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She-Hulk

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She-Hulk was one of the figures I was most curious about when Hasbro announced her inclusion in Marvel Universe Series 4. Of course, distribution being what it is, she was part of the wave of figures I never saw at local retail.

June 16, 2014 | By | Reply More
Red She-Hulk (Marvel Legends)

Ventolin salbutamol sulphate

It’s been quite a while since I read a Hulk comic, but thanks to the Internet I had a fair grasp of the history behind this Hulkette.

May 27, 2013 | By | 3 Replies More

Can you get ventolin over the counter

Dr http://tvandfilmtoys.com/buy-real-ventolin-online/ can you get ventolin over the counter. Hill reports fees and grant support from Abbott Vascular, Boston Scientific, Abiomed, Shockwave Medical and is a stockholder in Shockwave Medical. Dr.

Kereiakes is a consultant for SINO Medical Sciences Technologies, Inc., can you get ventolin over the counter Boston Scientific, Elixir Medical, Svelte Medical Systems, Inc., Caliber Therapeutics/Orchestra Biomed, Shockwave Medical and is a stockholder in Ablative Solutions, Inc. Dr. Shlofmitz is a speaker for Shockwave Medical, Inc.

Dr. Klein reports no relationships with industry. Dr.

Riley reports honoraria from Boston Scientific, Asahi Intecc, and Medtronic. Dr. Price reports personal fees from ACIST Medical, AstraZeneca, Abbott Vascular, Boston Scientific, Chiesi USA, Medtronic, and W.L.

Gore. Dr. Herrmann reports research funding from Abbott, Boston Scientific, Medtronic, Shockwave Medical and is a consultant for Abbott, Medtronic, and Shockwave.

Dr. Bachinsky reports consultant, speakers bureau and research grant support from Abbott Vascular, Boston Scientific, BD Bard Vascular, Medtronic, Shockwave Medical. Dr.

Waksman is on the Advisory Board of Amgen, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, Pi-Cardia Ltd. Is a consultant for Amgen, Biotronik, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, Pi-Cardia Ltd.. Has received grant support from AstraZeneca, Biotronik, Boston Scientific, Chiesi.

Is a speaker for AstraZeneca, Chiesi. And is a stockholder in MedAlliance. Dr.

Stone is a speaker for Cook Medical. Is a consultant for Valfix Medical, TherOx, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Miracor, Neovasc, V-Wave, Abiomed, Ancora, MAIA Pharmaceuticals, Vectorious, Reva, Cardiomech. And has equity/options from Ancora, Qool Therapeutics, Cagent, Applied Therapeutics, Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, and Valfix.Twitter summary.

Disrupt CAD III demonstrates safety and efficacy of intravascular lithotripsy to optimize stent expansion in severely calcified coronary artery disease.

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Walgreens Pharmacist Jessica Sahni holds the Pfizer-BioNTech asthma disease (asthma treatment) treatment at The New Jewish Home in New York, December 21, 2020.Yuki Iwamura | ReutersPfizer said it had ventolin salbutamol sulphate fully enrolled its asthma treatment trial in kids ages 12 to 15, a key step before the treatment could be used in that age Best price on levitra canada group.The study, an extension of the one used to support the company's Emergency Use Authorization of the treatment in people 16 and older, has enrolled 2,259 kids between 12 and 15, Pfizer told CNBC Friday. Its entry on a government website for clinical trials was updated to ventolin salbutamol sulphate note it's no longer recruiting subjects.The treatment, developed with German partner BioNTech, was authorized for people ages 16 and older in December. Trials in younger age groups are necessary to ensure the ventolin salbutamol sulphate correct dose, as well as safety and efficacy in those different groups, said Dr. Evan Anderson, a pediatrician at Emory University School of Medicine."I am very uncomfortable sending my children back to school, where — despite the best efforts of the school — there is a real risk for contracting asthma treatment," Anderson told CNBC in October.While children are less affected by asthma treatment than adults, they do still catch the ventolin and get sick.

Some have ventolin salbutamol sulphate even died. More than 2.5 million cases of asthma treatment had been reported in children as of ventolin salbutamol sulphate Jan. 14, about 13% of all cases, according ventolin salbutamol sulphate to a report from the American Academy of Pediatrics and the Children's Hospital Association."Children can still get sick and die from asthma treatment," said Dr. Paul Offit, director of the treatment Education Center and an infectious diseases physician at the Children's Hospital of Philadelphia.

"As many children this past year died from asthma treatment ventolin salbutamol sulphate as died from influenza. And we recommend an influenza treatment for children."Offit also pointed out that children can suffer from a disease called multisystem inflammatory syndrome associated with asthma treatment, "which can be debilitating."There have been 1,659 cases of the syndrome in children, referred to as MIS-C, and 26 deaths associated with it ventolin salbutamol sulphate as of Jan. 8, according to data from the Centers for Disease Control and Prevention. There have been 78 total deaths from asthma treatment among kids 4 and under, and 178 in kids 5 to 17, CDC data show, although those numbers ventolin salbutamol sulphate don't account for all deaths reported from the U.S.Children line up to attend class at PS 361 on the first day of a return to class during the asthma disease (asthma treatment) ventolin in the Manhattan borough of New York City, New York, U.S., December 7, 2020.Carlo Allegri | ReutersPfizer declined to say when it expected results from the trial, which are dependent on the rate of s observed to be able to compare the rates in the placebo group to those receiving the treatment.

With higher rates across ventolin salbutamol sulphate the U.S. Since the ventolin salbutamol sulphate fall — the seven-day average of daily cases is now about 187,500, according to a CNBC analysis of Johns Hopkins University data — treatment efficacy trials have seen their readouts sped up.But recruitment for trials in adolescents had been slower than hoped, at least for Moderna's study in kids age 12 to 17, said Moncef Slaoui, chief adviser to Operation Warp Speed, the Trump Administration's treatments effort, at its last briefing Jan. 12.As of then, about 800 kids had been enrolled in the trial over a month, he said, out of about 3,000 needed. Moderna's treatment was authorized for people 18 and over in December, weeks after it began ventolin salbutamol sulphate its trial in adolescents.

Pfizer lowered the age of ventolin salbutamol sulphate its trial to 12 in October."While enrollment was lower over the holiday season, we expect to see an increase in the new year as planned," Moderna spokeswoman Colleen Hussey said Friday. "We are on track to provide updated data around mid-year 2021."AstraZeneca, whose Oxford University-developed treatment is in late-stage trials in the U.S. And authorized ventolin salbutamol sulphate in the U.K., told CNBC Friday it plans to continue U.K. Trials in a new protocol ventolin salbutamol sulphate for kids between ages 5 and 18 "beginning in the coming months."Johnson &.

Johnson, whose phase three results in adults are expected imminently, said it's in discussions with ventolin salbutamol sulphate regulators about including pediatric populations in its development plan. It noted the same technology it's using for the asthma treatment has been used in treatments given to more than 200,000 people, including people over 65, infants, children, HIV-positive adults and pregnant women.Typically treatment trials proceed into younger age groups after they're proven safe and effective in older groups, and the manufacturers of asthma treatments have indicated they'll follow that plan here as well.Moderna's chief executive, Stephane Bancel, said this month it's unlikely the company would have data in kids age 11 and younger, which would involve a lower dose, before next year. He said he expects data for kids 12 and up ventolin salbutamol sulphate may be available before September.Public health officials in the U.S., like White House chief medical adviser Dr. Anthony Fauci, have said they hope as much as ventolin salbutamol sulphate 75% to 80% of the U.S.

Population could be vaccinated by the fall to enable life to return to some form of normalcy.About 78% of the U.S. Population, or 255 million people, are over ventolin salbutamol sulphate the age of 18, according to a CNBC analysis of Census data. Another 25 million people are aged 12 to 17.Fauci didn't immediately respond to an inquiry about whether including kids in vaccinations is necessary to reach his goal of 75% to 80% coverage."It's important for all kids to get vaccinated and the manufacturers can't do those trials quickly enough," Angela Rasmussen, a virologist and affiliate at the Georgetown ventolin salbutamol sulphate Center for Global Health Science and Security, told CNBC Friday. "The more people of any age vaccinated, the ventolin salbutamol sulphate better."U.S.

President Joe Biden speaks about his administration's plans to respond to the economic crisis during a asthma disease (asthma treatment) response event in the State Dining Room at the White House in Washington, January 22, 2021.Jonathan Ernst | ReutersPresident Joe Biden has painted a bleak picture of the nation's asthma outbreak in his first few days in office, warning that it will take months to turn around the ventolin's trajectory and that fatalities are expected to dramatically rise over the next few weeks."A lot of America is hurting. The ventolin ventolin salbutamol sulphate is surging. We're 400,000 dead expected to reach well over 600,000," Biden said on Friday before signing two executive orders designed to reduce hunger and ventolin salbutamol sulphate bolster workers' rights amid the ventolin.The U.S. Surpassed 400,000 total asthma treatment deaths on Tuesday, with a quarter of those coming over the previous 36 days, according to data compiled by Johns Hopkins University.

On Biden's first full day as ventolin salbutamol sulphate president on Thursday, he told reporters following a meeting with his asthma treatment advisors, including Dr. Anthony Fauci, that the nation would likely top 500,000 asthma treatment deaths in February.Biden warned on Friday that as the outbreak continues, "there's nothing we can do to change the trajectory of the ventolin in the next several months." The president has repeatedly warned that the situation is likely to worsen before it improves.While it wasn't ventolin salbutamol sulphate immediately made clear what projections Biden was referencing, one key projection from Institute for Health Metrics and Evaluation estimates that the U.S. Could reach 600,000 asthma treatment deaths ventolin salbutamol sulphate by March if states were to ease social distancing mandates. However, the model's current projections show asthma treatment deaths plateauing just above 560,000 asthma treatment deaths by late April.A spokesperson for the Biden administration was not immediately available for comment regarding the president's projections.The United States has reported a decline in asthma treatment cases in recent days, a glimmer of hope following a surge since the fall and through the winter holiday season.

The U.S ventolin salbutamol sulphate. Is reporting an average of roughly 187,593 new asthma treatment cases daily, a 22% decline compared with a week ago, according to a CNBC analysis of Johns Hopkins data.However, the nation is still "in a very serious situation," Fauci said during his first White House press briefing appearance under the new ventolin salbutamol sulphate administration on Thursday, noting the country's high death toll and strained hospital capacity.Fauci said that the daily number of cases, based on a weekly average, appears to be plateauing and turning around. It's possible that the dip could still be because of a reduced reporting following the holidays, he added."When we see that, we think it's real," Fauci said.Biden's warnings come as the country races to administer 100 million asthma treatment shots within the first 100 days in his administration. The nation's treatment rollout has been slow to start, though health experts have said that Biden's 100 million shots goal is doable.The ventolin salbutamol sulphate pace of vaccinations have picked up over the last week.

The U.S ventolin salbutamol sulphate. Has administered 1.6 million asthma treatments between Thursday and Friday, according to recent data from the Centers for Disease Control and Prevention, suggesting that 100 million shots in 100 days would be a feasible goal if that daily count continues.Biden has dismissed the idea that the goal might be too low of a threshold, claiming that he ventolin salbutamol sulphate was told before he took office that the aim might be too high. Biden's spokesperson didn't respond to CNBC's question regarding the president's comments."I find it fascinating that yesterday the press asked the question, 'Is 100 million enough?. ' The week before ventolin salbutamol sulphate they said, 'Biden, are you crazy?.

You can't do 100 million in 100 days," the president said ventolin salbutamol sulphate during the Friday press briefing. "We're, God willing, not only going to do 100 million, we're going to do more than that."— CNBC's Jacob Pramuk and Nate Rattner contributed to this report..

Walgreens Pharmacist Jessica Sahni holds the Pfizer-BioNTech asthma disease (asthma treatment) treatment at The New Jewish https://2019.swissbiotechday.ch/best-price-on-levitra-canada/ Home in New York, December 21, 2020.Yuki Iwamura | ReutersPfizer said it had fully enrolled its asthma treatment trial in kids ages 12 to 15, a key step before the treatment could be used in that age group.The study, can you get ventolin over the counter an extension of the one used to support the company's Emergency Use Authorization of the treatment in people 16 and older, has enrolled 2,259 kids between 12 and 15, Pfizer told CNBC Friday. Its entry on a government website for clinical trials was updated to note it's no longer recruiting subjects.The treatment, developed with German partner BioNTech, was can you get ventolin over the counter authorized for people ages 16 and older in December. Trials in younger age groups are necessary to ensure the correct dose, as well as can you get ventolin over the counter safety and efficacy in those different groups, said Dr.

Evan Anderson, a pediatrician at Emory University School of Medicine."I am very uncomfortable sending my children back to school, where — despite the best efforts of the school — there is a real risk for contracting asthma treatment," Anderson told CNBC in October.While children are less affected by asthma treatment than adults, they do still catch the ventolin and get sick. Some have even died can you get ventolin over the counter. More than 2.5 million cases of asthma treatment can you get ventolin over the counter had been reported in children as of Jan.

14, about can you get ventolin over the counter 13% of all cases, according to a report from the American Academy of Pediatrics and the Children's Hospital Association."Children can still get sick and die from asthma treatment," said Dr. Paul Offit, director of the treatment Education Center and an infectious diseases physician at the Children's Hospital of Philadelphia. "As many children this past year died from asthma treatment as died can you get ventolin over the counter from influenza.

And we recommend an influenza can you get ventolin over the counter treatment for children."Offit also pointed out that children can suffer from a disease called multisystem inflammatory syndrome associated with asthma treatment, "which can be debilitating."There have been 1,659 cases of the syndrome in children, referred to as MIS-C, and 26 deaths associated with it as of Jan. 8, according to data from the Centers for Disease Control and Prevention. There have been 78 total deaths from asthma treatment among kids 4 and under, and 178 in kids 5 to 17, CDC data show, although those numbers don't account for all deaths reported from the U.S.Children line up to attend class at PS 361 on the first can you get ventolin over the counter day of a return to class during the asthma disease (asthma treatment) ventolin in the Manhattan borough of New York City, New York, U.S., December 7, 2020.Carlo Allegri | ReutersPfizer declined to say when it expected results from the trial, which are dependent on the rate of s observed to be able to compare the rates in the placebo group to those receiving the treatment.

With higher can you get ventolin over the counter rates across the U.S. Since the fall — the seven-day average of daily cases is now about 187,500, according to a CNBC analysis of Johns Hopkins University data — treatment efficacy trials have seen their readouts sped up.But recruitment for trials in adolescents had been slower than hoped, at least for Moderna's study in kids age 12 to 17, said Moncef Slaoui, chief adviser to Operation Warp Speed, the Trump can you get ventolin over the counter Administration's treatments effort, at its last briefing Jan. 12.As of then, about 800 kids had been enrolled in the trial over a month, he said, out of about 3,000 needed.

Moderna's treatment was authorized can you get ventolin over the counter for people 18 and over in December, weeks after it began its trial in adolescents. Pfizer lowered the age of its trial to 12 in October."While enrollment was lower over the holiday can you get ventolin over the counter season, we expect to see an increase in the new year as planned," Moderna spokeswoman Colleen Hussey said Friday. "We are on track to provide updated data around mid-year 2021."AstraZeneca, whose Oxford University-developed treatment is in late-stage trials in the U.S.

And authorized in the U.K., told CNBC Friday it can you get ventolin over the counter plans to continue U.K. Trials in a new protocol for kids between ages 5 and 18 can you get ventolin over the counter "beginning in the coming months."Johnson &. Johnson, whose phase three results in adults are expected imminently, said it's can you get ventolin over the counter in discussions with regulators about including pediatric populations in its development plan.

It noted the same technology it's using for the asthma treatment has been used in treatments given to more than 200,000 people, including people over 65, infants, children, HIV-positive adults and pregnant women.Typically treatment trials proceed into younger age groups after they're proven safe and effective in older groups, and the manufacturers of asthma treatments have indicated they'll follow that plan here as well.Moderna's chief executive, Stephane Bancel, said this month it's unlikely the company would have data in kids age 11 and younger, which would involve a lower dose, before next year. He said he expects data for kids 12 and up may be available before September.Public health officials in the U.S., like White House chief can you get ventolin over the counter medical adviser Dr. Anthony Fauci, have said they can you get ventolin over the counter hope as much as 75% to 80% of the U.S.

Population could be vaccinated by the fall to enable life to return to some form of normalcy.About 78% of the U.S. Population, or 255 million people, are over can you get ventolin over the counter the age of 18, according to a CNBC analysis of Census data. Another 25 million people are aged 12 to 17.Fauci didn't immediately respond to an inquiry about whether including kids in vaccinations is necessary to reach his goal of 75% to 80% coverage."It's important can you get ventolin over the counter for all kids to get vaccinated and the manufacturers can't do those trials quickly enough," Angela Rasmussen, a virologist and affiliate at the Georgetown Center for Global Health Science and Security, told CNBC Friday.

"The more people of any can you get ventolin over the counter age vaccinated, the better."U.S. President Joe Biden speaks about his administration's plans to respond to the economic crisis during a asthma disease (asthma treatment) response event in the State Dining Room at the White House in Washington, January 22, 2021.Jonathan Ernst | ReutersPresident Joe Biden has painted a bleak picture of the nation's asthma outbreak in his first few days in office, warning that it will take months to turn around the ventolin's trajectory and that fatalities are expected to dramatically rise over the next few weeks."A lot of America is hurting. The ventolin is surging can you get ventolin over the counter.

We're 400,000 dead expected to reach well over 600,000," Biden said on Friday before signing two executive orders designed to reduce hunger and bolster workers' rights can you get ventolin over the counter amid the ventolin.The U.S. Surpassed 400,000 total asthma treatment deaths on Tuesday, with a quarter of those coming over the previous 36 days, according to data compiled by Johns Hopkins University. On Biden's first full day as can you get ventolin over the counter president on Thursday, he told reporters following a meeting with his asthma treatment advisors, including Dr.

Anthony Fauci, that the nation would likely top 500,000 asthma treatment deaths in February.Biden warned on Friday that as the outbreak continues, "there's nothing we can do to change the trajectory of the ventolin in the next several months." The president has repeatedly warned that the situation is likely to worsen before it can you get ventolin over the counter improves.While it wasn't immediately made clear what projections Biden was referencing, one key projection from Institute for Health Metrics and Evaluation estimates that the U.S. Could reach 600,000 asthma treatment deaths by March can you get ventolin over the counter if states were to ease social distancing mandates. However, the model's current projections show asthma treatment deaths plateauing just above 560,000 asthma treatment deaths by late April.A spokesperson for the Biden administration was not immediately available for comment regarding the president's projections.The United States has reported a decline in asthma treatment cases in recent days, a glimmer of hope following a surge since the fall and through the winter holiday season.

The U.S can you get ventolin over the counter. Is reporting an average of roughly 187,593 new asthma treatment cases daily, a 22% decline compared with a week ago, according to a CNBC analysis of Johns Hopkins data.However, the nation is still "in a very serious situation," Fauci said during his first White House press briefing appearance under the new administration on Thursday, noting the country's high death toll and strained hospital capacity.Fauci said that the daily number of cases, based on a weekly average, appears to can you get ventolin over the counter be plateauing and turning around. It's possible that the dip could still be because of a reduced reporting following the holidays, he added."When we see that, we think it's real," Fauci said.Biden's warnings come as the country races to administer 100 million asthma treatment shots within the first 100 days in his administration.

The nation's treatment rollout has been slow to start, can you get ventolin over the counter though health experts have said that Biden's 100 million shots goal is doable.The pace of vaccinations have picked up over the last week. The U.S can you get ventolin over the counter. Has administered 1.6 million asthma treatments between Thursday and Friday, according to recent data from can you get ventolin over the counter the Centers for Disease Control and Prevention, suggesting that 100 million shots in 100 days would be a feasible goal if that daily count continues.Biden has dismissed the idea that the goal might be too low of a threshold, claiming that he was told before he took office that the aim might be too high.

Biden's spokesperson didn't respond to CNBC's question regarding the president's comments."I find it fascinating that yesterday the press asked the question, 'Is 100 million enough?. ' The week before they said, 'Biden, are you crazy? can you get ventolin over the counter. You can't do 100 million in 100 days," the president said during can you get ventolin over the counter the Friday press briefing.

"We're, God willing, not only going to do 100 million, we're going to do more than that."— CNBC's Jacob Pramuk and Nate Rattner contributed to this report..

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Over the last decade, Medicare Advantage, the private how many times a day can you use ventolin plan alternative to traditional Medicare, has taken on a larger role in the Medicare program. In 2020, more than 24 million Medicare beneficiaries are enrolled in a Medicare Advantage plan. This brief provides an overview of the Medicare Advantage plans that are available for 2021 and key trends over time.Plan Offerings in 2021Number of PlansNumber how many times a day can you use ventolin of Plans Available to Beneficiaries. For 2021, the average Medicare beneficiary has access to 33 Medicare Advantage plans, the largest number of options available in the last decade (Figure 1).Figure 1.

The average Medicare beneficiary has access to 33 Medicare Advantage plans in 2021, an increase from prior yearsAmong the 33 Medicare Advantage plans generally available for individual enrollment to the average Medicare how many times a day can you use ventolin beneficiary, 27 of the plans include prescription drug coverage (MA-PDs). These numbers exclude employer or union-sponsored group plans, Special Needs Plans (SNPs) and PACE plans, which are only available to select populations.Total Number of Plans. In total, 3,550 Medicare Advantage plans are available nationwide for individual enrollment in 2021 – a 13 percent increase (402 more plans) from 2020 and how many times a day can you use ventolin the largest number of plans ever available (Figure 2. Appendix Table 1).

The vast majority (89 percent) of all Medicare Advantage plans offered how many times a day can you use ventolin include prescription drug coverage in 2021. .As in prior years, HMOs continue to account for about two-thirds (62%) of all plans offered in 2021. The availability of local PPOs has increased rapidly over recent how many times a day can you use ventolin years. In 2021, one-third of plans offered are local PPOs, compared to a quarter in 2018.

Between 2020 and 2021, the number of regional PPOs has remained constant, while the number of private fee-for-service plans has continued to decline.The growth in number of plans varies across states and counties, with the preponderance of the growth occurring in Florida and California (41 more and 30 how many times a day can you use ventolin more plans, respectively. Data not shown). Virginia has 6 fewer plans available for how many times a day can you use ventolin 2021 than in 2020, while South Carolina has 3 fewer plans, and Maryland and Nebraska each have one fewer plan available in 2021 than in 2020.While many employers and unions also offer Medicare Advantage plans to their retirees, no information about these 2021 plan offerings is made available by CMS to the public during the Medicare open enrollment period because these plans are not available to the general Medicare population.One notable change for 2021 is that people with end-stage renal disease (ESRD) are eligible to enroll in Medicare Advantage plans. Prior to this change, people with ESRD were not able to enroll in most Medicare Advantage plans, subject to limited exceptions, such as C-SNPS for people with ESRD.Special Needs Plans (SNPs).

More SNPs are available for 2021 than in any year since they were authorized, increasing from 855 plans in 2020 to 975 plans in 2021, a 14 percent increase (Figure 3). .The rise in SNPs for people who require how many times a day can you use ventolin an institutional-level of care (I-SNPs) has been particularly notable, more than doubling from 83 plans in 2017 to 174 plans in 2021. I-SNPs may be attractive to insurers because they tend to have much lower marketing costs than other plan types since they are often the only available option for people to receive their Medicare benefits in certain retirement communities and nursing homes. The number of SNPs for how many times a day can you use ventolin people dually eligible for Medicare and Medicaid (D-SNPs) has also increased sharply over the past five years, rising from 373 dual SNPs in 2017 to 598 dual SNPs in 2021, a 60% increase, suggesting insurers’ continue to be interested in managing the care of this high-need population.The number of SNPs offered for people with chronic conditions (C-SNPs) is also increasing in 2021, most of which focus on people with diabetes, heart disease, or lung conditions, as has been the case since the inception of C-SNPs.

For 2021, three firms are offering C-SNPs for people with dementia (the same as 2020), two firms are offering a C-SNP for people with mental health conditions (up one from 2020), three firms are offering C-SNPs for people with end-stage renal disease (one fewer than 2020) and two firms are offering C-SNPs for people with HIV/AIDS (similar to 2020).Variation in the Number of Plans, by Geographic Area. On average, beneficiaries in metropolitan areas can choose from about twice as many Medicare Advantage plans as beneficiaries in non-metropolitan areas (36 plans versus 20 plans, respectively).In 11 percent of counties (accounting for 41% how many times a day can you use ventolin of beneficiaries), beneficiaries can choose from more than 35 plans in 2021, including eleven counties in Ohio and five counties in Pennsylvania where more than 60 Medicare Advantage plans are available (Figure 4). In contrast, in 4 percent of counties (accounting for 1% of beneficiaries), beneficiaries can choose from two or fewer Medicare Advantage plans. The number how many times a day can you use ventolin of counties with no Medicare Advantage plans for 2021 is 82, similar to 2020.

As in prior years, there are no Medicare Advantage plans offered in Alaska. Additionally, no Medicare Advantage plans are available in territories other than Puerto Rico how many times a day can you use ventolin. .Access to Medicare Advantage Plans, by Plan TypeAs in recent years, virtually all Medicare beneficiaries (99%) have access to a Medicare Advantage plan as an alternative to traditional Medicare, including almost all beneficiaries in metropolitan areas (99.9%) and the vast majority of beneficiaries in non-metropolitan areas (97.7%). In non-metropolitan counties, a smaller share of beneficiaries have access to HMOs (87% in non-metropolitan versus 99% in metropolitan counties) or local PPOs (89% in non-metropolitan versus 96% in metropolitan counties), and a slightly larger share of beneficiaries have access to regional PPOs (77% in non-metropolitan counties versus 72% in metropolitan how many times a day can you use ventolin counties).

Number of FirmsThe average Medicare beneficiary is able to choose from plans offered by 8 firms in 2021, one more than in 2020 (Figure 5). Despite most beneficiaries having how many times a day can you use ventolin access to plans operated by several different firms, enrollment is concentrated in plans operated by UnitedHealthcare, Humana, and Blue Cross Blue Shield affiliates.Figure 5. More than one-quarter of beneficiaries can choose among Medicare Advantage plans offered by 10 or more firmsMore than one-quarter of beneficiaries (27%) are able to choose from plans offered by 10 or more firms. Fifteen or more firms are offering Medicare Advantage plans in three counties.

Orange County, California how many times a day can you use ventolin and Summit and Medina Counties in Ohio. In contrast, in 109 counties, most of which are rural counties with relatively few Medicare beneficiaries (1% of total), only one firm will offer Medicare Advantage plans in 2021. Over the past several years, the number of counties with a single firm offering Medicare Advantage plans how many times a day can you use ventolin has fallen substantially. As recently as 2019, there was a single firm offering plans in nearly 200 counties.UnitedHealthcare and Humana, the two firms with the most Medicare Advantage enrollees in 2020, have large footprints across the country, offering plans in most counties.

Humana is offering plans in 84 percent of counties and UnitedHealthcare is offering plans in 66 how many times a day can you use ventolin percent of counties in 2021 (Figure 6). More than 8 in 10 (87%) Medicare beneficiaries have access to at least one Humana plan and 86 percent have access to at least one UnitedHealthcare plans. .Most major how many times a day can you use ventolin Medicare Advantage firms have also expanded the number of counties where they are offering plans. UnitedHealthcare is offering plans in 2,117 counties in 2021, an increase of 245 from 2021, while Humana is offering plans in 2,703 counties in 2021, an increase of 33 from 2020.

Centene is offering plans in 1,129 counties in 2021, an how many times a day can you use ventolin increase of 261 plans from 2020. Blue Cross Blue Shield Affiliates are offering plans in 1,181 counties, an increase of 152 plans. CVS Health how many times a day can you use ventolin is offering plans in 1,759 counties, an increase of 119 plans. And Cigna is offering plans in 369 counties, an increase of 67 plans.

Kaiser Permanente had the smallest growth and is offering plans in 109 counties, an increase how many times a day can you use ventolin of 4 plans.New Market Entrants and ExitsMedicare Advantage continues to be an attractive market for insurers, with 14 firms entering the market for the first time in 2021, collectively accounting for about 6 percent of the growth in the number of plans available for general enrollment and about 10 percent of the growth in SNPs (Appendix Table 2). Nine new entrants are offering HMOs available for individual enrollment. Five of the how many times a day can you use ventolin new entrants are offering SNPs. Three firms are offering D-SNPs for people dually eligible for Medicaid, three firms are offering C-SNPs for people with select chronic conditions, and one firm is offering an I-SNPs Four of the new firm entrants are offering plans in California, two are offering plans in Indiana, and the remainder are offering plans in at least one of ten other states (Colorado, Georgia, Illinois, Mississippi, Missouri, Ohio, Texas, Utah, and Wisconsin).Six firms that previously participated in the Medicare Advantage market are not offering plans in 2021.

Two of the firms (ApexHealth, Inc. And Clarion Health) offered plans for the first time in 2020, but how many times a day can you use ventolin did not appear to enroll any participants. The other four firms had very low enrollment in 2020. Three of the six exiting firms offered plans how many times a day can you use ventolin in New York.PremiumsThe vast majority of Medicare Advantage plans for individual enrollment (89%) will include prescription drug coverage (MA-PDs), and 54 percent of these plans will charge no premium, other than the Part B premium, similar to 2020.

More than nine out of ten beneficiaries (96%) have access to a MA-PD with no monthly premium in 2021. However, in Wyoming, beneficiaries do not have access to a zero-premium MA-PD, and in Idaho, how many times a day can you use ventolin less than half of beneficiaries have access to a zero-premium MA-PD.In 2020, 60 percent of enrollees in MA-PD plans pay no premium other than the Medicare Part B premium of $144.60 per month. Based on enrollment in March 2020, nearly one in five enrollees (18%) pay at least $50 a month, and 6 percent pay $100 or more. CMS announced that the average monthly plan premium among all Medicare Advantage enrollees in 2021, including those who pay how many times a day can you use ventolin no premium for their Medicare Advantage plan, is expected to decrease 11 percent from 2020 to $21 a month.

CMS does not disclose the methods or assumptions used in deriving their calculations, but since most Medicare Advantage enrollees pay no additional premium, the average they report is heavily influenced by zero-premium plans, and does not reflect the average premium paid by those who are in plans with an additional premium.Extra BenefitsMedicare Advantage plans may provide extra benefits that are not available in traditional Medicare, are considered “primarily health related,” and can use rebate dollars (including bonus payments) to help cover the cost of these extra benefits. Beginning in 2019, CMS expanded the definition of “primarily health related” to allow Medicare Advantage plans how many times a day can you use ventolin to offer additional supplemental benefits. Medicare Advantage plans may also restrict the availability of these extra benefits to certain subgroups of beneficiaries, such as those with diabetes or congestive heart failure, making different benefits available to different enrollees.Beginning in 2020, Medicare Advantage plans have also been able to offer extra benefits that are not primarily health related for chronically ill beneficiaries, known as Special Supplemental Benefits for the Chronically Ill (SSBCI). Information on the availability of SSBCI for 2021 has not yet been published by CMS, but may include services such as how many times a day can you use ventolin pest control, food and produce (beyond a limited basis), and non-medical transportation.

Since plans are permitted to offer these benefits non-uniformly to enrollees, it will be important to examine how these benefits are distributed across subgroups of enrollees.Availability of Extra Benefits in Plans for General Enrollment. Historically, the most offered extra benefits how many times a day can you use ventolin were fitness, dental, vision, and hearing. Nearly two-thirds of plans (68%) provide all four of these benefits for 2021. Though these benefits are widely available, the scope of specific services varies.

For example, how many times a day can you use ventolin a dental benefit may include cleanings only or more comprehensive coverage. As of 2020, Medicare Advantage plans have also been allowed to offer more telehealth benefits than traditional Medicare (though Medicare has temporarily expanded these benefits during the ventolin). The vast majority (98%) of Medicare Advantage plans are offering telehealth in 2021 how many times a day can you use ventolin (up from 91% in 2020) (Figure 7).Figure 7. Most Medicare Advantage plans provide fitness and dental benefits but much fewer provide in-home or caregiver supportOther extra benefits that are frequently offered for 2021 include over the counter items (75%), meal benefits, such as a cooking class, nutrition education, or meal delivery (55%), and transportation benefits (36%).Less than 10 percent of plans provide bathroom safety devices (6%) or in-home support (6%).Availability of Extra Benefits in Special Needs Plans.

SNPs are designed to serve a disproportionately high-need population, and a somewhat larger percentage of SNPs than plans for how many times a day can you use ventolin other Medicare beneficiaries provide their enrollees with over the counter items (91%), transportation benefits (85%) and meal benefits (63%). Similar to plans available for general enrollment, a relatively small share of SNPs provide bathroom safety devices (11%) or in-home support (18%).Access to Extra Benefits. Virtually all Medicare beneficiaries live in a county where at least one Medicare how many times a day can you use ventolin Advantage plan available for general enrollment has some extra benefits not covered by traditional Medicare, with 98% having access to some dental, fitness, vision, and hearing benefits for 2021. The vast majority of beneficiaries also have access to telehealth benefits (99%), over the counter items (99%), transportation assistance (95%) and a meal benefit (98%), but far fewer have access to bathroom safety (55%) or in-home support (62%).DiscussionMore Medicare Advantage plans are being offered for 2021 than in any other year.

Fourteen insurers are entering the Medicare Advantage market for the first time, and six insurers are exiting the market, suggesting thatMedicare Advantage remains an attractive, profitable market how many times a day can you use ventolin for insurers. As in prior years, some (mostly non-metropolitan) counties are less attractive to insurers, with fewer firms and plans available, though the number of areas where this is the case has declined over time. Overall, more than how many times a day can you use ventolin 99 percent of beneficiaries will have access to one or more Medicare Advantage plans in 2021, similar to prior years. With more firms offering SNPs and the number of SNPs rapidly growing, there may be greater focus on how well high-need, vulnerable beneficiaries are being served by Medicare Advantage plans, including SNPs as well as plans for general enrollment.

As Medicare Advantage enrollment continues to grow, insurers how many times a day can you use ventolin seem to be responding by offering more plans and choices to the people on Medicare. This analysis focuses on the Medicare Advantage marketplace in 2021 and trends over time. The analysis includes more than 24 million enrollees in Medicare Advantage plans in 2020.Data on Medicare Advantage plan availability, enrollment, and premiums were collected from a set of data files released by the Centers for Medicare &. Medicaid Services (CMS):Medicare Advantage plan landscape files, released each fall prior to the annual enrollment periodMedicare Advantage plan and premium files, released each fallMedicare Advantage plan crosswalk files, released each fallMedicare how many times a day can you use ventolin Advantage contract/plan/state/county level enrollment files, released on a monthly basisMedicare Advantage plan benefit package files, released each fallMedicare Enrollment Dashboard files, released on a monthly basisIn previous years, KFF has used the Medicare Advantage Penetration Files to calculate the number of Medicare beneficiaries eligible for Medicare.

The Medicare Advantage Penetration Files includes people who were previously, but no longer covered by Medicare (e.g., people who obtained employer-sponsored health insurance coverage after initially enrolling in Medicare). It also includes people within 5 months of their 65th birthday, but not yet age how many times a day can you use ventolin 65. In addition, CMS has identified an issue where beneficiaries with multiple addresses were double counted in the Penetration File. KFF has refined its approach this year and is using the Medicare Enrollment Dashboard to calculate the number of Medicare beneficiaries because it only includes how many times a day can you use ventolin Medicare beneficiaries with either Part A or Part B coverage, which is a more accurate estimate of the Medicare population.

The numbers published here supersede all prior estimates by KFF of the number of Medicare beneficiaries.Jeannie Fuglesten Biniek, Meredith Freed, and Tricia Neuman are with KFF.Anthony Damico is an independent consultant.During the Medicare open enrollment period from October 15 to December 7 each year, beneficiaries can enroll in a plan that provides Part D drug coverage, either a stand-alone prescription drug plan (PDP) as a supplement to traditional Medicare, or a Medicare Advantage prescription drug plan (MA-PD), which covers all Medicare benefits, including drugs. Among the 46 million Part D enrollees in 2020, 20.2 million (44%) are in PDPs and 19.3 how many times a day can you use ventolin million (41%) are in MA-PDs (excluding the 7.0 million (15%) in employer-only group PDPs and MA-PDs). This issue brief provides an overview of Medicare Part D drug plans that will be available in 2021 and key trends over time.Part D Plan AvailabilityThe Average Medicare Beneficiary Has a Choice of Nearly 60 Medicare Plans with Part D Drug Coverage in 2021, Including 30 Medicare Stand-alone Drug Plans and 27 Medicare Advantage Drug PlansFigure 1. The Average Medicare Beneficiary Has a Choice of Nearly 60 Medicare Plans Offering Drug Coverage in 2021, Including 30 Stand-alone Drug Plans and 27 Medicare Advantage Drug PlansA larger number of Part D plans how many times a day can you use ventolin will be offered in 2021 than in recent years.

The average Medicare beneficiary will have a choice of 30 stand-alone PDPs in 2021, two more PDP options than in 2020, and eight more than in 2017, a 36% increase (Figure 1). Although the number of PDP options in 2021 is half of what it was at the peak in 2007 (when there were 56 PDP options, on average), this is the fourth year in a row with an increase in the average number of stand-alone drug plan options.In 2021, beneficiaries will also have access to 27 MA-PDs, on average, a 71% increase in MA-PD options since 2017 (excluding Medicare Advantage plans that do not offer the drug benefit and how many times a day can you use ventolin plans not available to all beneficiaries. Overall, an average of 33 Medicare Advantage plan options will be available in 2021).Based on September 2020 enrollment, 8 out of 10 PDP enrollees (80%) in 2021 are projected to be in PDPs operated by just four firms. UnitedHealth, Centene (which acquired WellCare in 2020), Humana, and how many times a day can you use ventolin CVS Health (based on PDP enrollment as of September 2020).

All four firms offer PDPs in all 34 PDP regions in 2021.A Total of 996 Medicare Part D Stand-Alone Prescription Drug Plans Will Be Offered in 2021, a 5% Increase From 2020 and a 34% Increase Since 2017 Figure 2. A Total of 996 Medicare Part D Stand-Alone Prescription Drug Plans Will Be Offered in 2021, a 5% Increase From 2020 and a 34% Increase Since 2017​A total of 996 PDPs will be offered in the 34 PDP regions in 2021 (plus another 11 PDPs in the territories), an increase of 48 PDPs (5%) over 2020, and 250 more PDPs (a 34% increase) since 2017 (Figure 2). This increase is primarily due to the Trump Administration’s elimination of the “meaningful difference” requirement for enhanced benefit PDPs offered by the how many times a day can you use ventolin same organization in the same region. Eliminating this requirement means that PDP sponsors no longer have to demonstrate that their enhanced PDPs offered in the same region are meaningfully different in terms of enrollee out-of-pocket costs.

In 2021, 62% of how many times a day can you use ventolin PDPs (618 plans) will offer enhanced Part D benefits—a 60% increase in the availability of enhanced-benefit PDPs since 2017, when just over half of PDPs (387 plans) offered enhanced benefits.The number of PDPs per region in 2021 will range from 25 PDPs in Alaska to 35 PDPs in Texas and will be the same or higher in 32 of the 34 PDP regions compared to 2020 (see map, Table 1). Part D PremiumsThe Estimated Average Monthly Premium for Medicare PDPs Is Projected to Increase by 9% to $41 in 2021, Based on Current EnrollmentFigure 3. The Estimated Average Monthly Premium for Medicare PDPs Is Projected to Increase by 9% to $41 in 2021, Based on Current Enrollment​The estimated national average monthly PDP premium for 2021 is projected to how many times a day can you use ventolin increase by 9% to $41, from $38 in 2020, weighted by September 2020 enrollment (Figure 3). It is likely that the actual average weighted premium for 2021, after taking into account enrollment choices by new enrollees and plan changes by current enrollees, will be somewhat lower than the estimated average.

CMS reported that the average premium for basic Part D coverage offered by PDPs how many times a day can you use ventolin and MA-PDs will be an estimated $30 in 2021. Our premium estimate is higher because it is based on PDPs only (excluding MA-PDs) and includes PDPs offering both basic and enhanced coverage (enhanced plans, which account for 62% of all PDPs in 2021, have higher premiums than basic plans, on average).Average Monthly Premiums for the 21 National Part D Stand-alone PDPs Are Projected to Range from $7 to $89 in 2021, with Higher Average Premiums for Enhanced Benefits and Zero-Deductible PDPsFigure 4. Average Monthly Premiums for the 21 National Part D Stand-alone Drug Plans Are Projected to Range from $7 to $89 in 2021​PDP premiums will vary widely across plans how many times a day can you use ventolin in 2021, as in previous years (Figure 4, Table 2). Among the 21 PDPs available nationwide, average premiums will range from a low of $7 per month for SilverScript SmartRx to a high of $89 per month for AARP MedicareRx Preferred.Changes to premiums from 2020 to 2021, averaged across regions and weighted by 2020 enrollment, also vary widely across PDPs, as do the absolute amounts of monthly premiums for 2021.The 1.9 million non-LIS enrollees in the largest PDP, CVS Health’s SilverScript Choice (which had a total of 3.9 million enrollees in 2020, including those receiving low-income subsidies) will face a modest $1 (2%) decrease in their average monthly premium, from $29 in 2020 to $28 in 2021.In contrast, the 1.8 million non-LIS enrollees in the second largest PDP, AARP MedicareRx Preferred, will face a $10 (12%) increase in their average monthly premium between 2020 and 2021, from $79 to $89.

This is the highest monthly premium among the national PDPs in 2021.The 1.3 million non-LIS enrollees in the fourth largest PDP, Humana Premier Rx, will see a $7 (13%) increase in their monthly premium, from $58 in 2020 to $65 in 2021.Most how many times a day can you use ventolin Part D stand-alone drug plans in 2021 (62% of PDPs) will offer enhanced benefits for a higher monthly premium. Enhanced benefits can include a lower (or no) deductible, reduced cost sharing, or a higher initial coverage limit than under the standard benefit design. The average premium in 2021 for enhanced benefit how many times a day can you use ventolin PDPs is $51, which is 55% higher than the monthly premium for PDPs offering the basic benefit ($33) (weighted by September 2020 enrollment).In 2021, a large majority of PDPs (86%) will charge a deductible, with most PDPs (67%) charging the standard amount of $445 in 2021. Across all PDPs, the average deductible in 2021 will be $345 (weighted by September 2020 enrollment).

The average monthly premium in 2021 for PDPs that charge no deductible is $88, nearly three times the monthly premium for PDPs that charge the standard deductible ($34) or a partial deductible ($31) (weighted by September 2020 enrollment).Nearly 8 in 10 Part D Stand-alone Drug Plan Enrollees Without how many times a day can you use ventolin Low-income Subsidies Will Pay Higher Premiums in 2021 If They Stay in Their Current PlanFigure 5. Nearly 8 in 10 Part D Stand-alone Drug Plan Enrollees Without Low-income Subsidies Will Pay Higher Premiums in 2021 If They Stay in Their Current Plan​Most (78%, or 10 million) of the 13.4 million Part D PDP enrollees who are responsible for paying the entire premium (which excludes Low-Income Subsidy (LIS) recipients) will see their monthly premium increase in 2021 if they stay in their same plan, while 2.8 million (21%) will see a premium reduction if they stay in their same plan (Figure 5).Nearly 2 million non-LIS enrollees (13%) will see a premium increase of $10 or more per month, while significantly fewer (0.2 million non-LIS enrollees, or 1%) will see a premium reduction of the same magnitude. One-third (34%) of non-LIS enrollees (4.6 million) are projected to pay monthly premiums of at least $60 if they stay in their current plans, and more than 230,000 (2% of non-LIS enrollees) are projected to pay monthly premiums of at least $100.The Average Monthly Part D Premium in 2021 for the Subset of Enhanced Stand-alone Drug Plans Covering Insulin at a $35 Monthly Copay Is Substantially Higher Than Premiums for Other PDPsFigure 6. The Average Monthly Part D Premium in 2021 for the Subset of Enhanced Stand-alone Drug Plans Covering Insulin at a $35 Monthly Copay is Substantially Higher than Premiums for Other Plans​New for 2021, beneficiaries in each state will have the option to enroll in a Part D plan participating in the Trump Administration’s new Innovation Center model in which enhanced drug plans cover insulin products at a monthly copayment of $35 in the deductible, initial how many times a day can you use ventolin coverage, and coverage gap phases of the Part D benefit.

Participating plans do not have to cover all insulin products at the $35 monthly copayment amount, just one of each dosage form (vial, pen) and insulin type (rapid-acting, short-acting, intermediate-acting, and long-acting).In 2021, a total of 1,635 enhanced Part D plans will participate in this model, which represents just over 30% of both PDPs (310 plans) and MA-PDs (1,325 plans) available in 2021, including plans in the territories. Between 8 and 10 enhanced PDPs in each region how many times a day can you use ventolin are participating in the model, in addition to multiple MA-PDs (see map). The average premium in 2021 for the subset of enhanced PDPs participating in the insulin $35 copay model ($59) is nearly twice as high as the monthly premium for basic PDPs ($33) and 61% higher than the average premium for enhanced PDPs that are not participating in the model ($37) (weighted by September 2020 enrollment). Part D Cost SharingPart D Enrollees Will Pay Much Higher Cost-Sharing Amounts for how many times a day can you use ventolin Brands and Non-preferred Drugs Than For Drugs on a Generic Tier, and a Mix of Copays and Coinsurance for Different Formulary TiersFigure 7.

In 2021, Part D Enrollees Will Pay Much Higher Cost-Sharing Amounts for Brands and Non-preferred Drugs than for Drugs on a Generic Tier, and a Mix of Copays and Coinsurance for Different Formulary Tiers​In 2021, as in prior years, Part D enrollees will face much higher cost-sharing amounts for brands and non-preferred drugs (which can include both brands and generics) than for drugs on a generic tier, and a mix of copayments and coinsurance for different formulary tiers (Figure 7). The typical how many times a day can you use ventolin five-tier formulary design in Part D includes tiers for preferred generics, generics, preferred brands, non-preferred drugs, and specialty drugs. Among all PDPs, median standard cost sharing in 2021 is $0 for preferred generics and $5 for generics (an increase from $4 in 2020), $40 for preferred brands (a decrease from $42 in 2020), 40% coinsurance for non-preferred drugs (an increase from 38% in 2020. The maximum allowed is 50%), and 25% coinsurance for specialty drugs (the how many times a day can you use ventolin same as in 2020.

The maximum allowed is 33%).Among the 21 national PDPs, 13 PDPs, covering 9.3 million enrollees as of September 2020, are increasing cost-sharing amounts for drugs on at least one formulary tier between 2020 and 2021 (Table 3). Five PDPs are increasing copayments for generics, with increases ranging from $1 how many times a day can you use ventolin to $4. Six PDPs are increasing copayments for preferred brands, with increases ranging from $3 to $10. And 10 PDPs are increasing coinsurance for non-preferred drugs, with increases ranging from 2 percentage points (e.g., from a 38% coinsurance rate to 40%) to 14 percentage points (e.g., from a 35% coinsurance rate to 49%).Low-Income Subsidy Plan AvailabilityIn 2021, 259 Part D Stand-Alone Drug how many times a day can you use ventolin Plans Will Be Premium-Free to Enrollees Receiving the Low-Income Subsidy (Benchmark Plans)Figure 8.

In 2021, 259 Part D Stand-Alone Drug Plans Will Be Available Without a Premium to Enrollees Receiving the Low-Income Subsidy (“Benchmark” Plans)​In 2021, a larger number of PDPs will be premium-free benchmark plans—that is, PDPs available for no monthly premium to Medicare Part D enrollees receiving the Low-Income Subsidy (LIS)—than in recent years, with 259 premium-free benchmark plans, or roughly a quarter of all PDPs in 2021 (Figure 8). Through the Part D LIS program, enrollees with low incomes and modest assets are eligible for assistance with Part D plan premiums and cost sharing. As of 2020, approximately 13 million Part D enrollees are receiving LIS, including 6.7 million (52%) in PDPs how many times a day can you use ventolin and 6.1 million (48%) in MA-PDs.On average (weighted by Medicare enrollment), LIS beneficiaries have eight benchmark plans available to them for 2021, or about one-fourth the average number of PDP choices available overall. All LIS enrollees can select any plan offered in their area, but if they enroll in a non-benchmark plan, they must pay some portion of their chosen plan’s monthly premium.

In 2021, 10% of all LIS PDP enrollees who are eligible for premium-free Part D coverage how many times a day can you use ventolin (0.6 million LIS enrollees) will pay Part D premiums averaging $33 per month unless they switch or are reassigned by CMS to premium-free plans.The number of benchmark plans available in 2021 will vary by region, from five to 10 (see map). In 2020, 89% of the 6.6 million LIS PDP enrollees are projected to be in PDPs operated by five firms. CVS Health, Centene, Humana, UnitedHealth, and Cigna (based on 2020 how many times a day can you use ventolin enrollment). DiscussionOur analysis of the Medicare Part D stand-alone drug plan landscape for 2021 shows that millions of Part D enrollees without low-income subsidies will face premium and other cost increases in 2021 if they stay in their current stand-alone drug plan.

There are more plans available nationwide in 2021, with Medicare beneficiaries having 30 PDP choices during this year’s open enrollment period, plus 27 Medicare Advantage drug how many times a day can you use ventolin plan options. Most Part D PDP enrollees who remain in the same plan in 2021 will be in a plan with the standard $445 deductible and will face much higher cost sharing for brands than for generic drugs, including as much as 50% coinsurance for non-preferred drugs.Some Part D enrollees who choose to stay in their current plans may see lower premiums and other costs for their drug coverage, but nearly 8 in 10 non-LIS enrollees will face higher premiums if they remain in their current plan, and many will also face higher deductibles and cost sharing for covered drugs. Some beneficiaries might find the best coverage and costs for their specific medications in a plan with a relatively low premium, while for other how many times a day can you use ventolin beneficiaries, a higher-premium plan might be more suitable. Because Part D plans vary in a number of ways that can have a significant effect on an enrollee’s out-of-pocket spending, beyond the monthly premium, all Part D enrollees could benefit from the opportunity to compare plans during open enrollment.Juliette Cubanski is with KFF.Anthony Damico is an independent consultant.

This analysis how many times a day can you use ventolin focuses on the Medicare Part D stand-alone prescription drug plan marketplace in 2021 and trends over time. The analysis includes 20.2 million enrollees in stand-alone PDPs, as of March 2020. The analysis excludes 17.4 million MA-PD enrollees (non-employer), and another 4.6 million enrollees in employer-group only PDPs and 2.3 million in employer-group only MA-PDs for whom plan premium and benefits data are unavailable.Data on Part D plan availability, enrollment, and premiums were collected from a set of how many times a day can you use ventolin data files released by the Centers for Medicare &. Medicaid Services (CMS):– Part D plan landscape files, released each fall prior to the annual enrollment period– Part D plan and premium files, released each fall– Part D plan crosswalk files, released each fall– Part D contract/plan/state/county level enrollment files, released on a monthly basis– Part D Low-Income Subsidy enrollment files, released each spring– Medicare plan benefit package files, released each fallIn this analysis, premium estimates are weighted by September 2020 enrollment unless otherwise noted.

Percentage increases are calculated based on non-rounded estimates and in some cases differ from percentage calculations calculated based on rounded estimates presented in the text..

Over the last decade, Medicare Advantage, the private plan alternative to traditional Medicare, has taken on a larger can you get ventolin over the counter role in the Medicare http://markgrigsby.net/buy-cipro-no-prescription/ program. In 2020, more than 24 million Medicare beneficiaries are enrolled in a Medicare Advantage plan. This brief provides an overview of the Medicare Advantage plans that are available for 2021 and key trends can you get ventolin over the counter over time.Plan Offerings in 2021Number of PlansNumber of Plans Available to Beneficiaries. For 2021, the average Medicare beneficiary has access to 33 Medicare Advantage plans, the largest number of options available in the last decade (Figure 1).Figure 1.

The average Medicare beneficiary has access to 33 Medicare Advantage plans in 2021, an increase from prior yearsAmong the 33 Medicare can you get ventolin over the counter Advantage plans generally available for individual enrollment to the average Medicare beneficiary, 27 of the plans include prescription drug coverage (MA-PDs). These numbers exclude employer or union-sponsored group plans, Special Needs Plans (SNPs) and PACE plans, which are only available to select populations.Total Number of Plans. In total, 3,550 Medicare Advantage plans are available nationwide for individual can you get ventolin over the counter enrollment in 2021 – a 13 percent increase (402 more plans) from 2020 and the largest number of plans ever available (Figure 2. Appendix Table 1).

The vast majority (89 percent) of all Medicare Advantage plans can you get ventolin over the counter offered include prescription drug coverage in 2021. .As in prior years, HMOs continue to account for about two-thirds (62%) of all plans offered in 2021. The availability can you get ventolin over the counter of local PPOs has increased rapidly over recent years. In 2021, one-third of plans offered are local PPOs, compared to a quarter in 2018.

Between 2020 and 2021, the number of regional PPOs has remained constant, while the number of private fee-for-service plans has continued to decline.The growth in number of plans varies across states and counties, with the preponderance of the can you get ventolin over the counter growth occurring in Florida and California (41 more and 30 more plans, respectively. Data not shown). Virginia has 6 fewer plans available for 2021 than in 2020, while South Carolina has 3 fewer plans, and Maryland and Nebraska each have one fewer plan available in 2021 than in 2020.While many employers and unions also offer Medicare Advantage plans to their retirees, no information about these 2021 plan offerings is made available by CMS to the public during the Medicare open enrollment period because these can you get ventolin over the counter plans are not available to the general Medicare population.One notable change for 2021 is that people with end-stage renal disease (ESRD) are eligible to enroll in Medicare Advantage plans. Prior to this change, people with ESRD were not able to enroll in most Medicare Advantage plans, subject to limited exceptions, such as C-SNPS for people with ESRD.Special Needs Plans (SNPs).

More SNPs are available for 2021 than in any year since they were authorized, increasing from 855 plans in 2020 to 975 plans in 2021, a 14 percent increase (Figure 3). .The rise in SNPs for people who require an institutional-level of care (I-SNPs) can you get ventolin over the counter has been particularly notable, more than doubling from 83 plans in 2017 to 174 plans in 2021. I-SNPs may be attractive to insurers because they tend to have much lower marketing costs than other plan types since they are often the only available option for people to receive their Medicare benefits in certain retirement communities and nursing homes. The number of SNPs for people dually eligible for Medicare and Medicaid (D-SNPs) has also increased sharply over the past five years, rising from 373 dual SNPs in 2017 to 598 dual SNPs in 2021, a 60% increase, suggesting insurers’ continue to be interested in managing the care of this high-need population.The number of SNPs offered for people can you get ventolin over the counter with chronic conditions (C-SNPs) is also increasing in 2021, most of which focus on people with diabetes, heart disease, or lung conditions, as has been the case since the inception of C-SNPs.

For 2021, three firms are offering C-SNPs for people with dementia (the same as 2020), two firms are offering a C-SNP for people with mental health conditions (up one from 2020), three firms are offering C-SNPs for people with end-stage renal disease (one fewer than 2020) and two firms are offering C-SNPs for people with HIV/AIDS (similar to 2020).Variation in the Number of Plans, by Geographic Area. On average, beneficiaries in metropolitan areas can choose from about twice as many Medicare Advantage plans as beneficiaries in non-metropolitan areas (36 plans versus 20 plans, respectively).In 11 percent of counties (accounting for 41% of beneficiaries), beneficiaries can choose can you get ventolin over the counter from more than 35 plans in 2021, including eleven counties in Ohio and five counties in Pennsylvania where more than 60 Medicare Advantage plans are available (Figure 4). In contrast, in 4 percent of counties (accounting for 1% of beneficiaries), beneficiaries can choose from two or fewer Medicare Advantage plans. The number of counties with can you get ventolin over the counter no Medicare Advantage plans for 2021 is 82, similar to 2020.

As in prior years, there are no Medicare Advantage plans offered in Alaska. Additionally, no Medicare Advantage plans are can you get ventolin over the counter available in territories other than Puerto Rico. .Access to Medicare Advantage Plans, by Plan TypeAs in recent years, virtually all Medicare beneficiaries (99%) have access to a Medicare Advantage plan as an alternative to traditional Medicare, including almost all beneficiaries in metropolitan areas (99.9%) and the vast majority of beneficiaries in non-metropolitan areas (97.7%). In non-metropolitan counties, a smaller can you get ventolin over the counter share of beneficiaries have access to HMOs (87% in non-metropolitan versus 99% in metropolitan counties) or local PPOs (89% in non-metropolitan versus 96% in metropolitan counties), and a slightly larger share of beneficiaries have access to regional PPOs (77% in non-metropolitan counties versus 72% in metropolitan counties).

Number of FirmsThe average Medicare beneficiary is able to choose from plans offered by 8 firms in 2021, one more than in 2020 (Figure 5). Despite most beneficiaries having access to plans operated by several different firms, enrollment is concentrated in plans operated by can you get ventolin over the counter UnitedHealthcare, Humana, and Blue Cross Blue Shield affiliates.Figure 5. More than one-quarter of beneficiaries can choose among Medicare Advantage plans offered by 10 or more firmsMore than one-quarter of beneficiaries (27%) are able to choose from plans offered by 10 or more firms. Fifteen or more firms are offering Medicare Advantage plans in three counties.

Orange County, California and Summit and can you get ventolin over the counter Medina Counties in Ohio. In contrast, in 109 counties, most of which are rural counties with relatively few Medicare beneficiaries (1% of total), only one firm will offer Medicare Advantage plans in 2021. Over the past several years, the number of counties with a single firm offering Medicare Advantage plans can you get ventolin over the counter has fallen substantially. As recently as 2019, there was a single firm offering plans in nearly 200 counties.UnitedHealthcare and Humana, the two firms with the most Medicare Advantage enrollees in 2020, have large footprints across the country, offering plans in most counties.

Humana is offering plans in 84 percent of counties and UnitedHealthcare is offering plans in 66 percent can you get ventolin over the counter of counties in 2021 (Figure 6). More than 8 in 10 (87%) Medicare beneficiaries have access to at least one Humana plan and 86 percent have access to at least one UnitedHealthcare plans. .Most major Medicare Advantage firms have can you get ventolin over the counter also expanded the number of counties where they are offering plans. UnitedHealthcare is offering plans in 2,117 counties in 2021, an increase of 245 from 2021, while Humana is offering plans in 2,703 counties in 2021, an increase of 33 from 2020.

Centene is offering can you get ventolin over the counter plans in 1,129 counties in 2021, an increase of 261 plans from 2020. Blue Cross Blue Shield Affiliates are offering plans in 1,181 counties, an increase of 152 plans. CVS Health is offering plans in can you get ventolin over the counter 1,759 counties, an increase of 119 plans. And Cigna is offering plans in 369 counties, an increase of 67 plans.

Kaiser Permanente had the smallest growth and is offering plans in 109 counties, an increase of 4 plans.New Market Entrants and ExitsMedicare Advantage continues to be an attractive market for insurers, with 14 firms entering the market for the first time can you get ventolin over the counter in 2021, collectively accounting for about 6 percent of the growth in the number of plans available for general enrollment and about 10 percent of the growth in SNPs (Appendix Table 2). Nine new entrants are offering HMOs available for individual enrollment. Five of the new entrants are offering can you get ventolin over the counter SNPs. Three firms are offering D-SNPs for people dually eligible for Medicaid, three firms are offering C-SNPs for people with select chronic conditions, and one firm is offering an I-SNPs Four of the new firm entrants are offering plans in California, two are offering plans in Indiana, and the remainder are offering plans in at least one of ten other states (Colorado, Georgia, Illinois, Mississippi, Missouri, Ohio, Texas, Utah, and Wisconsin).Six firms that previously participated in the Medicare Advantage market are not offering plans in 2021.

Two of the firms (ApexHealth, Inc. And Clarion Health) offered plans for the first can you get ventolin over the counter time in 2020, but did not appear to enroll any participants. The other four firms had very low enrollment in 2020. Three of the six exiting firms offered plans in New York.PremiumsThe vast majority of Medicare Advantage plans for individual enrollment (89%) will include prescription drug coverage (MA-PDs), and 54 percent of these plans will charge no premium, other than the Part B premium, similar to 2020 can you get ventolin over the counter.

More than nine out of ten beneficiaries (96%) have access to a MA-PD with no monthly premium in 2021. However, in Wyoming, beneficiaries do not have access to a zero-premium MA-PD, and in can you get ventolin over the counter Idaho, less than half of beneficiaries have access to a zero-premium MA-PD.In 2020, 60 percent of enrollees in MA-PD plans pay no premium other than the Medicare Part B premium of $144.60 per month. Based on enrollment in March 2020, nearly one in five enrollees (18%) pay at least $50 a month, and 6 percent pay $100 or more. CMS announced that the average monthly can you get ventolin over the counter plan premium among all Medicare Advantage enrollees in 2021, including those who pay no premium for their Medicare Advantage plan, is expected to decrease 11 percent from 2020 to $21 a month.

CMS does not disclose the methods or assumptions used in deriving their calculations, but since most Medicare Advantage enrollees pay no additional premium, the average they report is heavily influenced by zero-premium plans, and does not reflect the average premium paid by those who are in plans with an additional premium.Extra BenefitsMedicare Advantage plans may provide extra benefits that are not available in traditional Medicare, are considered “primarily health related,” and can use rebate dollars (including bonus payments) to help cover the cost of these extra benefits. Beginning in 2019, CMS can you get ventolin over the counter expanded the definition of “primarily health related” to allow Medicare Advantage plans to offer additional supplemental benefits. Medicare Advantage plans may also restrict the availability of these extra benefits to certain subgroups of beneficiaries, such as those with diabetes or congestive heart failure, making different benefits available to different enrollees.Beginning in 2020, Medicare Advantage plans have also been able to offer extra benefits that are not primarily health related for chronically ill beneficiaries, known as Special Supplemental Benefits for the Chronically Ill (SSBCI). Information on the availability of SSBCI for 2021 has not yet been published by CMS, but may include services such as pest control, food and produce (beyond a limited basis), and can you get ventolin over the counter non-medical transportation.

Since plans are permitted to offer these benefits non-uniformly to enrollees, it will be important to examine how these benefits are distributed across subgroups of enrollees.Availability of Extra Benefits in Plans for General Enrollment. Historically, the most offered extra benefits were fitness, dental, vision, and hearing can you get ventolin over the counter. Nearly two-thirds of plans (68%) provide all four of these benefits for 2021. Though these benefits are widely available, the scope of specific services varies.

For example, can you get ventolin over the counter a dental benefit may include cleanings only or more comprehensive coverage. As of 2020, Medicare Advantage plans have also been allowed to offer more telehealth benefits than traditional Medicare (though Medicare has temporarily expanded these benefits during the ventolin). The vast majority (98%) of Medicare Advantage plans are offering telehealth can you get ventolin over the counter in 2021 (up from 91% in 2020) (Figure 7).Figure 7. Most Medicare Advantage plans provide fitness and dental benefits but much fewer provide in-home or caregiver supportOther extra benefits that are frequently offered for 2021 include over the counter items (75%), meal benefits, such as a cooking class, nutrition education, or meal delivery (55%), and transportation benefits (36%).Less than 10 percent of plans provide bathroom safety devices (6%) or in-home support (6%).Availability of Extra Benefits in Special Needs Plans.

SNPs are designed to serve a disproportionately high-need population, and a somewhat larger percentage of SNPs than plans for other Medicare beneficiaries provide their enrollees with over the counter items can you get ventolin over the counter (91%), transportation benefits (85%) and meal benefits (63%). Similar to plans available for general enrollment, a relatively small share of SNPs provide bathroom safety devices (11%) or in-home support (18%).Access to Extra Benefits. Virtually all Medicare beneficiaries live in a county where at least one Medicare Advantage plan available can you get ventolin over the counter for general enrollment has some extra benefits not covered by traditional Medicare, with 98% having access to some dental, fitness, vision, and hearing benefits for 2021. The vast majority of beneficiaries also have access to telehealth benefits (99%), over the counter items (99%), transportation assistance (95%) and a meal benefit (98%), but far fewer have access to bathroom safety (55%) or in-home support (62%).DiscussionMore Medicare Advantage plans are being offered for 2021 than in any other year.

Fourteen insurers are entering the Medicare Advantage market for the first time, and six insurers are exiting the market, suggesting thatMedicare Advantage remains can you get ventolin over the counter an attractive, profitable market for insurers. As in prior years, some (mostly non-metropolitan) counties are less attractive to insurers, with fewer firms and plans available, though the number of areas where this is the case has declined over time. Overall, more than 99 can you get ventolin over the counter percent of beneficiaries will have access to one or more Medicare Advantage plans in 2021, similar to prior years. With more firms offering SNPs and the number of SNPs rapidly growing, there may be greater focus on how well high-need, vulnerable beneficiaries are being served by Medicare Advantage plans, including SNPs as well as plans for general enrollment.

As Medicare Advantage enrollment continues to grow, can you get ventolin over the counter insurers seem to be responding by offering more plans and choices to the people on Medicare. This analysis focuses on the Medicare Advantage marketplace in 2021 and trends over time. The analysis includes more than 24 million enrollees in Medicare Advantage plans in 2020.Data on Medicare Advantage plan availability, enrollment, and premiums were collected from a set of data files released by the Centers for Medicare &. Medicaid Services (CMS):Medicare Advantage plan landscape files, released each fall prior to the can you get ventolin over the counter annual enrollment periodMedicare Advantage plan and premium files, released each fallMedicare Advantage plan crosswalk files, released each fallMedicare Advantage contract/plan/state/county level enrollment files, released on a monthly basisMedicare Advantage plan benefit package files, released each fallMedicare Enrollment Dashboard files, released on a monthly basisIn previous years, KFF has used the Medicare Advantage Penetration Files to calculate the number of Medicare beneficiaries eligible for Medicare.

The Medicare Advantage Penetration Files includes people who were previously, but no longer covered by Medicare (e.g., people who obtained employer-sponsored health insurance coverage after initially enrolling in Medicare). It also includes people can you get ventolin over the counter within 5 months of their 65th birthday, but not yet age 65. In addition, CMS has identified an issue where beneficiaries with multiple addresses were double counted in the Penetration File. KFF has refined its approach this year and is using the Medicare Enrollment Dashboard to calculate can you get ventolin over the counter the number of Medicare beneficiaries because it only includes Medicare beneficiaries with either Part A or Part B coverage, which is a more accurate estimate of the Medicare population.

The numbers published here supersede all prior estimates by KFF of the number of Medicare beneficiaries.Jeannie Fuglesten Biniek, Meredith Freed, and Tricia Neuman are with KFF.Anthony Damico is an independent consultant.During the Medicare open enrollment period from October 15 to December 7 each year, beneficiaries can enroll in a plan that provides Part D drug coverage, either a stand-alone prescription drug plan (PDP) as a supplement to traditional Medicare, or a Medicare Advantage prescription drug plan (MA-PD), which covers all Medicare benefits, including drugs. Among the 46 million Part D enrollees in 2020, 20.2 million (44%) are in PDPs and 19.3 million (41%) are in MA-PDs (excluding the 7.0 can you get ventolin over the counter million (15%) in employer-only group PDPs and MA-PDs). This issue brief provides an overview of Medicare Part D drug plans that will be available in 2021 and key trends over time.Part D Plan AvailabilityThe Average Medicare Beneficiary Has a Choice of Nearly 60 Medicare Plans with Part D Drug Coverage in 2021, Including 30 Medicare Stand-alone Drug Plans and 27 Medicare Advantage Drug PlansFigure 1. The Average Medicare Beneficiary Has a Choice of Nearly 60 Medicare Plans Offering Drug Coverage in 2021, Including 30 Stand-alone Drug Plans and 27 Medicare Advantage Drug PlansA larger number of Part D plans will be offered in 2021 than can you get ventolin over the counter in recent years.

The average Medicare beneficiary will have a choice of 30 stand-alone PDPs in 2021, two more PDP options than in 2020, and eight more than in 2017, a 36% increase (Figure 1). Although the number of PDP options in 2021 is half of what it was at the peak in 2007 (when there were 56 PDP options, on average), this is the fourth year in a row with an increase in the average number of stand-alone drug plan options.In 2021, beneficiaries will also have access to 27 MA-PDs, on average, a 71% increase in MA-PD options since 2017 (excluding Medicare Advantage plans that do not can you get ventolin over the counter offer the drug benefit and plans not available to all beneficiaries. Overall, an average of 33 Medicare Advantage plan options will be available in 2021).Based on September 2020 enrollment, 8 out of 10 PDP enrollees (80%) in 2021 are projected to be in PDPs operated by just four firms. UnitedHealth, Centene (which acquired WellCare in 2020), Humana, can you get ventolin over the counter and CVS Health (based on PDP enrollment as of September 2020).

All four firms offer PDPs in all 34 PDP regions in 2021.A Total of 996 Medicare Part D Stand-Alone Prescription Drug Plans Will Be Offered in 2021, a 5% Increase From 2020 and a 34% Increase Since 2017 Figure 2. A Total of 996 Medicare Part D Stand-Alone Prescription Drug Plans Will Be Offered in 2021, a 5% Increase From 2020 and a 34% Increase Since 2017​A total of 996 PDPs will be offered in the 34 PDP regions in 2021 (plus another 11 PDPs in the territories), an increase of 48 PDPs (5%) over 2020, and 250 more PDPs (a 34% increase) since 2017 (Figure 2). This increase can you get ventolin over the counter is primarily due to the Trump Administration’s elimination of the “meaningful difference” requirement for enhanced benefit PDPs offered by the same organization in the same region. Eliminating this requirement means that PDP sponsors no longer have to demonstrate that their enhanced PDPs offered in the same region are meaningfully different in terms of enrollee out-of-pocket costs.

In 2021, 62% of PDPs (618 plans) will offer enhanced Part D benefits—a 60% increase in the availability of enhanced-benefit PDPs since 2017, when just over half of PDPs (387 plans) offered enhanced benefits.The number of PDPs per region in 2021 will range from 25 PDPs in Alaska to 35 PDPs in can you get ventolin over the counter Texas and will be the same or higher in 32 of the 34 PDP regions compared to 2020 (see map, Table 1). Part D PremiumsThe Estimated Average Monthly Premium for Medicare PDPs Is Projected to Increase by 9% to $41 in 2021, Based on Current EnrollmentFigure 3. The Estimated Average Monthly Premium for Medicare PDPs Is Projected to Increase by 9% to $41 in 2021, Based on Current Enrollment​The estimated national average monthly PDP premium can you get ventolin over the counter for 2021 is projected to increase by 9% to $41, from $38 in 2020, weighted by September 2020 enrollment (Figure 3). It is likely that the actual average weighted premium for 2021, after taking into account enrollment choices by new enrollees and plan changes by current enrollees, will be somewhat lower than the estimated average.

CMS reported that the average premium for basic Part D coverage can you get ventolin over the counter offered by PDPs and MA-PDs will be an estimated $30 in 2021. Our premium estimate is higher because it is based on PDPs only (excluding MA-PDs) and includes PDPs offering both basic and enhanced coverage (enhanced plans, which account for 62% of all PDPs in 2021, have higher premiums than basic plans, on average).Average Monthly Premiums for the 21 National Part D Stand-alone PDPs Are Projected to Range from $7 to $89 in 2021, with Higher Average Premiums for Enhanced Benefits and Zero-Deductible PDPsFigure 4. Average Monthly Premiums for the 21 National Part D Stand-alone Drug Plans Are Projected to Range can you get ventolin over the counter from $7 to $89 in 2021​PDP premiums will vary widely across plans in 2021, as in previous years (Figure 4, Table 2). Among the 21 PDPs available nationwide, average premiums will range from a low of $7 per month for SilverScript SmartRx to a high of $89 per month for AARP MedicareRx Preferred.Changes to premiums from 2020 to 2021, averaged across regions and weighted by 2020 enrollment, also vary widely across PDPs, as do the absolute amounts of monthly premiums for 2021.The 1.9 million non-LIS enrollees in the largest PDP, CVS Health’s SilverScript Choice (which had a total of 3.9 million enrollees in 2020, including those receiving low-income subsidies) will face a modest $1 (2%) decrease in their average monthly premium, from $29 in 2020 to $28 in 2021.In contrast, the 1.8 million non-LIS enrollees in the second largest PDP, AARP MedicareRx Preferred, will face a $10 (12%) increase in their average monthly premium between 2020 and 2021, from $79 to $89.

This is the highest monthly premium among the national PDPs in 2021.The 1.3 million non-LIS enrollees in the fourth largest PDP, Humana Premier Rx, will see a $7 (13%) increase in their monthly premium, from $58 in 2020 to $65 in 2021.Most Part D stand-alone drug plans in 2021 (62% of PDPs) will can you get ventolin over the counter offer enhanced benefits for a higher monthly premium. Enhanced benefits can include a lower (or no) deductible, reduced cost sharing, or a higher initial coverage limit than under the standard benefit design. The average premium in 2021 for enhanced benefit PDPs is $51, which is 55% higher than the monthly premium for PDPs offering the basic benefit ($33) (weighted by September 2020 enrollment).In 2021, a large can you get ventolin over the counter majority of PDPs (86%) will charge a deductible, with most PDPs (67%) charging the standard amount of $445 in 2021. Across all PDPs, the average deductible in 2021 will be $345 (weighted by September 2020 enrollment).

The average monthly premium in 2021 for PDPs that charge no deductible is $88, nearly three times the monthly premium for PDPs that charge the standard deductible ($34) or a partial deductible ($31) (weighted by September 2020 enrollment).Nearly 8 in 10 Part D Stand-alone Drug Plan Enrollees Without Low-income Subsidies Will Pay Higher can you get ventolin over the counter Premiums in 2021 If They Stay in Their Current PlanFigure 5. Nearly 8 in 10 Part D Stand-alone Drug Plan Enrollees Without Low-income Subsidies Will Pay Higher Premiums in 2021 If They Stay in Their Current Plan​Most (78%, or 10 million) of the 13.4 million Part D PDP enrollees who are responsible for paying the entire premium (which excludes Low-Income Subsidy (LIS) recipients) will see their monthly premium increase in 2021 if they stay in their same plan, while 2.8 million (21%) will see a premium reduction if they stay in their same plan (Figure 5).Nearly 2 million non-LIS enrollees (13%) will see a premium increase of $10 or more per month, while significantly fewer (0.2 million non-LIS enrollees, or 1%) will see a premium reduction of the same magnitude. One-third (34%) of non-LIS enrollees (4.6 million) are projected to pay monthly premiums of at least $60 if they stay in their current plans, and more than 230,000 (2% of non-LIS enrollees) are projected to pay monthly premiums of at least $100.The Average Monthly Part D Premium in 2021 for the Subset of Enhanced Stand-alone Drug Plans Covering Insulin at a $35 Monthly Copay Is Substantially Higher Than Premiums for Other PDPsFigure 6. The Average Monthly Part D Premium in 2021 for the Subset of Enhanced Stand-alone Drug Plans Covering Insulin at a $35 Monthly Copay is Substantially Higher than Premiums for Other Plans​New for 2021, beneficiaries in each can you get ventolin over the counter state will have the option to enroll in a Part D plan participating in the Trump Administration’s new Innovation Center model in which enhanced drug plans cover insulin products at a monthly copayment of $35 in the deductible, initial coverage, and coverage gap phases of the Part D benefit.

Participating plans do not have to cover all insulin products at the $35 monthly copayment amount, just one of each dosage form (vial, pen) and insulin type (rapid-acting, short-acting, intermediate-acting, and long-acting).In 2021, a total of 1,635 enhanced Part D plans will participate in this model, which represents just over 30% of both PDPs (310 plans) and MA-PDs (1,325 plans) available in 2021, including plans in the territories. Between 8 and 10 enhanced PDPs in each region are participating can you get ventolin over the counter in the model, in addition to multiple MA-PDs (see map). The average premium in 2021 for the subset of enhanced PDPs participating in the insulin $35 copay model ($59) is nearly twice as high as the monthly premium for basic PDPs ($33) and 61% higher than the average premium for enhanced PDPs that are not participating in the model ($37) (weighted by September 2020 enrollment). Part D Cost SharingPart D Enrollees Will Pay can you get ventolin over the counter Much Higher Cost-Sharing Amounts for Brands and Non-preferred Drugs Than For Drugs on a Generic Tier, and a Mix of Copays and Coinsurance for Different Formulary TiersFigure 7.

In 2021, Part D Enrollees Will Pay Much Higher Cost-Sharing Amounts for Brands and Non-preferred Drugs than for Drugs on a Generic Tier, and a Mix of Copays and Coinsurance for Different Formulary Tiers​In 2021, as in prior years, Part D enrollees will face much higher cost-sharing amounts for brands and non-preferred drugs (which can include both brands and generics) than for drugs on a generic tier, and a mix of copayments and coinsurance for different formulary tiers (Figure 7). The typical five-tier formulary design in Part D includes can you get ventolin over the counter tiers for preferred generics, generics, preferred brands, non-preferred drugs, and specialty drugs. Among all PDPs, median standard cost sharing in 2021 is $0 for preferred generics and $5 for generics (an increase from $4 in 2020), $40 for preferred brands (a decrease from $42 in 2020), 40% coinsurance for non-preferred drugs (an increase from 38% in 2020. The maximum allowed is 50%), and 25% coinsurance for specialty drugs (the same can you get ventolin over the counter as in 2020.

The maximum allowed is 33%).Among the 21 national PDPs, 13 PDPs, covering 9.3 million enrollees as of September 2020, are increasing cost-sharing amounts for drugs on at least one formulary tier between 2020 and 2021 (Table 3). Five PDPs are increasing copayments for can you get ventolin over the counter generics, with increases ranging from $1 to $4. Six PDPs are increasing copayments for preferred brands, with increases ranging from $3 to $10. And 10 PDPs are increasing coinsurance for non-preferred drugs, with increases ranging from 2 percentage points (e.g., from a 38% coinsurance rate to 40%) to 14 percentage points (e.g., from a 35% coinsurance rate can you get ventolin over the counter to 49%).Low-Income Subsidy Plan AvailabilityIn 2021, 259 Part D Stand-Alone Drug Plans Will Be Premium-Free to Enrollees Receiving the Low-Income Subsidy (Benchmark Plans)Figure 8.

In 2021, 259 Part D Stand-Alone Drug Plans Will Be Available Without a Premium to Enrollees Receiving the Low-Income Subsidy (“Benchmark” Plans)​In 2021, a larger number of PDPs will be premium-free benchmark plans—that is, PDPs available for no monthly premium to Medicare Part D enrollees receiving the Low-Income Subsidy (LIS)—than in recent years, with 259 premium-free benchmark plans, or roughly a quarter of all PDPs in 2021 (Figure 8). Through the Part D LIS program, enrollees with low incomes and modest assets are eligible for assistance with Part D plan premiums and cost sharing. As of 2020, approximately 13 million Part D enrollees are receiving LIS, including 6.7 million (52%) in PDPs and 6.1 million (48%) in MA-PDs.On average (weighted by Medicare enrollment), LIS beneficiaries have eight benchmark plans available can you get ventolin over the counter to them for 2021, or about one-fourth the average number of PDP choices available overall. All LIS enrollees can select any plan offered in their area, but if they enroll in a non-benchmark plan, they must pay some portion of their chosen plan’s monthly premium.

In 2021, 10% of all LIS PDP enrollees who are eligible for premium-free Part D coverage (0.6 million LIS enrollees) will can you get ventolin over the counter pay Part D premiums averaging $33 per month unless they switch or are reassigned by CMS to premium-free plans.The number of benchmark plans available in 2021 will vary by region, from five to 10 (see map). In 2020, 89% of the 6.6 million LIS PDP enrollees are projected to be in PDPs operated by five firms. CVS Health, Centene, Humana, UnitedHealth, and Cigna (based can you get ventolin over the counter on 2020 enrollment). DiscussionOur analysis of the Medicare Part D stand-alone drug plan landscape for 2021 shows that millions of Part D enrollees without low-income subsidies will face premium and other cost increases in 2021 if they stay in their current stand-alone drug plan.

There are more plans available nationwide can you get ventolin over the counter in 2021, with Medicare beneficiaries having 30 PDP choices during this year’s open enrollment period, plus 27 Medicare Advantage drug plan options. Most Part D PDP enrollees who remain in the same plan in 2021 will be in a plan with the standard $445 deductible and will face much higher cost sharing for brands than for generic drugs, including as much as 50% coinsurance for non-preferred drugs.Some Part D enrollees who choose to stay in their current plans may see lower premiums and other costs for their drug coverage, but nearly 8 in 10 non-LIS enrollees will face higher premiums if they remain in their current plan, and many will also face higher deductibles and cost sharing for covered drugs. Some beneficiaries might find the can you get ventolin over the counter best coverage and costs for their specific medications in a plan with a relatively low premium, while for other beneficiaries, a higher-premium plan might be more suitable. Because Part D plans vary in a number of ways that can have a significant effect on an enrollee’s out-of-pocket spending, beyond the monthly premium, all Part D enrollees could benefit from the opportunity to compare plans during open enrollment.Juliette Cubanski is with KFF.Anthony Damico is an independent consultant.

This analysis focuses on the Medicare Part D stand-alone prescription drug plan marketplace in 2021 and trends over can you get ventolin over the counter time. The analysis includes 20.2 million enrollees in stand-alone PDPs, as of March 2020. The analysis excludes 17.4 million MA-PD enrollees (non-employer), and another 4.6 million enrollees in employer-group only PDPs and 2.3 million in employer-group only MA-PDs for whom plan premium and benefits data are unavailable.Data on Part D plan availability, enrollment, and premiums were collected from a set of data files released by the Centers for Medicare &. Medicaid Services (CMS):– Part D plan landscape files, released each fall prior to the annual enrollment period– Part D plan and premium files, released each fall– Part D plan crosswalk files, released each fall– Part D contract/plan/state/county level enrollment files, released on a monthly basis– Part D Low-Income Subsidy enrollment files, released each spring– Medicare plan benefit package files, released each fallIn this analysis, premium estimates are weighted by September 2020 enrollment unless otherwise noted.

Percentage increases are calculated based on non-rounded estimates and in some cases differ from percentage calculations calculated based on rounded estimates presented in the text..

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Dear Reader, Thank you for following the Me&MyDoctor can you get ventolin over the counter blog. I'm writing to let you know we are moving the public health stories authored by Texas physicians, residents, and medical students, and patients to the Texas Medical Association's social media channels. Be sure to follow us on all our social media accounts (Facebook, Twitter, Instagram) as well as Texas Medicine Today to access these stories and more.

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Shutterstock New get redirected here Jersey residents can get free naloxone at more than 320 prijs ventolin diskus 200 participating pharmacies across the state from Sept. 24-26, Gov. Phil Murphy Human Services Commissioner Carole Johnson prijs ventolin diskus 200 announced Wednesday.

Part of Murphy’s efforts to combat the opioid crisis in that state, the program will allow New Jersey residents to visit participating pharmacies and anonymously obtain the opioid overdose reversal medication at no cost and with no prescription and no appointment. Each pack of naloxone contains two doses.Several locations of CVS, Rite Aid, prijs ventolin diskus 200 Sav-On, ShopRite, Walgreens, Walmart, and others, as well as many independent pharmacies, will be among the 322 pharmacies making the drug available. €œGiving people this live-saving antidote is an opportunity to get people on the path to recovery,” said New Jersey Department of Human Services Assistant Commissioner Valerie Mielke, who manages Human Services’ Division of Mental Health and Addiction Services.

Those who pick up the medication will also be given information on the state’s addiction treatment helpline, where New Jersey-based trained addiction counselors assist callers 24/7 prijs ventolin diskus 200 regardless of their insurance status. This is the second free naloxone distribution in New Jersey. In June prijs ventolin diskus 200 2019, the New Jersey Department of Human Services oversaw the distribution of more than 32,000 doses of naloxone for free at pharmacies throughout the state.

€œThe ongoing opioid epidemic continues to devastate communities across our state,” Murphy said. €œBy expanding access to Naloxone, New Jerseyans will have this lifesaving medication readily available to help those who may be suffering from an prijs ventolin diskus 200 overdose.”Shutterstock Florida Attorney General Ashley Moody and 211 are working together to combat the opioid crisis in that state. Moody’s office announced Wednesday that her office would be working with 211 to help provide information and resources for those affected by their or others’ opioid use disorder.

211 – a free, telephone hotline throughout Florida and the prijs ventolin diskus 200 United States that provides confidential information and referral services – would share resources from Moody’s website – DoseOfRealityFL.com. In exchange, the comprehensive statewide resource website would point visitors to 211 local resources. €œThis partnership is prijs ventolin diskus 200 designed to help Floridians, in their greatest time of need, access vital and life-saving resources.

I am proud to partner with the dedicated public servants at 211 as we join forces to combat and end the deadly opioid crisis plaguing our state. If you are seeking help, please do not hesitate to dial 211, and for a comprehensive view of ways you can join our fight to end the opioid crisis, visit DoseOfRealityFL.com,” prijs ventolin diskus 200 Moody said. Recent reports indicate that not only did opioid deaths increase in 2019 but that they are likely to skyrocket in 2020 in response to the asthma treatment ventolin.

Preliminary data from the Centers for Disease Control (CDC) and Prevention show that nearly 71,000 Americans died of fatal overdoses in 2019 prijs ventolin diskus 200. It’s likely, the CDC said, that number could increase by as many as 1,000. That number eclipses the prijs ventolin diskus 200 record high in 2017 of 70,237.

According to data collected by the Washington, D.C.-based Overdose Detection Mapping Application Program (ODMAP) at the University of Baltimore, drug overdose deaths have increased by an estimated 18 percent during the ventolin. More than 60 percent of counties participating in the prijs ventolin diskus 200 information-gathering project have reported increases in drug overdoses. Moody launched DoseOfRealityFL.com in September 2019 as a way to educate Floridians about the dangers of misusing opioids and other drugs.

Its partnership with 211 will provide a one-stop-shop for information about opioid use, resources for businesses, caregivers, educators, parents, seniors, and others. €œWe are proud to partner prijs ventolin diskus 200 with Dose of Reality to raise awareness about the resources available to those with opioid use disorder. 211 is a critical resource, and we encourage residents of Florida to dial 211 or visit our websites to connect with the local programs and services that can help them,” Sheila Smith, president and CEO of 211 Broward, said.Shutterstock Approximately 3.6 million young people in the United States used e-cigarettes in the past 30 days, according to a National Youth Tobacco Survey conducted in partnership with the U.S.

Food and Drug prijs ventolin diskus 200 Administration (FDA). Last year, 5.4 million young people used e-cigarettes.The number of disposable e-cigarettes used spiked 400 percent among middle school students and 1,000 percent among high school students. In addition, eight in 10 young e-cigarette users used flavored e-cigarettes.“These results demonstrate that the Administration missed the opportunity to prijs ventolin diskus 200 make far greater progress when it broke its promise to clear the market of all flavored e-cigarettes,” Matthew L.

Myers, Campaign for Tobacco-Free Kids president. Robin Koval, Truth Initiative CEO and president, and prijs ventolin diskus 200 Dr. Kelly Henning, Bloomberg Philanthropies, Public Health program lead said in a statement.

€œThey also show that the progress to date prijs ventolin diskus 200 is fragile and can quickly be reversed unless the FDA acts now to eliminate all flavored e-cigarettes, including the menthol products and cheap, disposable e-cigarettes to which kids have rapidly migrated. The evidence couldn’t be clearer. As long as any flavored e-cigarettes are left on the market, kids will get their hands on them, and we will not solve this public health crisis.”The FDA and prijs ventolin diskus 200 Centers for Disease Control analyzed data from the survey conducted Jan.

16–March 16 of sixth through 12th graders.Shutterstock The U.S. House Energy and Commerce Committee recently advanced legislation that would require drug manufacturers and distributors to report and halt suspicious prijs ventolin diskus 200 orders of controlled substances.Under the current law, drug manufacturers and distributors are required to report suspicious orders of opioids to the Drug Enforcement Administration (DEA).The Block, Report, and Suspend Suspicious Shipments Act would require suspicious orders of all controlled substances to be reported, halted, and investigated.In December 2018, the committee released a report highlighting and investigation of pill dumping in West Virginia. The report recommended Congress act to clarify drug distributors’ role in the drug crisis.

In the seven-year time frame ending prijs ventolin diskus 200 in 2012, 76 billion pills were distributed nationwide, according to DEA data.U.S. Reps. Debbie Dingell (D-MI) prijs ventolin diskus 200 and David B.

McKinley (R-WV) introduced the bill.“While Congress has been rightly focused on the asthma treatment ventolin, the opioid epidemic has not gone away. In fact, across the country, overdose deaths have only increased,” McKinley said. €œLast Congress, the Energy and Commerce Committee conducted an investigation which revealed that nearly 800 million opioid pills were shipped to West Virginia, amounting to 433 pills for every man, woman, and child in the state.

A year and nine months later, we’re finally passing legislation that will prevent this from ever happening again.”.

Shutterstock New Jersey residents can you get ventolin over the counter can get free naloxone at more than 320 participating pharmacies across the state from Sept. 24-26, Gov. Phil Murphy Human Services can you get ventolin over the counter Commissioner Carole Johnson announced Wednesday. Part of Murphy’s efforts to combat the opioid crisis in that state, the program will allow New Jersey residents to visit participating pharmacies and anonymously obtain the opioid overdose reversal medication at no cost and with no prescription and no appointment.

Each pack of naloxone contains two doses.Several locations of CVS, Rite Aid, Sav-On, ShopRite, Walgreens, Walmart, and can you get ventolin over the counter others, as well as many independent pharmacies, will be among the 322 pharmacies making the drug available. €œGiving people this live-saving antidote is an opportunity to get people on the path to recovery,” said New Jersey Department of Human Services Assistant Commissioner Valerie Mielke, who manages Human Services’ Division of Mental Health and Addiction Services. Those who can you get ventolin over the counter pick up the medication will also be given information on the state’s addiction treatment helpline, where New Jersey-based trained addiction counselors assist callers 24/7 regardless of their insurance status. This is the second free naloxone distribution in New Jersey.

In June 2019, the New Jersey Department of Human Services oversaw the distribution of more can you get ventolin over the counter than 32,000 doses of naloxone for free at pharmacies throughout the state. €œThe ongoing opioid epidemic continues to devastate communities across our state,” Murphy said. €œBy expanding access to Naloxone, New Jerseyans will have this lifesaving medication readily available to help those who may be suffering from an can you get ventolin over the counter overdose.”Shutterstock Florida Attorney General Ashley Moody and 211 are working together to combat the opioid crisis in that state. Moody’s office announced Wednesday that her office would be working with 211 to help provide information and resources for those affected by their or others’ opioid use disorder.

211 – a free, telephone hotline throughout Florida and the can you get ventolin over the counter United States that provides confidential information and referral services – would share resources from Moody’s website – DoseOfRealityFL.com. In exchange, the comprehensive statewide resource website would point visitors to 211 local resources. €œThis partnership is designed to help Floridians, in their can you get ventolin over the counter greatest time of need, access vital and life-saving resources. I am proud to partner with the dedicated public servants at 211 as we join forces to combat and end the deadly opioid crisis plaguing our state.

If you are seeking help, please do not hesitate to dial 211, and for a comprehensive view of ways you can join our fight to can you get ventolin over the counter end the opioid crisis, visit DoseOfRealityFL.com,” Moody said. Recent reports indicate that not only did opioid deaths increase in 2019 but that they are likely to skyrocket in 2020 in response to the asthma treatment ventolin. Preliminary data from the Centers for Disease Control (CDC) and Prevention show that can you get ventolin over the counter nearly 71,000 Americans died of fatal overdoses in 2019. It’s likely, the CDC said, that number could increase by as many as 1,000.

That number eclipses the record high in 2017 of can you get ventolin over the counter 70,237. According to data collected by the Washington, D.C.-based Overdose Detection Mapping Application Program (ODMAP) at the University of Baltimore, drug overdose deaths have increased by an estimated 18 percent during the ventolin. More than 60 can you get ventolin over the counter percent of counties participating in the information-gathering project have reported increases in drug overdoses. Moody launched DoseOfRealityFL.com in September 2019 as a way to educate Floridians about the dangers of misusing opioids and other drugs.

Its partnership with 211 will provide a one-stop-shop for information about opioid use, resources for businesses, caregivers, educators, parents, seniors, and others. €œWe are proud to partner with Dose can you get ventolin over the counter of Reality to raise awareness about the resources available to those with opioid use disorder. 211 is a critical resource, and we encourage residents of Florida to dial 211 or visit our websites to connect with the local programs and services that can help them,” Sheila Smith, president and CEO of 211 Broward, said.Shutterstock Approximately 3.6 million young people in the United States used e-cigarettes in the past 30 days, according to a National Youth Tobacco Survey conducted in partnership with the U.S. Food and can you get ventolin over the counter Drug Administration (FDA).

Last year, 5.4 million young people used e-cigarettes.The number of disposable e-cigarettes used spiked 400 percent among middle school students and 1,000 percent among high school students. In addition, eight in 10 young e-cigarette users used flavored e-cigarettes.“These results demonstrate that the Administration missed the opportunity to make far greater progress when can you get ventolin over the counter it broke its promise to clear the market of all flavored e-cigarettes,” Matthew L. Myers, Campaign for Tobacco-Free Kids president. Robin Koval, can you get ventolin over the counter Truth Initiative CEO and president, and Dr.

Kelly Henning, Bloomberg Philanthropies, Public Health program lead said in a statement. €œThey also show that the progress to date is can you get ventolin over the counter fragile and can quickly be reversed unless the FDA acts now to eliminate all flavored e-cigarettes, including the menthol products and cheap, disposable e-cigarettes to which kids have rapidly migrated. The evidence couldn’t be clearer. As long as any flavored e-cigarettes are left on the market, kids will get their hands on them, and we will not solve this public health crisis.”The can you get ventolin over the counter FDA and Centers for Disease Control analyzed data from the survey conducted Jan.

16–March 16 of sixth through 12th graders.Shutterstock The U.S. House Energy and Commerce Committee recently advanced legislation that would require drug manufacturers and distributors to report and halt suspicious orders of controlled substances.Under the current law, drug manufacturers and distributors are required to report suspicious orders of opioids to the Drug Enforcement Administration (DEA).The Block, Report, can you get ventolin over the counter and Suspend Suspicious Shipments Act would require suspicious orders of all controlled substances to be reported, halted, and investigated.In December 2018, the committee released a report highlighting and investigation of pill dumping in West Virginia. The report recommended Congress act to clarify drug distributors’ role in the drug crisis. In the can you get ventolin over the counter seven-year time frame ending in 2012, 76 billion pills were distributed nationwide, according to DEA data.U.S.

Reps. Debbie Dingell can you get ventolin over the counter (D-MI) and David B. McKinley (R-WV) introduced the bill.“While Congress has been rightly focused on the asthma treatment ventolin, the opioid epidemic has not gone away. In fact, across the country, overdose deaths have only increased,” can you get ventolin over the counter McKinley said.

€œLast Congress, the Energy and Commerce Committee conducted an investigation which revealed that nearly 800 million opioid pills were shipped to West Virginia, amounting to 433 pills for every man, woman, and child in the state. A year and nine months later, we’re finally passing legislation that will prevent this from ever happening again.”.

Ventolin rotacaps side effects

Dewsnap C, Sauer see U, ventolin rotacaps side effects Evans C. Sex Transm Infect 2020;96:79. Doi.

10.1136/sextrans-2019-054397This article was previously published with missing information. Please note the below:The authors would like to acknowledge their gratitude to Daniel Richardson, Zara Haider, Ceri Evans, Janet Michaelis and Elizabeth Foley for providing a helpful format for this piece.Richardson D, Haider Z, Evans C, et al. The joint BASHH-FSRH conference.

Sex Transm Infect 2017;93:380. Doi. 10.1136/sextrans-2017-053184Using cytokine expression to distinguish between active and treated syphilis.

Promising but not yet ready for prime timeDistinguishing between previously treated and active syphilis can be challenging in the subset of treated patients with serofast status, defined as persistent non-treponemal seropositivity (<4-fold decline in rapid plasma reagin titre ≥6 months after treatment). The study investigated whether serum cytokine expression levels, measured with a 62-cytokine multiplex bead-based ELISA, can help guide clinical management. Using samples from patients with active, treated and serofast syphilis, the authors developed a two-cytokine (brain-derived neurotrophic factor and tumour necrosis factor β) decision tree that showed good accuracy (82%) and sensitivity (100%) but moderate specificity (45%).

While further studies will be needed to confirm and refine the diagnostic algorithm, there also remain important technical, operational and financial barriers to implementing such cytokine assays in routine care.Kojima N, Siebert JC, Maecker H, et al. The application of cytokine expression assays to differentiate active from previously treated syphilis. J Infect Dis.

2020 [published online ahead of print, 2020 Mar 19].Global and regional prevalence of herpes simplex ventolin type 2 . Updated estimates for people aged 15–49 yearsEstimates of genital herpes simplex ventolin (HSV) s across regions inform advocacy and resource planning and guide the development of improved control measures, including treatments. In 2016, HSV-2 affected 13% of the global population aged 15–49 years (high-risk groups excluded), totalling 491 million people.

Of note, by excluding people aged >49 years, the analysis knowingly underestimated the true burden of HSV-2 .1 Prevalence showed a slight increase relative to 2012 and was highest in Africa and Americas and among women. Given the association between HSV-2 and subsequent HIV ,2 it is concerning that HSV-2 was estimated to affect ~50% of women aged 25–34 years in the African region. The analysis also estimated the prevalence of genital HSV-1 (3%), but uncertainty intervals were wide.James C, Harfouche M, Welton NJ, et al.

Herpes simplex ventolin. Global prevalence and incidence estimates, 2016. Bull World Health Organ.

2020. 98. 315-329.Observed pregnancy and neonatal outcomes in women with HIV exposed to recommended antiretroviral regimensThis large Italian observational cohort study analysed data from 794 pregnant women who were exposed within 32 weeks of gestation to recommended antiretroviral regimens in the period 2008–2018.

Treatment comprised three-drug combinations of an nucleoside reverse transcriptase inhibitor (NRTI) backbone plus a ritonavir-boosted protease inhibitor (78%, predominantly atazanavir), an non-NRTI (NNRTI) (15%, predominantly nevirapine) or an integrase strand transfer inhibitor (INSTI. 6%, predominantly raltegravir). No major differences were found for a wide range of pregnancy and neonatal outcomes, including major congenital defects.

The rate of HIV transmission ranged up to 2.4% in this study. This comprehensive evaluation will be useful for clinicians caring for women with HIV. More outcome data are needed for regimens comprising second-generation INSTIs.Floridia M, Dalzero S, Giacomet V, et al.

Pregnancy and neonatal outcomes in women with HIV-1 exposed to integrase inhibitors, protease inhibitors and non-nucleoside reverse transcriptase inhibitors. An observational study. 2020;48:249–258.HIV status and sexual practice independently correlate with gut dysbiosis and unique microbiota signaturesGut dysbiosis may contribute to persistent inflammation in people with HIV (PWH) who receive antiretroviral therapy (ART).

The study compared the gut microbiota of ART-treated PWH and HIV-negative controls matched for age, gender, country of birth, body mass index and sexual practice. Regardless of sex and sexual practice, the gut microbiota differed significantly in PWH vrsus controls, with expansion of proinflammatory gut bacteria and depletion of homeostasis-promoting microbiota members. The extent of dysbiosis correlated with serum inflammatory markers, nadir and pre-ART CD4 cell counts, and prevalence of non-infectious comorbidities.

Further studies are warranted to elucidate causality and investigate microbiota-mediated strategies to alleviate HIV-associated inflammation. Independent of HIV status, and in both men and women, receptive anal intercourse was associated with a unique microbiota signature.Vujkovic-Cvijin I, Sortino O, Verheij E, et al. HIV-associated gut dysbiosis is independent of sexual practice and correlates with non-communicable diseases.

Nat Commun. 2020;11:2448.Reducing the cost of molecular STI screening in resource-limited settings. An optimised sample-pooling algorithms with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are frequently asymptomatic and, if untreated, may lead to severe reproductive complications in women.

Molecular testing is highly sensitive but costly, especially for resource-limited settings. This modelling study explored a sample pooling strategy for CT and NG testing among women in Zambia. Based on cross-sectional data, participants were stratified into high, intermediate and low prevalence groups, and the respective specimens were mathematically modelled to be tested individually, in pools of 3, or pools of 4, using the GeneXpert instrument.

Overall, the pooling strategy was found to maintain acceptable sensitivity (ranging from 80% to 100%), while significantly lowering cost per sample. Investigation in additional cohorts will validate whether the approach may increase access to STI screening where resourced are constrained.Connolly S, Kilembe W, Inambao M, et al. A population-specific optimized GeneXpert pooling algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae to reduce cost of molecular STI screening in resource-limited settings.

J Clin Microbiol. 2020 [published online ahead of print, 2020 Jun 10].Girl-only HPV vaccination can eliminate cervical cancer in most low and lower middle income countries by the end of the century, but must be supplemented by screening in high incidence countriesProgress towards the global elimination of cervical cancer must include effective interventions in lower-middle income countries (LMICs). The study modelled the effect over the next century of girls-only human papilloma ventolin (HPV) vaccination with or without once-lifetime or twice-lifetime cervical screening in 78 LMICs, assuming 90% treatment coverage, 100% lifetime protection and screening uptake increasing from 45% (2023) to 90% (2045 onwards).

Vaccination alone would substantially reduce cancer incidence (61 million cases averted) and achieve elimination (<5 cases per 100 000 women-years) in 60% of LMICs. However, high-incidence countries, predominantly in Africa, might not reach elimination by vaccination alone. Adding twice-lifetime screening would achieve elimination of cervical cancer in 100% of LMICs.

Results have informed the targets of 90% HPV vaccination coverage, 70% screening coverage and 90% of cervical lesions treated by 2030 recently announced by the WHO.Brisson M, Kim JJ, Canfell K, et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination. A comparative modelling analysis in 78 low-income and lower-middle-income countries.

Dewsnap C, can you get ventolin over the counter Sauer U, Evans C. Sex Transm Infect 2020;96:79. Doi.

10.1136/sextrans-2019-054397This article was previously published with missing information. Please note the below:The authors would like to acknowledge their gratitude to Daniel Richardson, Zara Haider, Ceri Evans, Janet Michaelis and Elizabeth Foley for providing a helpful format for this piece.Richardson D, Haider Z, Evans C, et al. The joint BASHH-FSRH conference.

Sex Transm Infect 2017;93:380. Doi. 10.1136/sextrans-2017-053184Using cytokine expression to distinguish between active and treated syphilis.

Promising but not yet ready for prime timeDistinguishing between previously treated and active syphilis can be challenging in the subset of treated patients with serofast status, defined as persistent non-treponemal seropositivity (<4-fold decline in rapid plasma reagin titre ≥6 months after treatment). The study investigated whether serum cytokine expression levels, measured with a 62-cytokine multiplex bead-based ELISA, can help guide clinical management. Using samples from patients with active, treated and serofast syphilis, the authors developed a two-cytokine (brain-derived neurotrophic factor and tumour necrosis factor β) decision tree that showed good accuracy (82%) and sensitivity (100%) but moderate specificity (45%).

While further studies will be needed to confirm and refine the diagnostic algorithm, there also remain important technical, operational and financial barriers to implementing such cytokine assays in routine care.Kojima N, Siebert JC, Maecker H, et al. The application of cytokine expression assays to differentiate active from previously treated syphilis. J Infect Dis.

2020 [published online ahead of print, 2020 Mar 19].Global and regional prevalence of herpes simplex ventolin type 2 . Updated estimates for people aged 15–49 yearsEstimates of genital herpes simplex ventolin (HSV) s across regions inform advocacy and resource planning and guide the development of improved control measures, including treatments. In 2016, HSV-2 affected 13% of the global population aged 15–49 years (high-risk groups excluded), totalling 491 million people.

Of note, by excluding people aged >49 years, the analysis knowingly underestimated the true burden of HSV-2 .1 Prevalence showed a slight increase relative to 2012 and was highest in Africa and Americas and among women. Given the association between HSV-2 and subsequent HIV ,2 it is concerning that HSV-2 was estimated to affect ~50% of women aged 25–34 years in the African region. The analysis also estimated the prevalence of genital HSV-1 (3%), but uncertainty intervals were wide.James C, Harfouche M, Welton NJ, et al.

Herpes simplex ventolin. Global prevalence and incidence estimates, 2016. Bull World Health Organ.

2020. 98. 315-329.Observed pregnancy and neonatal outcomes in women with HIV exposed to recommended antiretroviral regimensThis large Italian observational cohort study analysed data from 794 pregnant women who were exposed within 32 weeks of gestation to recommended antiretroviral regimens in the period 2008–2018.

Treatment comprised three-drug combinations of an nucleoside reverse transcriptase inhibitor (NRTI) backbone plus a ritonavir-boosted protease inhibitor (78%, predominantly atazanavir), an non-NRTI (NNRTI) (15%, predominantly nevirapine) or an integrase strand transfer inhibitor (INSTI. 6%, predominantly raltegravir). No major differences were found for a wide range of pregnancy and neonatal outcomes, including major congenital defects.

The rate of HIV transmission ranged up to 2.4% in this study. This comprehensive evaluation will be useful for clinicians caring for women with HIV. More outcome data are needed for regimens comprising second-generation INSTIs.Floridia M, Dalzero S, Giacomet V, et al.

Pregnancy and neonatal outcomes in women with HIV-1 exposed to integrase inhibitors, protease inhibitors and non-nucleoside reverse transcriptase inhibitors. An observational study. 2020;48:249–258.HIV status and sexual practice independently correlate with gut dysbiosis and unique microbiota signaturesGut dysbiosis may contribute to persistent inflammation in people with HIV (PWH) who receive antiretroviral therapy (ART).

The study compared the gut microbiota of ART-treated PWH and HIV-negative controls matched for age, gender, country of birth, body mass index and sexual practice. Regardless of sex and sexual practice, the gut microbiota differed significantly in PWH vrsus controls, with expansion of proinflammatory gut bacteria and depletion of homeostasis-promoting microbiota members. The extent of dysbiosis correlated with serum inflammatory markers, nadir and pre-ART CD4 cell counts, and prevalence of non-infectious comorbidities.

Further studies are warranted to elucidate causality and investigate microbiota-mediated strategies to alleviate HIV-associated inflammation. Independent of HIV status, and in both men and women, receptive anal intercourse was associated with a unique microbiota signature.Vujkovic-Cvijin I, Sortino O, Verheij E, et al. HIV-associated gut dysbiosis is independent of sexual practice and correlates with non-communicable diseases.

Nat Commun. 2020;11:2448.Reducing the cost of molecular STI screening in resource-limited settings. An optimised sample-pooling algorithms with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are frequently asymptomatic and, if untreated, may lead to severe reproductive complications in women.

Molecular testing is highly sensitive but costly, especially for resource-limited settings. This modelling study explored a sample pooling strategy for CT and NG testing among women in Zambia. Based on cross-sectional data, participants were stratified into high, intermediate and low prevalence groups, and the respective specimens were mathematically modelled to be tested individually, in pools of 3, or pools of 4, using the GeneXpert instrument.

Overall, the pooling strategy was found to maintain acceptable sensitivity (ranging from 80% to 100%), while significantly lowering cost per sample. Investigation in additional cohorts will validate whether the approach may increase access to STI screening where resourced are constrained.Connolly S, Kilembe W, Inambao M, et al. A population-specific optimized GeneXpert pooling algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae to reduce cost of molecular STI screening in resource-limited settings.

J Clin Microbiol. 2020 [published online ahead of print, 2020 Jun 10].Girl-only HPV vaccination can eliminate cervical cancer in most low and lower middle income countries by the end of the century, but must be supplemented by screening in high incidence countriesProgress towards the global elimination of cervical cancer must include effective interventions in lower-middle income countries (LMICs). The study modelled the effect over the next century of girls-only human papilloma ventolin (HPV) vaccination with or without once-lifetime or twice-lifetime cervical screening in 78 LMICs, assuming 90% treatment coverage, 100% lifetime protection and screening uptake increasing from 45% (2023) to 90% (2045 onwards).

Vaccination alone would substantially reduce cancer incidence (61 million cases averted) and achieve elimination (<5 cases per 100 000 women-years) in 60% of LMICs. However, high-incidence countries, predominantly in Africa, might not reach elimination by vaccination alone. Adding twice-lifetime screening would achieve elimination of cervical cancer in 100% of LMICs.

Results have informed the targets of 90% HPV vaccination coverage, 70% screening coverage and 90% of cervical lesions treated by 2030 recently announced by the WHO.Brisson M, Kim JJ, Canfell K, et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination. A comparative modelling analysis in 78 low-income and lower-middle-income countries.