From Washington, DC

• SHOCKER — STAT News reports,
  • “The Centers for Medicare and Medicaid Services [CMS)] is pausing Medicare payments to doctors, as negotiations tied to the government shutdown drag on. 
  • “CMS announced the pause in a notice on its website but didn’t say when it would end. It’s happening because Congress needs to reauthorize certain Medicare payment programs related to telehealth and rural providers, and that reauthorization has gotten wrapped up in the overall deal to reopen the government.
  • It’s not clear why all physician payments have been cut off rather than just the programs that need to be renewed. CMS did not immediately respond to a request for comment.
  • “An extended payment pause could eventually cause cash flow concerns for doctors, several groups representing providers told STAT — and there are fears that, in some cases, claims could be left unpaid, should the renewal of programs that have lapsed not be made retroactive. Payments for ground ambulance transport services and Federally Qualified Health Centers are also in limbo.
  • “The paused payments include those going back to Oct. 1, when the government shutdown started and several health care programs lapsed.” 

• WHIPLASH (again from STAT News) — The Centers for Medicare and Medicaid Services said late last night that it was not pausing all Medicare payments to doctors, after a statement hours earlier had asserted that it would. Instead, the agency will only wait to process claims that are related to programs that have expired, such as some telehealth or rural services. 

• Per the Senate press gallery,
  • “2:55 p.m. October 15 — By a vote of 51-44, the Senate did not invoke cloture on the motion to proceed to H.R. 5371, [the House passed continuing resolution] upon reconsideration.
  • “Democrats voting in favor: Cortez Masto and Fetterman.
  • “Independent voting in favor: King.
  • “Republican voting against: Paul.
  • “Senators not voting: Blackburn, Duckworth, Hagerty, Marshall and Tillis.”

• Beckers Hospital Review offers four notes on the extension of the government shutdown into a third week.

• Govexec adds,
  • “More than 150 lawmakers, led by Sens. Tim Kaine, D-Va., Chris Van Hollen, D-Md., and Lisa Murkowski, R-Alaska, on Wednesday demanded that the Trump administration guarantee that furloughed federal employees are granted backpay at the conclusion of the ongoing federal government shutdown, which has entered its third week.
  • “Last week, the Office of Management and Budget floated a theory that the 2019 Government Employees Fair Treatment Act, which automatically provides backpay to furloughed federal workers following appropriations lapses and was signed by President Trump during the 2018-2019 partial government shutdown, merely authorizes Congress to provide backpay after a shutdown. OMB revised its shutdown FAQ document to remove reference to the law’s guarantee, and the Internal Revenue Service revoked shutdown guidance to employees, issued just days prior, that made reference to backpay.” * * *
  • In their letter to [OMB Director Russell] Vought, the lawmakers insinuated that OMB’s stance may be more motivated by politics than a good-faith legal analysis and urged the White House to reaffirm furloughed workers’ right to backpay.

• OPM has released a description of Federal Benefits Open Season Highlights 2026 Plan Year, which identifies the plans and plan options withdrawing from the FEHBP, the PSHBP and FEDVIP for the 2026 plan year. The as yet unreleased OPM benefit administration letter on program changes also identifies the plans with service area changes, for example.

• The American Hospital Association News tells us,
  • “Medicare open enrollment for 2026 began Oct. 15 and runs through Dec. 7. During the annual enrollment period, Medicare-eligible individuals can check their status, choose plans or change plans during the open enrollment period, including switching from Medicare Advantage and prescription drug plans to Traditional Medicare. The Centers for Medicare & Medicaid Services projects the average monthly premium for MA plans will fall by $2.40 in 2026 to $14.00, while the average standalone monthly total premium for a Medicare Part D prescription drug plan will fall by $3.81 to $34.50. Among other changes this year, out-of-pocket costs for prescription drugs will be capped at $2,100.”

• CMS reminds us,
  • “Medicare’s Open Enrollment Period is here! Visit Medicare.gov/plan-compare now through December 7 to compare all your coverage options. 
  • “Even if you’re happy with your current plan, it’s important to check for any changes next year. You can also check the star ratings to compare the quality of different health and drug plans.”

• The Wall Street Journal alerts us that “Big changes Are coming for 2026 Medicare Plans. What You Need to Know. Skinnier benefits, higher premiums and fewer options mean more than a million seniors should shop for new coverage during open enrollment.”

• Healthcare Dive reports,
  • “CMS Administrator Dr. Mehmet Oz highlighted areas where Medicare Advantage could improve — while reaffirming his support for the privatized Medicare program — during an event organized by the top MA lobby on Wednesday.
  • “Oz’s comments reflect the difficult tightrope regulators in the Trump administration walk as they pursue MA reform, especially in the areas of improper overpayments and prior authorizations, without offending the powerful insurance industry.
  • “I came both to celebrate what you’re trying to do, but also be honest about some of the issues that we’re seeing at CMS,” Oz said during the Better Medicare Alliance’s forum in Washington, D.C. “The opportunities we have if we do this correctly are massive. I see Medicare Advantage as this essential lever arm, this tool that we can use for good — and sometimes not — but if we use it correctly and nimbly, we can do all kinds of things to refine and improve the system.”

• Medscape notes,
  • “Enrollment in Medicare Advantage was associated with an increased likelihood of receiving an Annual Wellness Visit, especially among racial and ethnic minorities, those with dual eligibility, and those with Alzheimer’s disease and related dementias.”

• Per Fierce Healthcare,
  • “Fifteen governors unveiled Wednesday a new coalition to coordinate public health efforts in the latest sign of distrust in federal health agencies.
  • “The so-called Governors Public Health Alliance is now the largest alternative public health authority run by states, with leaders representing 129 million Americans, and follows the three-state West Coast Health Alliance and the 10-state Northeast Public Health Collaborative. The new effort is described as complementary to the states’ existing public health mechanisms and in line with the two existing coalitions.
  • “Announcements from several of the governors describe the effort as nonpartisan, though all the current participating leaders are Democrats. The alliance itself is supported by GovAct, a nonprofit and nonpartisan platform for gubernatorial collaborations.
  • “Similar to other states’ efforts, the governors said their new alliance will share best practices and expertise, coordinate on disease surveillance, co-draft public health guidelines and purchase supplies such as vaccines. It will also keep an open dialogue with the global health community while “elevating national considerations for vaccine procurement, policy solutions and more,” according to announcements.”

From the judicial front,

• The Wall Street Journal relates,
  • “A federal judge temporarily blocked the Trump administration from moving ahead with mass firings of federal employees while the government is shut down. 
  • “Judge Susan Illston issued the temporary restraining order in a ruling from the bench on Wednesday, stopping the government from cutting federal workers at multiple agencies. 
  • “The court record suggested that the Trump administration has “taken advantage of the lapse in government spending and government functioning to assume that all bets are off, that the laws don’t apply to them anymore and that they can impose the structures that they like on the government situation that they don’t like,” said Illston, a Bill Clinton appointee. 
  • “The Trump administration moved ahead on threats last week to lay off federal workers, sending reductions in force notices, otherwise known as RIFs, to about 4,000 employees at more than a half-dozen federal agencies, including the departments of Treasury, Health and Human Services, Education and Commerce.”

• Healthcare Dive informs us,
  • “A federal judge has thrown out a last-ditch effort from Humana to get the government to recalculate its Medicare Advantage star ratings for 2025.
  • “On Tuesday, Judge Reed O’Connor of the Texas Northern District Court ruled that the CMS acted legally in downgrading Humana’s stars based on unsuccessful customer service calls.
  • “O’Connor dismissed the case with prejudice, meaning it can’t be refiled but could still be appealed. A spokesperson for Humana said the company is “disappointed” with the ruling and is considering “all available legal options.”

• Sequoia explains how to navigate the legal landscape of gender-affirming care in employer health plans.

From the public health and medical / Rx research front,

• The University of Minnesota’s CIDRAP points out,
  • “A new update from the South Carolina Department of Health (SCDH) says the state’s measles outbreak has grown by 5 cases, to 16 infections since July, including 12 cases that are part of an Upstate outbreak that has seen two schools send hundreds of unvaccinated kids home after exposure to the highly contagious virus.
  • “The cases come as the US total climbs to 1,596 confirmed infections.”

• Medscape discusses a new COVID variant known as Frankenstein.
  • “According to the World Health Organization (WHO), this rise is associated with the emergence of a new SARS-CoV-2 variant, XFG, also referred to as “Frankenstein,” because it is a recombinant of two other variants, LF.7 and LP.8.1.2.
  • “XFG has been classified by the WHO as a variant under monitoring since 25 June 2025 and is growing globally. Current evidence suggests that the additional public health risk is low worldwide, and approved COVID vaccines are expected to remain effective against this variant to prevent symptomatic and severe disease.”
    
• The Washington Post lets us know,
  • “Health officials in New York state confirmed the first locally acquired case of chikungunya in the United States in six years. The virus is rarely fatal, and most patients recover in a week, but in some cases, it can cause prolonged and debilitating joint pain.
  • “It is also the first locally acquired case of chikungunya in New York, the state’s health department said. A resident of Nassau County, who was not named, had not reported any foreign travel before experiencing symptoms in early August, the county’s health department said. County officials said on Tuesday they had not found chikungunya in local mosquitoes, adding: “There is no evidence of ongoing transmission of the virus and the risk to the general public remains low.”

• Per Healio,
  • “Alcohol-induced deaths increased by 89% from 1999 to 2024, peaking in 2021.
  • “These deaths rose by 255% among women aged 25 to 34 years and by 188% among men aged 25 to 34 years.”
• and
  • “Mean BMI increased for premenopausal women and postmenopausal women in the U.S. from 1999 to 2018.
  • “The 50th percentile BMI for premenopausal and postmenopausal women peaked at about age 60 years.”

• Per Medscape,
  • “Egg- and non-egg-based influenza vaccines showed equivalent protection against laboratory-confirmed influenza‑like illness and related hospitalizations among healthy adults in the military health system. However, recombinant influenza vaccine achieved higher seroconversion rates across all influenza subtypes.”
• and
  • “Penicillin V was as effective as amoxicillin for treating pneumonia in primary care, with similar rates of hospitalization for lower respiratory tract infection or all-cause mortality within 28 days of starting antibiotic therapy, making it a viable alternative in primary care settings with similar resistance patterns.”
    
• Per Fierce Pharma,
  • “GSK’s ViiV Healthcare and its bimonthly pre-exposure prophylaxis (PrEP) medicine Apretude had to make room for another long-acting PrEP option this summer, when rival Gilead Sciences rolled out Yeztugo to much fanfare.
  • “But despite Yeztugo’s twice-yearly convenience factor, unprecedented efficacy performance in trials and award-winning pedigree, GSK has long maintained that one aspect of the rival drug’s clinical profile would block it from snatching the entire long-acting PrEP market.
  • “Now, armed with a new open-label crossover study, the company can back up its theory that the injection-site reactions from Gilead’s drug may give some potential users pause.

• Per BioPharma Dive,
  • “Eli Lilly released the results of two new Phase 3 trials of an experimental GLP-1 pill that the company says could become a “foundational treatment” for type 2 diabetes.
  • “The medicine, orforglipron, succeeded on all primary and key secondary endpoints in the studies of diabetes patients, Lilly said Wednesday. One trial, Achieve-2, compared orforglipron with dapagliflozin, sold by AstraZeneca as Farxiga. The other, Achieve-5, tested orforglipron against a placebo in patients also taking insulin.
  • “The Indianapolis-based drugmaker plans to submit global regulatory applications for orforglipron in the treatment of type 2 diabetes next year. The company said it will seek approval of the drug as an obesity medication by the end of 2025.”

• Beckers Hospital Review identifies “six new drug shortages and discontinuations, according to drug supply databases from the FDA and American Society of Health-System Pharmacists.”

From the U.S. healthcare business front,

• Modern Healthcare reports,
  • “CommonSpirit Health and the University of Pittsburgh Medical Center have signed a non-binding letter of intent to integrate Steubenville, Ohio-based Trinity Health System into UPMC. 
  • “CommonSpirit and Trinity Health leaders began a search earlier this year to find a regional health system that would add to Trinity’s offerings, according to a Wednesday news release.
  • “The health systems will work toward a definitive agreement over the next several months.” 
     
• Healthcare Dive informs us,
  • “CVS has completed a deal to buy 63 Rite Aid and Bartell Drugs stores in Idaho, Oregon and Washington. As part of the deal, which comes five months after Rite Aid filed for bankruptcy, CVS will also acquire the customer prescription files of 626 locations across 15 states.
  • “The agreement was first announced in May, though CVS at that time planned to acquire 64 locations and 625 prescription files. The transfer of assets was approved by a bankruptcy judge later that month.
  • “CVS is also bringing on more than 3,500 employees from the defunct chain and has made “targeted investments” in existing CVS locations to meet the needs of new shoppers. That includes adding more support and improving training programs for associates.”

• The New York Times reports,
  • “For years, Democrats and Republicans have sounded the alarm about America’s dependence on China for medicines. An analysispublished on Wednesday shows just how deep that reliance is at the earliest stage of the drug manufacturing process: Nearly 700 U.S. medicines use at least one chemical solely sourced from China.
  • “As tensions between Washington and Beijing have escalated in recent years, experts fear that this reliance could leave American patients vulnerable, especially if a trade war or future pandemic prompts China to curtail exports. Supply shortages for some generic medicines have already grown common.
  • “The new data, from U.S. Pharmacopeia, a nonprofit that tracks the drug supply, identified the origins of chemicals used to make medicines. The analysis found that China was the sole supplier of at least one chemical in widely used antibiotics, like amoxicillin, and generic drugs for heart problems, seizures, cancer and H.I.V.
  • “One example is the allergy-relief medicine best known by the brand name Benadryl. (Kenvue, the company that sells Benadryl, did not return a request for comment.)
  • “There is almost no production of these chemicals in the United States because making them is dirty and labor and other costs make manufacturing them unprofitable. Chinese factories, by contrast, don’t face the same environmental restrictions and can make these raw materials inexpensively.”
    
• Fierce Healthcare notes,
  • “Blue Cross Blue Shield Global Solutions is teaming with Carrot to offer family planning and fertility services to expatriate members across the world.
  • “BCBS Global Solutions, jointly owned by 15 Blue Cross plans and Bupa Global, will connect members globally with Carrot’s array of hormonal and family planning care, ranging from fertility, pregnancy, postpartum, surrogacy, adoption, menopause and low testosterone management. The organization shared the announcement exclusively with Fierce Healthcare.
  • “Through Carrot’s platform, members can access a network of more than 17,000 vetted providers worldwide, plus services that are available in more than 25 languages or through live translation across 300 languages.
  • “Following our recent rebrand, this partnership with Carrot marks another step forward in our commitment to deliver innovative global healthcare solutions,” said Simon Jackson, Chief Growth Officer of BCBS Global Solutions, in the announcement.”

• Per Fierce Pharma,
  • “With sales of potential blockbuster Lokelma scaling up, AstraZeneca is bolstering its production of the hyperkalemia treatment with a $445 million injection of funds.
  • “The investment will increase the capabilities of AZ’s manufacturing facility in Coppell, Texas, which is the company’s lone site in the world that produces Lokelma.
  • ‘AZ will build a new 9,000-square-foot building at the complex and add two production lines, doubling its capacity to manufacture the treatment. The investment also will support upgrades for drug substance production and lab testing, as well as additional warehouse and administrative space, the company said in an Oct. 15 release.”

From the artificial intelligence front,

• Fierce Healthcare offers a look inside Elevance Health’s AI strategy.
  • “The pace of digital innovation in healthcare is rapidly accelerating, and, for the team at Elevance Health, a simple mantra remains at the heart of its efforts: Keep the member at the center.
  • “Ratnakar Lavu, executive vice president and chief digital information officer at Elevance, told Fierce Healthcare in an interview that the perspective is born from his experience in consumer industries like retail, where many patients form their expectations for digital experiences.
  • “Digital platforms can make things simpler and more personalized for members, he said, but there’s also a risk of deploying new tech just for the sake of it.
  • “My obsession always has been, let’s focus on the consumer, the member, and in our case, the patient, and keep them at the center of how we think about overall transformation,” he said. “Because it’s not technology for the sake of technology, it is really trying to focus on the experiences that we want to bring to life.”

• STAT News reports,
  • “Lyra launches ‘clinical grade’ chatbot amid growing concern about mental health and AI
  • The company is the largest to launch a generative AI product as a part of ongoing therapy treatment.”
• and
  • “As more nurses deliver primary care, an AI startup wants to guide their decisions and training> Altitude has raised $5.4 million to develop its platform and expand customer base.

• MedTech Dive shares “five AI takeaways from AdvaMed’s conference. Medical device firms discussed privacy, regulations and prioritizing projects as AI becomes more prevalent in the industry.