“Simplicity is a virtue”

From Washington, DC,

• Congress is taking a State / District work break this week following Memorial Day.

• The Office of Management and Budget’s Office for Information and Regulatory Affairs has completed its review of the No Surprises Act Independent Dispute Resolution final rule, which indicates that this significant final rule will be published in the Federal Register this week.

From the judicial front,

• USA Today, via Yahoo Finance, reports
  • “CVS sued Tennessee state officials on May 22 to block legislation the pharmacy giant said would force the closure of the chain’s 136 Tennessee pharmacy locations.
  • “CVS filed the U.S. District Court lawsuit in Nashville after Tennessee Gov. Bill Lee signed legislation to prohibit companies from owning both pharmacy benefit managers and retail pharmacies. The Tennessee legislation takes effect July 1, 2028.”

From the public health and medical /Rx research front,

• STAT News reports,
  • “Eli Lilly said Monday that a high dose of its gene-editing therapy reduced cholesterol levels by 62% in participants in a clinical trial, an early but encouraging test of whether a one-time treatment may one day help people seeking to lower their LDL, or “bad,” cholesterol.
  • “Lilly acquired the therapy, VERVE-102, in its $1 billion buyout of Verve Therapeutics last year. Executives tout it as a potential treatment to broadly prevent heart disease, the world’s leading killer, as many patients struggle to stay on existing, more conventional medicines for reducing cholesterol levels.
  • “There were no treatment-related serious adverse events in the Phase 1 study — a notable finding, given that Verve had to shelve its first candidate due to safety concerns. 
  • “The data were simultaneously published in the New England Journal Medicine and presented at the European Atherosclerosis Society in Athens.
  • “Lilly now plans to begin a Phase 2 trial in an unspecified number of patients. It will likely need to then run Phase 3 trials in thousands of patients for the treatment to earn approval.” 

• The Washington Post relates,
  • “Pancreatic cancer is an exquisitely cruel diagnosis, leaving only 13 percent of people alive after five years. But in the early 1980s, scientists discovered a weakness — a mutated protein called KRAS — that spurred the aggressive growth and spread an array of tumors. In pancreatic cancer, it would turn out to be a key driver of nearly every case. 
  • “There was just one problem. The KRAS protein they needed to block was flat and smooth, without the crevices and cracks, pockets and sockets that a drug needs to get a toehold.
  • “No longer.
  • “In the span of a few weeks, the conventional wisdom on pancreatic cancer and KRAS has been upended. In April, biotech company Revolution Medicines announced that its experimental pill, called daraxonrasib, had notched an unprecedented success — patients lived for 13 months, twice as long as those given regular chemotherapy. The full details will be presented next weekend at the American Society of Clinical Oncology meeting in Chicago, but federal regulators have already expanded access to the drug while it is being reviewed.
  • “It’s the start of a huge wave for this disease,” said Eileen O’Reilly, a gastrointestinal medical oncologist at Memorial Sloan Kettering Cancer Center. Following behind are other drugs that may work better and the potential to use the approach against lung and colorectal cancers.”

• Medscape informs us,
  • “GLP-1 receptor agonists, like semaglutide, are gaining importance in liver disease treatment, notably for metabolic-associated steatohepatitis (MASH) and alcohol use disorder (AUD), offering benefits beyond weight loss, including potential hepatoprotection.
• and
  • “CAR T-cell therapy, initially for cancer, shows promise in treating autoimmune diseases like multiple sclerosis. While offering hope, it poses risks and uncertainties, including potential long-term side effects and high costs, necessitating further research.”

From the U.S. healthcare business front.

• Beckers Payer Issue points out,
  • ‘Point32Health reported an adjusted net income of $248 million in the first quarter, a sharp reversal from a $21 million adjusted net income a year prior.
  • “The insurer, parent company of Harvard Pilgrim Health Care and Tufts Health Plan, said the Q1 results included an operating income of $86 million, investment income of $6 million, and a gain from the sale of its Integra Partners subsidiary. Revenues were $2.4 billion and membership was nearly 2 million.
  • “In the first quarter of 2025, the company reported an operating loss of $39 million and investment income of $61 million, on revenues of $2.4 billion and membership of approximately 2 million.
  • “While we are optimistic for the remainder of the year, we recognize that medical and pharmaceutical cost trends remain volatile and will continue to present challenges,” CFO Michael Marrone said.’

• Per a Health Care Cost Institute news release,
  • “Conventional wisdom and economic theory suggest that more competition means lower prices. In health care, there is longstanding evidence that geographic areas with less competition among hospitals are associated with higher negotiated commercial prices. Regulators and researchers use the Herfindahl-Hirschman Index (HHI) to measure market concentration at a geographic area. HHI can range from 0 (competitive market) to 10,000 (monopoly market). Hospital markets that are considered “highly concentrated,” (HHI greater than 2,500) generally means that there are a limited number of hospitals or health systems that dominate the market. There also is evidence in the economic literature that geographic areas that have a limited number of insurance companies are associated with lower negotiated commercial prices. These insurance markets are considered “highly concentrated.” 
  • “In this cross-sectional analysis of 2022 data, we examine the impact of competition on prices across the US.  Specifically, we compared a measure of hospital prices – the inpatient hospital price index from HCCI’s Health Cost Landscape – in areas with varying levels of hospital and insurance company concentration. We focused on inpatient hospital prices because they are most directly related to hospital and health insurance market dynamics.      
  • “We find that inpatient hospital prices are the highest in metro areas where hospital markets are very highly concentrated (least competitive) and insurance markets were moderately concentrated (the most competitive among the markets in the Landscape). Inpatient hospital prices in these metro areas were, on average, about 25% higher than the national median in 2022. Inpatient prices were lowest, in contrast, in metro areas where hospital markets were the least concentrated but the health insurer market was highly concentrated.  Among metro areas where health insurers are highly concentrated and hospitals are least concentrated, inpatient hospital prices were about 10% lower than the national median.”  

• Kaufmann Hall lets us know,
  • “[H]ospitals across the country are facing difficulty placing patients into SNFs and other post-acute sites of care, delaying discharge of medically ready patients. Post-acute access constraints are structural and systemic and are reshaping hospital performance—including hospital margins, capacity, throughput, quality metrics, staff morale, and patient experience. Health systems that proactively redesign their post-acute strategy, particularly through aligned SNF and other post-acute partnerships, can materially improve performance across these dimensions and mitigate risk, while also equipping these facilities with the alignment and financial resources necessary to thrive.” * * *
  • “SNF bed supply fell 2.5% between 2019 and 2024, creating a sustained imbalance between supply and demand. As this imbalance persists, access challenges are likely to intensify rather than normalize. Hospitals in regions with SNF bed under capacity tend to experience greater mean length of stay, percentage of stays 28 days or more, and median distance traveled to admitting SNFs.” * * *
  • “Ultimately, improved SNF access is driven by alignment, incentives, and operating expertise—not [hospital] ownership alone. 
  • “Several health systems, such as Stanford Health Care, Scripps Health, and UC Davis Health, have also had success with the bed reservation / bed lease program as an aligned alternative for post-acute care access and patient throughput.”

• Healthcare Dive tells us,
  • “Private equity-owned hospital operator Quorum Health plans to transition to nonprofit status this year through a deal with Healthside Partners.
  • “The definitive agreement announced Thursday is meant to help put Quorum, which has struggled to recover following its bankruptcy in 2020, on more stable financial footing through access to the tax and funding benefits nonprofit hospitals receive.
  • “The deal appears to be structured as straight asset transfer, wherein the nonprofit system Healthside will acquire Quorum’s assets without inheriting its liabilities and obligations. Quorum will remain a separate company that will then be dissolved, a spokesperson for the system said. The transition is expected to close this fall.”