“Simplicity is a great virtue but it requires hard work to achieve it and education to appreciate it. And to make matters worse: complexity sells better.”
– Edsger W. Dijkstra

From Washington, DC

• Politico Pro reports,
  • “The top Republican and Democrat on the Energy and Commerce Committee are taking seriously the pleas of large employers and health insurers who say the No Surprises Act is driving up insurance premiums.
  • “The House panel’s chair, Brett Guthrie of Kentucky, and ranking Democrat, Frank Pallone of New Jersey, asked the Congressional Budget Office on Monday to determine if and how the law will raise premiums over the next decade.
  • “The lawmakers’ letter to CBO Director Phillip Swagel — his office is Congress’ nonpartisan arbiter of the cost of legislation.”

• Beckers Behavioral Health adds,
  • “Health plans want the next federal mental health parity rule to do something regulators haven’t yet: show them what compliance looks like. The 2021 law called for illustrative examples of good compliance, and plans are still waiting for them, according to Debbie Witchey, president and CEO of the Association for Behavioral Health and Wellness.
  • “ABHW represents the health plans that provide mental health and substance use benefits, including Optum and Aetna. Its members cover about 200 million lives.” * * *
  • “She called a recent field assistance bulletin from the Employee Benefits Security Administration helpful because it narrows where enforcement should focus while a new rule is pending: utilization management, treatment exclusions and network adequacy, the areas the bulletin identifies as having the greatest impact on patients.
  • “Still, Ms. Witchey said the bulletin is no substitute for the compliance examples ABHW wants to see when the new rule comes out.”

• Healthcare Dive relates,
  • “Millions of seniors in standalone Medicare prescription drug plans could see their premiums skyrocket next year if they don’t switch to a cheaper option.
  • “Average monthly premiums for Part D plans are set to jump 50%, from $34 to $51 in 2027 — assuming seniors stay on their current plans, according to a new analysis from the KFF.
  • “But premiums for plans on offer vary widely, ranging from $6 to $204 among national Part D carriers, the KFF found. Researchers with the health policy think tank stressed the importance of plan shopping during Medicare open enrollment, which runs until Dec. 7.”

• CMS has posted the slide deck from its September 30, 2026, webinar about the Group Health Plan (GHP) Recovery: Best Practices Webinar.

From the U.S. Office of Personnel Management front,

• Govexec reports,
  • “For the second straight month, most offerings in the federal government’s 401(k)-style retirement savings program lost value, reflecting continued volatility across the economy.
  • “Only the fixed income (F) fund, and the G Fund, which is made up of government securities, posted gains in October. The F Fund grew 2.47%, while the G Fund increased by its statutorily mandated rate of 0.46%.
  • “Since January, the F Fund has lost 0.35%; the G Fund has gained 3.89%.
  • “The common stocks of the C Fund finished October 0.87% in the red, bringing its 2026 performance down to 11.75%. And the small- and mid-size businesses of the S Fund fell 0.40% last month; since January, the S Fund has increased 11.17% in value.
  • “The international investments in the I Fund lost 2.89% last month. So far this year, the I Fund is 13.09% in the black.”

• Per OPM news releases,
  • “The US Office of Personnel Management (OPM) today announced that applications are now open for the 2027–2028 class of White House Fellows, offering exceptional Americans a unique opportunity to serve at the highest levels of the federal government and help shape the future of our nation.
  • “Established in 1964, the White House Fellows Program is one of the nation’s most prestigious leadership and public service programs. Each year, a select group of accomplished individuals from across the country is chosen to spend a year working alongside cabinet secretaries, senior White House staff, and other top government officials, gaining firsthand experience in federal leadership and policymaking.” * * *
  • “Applications for the 2027–2028 White House Fellows class are open now. Interested candidates can learn more about the program and application process here.”
• and
  • “The US Office of Personnel Management (OPM) has identified approximately 50,000 deceased individuals who remain listed in the Federal Employees Health Benefits Program (FEHBP) by matching Treasury’s August 2026 Death Record Confidence Scoring Tool (DRCST) against OPM’s FEHB enrollment records.
  • “The review identified $96.3 million in improper payments made after date of death, including $70.6 million in government FEHB premium contributions and $25.7 million in retirement payments.
  • “OPM also estimates $10.4 million in carrier costs tied to over 20,000 individuals who remain on carrier rolls even though no government premium is being paid for them. Carriers charge FEHB funds each month for administrative and per-member costs. OPM will examine claims that may have been paid after date of death in the coming weeks.”
• FEHBlog observation — FEHB and PSHB plans have no way to reconcile premiums with individual enrollments. Plans would gain that ability if OPM simply adopted the HIPAA 820 enrollment transaction which has been in service since 2012.

From the U.S. Food and Drug Administration front,

• The American Hospital Association News reports,
  • “The Food and Drug Administration has identified Class I recalls of two products: certain platelet factor 4 radioimmunoassay products by Instrumentation Laboratories due to customer reports of obtaining an invalid calibration curve; and certain StatStrip Glucose Hospital Meters by Nova Biomedical due to a scanning issue that could lead to a glucose result being assigned to the wrong patient’s medical record or quality control ID. Nova Biomedical reported one serious injury related to the issue as of Oct. 5. The FDA said no deaths have been associated with either issue.” 
    
• Reuters relates,
  • “Dr Reddy’s (REDY.NS) said on Monday that the US FDA has tentatively approved a generic version of a new and highly effective HIV prevention drug, paving the way for ​sales in many low- and middle-income countries, though not yet in the United ‌States.
  • “Some doctors and activists say the new treatment could help control the 44-year-long AIDS epidemic which still infects 1.3 million people a year, and which the World Health Organization estimates has killed 44 million since it first ​emerged.” * * *
  • “FDA tentative approval is given to drugs that ​meet all the agency’s safety, efficacy and quality standards but cannot yet be sold in the ​US due to patent or exclusivity issues.”

• Per a FDA news release,
  • “The U.S. Food and Drug Administration today issued final guidance for manufacturers of cellular and gene therapy (CGT) products to implement a comprehensive, science- and risk-based plan for making sure their products meet potency standards. The guidance provides FDA’s recommendations for a Potency Assurance Strategy, which guides manufacturers to test and verify — before a product reaches a patient — that every batch meets a defined standard of potency to do what the product is supposed to do therapeutically.
  • “The Potency Assurance for Cellular and Gene Therapy Products final guidance replaces FDA’s 2011 potency testing guidance for CGT products and applies to treatments for serious and often life-threatening conditions. By law, manufacturers are expected to verify that their products work as intended, from the time of approval through post-approval monitoring. This final guidance provides FDA’s current thinking and recommendations on how manufacturers can meet that requirement.”  

• Beckers Behavioral Health adds,
  • “The American Medical Association is calling on the FDA to require botanical drug products, including kratom and cannabis, to prove safety and efficacy in clinical trials before they are marketed or prescribed, warning that unproven products can pose serious risks to patients.
  • “The AMA made its case in an Oct. 28 letter to FDA Deputy Commissioner Grace Graham. The physician group argued that rising consumer demand, anecdotal claims and influencer marketing on social media should not replace high-quality clinical trials or postmarket safety monitoring.
  • “AMA President Willie Underwood III, MD, said manufacturers are producing increasingly potent botanical products in forms ranging from gummies and powders to oils and injections. He said consumers face harms that include dependence, substance use disorders, overdose and death.
  • “Calling something ‘natural’ doesn’t make it safe,” Dr. Underwood said.”

From the public health and medical / Rx research front,

• Cardiovascular Business reports,
  • “A deep dive into a recent Heart Failure Society of America (HFSA) report makes it clear that heart failure (HF) outcomes can still be significantly influenced by where a person lives or how much money they earn. That report, the HFSA Heart Failure Clinic Database Annual Report, includes data from more than 300 U.S. clinics. And it says a lot about the modern healthcare landscape in the United States.
  • “Cardiology health policy experts Nicholas Chiu, MD, MPH, and Rishi K. Wadhera, MD, believe the report should be a wake-up call for healthcare policy reform. They made their case in a new editorial published in the Journal of Cardiac Failure Intersections.[1]. 
  • Wadhera is the associate director of the Richard A. and Susan F. Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center in Boston. Chiu is a cardiology fellow with Harvard Medical School and Mass General Brigham/Brigham and Women’s Hospital.
  • “The two co-authors said these stats provide a map of the policy choices that resulted in poor outcomes. At the same time, the numbers show how much room there is for improvement. 
  • “For example, the U.S. is one of the wealthiest nations in the world, but it has greater income inequality than most other high-income countries. In addition, the gap in health outcomes between the richest and poorest Americans is widening over time.
  • “Poverty is one of the most powerful and persistent determinants of health in the United States,” the authors wrote. “Patients with heart failure are especially vulnerable to the downstream effects of poverty, because effective care requires costly medications, frequent monitoring, and reliable access to specialty care. Despite a decade of therapeutic advances, poverty continues to shape who develops HF, who can access high-quality care, and how patients live with the disease.”

• tctMD adds,
  • “Hospitalizations for heart failure (HF) seem to go up with colder ambient temperatures, but the same rise is not seen when temperatures run warmer, an analysis of Medicare data suggests.
  • “Several prior studies have illuminated the relationship between cardiovascular health and climate, with many showing increases in cardiovascular death with rising heat and others showing profound negative effects of cold weather as well.
  • “The new analysis, published online this week in JAMA Network Open with first author Nathaniel Kuhrt, MD (Thomas Jefferson University, Philadelphia, PA), looks specifically at HF hospitalizations documented in Medicare claims data between 2007 and 2022.” 

• The American Medical Association lets us know what doctors want patients to know about perimenopause.
  • “Perimenopause symptoms can be confusing. Learn what perimenopause is, when it starts and what to know about symptoms, treatment and changing periods.”

• tctMD relates,
  • “Cancer survivors who adhere to a healthy dietary pattern appear to fare better over the long term compared with those who eat less healthy diets, an analysis of the UK Biobank shows.
  • “Out of eight different dietary patterns, better adherence to all but one of them was associated with lower risks of CVD and all-cause death over about a dozen years, lead authors Qing-Yuan Gao, PhD, and Jing-Wei Gao, PhD (both from Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China), and colleagues report.
  • “An average 45-year-old gained an estimated 1.66 to 3.32 years in life expectancy by consuming healthy foods.
  • “The findings, published online this week in JACC: Advances, highlight “the potential for diet to support cardio-oncology care,” the authors write, noting that “dietary interventions may exert cardioprotective effects in cancer survivors through modulation of metabolic dysfunction and aging processes.”
  • “There remains a need for more definitive research, however.”

• Medscape tells us,
  • “Remibrutinib, an investigational Bruton tyrosine kinase (BTK) inhibitor developed by Novartis, significantly reduced relapse rates and inflammatory brain lesions compared with teriflunonmide, the current standard of care, in patients with relapsing multiple sclerosis (MS), new findings from two industry-sponsored phase 3 trials showed.
  • “The REMODEL-1 and REMODEL-2 trials showed relative reductions in annualized relapse rates (ARRs) of 35% and 31.2%, respectively, although the absolute differences were small. Remibrutinib was also associated with a reduction in new or enlarging brain lesions by approximately 65%-70% compared with teriflunomide.
  • “The studies also suggested a potential benefit in delayed disability progression with remibrutinib although the findings were not statistically conclusive. The results also showed fewer liver enzyme elevations with remibrutinib vs teriflunomide.
  • “These findings support remibrutinib as a new safe and highly efficacious oral therapy for relapsing MS,” lead author Heinz Wiendl, MD, professor and chair, Department of Neurology, University of Freiburg, Freiburg, Germany, told Medscape Medical News.”

• MedTech Dive informs us,
  • “Abbott has started a pivotal clinical trial of its investigational Cephea mitral valve system, the company said Thursday.
  • “The device, which Abbott acquired in its 2019 takeover of Cephea Valve Technologies, replaces the diseased mitral valve to restore normal blood flow through the heart. 
  • “Cephea performs the same function as Abbott’s Tendyne but is delivered through a vein in the leg, rather than via a small incision in the chest.”

From the U.S. healthcare business and artificial intelligency front,

• Beckers Hospital Review reports,
  • “Corvallis, Ore.-based Samaritan Health Services joined Tacoma, Wash.-based MultiCare Health System Nov. 1, completing an affiliation announced in 2025.
  • “As part of the agreement, MultiCare has committed to investing $700 million over 10 years to expand access to care, recruit and retain clinicians, support workforce development and improve facilities and technology across Samaritan’s region, according to a Nov. 2 news release. A regional strategic planning process led by local leaders and shaped by community input will set longer-term service priorities and investments. 
  • “Samaritan keeps its name, now paired with MultiCare’s, along with its local leadership and community-based governance. Samaritan operates five hospitals and serves more than 280,000 residents in Oregon’s mid-Willamette Valley and central coast.” 

• Modern Healthcare adds,
  • “Providence has completed the final phase of a joint venture with home care company Compassus to provide home health, hospice and palliative care services in Oregon.
  • “The joint venture will operate under the name Providence at Home with Compassus, the two organizations said Monday in a news release. Under terms of the deal, Brentwood, Tennessee-based Compassus will manage 17 home care programs Providence previously operated across Oregon.
  • “The Oregon Health Authority gave final approval for the arrangement last July following a 19-month review. The state sought public input of the deal over concern the joint venture could alter the way patients receive home health and hospice services.” * * *
  • “Providence is a nonprofit Catholic health system that operates across seven states. Compassus offers home care services across 34 states.”
    
• Beckers Hospital Review relates,
  • “UnitedHealthcare will stop requiring prior authorization for more than 2,000 pediatric care codes for members under 18 starting Dec. 1.
  • “The payer published the full list of CPT codes Nov. 2. The codes span common services, diagnostic imaging, sleep studies, cancer treatment and orthopedic care, according to a UnitedHealthcare news release. Examples are ear tube and tonsil procedures, MRI and CT scans, joint and cardiac procedures, and some oncology and chemotherapy services.
  • “UnitedHealthcare said it chose services widely considered safe and effective in the medical community. The selection cuts pediatric prior authorization volume by nearly two-thirds and fulfills a commitment the insurer made in May. 
  • “Some complex services will still require prior authorization. These include certain injectable medications, genetic tests, surgical procedures and services that must be managed under state regulations. Some pediatric services will also still require advance notification.
  • “The changes apply to UnitedHealthcare commercial plans, Individual Exchange plans and UnitedHealthcare Community Plans, where permissible by state law.”
• and
  • “Franklin, Tenn.-based Community Health Systems is still waiting longer for insurers to pay its claims, but the slowdown has not worsened, CFO Jason Johnson said on the system’s Oct. 29 third-quarter earnings call.
  • “In July, Mr. Johnson said insurers were auditing more claims before paying them and asking for more records. Payers used to run those audits after payment. He said CHS’s accounts receivable was growing as a result. He called it a timing issue rather than a collection problem and said the system would return to a normal run rate once it anniversaried the change. 
  • “It has not worsened. We continue to see a slowdown in the payment of claims,” Mr. Johnson said on the Oct. 29 call. “No worse than it was in the first quarter when we really first started seeing that shock. But it has not changed either. Our days in A/R are consistent from [June 30 to Sept. 30], so we have kind of maintained.”
  • “CHS’s cash flow improved in the third quarter despite the slowdown. Cash generated from operations was $168 million, excluding taxes on divestiture gains, up from $121 million a year earlier. On a reported basis, it rose to $155 million from $70 million. Mr. Johnson credited better management of accounts payable and continued collection of accounts receivable, including the timing of state-directed payments.”
• and
  • “Blockbuster medicines now account for nearly half of prescription medicine spending worldwide, according to an Oct. 22 report from the IQVIA Institute for Human Data Science that analyzes blockbuster drugs from 2000 to 2024.”

• Fierce Healthcare tells us,
  • “Teladoc Health raised its 2026 outlook after better-than-expected third-quarter results, as BetterHelp’s insurance pivot gained traction and Integrated Care profitability improved.
  • “The virtual care company posted declining revenue but still beat Wall Street on both revenue and profit. Teladoc Health’s Q3 beat drove shares up nearly 27% Thursday after the company reported Q3 earnings Wednesday after market close.
  • “Teladoc Health faces near-term pressure as it transitions its virtual mental health business, BetterHelp, from a cash pay model to an in-network, insurance-covered model.” 

• Healthcare IT News adds,
  • “Telemedicine is becoming an increasingly important part of cancer care, allowing patients to access specialized expertise without always traveling to a hospital. At The University of Texas MD Anderson Cancer Center, virtual visits now account for one-quarter of ambulatory encounters.
  • “The organization conducted more than 295,000 virtual visits in fiscal 2026, with 60% of patients having used telemedicine at some point. Those numbers are helping MD Anderson understand where virtual care works best, where it falls short and how it can reshape cancer treatment.”

• Beckers Health IT gives us a look at Amazon’s healthcare playbook.

• Fierce Health points out,
  • “Electronic health record company athenahealth is opening up patient health records to outside AI assistants, starting with Anthropic’s Claude, through a new connection designed to give patients personalized answers based on their clinical data.
  • “The new server solution, athenaPatient MCP, uses the Model Context Protocol to connect Claude directly with the athenaOne platform. Patients authenticate using their athenahealth patient portal credentials and decide what information Claude can access, according to the EHR company. Credentials are not shared with Claude.
  • “Paul Brient, athenahealth’s chief product and operations officer, said that information is encrypted in transit, patients control what information is shared, and they can revoke access at any time. “Once the connection is established and patients approve what types of data they would like to share, the rest is between Claude and the patient,” he told Fierce Healthcare in an interview.”

• BioPharma Dive notes,
  • “Karyopharm Therapeutics, a cash-strapped cancer drugmaker, has filed for bankruptcy in a bid to sell itself and reorganize.  
  • “Through the Chapter 11 filing announced Monday, Karyopharm intends to hold an auction in which Ayrmid, the parent of cell therapy maker Gamida Cell, will serve as the lead bidder. Karyopharm will continue to operate during the proceedings with the help of a $55 million bankruptcy loan from its current lenders. An acquisition should close in early 2027.  
  • “Karyopharm sells the blood cancer drug Xpovio, which was first approved for multiple myeloma in 2019 and has since been cleared for a common form of lymphoma. U.S. regulators could soon clear use in myelofibrosis, too. In a statement, Ayrmid CEO Joe Wiley said adding Xpovio to Gamida Cell’s line of blood cancer cell therapies could “build a broader, stronger commercial-stage hematology business with meaningful opportunities for future growth.”