Veterans Day Observed on Friday, November 10

The origins of what we know as Veterans Day date back to World War I, The Great War, when the Allied nations and Germany agreed to an armistice to end the hostilities. The countries agreed to lay down their arms at 11 a.m. on November 11th, with the end of the conflicting coming to be known as Armistice Day. Although the Treaty of Versailles signed months later formally ended the war, November 11 was the date the public saw as marking the end of the four-year conflict. Legislation in 1954 officially changed the name commemorating November 11th to Veterans Day. When November 11th falls on a Saturday or Sunday, like this year, the government observes the holiday on the previous Friday or following Monday. State and federal buildings are closed in respect for the days' significance. On this Veterans Day, please take time to honor those veterans both living and those who have passed.

Saturday, November 18 - Christiana Hilton, Newark

Registration is open for the 234th MSD Annual Meeting to be held on Saturday, November 18th. This year's meeting will be held at the Christiana Hilton in Newark. All MSD members are encouraged to attend. Thank you to our Council members for their service to MSD and their constituents. Your fork is the most powerful tool to heal your body. Learn about the influence of nutrition on patients' wellbeing and how food can help manage chronic diseases and improve overall health during the planned education sessions. Register for the presentation (and cooking demo!) and discover the power of nutrition. It is vital for physicians to be able to educate their patients about nutrition to achieve optimal health.

Four resolutions have been submitted for the Council's consideration:

• Artificial Intelligence in Health Care
• MSD Response to the Obesity Epidemic - A Chronic Disease
• Support for Refugees in Delaware
• Gun Violence is a Public Health Crisis

Things to know:

• Registration deadline is Friday, November 10th!
• The Inaugural Gala is on hold for this year. View the Annual Meeting agenda.
• There will be two education sessions on the topic of "Food as Medicine." The Medical Society of Delaware designates this live activity for a maximum of 2 AMA PRA Category 1 Credit™. 
• Those members who graduated medical school fifty years ago (1973) will be recognized in a ceremony following the first education session.
• Delaware Medical Political Action Committee (DELPAC) members can enjoy gourmet coffee and conversation with Delaware lawmakers. Join DELPAC if you are not already a member.

FRIDAY, NOVEMBER 10TH IS THE LAST DAY TO REGISTER!

Medicare Reform of High Priority

The Medical Society of Delaware will be represented through our Delegation at the American Medical Association (AMA) Interim Meeting taking place at National Harbor, Maryland from November 10-14. The Interim Meeting considers matters of policy, including legislative priorities. With the 2024 Medicare Physician Fee Schedule rule including a decrease to the fee schedule's conversion factor used to calculate Medicare payouts to physicians, Medicare reform is top of mind for the House of Delegates with the impending 3.4% Medicare pay cut. Look for more information as the meeting takes place.

Nicholas Petrelli, MD; James Spellman, MD; and John Shevock Submit Clarification

The Delaware Cancer Registry Advisory Committee (DCRAC) recently discussed the accuracy of death certificates as related to patients with the diagnosis of cancer with representatives from the Centers for Disease Control and Prevention (CDC). This is critical because the inaccurate listing of the cause of death in cancer patients could contribute to an inaccurate cancer mortality rate.

As described on page 11 of the Physicians Handbook on Medical Certification of Death, the cause of death section has two parts. Part 1 is for reporting the chain of events leading directly to death, with the immediate cause of death (the final disease, injury or complication directly causing death) listed on line "a" and the underlining cause of death (the disease or injury that initiated the chain of events that led directly and inevitably to death) listed on the lowest line used.

Part 2 Is for reporting all other significant diseases, conditions or injuries that contributed to death, but did not result in the underlying cause of death given in Part 1.

An example of inaccurate reporting would be listing CANCER as the immediate cause of death in a patient who underwent surgery for peritoneal carcinomatosis and who died from an aspiration pneumonia. The immediate cause of death was Aspiration Pneumonia.

Pages 11-14 in the Handbook would be worth your reading.

ACS Partners with Delaware for National Lung Cancer Screening Day, Nov 11

The American Cancer Society (ACS) has partnered with hospitals and imaging facilities across Delaware to present National Lung Cancer Screening Day (NLCSD) as a statewide event. On Saturday, November 11, representatives from the Bureau of Cancer Prevention and Control within the Delaware Division of Public Health (DPH) will be on-site at several imaging facilities. Delaware is the first state to have all the health systems and major imaging facilities formally collaborate to support lung cancer screening and open weekend hours to address screening barriers for those that can’t make it Monday through Friday. Read more and find locations.

Details Grim Realities of Worsening Overdose Epidemic

The 2023 Overdose Epidemic Report, released today by the American Medical Association (AMA), finds opioid prescribing by physicians and other health professionals decreased for the 13th consecutive year, down nearly 50% nationally since 2012, while overdoses and deaths related to illicitly manufactured fentanyl, xylazine and other synthetic substances continue to increase. Opioid prescribing in Delaware has decreased by 51.2% since 2012. In 2022, more than 107,000 people died from a drug-related overdose in the United States. Data shows the epidemic is increasingly impacting young people, Black and Brown people, and pregnant people. Read the AMA Press Release.

There have been signs of progress in the past year - notably community-based distribution of naloxone by leading harm reduction supporters and approval by the U.S. Food and Drug Administration of over-the-counter (OTC) naloxone, which the AMA and the Medical Society of Delaware have long championed. Naloxone dispensing has increased nationally more than 200% since 2018 and by 122% in Delaware. The AMA continues to support widespread distribution of naloxone and urges physicians to educate patients on naloxone and prescribe to patients at risk of overdose. 

CMS Approves a 3.4% Reduction

As you well know, the flawed Medicare physician payment system is in desperate need of fixing and unfortunately things are about to get worse. Recently the Centers for Medicare and Medicaid Services (CMS) announced final plans for payment schedules for physicians and spoiler alert, it's not good! CMS approved a 3.4% reduction in Medicare's physician payments for 2024. That means if Congress doesn't act before the end of the year, these proposed cuts will go into effect and patient access to care will be negatively impacted. These cuts could disproportionately affect small, independent, and rural physician practices, as well as those treating low-income or other historically minoritized or marginalized patient communities. Congress needs to act NOW – tell your legislators to fix the flawed Medicare physician payment system and cancel the cut! To make matters worse, physicians are the only Medicare providers whose payments do not automatically receive an annual inflationary update which means they will not receive a 4.6% update in 2024 like other health care providers. In fact, since 2001, Medicare physician payments have lagged 26% behind the rate of inflation! Sadly, America's patients are the ones who will suffer the most with worse access to care and fewer physicians accepting Medicare patients. Everyone agrees the Medicare physician payment system is broken, and it's time for Congress to do something about it - Please contact your Representative and Senators and urge them to cancel the cut today!

American Medical Association Sounds the Alarm

On October 30, the AMA sent a letter to the Department of Health and Human Services (HHS) and the Treasury detailing strong concerns with recent correspondence practices are receiving concerning Provider Relief Fund (PRF) repayments. Specifically, practices are being informed that they will have any amounts owed, along with 11.5% annual interest and additional penalties, automatically recouped through reductions to their Medicare claims payments. The AMA expressed extreme concern about the abruptness and lack of transparency of these claw backs on Medicare payments without rulemaking or public notice, particularly after the AMA raised persistent concerns over lack of communication regarding the PRF reporting requirements and deadlines. The AMA also reiterated past concerns that PRF recoupments will disproportionately harm small, rural and safety net practices and the communities they serve. In the letter, the AMA reiterated once again a desire to work with the administration to find a resolution and outlined several specific recommendations to help bring practices into compliance and mitigate the financial impact on potentially thousands of practices across the country. 

Focuses on Health Care Professionals

On October 30, the Office of the National Coordinator for Health Information Technology (ONC) and the CMS published a proposed regulation specifying the “appropriate disincentives” for health care professionals that the HHS Office of Inspector General (OIG) has determined committed information blocking. This effort complements the regulation published earlier this year that defines the civil monetary penalties for other regulated actors: health IT developers, health information exchanges and health information networks. This new regulation focuses on health care professionals, specifically physicians, hospitals and Accountable Care Organizations (ACOs). For those that OIG determines are information blockers, CMS is planning to use its payment policies to implement the disincentives. Read more.

Would Permanently Allow Clinicians to Prescribe Buprenorphine Through Telehealth Without a Prior In-Person Exam

A bipartisan group of four senators reintroduced legislation that would eliminate barriers to the virtual prescription of medication for opioid use disorder (OUD). Called the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act, the bill would permanently extend telehealth prescribing flexibilities enacted during the COVID-19 public health emergency (PHE). This would waive the requirement for health care professionals to conduct an in-person examination before prescribing medication like buprenorphine via telehealth for OUD patients. The United States Drug Enforcement Administration (DEA) recently extended this flexibility through 2024. However, the TREATS Act would permanently extend virtual access to OUD treatment.

First Treatment for Patients with Rare Inherited Disorder

On Thursday this week, the U.S. Food and Drug Administration (FDA) approved Adzynma, the first recombinant (genetically engineered) protein product indicated for prophylactic (preventive) or on demand enzyme replacement therapy (ERT) in adult and pediatric patients with congenital thrombotic thrombocytopenic purpura (cTTP), a rare and life-threatening blood clotting disorder.

First Vaccine to Prevent Disease Caused by Chikungunya Virus

On Thursday this week, the U.S. Food and Drug Administration (FDA) approved Ixchiq, the first chikungunya vaccine. Ixchiq is approved for individuals 18 years of age and older who are at increased risk of exposure to chikungunya virus. The chikungunya virus is primarily transmitted to people through the bite of an infected mosquito. Chikungunya is an emerging global health threat with at least 5 million cases of chikungunya virus infection reported during the past 15 years. The highest risk of infection is in tropical and subtropical regions of Africa, Southeast Asia, and parts of the Americas where chikungunya virus-carrying mosquitos are endemic. However, chikungunya virus has spread to new geographical areas causing a rise in global prevalence of the disease. The most common symptoms of chikungunya include fever and joint pain. Other symptoms may include a rash, headache, and muscle pain. Some individuals may experience debilitating joint pain that persists for months or even years. Treatment includes rest, fluids, and over-the-counter medications for pain and fever.

ACON Laboratories' Flowflex is First Indicated for Use in Children Under 18

On Thursday this week, the U.S. Food and Drug Administration (FDA) cleared for marketing the first over-the-counter (OTC) antigen test for COVID-19. ACON Laboratories’ Flowflex COVID-19 Antigen Home Test, originally authorized for emergency use in 2021, is now the second home COVID-19 test to successfully complete a traditional FDA premarket review pathway, and the first indicated for use in children under 18. Today’s announcement follows clearance of a molecular home test earlier this year. The Flowflex COVID-19 Antigen Home Test is a visually-read test cleared for OTC home use by symptomatic individuals within six days of symptom onset. It is cleared for individuals aged 14 years or older testing themselves, or adults testing individuals aged two years or older. In a study reviewed by the FDA, this test correctly identified 89.8% of positive and 99.3% of negative samples in individuals with signs and symptoms of upper respiratory infection. As with antigen tests authorized for emergency use, this test is intended to be used at least twice over three days with at least 48 hours between tests. This means that a symptomatic individual with an initial negative test result should be re-tested once between 48 and 72 hours after the first test using an antigen test for COVID-19 or followed up with a molecular COVID-19 test. 

Beyond COVID-19, Will Include Flu and RSV Sample Testing

The U.S. Centers for Disease Control and Prevention (CDC) indicated this week it was expanding testing of samples collected from international air travelers beyond COVID-19, to include flu and respiratory syncytial virus (RSV) beginning November. The agency's traveler-based genomic surveillance program, or TGS, began in 2021 to help with early detection of new SARS-CoV-2 variants. CDC conducts voluntary nasal swabbing and airport wastewater sampling as part of it. The pilot expansion, which will last for several months, comes ahead of the U.S. winter months when respiratory-disease causing viruses usually circulate more heavily.

FDA Approves Eli Lilly's Diabetes Drug

On Wednesday this week, the U.S. Food and Drug Administration (FDA) approved Zepbound (tirzepatide) injection for chronic weight management in adults with obesity (body mass index of 30 kilograms per square meter (kg/ m2) or greater) or overweight (body mass index of 27 kg/m2 or greater) with at least one weight-related condition (such as high blood pressure, type 2 diabetes or high cholesterol) for use, in addition to a reduced calorie diet and increased physical activity. Tirzepatide, the active ingredient in Zepbound, is already approved under the trade name Mounjaro to be used along with diet and exercise to help improve blood sugar (glucose) in adults with type 2 diabetes mellitus. Zepbound is administered by injection under the skin once weekly, and the dosage must be increased over four to 20 weeks to achieve the target dosages of 5 milligram (mg), 10 mg or 15 mg once weekly. The maximum dosage of Zepbound is 15 mg once weekly.

Helps Identify Hospitals, Health Systems Providing Quality Maternity Care

On Wednesday this week, the Centers for Medicare & Medicaid Services (CMS) will begin displaying the "Birthing-Friendly" designation icon on CMS’s Care Compare online tool. CMS created the new designation to identify hospitals and health systems that participate in a statewide or national perinatal quality improvement collaborative program and that implement evidence-based care to improve maternal health. The public can use the Care Compare tool — along with a complementary interactive map — to find a hospital or health system with the ‘Birthing-Friendly’ designation in their area. 

Ways Family Physicians Can Use Recommendations, Resources for Patients

The Community Guide shares an editorial published in the October edition of American Family Physician (AFP), a journal by the American Academy of Family Physicians (AAFP). The article highlights the important work of the Community Preventive Services Task Force (CPSTF) and The Community Guide. The editorial provides readers with an overview of the roles of CPSTF, The Community Guide, CPSTF liaisons, and the Community Guide Program. The article features CPSTF recommendations relevant to family physicians and details CPSTF’s history and current priority topics. Family physicians see patients of all ages and stages and play a vital role in protecting and promoting the health of our nation. The authors also outline ways family physicians can use CPSTF recommendations and Community Guide resources to benefit their patients.

Melnikow J, Istas K. The Community Preventive Services Task Force: A Useful Resource for Family Physicians. American Family Physician. 2023;108(4):337-40.

Now Accepting Applications for Health Centers Interested

Live to The Beat (LTTB) is a national campaign developed by the Centers for Disease Control and Prevention (CDC) Foundation’s Alliance for the Million Hearts® campaign, a public-private coalition supporting the Million Hearts® Initiative. The campaign aims to reduce cardiovascular disease risk (CVD) among Black adults ages 35 to 54 by empowering the Black community with a consistent and regular set of messages with healthy habits, tips, and routines to reduce the risk of heart attack and stroke. The National Association of Community Health Center's (NACHC) Million Hearts® Initiative is now accepting applications for health centers interested in recruiting LTTB Ambassadors who will conduct in-person and online outreach and events. During this six-month program health centers will develop and test the effectiveness of a local LTTB Ambassador program and use of resources to engage adult Black health center patients and community members in taking positive steps towards improving their health outcomes and reducing risks for CVD. There is $5,000 in funding support by NACHC upon grant award. Applications are due November 17th. Learn more about eligibility requirements and how to apply.

FDA Letter to Health Care Professionals

On Thursday this week, the U.S. Food and Drug Administration (FDA) issued a Letter to health care professionals about labeling updates for Becton, Dickinson and Company (BD) surgical mesh products. The FDA is aware of increased use of surgical mesh products in breast surgery. The safety and effectiveness of surgical mesh in breast surgery, including in augmentation or reconstruction, has not been determined by the FDA. There are no surgical mesh products cleared or approved by FDA for use in breast surgery, including in augmentation or reconstruction.

Nationwide and to Canada Due to Potential for a Lack of Sterility Assurance

On November 6, 2023, Nurse Assist, LLC initiated a voluntary recall of 0.9% sodium chloride irrigation USP and sterile water for irrigation USP, due to the potential for a lack of sterility assurance, which could result in a nonsterile product. In populations most at risk, such as patients who are immunocompromised, there is a possibility that the use of the affected product could potentially result in severe or life-threatening adverse events. To date, Nurse Assist, LLC has not received any reports of adverse events for these products. The product was distributed in the United States and Canada. Recalled Product was distributed from November 1, 2021 to September 18, 2023.

Due to Mislabeling

Teleflex, and its subsidiary Arrow International, are recalling the Pressure Injectable Catheter Kits due to mislabeling regarding the presence of chlorhexidine in these products. The product code and product name are incorrectly listed as non-coated on the lids of the affected Pressure Injectable Catheter Kits. However, the banner card correctly lists the product code and product name as chlorohexidine coated. The FDA has identified this as a Class I recall, the most serious type of recall. Use of these devices may cause serious injuries or death.

Advantages of Well-Designed Strategy

The importance of education and communication in employee benefit programs cannot be understated. Comprehensive and transparent communication is fundamental in ensuring that employees are well informed about their benefit options. By utilizing a variety of communication methods, such as emails, intranet portals, webinars and in-person meetings, employers can reach all employees regardless of their level of benefit knowledge and proactively address potential areas of concern or confusion. Transparent communication fosters trust and empowers employees to make informed decisions about their benefits, increasing overall program participation and satisfaction. Similarly, a sound education strategy is essential to help employees fully understand the value and purpose of the benefits being provided by their employer. Offering educational resources, such as workshops, seminars, webinars, and other informative materials, provides a means for employees to more adequately grasp the intricacies of their benefit packages. Both communication and education efforts should be continuous and not limited to initial onboarding or open enrollment periods. Employers should establish a continuous feedback loop by seeking employee input and regularly communicating updates, enhancements, and new offerings within the benefits portfolio. Additionally, conducting regular program evaluations and soliciting employee feedback through surveys or focus groups enables organizations to identify areas for improvement and make necessary adjustments to better align benefits to match employee needs and expectations.

The Medical Society of Delaware Insurance Services offers its members access to My Benefit Advisor as a solution for employee benefits, including voluntary offerings. For more information about My Benefit Advisor, visit our website at www.mybenefitadvisor.com or contact Sharon Ruth at (302) 397-0173.

What You Need to Know

With the release of the 2024 FINAL RULE last week, our aim is to assist you in being fully prepared, so you can continue to offer excellent care while optimizing your Medicare billing process!

Here are just a few key updates CMS has finalized for 2024

1. A Longer Promoting Interoperability (PI) Reporting Period - Starting from 2024, the Promoting Interoperability reporting period will be extended from the previous 90-day duration to a new span of 180 days. 
2. Threshold for Penalty Avoidance Remains Unchanged - The threshold to avoid a penalty will continue to be 75/100. Maintaining or exceeding this score is crucial for ensuring that you avoid any Medicare-related penalties in the upcoming year.
3. Changes in Quality Measures - Please be informed that the following quality measures will be removed unless they are used within an MVP (MIPS Value Pathway):

• 112: Breast Cancer Screening
• 113: Colorectal Cancer Screening
• 128: (BMI) Screening and Follow-up Plan

These changes might necessitate adjustments in the way you currently report or capture your measures. To see a full snapshot of what’s changing in 2024 check out the Chirpy Bird blog. 

Remember what you don’t know can hurt you - Not staying up to date with these new requirements can result in a decline of Medicare and other commercial payer reimbursement.

Be Proactive with High-Risk Patients

Many medical practices are using patient care registries to track high-risk patients or those with complex care needs to ensure those patients are receiving appropriate services. A properly optimized registry can create customized planned visit protocols for each patient visit and help conduct necessary outreach between visits. Registry data can also support quality improvement efforts.

LEARN MORE:

Toolkits:

• Patient Care Registries
• Pre-Visit Planning

Resource:

• Example Chronic Care Registry Report

AMA STEPS Forward^® offers a collection of engaging and interactive educational content designed to help put the joy back into medicine.

"Kind to Kids" - Children, Teens in Foster Care Affected by Trauma

The Medical Society of Delaware (MSD) has selected Kind to Kids as our winter season charity fundraising beneficiary. Our goal is to raise $1,200 to help children and teens in foster care who are victims of child abuse and neglect. Your donation will provide direct support for a child in foster care. Kind to Kids is a foundation that helps meet the needs of children and teens in foster care who are deeply affected by the trauma in their lives. 100% of every dollar donated online will go directly to help a foster child during these difficult times. Please donate now and help us make a difference in the lives of these deserving kids. You can donate online at https://www.classy.org/fundraiser/5051939. Thank you for your support! 

Assistance During the Holidays

The Division of Social Services’ Community Partner Support Unit (CPSU) helps increase access to social services and promotes self-sufficiency by providing ongoing support to organizations that serve those in need. The CPSU uses a statewide network of more than 250 community and business partners to connect individuals to employment opportunities and other benefits and services. Click here for a list of organizations providing food assistance and resources during the holiday season.

One Step At A time Foundation Requesting Help With Health Screenings

On Wednesday, November 22 – the day before Thanksgiving – the One Step At A Time Foundation is hosting an event for the community in Wilmington to enjoy a meal, educational opportunities on various health issues, and, hopefully, some basic health care assessments. That’s where you come in. The organization is looking for health care professionals willing to offer a few hours of their time to provide health screenings for these families. If you are available on November 22 between 11:00 am and 3:00 pm, please contact Frank Howard at Frank@ConvergencePubAffairs.com to get more details and make arrangements. This family health event will take place at the William "Hicks" Anderson Community Center, located at 501 N. Madison St., Wilmington. Help make a difference.

Beebe Healthcare

TidalHealth Nanticoke

Jigar C. Chauhan, MD - Pediatric Critical Care, Nemours Children's Hospital

Maria P. Childers, MD - Pediatrics, Atracare

Jane William Moore, MD - Family Medicine, Saint Francis Family Medicine

Kwabena Osei-Bonsu, MD - Internal Medicine, Seaford Internal Medicine 

Please join MSD in welcoming the newest members of the Medical Society of Delaware. As the third oldest medical society in the country, MSD has an amazing history. Thank you for taking part in our continued success!

Louis Crevecoeur MD - IM/ID, Delaware Primary, Care, LLC

Chantel Imran, MD - OB/GYN, University of Delaware Student Health Srvcs.

Katherine P. Lewis, MD - Pediatrics, Atracare

Shab E. Gul Rahim, MD - Nephrology, Nephrology Associates, PA

MSD members are afforded a seven-day review period from the date of this publication to comment regarding applicants for membership. Please contact Michelle Seymour at (302) 224-4905 or Michelle.Seymour@medsocdel.org with any comments on the current pending members(s) listed above or if you know of someone interested in joining MSD. You could be eligible for a membership referral dues discount!

The Latin phrase Rerum Cognoscere translates to learn, examine, or become aware of facts or things. In this section, we highlight measurable items of interest in health care from MSD, Delaware, the US, and the world.

The CDC adopted the 2023-2024 Advisory Committee on Immunization Practices’ (ACIP) recommendations on annual influenza (flu) vaccination for everyone 6 months and older in the United States on June 27, 2023. There were small changes to the annual recommendations around flu vaccination, including an acknowledgement of the updated flu vaccine composition for the 2023-2024 flu season and a change in the recommendations for vaccination of people with egg allergies. The adoption of the ACIP recommendations makes them official CDC policy, which have been published in the Morbidity and Mortality Weekly Recommendation Report August 23, 2023. Health care professionals should begin vaccinating patients according to CDC’s recommended timing, which remains the same as last season. Read the CDC Vaccine Recommendations for the 2023-2024 flu season.

Flu Vaccination Guidance for Children

Flu can be a serious threat to children. During a COCA call on August 31, 2023, presenters discussed flu prevention and treatment recommendations from the American Academy of Pediatrics and CDC. If you’ve missed it, this recording is a great update on vaccination, coadministration of flu vaccines, coverage, and health disparities.

The FDA has outlined the following brief guidelines for the updated COVID-19 vaccines to simplify the questions regarding whom should receive the vaccine and when: 

• Individuals 5 years of age and older regardless of previous vaccination are eligible to receive a single dose of an updated mRNA COVID-19 vaccine at least 2 months since the last dose of any COVID-19 vaccine.  
• Individuals 6 months through 4 years of age who have previously been vaccinated against COVID-19 are eligible to receive one or two doses of an updated mRNA COVID-19 vaccine (timing and number of doses to administer depends on the previous COVID-19 vaccine received).  
• Unvaccinated individuals 6 months through 4 years of age are eligible to receive three doses of the updated authorized Pfizer-BioNTech COVID-19 Vaccine or two doses of the updated authorized Moderna COVID-19 Vaccine. 
• The Moderna COVID-19 Vaccine (2023-2024 Formula) is authorized for use in individuals 6 months through 11 years of age. Ensure that the correct dose of the Moderna COVID-19 Vaccine (2023-2024 Formula) is administered to individuals 6 months through 11 years of age and that (0.25 mL) is withdrawn from the vial. FDA has become aware that some health care professionals may not recognize that the single dose vial of Moderna COVID-19 Vaccine (2023-2024 Formula) contains notably more than 0.25 mL of the vaccine and some may be withdrawing the entire contents of the vial to administer to this age group 
• On October 3, 2023, the FDA amended the emergency use authorization (EUA) of the Novavax COVID-19 Vaccine, Adjuvanted for use in individuals 12 years of age and older to include the 2023-2024 formula. Individuals 12 years of age and older previously vaccinated with a COVID-19 vaccine (and who have not already been vaccinated with a recently updated mRNA COVID-19 vaccine) are eligible to receive one dose and unvaccinated individuals receive two doses. As part of this action, the Novavax COVID-19 Vaccine, Adjuvanted (Original monovalent) is no longer authorized for use in the United States.

Vaccination will be available free for everyone through one of three methods.

• Most Private and government insurance plans - cost fully covered by insurance (receive through pharmacies, health care professionals)
• Uninsured, underinsured - cost covered through FQHCs; public health clinics; pharmacies; health care professionals via Delaware Immunization Program; and Walgreens, CVS, and pharmacies affiliated with ETrue North pharmacy network through Bridge Access Program.
• Children participating in CDC's Vaccines for Children Program - free from where they receive routine vaccinations.

 A full listing of vaccine locations is posted on www.vaccines.gov.

• Ellume tests available for those who are blind or have low vision (free at-home COVID-19 tests) https://acl.gov/accessibletests
• Find COVID-19 Vaccines: https://www.vaccines.gov/
• No Cost COVID-19 Testing Locator can help people find current community and pharmacy partners participating in the Increasing Community Access to Testing (ICATT) program.
• FDA At-Home OTC COVID-19 Diagnostic Tests provides a list of all FDA-authorized at-home over-the-counter (OTC) COVID-19 diagnostic tests
• Federal website for information on navigating COVID: COVID.gov
• CDC Isolation and Precautions for People with COVID-19
• COVID-19 Therapeutics Locator
• CDC COVID Data Tracker
• CDC will report regional-level test positivity data from the National Respiratory and Enteric Virus Surveillance System (NREVSS)
• COVID-19 by County Community Level Check (# hospital admissions and beds used and total number of new cases)
• (Delaware) General Questions: call 211 or email DPHCall@delaware.gov or Vaccine@delaware.gov for vaccine-specific questions.
• Latest information on Delaware's response (testing, treatment, vaccination): de.gov/coronavirus (Updated 2/2023)