'Concerning COVID Variant Shows Up in 29 States'

 

• The SARS-CoV-2 variant BA.3.2 spread slowly before being detected in at least 23 countries in five continents by February.
• The prevalence of BA.3.2 was 0.55% among 5,238 U.S. samples collected from December 2025 to mid-March.
• BA.3.2's in-vitro ability to evade antibodies, likely due to spike protein mutations, highlights the need for ongoing genomic surveillance, researchers said.

A SARS-CoV-2 variant that's better at evading immune responses and resisting antibodies induced by current COVID-19 vaccines may be on the rise, but its prevalence remains low in the U.S., according to a CDC report.

First detected in South Africa in November 2024, the SARS-CoV-2 variant BA.3.2 spread slowly before being detected in at least 23 countries in five continents by February 2026. BA.3.2 is distinct from the dominant JN.1 lineages circulating in the U.S. since January 2024, including LP.8.1 and XFG, reported Mila Shakya, DPhil, of the CDC's National Center for Immunization and Respiratory Diseases, and colleagues in the Morbidity and Mortality Weekly Report.

The first detected U.S. case of BA.3.2 was found in June 2025 in a person traveling from the Netherlands, with three detections in U.S. patients across three states by January, including two hospitalized older adults with comorbidities. All three patients survived.

The prevalence of BA.3.2 was 0.55% among 5,238 U.S. samples collected from December 2025 to mid-March, with the variant detected in wastewater samples from 29 states and Puerto Rico. As of March 14, XFG and its subvariants still accounted for an estimated two-thirds of circulating SARS-CoV-2 variants in the U.S., according to CDC estimates.

The 2025-2026 COVID season's vaccines provide protection against predominant JN.1 strains such as LP.8.1 and XFG. However, a laboratory study of seven SARS-CoV-2 variants showed the current vaccine had the lowest antibody neutralization against BA.3.2.

While rising BA.3.2 prevalence in some northern European countries may reflect "substantial antibody evasion," Shakya and colleagues noted, BA.3.2 hasn't rapidly pushed its way to the top of the circulating-variant list. Instead, prevalences in several European countries have hovered at 10% to 40%.

BA.3.2's reduced ability to bind to angiotensin-converting enzyme 2 (ACE2) on cell surfaces and enter lung cells may be keeping it from dominance. Hospitalized patients with detected BA.3.2 don't appear to have more severe COVID.

BA.3.2's in-vitro ability to efficiently evade antibodies, likely because of spike protein mutations, highlights "the need for ongoing genomic surveillance and observational evaluations of vaccine and antiviral effectiveness," the authors wrote.

The strains for the 2026-2027 COVID shots have yet to be selected, but the World Health Organization and FDA are expected to make their recommendations for vaccine makers in the coming months.

Limitations to this report included variations in international sequencing and reporting, as well as a lack of internationally standardized methods for submitting viral genomic sequences. The decline in U.S. specimens and sequences also reduces the sensitivity of genomic surveillance.

Disclosures

Shakya had no disclosures.

Co-authors reported relationships with the Sergey Brin Family Foundation, the U.S. National Science Foundation and Sloan Foundation, and the state of California wastewater-based epidemiology committee of the State Water Resources Control Board.

Primary Source

Morbidity and Mortality Weekly Report

Source Reference: Shakya M, et al "Early detection and surveillance of the SARS-CoV-2 variant BA.3.2 -- worldwide, November 2024-February 2026" MMWR 2026; DOI: 10.15585/mmwr.mm7510a1.

https://www.medpagetoday.com/infectiousdisease/covid19/120519

DO Grads Report Bias When Applying for Residencies

 Graduates of osteopathic medical schools continue to experience bias when applying for medical residencies, according to a survey by the American Association of Colleges of Osteopathic Medicine (AACOM).

In a survey of more than 3,700 graduating students, 79.1% reported experiencing some form of bias related to their coming from osteopathic medical schools rather than allopathic schools.

Examples of bias included unequal access to visiting student rotation programs; biased comments by interviewers; explicit expressions of preference for MDs rather than DOs during the interview process; and DO residency candidates being required to take and pass the U.S. Medical Licensing Examination (USMLE) even though they had already taken and passed the Comprehensive Osteopathic Medical Licensing Examination (COMLEX), which is the equivalent test for DOs.

"DO students are not required to take the USMLE for licensure," Mark Speicher, PhD, AACOM's senior vice president for research, learning, and innovation, said at a press conference Thursday. "However, many residency programs use a USMLE score to determine whether or not a student is suitable for their residency program."

He pointed out that many DO students have to take both the COMLEX and the USMLE, even though no MD students -- either domestic or international -- have to take the COMLEX.

Taking this second exam requires considerable extra effort and resources, said AACOM Director of Government Relations Julie Crockett. "Just to sit for the USMLE is over $2,300 and 32 hours of exam time, and some students have to go to [other] states because the test is not administered in their state," she said, adding that 73% of programs that interview DOs for residency slots require them to take the USMLE, a 30% increase from 2022.

"It's important to note that things are not getting better," even though it has been 11 years since a unified, single-system graduate medical education accreditation system was launched for allopathic and osteopathic physicians, said Crockett.

In addition to the extra testing requirement, some interactions that survey respondents reported having during the application process included:

• "One attending told me flat out: 'You people shouldn't be doing surgery.' That comment never left me."
• "I was asked during an interview if I regretted 'settling' for a DO school. It was insulting and demoralizing."
• "After a grueling interview day, the program director ended with: 'We usually don't take DOs, but thanks for coming.'"

Despite these issues, this year's graduating DO students had their best match year ever, with 93.2% of 8,503 DO seniors matching to a residency position, compared with 93.5% of nearly 21,000 MD seniors, according to the National Resident Matching Program (NRMP).

However, "while the overall match was excellent, there are some specialties -- orthopedic surgery, neurosurgery, dermatology, and others -- where the match rate for DOs has actually declined since single accreditation," Speicher said, adding that there appeared to be more bias among residency programs participating in the NRMP match compared to other matches. "In the military match, only 22% of our students reported experiencing something that they perceived as bias, whereas in the NRMP match, it was over 60%. So the setting matters and the specialty matters."

In addition, only 58% of graduating DO students got their "ideal match," which was defined as getting into the specialty you wanted, getting into one of the top three programs you wanted, and getting a residency in the specialty you plan on practicing later in your career.

Asked by MedPage Today why such bias was still occurring despite decades of DOs practicing in the U.S., Speicher said that while his organization has not investigated that issue, other studies suggest "the stronger the old boys' network, the stronger the tradition of an academic medical center, the stronger the hierarchy, I think -- the more traditional, the more storied the program, you would be more likely to find bias in those specialties."

Speicher said he didn't think this problem would go away even as more seasoned residency directors retired. "Many of your practice habits are learned in residency and they stay with you," he noted. A lot of studies show "that where you're trained determines how much utilization you have of ancillary services, how much your care costs, and all those kinds of things."

While there are no studies on this particular topic, "it seems that in addition to practice patterns and practice habits being passed down in residency, it would be possible for these attitudes to be passed down," he added.

Some members of Congress are trying to address the bias issue, said Crockett. The Fair Access in Residency (FAIR) Act, introduced in the House by Rep. Diana Harshbarger (R-Tenn.) and in the Senate by Sen. Steve Daines (R-Mont.), would require all Medicare-funded graduate medical education programs to report annually on the number of osteopathic and allopathic applicants and accepted residents, and affirm that DO applications and the COMLEX are accepted for consideration if an exam score is required.

"The legislation is very clear that there are no mandates," said Crockett. "So a residency program can have no DOs or no MDs and be fully compliant. It just requires that the residency programs report on the types of applicants that they're receiving and the types of applicants that they are accepting." So far, the FAIR Act has 15 House cosponsors and seven Senate cosponsors.

https://www.medpagetoday.com/publichealthpolicy/medicaleducation/120520

'Should Doctors Charge Patients for Prior Authorization?'

 Some physician practices are charging patients for prior authorization requests or requiring annual administrative fees for such requests and letters of medical necessity, among other services.

In February, patients at one Washington, D.C.-based practice received an email stating that due to the increasing administrative burden on physicians and staff, "a $50 fee will be assessed" for each request to draft a letter or process a medication prior authorization.

Meanwhile, a specialty practice in New Jersey requires office visits for some prior authorization requests to help complete the paperwork accurately.

A physician who asked not to be named told MedPage Today that having a physician or physician assistant work with the patient rather than a non-clinician avoids delays. The practice also sometimes schedules peer-to-peer calls with health plans to coincide with patient visits.

"Having [the patients] there just listening to the process ... I think they start to realize that it's really not the doctors, it's really the insurance industry that's causing their grief," the physician said.

Medication prior authorizations and other requests not requiring clinical information are frequently excluded from the requirement, but for patients for whom an office visit is required, there can be a copay, he noted.

In 2024, Alex Shteynshlyuger, MD, of New York Urology Specialists in New York City, floated a different idea: establishing a dedicated Current Procedural Terminology (CPT) code to charge insurers for the requests.

He asked the American Medical Association (AMA) CPT Editorial Panel to clarify whether it's allowable to charge for an extended visit length if it takes 30 minutes for the visit and another 60 to do a prior authorization.

"And the answer has been no," he said.

However, it does make sense for patients to pay for these services, just as they do pharmacy services, Shteynshlyuger noted. At the pharmacy, "they pay for the actual medication, but it also includes the cost of filling the medication."

An AMA spokesperson said CPT codes to bill insurers for administrative work, including prior authorization, do exist. These include codes for “prolonged evaluation and management,” and for “special reports” such as insurance forms that require more information than the standard reporting form.

Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association, said he is "deeply sympathetic" to physicians and practices enduring the constant burden of prior authorization requests.

"Many practices [particularly primary care practices] have dedicated staff just to do authorizations all day long, but ... they're just doing it for a referral. So they're not getting paid for the service they're authorizing," he explained.

Still, the idea of recouping that lost time and expense, particularly by charging patients on Medicare or Medicaid, is "very risky," Gilberg said. Prior authorization fees are considered part of the practice expense relative value units and some contracts, even commercial contracts, might "explicitly prohibit" them.

Any practice considering this type of policy should have an attorney review commercial contracts and relationships with federal or state payers and programs, he added.

The American Academy of Family Physicians also urges practices to review their payer contracts before billing patients for these types of services. Some concierge practices charge monthly and annual fees "to cover services such as care coordination, improved access, and administrative work (e.g., prior authorizations)," and organizations exist to help practices transition to those models.

As for the impact on patients, Gilberg said "any additional fees ... potentially could deter them from pursuing various treatments or drugs." Practices should bear in mind the potential "blowback from patients," such as bad online reviews and competition from other practices, he cautioned.

Still, many practices don't have any other option but to require new charges, and many practices, particularly primary care, are switching to a concierge model. "That's obviously much worse for patients," Gilberg said.

A spokesperson for the AMA said it hasn't studied "emerging administrative charges," adding that "there's no information available on how common these fees are or what practices are charging them, but cost relief rests with real prior authorization reforms."

Physicians handle nearly 40 prior authorization requests every week, according to AMA President Bobby Mukkamala, MD. That's time spent away from patients, and adds to the financial strain on practices, he said.

"The most effective way to lower administrative costs is to cut down on unnecessary prior authorizations and streamline the inefficient processes insurers require," Mukkamala noted.

A spokesperson for AHIP (formerly America's Health Insurance Plans) told MedPage Today that "health plans are doing their part -- leading the way to improve this vital patient protection tool by streamlining prior authorization to connect patients with care faster, reduce provider burden, and modernize a fragmented system."

While insurers promised to simplify the system and make it less burdensome last year, "many patients and physicians remain skeptical," Mukkamala said. "What's needed now is real transparency, and the AMA is calling on insurers to publicly share clear, measurable proof of progress so patients and physicians can see whether these reforms are making a difference."

https://www.medpagetoday.com/practicemanagement/practicemanagement/120392

What to Expect for Prior Authorization in 2026

 Prior authorization requirements cost the U.S. healthcare system an estimated $35 billion each year, and their overuse has triggered a backlash, stirring some policymakers into action.

Whether these changes actually fix prior authorization for patients and clinicians is an open question. Meanwhile, stakeholders are weighing the risks versus benefits of artificial intelligence (AI) to streamline processes, according to a recent Health Affairs Insider report.

Prior authorization is a form of utilization management designed to gauge the appropriateness of certain medical and pharmacy services -- think elective surgeries, imaging tests, brand-name drugs, and biologics. However, the time and expense for physicians chasing approvals and the potential harm to patients leave many wondering whether these policies serve their intended purpose.

On the clinician side, practices complete about 39 prior authorization requests per physician per week, according to a 2024 American Medical Association survey. Ninety-three percent of physicians experienced delays in care while waiting for prior authorization approvals, 82% said prior authorization has sometimes led patients to abandon treatment, and 29% blamed prior authorization for delays that led to serious adverse events including hospitalizations and deaths.

Moreover, a 2023 KFF survey showed that about 16% of U.S. adults reported problems with prior authorization in the prior year.

A study of Medicare Part D patients in plans that use prior authorization or step therapy for certain medications used to treat atrial fibrillation were both less likely to receive and to take their medications consistently. Notably, patients enrolled in the more restrictive plans had a higher risk for death, stroke, or mini-stroke versus patients in plans that did not require prior authorization.

Another study found that each prior authorization transaction costs practices between $20 and $30. At the same time, about 90% of requests to private payers are approved, suggesting that "spending is not producing meaningful value," noted the Insider report. Payers spend between $40 and $50 per request but maintain that there is "an overarching financial benefit to doing so," the report said.

On the payer side, insurers argue that prior authorization is critical for cost containment. A 2023 report commissioned by the Blue Cross Blue Shield Association found that if health plans are allowed to continue leveraging prior authorization cost controls, the health system could save up to $308 billion between 2024 and 2033. However, the Insider report stressed that the evidence for major cost savings stems from "narrow use cases in the public payer space" -- for example, pilot programs that use the requirements to rein in nonemergent medical transportation.

When researchers asked employees of private insurers whether prior authorization is needed, 94% said yes, according to Health Affairs Scholar.

At the federal level, the CMS Interoperability and Prior Authorization final rule of 2024 includes a number of provisions seeking to change how payers implement these tools and to require more transparency from them. For example, patients must be able to learn whether prior authorization is required for a service, what documentation is needed, and the status of their request. The rule also mandates that urgent requests be decided in 72 hours and non-urgent requests in 7 calendar days.

Members of Congress have introduced a number of bills aimed at reforming prior authorization, which range from prohibiting prior authorization outright to requiring an audit of prior authorization requirements in Medicare Advantage, in which the mechanism is widely used. However, none of these bills have been passed into law.

States, in comparison, have had more success. Roughly 10 states, including Arkansas, Wyoming, and West Virginia, have enacted exemptions to prior authorization for clinicians who maintain high approval rates over a certain period -- a practice known as "gold carding."

Other states have passed bills tightening response times. In Virginia, payers must respond to urgent requests within 24 hours and to non-urgent requests in 2 business days. More than half of states have passed laws aimed at promoting the use of electronic prior authorization, which can reduce both completion times and denial rates.

Despite widespread efforts at the state and federal level to curb the misuse of prior authorization, CMS recently introduced a pilot initiative to test these same tools in traditional Medicare.

The Health Affairs Insider report also suggested that AI creates new opportunities and invites new risks. Generative AI can help physicians draft appeals more quickly, but insurers' efforts to weave AI into their processes has already triggered lawsuits and claims of improper use.

https://www.medpagetoday.com/practicemanagement/reimbursement/120526

ADMA Biologics Addresses Misleading Short-Seller Report

 ADMA Biologics, Inc. (Nasdaq: ADMA) (“ADMA” or the “Company”), a U.S. based, end-to-end commercial biopharmaceutical company dedicated to manufacturing, marketing and developing specialty biologics, today addressed a report issued on March 24, 2026 by Culper Research (the “Short Report”), a firm that has published similarly negative “research reports” regarding public companies after taking short positions in the stock. The Short Report discloses that Culper Research holds a short position in ADMA. ADMA, and its Board of Directors takes seriously its obligations to fairly and accurately report its operating and financial results and make all public disclosures in accordance with the rules and regulations of the U.S. Securities and Exchange Commission and in accordance with the standards of U.S. GAAP. The Short Report, by contrast, appears premised on speculative assertions derived from unidentified and unreliable sources and contains numerous misleading, false and inaccurate statements. Despite the conjecture pervading the Short Report, ADMA is taking appropriate steps to review the assertions.

https://ir.admabiologics.com/news-releases/news-release-details/adma-biologics-addresses-misleading-short-seller-report

Medtronic wins FDA clearance for Stealth AXiS robot in cranial, ENT procedures

 Medtronic (NYSE:MDT) announced today that the FDA cleared its Stealth AXiS surgical robotic system for new indications.

The Stealth AXiS system already held clearance for spine surgery, which it picked up last month. Now, its indications also cover cranial and ear, nose and throat (ENT) procedures.

Stealth AXiS brings planning, navigation and robotics together into a single, intelligent system. Michael Carter, SVP and president of Medtronic Cranial & Spinal Technologies, spoke to MassDevice recently to outline the benefits of the system.

Medtronic built its system to support a range of surgeon preferences, clinical complexity and care settings. It designed Stealth AXiS for use across hospitals and the increasingly popular ambulatory surgery centers (ASCs). The system can operate in these settings without relying on multiple standalone technologies.

Stealth AXiS combines familiar navigation workflows with a modular robotic design, the medtech giant says. It allows institutions to deploy what they need and expand over time as needs evolve. The company built the system on its existing Mazor and StealthStation technologies.

This marks the latest surgical robotics advancement for Medtronic, which also won FDA approval for its Hugo soft tissue robot at the end of 2025.

Medtronic said Stealth AXiS’ latest clearance reinforces the company’s strategy to deliver connected technologies that support surgeons across multiple specialties on a single platform.

The medtech giant says a major feature of Stealth AXiS comes in the form of AI-enabled architecture. It supports advanced planning and visualization before, during and after surgery. The platform integrates intraoperative ultrasound through GE HealthCare’s bkActiv platform as well.

In cranial procedures, AI-based automatic tractography helps surgeons generate patient-specific brain maps and visualize critical neural pathways associated with essential brain functions.

For ENT procedures, Stealth AXiS delivers high-precision navigation and advanced visualization tailored to the intricate anatomy of the sinuses and skull base.

Medtronic said the system’s flexible architecture supports continuous software innovation and expanded capabilities. It hopes the deeper ecosystem of connectivity helps to shape the “next era of surgery.

https://www.massdevice.com/medtronic-fda-clearance-stealth-axis-cranial-ent/

'Accumulate more gold at current levels - Julius Baer'

 Bhaskar Laxminarayan, chief investment officer for Asia and the Middle East at Julius Baer, is making an emphatic case for gold (GLD), (IAU), (SGOL), (OUNZ) accumulation despite recent price weakness.

“Please accumulate more gold at around current levels,” Laxminarayan said in an interview with CNBC, describing the pullback as a counterintuitive opportunity for investors.

The strategist attributed gold’s (XAUUSD:CUR) recent price decline to forced selling during periods of global uncertainty.

When investors needed immediate liquidity amid geopolitical tensions, gold became a go-to source of cash because of its tight spreads and ease of trading.

“Assets that were easier to sell or liquidate were gold… that’s partially what’s happened,” Laxminarayan explained, adding that potential supply from Russian sellers following sanctions-era accumulation may also be a factor.

Laxminarayan sees gold playing a larger role as the world transitions from a bipolar to a multipolar economic structure, a shift he says has become “much more pronounced since 2025.”

He noted that gold is reclaiming ground that cryptocurrency once threatened to take.

“In such a scenario, gold (XAUUSD:CUR) suddenly comes back because Bitcoin (BTC-USD) was supposed to be that replacement,” he said, citing ongoing concerns about regulation and quantum computing as reasons for Bitcoin’s diminished appeal.

The CIO emphasized that gold’s (GLD) relevance today stems not from its traditional role as an inflation hedge but from broader shifts in global trade and monetary systems.

Laxminarayan suggested the world is taking “one step towards” a renewed gold standard as nations build independent financial relationships.

For investors looking to act on his recommendation, Laxminarayan prioritizes physical ownership over paper alternatives.

“Your number one option is to buy physical bars of gold and store them,” he advised, noting that paper gold products can have uncertain backing. Traders seeking short-term opportunities can use options strategies to capitalize on elevated volatility.

The strategist also stressed the importance of geographic diversification in gold storage, warning that government seizure remains a real possibility during crises.

“Location and that’s why having locational diversification in your world ownership [is] very important,” he cautioned, pointing to historical examples of voluntary and forced gold confiscation during national emergencies.

Gold and Gold Miner ETFs: (GLD), (IAU), (SGOL), (OUNZ), (BAR), (GDX), (GDXJ), (NUGT), (RING), and (DUST).

https://www.msn.com/en-us/money/markets/accumulate-more-gold-at-current-levels-julius-baer/ar-AA1ZxTbR