First Edition: February 4, 2019

Kaiser Health News: Winners And Losers Under Bold Trump Plan To Slash Drug Rebate Deals
Few consumers have heard of the secret, business-to-business payments that the Trump administration wants to ban in an attempt to control drug costs. But the administration’s plan for drug rebates, announced Thursday, would end the pharmaceutical business as usual, shift billions in revenue and cause far-reaching, unforeseen change, say health policy authorities. (Hancock, 2/1)

California Healthline: Patients Suffer When Health Care Behemoths Quarrel Over Contracts
David Lerman, a Berkeley, Calif., lawyer, changed health plans this year only to learn that his new insurer has no contract with the dominant medical provider in his community. Anthem Blue Cross of California, one of the state’s largest health insurers, is battling with Sutter Health over how much it should pay to care for tens of thousands of its enrollees in Northern California. Sutter operates 24 hospitals in the region and lists about 5,000 doctors in its network. (Ostrov, 1/31)

Kaiser Health News: Transparent Hospital Pricing Exposes Wild Fluctuation, Even Within Miles
The federal government’s new rule requiring hospitals to post prices for their services is intended to allow patients to shop around and compare prices, a step toward price transparency that has generated praise and skepticism. Kaiser Health News examined the price lists — known in hospital lingo as “chargemasters” — of the largest acute care hospitals in several large cities. (Rowan, 2/4)

The New York Times: Medicare For All Emerges As Early Policy Test For 2020 Democrats
Senator Elizabeth Warren spoke at length this week about her vision for improving the American health care system, like strengthening the Affordable Care Act and making prescription drugs more affordable. Twice, though, she ignored a question posed to her: Would she support eliminating private health insurance in favor of a single-payer system? “Affordable health care for every American” is her goal, Ms. Warren said on Bloomberg Television, and there are “different ways we can get there.” To put it another way: I am not walking into that political trap. (Martin and Goodnough, 2/2)

The New York Times: Cory Booker On The Issues: Where He Stands
In his six years in the Senate, Cory Booker has progressed from a moderate who defended private equity to a leading progressive voice on issues like criminal justice reform and marijuana legalization. As he transitions to a national presidential campaign, which he announced Friday, the candidate has been focusing on some key issues that animate the left wing of the Democratic Party. ... In 2017, Mr. Booker announced his support for the Medicare for All Act drafted by Senator Bernie Sanders, and reiterated his support in an interview after he announced his candidacy Friday, saying “I signed up and am a big believer in Medicare for all.” (Corasaniti, 2/1)

Politico: Buttigieg: 'Medicare For All' Wouldn't End Private Insurance
South Bend Mayor Pete Buttigieg, a declared 2020 presidential candidate, on Sunday said a single-payer health care system is "the right place for us to head as a country," while saying a "Medicare for All" program doesn’t necessarily require doing away with private insurance. Buttigieg responded to questions from ABC host George Stephanopoulos about whether Medicare for all means an end to private insurance. (Beavers, 2/3)

Kaiser Health News: Lawsuit Details How The Sackler Family Allegedly Built An OxyContin Fortune
The first nine months of 2013 started off as a banner year for the Sackler family, owners of the pharmaceutical company that produces OxyContin, the addictive opioid pain medication. Purdue Pharma paid the family $400 million from its profits during that time, claims a lawsuit filed by the Massachusetts attorney general. However, when profits dropped in the fourth quarter, the family allegedly supported the company’s intense push to increase sales representatives’ visits to doctors and other prescribers. (Willmsen and Bebinger, 2/1)

The New York Times: McKinsey Advised Purdue Pharma How To ‘Turbocharge’ Opioid Sales, Lawsuit Says
The world’s most prestigious management-consulting firm, McKinsey & Company, has been drawn into a national reckoning over who bears responsibility for the opioid crisis that has devastated families and communities across America. In legal papers released in unredacted form on Thursday, the Massachusetts attorney general said McKinsey had helped the maker of OxyContin fan the flames of the opioid epidemic. (Forsythe and Bogdanich, 2/1)

Los Angeles Times: Even In Best-Case Scenario, Opioid Overdose Deaths Will Keep Rising Until 2022
In the nation’s opioid epidemic, the carnage is far from over. A new projection of opioid overdose death rates suggests that even if there is steady progress in reducing prescription narcotic abuse across the country, the number of fatal overdoses — which reached 70,237 in 2017 — will rise sharply in the coming years. (Healy, 2/1)

The Washington Post: Combating The Opioid Crisis One Doctor At A Time
Sandeep “Sonny” Bains pulled up to Lyons Family Medicine in the pre-dawn dark armed with coffee, doughnuts and glossy brochures about pain treatments. “What can I help you with for acute pain?” he inquired of ­father-and-son primary-care doctors Michael and Zachary Lyons as he was ushered into a wood-paneled back office. Bains’s quick drop-ins are modeled on those used by pharmaceutical sales reps to pump up sales. (Johnson, 2/1)

The Wall Street Journal: Cigna Says Proposed Drug-Rebate Curbs Will Have Minimal Impact On Earnings
Cigna Corp. said a new federal proposal that would curb rebates from drugmakers would have minimal impact on its results and offered conservative earnings guidance for 2019, the first year it will include the operations of Express Scripts Holding Co. The insurer’s projections for the year were expected to be closely watched by investors, as they provide the first snapshot of the newly merged company’s expected 2019 performance. The insurer closed its $54 billion deal for the pharmacy-benefit manager in December. (Wilde Mathews and Chin, 2/1)

The Associated Press: Trump Health Chief Asks Congress To Pass Drug Discount Plan
The Trump administration's top health official asked Congress on Friday to pass its new prescription drug discount plan and provide it to all patients, not just those covered by government programs like Medicare. The plan would take now-hidden rebates among industry players like drug companies and insurers and channel them directly to consumers when they go to pay for their medications. (Alonso-Zaldivar, 2/1)

Stat: Azar Calls On Congress To Help Eliminate Drug Rebates 
“Congress has an opportunity to follow through on their calls for transparency, too, by passing our proposal into law immediately and extending it into the commercial drug market,” Azar said in a speech, according to prepared remarks. His remarks, however, highlight a key tension underlying the proposal: whether or not HHS itself has the power to implement such a massive change without additional authority from Congress. Critics of the proposal, most notably in the pharmacy benefit manager industry, have suggested they would sue HHS over such a proposal on those grounds. (Swetlitz, 2/1)

Stat: Will Trump’s New Drug Pricing Idea End PBMs? And Other Key Questions
The Trump administration’s newest drug pricing idea suggests change on a massive scale: it pitches a wholesale transformation of the way millions of Americans pay for drugs, one that could have a ripple effect into nearly every corner of the country’s health care system. The proposal would effectively eliminate the rebates that drug makers pay insurance companies in Medicare and parts of Medicaid. Manufacturers pay these rebates to secure good placement on an insurer’s formulary, which makes it easier for patients to get those drugs and harder for them to get competitors’. (Florko and Swetlitz, 2/1)

The Associated Press: Prescription Manager Stocks Dip After Rebate Change Pitched
Shares of some insurers and pharmacy benefit managers were pressured Friday after President Donald Trump's administration laid out a plan to change how prescription rebates are handled for the government's Medicare and Medicaid programs. CVS Health Corp., Humana Inc. and UnitedHealth Group Inc. all slipped less than 1 percent while broader indexes climbed in late-morning trading. (2/1)

Reuters: Exclusive: Top U.S. Insurer To Cover Amgen, Eli Lilly Migraine Drugs, Exclude Teva
A top U.S. pharmacy benefit manager (PBM) owned by UnitedHealth Group Inc has included new migraine drugs from Amgen Inc and Eli Lilly and Co as preferred treatments on its lists of covered drugs, according to an OptumRx client note viewed by Reuters. Teva Pharmaceutical Industries Ltd's rival migraine headache preventer is excluded on one list and patients can pay more for it in some cases on a second list, the note said. (Hummer, 2/1)

Politico: Trump’s State Of The Union Pledge: Ending HIV Transmissions By 2030
President Donald Trump plans to use Tuesday night’s State of the Union address to promise an end to the HIV epidemic in America, four individuals with knowledge of the planned remarks told POLITICO. Under Trump’s 10-year strategy, health officials would target the U.S. communities with the most HIV infections and work to reduce transmissions by 2030. The strategy has been championed by top health officials, including HHS Secretary Alex Azar and CDC Director Robert Redfield. (Diamond, 2/3)

The Associated Press: US Sees Limitations On Reuniting Migrant Families
The Trump administration says it would require extraordinary effort to reunite what may be thousands of migrant children who have been separated from their parents and, even if it could, the children would likely be emotionally harmed. Jonathan White, who leads the Health and Human Services Department's efforts to reunite migrant children with their parents, said removing children from "sponsor" homes to rejoin their parents "would present grave child welfare concerns." He said the government should focus on reuniting children currently in its custody, not those who have already been released to sponsors. (Spagat, 2/2)

Reuters: U.S. Judge Throws Out Maryland Bid To Protect Obamacare Law
A U.S. judge on Friday threw out the state of Maryland's bid to protect the healthcare law known as Obamacare in a ruling that also sidestepped a decision on whether President Donald Trump's appointment of Matthew Whitaker as acting attorney general was lawful. In a win for the Republican president, Baltimore-based U.S. District Judge Ellen Hollander said Maryland had failed to show that the Trump administration is likely to terminate enforcement of the 2010 law, officially called the Affordable Care Act. (2/1)

The Wall Street Journal: Judge Dismisses Maryland Lawsuit Challenging Trump On Health-Law Enforcement, Whitaker Appointment
In her Friday ruling, Judge Hollander, an Obama appointee, said Maryland didn’t have legal standing to bring the lawsuit because the Trump administration was continuing to abide by the health law for now, which means the state isn’t being harmed. The judge then chose not to decide the legality of Mr. Whitaker’s appointment, saying it would be improper to do so given that Maryland didn’t have standing to bring the lawsuit to begin with. (Kendall, 2/1)

The Associated Press: Judge Dismisses Maryland Suit Seeking To Protect Health Law
"In effect, the state proclaims the sky is falling. But, falling acorns, even several of them, do not amount to a falling sky," Hollander wrote in her 48-page opinion that entitles Maryland to revive the litigation at some later date. Maryland Attorney General Brian Frosh, a Democrat, had sought a declaratory judgment that ACA was constitutional and the Trump administration must stop trying to "sabotage" the Obama-era law twice sustained by the U.S. Supreme Court. (2/1)

The Washington Post: Maryland Judge Dismisses Lawsuit Seeking To Protect Affordable Care Act
The suit, filed in September by Maryland Attorney General Brian E. Frosh, has been a counterpoint of sorts to a federal lawsuit in Texas challenging the ACA’s constitutionality brought by that state’s Republican attorney general and nearly a score of GOP counterparts. In mid-December, a conservative federal judge in Fort Worth ruled the entire law is unconstitutional. That case is being appealed and is considered likely to reach the Supreme Court, which has twice before upheld the ACA’s constitutionality. (Goldstein, 2/1)

The Associated Press: Changed Supreme Court Weighing Louisiana Abortion Clinic Law
The outcome of a fight over a Louisiana law regulating abortion providers could signal whether a fortified conservative majority on the Supreme Court is willing to cut back on abortion rights. The high court is expected to decide in the next few days whether the state can begin enforcing a law requiring doctors who work at abortion clinics to have admitting privileges at a nearby hospital. It was passed in 2014, but has never taken effect. (2/3)

Politico: Supreme Court Temporarily Halts Louisiana Abortion Law
Abortion providers, represented by the Center for Reproductive Rights, had petitioned the court for an emergency stay, saying the law, due to take effect Monday, would leave just one qualified abortion provider to practice in the state. The state contended there was no need for an emergency stay since the law would be implemented over time and not shut down facilities overnight. (Ollstein, 2/1)

The Hill: Virginia Abortion Bill Reignites National Debate 
Republicans at the national level this week jumped into the firestorm surrounding a Virginia abortion-rights bill, marking a rare instance in which a state issue has drawn harsh rebukes from members of Congress and the White House. The bill, proposed by a Democratic state lawmaker, would have made it easier for women to get third trimester abortions if their health was threatened by pregnancy. (Hellmann, 2/2)

The New York Times: Clash Of Giants: UnitedHealth Takes On Amazon, Berkshire Hathaway And JPMorgan Chase
Inside a federal courtroom in Boston this week, a bit of intrigue has emerged as lawyers try to pry open the secretive plans of a new venture created by three of the world’s most powerful corporations. The underlying case involves allegations made by UnitedHealth Group, which is asking a judge to stop a former executive from working at the new health care outfit created by Amazon, Berkshire Hathaway and JPMorgan Chase. UnitedHealth has accused the executive, David William Smith, of removing confidential, proprietary information that could benefit his new employer, and he has denied any inappropriate action. (Abelson, 2/1)

Politico: How Your Health Information Is Sold And Turned Into ‘Risk Scores’
Companies are starting to sell “risk scores” to doctors, insurers and hospitals to identify patients at risk of opioid addiction or overdose, without patient consent and with little regulation of the kinds of personal information used to create the scores. While the data collection is aimed at helping doctors make more informed decisions on prescribing opioids, it could also lead to blacklisting of some patients and keep them from getting the drugs they need, according to patient advocates. (Ravindranath, 2/3)

The New York Times: As Pelvic Mesh Settlements Near $8 Billion, Women Question Lawyers’ Fees
When Sherise Grant filed a claim against the manufacturer of her pelvic mesh implant, she hoped to use the money from a settlement to pay for its removal. Ms. Grant, 51, was among the millions of women around the globe whose urinary problems were treated with pelvic mesh. But not only has the surgically implanted device done little to help her, it frequently causes Ms. Grant discomfort, including pain during sex with her husband. (Goldstein, 2/1)

The Washington Post: Conservatives Bash FDA For ‘Regulatory Panic’ On E-Cigarettes
A coalition of conservative and libertarian groups is demanding President Trump “pump the brakes” on the administration’s crackdown on e-cigarettes, arguing the anti-vaping efforts will hurt “an innovative industry that is helping American smokers quit.” The letter, sent to the White House on Monday, criticized the Food and Drug Administration — and specifically its commissioner, Scott Gottlieb — for waging an “aggressive regulatory assault” on e-cigarettes. The signers include Americans for Tax Reform, ALEC Action, the Competitive Enterprise Institute and the Goldwater Institute. (McGinley, 2/4)

Modern Healthcare: Hospital Develops Package Prices To Lure Cash-Paying Patients
Nearly a decade ago, leaders at Pomerene Memorial Hospital in Millersburg, Ohio, realized they needed to do things differently to better serve the large Amish and Anabaptist community in their county. The Amish and other Anabaptists, including Mennonites, do not carry commercial health insurance; they prefer to pay for healthcare and other goods and services in cash, and they are famously thrifty shoppers. They wanted one all-inclusive price for tests, procedures and episodes of care, rather than a lengthy list of itemized charges that didn't even include professional fees. (Meyer, 2/2)

The Washington Post: Transgender Teens Experience Higher Levels Of Violence And Health And Safety Issues
Transgender teens — those whose gender identity does not align with their biological sex at birth — now represent almost 2 percent of U.S. high school students, according to a new report from the Centers for Disease Control and Prevention. That conclusion stems from the agency’s analysis of data based on a nationally representative sample of 131,901 public school students in grades nine through 12, who were asked a variety of questions about gender identity and personal health and safety issues. (Searing, 2/3)

The Washington Post: D.C. Hate Crimes Nearly Double Since 2016, With LGBTQ Community The Biggest Target
The number of hate crimes in the District rose sharply in 2018, nearly doubling the total attributed to bias in the city just two years earlier, according to city statistics. Crimes based on sexual orientation topped the list, according to the Center for the Study of Hate and Extremism, a research center at California State University at San Bernardino. The center analyzed the rise in hate crimes in the District and in cities across the nation in its annual report on bias crimes. (Zauzmer and McCoy, 2/2)

The Washington Post: Judge Says Tampa Conversion Therapy Ban Violates First Amendment Free-Speech Rights
A federal magistrate judge this week recommended that a ban on conversion therapy in Tampa be partially blocked, arguing it violates therapists' free-speech rights under the First Amendment. A pair of licensed marriage and family therapists, along with a Christian ministry organization, sued the city of Tampa over an ordinance adopted in April 2017 that barred mental health professionals from subjecting minors to conversion therapy, a highly controversial practice that attempts to change a person’s sexual orientation or gender identity. (Schmidt, 2/1)

The New York Times: Obesity Tied To Higher Cancer Rates In Younger People
The risk of developing obesity-related cancer is increasing in successive generations, along with increasing rates of obesity. Researchers studied the incidence of 30 of the most common cancers, including 12 that are obesity related, from 1995 to 2014 in people ages 25 to 84 — more than 14.6 million cases. The study is in Lancet Public Health. (Bakalar, 2/4)

Stat: As Cystic Fibrosis Drugs Deliver New Hope, Progress Isn't Reaching Everyone
Those medications, the first to be tuned to the genetic mutations that cause the disease, have helped people experience fewer flare-ups and hospitalizations. They have also brought the relief of simply feeling better and breathing easier. The drugs have been touted as a testament to what’s possible with precision medicine treatments, which target the roots of diseases instead of just addressing symptoms. The catch is that cystic fibrosis is not caused by one mutation, or a handful, but more than 1,500 different rearrangements in the code for the gene known as CFTR. (Joseph, 2/4)

The New York Times: When Is The Surgeon Too Old To Operate?
In the fall of 2015, Dr. Herbert Dardik, chief of vascular surgery at Englewood Hospital and Medical Center in New Jersey, nodded off in the operating room. Note that Dr. Dardik, then 80, was not performing the operation. He’d undergone a minor medical procedure himself a few days earlier, so he’d told his patient that another surgeon would handle her carotid endarterectomy, in which plaque is removed from the carotid artery to improve blood flow. (Span, 2/1)

The Washington Post: Breast Cancer Survivors Sometimes Encounter Sex And Intimacy Problems
Jill was just 39 in July 2010 when she was diagnosed with stage 2 breast cancer. Her longtime boyfriend had felt a lump in her right breast. Two weeks later, she had a mastectomy and began chemotherapy. The shock, stress, fatigue and treatment took its toll on the relationship, and her boyfriend left. “That’s when I began to realize that breast cancer was not only threatening my life, but would affect me physically, emotionally and sexually going forward,” said Jill, a library specialist in Denver who asked that her last name not be used to protect her privacy. (Sadick, 2/2)

The Washington Post: Lonely And Out Of Shape? Find Company While Walking Away Pounds.
On a mild January morning in Lafayette, Colo., 22 residents and five dogs gathered for a walk along the Coal Creek Trail. Bundled in puffy coats and fleece hats, they explored the great outdoors, taking in views of snow-covered Longs Peak. Two thousand miles away, in Naples, Fla., a cluster of walkers put in laps on the fitness trail around Lake Avalon. Meanwhile, outside the New Brunswick train station in New Jersey, dozens of men and women huddled together before setting off on the Delaware and Raritan Canal State Park Trail. (Rough, 2/2)

The Wall Street Journal: Two Sisters Bought DNA Kits. The Results Blew Apart Their Family.
Sonny and Brina Hurwitz raised a family in Boston. They both died with secrets. In 2016, their oldest daughter, Julie Lawson, took a home DNA test. Later, she persuaded her sister, Fredda Hurwitz, to take one too. In May, the sisters sat down at the dinner table in Ms. Hurwitz’s Falls Church, Va., home to share their results. A man’s name popped up as a close genetic match for Ms. Hurwitz. Neither had ever heard of him. (Dockser Marcus, 2/1)

The Wall Street Journal: Debunking The Myths About Male Sexuality
What do men secretly want? Long-held stereotypes contend they’re always interested in sex; happiest being the pursuer; focused on the physical rather than the emotional connection. If we discuss male sexuality at all, we tend to focus on the darker, toxic side—the entitlement and aggression increasingly exposed by the #MeToo movement. (Bernstein, 2/2)

The Washington Post: First He Was Hoarse. Then He Couldn’t Chew. How One Man’s Hunch Led To The Truth.
Larry Weller didn’t want to spoil the party. Surrounded by relatives who had gathered to celebrate his oldest granddaughter’s 18th birthday at a favorite Italian restaurant, he fervently hoped that no one, other than his wife who murmured her concern, noticed what he was doing. (Boodman, 2/2)

NPR: Depression Symptoms Can Include Anger, And That's Often Misunderstood
When registered nurse Ebony Monroe of Houston went through a period of being quick to anger about every little thing recently, she didn't realize what it might mean for her health. "If you had told me in the beginning that my irritability was related to depression, I would probably be livid," Monroe says with a laugh. "I did not think irritability aligned with depression." (Greenfieldboyce, 2/4)

NPR: Good Treatment For Mental Illness Still Scarce In U.S. Prisons
Ashoor Rasho has spent more than half his life alone in a prison cell in Illinois — 22 to 24 hours a day. The cell was so narrow he could reach his arms out and touch both walls at once. "It was pretty broke down — the whole system, the way they treated us," says the 43-year-old Rasho, who has been diagnosed with several mental health conditions, including severe depression, schizophrenia and borderline personality disorder. (Herman, 2/3)

The Washington Post: Facts About The Ebola Virus
Since last summer, Congo has been in the crosshairs of the second worst outbreak of the Ebola virus disease. As of the end of January, more than 730 cases and 459 deaths have been reported. International public health officials are working to get effective treatments into the conflict-ridden region. The World Health Organization’s Ebola virus disease website is a clearinghouse for information on the epidemic, from details about its toll to publications about the virus and how the world is working to fight it. (Blakemore, 2/2)

The New York Times: How One Woman Changed What Doctors Know About Heart Attacks
Katherine Leon was 38 and living in Alexandria, Va., when she gave birth to her second son in 2003. She was discharged from the hospital, but instead of getting better, she recalls, she kept feeling “worse and worse and worse. ”Five weeks after she had her child, Ms. Leon’s husband came back early from work and found her barely able to breathe. “I hate to use the word panic, because so many people say if it’s a woman she is just having a panic attack, but I was terrified,” she said. (Warraich, 2/1)

The Associated Press: Digital Design, QB Investments Could Aid Football Helmets
Football helmets could be getting another boost toward enhanced safety features with announcements by two major manufacturers Friday. Riddell has partnered with Carbon, a tech company that features 3-D printing, to bring digital design innovation and customization to head protection through its new Diamond helmets. (Wilner, 2/1)

The Wall Street Journal: One School District’s Security Upgrade: Facial Recognition, Tracking IDs And AR-15s
The school district here uses a facial recognition system to scan for people not allowed on school grounds. IDs track the whereabouts of students and staff. Teachers have cellphone panic buttons to alert police and soon will have special locks on classroom doors that can be activated remotely. A newly expanded security team keeps 22 AR-15 rifles in their offices. The district has spent $6.3 million in eight months on these and other security measures to keep students safe from potential shooters. (Hobbs, 2/3)