| THIS WEEK IN HEALTHCARE
What happened in healthcare this week—and what we think about it.
1. Federal health officials to investigate increase in “Paxlovid rebound” cases. The Food and Drug Administration (FDA) says there’s “no evidence” that a second course of Paxlovid, Pfizer’s COVID antiviral drug, will help patients who are experiencing a relapse of symptoms after taking the medication. In the wake of a growing number of reports that patients’ COVID symptoms are returning after a five-day dose of Paxlovid, Pfizer’s CEO Albert Bourla told Bloomberg that patients should take another course. As it’s unclear why some patients are experiencing a so-called “Paxlovid rebound,” federal health officials said they plan to study the phenomenon.
The Gist: The Biden Administration has made Paxlovid a key tool in the fight against COVID, encouraging physicians to prescribe it, and launching the “Test to Treat” initiative to allow patients to get both tested and be prescribed the medication in the same pharmacy visit. Yet the drug’s rollout has, to date, been riddled with confusion, inconsistency, and subpar access for both physicians and patients. It’s important that the FDA step up its monitoring of Paxlovid, in order to better determine who benefits from it and who doesn’t, so that it can more clearly message and promote its use.
2. Providers ponder a post-Roe future. If the leaked Supreme Court draft opinion overturning Roe v. Wade—which in 1973 established an individual’s constitutional right to an abortion—is finalized, as many as 26 states are either certain or likely to ban abortion. The resulting patchwork of abortion laws across the country could create confusion for providers and hospitals on multiple fronts, including cases related to the federal Emergency Medical Treatment and Labor Act (EMTALA), as well as for health systems that operate in multiple states. Medical training on the procedure could become much more limited, as about half of the nation’s obstetrics and gynecology residencies are in states likely to ban abortion. Recognizing the precarious position that abortion bans will put some providers in, the American Medical Association released a statement on Thursday saying that it is “deeply concerned” with the draft opinion, and that it “would lead to government interference in the patient-physician relationship, dangerous intrusion into the practice of medicine, and potentially criminalizing care.”
The Gist: Abortion is just one of a raft of issues where the provision of health services increasingly intersects with charged politics in this country. If Roe is overturned, medication abortion—the use of abortion pills—which already accounts for more than half of all abortions, will increase, although multiple states are already seeking to limit access. Restricting access to safe abortions will also further exacerbate health disparities, driving up the already distressingly high US maternal mortality rate, especially among Black women. And overturning Roe would have implications far beyond access to abortion, especially for patients experiencing miscarriages, ectopic pregnancies, or other life-threatening medical conditions related to pregnancy.
3. Questions resurface about nonprofit hospitals’ tax-exempt status. A report from The Lown Institute, a Boston-based think tank, finds that many health systems—227 of the 275 evaluated—spend less on providing “community benefit” than the value of their tax exemptions. The American Hospital Association (AHA) criticized the report’s methodology, claiming it “cherry-picks categories of community investment.” This report builds on previous analyses that have found that, taken together, nonprofit hospitals spend less on charity care than government or for-profit hospitals.
The Gist: Policymakers and academics, prompted by massive capital projects, high executive salaries, and—especially—aggressive pricing and billing strategies, are increasingly questioning whether nonprofit health systems provide sufficient community benefit to retain their tax-exempt status. A recent piece in Health Affairs suggests updating the community benefit standard, which the Internal Revenue Service (IRS) uses to evaluate nonprofit status, to focus on social determinants of health and measurable health outcomes. We’d expect tougher scrutiny on this topic in the future, especially if state budgets come under pressure from a deterioration in the broader economy.
Plus—what we’ve been reading.
4. Scrutiny of Adderall telehealth scripts intensifies. Digital mental health company Cerebral will stop prescribing medications like Adderall and Ritalin for new patients who suffer from attention deficit hyperactivity disorder (ADHD), as the company faces increasing scrutiny of its marketing and prescribing practices. The San Francisco-based startup, founded in 2020, has grown quickly; it now prescribes to patients in all 50 states and has been endorsed by Olympic gymnast Simone Biles. Former Cerebral employees allege they were pressured to prescribe more Schedule II controlled stimulants to retain patients. The Wall Street Journal reported that Truepill, Cerebral’s preferred online pharmacy, is halting prescriptions of Schedule II drugs from the company.
The Gist: The moves by Truepill and others, including CVS, Walmart, and Walgreens, to delay or halt filling Adderall and other controlled substance prescriptions by telehealth companies, are fueling the debate about the limits of telehealth. While pandemic-era flexibilities have increased consumers’ access to behavioral healthcare, several startups have focused on quick access to medication. As the country is still dealing with the effects of the opioid crisis, concerns about the overprescribing of controlled substances will surely weigh on lawmakers’ minds as they decide how to regulate telehealth companies.
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