Reuters: U.S. Supreme Court Justices Lean Toward Insurers On $12 Billion Obamacare Claims
U.S. Supreme Court justices on Tuesday appeared sympathetic to claims made by health insurers seeking $12 billion from the federal government under a program set up by the Obamacare law aimed at encouraging them to offer medical coverage to previously uninsured Americans. The justices considered a challenge by a group of insurers of a lower court's ruling that Congress had suspended the government's obligation to make such payments. (Hurley, 12/10)

The New York Times: Supreme Court May Back Insurers In $12 Billion Obamacare Case
Paul D. Clement, a lawyer for the insurance companies, said his clients had been the victims of “a massive government bait-and-switch.” But Edwin S. Kneedler, a lawyer for the federal government, said a statutory promise to cover the companies’ losses was ineffective without a separate congressional appropriation of money. “The appropriations clause of the Constitution is central to this case,” he said, referring to a provision that says, “No money shall be drawn from the Treasury, but in consequence of appropriations made by law.” Requiring the government to pay the insurers, Mr. Kneedler said, “would impose unprecedented liability on the United States of billions of dollars.” (Liptak, 12/10)

The Wall Street Journal: Supreme Court Questions Government Bid To Avoid Paying Insurers Under Affordable Care Act
During an hourlong oral argument Tuesday, most of the justices seemed skeptical about the Justice Department’s arguments that the government didn’t have to pay roughly $12 billion. The money wasn’t owed, the department said, because lawmakers made changes to a program under the ACA called the “risk corridors” program. The three-year program aimed to keep premiums low and limit financial risks for insurers that offered coverage on the exchanges, a critical feature of the Obama-era health law. But after the ACA was enacted, Congress in later budget years attached appropriations provisions that effectively prohibited the government from making payments under the program. (Kendall, 12/10)

Kaiser Health News: Supreme Court Seems Sympathetic To Insurers In Obamacare Case
No clear split between conservative and liberal Supreme Court justices emerged Tuesday as justices heard arguments over whether the federal government could renege on Congress’ promise to pay health insurance companies billions to motivate them to participate in the Obamacare marketplaces. (Galewitz, 12/10)

The Washington Post: Supreme Court Considers Claims Under Obamacare That Government Owes Billions To Insurers
Kneedler had a harder time with the justices. He said the provision in the statute was not a contract, but a provision like any other that depends on congressional appropriations. “The insurers were not performing services for the government. They weren’t working for the government,” Kneedler said. “They weren’t furnishing goods to the government. They were participating in a market economy.” Breyer said that raised all sorts of questions. There are plenty of statutes, he said, “that say, if you do X, the government shall pay you, Mr. Veteran, Mr. Paratrooper, Mr. — you know, you name it.” Does that mean “they don’t really mean it?” Breyer asked. (Barnes, 12/10)

CNN: Insurers Plead With Supreme Court For $12 Billion In Government Reimbursements For Obamacare
"Why doesn't the government have to pay?" Justice Stephen Breyer asked at one point. Breyer and Chief Justice John Roberts, among others, pointed to a risk mitigation program, written into the law, for insurers who might incur losses from 2014-2016. "You don't question that these insurance companies would not have participated," Roberts asked the government lawyer, "but for the government's promise to pay?" (De Vogue, 12/10)

The Hill: Justices Grapple With Multibillion-Dollar ObamaCare Case 
Justice Brett Kavanaugh, a Trump appointee, put his finger on the dilemma at the heart of the case, laying out the wide-reaching implications for future partnerships between the federal government and the private sector, as well as potential burdens on the legislative process. “If we were to rule for you, everyone will be on notice going forward, private parties and Congress itself, that ‘shall pay’ doesn't obligate actual payments,” he said. “If we rule against you, Congress also will be on notice going forward that it needs to include ‘subject to appropriations’ kind of language in any mandatory statute.” (Kruzel, 12/10)

The Associated Press: Justices Seem To Favor Insurers' Obamacare Claims For $12B
“Are you saying the insurers would have done the same thing without the promise to pay?” Justice Elena Kagan asked Deputy Solicitor General Edwin Kneedler. Kneedler said the health care law created a “vast new market” of customers, most of whom would qualify for subsidies. “The primary point was to encourage companies to go on the marketplace,” Kneedler said. (Sherman, 12/10)

Modern Healthcare: Supreme Court May Side With Insurers On ACA Payments
Some of the justices were also skeptical that Congress intended to overturn the government's obligation to pay insurers when it didn't appropriate the funds because they never repealed the risk-corridor provision of the ACA, even though they had an opportunity. Congress knows how to write a law that is conditional on appropriations and it never said that the risk-corridor payments were conditional, Justices Kagan and Brett Kavanaugh said. (Brady, 12/10)

SCOTUSblog: Argument Analysis: Justices Appear Sympathetic To Insurers In Dispute Over Risk-Corridor Compensation
Justice Samuel Alito was the least sympathetic of the justices to the insurers’ position, and he peppered Clement with questions throughout Clement’s initial stint at the lectern. What if, Alito queried, the measures limiting the funds that were available to compensate the insurers had been included in the original legislation? Would it have made a difference? Or, Alito continued, what if the law had specifically provided that the money to reimburse the insurers would come only from the “payments in”? (Howe, 12/10)

NPR: Supreme Court Hears Arguments In Obamacare Insurers Case
Enacted by a Democratic-controlled Congress in 2010, the Affordable Care Act promised to partially reimburse insurers if they lost money by covering people with preexisting conditions. The law said that the government "shall" make these payments. But in 2015, Republicans, by then in control of both houses of Congress, attached riders to appropriations bills barring the use of the money for the promised payments. (Totenberg, 12/11)

Los Angeles Times: Obamacare Insurers May Win A $12-Billion Claim In Supreme Court
The insurers, some of whom were driven out of business, later filed claims in federal court that totaled $12 billion. A U.S. court of claims ruled for the insurers, but a federal appeals court reversed that decision and said Congress had the final word on whether to appropriate money to pay for earlier promises. (Savage, 12/10)

ABC News: Will The Supreme Court Hand Obamacare Health Insurers A $12B Billion Payout?
Eighteen of 24 insurance providers that joined the insurance exchanges went out of business after the government stopped making the risk corridors payments. Several others either stopped offering Affordable Care Act plans or charged significantly higher premiums. The Trump administration argues the health law's promise to pay insurers was implicitly contingent on Congress appropriating the funds. When lawmakers later chose to limit the funds, the money rightfully didn't flow, they say. (Dwyer, 12/10)

The Associated Press: Buttigieg Discloses Ex-Clients As Fundraising Swing Begins
Facing intense pressure to answer questions about his work in the private sector, Democratic presidential contender Pete Buttigieg on Tuesday disclosed a roster of former consulting clients that include a major health insurance provider, a nationwide electronics retailer, the U.S. Department of Energy and the Department of Defense. (Peoples and Smith, 12/10)

The New York Times: How Pete Buttigieg Spent His McKinsey Days: Blue Cross, Best Buy, U.S. Agencies
The most politically troubling element of his client list might be his tenure working for Blue Cross Blue Shield of Michigan, a health care firm that at the time was in the process of reducing its work force. Last week Mr. Buttigieg’s campaign said his time in Michigan included “analytical work as part of a team identifying savings in administration and overhead costs.” While it was not yet clear exactly what Mr. Buttigieg did at Blue Cross, his work appeared to come at about the same time the insurer announced that it would cut up to 1,000 jobs — or nearly 10 percent of its work force — and request rate increases. (Epstein and Saul, 12/10)

The Atlantic: What Pete Buttigieg Says He Did At McKinsey
He said that while working with Blue Cross Blue Shield of Michigan, he remembered going along with his manager to a few meetings with people on staff, but he couldn’t remember any meeting he’d been able to attend on his own. “Mostly I was with fellow consultants in a room working on a spreadsheet,” he said, explaining that the analysis had focused on rent, travel costs, mail, and printing, but nothing having to do with policy or premium costs. He insisted that none of his work could have led to people’s insurance changing, or being taken away. (Dovere, 12/10)

Politico: Buttigieg Releases Names Of Consulting Clients
In 2007, Buttigieg analyzed Blue Cross Blue Shield of Michigan’s “overhead expenditures,” like rent, utilities and company travel, according to a memo from Buttigieg’s campaign. ... The insurance company was running into trouble, and two years later, in January 2009, Blue Cross and Blue Shield of Michigan cut nearly 10 percent of its workforce, after the company reported a loss of $140 million on health care plans. It had been a target for Michigan’s then-attorney general, who sued Blue Cross Blue Shield of Michigan multiple times and, in 2007, published a presentation titled, “Profits Over People: The Drive to Privatize and Destroy the Social Mission of Blue Cross and Blue Shield.” (Schneider, 12/10)

The Washington Post: Under Pressure, Buttigieg Releases Names Of Former McKinsey Clients
Buttigieg was 25 years old at the time he joined McKinsey, working his first job after graduating from Oxford University, and reported $73,557 in income on his 2007 federal tax return. Buttigieg also filed a state return in Michigan that year, in which he reported that just more than $22,000 of that income came from the work he did for Blue Cross Blue Shield there. Buttigieg has received about $26,000 in contributions from individuals associated with the national health conglomerate, according to OpenSecrets.org — more than any of his rivals, though Biden and Sanders have received nearly as much. (Janes and Wang, 12/10)

Los Angeles Times: Buttigieg's Clients At McKinsey Included The Pentagon
To Warren and other Buttigieg rivals, the secrecy surrounding his work at McKinsey has offered a tempting target. McKinsey’s image has been battered in recent years as news stories revealed its work for authoritarian regimes, opioid manufacturers and U.S. Immigration and Customs Enforcement. (Finnegan, 12/10)

Axios: Buttigieg Says He Doubts His Consulting Work Led To Insurer's Layoffs
Why it matters: The Southbend mayor has faced scrutiny from other 2020 candidates and liberal activists in recent weeks over his work for McKinsey & Company. A ProPublica report this month, headlined "How McKinsey helped the Trump administration detain and deport immigrants," raised further concerns about the company. Buttigieg says he "never worked on a project" inconsistent with his values. (Falconer, 12/11)

Bloomberg: Buttigieg Says McKinsey Clients Included Blue Cross, Best Buy 
Pete Buttigieg on Tuesday released the names of clients that he worked for as a consultant at McKinsey & Co., a list that includes Blue Cross Blue Shield Michigan, the U.S. Postal Service and the Department of Defense. Buttigieg, who has risen to the top tier of candidates in the Democratic primary, had come under fire from Democratic rivals, including Senator Elizabeth Warren, for not giving voters a full picture of his private sector experience. He made public the names one day after the firm released him from a nondisclosure agreement. (Pager, 12/10)

In other news from the elections —

The Hill: 'Medicare For All' Backers Notch Win With High-Profile Hearing 
"Medicare for All" supporters scored a victory Tuesday with a long-awaited hearing in one of the House's most powerful committees, putting more focus on the health care proposal that has divided the field of 2020 Democratic presidential candidates. The Energy and Commerce Committee discussed the single-payer health plan backed by White House hopefuls Sens. Elizabeth Warren (D-Mass.) and Bernie Sanders (I-Vt.) after a sustained campaign led by Rep. Pramila Jayapal (D-Wash.), a co-chairwoman of the Congressional Progressive Caucus, and other members of the party's liberal wing. (Hellmann, 12/10)

Politico: ‘A F—Ing Soap Opera’: The Health Care Drama Riveting The White House
They’re not obsessing about the impeachment imbroglio consuming the rest of the Washington. At the West Wing’s Navy mess, in hallway asides and at staff meetings, many White House aides just want to chatter about an increasingly vicious public spat between two of President Donald Trump’s top health officials. Among top Trump aides, it’s now an open question as to whether Secretary of Health and Human Services Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma can survive the scale of bickering that has appalled and horrified people internally, a White House official said. (Cook, 12/11)

The New York Times: White House Summons Feuding Health Officials For Counseling Session
The acting White House chief of staff has summoned President Trump’s top two health policy officials to the White House on Thursday to assess whether the president’s health secretary and his Medicare chief can continue to work together, a senior administration official confirmed on Tuesday. White House aides said President Trump is still standing by his embattled administrator of the Centers for Medicare and Medicaid Services, Seema Verma, amid reports that she had requested that taxpayers reimburse her $47,000 for property stolen on a trip, including jewelry priced at more than $40,000. (Rogers, Abelson and Goodnough, 12/10)

The Wall Street Journal: White House Calls Top Health Officials For Meeting To Resolve Tensions
People familiar with the matter said distrust between Ms. Verma and Mr. Azar has arisen in part because some people at HHS suspect Ms. Verma leaked information to the media about former HHS Secretary Tom Price’s use of private and military planes for work travel. Reports about that travel led Mr. Price to resign last year. These people also said the tension is partly fueled by a belief that Ms. Verma wants the HHS secretary position. Allies of Ms. Verma have said she played no role in providing leaks to the press about Mr. Price’s travel and that she wasn’t aware he was doing it. (Armour, 12/10)

Politico: Medicare Chief Sought To Bring Complaints Against Previous Boss, As Well
Medicare chief Seema Verma allegedly retained a lawyer to discuss a claim that President Donald Trump’s first Health and Human Services secretary, Tom Price, was creating a hostile work environment, according to an internal 2017 memo prepared by a HHS appointee. A spokesperson for Verma denied that she hired a lawyer. (Pradhan, Diamond and Cancryn, 12/10)

Modern Healthcare: Political Complaint Against Seema Verma Dropped For 'Insufficient Evidence'
The U.S. Office of Special Counsel said it found insufficient evidence to conclude that CMS Administrator Seema Verma violated the law barring federal employees from engaging in political activities while on the job. The nonpartisan Center for Responsibility and Ethics in Washington filed a complaint in November 2018 alleging that Verma used her official Twitter account and blog post to advocate against Democratic Medicare for All proposals, in violation of the Hatch Act. The group claimed Verma did so as part of a White House-coordinated effort to defeat Democratic party candidates in the 2018 midterm elections. (Meyer, 12/10)

The Wall Street Journal: Six CEOs And No Operating Room: The Impossible Job Of Fixing The Indian Health Service
Three years ago, the U.S. Indian Health Service needed a savior for its hospital in Rosebud, S.D. The federal health-care agency was forced to shut down the emergency department under pressure from federal regulators. Capt. Michael Weahkee seemed the man for the job, having run the IHS’s flagship hospital in Phoenix. He launched quality-improvement efforts and got the hospital’s emergency department running again, before departing later that year to resume his Phoenix post. He signed off with a laudatory email to the Rosebud hospital staff: “For those of you who have weathered this storm, I salute you.” (Wilde Mathews and Weaver, 12/10)

In other administration news —

KCUR: U.S. Pays $7 Million To Veterans Who Were Sexually Molested At The Leavenworth VA Hospital 
Eighty-two veterans who were sexually abused by a former physician assistant at the VA hospital in Leavenworth have settled their lawsuits against the government for nearly $7 million. The physician assistant, Mark Wisner, was convicted in 2017 of aggravated sexual battery and aggravated criminal sodomy and sentenced to 15 years and seven months in prison. At his jury trial, four former patients at the Dwight D. Eisenhower Department of Veterans Affairs Medical Center testified that Wisner had groped and molested them while giving them physical exams. (Margolies, 12/10)

The New York Times: The I.R.S. Sent A Letter To 3.9 Million People. It Saved Some Of Their Lives.
Three years ago, 3.9 million Americans received a plain-looking envelope from the Internal Revenue Service. Inside was a letter stating that they had recently paid a fine for not carrying health insurance and suggesting possible ways to enroll in coverage. New research concludes that the bureaucratic mailing saved lives. Three Treasury Department economists have published a working paper finding that these notices increased health insurance sign-ups. Obtaining insurance, they say, reduced premature deaths by an amount that exceeded any of their expectations. (Kliff, 12/10)

In other health law and insurance news —

Atlanta Journal-Constitution: Narrow Health Insurance Networks A Danger As Open Enrollment Nears End
Events this year have underlined a big vulnerability for Georgians buying private insurance individually through the Affordable Care Act. Insurance companies’ networks of covered health care providers such as hospitals and doctors no longer blanket the map. And if a shopper knows that, and hunts for a list of providers the company covers, they can find a list — but it’s not guaranteed. (Hart, 12/10)

The Oregonian: Many Oregonians Can Secure Health Insurance Without Premiums -- If They Take Advantage Of Tax Credits 
A new analysis by the Kaiser Family Foundation concludes that thousands of Oregonians eligible for health insurance through the Affordable Care Act could utilize tax credits to get a 2020 plan that would see them pay nothing in premiums. The premium is the amount you pay an insurance company to have coverage, separate from deductibles and other costs you might end up owing for seeing a doctor or getting medical tests. (Perry, 12/10)

The New York Times: Trump Aides And Democrats Agree On Trade Pact With Mexico And Canada
The White House and House Democrats reached an agreement to strengthen labor, environmental, pharmaceutical and enforcement provisions in President Trump’s North American trade pact, a significant development that made it all but certain that the signature trade deal would become law. ... One of the most significant revisions will roll back protections for new pharmaceutical products, in particular an advanced class of drugs called biologics, which were initially given 10 years of patent protection from cheaper alternatives. It also removed language that would ensure patent protections when drug companies find new uses for their existing products, a process known as “evergreening.” (Cochrane and Swanson, 12/10)

Modern Healthcare: Biologic Exclusivity Provision Stripped From Revised USMCA Deal
Biologics make up a large portion of spending on physician-administered drugs. The Medicare Payment Advisory Commission reported that biologics accounted for two-thirds of spending and all 10 of the highest-expenditure drugs in Medicare Part B in 2017. Biologic exclusivity in the United States is currently set at 12 years, but Democrats argued that enshrining a 10-year guarantee in the trilateral trade deal would have tied Congress' hands if lawmakers wanted to change the threshold. Also, Mexico and Canada both currently offer less than 10 years of exclusivity for biologics. (Cohrs, 12/10)

Politico: ‘We Ate Their Lunch’: How Pelosi Got To ‘Yes’ On Trump’s Trade Deal
Some issues were worked out quickly: An agreement to strip out protections for biologic drugs, which opponents say would allow drug companies to keep prices high, was struck in those first few weeks, said Rep. Earl Blumenauer (D-Ore.), who focused on the issue for the working group. It was deliberately kept under a proverbial lock-and-key to help prevent a propaganda campaign from the powerful pharmaceutical lobby, which could have derailed the handshake deal. The early win for Democrats boosted members’ confidence and showed the administration was willing to make concessions. But compromises on other areas — specifically, labor and enforcement provisions — remained elusive. The caucus began to splinter over summer recess as moderate Democrats grew increasingly anxious to hold a vote on the agreement. (Cassella, 12/10)

The Washington Post: With USMCA And Parental Leave, Democrats Say They Won Big Concessions From Trump
Democrats have emphasized that they won inclusion of new protections for workers’ rights and scrapped part of the initial agreement that would have raised prescription drug prices. “The same Republicans who are complaining they are not included are also too scared to vote against [Trump]. So why would he bother negotiating with them?” said an aide to a GOP senator, speaking on the condition of anonymity to discuss caucus dynamics. (Kim and Stein, 12/10)

The Hill: Democrats Declare Victory For Eliminating Drug Protections In Trade Deal
House Democrats are taking a victory lap after getting rid of controversial protections for biologic drugs in the new North American trade agreement. House Democrats and the White House on Tuesday announced a deal on a trade pact to update the North American Free Trade Agreement (NAFTA), securing a major legislative goal for both Democrats and President Trump. (Weixel, 12/10)

Stat: With New Trade Deal, Trump Deals A Blow To Drug Makers 
“The real losers today are America’s scientists, entrepreneurs and patients waiting for the next generation of breakthrough medicines,” said Jim Greenwood, CEO of the Biotechnology Innovation Organization, which represents many biologic manufacturers. “They have forsaken a sector in which America leads the world.” Privately, lobbyists had even harsher words for the Trump administration. “This was a reflection of the weakness of the negotiating skills of the president and his team,” said one lobbyist, who added that this was the worst-case scenario for drug makers. “This was an unforced error and very, very weak negotiating.” (Florko, 12/10)

In other pharmaceutical news —

Bloomberg: Drug-Plant Inspections Ebbed As Tainted Pills Flowed To U.S. 
Inspections of foreign drug manufacturers by the U.S. Food and Drug Administration have fallen in recent years despite increasing worry about the safety and quality of generic medications, congressional investigators said. FDA inspections of overseas pharmaceutical manufacturers declined 10% from 2016 to 2018, according to a report by the Government Accountability Office, in part because the agency has fewer inspectors and has struggled to fill open jobs abroad. The number of domestic drug-plant inspections dropped 13%. (Annett, Cortez and Lee, 12/10)

Stat: Drug Pricing Bill Is A Sneak Peek At Democrats' 2020 Campaign Message
If Democrats are spoiling for a 2020 fight focused on anything besides impeaching President Trump, consider this week’s vote on a massive drug pricing package their opening salvo. House Speaker Nancy Pelosi’s “Lower Drug Costs Now” Act, a sweeping bill that pledges to lower consumer drug costs by 50%, includes ideas long touted by progressives in Washington: It would let Medicare directly negotiate the price of at least 50 drugs per year and it would cap U.S. drug payments based on costs in other developed countries. (Facher, 12/10)

Politico: Pelosi Brokers Deal With Liberals On Drug Pricing Bill
House Democratic leadership on Tuesday clinched a deal to win progressive leaders’ support for a sweeping drug pricing bill that could clear its path for passage in the full House on Thursday. The pact between Speaker Nancy Pelosi and progressive leaders includes an agreement to expand the government’s authority to directly negotiate drug prices under the legislation, ultimately requiring federal officials to hammer out the cost of at least 50 medicines a year, from the original 35. (Cancryn and Ferris, 12/10)

The Hill: Pelosi Reaches Deal With Progressives To Avert Showdown Over Drug Price Bill
Those changes are to increase the minimum number of drugs subject to negotiation under the bill from 35 to 50 and to restore the implementation of Jayapal’s amendment, which would extend protections against drug price spikes to people on employer-sponsored health insurance plans, not just those on Medicare. The deal prevents a showdown on Thursday when the bill will come to the floor for a vote. Progressive leaders had been contemplating a rare full-scale rebellion against Pelosi, thinking of blocking a vote on the drug pricing bill by trying to vote down a procedural motion. (Sullivan, 12/10)

Stat: What’s Real And What’s Illusion In Drug Pricing Legislation On Capitol Hill
The House will vote this week on Democrats’ signature drug pricing bill, H.R. 3, which would direct Medicare to negotiate the price of certain high cost drugs. Republicans also introduced their own competing bill Monday afternoon. The House bill is likely to pass resoundingly, but then go nowhere in the Senate. Republicans’ competing bill is unlikely to gain much, if any, Democratic support, but the bill is good messaging from a party that has been criticized in the past for being too cozy with drug makers. (Florko, 12/10)

The Hill: Pelosi Drug Pricing Plan Would Save $456 Billion Over Ten Years: Analysis
House Speaker Nancy Pelosi's bill that would let Medicare negotiate prices with drug companies would save the government $456 billion over ten years, according to an analysis released Tuesday. The bill, which will get a vote on the House floor this week, would require that federal health officials negotiate the prices of at least 35 brand-name drugs per year. (Hellmann, 12/10)

CNBC: Investors Fear Pelosi's Drug Price Plan Will Kill Small Biotech Firms
Private equity investors are lobbying against Nancy Pelosi’s sweeping drug pricing bill, telling her legislative aides in a series of private meetings in recent weeks that the plan would dry up financing for small biotech companies. A group of venture capitalists, including Peter Kolchinsky of RA Capital Management, Johannes Fruehauf of BioInnovation Capital and Sara Nayeem of New Enterprise Associates, met with Pelosi’s staff as well as moderate House and Senate Democrats on Oct. 29 to discuss their concerns. The investors have had follow-up meetings since, according to John Stanford, executive director of venture capital advocacy group Incubate and attended the meetings. (Lovelace, 12/10)

Prescription Drug Watch: For news on rising drug costs, check out our weekly roundup of news coverage and perspectives of the issue.

The New York Times: 3 Crime Scenes And 6 Dead: Rampage Stuns Jersey City
The shooting began outside a cemetery in Jersey City, N.J., on Tuesday when a 40-year-old detective tried to intercept two people who were suspects in a homicide. They opened fire and fled, speeding off in a rented truck that had been reported stolen and leaving the detective dead on the ground. They drove about a mile, stopping in a Hasidic neighborhood where dozens of young ultra-Orthodox families have relocated to in recent years. With traffic at a standstill as the police rushed to answer 911 calls about the shooting at the cemetery, the pair invaded a kosher market. (Barron and Gold, 12/10)

The Washington Post: Jersey City Shooting: Six Dead, Including One Police Officer And Two Suspects
Authorities initially said there was “no indication” of terrorism and suggested that the shooters stormed the Jewish market at random. But hours after he addressed reporters on Tuesday, Fulop said on Twitter that an “initial investigation,” which remains ongoing, has led them to believe “the active shooters targeted the location they attacked.” He did not elaborate, but said police have no indication of additional threats. (Thebault, 12/10)

The Associated Press: 6 Killed In New Jersey Gunbattle, Including Police Officer
Video shot by residents recorded loud volleys of gunfire reverberating along one of the city’s main streets and showed a long line of law enforcement officers pointing guns as they advanced, yelling to bystanders, “Clear the street! Get out of the way!” “It’s like firecrackers going off,” said Andy Patel, who works at a liquor store about three blocks away. “They were shooting like crazy. ... The cops were clearing everyone off the streets.” (Porter, 12/10)

Politico: Murphy, Booker Go To Jersey City After Deadly Shootout; Trump Briefed On Incident
U.S. Sen. Cory Booker (D-N.J.) and Gov. Phil Murphy, who canceled a trip to a fundraiser in Washington, both arrived in Jersey City on Tuesday evening to speak to police and local officials. In brief remarks, the governor acknowledged “the selfless work of all members of law enforcement who responded to this incident not knowing what they were entering or even if they would make it out.” (Hutchins, 12/10)

In other gun violence news —

California Healthline: Books, Binders, Bleed-Control Kits: How School Shootings Are Changing Classroom Basics
When a student recently opened fire at a California high school, staff members did what they were trained to do. They shepherded students to safe spaces, barricaded doors, pulled shades — and, when gunfire struck, used techniques adapted from the battlefield to save lives. The staffers used two bleeding-control kits in the Nov. 14 shooting in Santa Clarita, in which two students were killed and three injured before the gunman fatally shot himself, said Dave Caldwell, spokesman for the William S. Hart Union High School District. The kits, a recent addition to the district northwest of Los Angeles, are equipped with tourniquets, compression bandages and blood-clotting hemostatic gauze to prevent excessive blood loss. (West, 12/10)

Texas Tribune: Houston Police Chief Calls Out Texas Republicans For Opposing "Boyfriend Loophole" Law After Officer Dies In Domestic Violence Call
Houston Police Chief Art Acevedo called out prominent Texas Republicans on Monday for opposing gun restriction legislation to close the so-called "boyfriend loophole" after one of his officers was killed over the weekend responding to a domestic violence call. Arturo Solis, who according to The Houston Chronicle had a previous misdemeanor domestic violence charge against a former girlfriend, should have never had access to a gun in the first place, Acevedo said in a press conference video. (Fernandez, 12/10)

Health News Florida: Groups Seek Green Light For Assault Weapons Ban
Pushing back against arguments raised by Attorney General Ashley Moody and the National Rifle Association, gun-control supporters contend the Florida Supreme Court should sign off on a proposed constitutional amendment aimed at blocking possession of assault weapons. The political committee Ban Assault Weapons NOW, the gun-control group Brady and a coalition of 13 cities filed briefs Friday saying that the proposal meets legal tests to go before voters. (Saunders, 12/10)

The Washington Post: FDA Can Regulate E-Cigarettes Just Like Conventional Cigarettes, Appeals Court Says
The Food and Drug Administration can regulate e-cigarettes like it does conventional cigarettes, an appeals court said Tuesday, finding that the products are “indisputably highly addictive and pose health risks, especially to youth, that are not well understood.” The case before the U.S. Court of Appeals for the District of Columbia Circuit, brought by an e-cigarette manufacturer, was not about banning the sale of the devices and did not pose the question of whether e-cigarettes are more or less safe than traditional cigarettes. (Marimow, 12/10)

NPR: When Vaping Marijuana For Chronic Pain Leads To Lung Illness
As vaping has grown more popular in recent years, the trend has been fueled by the habit's pleasurable allure: Compared with smoking cigarettes or pot, vaping is discrete and less smelly. Vaping fluids come in hundreds of flavors. There's no tar or other byproducts of burning. And vape pens are high-tech, customizable and sleek. But none of that mattered to Paul Lubell when he decided to try vaping. He wasn't thinking about pleasure; he was just trying to avoid pain. The retired Navy veteran turned to vaping marijuana, hoping it would help him cope with his chronic, debilitating musculoskeletal pain. (Harris-Taylor, 12/11)

Boston Globe: Ban On Vape Sales In Massachusetts Ends Wednesday — What Happens Next?
Governor Charlie Baker’s ban on vape sales will lift Wednesday, nearly three months after it started amid an outbreak of vaping-related lung injuries. Baker’s public health council will vote on regulations Wednesday that could pave the way for some nicotine products to return to stores, albeit under tighter restrictions. (Martin, 12/10)

WBUR: The Mass. Ban On Vaping Product Sales Lifts Wednesday. Here's What You Need To Know
Gov. Charlie Baker’s administration plans to lift the emergency vaping products sales ban Wednesday during a meeting of the state's Public Health Council. That means some products will again be available for legal purchase, but the retail sale of flavored vaping liquids will remain illegal, under a recently passed state law. (Chen, 12/10)

The Associated Press: California Considers Calling THC In Pot A Risk To Moms-To-Be
More than three years after California voters broadly legalized marijuana, a state panel is considering if its potent, high-inducing chemical — THC — should be declared a risk to pregnant women and require warnings. Studies have indicated that a rising number of mothers-to-be have turned to marijuana products for relief from morning sickness and headaches, though it's effectiveness has not been backed by science. (Blood, 12/11)

The Washington Post: Facebook Ads Pushed Misinformation About HIV Prevention, PrEP, LGBT Activists Say
Facebook users have been bombarded with misleading ads about medication meant to prevent the transmission of HIV, according to lesbian, gay, bisexual and transgender advocates, who say the tech giant’s refusal to remove the content has created a public-health crisis. The ads have been viewed millions of times in recent months, Facebook’s archive reveals, and LGBT organizations argue they’ve had a dire effect: They’ve scared patients, potentially those who may be most at risk of contracting HIV, out of taking preventative drugs, known as PrEP, even though health officials and federal regulators have said they are safe. (Romm, 12/9)

The Advocate: Over 50 LGBTQ Groups Demand Facebook Remove Misleading Ads On PrEP
The targeted ads, which appear to be from personal injury attorneys, claim Truvada, a drug shown to be up to 99 percent effective in HIV prevention if administered daily, has harmful side effects, including issues related to bone density and kidney function. These ads are "causing significant harm to public health," the letter warns, because they are inciting public mistrust in PrEP, a key tool in fighting the AIDS epidemic. (Reynolds, 12/9)

The Hill: LGBTQ Groups Accuse Facebook Ads Of Spreading Misinformation About HIV Drugs
The ads "are convincing at-risk individuals to avoid PrEP, invariably leading to avoidable HIV infections," according to the groups. According to the Centers for Disease Control and Prevention, PrEP "reduces the risk of getting HIV from sex by about 99% when taken daily." The groups, including GLAAD, the Human Rights Campaign and The Trevor Project, wrote in the letter that they had already contacted Facebook about the ads. (Mills Rodrigo, 12/9)

KQED: LGBTQ Groups Call On Facebook To Remove Misleading Ads About HIV Prevention Drugs
In a statement, Facebook countered, "We value our work with LGBTQ groups and constantly seek their input. While these ads do not violate our ad policies nor have they been rated false by third-party fact-checkers, we're always examining ways to improve and help these key groups better understand how we apply our policies.” (Myrow, 12/10)

Stat: ‘Dump It Down The Drain’: How Contaminants From Prescription-Drug Factories Pollute Waterways
The drug-tainted wastewater streamed through underground pipes to a municipal treatment plant, but some of the medicine likely passed through unhindered and out to the Monongahela River. Typically, wastewater treatment plants are not equipped to remove pharmaceuticals, so when scientists from the United States Geological Survey tested effluent from the Morgantown, W.Va., plant several years ago, along with the discharges from six other treatment plants, it detected very high levels of some drugs. (Gilbert, 12/11)

The Baltimore Sun: University Of Maryland Researchers Testing Potential Vaccine For E. Coli, Shigella
Researchers at the University of Maryland’s medical school are testing a potential vaccine for E. coli and other diarrheal diseases. In a news release, the university wrote that Dr. Wilburn Chen and Dr. Eileen Barry will test a vaccine developed at the School of Medicine’s Center for Vaccine Development and Global Health. The testing is being funded by a $4.5 million agreement with Emergent Biosolutions, “a global life sciences company focused on addressing public health threats, including travel health diseases,” the university wrote. (Davis, 12/10)

The New York Times: Marathon Running May Be Good For Your Knees
Could it be that marathon training and racing are actually good for our knees? A myth-toppling new study of novice, middle-aged runners suggests that the answer is a qualified yes. The study finds that taking up distance running rebuilds the health of certain essential components of middle-aged knees, even if the joints start off somewhat tattered and worn. (Reynolds, 12/11)

Kaiser Health News: When Teens Abuse Parents, Shame And Secrecy Make It Hard To Seek Help
Nothing Jenn and Jason learned in parenting class prepared them for the challenges they’ve faced raising a child prone to violent outbursts. The couple are parents to two siblings. They first fostered the children as toddlers and later adopted them. (KHN has agreed not to use the children’s names or the couple’s last names because of the sensitive nature of the family’s story.) In some ways, the family seems like many others. Jenn and Jason’s 12-year-old daughter is into pop star Taylor Swift and loves playing outside with her older brother. (Herman, 12/11)

Kaiser Health News: Among U.S. States, New York’s Suicide Rate Is The Lowest. How’s That?
“I just snapped” is how Jessica Lioy describes her attempt in April to kill herself. After a tough year in which she’d moved back to her parents’ Syracuse, N.Y., home and changed colleges, the crumbling of her relationship with her boyfriend pushed the 22-year-old over the edge. She impulsively swallowed a handful of sleeping pills. Her mom happened to walk into her bedroom, saw the pills scattered on the floor and called 911. (Andrews, 12/11)

The Wall Street Journal: New York Life In Talks To Buy Cigna Unit For Up To $6 Billion
New York Life Insurance Co. is negotiating with Cigna Corp. to acquire a unit that sells nonmedical insurance products to employers, a deal that could be valued at as much as $6 billion, according to people familiar with the matter. Cigna in recent months has been seeking a buyer for a business that sells life, accident and disability-income insurance to employers for their workers, in a move that would help the health giant focus on its core business, according to the people. (Scism, Cimilluca and Wilde Mathews, 12/10)

Bloomberg: New York Life In Talks To Buy Cigna Non-Health Insurance Unit 
Insurers have been striking deals for units that sell insurance through employers. Lincoln National Corp. bought a group-benefits business from Liberty Mutual Holding Co. in 2018 for $3.3 billion. Hartford Financial Services Group Inc. acquired an Aetna Inc. life and disability business in 2017. The businesses are attractive to insurers seeking to diversify. The units are less capital-intensive, don’t rely as much on investment income and provide cash flow, Evercore ISI analysts said in an August note after initial reports that Cigna was looking to sell the business. (Chiglinsky and Tozzi, 12/10)

Modern Healthcare: KPC Group Misses Key Deadline On Verity Hospitals Purchase
The corporation poised to buy Verity Health's four remaining hospitals missed last week's court-appointed deadline to close the deal, which appears increasingly uncertain. Court filings show the bankrupt El Segundo, Calif.-based health system's frustration with the would-be buyer, Strategic Global Management, owner of the KPC Group, escalated after SGM missed the Dec. 5 deadline. Verity tried unsuccessfully to get a judge to force SGM's leaders to appear in court on Wednesday and explain why they didn't close the $610 million deal, announced almost a year ago. (Bannow, 12/10)

The Wall Street Journal: Tiny Tax Moves Can Save You Big On Medicare Premiums
Now is a good time for higher-earning Medicare recipients to check whether a small reduction in this year’s income could make a big difference in future premiums. Here’s why. Medicare premiums are based on income, and the formulas have “cliffs” that can raise premiums steeply if income rises by even one dollar. In addition, there’s a new inflation adjustment for 2020 that complicates the situation. (Saunders, 12/10)

The Associated Press: Report: Medicaid Recipients Often Use ER For Dental Issues
A new state report found that many Virginians on Medicaid often go to emergency rooms for dental issues that could have been prevented or treated at a dentist’s office. A recently released report by the Department of Medical Assistance Services found that about 16,000 Medicaid recipients visited emergency rooms about 19,000 times in 2018. More than half of those 16,000 were treated for “non-traumatic dental conditions” like tooth aches and loose teeth. (12/11)

Louisville Courier Journal: Lawmakers Rip $8 Billion In Last-Minute Award Of Medicaid Contracts
A recent award of $8 billion in state Medicaid contracts by the administration of Gov. Matt Bevin came under fire on two fronts by lawmakers on Monday. They were angered over the seeming haste to award the contracts, as well as the administration's attempt to bypass a legislative committee that's supposed to review them. On Monday, the General Assembly's Government Contract Review Committee, which has only advisory power, voted unanimously to reject the contracts after finding the Bevin administration failed to give them the contracts in advance. (Yetter, 12/9)

Bangor Daily News: Medicaid Expansion Enrollment Is Lagging Behind Projections In Maine. These Are The Barriers.
It has been nearly a year since Maine expanded Medicaid under the Affordable Care Act, with enrollment on track to fall below projections once the mark is reached in early 2020. More than 42,000 people eligible for MaineCare under the expansion provisions have signed up since Gov. Janet Mills, a Democrat, opened the voter-approved program in January. That’s just 60 percent of the population that the state expected to be covered by the end of this year. (Andrews, 12/11)

Milwaukee Journal Sentinel: Transgender Surgery: Wisconsin Medicaid Will Now Cover Needed Surgery
Wisconsin will no longer categorically deny Medicaid coverage for medically necessary gender-confirming surgery, a practice a federal judge found violated patients' civil rights and federal health care law. Lawyers for transgender residents who sued last year announced a settlement Tuesday after the deadline had passed for the state to appeal last month's final judgment in the class action case. (Vielmetti, 12/10)

The Washington Post: GWU Sues Corporate Hospital Partner, Leaving Fate Of Southeast Project Uncertain
George Washington University is suing its corporate partner in one of the Washington region’s foremost hospitals, crossing a new threshold in a dispute that could affect plans to build a new medical center east of the Anacostia River. The lawsuit, filed last week in D.C. Superior Court, alleges that Universal Health Services (UHS) — a Pennsylvania-based health-care corporation that owns hospitals across the country — has improperly diverted more than $100 million from George Washington University Hospital. (Jamison, 12/10)

Miami Herald: FL Senators Advance Parental Consent For Abortions
A key Florida Senate committee voted Tuesday, along party lines, to advance a bill that would require parental consent for abortion, overcoming a procedural hurdle by Democrats last month to stall the legislation. The 6-3 vote also begins moving what is likely to be one of the legislative session’s most controversial bills through the more moderate Senate, which looks likelier this year to pass the proposal. (Koh, 12/10)

The Associated Press: New Judge To Decide On Removing Life Support For Texas Baby
A new judge will consider if a Texas hospital can take a 10-month-old girl off life support despite her family's opposition after the impartiality of the previous judge was questioned. A temporary restraining order stopping Cook Children's Medical Center in Fort Worth from removing life-sustaining treatment for Tinslee Lewis was set to expire Tuesday. But after the removal last week of Tarrant County Juvenile Court Judge Alex Kim, a new hearing on the family's request for a temporary injunction will now be held Thursday in Fort Worth. (12/10)

The Associated Press: Lab Owner To Plead Guilty In Medicare Kickback Scheme
A Pennsylvania business owner has agreed to plead guilty in a $127 million kickback scheme involving his genetic testing labs. Ravitej Reddy is scheduled to plead guilty to federal charges that he conspired with out-of-state marketing companies to pay kickbacks for lucrative lab tests at his two testing facilities, the Pittsburgh Post-Gazette reported Tuesday. A plea hearing is scheduled for Jan. 10. (12/10)

North Carolina Health News: Community Clinics Brace For Funding Lapse 
Across North Carolina, community health centers are contending with what has become an unpleasant tradition: planning for a potential federal funding lapse. The nation’s safety net clinics — 250 of which are in North Carolina — serve thousands of uninsured and underinsured patients and enjoy bipartisan support. But a battle between Congress and President Donald Trump over funding a border wall at the U.S.-Mexico border has stalled the passage of a full federal budget, which includes funding for community health centers. (Engel-Smith, 12/11)

The Washington Post: With Dozens Of Kids Orphaned By The Opioid Crisis, This Md. County Has A New Outlook On Trauma Services
Growing up in a Cecil County trailer park, Ray Lynn has been shaped by tragedy. He went from seeing drug addiction firsthand in his neighborhood as a child to tackling the problem as a police officer decades later. “I can name you friends that are dead because of it,” he said. (Davis, 12/10)

The Wall Street Journal: Frontier Airlines Is Sued For Pregnancy Discrimination
When Renee Schwartzkopf, a flight attendant with Frontier Airlines, gave birth in 2017, she didn’t tell her employer that she planned to breast-feed her son after returning to work. Ms. Schwartzkopf said she knew of another flight attendant who had asked to pump milk during flights and was told no. As the primary breadwinner in her family at the time, she couldn’t afford to lose her income if she requested permission and was denied, then forced to choose whether to quit or take unpaid leave. (Weber, 12/10)

The Advocate: Free Hepatitis C Tests To Be Offered In Local Walmarts 
In hopes of halting the spread of hepatitis C, state officials are working with Walmart to offer free testing at rural stores across the state. The idea is to screen and educate patients in places they already frequent, rather than making them go out of their way to hospitals or clinics. ...The program was announced Tuesday at a Walmart in Watson, which will serve as one of 10 pilot program sites through Feb. 1. (Kennedy, 12/10)

Cleveland Plain Dealer: Cleveland’s HIV/AIDS Program Failed To Test Highest Risk Populations, Reach Out To Exposed Partners Quickly
Several of the deficiencies the Ohio Department of Health cited as reasons for not renewing Cleveland’s $1.5 million HIV/AIDS grant are core to preventing infection and eradicating the epidemic, experts in the field told The Plain Dealer. (Dissell, 12/10)

Georgia Health News: Five Unreported Cases Started Cobb County Measles Outbreak
The recent Cobb County measles outbreak began in October with five cases that were not reported to public health officials. Health officials didn’t learn of the October cases — all within one family — until they began investigating the six additional cases that emerged in November in the suburban Atlanta county. (Miller, 12/10)

Miami Herald: New Report Sheds Light On Florida Immigration Detention
National civil rights and immigration lawyers are calling on state and federal officials to mandate complete oversight of all adult immigration detention facilities in Florida following a scathing report by the Southern Poverty Law Center and Americans for Immigrant Justice released Monday. The 104-page report highlights “substandard” conditions at Florida’s four adult detention centers — Krome Service Processing Center South Miami-Dade, Broward Transitional Center in Pompano Beach, Monroe County Detention Center in Key West and Glades County Detention Center in Moore Haven, Fla. (Madan, 12/10)

New Orleans Times-Picayune: A Look Inside The Progress At Children’s Hospital Expanded Mental Health Facility 
Children's Hospital New Orleans is close to opening a new 51-bed unit for children in need of inpatient mental health services, expanding its current 39-bed facility amid what experts say is a shortage of treatment options in Louisiana for kids with mental illness. The 70,000-square-foot building, set to open next month, is part of a $300 million renovation and expansion plan at the hospital's Uptown campus. (Woodruff, 12/10)

The Oregonian: Woman Files $3M Lawsuit Against Medical Providers, Claims Meningococcal Diagnosis Was Delayed
An Oregon State University student who visited Portland-area medical providers amid a meningococcal outbreak at her Corvallis campus in 2017 — but was not immediately diagnosed with the disease — has sued the companies for $3 million. Julia L. Hanson, then a 21-year-old Oregon State student, was eventually diagnosed with the disease, according to the lawsuit. She nearly died, had a prolonged hospital stay and suffers from permanent brain damage and other negative effects, the lawsuit claims. (Ryan, 12/10)

The Advocate: Our Lady Of The Lake, NeuroMedical Center To Announce New Partnership 
Our Lady of the Lake Regional Medical Center and The NeuroMedical Center are set to announce a new partnership that will expand stroke and neurological care in Baton Rouge and statewide. Gov. John Bel Edwards will attend a press conference Wednesday morning, along with Scott Wester, president and chief executive officer of Our Lady of the Lake, and Dr. Gregory Fautheree, president of The NeuroMedical Center Clinic, to detail an announcement. (Boone, 12/10)

Health News Florida: Panel Grapples With Substance Abuse, Mental Health Concerns Among Physicians
A state licensing board continues to grapple with how best to address mental-health issues and substance abuse among medical students and physicians across Florida. A Florida Board of Medicine subcommittee last week agreed to reduce a look-back period for mental health and substance abuse on a licensure application from five years to two years. But a day later, the full Board of Medicine raised concerns that it could put the public’s health at risk. (Sexton, 12/10)

Atlanta Journal-Constitution: Georgia Ranks Among Least Healthy States In The Nation, Report Finds
Georgia ranks among the least healthy states in the nation, according to a new report. The rankings, released by the United Health Foundation, put Georgia at No. 40 for overall healthiest states. The foundation has been putting out its “America’s Health Rankings Annual Report” for 30 years. It looks at factors like behaviors, community and environment, policy, clinical care and health outcomes. (Kueppers, 12/10)

The Star Tribune: Woman Sues Over Denial Of Emergency Contraceptives At Two Minn. Pharmacies
Andrea Anderson says she asked the pharmacist at her drugstore in north central Minnesota more than once why he couldn't fill her prescription for emergency contraception. The 39-year-old mother of five in McGregor, Minn., initially thought the man on the phone was concerned that the medication would not interact well with her allergy and asthma medication. But she said the pharmacist at Thrifty White kept insisting it was a matter of his own discomfort. (Montemayor, 12/10)

St. Louis Post Dispatch: Black Leaders Question Mercy’s Plan To Open Health Clinic In Ferguson 
The founder of a black midwife-led health center that opened three years ago in Ferguson to address stark racial disparities in maternal health care is claiming hospital giant Mercy is violating an agreement with plans to open a similar clinic in Ferguson. A letter was published Monday in the St. Louis American, signed by area black female leaders and politicians, demanding an apology and that Mercy stop all plans to build its clinic. (Munz, 12/10)

San Francisco Chronicle: SF To Open First Site For Homeless Living Out Of Vehicles. Is It Enough?
The lot is being dubbed a “Vehicle Triage Center,” where people will have daily access to case managers, portable toilets and a portable shower three times a week. While city officials hail it as a productive first step toward addressing vehicular homelessness, others see it as an inadequate response to the crisis and a veiled attempt to clear RVs from residential neighborhoods. (Thadani, 12/10)

The Wall Street Journal: Big Drugmakers Push Deeper Into Cancer Treatment
Two of the world’s biggest drugmakers struck multibillion-dollar deals on Monday aimed at bolstering their lineups in the fiercely competitive cancer-drugs market. Merck & Co. said it would acquire ArQule Inc. for about $2.7 billion, paying a 107% premium in a bid to diversify its cancer treatments beyond top-selling drug Keytruda. Meanwhile, Sanofi SA said it would spend $2.5 billion, a 172% premium, to acquire Synthorx Inc. in the French drugmaker’s own effort to catch up with oncology rivals. (Hopkins and Roland, 12/9)

Stat: Merck And Sanofi Buy Smaller Cancer Drug Firms At Big Premiums
The drug giants Merck and Sanofi (SNY) each said they would acquire a smaller drug maker for more than $2 billion Monday — in each case, more than double the smaller company’s market capitalization — cheering investors about large companies’ appetite to execute buyouts in the biotechnology sector. Merck, of Kenilworth, N.J., is purchasing ArQule (ARQL) of Burlington, Mass., a developer of pills aimed at treating multiple cancers, for $2.7 billion, or $20 per share, a 107% premium to the stock’s closing price Friday. (Herper, 12/9)

Stat: More Hospital Drug Spending Going Toward Cancer Immunotherapies 
Amid intense scrutiny over prescription drug costs, a new analysis finds some hospitals are spending a larger share of their budgets for new cancer and migraine treatments, as well as for a biosimilar version of a brand-name drug that is used to prevent white-cell depletion in patients given chemotherapy. Not surprisingly, the spending reflects a growing trend among hospitals to shell out more of their dollars for outpatient infusion treatments and, in particular, costly specialty drugs, according to Bonnie Lai, vice president of product management at Lumere, a research and analytics firm that focuses on hospitals and generated the data from 26 facilities across four hospitals systems. (Silverman, 12/6)

The Wall Street Journal: Sanofi, Maker Of World’s Top-Selling Insulin, To Exit Diabetes Research
The maker of the world’s top-selling insulin has given up on finding new diabetes drugs. Sanofi SA, which makes Lantus, said Monday it would stop investing in diabetes research after years of frustrated attempts to bring a fresh blockbuster to the market. The decision is part of a broader strategic overhaul by new Chief Executive Paul Hudson, who hopes to reinvigorate growth at the French health-care giant by focusing on fewer, more specialized disease areas such as cancer—mirroring a move being made across the drug industry. (Roland, 12/9)

Bloomberg: FDA Approving Drugs At Breakneck Speed, Raising Alarm 
The U.S. is approving new drugs so fast that companies are now preparing for a green light months in advance of the scheduled decision date, a pace that’s helping patients with rare or untreatable diseases but raising alarm among consumer advocates. Global Blood Therapeutics Inc., maker of a new sickle cell disease drug called Oxbryta, built a booth to showcase the medicine at the annual meeting of the American Society of Hematology that begins this weekend -- even though the Food and Drug Administration’s deadline for approval was Feb. 26. (Cortez and Flanagan, 12/6)

The New York Times: Two New Drugs Help Relieve Sickle-Cell Disease. But Who Will Pay?
The Food and Drug Administration recently approved two transformative new treatments for sickle-cell disease, the first in 20 years. But the drugs are wildly expensive, renewing troubling questions about access to cutting-edge medicines. Adakveo, made by Novartis, can prevent episodes of nearly unbearable pain that occur when malformed blood cells get stuck in blood vessels. Approved only for patients aged 16 and over, it is delivered as an infusion once a month. (Kolata, 12/7)

Politico Pro: Second Generic Drug Company Admits To Price Fixing
Generic drug manufacturer Rising Pharmaceuticals has admitted to conspiring to fix prices and allocate customers for a blood pressure drug, becoming the second company to admit wrongdoing in a sweeping federal probe into collusion among the makers of off-patent medicines. The New Jersey-based company agreed to cooperate with the Justice Department's criminal investigation in return for three years of deferred prosecution or until the company’s bankruptcy proceedings become final. (Karlin-Smith, 12/3)

Columbus Dispatch: Even After A Few Years Of Drug Price Reforms Across The US, PBMs Are Still Finding Ways Around Them
Since 2015 — and particularly in 2019 — state after state has passed scores of measures attempting to rein in middlemen known as pharmacy benefit managers. But key players in Ohio and elsewhere say that, so far, the results are mixed at best. Critics say PBMs have used a lack of transparency to pocket excessive fees and rebates, under-reimburse pharmacies and steer the most profitable business to pharmacies they own themselves. A 2018 study paid for by the Ohio Department of Medicaid said that just one of those practices meant that in a single year two PBMs billed the state $244 million more for drugs than they paid the pharmacists who bought and dispensed them. (Schladen, 12/8)

Columbus Dispatch: Insulin Prices Double, Pinching Diabetics’ Budgets
In people with Type 1 diabetes, the pancreas can’t make insulin. Those with the condition require several doses of insulin a day and spent $5,705 per person on it in 2016, an increase of $2,841, or 99%, per person since 2012, according to the nonprofit Health Care Cost Institute. Costs continue to rise, so much so that almost half of diabetics have temporarily skipped taking their insulin, according to a 2018 survey by UpWell Health, a Salt Lake City company that provides home delivery of medications and supplies for chronic conditions. (Henry, 12/9)

The Associated Press: West Virginians Head To Canada To Find Affordable Insulin
A group of West Virginians left the country Sunday in search of affordable insulin — they went to Canada, where insulin prices are reported to be about a tenth of what it costs people in the United States. Across the border, no prescription is even necessary to purchase the life-saving medication, The Charleston Gazette-Mail reports. State data says about 15% of West Virginians rely on insulin. The nonprofit Health Care Cost Institute says insulin cost a person with Type 1 diabetes about $6,000 in 2016, and prices have only increased since then, making it difficult for even insured people to afford it. (12/9)

Columbus Dispatch: State Senators Look To Eliminate ‘Fail First’ Step Therapy For Stage 4 Cancer Patients
An upcoming proposal in the Statehouse could give stage 4 cancer patients in Ohio a better chance at beating the odds, legislators and doctors say. The bipartisan bill would eliminate the need for people with late-stage cancer to go through what is commonly referred to as “step therapy.” Insurers now can require stage 4 cancer patients to “fail first” with a cheaper treatment specified by the health insurance company that might not be the best or latest treatment available. Patients must then fail on the treatment before they are allowed a “step up” to another medication that might be more expensive for the insurer. (Filby, 12/9)

Stat: Sanofi Aims To Make Dupixent A $10B Drug, Sell Cialis Over The Counter
The new CEO of Sanofi (SNY), the French drug giant, believes that its drug Dupixent, for the treatment of severe rashes and asthma, could surpass $10 billion in annual sales. Paul Hudson, who became CEO in September, said Monday that growing sales of Dupixent, which is sold with the U.S. biotech Regeneron, would be Sanofi’s top priority. It “has the chance to be one of the most successful medicines in the history of the industry, built on the back of patients with huge unmet need who are living horribly debilitated lives, who can reach, in many cases, normal lives,” Hudson said. (Herper, 12/9)

The Wall Street Journal: Sienna Biopharmaceuticals To Shut Down After Asset Sale Flops
Clinical-stage biopharmaceutical company Sienna Biopharmaceuticals Inc. will shut down by the end of the week and layoff its remaining employees after failing to sell itself out of bankruptcy. The publicly traded drugmaker had hoped to find a buyer to acquire it since before it filed for chapter 11 bankruptcy protection in September but didn’t receive any bids for the whole company. (Al-Muslim, 12/10)

USA Today: My Son Died From Rationing Insulin. Democrats' Drug Pricing Plan Still Wouldn't Help Him.
My son Alec had just turned 26 when he died from rationing insulin in 2017. After his birthday, he was no longer eligible to be covered by my health insurance. The pharmacist told him he would have to pay $1,300 for his supplies. Within a month, I got a call that no parent wants to get. I wish everyone had the chance to meet Alec. He was loving, caring, goofy, compassionate, adventurous, generous and persistent. His hugs are one of the things I miss the most. But my son was not the only one. (Nicole Smith-Holt, 12/10)

Los Angeles Times: My Wife's Life Is Priceless, But Her Chemo Is Too Expensive
Doctors told my wife there was “very little chance” her breast cancer would return. But five years later, three months after Paula’s 51st birthday, I typed “prognosis of metastatic breast cancer” into my browser and through tears read the search results: “dismal prognosis,” “incurable,” “median survival of three years.” Paula’s doctors urged us not to despair — there were great new medicines available they hoped could slow down the tumor. And now, three years later, her cancer has not progressed. As a husband, I’m obviously ecstatic. (Peter Ubel, 12/6)

The Washington Post: Generic Drugs Are Cheap And Popular, But May Not Always Be As Safe As You Think
Generic prescription drugs have saved the United States about $1.7 trillion in the past decade. The Food and Drug Administration approved a record 781 new generics in 2018 alone, including generic versions of Cialis, Levitra and Lyrica. They join generic versions of blockbusters from yesteryear, such as Lipitor, Nexium, Prozac and Xanax. The elderly are the biggest buyers of generics, because they take the most medications and are on fixed incomes, but virtually everyone has taken a generic antibiotic or pain pill at one time. (C. Michael White, 12/8)

Stat: H.R. 3 Is The Wrong Path To Lower Drug Costs
Americans want health care to be less expensive. We also want our health care to be the most innovative in the world. The key to simultaneously achieving both of these goals is good public policy. Back in September, House Energy and Commerce Committee Chairman Frank Pallone (D-N.J.) introduced H.R. 3, also known as the Lower Drug Costs Now Act of 2019, into the House of Representatives with 105 co-sponsors, all Democrats. The House is set to vote on the bill this week.H.R. 3 would adopt international reference pricing for the Medicare program in an effort to lower drug costs. In other words, it would impose foreign price controls on the U.S. market. This would indeed reduce prices, but at what cost to innovation? (Mike Guerra, 12/9)

The New York Times: Terminally Ill At 25 And Fighting Fake News On Vaccines 
In 2015, an anti-vaccination campaign in Ireland caused a sudden fall in the number of HPV vaccines administered, given to young girls and boys to prevent cervical cancer. Dr. Grimes tells the story of how, with the help of a remarkable woman named Laura Brennan, they were able to reverse the trend, and what countries like the United States can learn in their fight against medical misinformation. (David Robert Grimes, 12/11)

The Hill: Deadly Measles And Ebola Outbreaks Show Why Vaccinations Are So Essential
Vaccines are our greatest public health tool in the war against emerging and re-emerging bacteria and viruses, a war that is being fought and won, or fought and lost, across the globe every day. The war against measles is still ongoing, and we have lost several key recent battles. Measles is one of the most contagious viruses in nature. Keep in mind there is a 90 percent chance of an unvaccinated individual getting infected with measles simply by entering a room where a measles patient had been up to two hours earlier. (Marc Siegel, 12/10)

Stat: 11-Country Survey Of Primary Care Offers Lessons For The U.S.
Primary care is the backbone of any high-performing health care system. It works best when primary care providers sit at the center of a patients’ health care experience and are aware not only of their medical needs but also of their social needs: Do they have food, housing, heat, a way to get to their appointments? Coordinating what can be a complex nexus of specialty care and social services for patients is a challenge that physicians the world over are grappling with. Our survey of more than 13,000 primary care physicians in 11 high-income countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States), published Tuesday in the journal Health Affairs, shows where the U.S. is falling behind, where we are keeping pace and possible paths to improvement. (Michelle Doty and David Blumenthal, 12/10)

The Washington Post: A Stunning Indictment Of The U.S. Health-Care System, In One Chart
One quarter of American adults say they or a family member has put off treatment for a serious medical condition because of cost, according to data released this week by Gallup. That number is the highest it’s been in nearly three decades of Gallup polling. An additional 8 percent have made the same choice for less serious ailments, the survey showed. That means a collective 33 percent of those polled have prioritized financial considerations over their health, tying the high set in 2014. (Christopher Ingraham,12/10)

USA Today: Democratic Plan To Reduce Drug Prices Is No Help To Uninsured
My son Alec had just turned 26 when he died from rationing insulin in 2017. After his birthday, he was no longer eligible to be covered by my health insurance. The pharmacist told him he would have to pay $1,300 for his supplies. Within a month, I got a call that no parent wants to get. I wish everyone had the chance to meet Alec. He was loving, caring, goofy, compassionate, adventurous, generous and persistent. His hugs are one of the things I miss the most. (Smith-Holt, 12/10)

Stat: Oral Immunotherapy Can Be A Game Changer For Many With Food Allergies 
Food allergies upend lives. In children, food allergies can scale back or completely stop participation in birthday parties, organized sports, and summer camps. Parents may need to reduce their work hours and homeschool their children. For adults, grocery shopping or eating out becomes an ordeal. Oral immunotherapy could change that. (Charles Feng, 12/11)

Des Moines Register: Planned Parenthood Offers Online Tool To Find Abortion Services
A rose to Planned Parenthood for using a new online tool to help Iowa women connect to needed health care. The database, called the “Abortion Care Finder,” locates clinics for people seeking abortion services. It also provides information about options based on state regulations and helps women determine how far along they are in a pregnancy. Such a tool is helpful when anti-choice politicians have made it more and more difficult for women to access a needed surgical or medication abortion. (12/6)

Stat: Mental Health, Addiction Care Poorly Covered By Insurance Networks
More than 70,000 Americans died of overdoses in 2017, yet insurers spent only 1% of their total health care dollars on treatment for substance use disorders — a decrease from two years earlier. This alarming statistic is just one of many in a new report released by Milliman, an independent actuarial firm. The report confirms that insurers have failed to adequately cover lifesaving care even as U.S. life expectancy declined over the past three years, primarily due to overdoses and suicides. (Patrick Kennedy, 12/10)

Nashville Tennessean: Median Price Benchmark Is A Free Market Answer To Surprise Billing
The binding arbitration proposal that U.S. Rep. Scott DesJarlais favors in his Oct. 16 guest column on surprise medical billing does little to protect patients from the impact of surprise medical billing because it is a backend solution that gives patients no knowledge of what they are going to owe when they enter an in-network hospital. The hospital-based physicians treating these patients know full well that patients are going to a hospital that is in their network with little to no knowledge that some of their treating physicians may be out of network, yet they have purposefully chosen to stay out of network. (Patsy Writesman and Gregg Lawrence, 12/10)

The CT Mirror: Medicare’s New Primary Care Payment Rule Is Good News For Patients
The ongoing relationship between primary care physicians and their patients forms the foundation of good health. Although that relationship has survived over the decades, cracks are appearing in it — the result of decades in which Medicare and other payers have devalued primary care by paying more for tests and procedures than for primary care visits. To make matters worse, Medicare has placed excessive administrative burdens on primary care physicians that hinder the delivery of quality patient care and add to the cost of care. (Robert McLean and Gary Leroy, 12/11)