The real-world impact of federal COVID cuts

Also: Mass General Brigham pulls suburban expansion plan [View in browser](    [❤️]( April 4, 2022 Hello CommonHealth reader, Starting last Tuesday, some COVID patients found themselves in a bind: Get monoclonal antibody treatment and face an unknown bill — or forgo treatment and hope you don’t get severely ill. The reason for their predicament is that President Joe Biden's administration [doesn’t have enough money]( to continue footing the bill. Biden's asked for additional COVID response funds, but Congress [didn't include the money in the most recent spending bill](. The result is a whole slew of COVID services and programs are being curtailed or cut altogether. I’ve been digging into these cutbacks, and one immediate consequence is being felt by patients getting monoclonal antibody infusions to treat COVID. Until now, the federal government had covered the cost of COVID medications and the cost of administering them. Now, it has stopped buying more doses and is stretching the existing supply as long as possible. Scott Dryden-Peterson, the medical director of COVID Outpatient Therapy at Mass General Brigham, told me he expects the supply to last anywhere from weeks to months. But he also said the federal government has already stopped paying to administer the treatments. That's no problem for oral antivirals, which can be taken at home. But monoclonal antibodies require an infusion and that can cost [over $1,000 a dose](. The Biden administration stopped accepting claims for this last Tuesday. Dryden-Peterson says it’s unclear how much patients might be charged for an infusion since it's still the early days of figuring out this new system, and it may vary depending on their insurance. Another challenge is this treatment should be given early while symptoms are mild. That means patients have to decide quickly whether they want it, and without knowing if they’ll be one of the unlucky ones who get severely ill. “These are hard decisions for them to make," Dryden-Peterson said. As the state and the country push to reduce pandemic precautions and remain open, Dryden-Peterson says a plan for providing treatment must be part of the plan. “Staying open will mean more people get COVID, and we need to be able to respond to take care of those who are vulnerable from getting severely ill,” he said. “The lack of support to be able to provide care for them is a major challenge of that strategy.” This is just one of several serious consequences flowing from Congress not providing additional COVID-related funding. Keep your eyes and ears out for a piece coming this week with details on some of the other changes and roll backs we’ll see in Massachusetts. Gabrielle Emanuel Health reporter [Follow]( Support the news  This Week's Must Reads [Mass General Brigham pulls suburban expansion plan]( Mass General Brigham officials say the hospital system has withdrawn its controversial proposal after learning staff at the Department of Public Health would not recommend approval of the projects. [Read more.]( [Mass General Brigham pulls suburban expansion plan]( Mass General Brigham officials say the hospital system has withdrawn its controversial proposal after learning staff at the Department of Public Health would not recommend approval of the projects. [Read more.]( [Chinatown in 'high exposure zone' for unregulated air pollutants, study shows]( A new study of Boston's air quality finds higher air pollution in areas with large Asian populations, compared to predominantly white neighborhoods. 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[Read more.]( What We're Reading 📚 Money can’t fix everything — but it can do an awful lot to help people stop using stimulants like methamphetamine. That’s according to Emefa Addo Agawu, who wrote an opinion piece in the Washington Post [about the power of so-called "contingency management."]( As she writes, the idea of contingency management is simple: get rewards for abstaining from drugs. The reward can be cash after each negative drug test, or it can be a “fish bowl” approach where you pick a reward from a bowl. Sometimes, it's just a “good job!” Other times, it’s a gift certificate. Addo Agawu argues that contingency management stacks up well against other programs aimed at helping people with drug addiction, both in terms of cost and effectiveness. “Contingency management is not a panacea. But a massive body of research tells us that it is the best tool we have to help people abstain from stimulant use,” she writes. She points to the VA as the main place where this strategy has been implemented. With more than 5,000 patients going through its program, Addo Agawu reports that 92% of participants’ samples have come back drug-free. Of course, some people voice concerns about how the reward money is used. Might someone spend it on obtaining drugs? And is a program offering cash for stopping drug use going to incentivize people to start using in the first place? However, according to Addo Agawu, the data on these programs suggests these concerns haven’t been major problems. She writes that it’s often basic, bureaucratic hurdles that prevent such programs from being more widely used, like the fact that contingency management doesn’t have a billing code for providers to enter and get reimbursed. The Biden administration has taken some small steps toward making this treatment strategy a possibility for more patients — and Addo Agawu is hopeful more can be done relatively easily, if there’s the will. "We need to start treating COVID as a risk factor for diabetes," — [Ziyad Al-Aly]( the lead author of a study that found people who had COVID were about 40% more likely to develop diabetes ICYMI [He built New Hampshire's largest addiction treatment center. Now, he's accused of sexual misconduct]( An NHPR investigation discovered multiple allegations against Eric Spofford, including sexual misconduct, abusive leadership and retaliation. [Read more.]( [He built New Hampshire's largest addiction treatment center. Now, he's accused of sexual misconduct]( An NHPR investigation discovered multiple allegations against Eric Spofford, including sexual misconduct, abusive leadership and retaliation. [Read more.]( Did you know...exposure to even faint light while sleeping can be harmful to your health? [A recent 20-person study]( suggests that even that glow from your electronics can raise your pulse and increase insulin resistance. 😎 Forward to a friend. 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