From Washington, DC

• Fierce Healthcare reports,
  • “Another top Republican lawmaker is floating plans to overhaul the Current Procedural Terminology, or CPT, code system. 
  • “Rep. James Comer, R-Kentucky, who chairs the House Committee on Oversight and Government Reform, penned a letter late last week to the Centers for Medicare and Medicaid Services seeking information on the CPT code system’s complexity and whether its structure is facilitating improper billing such as upcoding or unbundling. 
  • “Further, he asked the agency to describe “any constraints—statutory, regulatory or operational—that limit CMS’ ability to modify or move away from the current CPT-based system.” 
  • “The questions come as one of Comer’s colleagues in the Senate Health, Education, Labor and Pensions (HELP) Committee Chair Bill Cassidy, M.D., R-Louisiana, has placed a magnifying lens on the American Medical Association (AMA) over the millions in revenue it collects managing, and advising on, the CPT code system (see that coverage below the break).
  • “Comer’s approach was less combative, and his letter to CMS does not directly place blame on the AMA. Still, it notes that Medicare and Medicaid’s codified use of the association’s proprietary system “raises concerns about federal reliance on a privately owned and licensed coding system. These concerns include fundamental questions about transparency, cost control, and whether federal healthcare policy is shaped in the best interest of patients, or by entities with financial incentives tied to the system’s continued complexity.” 

• Kevin Moss, writing in Govexec, “weighs the costs and trade-offs of suspending FEHB for Medicare Advantage.”

• CMS Administrator Dr. Mehmet Oz lets us know,
  • “Last year, the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS) announced a landmark pledge with major health plans from across the country to streamline and improve the prior authorization process across the entire health care industry. This pledge reflects a shared commitment to modernizing prior authorizations to create a more responsive, patient-centered experience. 
  • “Since then, the health care industry has already begun delivering results. For example, leading health plans announced in April that they eliminated 11% of prior authorizations across a range of medical services, representing 6.5 million fewer prior authorizations for patients. Other plans are rapidly scaling standardized processes and reducing requirements, demonstrating that meaningful change is not only possible—it’s happening. For example, one large national plan is eliminating authorization requirements for 30% of healthcare services and has committed to removing an additional 30% of remaining requirements by the end of 2026. 
  • “CMS is proud to announce the next chapter of that commitment: adding electronic prior authorization to the Health Tech Ecosystem. The initial landmark pledge effort brought the nation’s major health plans to the table. This new initiative brings everyone else. Health systems, hospitals, physician practices, electronic health record (EHR) vendors, and digital health developers are now joining payers as a unified coalition aligned around a single mission: making electronic prior authorization work end-to-end, on time, for every patient.” 

• The Wall Street Journal adds,
  • “UnitedHealth Group plans to stop requiring doctors to get approvals for an array of procedures, tests and services, cutting back on a process that has long been detested by physicians and patients.
  • “UnitedHealth, parent of the biggest U.S. health insurer, said the changes will slash the number of reviews by nearly a third starting later this year. Doctors have long complained about the paperwork they must complete to get insurers’ permission for care, which can lead to delays and denials.
  • “UnitedHealthcare will stop requiring signoffs for tests including echocardiograms, some chiropractic care and certain outpatient surgeries. Also on the list is some outpatient therapy.
  • “The insurer said it is using technology backed by artificial intelligence to help reduce the need for pre-authorization reviews.
  • “The rollback is part of an effort by health insurers to counter a backlash against pre-authorizations. Rivals like CVS Health’s Aetna and Cigna Group have also made moves to ease these types of reviews.”

• Per an HHS news release,
  • “The Advanced Research Projects Agency for Health (ARPA-H), an agency within the U.S. Department of Health and Human Services (HHS), today announced the launch of its Intelligent Generator of Research (IGoR) program, a systemic effort to deliver gold-standard biomedical science faster. The program will accelerate breakthroughs with a next-generation, AI-powered research ecosystem built to expand the experimental capabilities available to researchers. Crucially, the system will continuously refine advanced models of complex and chronic health conditions that impose a growing burden on Americans and the U.S. health system.” * * *
  • “For centuries, intrepid scientists have discovered amazing insights about health and disease. Yet, as frontier problems become more complex, the speed of discovery has been limited by what information and experimental capabilities are at researchers’ fingertips,” said IGoR Program Manager Paul E. Sheehan, Ph.D. “Through ARPA-H’s new IGoR program, we can amplify human creativity by reimagining the research ecosystem and empowering our scientists to answer ever more challenging questions about medicine’s unsolved mysteries.”
  • “The IGoR program will span 5 years. ARPA-H will solicit proposals under its Innovative Solutions Opening (ISO) and encourages collaboration among experts across disciplines to meet the program’s ambitious goals.” * * *
  • “For more information, including solicitation details and Proposers’ Day registration for this funding opportunity, visit the IGoR program page.”

From the Food and Drug Administration front,

• Per an FDA news release,
  • “The U.S. Food and Drug Administration (FDA) today authorized the marketing of four Glas electronic nicotine delivery systems (ENDS) through the premarket tobacco product application (PMTA) pathway. Each product is an e-liquid pod containing 50mg/ml (or 5%) of tobacco-derived nicotine. The authorized pods include Classic Menthol, Fresh Menthol, Gold, and Sapphire. This action marks the FDA’s first authorization of non-tobacco and non-menthol ENDS products.
  • “Smoking is the leading preventable source of chronic disease and premature death in the U.S. Last year, one in five deaths resulted from cigarette smoking.  More than 25 million Americans External Link Disclaimer still smoke combustible cigarettes, and they deserve better, less harmful alternatives. Under President Trump’s leadership, the FDA has authorized a number of less harmful alternatives for smokers, including 11 ENDS products from American companies.”

From the judicial front,

• Modern Healthcare reports,
  • “A California hospital trade group sued to stop Elevance Health from implementing a policy that would cut payments to hospitals that refer some members to out-of-network providers. 
  • “In a complaint filed Monday in the state Superior Court of Los Angeles County, the California Hospital Association contended the policy allegedly violates state consumer protection and healthcare laws.” * * *
  • “Starting in June, Elevance Health plans to reduce California hospitals’ payments by up to 10% if they refer commercial patients to out-of-network physicians. 
  • “The Blue Cross Blue Shield licensee has introduced similar versions of the policy in at least 12 other states where it operates Anthem Blue Cross Blue Shield commercial plans. 
  • “The policy is intended to lower commercial healthcare costs, an Elevance Health spokesperson said in a statement. The spokesperson also said some out-of-network providers abuse the federal arbitration process enacted under the No Surprises Act of 2020.”

From the public health and medical / Rx research front,

• The Wall Street Journal reports,
  • “The World Health Organization said human-to-human hantavirus transmission is possible on a cruise ship.
  • “A suspected hantavirus outbreak on the MV Hondius led to three deaths and four other infections among 147 people on board.
  • “The WHO assumes the hantavirus is the Andes variant, known in Argentina, where initial patients boarded the ship.”

• The New York Times lets us know what doctors want you to know about cannabis and health.
  • “The government recently loosened medical marijuana rules. Experts separate fact from fiction about the drug’s safety and benefits.”

• MedPage relates,
  • “New research is raising alarms about inhalants, which are often portrayed online as harmless while putting teens at real risk.
  • “Two new studies point to a troubling pattern: Younger teens, especially girls, may be more vulnerable — and social media is a major source of exposure.
  • “In one study, recently published in the Journal of Studies on Alcohol and Drugs, researchers reviewed 30 videos about nitrous oxide — often called “laughing gas” — posted in early 2025.
  • “Those videos averaged 23 million views. Some showed how to use it, with no age restrictions or health warnings. Others promoted “free trials” of nitrous oxide products, highlighting how easy and accessible these substances can be for teens.
  • “Inhalants remain one of the least-studied and least-discussed substance-use categories, despite the seriousness of their health risks,” said lead author Rachel Hoopsick, an assistant professor of health and kinesiology at the University of Illinois Urbana-Champaign.”
• and
  • “Maternal respiratory syncytial virus (RSV) vaccination and infant nirsevimab immunization, administered alone or sequentially, are safe and effective, according to a study published online May 4 in Pediatrics.
  • “Christina A. Rostad, M.D., from the Emory University School of Medicine in Atlanta, and colleagues conducted a randomized, open-label phase 4 study at eight U.S. sites of mother-infant pairs to examine administration of maternal RSV prefusion F vaccination (RSVpreF) and infant nirsevimab immunization. Pairs were randomly assigned during pregnancy to receive maternal RSVpreF vaccine alone, maternal RSVpreF vaccine/infant nirsevimab at birth, maternal RSVpreF vaccine/infant nirsevimab at 3 months, or infant nirsevimab alone at birth. To ascertain safety, infant tolerability, and the magnitude and durability of RSV-A and B neutralizing antibodies (nAbs), pairs were followed for 12 months.”

• MedPage Today adds,
  • “Older U.S. adults who received the recombinant shingles vaccine had a lower incidence rate of dementia than their peers.
  • “Receiving the recombinant zoster vaccine also was linked to reduced risks of Alzheimer’s disease and vascular dementia.
  • “The analysis assessed dementia risk with the current two-dose shingles shot in the U.S., unlike other research.”
• and
  • “Over 6 years, about 30% of people with pure autonomic failure converted to Parkinson’s, dementia with Lewy bodies, or multiple system atrophy.
  • “The incidence rate for general conversion, 5.1 per 100 person-years, far exceeded rates in the general population.
  • “The findings were based on a meta-analysis of nine studies that included 900 people with confirmed pure autonomic failure.”

• Genetic Engineering and Biotechnology News informs us,
  • “Tracking microbes is challenging, particularly when there are coexisting strains of the same species within metagenomic data. However, overcoming that challenge is important for inferring transmission of both pathogenic and commensal microbes.
  • “A new tool, called TRAnsmision Clustering of Strains (TRACS), distinguishes between closely related bacterial strains. The “highly accurate algorithm” can be used for “estimating genetic distances between strains at the level of individual single nucleotide polymorphisms, which is robust to intra-species diversity within the host.”
  • “Researchers used the TRACS tool to map the transmission of SARS-CoV-2, Streptococcus pneumoniae, and Plasmodium falciparum (the causative agent of malaria) across different populations. The tool may play an important role in infection prevention, outbreak response, and the development of treatments designed to help the human microbiome fight infection. They note that this tool can be used across microbial kingdoms to uncover strain dynamics.”
    
• STAT News points out,
  • “A closely watched therapy developed by Johnson & Johnson failed to show a statistically meaningful improvement for patients with inflammatory bowel disease. But the company plans to advance the drug into late-stage testing, focusing on a growing subgroup of patients. 
  • “On Tuesday, trial investigators presented the results of Johnson & Johnson’s DUET study, testing how well combining the drugs Tremfya and Simponi would stop the immune system from mistakenly attacking healthy tissues in the digestive tract. It’s a follow-up to a 2022 clinical trial that showed a significant benefit to patients, nearly doubling the rates of disease remission and spurring several companies to start developing combination approaches for IBD. 
  • “Johnson & Johnson tested its combined therapy, dubbed JNJ-4804, in two Phase 2b clinical trials hitting both major forms of inflammatory bowel disease — ulcerative colitis and Crohn’s disease. In each trial, the combination therapy performed better than the individual drugs, but did not meet the primary endpoint of clinical remission. 
  • “Though the results didn’t meet the mark statistically, Esi Lamousé-Smith, the company’s vice president of gastroenterology, said they were clinically meaningful. Data showed the drug was particularly effective in participants who had previously tried at least two medications, she added.”

• BioPharma Dive notes,
  • “Cytokinetics said Tuesday that its drug Myqorzo succeeded in a Phase 3 trial in people with a progressive heart condition, opening up a sizable market opportunity and separating the treatment from a rival therapy marketed by Bristol Myers Squibb.
  • “According to Cytokinetics, Myqorzo met the dual main goals of a study in people with the “non-obstructive” form of hypertrophic cardiomyopathy, or HCM. When compared to a placebo, people receiving Myqorzo had a statistically significant improvement in peak oxygen consumption as well as scores on an assessment of heart health after 36 weeks. The drug also hit on key secondary measures, among them a commonly used evaluation of heart symptoms.
  • “Cytokinetics said no new safety signals were identified in the trial and that the percentage of patients completing treatment was similar between those getting Myqorzo or a placebo. Drops of over 50% in left ventricular “ejection fraction”— or the amount of blood pumped into the arteries, a known risk of drugs like Myqorzo — occurred in 27 treatment recipients, versus one in the placebo group. That side effect was associated with two cases of heart failure and led 3% of participants to interrupt treatment.”

From the U.S. healthcare business front,

• The New York Times lets us know “there’s a right and wrong way to use urgent care.”
  • “We asked experts when you should use one, and when you’re better off visiting an ER or primary care doctor instead.”

• Beckers Hospital Review tells us,
  • “Irving, Texas-based Christus Health took over operations May 1 at Mount Pleasant, Texas-based Titus Regional Medical Center, and renamed it Christus Health – Mount Pleasant Hospital, according to a May 1 release shared with Becker’s. 
  • “Christus Health was selected as the strategic partner for Titus Regional in early February after the board of managers for the 174-bed hospital voted to move forward with the transaction. 
  • “The acquisition is part of Christus Health’s broader expansion in the area. The system opened the Christus Health Mount Pleasant Emergency Care Center Feb. 9, a $33 million, 36,000-square-foot facility that also houses a multispecialty clinic, which opened April 13, and houses cardiology, gastroenterology, primary care, pulmonology, urology and more services.”
• and
  • “As retailers, payers and drugmakers expand access to GLP-1 therapies — with companies like Amazon and Walmart launching weight management programs — the drug class is reshaping both care delivery and pharmaceutical investment strategies.
  • “That demand is influencing drug development, with obesity treatments overtaking oncology as the largest contributor to late-stage pipeline value for the first time in 16 years, according to a May 4 report from Deloitte.”

• Fierce Pharm informs us,
  • “With a better-than-expected first quarter in the books, Pfizer—continuing to grapple with the post-pandemic overhang from its COVID-19 franchise—is sticking with the sales forecast it set earlier this year, raising questions from at least one analyst about whether it could have lifted its outlook.
  • “Buoyed by notable sales beats from blood thinner Eliquis, pneumococcal vaccine Prevnar and breast cancer medicine Ibrance, among others, Pfizer’s overall revenue in the first quarter grew 2% year over year on an operational basis to $14.5 billion. When excluding sales of its COVID-19 products Comirnaty and Paxlovid, the growth rate (PDF) was 7% for the period on an operational basis, the company said Tuesday.
  • “Pfizer’s “strong” performance across the board helped the company deliver first-quarter revenue about $641 million above consensus forecasts, according to a May 5 note from analysts at Citi. Pfizer is also demonstrating that its commercial portfolio can flourish beyond the historically mammoth sales of its COVID-19 vaccine and antiviral, the Citi team said, noting that the company’s crop of recent launches and acquired products—including Padcev, Nurtec and Lorbrena—grew 22% operationally for the quarter.”
    
• Fierce Healthcare points out,
  • “CVS announced Tuesday it will expand its use of lower-cost biosimilars and transition to interchangeable alternatives for select brands, including Johnson & Johnson’s psoriasis drug Stelara.
  • “The change comes as CVS Caremark works to increase adoption of U.S. Food and Drug Administration approved biosimilars for its most common formularies. The update aligns with the company’s broader formulary strategy, emphasizing affordability, access and value.
  • “The changes will be effective July 1, the company said in the announcement. 
  • “Our formulary plays a critical role in addressing rising drug costs without compromising clinical quality,” said Joshua Fredell, CVS Health senior vice president, in a statement. “Expanding adoption of FDA-approved biosimilars allows us to deliver significant savings for clients while supporting broader, more affordable access to proven therapies.”

• BioPharma Dive reports,
  • “Shares of Vertex Pharmaceuticals were little changed late Monday after the Boston-based biotechnology company reported its latest round of earnings.
  • “Vertex, which has ballooned to a roughly $110 billion value thanks to the market success of its cystic fibrosis medicines, recorded $3 billion in revenue across the first three months of the year. That total was just shy of Wall Street estimates, according to Evercore ISI analyst Cory Kasimov.
  • “The lion’s share of revenue again came from Trikafta, a three-in-one oral therapy that was approved in 2019 and has the potential to work in approximately 90% of cystic fibrosis patients. It generated $2.35 billion in the quarter, down 7% from the same period a year prior. Meanwhile, revenue from a successor drug called Alyftrek grew eightfold, to $424 million, which Kasimov argued “may potentially signal a healthy switch rate.”

• MedTech Dive relates,
  • “Olympus is partnering with EndoRobotics to distribute the South Korea-based medical device manufacturer’s endoscopic robotic devices for gastroenterology.
  • “Olympus will exclusively distribute the technologies globally, beginning in the U.S., as part of its EndoTherapy portfolio, the Tokyo-based company said Monday in the announcement.
  • “The deal comes less than a year after Olympus entered into an agreement with investment firm Revival Healthcare Capital to found a company called Swan EndoSurgical for the purpose of co-developing a robotic platform for gastrointestinal treatment.”