How Will Medicare's New Drug Rebate Law Work?

 The Biden administration issued initial guidance

opens in a new tab or window yesterday on how it plans to implement the Medicare drug rebate program, but how the program might affect physicians who administer drugs under Medicare Part B remains unclear.

The program, passed in August 2022opens in a new tab or window as part of the Inflation Reduction Act, requires manufacturers who raise their drugs' prices faster than the rate of inflation to pay rebates to the federal government. The rebate rule, which applies to drugs administered to beneficiaries under either the Medicare Part Bopens in a new tab or window or Medicare Part Dopens in a new tab or window program, requires the companies to pay the rebates directly to the Medicare trust fund.

Medicare beneficiaries whose prescription drugs are subject to a rebate "will also benefit through lower cost-sharing" starting in April when the program begins to kick in, Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services (CMS) told reporters during a phone call Thursday. "The inflation rebate program will make prescription drugs more affordable for millions of people and strengthen Medicare's sustainability for future generations."

If the inflation Reduction Act had been in place from July 2021 to July 2022, 1,200 prescription drugs would have been subject to the rebates according to an HHS report, Meena Seshamani, MD, PhD, director of the Center for Medicare at CMS, said during the call. "Today's initial guidance is an important step in our work to lower out-of-pocket drug costs."

The guidance was released only a few days after a reportopens in a new tab or window from the HHS Inspector General concluded that "unless CMS takes action to remedy several administrative issues, the agency will face the following challenges in implementing rebates: identifying products subject to Part B rebates and excluding claims from Part B rebate calculations that were already subject to rebates under the Medicaid Drug Rebate Program and discounts under the 340B Drug Discount Program."

The report noted that in the Part B program, "rebates are calculated on the basis of increases in Part B payment amounts, which are set at the HCPCS [Healthcare Common Procedure Coding System] code level. However, in a small number of cases, a single HCPCS code may represent several single source drugs from different manufacturers. For these codes, CMS would find it difficult to determine which manufacturer(s) owe rebates, as well as the number of units and amount of rebates associated with each drug."

In addition, when it comes to claims for "dual eligibles" -- low-income Medicare beneficiaries that are also enrolled in the Medicaid program -- there "are no fields on Part B claims that indicate whether Medicaid will pay a portion of the claim and that, as a result, the units would be subject to Medicaid rebates," the report outlined.

The report suggested possible solutions to both problems. For the HCPCS issue, CMS could "require providers to include on claims national drug codes identifying the specific drug administered and the manufacturer of the drug; or for HCPCS codes associated with single source drugs from multiple manufacturers, develop a method to apportion the number of units and amount of rebates to each manufacturer."

For the Medicaid issue, CMS could "use the MMA [Medicare Modernization Act] File to identify whether a Part B claim is for a dual eligible enrollee; add a field to Part B claims to indicate whether Medicaid will pay a portion of the claim; or develop an automated mechanism to identify Part B claims for which Medicaid will pay a portion," they said.

Asked during the phone call about the report, Seshamani responded that now that the agency has issued its draft guidance, "we are interested in getting comments on these kinds of issues."

Because doctors who administer Part B drugs pay for them upfront and are later reimbursed by Medicare, the rebate program appears to potentially affect them as well, particularly because Medicare's reimbursement is calculated based on the drug's average sales price (ASP) plus a 6% administration fee.

In a Medicare Learning Network postopens in a new tab or window on Thursday, the agency said that once the rebate program starts, if a Part B drugmaker raises prices higher than the inflation rate, "patient coinsurance will be based on 20% of the inflation-adjusted payment amount for the quarter and will be reflected as a percentage (that is, less than 20%) of the Medicare Part B payment amount. The Medicare portion of your payment will be increased for the difference between the Medicare Part B payment amount and patient coinsurance, minus any Part B deductible and sequestration."

For instance, the post said, "if the Medicare Part B payment amount for the drug is $100 and the patient coinsurance is 18.525%, you would charge the patient $18.52. Typically, the Medicare portion of payment to practitioners for Part B drugs and biologicals is limited to 80%. When the patient coinsurance is adjusted, the percentage of the Medicare portion of payment to you will be higher. In this example, the percentage of the Medicare portion would be 81.475% or $81.48 of the Medicare Part B payment amount."

"You must charge patients the correct amount of coinsurance, which may change quarterly," it read.

The post did not address the issue of how the "ASP plus 6%" calculation would be affected by the rebate law, particularly when a drug's price is increased more than the inflation rate. Medicare was unable to respond by press time to a question about that issue.

https://www.medpagetoday.com/publichealthpolicy/medicare/103066

New Guidance Targets Infection Hazards in Fingernails, Sinks, Excessive Hand-Washing

 New infection prevention guidelines,

opens in a new tab or window recently issued by several organizations, tackle fingernails, sinks, and cracked hands.

Among the recommendations, published in Infection Control & Hospital Epidemiology, from the Society for Healthcare Epidemiology, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and the Joint Commission are:

• Healthcare workers should cut their fingernails so they don't extend beyond the fingertips, and should keep them natural.
• Patient-facing healthcare workers should avoid washing their hands so much that they become dry and cracked, which can lead to cuts or bruising and infection, putting the patient and the provider at risk. Instead, alcohol-based hand sanitizers should be used.
• Hospitals should install hand sanitizer dispensers not just on the inside or outside of each patient room, but in both places.
• Certain basins should be dedicated to hand-washing alone, with no other fluids being dumped into them, to avoid infectious organisms splashing onto the counter or becoming aerosolized. Instead, use a toilet or a dedicated receptacle for other fluid disposal purposes.
• Instead of cleaning sink drains with a splash of bleach -- now common practice -- use products newly approved by the U.S. Environmental Protection Agency specifically capable of removing biofilm.
• The advisories are based on new evidence showing previously unappreciated ways that various pathogens can spread in healthcare settings. They are most appropriate for hospitals, but are applicable

opens in a new tab or window to long-term and ambulatory care settings, including dialysis facilities, said lead author Janet B. Glowicz, PhD, RN, of the CDC, in an interview with MedPage Today during which a CDC public relations representative was present.

The CDC participated in the guidelines' development, the latest in a 40-year series since 2014opens in a new tab or window.

One of the most important recommendations has to do with new recognition of how pathogens can spread through "premise plumbingopens in a new tab or window," i.e., the hospital's sinks.

"Nurses in particular don't realize that all the stuff they're putting down those sinks can create biofilms and can also create resistant bacteria, and that can be aerosolized and contaminate the patient environment," Glowicz said.

Hand Hygiene

More recent surveys of various healthcare settings since 2014 found enormous variation in hand hygiene compliance, ranging from 7% in a trauma resuscitation centeropens in a new tab or window (although the sample was small), to 83.5% among nurses and 45.2% among physicians in a Canadian intensive care unitopens in a new tab or window.

"I don't think that healthcare personnel recognize the damage that can be done to their hands by hand-washing, and when hand-washing is their preferred method of cleaning their hands, they are probably removing the lipids from their hands," Glowicz said. "That's a very different message than what you see in a community setting, where it's hand-wash, hand-wash, hand-wash. We know that alcohol-based hand sanitizer kills more bugs than hand-washing removes."

"We are stating it explicitly, because we know that the skin on the hands of healthcare workers, when they over-wash their hands, they can damage that skin, and then their skin will carry more bacteria," she added.

Furthermore, fingernail polish and gel shellac are okay at the discretion of the organization's infection prevention program, except for healthcare professionals who scrub for surgical procedures. For them, nail polish and gel shellac "should be prohibited," according to the guidelines.

Monitoring Adherence

One section in the guidelines that may be controversial encourages healthcare organizations to monitor their workers' hand-washing practices through a combination of methods. There are drawbacks to the direct overt method, because when a monitor's presence in the room is known, workers tend to alter their behavior when they know they're being watched.

Other approaches include direct covert monitoring, like a "secret shopper" approach, although this strategy can also fail when workers alter their behavior after realizing the observer's presence.

Remote video observation, in which healthcare workers and patients are aware that cameras are recording hand hygiene behaviors but do not know who is observing them or when, can reduce this "Hawthorne effect,"opens in a new tab or window but views are limited to camera angles. Among the most important aspects of hand-washing adherence surveillance is that the frontline worker gets feedback, Glowicz and co-authors noted.

Glowicz said she wished there was concurrence on the best approach, "but there just isn't yet. It depends on the facility's needs and resources. Each method has strengths and weaknesses. Facilities need to do some combination of the methods."

Other take-aways in the guidelines include:

• Individual pocket-sized alcohol-based hand sanitizers should not be a substitute for wall-mounted dispensers.
• Soap, moisturizer, and alcohol-based sanitizer dispensers intended for single use should not be refilled.
• Except in response to certain "high-consequence pathogens," or in situations in which compounding pharmacists are preparing sterile medications, double gloving is not recommended, in part because of the risk of contamination from the outer glove.
• Healthcare workers should receive training in proper glove doffing and should wash their hands after removing their gloves, based on a study that showed inappropriate glove use among certified nursing assistants in a long-term care facility, among others.

According to Glowicz, the guidelines are supposed to be updated every 5 years, but the COVID-19 pandemic disrupted the schedule. The new report is not intended to replace recommendations from the CDC's Healthcare Infection Control Practices Advisory Committeeopens in a new tab or window, she said.

Disclosures

Glowicz reported no disclosures. Co-authors reported relationships with Medillum, Nozin, the North Carolina Department of Public Health, PDI Healthcare, Specified Technologies, Northshore University Health System, Saxton & Stump, Teleflex Medical Advisory Board, the Association for Professionals in Infection Control and Epidemiology, and the Joint Commission Resources.

Primary Source

Infection Control & Hospital Epidemiology

Source Reference: opens in a new tab or windowGlowicz JB, et al "SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 update" Infect Control Hosp Epidemiol 2023; DOI: 10.1017/ice.2022.304.

https://www.medpagetoday.com/special-reports/features/103050

Disinflation Trades To Soon Hit The Rocks As Prices Stay Sticky

 by Simon White, Bloomberg macro strategist,

Trades favoring disinflation are soon set to reverse as price increases prove more entrenched than anticipated.

This year, higher-duration sectors, such as tech, telcos and consumer discretionary have led stocks’ advance, while low-duration ones such as energy and utilities have underperformed. This is a reversal of the trend from late 2021, where investors started to shun high-duration stocks as inflation began to rise rapidly.

Duration is the ultimate driver of investor preferences in an inflationary cycle such as the current one. This year growth has begun to outperform value again, and cyclicals are outpacing defensives, but these obscure the bigger picture of how long-duration assets are best avoided when inflation risk is high.

Investors re-embracing higher-duration stocks is a signal they are also embracing the disinflationary narrative, one endorsed by the Fed and priced in to inflation swaps.

That narrative may soon run into trouble though. Headline inflation is falling, but this is almost all due to the drop in cyclical inflation. We can estimate cyclical and structural inflation by looking at the sub-components of CPI that are persistently above trend (structural) and those that are not (cyclical).

The chart below shows that while cyclical inflation has fallen, structural inflation is barely off its peak.

What is likely to happen is that cyclical inflation will keep falling in the near term, taking headline CPI lower. But structural inflation will remain stubborn, meaning CPI will make a higher low. At this point, cyclical inflation will begin rising again, taking headline inflation with it.

This would be a rude awakening for tech and consumer discretionary and other high-duration sectors that have risen this year. 

The bigger trend of lower-duration sectors outperforming – encapsulated in the energy vs tech stock rotation – is likely to re-assert itself sooner rather than later, taking the market lower with it.

https://www.zerohedge.com/markets/disinflation-trades-soon-hit-rocks-prices-stay-sticky

CFPB Looks to Expand Its Oversight of Nonbanks through Two Controversial New Registries

 The Consumer Financial Protection Bureau (“CFPB” or “Bureau”) released two new proposals that aim to expand the Bureau’s authority over nonbank financial institutions:

1. A “repeat offender” registry of consent orders or settlements with an array of state and federal regulators relating to compliance with consumer protection laws (“Repeat Offender Proposal”); and
2. A public registry of the terms and conditions nonbanks use in “form contracts” that consumers typically are not able to negotiate (“Terms and Conditions Proposal”).

Assuming these registries are created as proposed and survive any ensuing legal challenges, complying with the reporting obligations should be relatively easy. The larger challenge will be managing the increased regulatory and litigation risk imposed by the registries.

Repeat Offender Proposal

On December 12, 2022, the CFPB issued a proposal to establish a “repeat offender” registry requiring certain nonbank covered entities to report all final public written orders and judgments (including any settlements, consent decrees, or stipulated orders and judgments) obtained or issued by any federal, state, or local government agency for violation of a number of enumerated consumer protection laws, including those related to unfair, deceptive, or abusive acts or practices (“UDAAPs”).

After receiving these written orders and judgments, the CFPB intends to create a database of enforcement actions that would be available online for use by the public and other regulators. The database will be limited to final settlement or consent orders, so injunctions, preliminary orders, temporary cease-and-desist, and other tentative or temporary orders would not be reportable.

In addition, the proposal would require supervised nonbanks to submit annual written statements regarding compliance with an attestation for each underlying order by an executive with “knowledge of the entity’s relevant systems and procedures for achieving compliance and control over the entity’s compliance efforts.”[1] These entities would also be required to identify a central point of contact related to an entity’s compliance with reportable enforcement actions.

The proposed rule would only apply to certain nonbank covered entities subject to CFPB’s authority. At present, insured depository institutions and credit unions, related persons, states, natural persons, and certain other entities are excluded from registry participation requirements. However, the CFPB stated in the press release for the proposal that it “might later consider collecting or publishing the information described in the proposal from insured banks and credit unions.”[2]

Terms and Conditions Proposal

One month after issuing its repeat offender registry proposal, the CFPB issued a new proposal that would require most CFPB-supervised nonbanks to register certain terms and conditions in their form contracts that the CFPB believes are risky to consumers and/or may violate certain state, federal, or Tribal consumer protection laws.

Specifically, the proposal focuses on terms and conditions that attempt to waive consumers’ legal protections, limit how consumers enforce their rights, or restrict consumers’ ability to file complaints or post reviews.

The proposed rule would apply to nonbank entities subject to CFPB’s supervision authority, including nonbank mortgage originators and servicers, payday lenders, private student lenders, and “larger participants of other consumer financial markets” as defined by Bureau rules. To date, that final category is limited to consumer reporting agencies, consumer debt collectors, student loan servicers, international money transferors, and auto lenders. The proposal provides a limited exemption for certain smaller entities.

For entities subject to the rule, it would create a public registry of terms and conditions used in non-negotiable, “take it or leave it” form contracts that claim to waive or limit consumer rights and protections, and would require supervised nonbank companies to report annually their use of standard-form contract terms that “seek to waive consumer rights or other legal protections or limit the ability of consumers to enforce or exercise their rights.”[3] Specifically, the rule focuses on “covered terms and conditions,” which include the following contractual provisions:

• Mandatory arbitration agreements and class action waivers;
• Limitations on nonbanks’ liability to consumers;
• Restrictions on consumers’ ability to commence legal action by dictating timeframe, forum, or venue requirements;
• Bans or limitations on consumers’ ability to complain or post reviews of nonbanks; and
• Other waivers or limits on consumers’ rights or legal protections.

Statements from Director Chopra indicate that the CFPB intends this registry to help regulators, law enforcement, and private litigants detect potentially unlawful, unfair, or abusive contractual terms that are pushed on consumers without any real ability to negotiate.[4]

Notably, the CFPB’s proposal specifically emphasizes legal theories for how certain contractual provisions may violate a number of state, federal, or Tribal laws, including those enforced by both the Federal Trade Commission (“FTC”) and CFPB, such as the Holder Rule; the 2016 Consumer Review Fairness Act (restricting “gag orders” on bad reviews, assessments, etc.); the FTC Act (including unfair or deceptive acts or practices (“UDAP”) restrictions); the Consumer Financial Protection Act (including UDAAP restrictions); the Credit Repair Organizations Act; and the Servicemembers Civil Relief Act and the Military Lending Act.

What do these proposals mean for nonbanks?

Both proposals rely on the CFPB’s broad authority under Sections 1022(b) and (c) and 1024(c) of the Dodd-Frank Act, which give the CFPB the authority to promulgate rules that “facilitate the Bureau’s market monitoring function and its risk based supervisory process” but were rarely used prior to Director Chopra’s tenure as CFPB director.[5] This is a shift from rules issued via the CFPB’s direct authorities under statutes it administers such as the Truth in Lending Act and the Equal Credit Opportunity Act or its authority to promulgate rules to address unfair, deceptive, or abusive acts or practices.

The CFPB’s use of its market monitoring authority continues a pattern of the Bureau flexing its muscles over nonbank market participants that historically have been better able to fly under the CFPB’s regulatory and enforcement radar than larger institutions that undergo periodic examinations. It also signals a shift in the CFPB’s methods of imposing its will on these types of institutions, moving from direct threat of CFPB enforcement to publicly shaming companies that have been subject to actions by other regulators, or collecting and providing ammunition to other regulators and private litigants who may also enforce consumer protection laws by initiating their own actions. Thus, these proposals show increased interagency coordination to enforce consumer protection laws.

This approach could also be viewed as an attempt by the federal government to encroach on the prudential regulatory authority of state regulators in matters such regulators had sought to keep confidential for reasons of public trust in markets and safety and soundness. The proposal would blindly upend this dynamic for the sake of transparency without regard to broader market and economic implications.

In part, these rulemakings also may relate to past efforts by the CFPB to develop and impose proscriptive discretionary rules on market participants. Chiefly, the CFPB’s Arbitration Rule (which would have prohibited the use of arbitration clauses with class action waivers as a means of avoiding class action liability), which was overturned in 2017 by a Congressional Review Act resolution and the Payday and Small Dollar Lending Rule, which was largely repealed by CFPB leadership during the Trump Administration, with its surviving pieces mired in litigation and still not effective.

With these two new proposals, the CFPB would shift roles into that of an information collector or a data aggregator. This data would be available to parties mining troublesome contractual provisions that could be deemed unfair or abusive and give rise to private actions or enforcement actions by other regulators and state attorneys general.

The Repeat Offender Proposal was published in the Federal Register on January 31, 2023, with a comment period that ends March 31, 2023. The Terms and Conditions Proposal was published February 3, 2023, with a comment period that ends April 3, 2023. Each is likely to draw a substantial number of comments and any final rule promulgated by the CFPB is also likely to face legal challenges.

---

[1] Registry of Nonbank Covered Persons Subject to Certain Agency and Court Orders, 88 Fed. Reg. 6088 (proposed Dec. 12, 2022) (to be codified at 12 CFR 1092).

[2] Press Release, CFPB Proposes Registry to Detect Repeat Offenders (Dec. 12, 2022).

[3] Registry of Supervised Nonbanks that Use Form Contracts to Impose Terms and Conditions that Seek to Waive or Limit Consumer Legal Protections, 86 Fed, Reg. 6906 (proposed Jan. 11, 2023) (to be codified at 12 CFR 1092).

[4] Press Release, Statement of CFPB Director Rohit Chopra on Proposed Registry of Supervised Nonbanks that Use Form Contracts to Impose Terms and Conditions that Seek to Waive or Limit Consumer Legal Protections (Jan. 11, 2023).

[5] Registry of Nonbank Covered Persons Subject to Certain Agency and Court Orders, 88 Fed. Reg. 6088 (proposed Dec. 12, 2022) (to be codified at 12 CFR 1092); Registry of Supervised Nonbanks that Use Form Contracts to Impose Terms and Conditions that Seek to Waive or Limit Consumer Legal Protections, 86 Fed. Reg. 6906 (proposed Jan. 11, 2023) (to be codified at 12 CFR 1092).

[View source.]

https://www.jdsupra.com/legalnews/cfpb-looks-to-expand-its-oversight-of-8484039/

Japan Astronomers Believe Chinese Satellite Fired Green Lasers Over Hawaii

 Late last month, mysterious green laser beams were spotted from Hawaii's tallest peak. Experts initially said the burst of laser beams was emitted by a NASA spacecraft though that was proven incorrect this week -- with evidence pointing to a Chinese satellite. 

Space experts at the National Astronomical Observatory of Japan (NAOJ) initially tweeted on Jan. 30 that the Subaru-Asahi Star Camera "captured green laser lights in the cloudy sky over Maunakea, Hawai'i. The lights are thought to be from a remote-sensing altimeter satellite ICESAT-2/43613." 

But on Feb. 6, one week later, NAOJ issued a correction on YouTube that specified the laser beams weren't from a US spacecraft but the "most likely candidate" was a "Chinese Daqi-1/AEMS satellite." 

"According to Dr. Martino, Anthony J., a NASA scientist working on ICESat-2 ATLAS, it is not by their instrument but by others," a correction note on the YouTube video explains. 

"His colleagues, Dr. Alvaro Ivanoff et al., did a simulation of the trajectory of satellites that have a similar instrument and found a most likely candidate as the ACDL instrument by the Chinese Daqi-1/AEMS satellite.

"We really appreciate their efforts in the identification of the light. We are sorry about our confusion related to this event and its potential impact on the ICESat-2 team."

Here's the video of the Chinese satellite firing bursts of lasers toward Earth. 

Even though the Daqi-1 satellite is supposedly an atmospheric environment monitoring spacecraft, there are many concerns after the spy balloon incident last week of space-base and even high-altitude surveillance equipment monitoring the US and allies. 

https://www.zerohedge.com/geopolitical/experts-believe-chinese-satellite-fired-green-lasers-hawaii

China Demands US "Explain Itself To The World" Over Nord Stream Attack Story

 by Paul Joseph Watson via Summit News,

China has demanded that the United States “explain itself to the world” if the revelations in Seymour Hersh’s story about US intel being responsible for destroying the Nord Stream gas pipelines are true.

The Pulitzer Prize-winning investigative journalist published an article this week in which he asserted that the pipelines were destroyed by the US as part of a covert operation.

According to Hersh’s sources, the explosives were planted in June 2022 by US Navy divers under the guise of the BALTOPS 22 NATO exercise and were detonated three months later with a remote signal sent by a sonar buoy.

One source told Hersh that the plotters knew the covert operation was an “act of war,” with some in the CIA and State Department warning, “Don’t do this. It’s stupid and will be a political nightmare if it comes out.”

Now Beijing is demanding that the White House address the issue, seemingly unimpressed with the Biden administration’s rather weak response to merely label the story “false”.

Earlier today, Chinese Foreign Ministry spokeswoman Mao Ning asserted that Washington would have to bear responsibility if the report is confirmed as accurate.

“If the conclusions of the investigation are true, then the US behavior is unacceptable,” the diplomat told reporters, adding that the US would need to “explain itself to the world community.”

The Kremlin also responded to the report by demanding a fresh international investigation into the attack, which was preceded by both Joe Biden and Victoria Nuland asserting that the pipelines would be taken out if Russia invaded Ukraine.

Kremlin Press Secretary Dmitry Peskov said Hersh’s article showed “the need for an open international investigation into this unprecedented attack on this critical infrastructure.”

“It’s a very important piece, which… must provoke the acceleration of the international probe. But we, on the contrary, witness attempts to silently wind down such international investigation,” he added.

Meanwhile, in Germany, the Alternative for Germany (AfD) party is also calling for a full inquiry.

“The Pulitzer Prize winner’s suspicions must be investigated,” wrote co-chairman of the AfD parliamentary group, Tino Chrupalla.

“Has NATO’s leading power carried out an attack on our country’s vital critical infrastructure in European waters? Then one would have to question whether the alliance guarantees security in Europe or rather endangers it. The consequence would be the withdrawal of all U.S. troops.”

https://www.zerohedge.com/geopolitical/china-demands-us-explain-itself-world-over-nord-stream-attack-story

PAYPAL PAUSES STABLECOIN WORK AMID REGULATORY SCRUTINY OF CRYPTO

PayPal Holdings Inc is pausing work on its stablecoin as regulators increase scrutiny of cryptocurrencies and a key partner on the project faces a probe by the New York State Department of Financial Services, Bloomberg News reported on Friday.

PayPal had hoped to debut the stablecoin, which will be backed one for one by the dollar, in the coming weeks, Bloomberg reported, citing a person with knowledge of the matter.

The payments firm did not immediately respond to a Reuters request for comment.

The cryptocurrency market is going through a turbulent period as the collapse of some of its biggest players, including FTX, has shaken the faith of investors in what was seen as the next big thing in the world of finance.

A string of high-profile bankruptcies has sparked tough global regulatory scrutiny of firms operating in the crypto industry.

The macroeconomic weakness has also begun to pressure growth at PayPal's core business as consumer spending, particularly discretionary purchases, comes under pressure due to a cost-of-living crisis, triggered by decades-high inflation.

https://www.marketscreener.com/quote/stock/PAYPAL-HOLDINGS-INC-23377703/news/PayPal-pauses-stablecoin-work-amid-regulatory-scrutiny-of-crypto-Bloomberg-News-42957809/