Is Monoclonal Antibody Therapy Right for Me?

Total Page:16

File Type:pdf, Size:1020Kb

Is Monoclonal Antibody Therapy Right for Me? Is monoclonal antibody therapy right for me? When administered to non-hospitalized, high-risk patients as soon as possible after positive viral testing for COVID-19 and within 10 days of symptom onset, monoclonal antibodies may improve symptoms and reduce risk of hospitalizations and death associated with COVID-19. Monoclonal antibodies may also be used following exposure to COVID-19 for some high-risk individuals, but is not a substitute for vaccination. Step 1: Test positive for COVID-19, develop Step 2: Contact Step 3: Contact an symptoms, and health care provider available infusion location answer yes to high-risk for referral. (covid.infusioncenter.org). conditions. High-risk adults and children (12-17) who have had symptoms of COVID-19 for 10 days or less should be considered for treatment by their health care providers and directed to available infusion locations. High- risk individuals with a known exposure may be eligible for treatment to reduce risk of becoming seriously ill. Steps 2 and 3 remain the same for this alternate pathway. What are antibodies? Antibodies are naturally made in our bodies to fight infection. Without Antibodies With Antibodies Virus Spike protein A virus enters Antibodies block the a cell virus from entering the cell or enable it to be Cell lining destroyed. Antibody What are monoclonal antibodies? Monoclonal antibodies (mAbs) are proteins developed in a laboratory. They act like natural antibodies to attack and neutralize the virus. Monoclonal antibody therapies are administered through an intravenous (IV) infusion. The federal government is distributing antibody supplies at no cost to patients. Medicare, Medicaid, and most third-party insurers cover the infusion cost. Uninsured individuals can still receive mAb as providers can submit for reimbursement to the HRSA Uninsured Program. If you get a positive test result, talk to your doctor about your risk and your treatment options so you can decide what’s right for you. Remember – this has to be done within 10 days of symptom onset. August 13, 2021 Who is eligible to receive mAb therapy? Anyone over 12 years of age weighing more than 40kg (89 pounds) and has one of the following high- risk factors making them more susceptible to severe COVID-19 illness: • Are older in age (e.g., age > 65 years of age). • Are obese (Body Mass Index >35) or are overweight (e.g., adults with BMI >25, or if age 12-17, have BMI >85th percentile for their age and gender based on CDC growth charts, Growth Charts - Clinical Growth Charts (cdc.gov)) • Are pregnant • Have chronic kidney disease • Have diabetes • Have immunosuppressive disease or are receiving immunosuppressive treatment • Have cardiovascular disease or hypertension • Have chronic lung diseases (chronic obstructive pulmonary disease, moderate to severe asthma, interstitial lung disease, cystic fibrosis, or pulmonary hypertension) • Have sickle cell disease • Have a neurodevelopmental disorder (e.g., cerebral palsy) or other condition that confers with medical complexity • Have a medical-related technological dependence (e.g., tracheostomy, gastrostomy, or positive pressure ventilation (not related to COVID-19)) Other medical conditions or factors (e.g., race or ethnicity) may also place individual patients at high risk for progression to severe COVID-19 and authorization of mAb therapy under the EUA is not limited to the medical conditions or factors listed above. For additional information on medical conditions and factors associated with increased risk for progression to severe COVID-19, see the CDC website: Certain Medical Conditions and Risk for Severe COVID-19 Illness | CDC For treatment following exposure to COVID-19: Casirivimab + imdevimab has also received authorization for use as post-exposure prophylaxis of COVID-19 in individuals who are at high risk of progression to severe COVID-19 and are: • Not fully vaccinated or who are not expected to mount an adequate immune response to complete vaccination (for example, indiviuals with immunocompromising conditions including those taking immunosuppressive medications) and • Have been exposed to an individual infected with COVID-19 consistent with close contact criteria, or • Who are at high risk of exposure to an individual infected with COVID-19 because of occurrence of COVID-19 infection in other individuals in the same institutional setting (for example, nursing home or correctional facility). Post-exposure prophylaxis is not a substitute for vaccination for COVID-19. Find an infusion location covid.infusioncenter.org If you have questions, visit Michigan.gov/COVIDtherapy, call the COVID-19 hotline at 888-535-6136 or email [email protected]. August 13, 2021.
Recommended publications
  • Lactoferrin and Its Detection Methods: a Review
    nutrients Review Lactoferrin and Its Detection Methods: A Review Yingqi Zhang, Chao Lu and Jin Zhang * Department of Chemical and Biochemical Engineering, University of Western Ontario, London, ON N6A 5B9, Canada; [email protected] (Y.Z.); [email protected] (C.L.) * Correspondence: [email protected] Abstract: Lactoferrin (LF) is one of the major functional proteins in maintaining human health due to its antioxidant, antibacterial, antiviral, and anti-inflammatory activities. Abnormal levels of LF in the human body are related to some serious diseases, such as inflammatory bowel disease, Alzheimer’s disease and dry eye disease. Recent studies indicate that LF can be used as a biomarker for diagnosis of these diseases. Many methods have been developed to detect the level of LF. In this review, the biofunctions of LF and its potential to work as a biomarker are introduced. In addition, the current methods of detecting lactoferrin have been presented and discussed. We hope that this review will inspire efforts in the development of new sensing systems for LF detection. Keywords: lactoferrin; biomarkers; immunoassay; instrumental analysis; sensor 1. Introduction Lactoferrin (known as lactotransferrin, LF), with a molecular weight of about 80 kDa, is a functional glycoprotein, which contains about 690 amino acid residues. It was first isolated from bovine milk by Sorensen in 1939 and was first isolated from human milk by Citation: Zhang, Y.; Lu, C.; Zhang, J. Johanson in 1960 [1,2]. The three-dimensional structure of LF has been unveiled by high Lactoferrin and Its Detection resolution X-ray crystallographic analysis, and it consists of two homologous globular lobes Methods: A Review.
    [Show full text]
  • USAN Naming Guidelines for Monoclonal Antibodies |
    Monoclonal Antibodies In October 2008, the International Nonproprietary Name (INN) Working Group Meeting on Nomenclature for Monoclonal Antibodies (mAb) met to review and streamline the monoclonal antibody nomenclature scheme. Based on the group's recommendations and further discussions, the INN Experts published changes to the monoclonal antibody nomenclature scheme. In 2011, the INN Experts published an updated "International Nonproprietary Names (INN) for Biological and Biotechnological Substances—A Review" (PDF) with revisions to the monoclonal antibody nomenclature scheme language. The USAN Council has modified its own scheme to facilitate international harmonization. This page outlines the updated scheme and supersedes previous schemes. It also explains policies regarding post-translational modifications and the use of 2-word names. The council has no plans to retroactively change names already coined. They believe that changing names of monoclonal antibodies would confuse physicians, other health care professionals and patients. Manufacturers should be aware that nomenclature practices are continually evolving. Consequently, further updates may occur any time the council believes changes are necessary. Changes to the monoclonal antibody nomenclature scheme, however, should be carefully considered and implemented only when necessary. Elements of a Name The suffix "-mab" is used for monoclonal antibodies, antibody fragments and radiolabeled antibodies. For polyclonal mixtures of antibodies, "-pab" is used. The -pab suffix applies to polyclonal pools of recombinant monoclonal antibodies, as opposed to polyclonal antibody preparations isolated from blood. It differentiates polyclonal antibodies from individual monoclonal antibodies named with -mab. Sequence of Stems and Infixes The order for combining the key elements of a monoclonal antibody name is as follows: 1.
    [Show full text]
  • Monoclonal Antibody Playbook
    Federal Response to COVID-19: Monoclonal Antibody Clinical Implementation Guide Outpatient administration guide for healthcare providers 2 SEPTEMBER 2021 1 Introduction to COVID-19 Monoclonal Antibody Therapy 2 Overview of Emergency Use Authorizations 3 Site and Patient Logistics Site preparation Patient pathways to monoclonal administration 4 Team Roles and Responsibilities Leadership Administrative Clinical Table of 5 Monoclonal Antibody Indications and Administration Indications Contents Preparation Administration Response to adverse events 6 Supplies and Resources Infrastructure Administrative Patient Intake Administration 7 Examples: Sites of Administration and Staffing Patterns 8 Additional Resources 1 1. Introduction to Monoclonal Therapy 2 As of 08/13/21 Summary of COVID-19 Therapeutics 1 • No Illness . Health, no infections • Exposed Asymptomatic Infected . Scope of this Implementation Guide . Not hospitalized, no limitations . Monoclonal Antibodies for post-exposure prophylaxis (Casirivimab + Imdevimab (RGN)) – EUA Issued. • Early Symptomatic . Scope of this Implementation Guide . Not hospitalized, with limitations . Monoclonal Antibodies for treatment (EUA issued): Bamlanivimab + Etesevimab1 (Lilly) Casirivimab + Imdevimab (RGN) Sotrovimab (GSK/Vir) • Hospital Adminission. Treated with Remdesivir (FDA Approved) or Tocilizumab (EUA Issued) . Hospitalized, no acute medical problems . Hospitalized, not on oxygen . Hospitlaized, on oxygen • ICU Admission . Hospitalized, high flow oxygen, non-invasive ventilation
    [Show full text]
  • REGENERON PHARMACEUTICALS, INC. (Exact Name of Registrant As Specified in Charter)
    UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 8-K CURRENT REPORT Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 Date of Report (Date of earliest event reported): February 9, 2017 (February 9, 2017) REGENERON PHARMACEUTICALS, INC. (Exact Name of Registrant as Specified in Charter) New York 000-19034 13-3444607 (State or other jurisdiction (Commission (IRS Employer of Incorporation) File No.) Identification No.) 777 Old Saw Mill River Road, Tarrytown, New York 10591-6707 (Address of principal executive offices, including zip code) (914) 847-7000 (Registrant's telephone number, including area code) Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions: ☐ Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425) ☐ Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12) ☐ Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b)) ☐ Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c)) Item 2.02 Results of Operations and Financial Condition. On February 9, 2017, Regeneron Pharmaceuticals, Inc. issued a press release announcing its financial and operating results for the quarter and year ended December 31, 2016. A copy of the press release is being furnished to the Securities and Exchange Commission as Exhibit 99.1 to this Current Report on Form 8-K and is incorporated by reference to this Item 2.02.
    [Show full text]
  • The Future of Antibodies As Cancer Drugs
    REVIEWS Drug Discovery Today Volume 17, Numbers 17/18 September 2012 The biopharmaceutical industry’s pipeline of anticancer antibodies includes 165 candidates with substantial diversity in composition, targets and mechanisms of action that hold promise to be the cancer drugs of the future. Reviews FOUNDATION REVIEW Foundation review: The future of antibodies as cancer drugs 1 2 Dr Janice Reichert Janice M. Reichert and Eugen Dhimolea is Research Assistant Professor at Tufts 1 Center for the Study of Drug Development, Tufts University School of Medicine, 75 Kneeland Street, University’s Center for the Study of Drug Development Suite 1100, Boston, MA 02111, USA 2 (CSDD). She is also Founder Department of Medical Oncology, Dana-Farber Cancer Institute/Harvard Medical School, 77 Louis Pasteur Ave., and Editor-in-Chief of mAbs, Harvard Institutes of Medicine, Room 309, Boston, MA 02215, USA a peer-reviewed, PubMed- indexed biomedical journal that focuses on topics relevant to antibody research Targeted therapeutics such as monoclonal antibodies (mAbs) have proven and development; President of the board of directors of The Antibody Society; and a member of the board successful as cancer drugs. To profile products that could be marketed in of the Peptide Therapeutics Foundation. At CSDD, the future, we examined the current commercial clinical pipeline of mAb Dr Reichert studies innovation in the pharmaceutical and biotechnology industries. Her work focuses on candidates for cancer. Our analysis revealed trends toward development of strategic analyses of investigational candidates and marketed products, with an emphasis on the clinical a variety of noncanonical mAbs, including antibody–drug conjugates development and approval of new therapeutics and (ADCs), bispecific antibodies, engineered antibodies and antibody vaccines.
    [Show full text]
  • CYRAMZA (Ramucirumab) Injection Label
    1 HIGHLIGHTS OF PRESCRIBING INFORMATION • 500 mg/50 mL (10 mg per mL) solution, single-dose vial (3) These highlights do not include all the information needed to use CYRAMZA safely and effectively. See full prescribing information ------------------------------- CONTRAINDICATIONS ------------------------------ for CYRAMZA. None CYRAMZA (ramucirumab) injection, for intravenous infusion ------------------------ WARNINGS AND PRECAUTIONS ----------------------- Initial U.S. Approval: 2014 • Arterial Thromboembolic Events (ATEs): Serious, sometimes fatal WARNING: HEMORRHAGE ATEs have been reported in clinical trials. Discontinue CYRAMZA for severe ATEs. (5.2) See full prescribing information for complete boxed warning. • Hypertension: Monitor blood pressure and treat hypertension. CYRAMZA increased the risk of hemorrhage, including severe Temporarily suspend CYRAMZA for severe hypertension. and sometimes fatal hemorrhagic events. Permanently Discontinue CYRAMZA for hypertension that cannot be medically discontinue CYRAMZA in patients who experience severe controlled. (5.3) bleeding [see Dosage and Administration (2.3), Warnings and • Infusion-Related Reactions: Monitor for signs and symptoms Precautions (5.1)]. during infusion. (5.4) • Gastrointestinal Perforation: Discontinue CYRAMZA. (5.5) --------------------------- RECENT MAJOR CHANGES -------------------------- • Impaired Wound Healing: Withhold CYRAMZA prior to surgery. Indications and Usage 11/2014 (5.6) • Clinical Deterioration in Patients with Cirrhosis: New onset or Dosage and Administration:
    [Show full text]
  • COVID-19 Immunotherapy: Novel Humanized 47D11 Monoclonal Antibody
    Review Article ISSN: 2574 -1241 DOI: 10.26717/BJSTR.2020.29.004828 COVID-19 Immunotherapy: Novel Humanized 47D11 Monoclonal Antibody Basma H Marghani* Department of Physiology, Faculty of Veterinary Medicine, Mansoura University, Egypt *Corresponding author: Basma H Marghani, Department of Physiology, Faculty of Veterinary Medicine, Mansoura University, Egypt ARTICLE INFO ABSTRACT Received: August 10, 2020 Published: August 18, 2020 rapidly to the other countries all over the world, caused a novel Coronavirus-2019 (COV- SARS-CoV-2 was appeared firstly in Wuhan, China in December 2019, then spread- gency. After infection, virus entry the host cell through spike proteins (S)- angiotensin Citation: Basma H Marghani. COVID-19 ID-19). The World Health Organization was branded COVID-19 as a global health emer Immunotherapy: Novel Humanized 47D11 converting enzyme 2 (ACE2) cell membrane receptor via their S-Binding domain, then Monoclonal Antibody. Biomed J Sci & Tech virus replication caused acute respiratory disease syndrome (ARDS). Till now there was Res 29(4)-2020. BJSTR. MS.ID.004828. no vaccines or anti-viral drugs for coronavirus infection. One effective treatment is the use of human monoclonal antibodies (mAbs) which are engineered to target and block Keywords: COVID-19; Immunotherapy; cell surface receptor. mAbs could be given to people in the early stages of COVID-19 as a Full-Length Humanized Monoclonal Anti- therapeutic, or used prophylactically to give immediate, long-term immunity to vulnera- bodies; ACE Inhibitor ble people such as healthcare workers. The neutralizing humanized 47D11 monoclonal antibody targets a common epitope on SARS-CoV2 virus and may offer potential for pre- Abbreviations: ACE2: Angiotensin-Con- vention and treatment of COVID-19.89U (Graphical Abstract 1).
    [Show full text]
  • Ab200015 Human Lactoferrin Simplestep ELISA® Kit
    Version 1 Last updated 28 August 2019 ab200015 Human Lactoferrin SimpleStep ELISA® Kit For the quantitative measurement of Lactoferrin in human serum, plasma, milk, urine, saliva, and cell culture supernatants. This product is for research use only and is not intended for diagnostic use. Copyright © 2018 Abcam. All rights reserved Table of Contents 1. Overview 1 2. Protocol Summary 2 3. Precautions 3 4. Storage and Stability 3 5. Limitations 4 6. Materials Supplied 4 7. Materials Required, Not Supplied 5 8. Technical Hints 5 9. Reagent Preparation 7 10. Standard Preparation 8 11. Sample Preparation 9 12. Plate Preparation 11 13. Assay Procedure 12 14. Calculations 14 15. Typical Data 15 16. Typical Sample Values 16 17. Assay Specificity 23 18. Species Reactivity 23 19. Troubleshooting 24 20. Notes 25 Technical Support 26 Copyright © 2018 Abcam. All rights reserved 1. Overview Lactoferrin in vitro SimpleStep ELISA® (Enzyme-Linked Immunosorbent Assay) kit is designed for the quantitative measurement of Lactoferrin protein in humanserum, plasma, milk, urine, saliva, and cell culture supernatants. The SimpleStep ELISA® employs an affinity tag labeled capture antibody and a reporter conjugated detector antibody which immunocapture the sample analyte in solution. This entire complex (capture antibody/analyte/detector antibody) is in turn immobilized via immunoaffinity of an anti-tag antibody coating the well. To perform the assay, samples or standards are added to the wells, followed by the antibody mix. After incubation, the wells are washed to remove unbound material. TMB Development Solution is added and during incubation is catalyzed by HRP, generating blue coloration. This reaction is then stopped by addition of Stop Solution completing any color change from blue to yellow.
    [Show full text]
  • Tests for Autoimmune Diseases Test Codes 249, 16814, 19946
    Tests for Autoimmune Diseases Test Codes 249, 16814, 19946 Frequently Asked Questions Panel components may be ordered separately. Please see the Quest Diagnostics Test Center for ordering information. 1. Q: What are autoimmune diseases? A: “Autoimmune disease” refers to a diverse group of disorders that involve almost every one of the body’s organs and systems. It encompasses diseases of the nervous, gastrointestinal, and endocrine systems, as well as skin and other connective tissues, eyes, blood, and blood vessels. In all of these autoimmune diseases, the underlying problem is “autoimmunity”—the body’s immune system becomes misdirected and attacks the very organs it was designed to protect. 2. Q: Why are autoimmune diseases challenging to diagnose? A: Diagnosis is challenging for several reasons: 1. Patients initially present with nonspecific symptoms such as fatigue, joint and muscle pain, fever, and/or weight change. 2. Symptoms often flare and remit. 3. Patients frequently have more than 1 autoimmune disease. According to a survey by the Autoimmune Diseases Association, it takes up to 4.6 years and nearly 5 doctors for a patient to receive a proper autoimmune disease diagnosis.1 3. Q: How common are autoimmune diseases? A: At least 30 million Americans suffer from 1 or more of the 80 plus autoimmune diseases. On average, autoimmune diseases strike three times more women than men. Certain ones have an even higher female:male ratio. Autoimmune diseases are one of the top 10 leading causes of death among women age 65 and under2 and represent the fourth-largest cause of disability among women in the United States.3 Women’s enhanced immune system increases resistance to infection, but also puts them at greater risk of developing autoimmune disease than men.
    [Show full text]
  • Understanding the Immune System: How It Works
    Understanding the Immune System How It Works U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES NATIONAL INSTITUTES OF HEALTH National Institute of Allergy and Infectious Diseases National Cancer Institute Understanding the Immune System How It Works U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES NATIONAL INSTITUTES OF HEALTH National Institute of Allergy and Infectious Diseases National Cancer Institute NIH Publication No. 03-5423 September 2003 www.niaid.nih.gov www.nci.nih.gov Contents 1 Introduction 2 Self and Nonself 3 The Structure of the Immune System 7 Immune Cells and Their Products 19 Mounting an Immune Response 24 Immunity: Natural and Acquired 28 Disorders of the Immune System 34 Immunology and Transplants 36 Immunity and Cancer 39 The Immune System and the Nervous System 40 Frontiers in Immunology 45 Summary 47 Glossary Introduction he immune system is a network of Tcells, tissues*, and organs that work together to defend the body against attacks by “foreign” invaders. These are primarily microbes (germs)—tiny, infection-causing Bacteria: organisms such as bacteria, viruses, streptococci parasites, and fungi. Because the human body provides an ideal environment for many microbes, they try to break in. It is the immune system’s job to keep them out or, failing that, to seek out and destroy them. Virus: When the immune system hits the wrong herpes virus target or is crippled, however, it can unleash a torrent of diseases, including allergy, arthritis, or AIDS. The immune system is amazingly complex. It can recognize and remember millions of Parasite: different enemies, and it can produce schistosome secretions and cells to match up with and wipe out each one of them.
    [Show full text]
  • Datasheet: MCA2763 Product Details
    Datasheet: MCA2763 Description: MOUSE ANTI HUMAN LACTOFERRIN Specificity: LACTOFERRIN Format: Purified Product Type: Monoclonal Antibody Clone: 2B8 Isotype: IgG1 Quantity: 0.2 mg Product Details Applications This product has been reported to work in the following applications. This information is derived from testing within our laboratories, peer-reviewed publications or personal communications from the originators. Please refer to references indicated for further information. For general protocol recommendations, please visit www.bio-rad-antibodies.com/protocols. Yes No Not Determined Suggested Dilution Flow Cytometry Immunohistology - Frozen Immunohistology - Paraffin ELISA Immunoprecipitation Western Blotting Functional Assays Where this product has not been tested for use in a particular technique this does not necessarily exclude its use in such procedures. Suggested working dilutions are given as a guide only. It is recommended that the user titrates the product for use in their own system using the appropriate negative/positive controls. Target Species Human Product Form Purified IgG - liquid Preparation Purified IgG prepared by affinity chromatography on Protein G from tissue culture supernatant Buffer Solution Phosphate buffered saline Preservative 0.09% Sodium Azide (NaN ) Stabilisers 3 Approx. Protein 1.0mg/ml Concentrations Immunogen Purified Lactoferrin from human milk. External Database UniProt: Links P02788 Related reagents Page 1 of 3 Entrez Gene: 4057 LTF Related reagents Synonyms LF Fusion Partners Spleen cells from immunised Balb/c mice were fused with cells of the Sp2/0 myeloma cell line. Specificity Mouse anti Human Lactoferrin antibody, clone 2B8 recognizes human lactoferrin, a ~80 kDa globular iron binding glycoprotein found in body secretions such as milk and saliva and is a member of the transferrin family proteins.
    [Show full text]
  • Coverage of Monoclonal Antibody Products to Treat COVID-19
    Coverage of Monoclonal Antibody Products to Treat COVID-19 Monoclonal antibody products to treat Coronavirus disease 2019 (COVID-19) help the body fight the virus or slow the virus’s growth. Medicare beneficiaries have coverage without beneficiary cost sharing for these products when used as authorized or approved by the Food and Drug Administration (FDA). Disclaimer: The contents of this document do not have the force and effect of law and are not meant to bind the public Medicare in any way, unless specifically incorporated into a contract. This document is intended only to provide clarity to the public regarding existing requirements under the law. This communication was printed, published, or produced and disseminated at U.S. taxpayer expense. Site of Care1 Payable by Expected Patient Expected Payment to Providers: Medicare Cost-Sharing Key Facts • Medicare payment for monoclonal antibody products to treat COVID-19 is similar across Inpatient No patient sites of care, with some small differences. Hospital cost-sharing • Medicare pays for the administration of monoclonal antibody products to treat COVID-19. For example, beginning on May 6, 2021, Medicare will pay approximately Outpatient $450 in most settings, or approximately $750 No patient in the beneficiary’s home or residence, for Hospital or cost-sharing the administration of certain monoclonal “Hospital 4 2 antibody products to treat COVID-19. For without Walls ” monoclonal antibody products to treat COVID-19 that are administered before May 6, 2021, the Medicare payment rate in all No patient settings is approximately $310. Outpatient cost-sharing3 Physician Office/ • CMS will exercise enforcement discretion to Infusion Center allow Medicare-enrolled immunizers working within their scope of practice and subject to applicable state law to bill directly and receive direct reimbursement from the Medicare program for administering Nursing Home monoclonal antibody treatments to No patient (See third bullet in Medicare Part A Skilled Nursing Facility Key Facts on CMS cost-sharing residents.
    [Show full text]