharmacies across the country will not have vaccine, or may have very limited supply,” he said.

The US Centers for Disease Control and Prevention is working with states to select pharmacy sites, which will take into account “their ability to reach some of the populations most at risk for severe illness from Covid-19, including socially vulnerable communities,” Zients said.

Administration officials briefed representatives from major pharmacy chains on Tuesday before announcing the plan publicly.

The White House listed 21 national pharmacy chains that will participate in the initial phase of the program, including Walgreens, CVS and Rite Aid.

The plan to expand vaccine availability in pharmacies has long been in the works and was a key component in the former Trump administration’s distribution plan as well. In some states, such as Maryland, those plans are underway, and pharmacies have already begun distributing vaccines.

Public health experts have said it’s critical to expand locations Americans can visit to get vaccinated, both to streamline distribution efforts but also to ensure the vaccine is available to a wider swath of the public as vaccine disparities emerge.

Adding new locations for vaccinations will only alleviate part of the problem, though. Vaccine supply remains extremely limited and the additional locations are likely to come as states are still clamoring for more doses.

Just last month, the new US Centers for Disease Control and Prevention Director Dr. Rochelle Walensky told NBC News that the early expansion to pharmacies wouldn’t mean every pharmacy, everywhere.

“I don’t think late February we’re going to have vaccine in every pharmacy in this country,” Walensky said.

Head-Scratching Over Newsom’s Choice of Blue Shield to Lead Vaccination Push

Head-Scratching Over Newsom's Choice of Blue Shield to Lead Vaccination Push  | California Healthline

Source: Kaiser Health News, by Bernard J. Wolfson

California Gov. Gavin Newsom, struggling to salvage a once-bright political future dimmed by his mishandling of the covid crisis, tapped nonprofit health insurer Blue Shield of California last week to allocate the state’s covid vaccine.

The company has thus far said little about how it plans to reorganize a gargantuan and complicated vaccination campaign that has befuddled and frustrated public health officials and vaccine seekers alike.

The agreement with Blue Shield was made under an emergency authorization, circumventing the customary bidding process. Kaiser Permanente, California’s largest health plan, will also assist in the effort under an emergency contract. (KHN is not affiliated with Kaiser Permanente.)

Blue Shield’s job will be to develop and manage a network of providers to distribute and administer vaccines at numerous venues statewide, including mobile clinics, major vaccination sites and the homes of at-risk residents, according to details released by the state Monday. Blue Shield will also design a system of financial incentives to encourage providers to use their vaccine supply more quickly, with a particular focus on those disproportionately hit by the pandemic. And it will create a real-time data aggregation and reporting system.

Kaiser Permanente, beyond inoculating its 9 million members, will create and oversee at least two vaccination sites, in addition to other unspecified efforts, to vaccinate underserved communities.

Newsom hopes that replacing the patchwork of county-by-county efforts with a centralized system will accelerate the pace of vaccinations.

The vaccine rollout has been plagued by early stumbles, including confusing appointment systems; shifting rules on vaccine eligibility; long lines that have kept older people waiting for hours, leading some to abandon their quest and go home unvaccinated; and faulty data collection that left state officials unable to say whether Newsom had met his goal of administering 1 million doses in 10 days.

Some health care experts cautiously welcomed the new plan, saying Blue Shield could help bring more structure and efficiency to the enterprise of vaccinating California’s nearly 40 million residents.

Blue Shield is the third-largest health insurer in California, after Kaiser Permanente and Anthem Blue Cross. It contracts with a large number of hospitals, medical groups, pharmacies and other providers across the state. Newsom is counting on the insurer’s extensive web of relationships to help get vaccines out more quickly and effectively.

Since Blue Shield “has got an organization with a statewide footprint and knowledge of the geography and the population, it seems they could think through all the scheduling and logistics,” said Glenn Melnick, a professor of health economics at the University of Southern California’s Sol Price School of Public Policy.

A coalition of skeptical groups representing county and local health officials warned Newsom on Friday that his plan “threatens to eclipse our members’ core local public health expertise and functions.” Some health experts suspected the decision to bring in Blue Shield was related to the insurer’s history as a major Newsom donor.

Here are answers to five key questions about Blue Shield’s participation in the covid vaccination program:

1. Is Blue Shield up to the task?

Time will tell. Despite its experience and clout in the health care industry, Blue Shield has never attempted anything of such magnitude — with so much riding on it and so many eyes watching.

Skeptics note that Blue Shield’s track record in delivering health care to its enrollees has not always been stellar. Its rollout of Affordable Care Act health plans in 2014 was beset by errors, and it has been fined by regulators for improper coverage cancellations and consumer grievance violations, among other things. In 2015, it lost its state tax-exempt status following a controversy over large premium hikes and its hefty financial reserves.

In 2019, the most recent year for which data is available, Blue Shield had the second-highest rate of consumer complaints — after UnitedHealthcare — among the nine largest California health plans regulated by the state’s Department of Managed Health Care. And it got the lowest possible score on access to care in the 2019-20 health plan ratings by the National Committee for Quality Assurance.

2. Was Newsom’s decision politically motivated?

It’s hard to say definitively without having been a fly on the wall, but Blue Shield is on very good terms with the governor.

It gave about $1 million to support Newsom’s 2018 gubernatorial bid, according to filings with the California Secretary of State Office. Last year, the company contributed an additional $31,000 to Newsom’s 2022 campaign for governor, as well as $269,000 to his ballot measure committee.

“The reality, I think, is that it reflects the tight relationship Blue Shield has built with Newsom, not its capabilities,” said Michael Johnson, a former Blue Shield executive who resigned from the company in 2015 and is now one of its fiercest critics.

In addition, Blue Shield’s CEO, Paul Markovich, was co-chair of Newsom’s covid testing task force from March to June last year – experience that some health care experts cited as an asset in the insurer’s new role.

Another possible factor in the governor’s decision to shake things up is his political need to turn things around quickly, with an effort to recall him gaining momentum from the vaccination chaos.

3. Is Blue Shield well placed to accomplish the equitable distribution of vaccines to underserved communities that Newsom called “the North Star” of the new centralized system?

These communities are not among Blue Shield’s core constituency. It has a small presence in Medi-Cal, the state-funded insurance program for people with low incomes — and only in Los Angeles and San Diego counties. But it does have relationships with numerous hospitals and other providers that serve Medi-Cal patients. It will also need to collaborate with the state’s counties.

“It’s critical that Blue Shield be required to work hand in hand with local public health jurisdictions to reach vulnerable populations that do not have the same level of access to traditional health care,” said Sara Bosse, director of Madera County’s Department of Public Health.

4. What could have motivated Blue Shield to tackle such an onerous assignment?

Its payment from the state will be at cost, so there’s no apparent profit motive. Though Blue Shield could theoretically leverage its vaccine decision-making power to the advantage of its own business, health care experts doubt it would behave in such a cynical manner.

“Our goal is to do all we can to help overcome this pandemic, and it is our commitment to do that work at cost without making a profit from the state,” Blue Shield said in a news release Friday.

Melnick said he knew of no other health plan in the country that has jumped in to help public officials with testing or vaccinations. If Blue Shield succeeds, “it could be an answer for a lot of states and could put pressure on other plans to step up,” he said. By the same token, Blue Shield will probably catch the blame if vaccine supply shortages continue.

Johnson, the former Blue Shield executive, suggested a motive other than pure selflessness. “I think the biggest value to Blue Shield is the prestige of it,” he said. “It implies Blue Shield has the skill and integrity to be entrusted with something this vital to tens of millions of people.”

5. How will Blue Shield’s results be measured?

It shouldn’t be too difficult to determine whether the insurer is meeting two key goals the state set for it: to speed up the pace of vaccinations and to focus in particular on underserved communities. Both can be measured.

The bar for success is pretty low, Johnson said. “The whole thing has been managed so disastrously,” he said, “that it wouldn’t be difficult for Blue Shield to improve on the state’s performance thus far and come out of this looking like it did a good job.”

Californians Ask: Where Are Our Coronavirus Vaccines?

Californians ask: Where are our coronavirus vaccines? |

Source: CBS8, by Ana B. Ibarra

With Californians growing desperate to protect themselves from COVID-19 and put the pandemic behind them, many want to know: where are their vaccines?

State officials have mostly pointed to insufficient federal supply as the culprit for a slower than expected vaccine rollout. About 4.7 million doses have been sent to the state, not including what’s sent for long term care facilities via a federal pharmacy partnership. But as of late Thursday, 1.8 million doses, or about 40%, had not yet been administered, according to a state vaccine dashboard.

California’s vaccine rollout per capita has been among the slowest in the country and state officials can’t say where unused doses are, whether they are reserved for upcoming appointments or whether they are sitting in freezers unnecessarily. The state announced this week that locally controlled distribution of the vaccine isn’t working. Instead, it will contract with Blue Shield to coordinate delivery statewide and speed the process.

“We understand that vaccine supply is limited. But we also need to address that the supply we have now needs to get administered as quickly as possible, so we’re developing an approach that allows us to do just that,” Yolanda Richardson, the state’s government operations secretary, said earlier this week.

Blue Shield will be what the state calls a “third party administrator.” It won’t inject shots into people’s arms, but rather will allocate doses to health providers and local health departments.

Blue Shield declined to provide a spokesperson to answer questions about how it will improve vaccine delivery. Instead, it released a statement that said, “Blue Shield’s role will be to maximize the speed at which vaccinations are made available across California with a focus on disparately affected communities.”

This new vaccine delivery system, which will take several weeks to roll out, is supposed to provide the state a clearer picture of what’s happening on the ground.

It’s the on-the-ground coordination that has been complicated.

To date, the state’s vaccine allocation has been divided among local health departments, seven major health systems, the department of state hospitals and the department of corrections. How much vaccine each system or department is given is based on its eligible population — which is made up of mostly health care workers and people aged 65 and over.

Local health departments in 58 counties and three cities further split their cut of doses with local providers, including pharmacies and clinics, that distribute shots at their own pace. Hospital systems report orders to the state, but get their doses directly from Pfizer and McKesson, the intermediary for Moderna, and county officials do not always know how many doses their large hospitals have.

This decentralized approach hasn’t worked for California. Rules vary by county, causing confusion. And without strong singular oversight, it’s been impossible to ensure efficiency and speed.

“We do a lot with our counties, which I think is a strength in California. But in this case, it was a challenge for administering the vaccine as quickly as we possibly could,” Dr. Nadine Burke Harris, the state’s surgeon general, told NPR this week.

Aside from overall supply and delivery issues, the state also has been dealing with data issues. “We don’t really have a way to track vaccines sitting in the freezer,” said Kat DeBurgh, executive director of the state’s health officers association.

“What we do know is some are sitting in the freezer with a name because of an appointment for next week,” she said. Many of the doses not yet administered are accounted for, but how many is unknown.

Without concrete data, the state cannot identify delivery bottlenecks or know whether providers are hoarding vaccines or just not entering data in the state’s vaccine registry in a timely manner.

The Blue Shield deal is just one step the state is taking to improve vaccination delivery. It recently rolled out the My Turn website, where people can sign up to learn when they qualify for vaccinations and schedule appointments. This system, in turn, will automatically provide data to the state so it can better track inventory and reduce data lags.

state dashboard already tracks total doses administered, assigning them to the vaccinated person’s county of residence. But it does not show what percentage of a county and health system’s supply has been administered.

Darrel Ng, spokesman for the state’s public health department, said the state has been working to identify vaccination bottlenecks, but credited health systems with doing a good job of getting vaccines out quickly.

As of Wednesday, Kaiser Permanente, the largest health system in the state, had administered 305,000 doses to health workers and patients — about 10% of the doses administered in the state, not counting nursing homes. But it could administer up to 250,000 a week if it had the supply, Marc Brown, a Kaiser spokesman said. Kaiser will help Blue Shield with the new vaccine delivery network.

Of course it’s a lot easier for health systems than for counties to distribute the vaccine quickly because they’re dealing with a specific audience — their workers and patients who they can easily reach, DeBurgh said.

While speed is important, good delivery is also about being equitable, and that’s a balance the state and Blue Shield will have to find, she said. “You can’t just give more vaccines to those who do it faster, it’s also important to reach communities that don’t have transportation or easy access to health care,” she said.

Some local officials are cautiously optimistic about the state’s new plans.

“I think in any response when you bring in additional resources that is a plus,” said Joe Prado, Fresno County’s health division manager. “But if you don’t coordinate well, and you don’t really get a focus plan together in line with the locals, then it can become inefficient.”

CMS Finalizes Drug Transparency, Pharmacy Quality Rules

CMS finalizes drug transparency, pharmacy quality rules

Source: Fyne Fettle, by James Schneider

CMS on Friday finalized a rule it estimates will save the federal government $75.4 million over the next decade in Medicare Advantage and Part D payments, with the agency crediting cost-savings to several measures enacted to curb prescription drug spending.

Under the new rule, CMS expanded drug and medication therapy management programs that require Medicare Part D plans to review potentially-risky opioid use trends with providers and patients. The final law also requires Medicare Part D sponsors to report payment suspensions against pharmacies facing fraud allegations to CMS, falling in line with the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, also known as the SUPPORT Act. The legislation also mandated Medicare Advantage and Part D plan sponsors report inappropriate opioid prescriptions and insurers’ actions to CMS via a secure internet portal.

In addition to cracking down on providers’ opioid prescriptions, the new rule includes steps to reduce out-of-pocket drug costs for Part D beneficiaries, standardize insurers’ process for reviewing pharmacy quality and allow enrollees to know more about their prescription drug costs in advance. The new rule follows an earlier set of Medicare Advantage and Part D updates CMS made in May 2020.

CMS will now require insurers to tell the agency how they calculate pharmacy performance measures by January 1, 2022, after complaints from the pharmaceutical industry the criteria used were unfair. CMS will publicly report the metrics to help insurers standardize the process for reviewing pharmacy performance, the agency said.

The federal agency will also give Part D plans the ability to create a “preferred” specialty tier of high-cost drugs with lower cost-sharing for enrollees by January 1, 2022. That change could help negotiate lower prices for expensive medications with drugmakers by promising them access to the so-called preferred tier.

Continuing the Trump administration’s efforts to reduce healthcare spending through increased transparency and lower drug costs, CMS wants Part D prescription drug plans to offer beneficiaries access to patient-specific drug costs in real-time by January 1, 2023. As an example, CMS said this tool will allow consumers to compare the price of similar, cholesterol-lowering drugs to see which requires the lowest individual copay. The final rule pushes this requirement back a year from its initial proposal.

“The changes in this final rule provide desperately needed transparency on the out-of-pocket costs for prescription drugs that have been obscured for seniors,” CMS Administrator Seema Verma said in a statement. “It will strengthen Part D plans’ negotiating power with prescription drug manufacturers so American patients can get a better deal.”

The final rule also updates Star Ratings and Quality Bonus Payment ratings, although CMS did not give details on the specific changes. The agency added that it is also working to codify policy changes related to supplemental benefits and provisions aimed at reducing the administrative burden for Programs of All-Inclusive Care for the Elderly, or PACE.

Last Updated 02/24/2021

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