Aetna To Cover Breast Augmentation Surgery For Transgender Patients

The New York Times: Aetna To Expand Coverage For Gender-Affirming Surgeries 
Allison Escolastico, a 30-year-old transgender woman, has wanted breast augmentation surgery for a decade. By 2019, she finally thought her insurance company, Aetna, would pay for it, only to find that it considered the procedure cosmetic, not medically necessary, and refused to cover it. “I knew from my case, it wasn’t cosmetic,” said Ms. Escolastico, who contacted a lawyer after she lost her appeal last year. “I knew I had to fight for this,” she said. (Abelson, 1/26)

FierceHealthcare: Aetna Grows Coverage For Gender-Affirming Surgeries For Transgender Women 
Aetna is expanding coverage for gender-affirming surgeries for transgender women. The insurer will now cover gender-affirming breast augmentation in most of its commercial plans, the CVS Health subsidiary announced this week. The change came as a result of a collaboration between Aetna, the Transgender Legal Defense & Education Fund (TLDEF), Cohen Milstein Sellers & Toll law firm and several transgender Aetna members. (Minemyer, 1/27)

In other health care industry news —

Modern Healthcare: Hospitals Push CMS To Pause 'Most Favored Nation' Drug-Pricing Rule
Hospitals want CMS to pull the plug on its contentious "most favored nation" drug-pricing rule, a Trump-era demonstration that would tie Medicare outpatient drug pay to drug prices in other wealthy countries. Providers argued the policy is illegal and wouldn't lower drug prices or patients' out-of-pocket costs in comments on the interim final rule due Tuesday. The American Hospital Association said it would "harm patients' access to critical, lifesaving drugs" and create more financial problems for hospitals because "the rule places the entire onus of reducing drug prices on hospitals, rather than on drug companies or on Medicare." Experts have said the Trump administration's last-minute plan depends on providers negotiating drugmakers' prices down to meet reduced payment levels. (Brady, 1/27)

The Wall Street Journal: Roz Brewer To Bring Pandemic Experience To Walgreens At Pivotal Time 
When Rosalind Brewer, then the CEO of Sam’s Club, called out the lack of diversity in American corporations in a 2015 interview, she received death threats and a torrent of criticism. Five years later, Ms. Brewer, now Starbucks Corp.’s No. 2 executive, is set to become the only Black woman to lead a Fortune 500 company as she takes over as chief executive of Walgreens Boots Alliance Inc. amid a national debate about systemic racism. (Terlep, Haddon and Nassauer, 1/27)

FierceHealthcare: Nearly Half Of Adults Older Than 65 Don't Have Online Medical Accounts That Could Connect Them With COVID-19 Vaccines 
Older adults are being prioritized for COVID-19 vaccines because they are among the most vulnerable to complications from the novel coronavirus. But they are also less likely to be using the tech tools such as online patient portals that would help notify them about vaccine availability and appointment scheduling, according to newly analyzed data from National Poll on Healthy Aging, based at the University of Michigan’s Institute for Healthcare Policy and Innovation. Nearly half (45%) of individuals between the ages of 65 and 80 said they had not set up an account with their health provider’s online portal system, the analysis found. (Reed, 1/27)

Becker's Hospital Review: 12 States With The Most Rural Hospitals At Risk Of Closure
Across the U.S., more than 800 hospitals — 40 percent of all rural hospitals in the country — are either at immediate or high risk of closure, according to a report from the Center for Healthcare Quality and Payment Reform. More than 500 rural hospitals in the U.S. were at immediate risk of closure before the COVID-19 pandemic because of financial losses and lack of reserves to maintain operations. The hospitals identified as being at immediate risk of closure had a cumulative negative total margin over the most recent three-year period, and their financial situation has likely deteriorated because of the pandemic. (Ellison, 1/27)

Crain's Cleveland Business: Cleveland Clinic, Doctors Hospital Form Advisory Council To Expand Health Care In The Bahamas
Cleveland Clinic has formed a strategic advisory council with Doctors Hospital Health System, a tertiary healthcare institution in the Bahamas, where the two organizations aim to expand and improve the delivery of healthcare services. A two-year strategic advisory agreement — through which the two agreed to form the council — will provide Doctors Hospital access to Cleveland Clinic's network of internal experts for strategic planning, clinical education and leadership development, according to a news release. The Clinic is paid a fee under the agreement, but specific financial terms weren't disclosed. (Coutre, 1/27)

An obituary —

Becker's Hospital Review: Former St. Jude Director Dies
Joseph V. Simone, MD, a former St. Jude Children's Research Hospital director who helped lead the first curative treatment for childhood leukemia, died Jan. 21, the Memphis, Tenn.-based hospital said. He was 85. "Dr. Simone was an extraordinary leader and a giant in the field of oncology," James Downing, MD, president and CEO of St. Jude, said in a news release. "Our hospital — in truth, the world — owes a great debt of gratitude to him for his many accomplishments. A visionary and a world-class clinician, he was, most importantly, a man of principle." (Gooch, 1/27)