First Edition: July 25, 2019

Kaiser Health News: First Kidney Failure, Then A $540,842 Bill For Dialysis
For months, Sovereign Valentine had been feeling progressively run-down. The 50-year-old personal trainer, who goes by “Sov,” tried changing his workout and diet to no avail. Finally, one Sunday, he drove himself to the hospital in the small town of Plains, Mont., where his wife, Jessica, happened to be the physician on call. “I couldn’t stop throwing up. I was just toxic.” (Gold, 7/25)

Kaiser Health News: Your Go-To Guide To Decode Medical Bills
In 2018 Kaiser Health News and NPR teamed up to create “Bill of the Month,” a crowdsourced investigative series in which we dissect and explain medical bills you send us. We have received nearly 2,000 submissions of outrageous and confusing medical bills from across the country. Each month we select one bill to thoroughly investigate, often resulting in the bill being resolved soon after the story is published. But what about the large number of Americans who receive surprise medical bills that reporters can’t examine? (7/25)

Kaiser Health News: On A Mission To Help People Control Diabetes — And Save Money On Insulin
In a former church parsonage in Grundy County, Tenn., Karen Wickham ladled out her lentil stew as people arrived for an evening health education class. Wickham and her husband, Steve, are white-haired, semi-retired nurses who have dedicated the last years of their working lives to helping people with Type 2 diabetes control and even reverse the condition with diet and exercise. Wendy Norris is in the group, and she has brought along her father and daughter. Since her diagnosis several years ago, Norris said, her doctor prescribed insulin shots and told her to watch what she ate. (Farmer, 7/25)

Reuters: Exclusive: White House Preparing Order That Would Cut Drug Prices For Medicare-Sources
U.S. President Donald Trump is considering a sweeping executive order that would cut prices on virtually all branded prescription drugs sold to Medicare and other government programs, according to two industry sources who had discussions with the White House. The order under discussion would be much broader than the Administration's previously disclosed proposal to lower prices on physician administered, or Part B, drugs by tying prices to lower costs in other countries. (Erman and O'Donnell, 7/24)

Stat: 6 Questions About Lawmakers’ Latest Drug Pricing Plan 
The Senate Finance Committee’s new bipartisan drug pricing package has the potential to change Medicare more dramatically than almost any piece of health care policy in the last 20 years. But with that big of an overhaul comes even bigger questions. The package, which was unveiled Tuesday, fundamentally reworks the complicated scheme used to split Medicare drug costs between the government, patients, insurers, and drug makers. It caps how much Medicare patients can pay out of pocket for drugs each year, and it imposes strict limits on how much drug makers can hike their prices. (Florko, 7/24)

The Hill: Azar Calling GOP Senators To Back Grassley Drug Price Plan 
Secretary of Health and Human Services Alex Azar is calling Republican senators to encourage them to vote for a bill to lower drug prices being considered on Thursday in the Senate Finance Committee, according to sources familiar with the matter. The calls from Azar are a sign of the Trump administration’s support for the bipartisan deal between Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.), amid blowback from some in the GOP. (Sullivan, 7/24)

Stat: Some Senators Seek To Water Down Drug Pricing Bill In Flood Of Amendments
Lawmakers will wade through more than 100 potential amendments when the Senate Finance Committee takes up its sweeping new drug pricing package on Thursday. Some of the amendments could significantly rework the package, like an amendment from Sens. Pat Toomey (R-Pa.) and Pat Roberts (R-Kan.) that would eliminate the controversial provisions in the bill that would restrict drug makers from raising prices beyond the rate of inflation. A separate amendment from Sen. John Cornyn (R-Texas) would only allow that provision to go into effect if HHS certifies it won’t lead to higher launch prices. (Florko, 7/24)

Stat: Medicare Paid For Medicines That Three Other Wealthy Nations Decided Had Little Value 
As the U.S. grapples with rising prices for medicines, a new analysis finds Medicare spent more than $26 billion in recent years on dozens of medicines that were not recommended for coverage in three other wealthy nations because government advisory groups there found the drugs did not have sufficient value to justify the costs. The researchers identified a total of 134 medicines that were approved by the Food and Drug Administration prior to 2016 but were not endorsed by agencies in Australia, Canada, and the U.K. that conduct so-called health technology assessments, according to the study in the Journal of General Internal Medicine. (Silverman, 7/24)

The Associated Press: Study: Home-Delivered Meals Could Save Money For Medicare
Medicare could save $1.57 for every dollar spent delivering free healthy meals to frail seniors after a hospitalization, according to a new study that comes as lawmakers look to restrain costs by promoting patients' well-being. The report Thursday from the Bipartisan Policy Center addresses ways that Medicare can do a better job coordinating care for chronically ill patients, who account for most of the program's $650 billion annual cost. (Alonso-Zaldivar, 7/25)

The New York Times: Breast Implants Linked To Rare Cancer Are Recalled Worldwide
Textured breast implants made by Allergan that have been linked to an unusual cancer are being recalled in the United States at the request of the Food and Drug Administration, and will also be recalled globally, the agency announced on Wednesday. The F.D.A. decision, based on an increasing number of cases and deaths from the implant-associated cancer, lags far behind action in Europe, where the Allergan devices were effectively banned late last year. (Grady, 7/24)

The Associated Press: Breast Implant Recalled After Link To More Rare Cancer Cases
The FDA is not recommending women with the implants have them removed because the cancer is so rare, but say they should check with their doctor if they have symptoms, which include pain and swelling. Biocell implants feature a textured surface designed to prevent slippage and to minimize scar tissue. Those models account for just 5 percent of the U.S. market. The vast majority of breast implants used in the U.S. have a smooth surface. (Perrone, 7/24)

The Washington Post: Allergan Said It Acted After Getting New Data On Illnesses And Deaths From The FDA
The FDA said the new data shows that 573 cases worldwide have linked the rare cancer to the implants since the agency began tracking the issue in 2011. The vast majority of those cases involve Allergan products. Thirty-three women have died of what’s known as breast implant-associated anaplastic large cell lymphoma, a cancer of the immune system. Of those fatalities, authorities identified the implant manufacturer in 13 cases — and it was Allergan in all but one. (McGinley, 7/24)

The Wall Street Journal: Allergan Recalls Breast Implants After FDA Cites Lymphoma Link
“While the overall incidence appears to be relatively low, once the evidence indicated the Allergan product was linked to patient harm including deaths, the FDA took action,” Amy Abernethy, the FDA’s principal deputy commissioner, said on a conference call with reporters. “We know that today’s news will be alarming to patients with breast implants.” (Loftus, 7/24)

NPR: Textured Breast Implants Linked To Rare Type Of Cancer Are Recalled
It's not clear whether the texturing is actually responsible for the cancer or is just associated with a higher incidence of the disease. But Maman and others say the surface can interact with the surrounding scar tissue that the body forms as an immune response to the implant. "It's that response that is believed to cause the formation of the lymphoma," Maman said, noting that he only uses smooth, round implants. Given the risks linked to textured implants, he said, "taking them off the market is very prudent and the right approach." (Aubrey and Laidlaw, 7/24)

USA Today: FDA Recalls Allergan Textured Breast Implants Linked To Rare Cancer
Dr. Elisabeth Potter, a plastic surgeon in Austin, Texas, has cared for women with cancer after receiving textured implants. She says the recall is an important step to protect women from the potential risks of textured implants. "It was influenced by folks speaking up when the FDA didn’t act quickly enough," Potter says. "The power is now back in a woman’s hands, and the FDA is backing her up." Potter says women with textured implants should talk with their doctors and monitor for any symptoms such as pain, swelling, redness or anything abnormal. (Alltucker, 7/24)

The Hill: Senate Will Not Vote On Bipartisan Health Costs Bill Before Leaving For August 
The Senate will not vote on a bipartisan measure aimed at lowering health care costs before lawmakers leave Washington for the August recess. Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) said in a joint statement that the Senate “does not have time before the August recess” to consider the bill. (Sullivan, 7/24)

Modern Healthcare: Senate Stalls Vote On Hospital Contract Reforms, Balance Billing
Senate health committee Chair Lamar Alexander (R-Tenn.) and ranking member Patty Murray (D-Wash.) said Wednesday that the Senate "does not have time before the August recess" to consider legislation, although Alexander previously told reporters this week that he hoped for a vote before the recess. Disputes are ongoing over the proposal to ban surprise medical bills with a cap on charges for out-of-network care. "We are engaged in very productive conversations about this legislation with our colleagues in the Senate and the House, and will continue to work during August and into September to move this legislation forward," the senators said. (Luthi, 7/24)

The Washington Post: Opioid Makers Say There’s No Proof They Are Responsible For The Epidemic’s Harms 
Major opioid manufacturers have asked a judge to throw out the first test case of whether they must pay for the nation’s drug crisis, arguing that two Ohio counties cannot prove the drug companies’ actions were responsible for overdose deaths or other harms, newly unsealed court documents show. Lawyers for Purdue Pharma, Mallinckrodt Pharmaceuticals and other drug companies contend that Cuyahoga and Summit counties cannot sufficiently connect the tens of billions of legal painkillers the companies produced to fatalities and addiction. Nor can the counties show that drug company sales calls caused doctors to overprescribe the medications, they said. (Bernstein and Zezima, 7/24)

The Associated Press: No Obligation To The Public, Opioid Distributor Tells Lawyer
An executive at one of the nation’s largest drug distribution companies said under questioning recently that the business has no obligation to the public when it comes to the amount of prescription opioid painkillers it ships. That’s one of the exchanges included in thousands of pages of court documents, including depositions and internal emails, made public this week in lawsuits brought against the pharmaceutical industry over the nation’s deadly opioid crisis. (Hoyer and Mulvihill, 7/24)

The Associated Press: As The Nation's Opioid Crisis Grew, The Pills Got Stronger
In 2012, as the death toll from the nation's opioid crisis mounted, drug companies shipped out enough of the powerful and addictive painkillers for every man, woman and child in the U.S. to have nearly a 20-day supply. In some counties, mostly in Appalachia, it was well over 100 days.An Associated Press analysis of drug distribution data released as a result of lawsuits against the industry also found that the amount of opioids as measured by total potency continued to rise early this decade even as the number of pills distributed began to dip. (7/24)

The Washington Post: Opioids In Appalachia: Addiction And Recovery In Painkiller Epidemic
At her very worst, Amber Wood was so desperate for the opioid high she had a dentist pull a tooth — and not even a particularly bad tooth, just one of those molars she didn’t think she’d need as much as she needed a pill. The dentist, she said, gave her a prescription for the opioid painkiller Lortab. She’d been abusing drugs since the age of 13. “None of us said when we went to pre-K, ‘You know what I want to be when I grow up? I want to be a drug addict.’ Nobody thought that. (Achenbach, Koh, Bennett and Mara, 7/24)

Reuters: Anthem Shares Sink As Cost Concerns Overshadow Earnings Beat
Anthem Inc shares fell as much as 4% on Wednesday after the U.S. health insurer missed Wall Street expectations for a key medical cost gauge as a result of higher costs of selling Medicaid health plans for low-income customers. Anthem reported a 10.2% fall in operating profit from its unit which sells government health plans, in the quarter, saying the decline was driven by continued elevated medical cost trends in Medicaid in some states. (7/24)

The Associated Press: Anthem Tops 2Q Expectations, Shares Slide On Expense Worries
The Blue Cross-Blue Shield insurer said it has added nearly 700,000 Medicaid customers over the past year, but expenses were coming in higher than expected in a handful of states. Chief Financial Officer John Gallina told analysts the issue was "very manageable," and he expected the business's profitability to improve in the second half of the year. He said the populations covered in these states, which he declined to name, had changed slightly since rates were set, and they were seeking rate adjustments. (Murphy, 7/24)

The Wall Street Journal: Anthem Shares Fall Following Earnings Results 
Anthem said the launch process for its new pharmacy-benefits manager, IngenioRx, was moving ahead of expectations, and the company now expects IngenioRx’s results to hit the higher end of its previous projections. The insurer also said it had enrolled a new IngenioRx client, Blue Cross of Idaho, for next year. Anthem has said that it sees fellow Blue Cross Blue Shield insurers as a potentially fertile source of business across various areas. Anthem raised its outlook for multiple 2019 earnings metrics, but tightened its projected medical-loss ratio range to the higher end of its prior suggestion. The company expects an MLR of 86.2% to 86.5%. It had been expecting that ratio to be 86.2% plus or minus 30 basis points. (Wilde Mathews and Prang, 7/24)

Politico: New Texas Anti-Abortion Group Vies For Family Planning Funds
A new faith-based, anti-abortion health group in Texas is suing HHS for the right to receive federal family planning funds — another sign such groups are moving aggressively to win some of the backing that long went to organizations like Planned Parenthood. The class action lawsuit filed on behalf of religious health care providers that oppose abortion argues that the newly-formed Vita Nuova Inc. and groups like it have the right to Title X grants under new Trump administration rules that are tied up in multiple court battles. (Ollstein and Rayasam, 7/24)

The New York Times: Most High-Risk Men Don’t Take PrEP To Prevent H.I.V.
Among men who are at high risk for H.I.V. infection, only about one in three is taking a drug to prevent transmission of the virus, according to a survey from the Centers for Disease Control and Prevention. The drug, Truvada, is taken daily as part of a preventive strategy called pre-exposure prophylaxis, or PrEP. For the report, published in MMWR, C.D.C. researchers studied 7,873 high-risk men from 20 American cities who were negative for H.I.V. and completed a behavioral survey in 2014 or 2017. (Bilanow, 7/25)

Stat: An AI Expert's Toughest Project: Writing Code To Save His Son's Life 
It was developed as part of an ambitious project funded by the National Institutes of Health to link and make searchable decades worth of biomedical data collected by universities and research labs on genes, proteins, disease symptoms, patient outcomes, drugs, and more. This information is now dispersed among hundreds of databases, in a confusing patchwork of formats and terminology that defies easy analysis. (Ross, 7/25)

NPR: Precision Medicine Research Must Build More Diversity And Trust Says Bioethicist
Precision medicine is the field of dreams for human health — drugs and treatments that would take into account a person's individual DNA configurations, as well as lifestyle and environment, would presumably be better tailored to each person's needs. Still, while the goal of precision medicine is to help everybody, the current research available has a major flaw — it's largely based on the genes of people who are predominantly of white and European descent. (Huang, 7/25)

The New York Times: You Are What You Watch? The Social Effects Of TV
Other than sleeping and working, Americans are more likely to watch television than engage in any other activity. A wave of new social science research shows that the quality of shows can influence us in important ways, shaping our thinking and political preferences, even affecting our cognitive ability. In this so-called golden age of television, some critics have pointed out that the best of the form is equivalent to the most enriching novels. (Rothwell, 7/25)

NPR: Robotic Hand Improved To Give User A Sense Of Touch And Better Control
Keven Walgamott, a real estate agent who lost his left hand and part of his arm in an electrical accident in 2002, got emotional when he was able to clasp his hands together and "feel" the space between his thumb and his index finger using a 3D-printed prosthetic hand in 2016. "That was the first time I ever felt anything in my left hand since my amputation," Walgamott says. He got emotional a second time when he was able to grasp his wife's hand and "feel" her touch, this time through a newly designed, experimental prosthetic hand that can be directed with the user's mind. (Torres, 7/24)

The New York Times: Need A Mental Health Day? Some States Give Students The Option
Depression and anxiety. The state of the country. Climate change. Mass shootings. Today’s students are grappling with a variety of issues beyond the classroom. To that end, lawmakers in two states have recently recognized the importance of the mental health of their students by allowing them to take sick days just for that. The measures “empower” children to take care of their mental health, one expert said. (Taylor, 7/24)

Reuters: Former U.S. Pro Football Players May Face Increased Risk Of Heart Rhythm Problem
Former players from the National Football League may face an increased risk of a type of irregular heartbeat that could lead to stroke, a new study suggests. Researchers found that retired NFL players were nearly six times as likely to develop atrial fibrillation as men of the same age in the general population, according to results published in the Journal of the American Heart Association. (7/24)

The Associated Press: Health System Offers Free DNA Tests For 10,000 Floridians
An operator of hospitals and clinics began offering free DNA testing on Wednesday to 10,000 Floridians in a partnership with a private genomics company. Some biomedical ethicists warn that participants need to realize their data can be used for purposes other than their health care. Researchers at AdventHealth in Orlando said the DNA test screens for an inherited condition that can lead to high cholesterol and heart attacks if left untreated. (7/24)

The Associated Press: Oregon Removes Assisted Suicide Wait For Certain Patients
Legislation allowing certain terminally ill patients to have quicker access to life-ending medications under the state’s first-in-the-nation assisted suicide law has been signed into law, Gov. Kate Brown’s office announced Wednesday. The law allows those with 15 days left to live to bypass a 15-day waiting period required under the Death with Dignity Act, something proponents say will reduce bureaucracy and bring relief to gravely ill people. (Zimmerman, 7/24)

The New York Times: Columbine High School Will Not Be Torn Down And Rebuilt
Facing community opposition, a Colorado school district said on Wednesday that it would drop a proposal to tear down Columbine High School, which has been confronting growing threats and thousands of curious trespassers since the 1999 massacre there. In June, the Jefferson County Public Schools in suburban Denver asked for community input on what, to many, was a radical idea to reduce Columbine’s morbid allure. (Healy, 7/24)