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Updates For Brokers & Employers

January 13, 2022

To Our Valued Clients and Partners,

As we enter the second full year of the pandemic this month, this week is tracking to have the highest number of reported weekly coronavirus cases since the beginning of the pandemic. At the same time there’s a massive shortage of COVID-19 PCR and antigen tests to fully measure and report on the actual spread of the virus. 

Regional Stats

Across our region, according to each state’s health department, the fully vaccinated rate for people 5 years and older is 52.5% in Idaho, 63.9% in Utah, 65.5% in Oregon, and 71.1% in Washington.

Today, full vaccination rates for those age 5 and over vary widely between states ranging from a low of 48% in Wyoming to a high of 78.3% in Vermont and a national average of 66.7% according to the CDC.

The CDC’s now reports at the state-level on the rates of adults 18 years and older who are fully vaccinated AND have received a booster. Oregon is at 46.1%, Idaho is at 40.8%, and Washington is at 45.8% and Utah is at 36.8%. Nationally, this metric ranges from a low of 17.2% in New Hampshire to a high of 57.9% in its neighboring state, Vermont.

The CDC’s current US seven-day case count average is about 760,000 per day fueled by a single-day record on January 10th of over 1.4 million cases. The daily number of COVID-19 cases is nearly 4 times the previous highest COVID-19 spike in January 2021, yet the daily number of deaths is about half of where it was during the same previous spike, currently averaging about 1700 daily deaths. The good news is that while the case rate is unprecedented, the survival rate is improving. That said, now is not the time to ease protections.

The seven-day hospital admissions count average also surged to near record levels of about 20,000 new admissions per day, with over 140,000 people hospitalized as hospitals race to shut down non-essential services and prepare for an anticipated admissions flood in the coming weeks  

Omicron, Omnipresent

The CDC classified the Omicron variant as a Variant of Concern on November 26, 2021. Omicron was first detected in the US on December 1st. One month later, Omicron accounted for over 92% of all COVID-19 cases in the U.S. Today, Omicron is close to 99% of all cases. The Delta variant took over four months to reach similar infection rates. Delta and Omicron remain the only Variants of Concern.

On January 11th, Dr. Janet Woodcock, Acting Commissioner of the Food and Drug Administration, in questions following her testimony before the Senate Health, Education, Labor, and Pensions Committee on Capitol Hill, stated, "I think right now, we need to focus on continuity of operations for hospitals and other essential services as this variant sweeps through the population."

Booster and Vaccine Update

Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases and the Chief Medical Advisor to the President, in a White House briefing on Wednesday, January 12th, emphasized the importance “that the up-to-date COVID-19 vaccination with boosters prevents severe disease and keeps you out of the hospital”. This follows the CDC’s recent updates to its CDC’s COVID-19 Booster dose recommendations.

On January 3rd, the FDA amended the Pfizer EUA to include a booster dose in those 12-15 years of age and shortened the time between the completion of the primary vaccination series and a booster dose to five months and allows for a third primary series dose for certain children 5-11 years of age. The CDC’s Advisory Committee on Immunization Practices (ACIP) then followed suit and expanded booster eligibility accordingly.

On January 7th, the FDA amended the Moderna EUA to shorten the time between the completion of primary vaccination and a booster dose to five months for those 18 and older. As of this publication date, the CDC has not yet acted on the FDA’s amended Moderna EUA.

The following groups are now eligible for booster shots:

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While the federal Public Health Emergency declaration remains in place, plans are required to cover COVID-19 vaccines including boosters that have emergency use approval (EUA) by the FDA and follow CDC recommendations. Additionally, once a vaccine receives full FDA approval, it is considered a covered preventive care benefit under the CARES Act, which applies to all non-grandfathered group health plans under the ACA rules.

New COVID Treatments  

Vaccines remain the most effective treatment to reduce the risk of severe COVID-19 infections. Yet, scientists continue the race to develop effective treatments for those facing a fight for their lives with COVID-19 infections. The FDA has recently issued EUAs for new drugs to treat COVID-19 patients. This is welcome news given the spike in COVID-19 hospitalization. One of the new drugs, Pfizer’s Paxlovid, has potential broad application for less severe cases.

On December 28th, the FDA updated the emergency use authorization (EUA) for COVID-19 convalescent plasma.  The update limits the authorization to the use of COVID-19 convalescent plasma with high titers of anti -SARS-CoV-2 antibodies for the treatment of COVID-19 in patients with immunosuppressive disease or who are receiving immunosuppressive treatment.  These patients may be treated in outpatient or inpatient settings.  Additionally, to help assure the manufacture of high titer COVID-19 convalescent plasma, the revisions to the EUA revise acceptable tests and increase qualifying result cutoffs to be used for manufacturing COVID-19 convalescent plasma with high titers of anti-SARS-CoV-2 antibodies.

On December 23rd, the FDA’s advisory issued an emergency use authorization (EUA) for Merck’s molnupiravir antiviral pill for the treatment of mild-to-moderate coronavirus disease (COVID-19) in adults with positive results of direct SARS-CoV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death, and for whom alternative COVID-19 treatment options authorized by the FDA are not accessible or clinically appropriate. Molnupiravir is available by prescription only and should be initiated as soon as possible after diagnosis of COVID-19 and within five days of symptom onset.

Molnupiravir is not authorized for use in patients younger than 18 years of age because molnupiravir may affect bone and cartilage growth. It is not authorized for the pre-exposure or post-exposure prevention of COVID-19 or for initiation of treatment in patients hospitalized due to COVID-19 because benefit of treatment has not been observed in people when treatment started after hospitalization due to COVID-19.  

On December 22nd, the FDA issued an emergency use authorization (EUA) for Pfizer’s Paxlovid (nirmatrelvir tablets and ritonavir tablets, co-packaged for oral use) for the treatment of mild-to-moderate coronavirus disease (COVID-19) in adults and pediatric patients (12 years of age and older weighing at least 40 kilograms or about 88 pounds) with positive results of direct SARS-CoV-2 testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death. Paxlovid is available by prescription only and should be initiated as soon as possible after diagnosis of COVID-19 and within five days of symptom onset. We are currently working with our contracted PBM partners to how this drug will be covered on your Pharmacy benefit plans.

Regular COVID Reporting Continues

All clients currently receive regular reporting on their plan’s COVID-related claims and payments. Please connect with your Account Manager to receive your latest report or you can access this report in BenefitFocus. 

Our focus, dedication, and support remain steadfast as we navigate these unique times with you. Know that our Care Management nurses are reaching out to those members diagnosed with COVID-19 to help them access the care and resources they need to recover safely.

Updated COVID-19 Member Information and Resources on Our Website

We update our COVID-19 information and resource pages for members regularly. Many members call us with questions that are of a more clinical nature. We recommend that members consult their primary care physician for clinical questions. For non-clinical questions, please share this page with members where they will find links to additional resources on self-care, vaccines, and other useful information.

 

We’re Here for You 

Our focus, dedication, and support remain steadfast as we navigate these unique times with you. Know that our Care Management nurses are reaching out to those members diagnosed with COVID-19  to help them access the care and resources they need to recover safely. Thank you for your continued trust in our organization. We are in this with you and hope that you and yours stay safe and healthy. Please reach out to your Account Manager if you have any questions or if there’s anything we can do to help. 

Best Regards,

Lindsay Harris, MPP President

Regence Group Administrators

Links to prior COVID-19 updates from RGA:

December 13, 2021

  • The Omicron Variant
  • Booster and Vaccine Update 
  • Coverage for Employer-Mandated Testing
  • Coverages for At-Home Test Kits
  • COVID Treatments Update  
  • New COVID Treatments
  • Regular COVID Reporting Continues
  • Member Support 

November 15th, 2021

  • Vaccine Update
  • Booster Update 
  • Coverage for Employer-Mandated Testing
  • COVID Treatments Update  
  • Regular COVID Reporting Continues
  • Member Support 

October 15th, 2021

  • OSHA Moving Closer to Publishing Vaccination Mandate Rule  
  • Coverage for Employer-Mandated Testing   
  • New COVID Treatments  
  • Boosters and Vaccine Update  
  • Regular COVID Reporting Continues 
  • Member Support 

September 10, 2021

  • President Biden Issues Vaccination Mandates for Over 100M Workers and New Testing and Safety Measures
  • 'Crisis Standard of Care' Activated in Response to Overwhelmed Hospitals
  • Exploring Surcharges for Employees Not Vaccinated Against COVID-19
  • From Delta to Mu
  • Regular COVID Reporting Continues
  • Member Support

August 12, 2021

  • Employer Vaccine Mandates Gaining Popularity
  • The DOJ and EEOC Updates on Employer-mandated Vaccinations
  • COVID Vaccination Requirements & HIPAA Considerations
  • OSHA Updates on Protecting Workers from the Spread of COVID-19
  • The Raging Delta
  • Booster Vaccines Approved…for Some
  • Public Health Emergencies- Anticipated End Dates and Next Steps
  • Benefit Design – COVID Testing 
  • Benefit Design – Telemedicine Coverage 
  • Telemedicine Reimbursement Rates
  • Regular COVID Reporting Continues
  • Vaccine Costs and Trends Across our Membership
  • Testing Trends Across Our Membership 
  • Treatment Claims Trends Across Our Membership
  • Updated COVID-19 Member Information and Resources on Our Website

June 28, 2021

  • The ‘next normal’, is it here?
  • Public Health Emergencies- anticipated end dates and next steps
  • Do vaccine incentives work?
  • EEOC update on employer-mandated vaccinations
  • OSHA updates on protecting workers from the spread of COVID-19
  • Planning for booster vaccines
  • Telemedicine reimbursement rates
  • PPE Coverage Update
  • Regular COVID reporting continues
  • Trends – current and anticipated
  • Member support

May 28, 2021

  • The 'next' normal', just around the corner?
  • Overcoming vaccine hesitancy with incentives
  • Continuing COVID support for our clients
  • Planning for booster vaccines
  • Regular COVID reporting to continue
  • Trends - current and anticipated
  • Member support

April 29, 2021

  • The race to vaccinate
  • Is herd immunity possible?
  • Vaccine safety and efficacy
  • Health plan coverage of vaccines
  • Vaccine costs and trends across our membership
  • An update on employer-mandated vaccinations and new OSHA requirements
  • Updated COVID-19 member information and resources on our website
  • Testing trends across our membership
  • Treatment claims trends across our membership

March 26, 2021

  • Latest Update  
  • COVID-19 Variants Pose Surge Risk 
  • COVID-19 Vaccinations
  • Vaccine Efficacy - What You Should Know
  • Vaccine Eligibility and Access 
  • Health Plan Coverage of Vaccines
  • Vaccine Costs and Trends Across our Membership
  • An Update on Employer-mandated Vaccinations
  • Updated COVID-19 Member Information and resources on our Website
  • Testing Trends Across our Membership 
  • Treatment Claims Trends Across Our Membership 

February 26, 2021

  • US and Regional Update
  • COVID-19 Vaccinations 
  • COVID-19 Variants
  • Vaccine Eligibility and Access 
  • Health Plan Coverage of Vaccines
  • Vaccine Costs and Trends Across our Membership
  • An Update on Employer-mandated Vaccinations
  • Updated COVID-19 Member Information and resources on our Website
  • Testing Trends Across our Membership
  • Treatment Claims Trends Across Our Membership

January 29, 2021

  • US and Regional Update
  • Testing Trends Across our Membership
  • Treatment Claims Trends Across Our Membership
  • COVID-19 Vaccinations
  • Health Plan Coverage
  • Vaccine Costs
  • Vaccine Access
  • Government-mandated Vaccinations?
  • What About Employer-mandated Vaccinations?
  • Will RGA Provide Reporting on Employees Who Have Been Vaccinated?

December 18, 2020 

  • Testing Trends Across our Membership
  • Treatment Claims Trends Across Our Membership
  • COVID-19 Vaccinations Begin...What to Expect
  • Health Plan Coverage
  • Vaccine Costs
  • Government-mandated Vaccinations?
  • Employer-mandated Vaccine Update
  • Will RGA Provide Reporting on Employees Who Have Been Vaccinated?

November 24, 2020 

  • US and Regional Update
  • Testing Trends Across our Membership
  • Treatment Claims Trends Across Our Membership
  • Member Difficulty Finding Testing
  • Preparing for COVID-19 Vaccinations
  • Employer-Mandated Vaccines?

October 30, 2020 

  • US & Global update
  • Testing trends regionally
  • Outcome trends by state & age Group across regional Covid-19 positive cases
  • Treatment claims trends across our membership
  • Preparing for Covid-19 vaccinations
  • Employer-mandated vaccines?

September 25, 2020 

  • US & Global update
  • Testing trends regionally
  • Treatment claims trends across our membership
  • Testing claims trends across our membership

August 26, 2020 

  • US & Global update
  • Testing trends regionally
  • Treatment claims trends across our membership
  • Testing claims trends across our membership

July 24, 2020 

  • US & Global update
  • Testing trends regionally
  • Treatment claims trends across our membership
  • Testing claims trends across our membership

June 26, 2020 

  • RGA Open Arms Program launches July 1st
  • COVID-19 updates to our website
  • The CDC expands and updates the list of people at risk of severe COVID-19 illness
  • The joint agencies clarify FFCRA and CARES Act implementation guidance
  • Trends we are seeing 

June 11, 2020 

  • Return to work webinar series launched this week
  • COVID-19 updates to our website
  • An update no provider personal protective equipment (PPE) surcharges
  • Trends we are seeing

May 29, 2020 

  • Return to work webinar series
  • How to participate in the IRS relief for FSAs and other cafeteria plans
  • Provider personal protective equipment (PPE) surcharges
  • Unemployment fraud update
  • Trends we are seeing

May 15, 2020 

  • Taking Care: An emerging mental and behavioral health pandemic
  • Unemployment fraud rampant and how to report it
  • Return to work testing resources
  • Trends we are seeing

 May 8, 2020 

  • Interim Compliance Alert: COVID-19

May 1, 2020 

  • COVID-19 Client Impact Reports now available
  • Benefit change request form reminder
  • Trends we are seeing 

April 24, 2020 

  • $484 billion and more to come?
  • Proclamations & regulatory orders vs health plans – Options for stability in unstable times
  • The heated debate over when and how to return to work

April 17, 2020 

  • Expansion of coverage for COVID-19 and pricing for COVID-19 related claims 
  • Access to non-urgent care during the stay at home orders 
  • Trends, testing, and antibody studies

April 10, 2020 

  • A preview of COVID-19 reporting
  • More Telehealth and Telemedicine updates
  • Trends we are seeing and how they may affect your health plan

April 3, 2020 

  • How does the CARES Act affect my health plan?
  • An overview of the recent changes to Telemedicine and Telehealth
  • Trends we are seeing and how they may affect your health plan

March 27, 2020

March 20, 2020

March 12, 2020

March 5, 2020

March 2, 2020

Since our last newsletter, we have a new metric to track, vaccination rates for people aged 5 and over. Last week, on November 2nd, the CDC recommended the Pfizer-BioNTech pediatric vaccine for children aged 5-11. Those vaccines are now rolling out and have already been administered to nearly 500,000 of the roughly 28 million youth in this age group.

 

Across our region, Oregon and Utah have started to publish vaccination data for 5-11 age group. Washington and Idaho have not yet reported for this age group. According to each state’s health department, the fully vaccinated rate for people aged 5 and over in Utah is 59.7% and 68.4% in Oregon, the fully vaccinate rate for people 12 and over is 73.5% in Washington and 55.7% in Idaho.

 

Today full vaccination rates for those 12 and over vary widely between states ranging from a low of 47.3% in West Virginia to high of 81.7% in Connecticut according to the CDC.

 

 

Coverage for Employer-Mandated Testing 

 

OSHA’s vaccination and testing ETS does not mandate that employers cover the cost of mandated testing for employees who choose testing in lieu of vaccination. Thus, plan coverage of employer-mandated COVID-19 testing remains unchanged. Such testing falls into the same category as other examinations and treatments required to obtain and maintain employment, and such expenses are typically excluded from health plan coverage. We have a small number of clients that have chosen to amend their plan language to cover asymptomatic COVID-testing for all plan members (not just members who are also employees). In these cases, we accept COVID-19 testing claims regardless of the reason that the test is requested and apply the plan’s designated benefit coverage.

 

New COVID Treatments  

 

Vaccines remain the most effective treatment to prevent the spread of COVID-19. Yet, scientists continue the race to develop effective treatments for those facing a fight for their lives with COVID-19 infections. This month shows promise for potential at-home treatments for those suffering from less aggressive cases.