Tuesday report

CMS

Tuesday report

David Ermer–CDC, CMS, COVID-19 vaccine, FDA, Federal employment benefits, Generative AI, Medical / Rx research, Medicare, No Surprises Act, Obesity, OPM, Telehealth, U.S. Healthcare–

From Washington, DC,

  • Federal News Network tells us,
    • “The guarantee of back pay for furloughed federal employees is now in limbo, as the White House weighs a different interpretation of the 2019 law that ensures federal employees get compensated following a government shutdown.
    • “A new draft legal opinion from the Office of Management and Budget, as first reported by Axios, argues that whatever funding legislation Congress ultimately passes to end the current shutdown must explicitly include appropriations to provide back pay for furloughed federal employees. And if it’s not expressly written in the spending legislation, the OMB memo argues that furloughed workers cannot receive any retroactive compensation.
    • “A copy of the OMB document, which a senior White House official shared with Federal News Network, appears to contradict OMB’s previous interpretation of the Government Employee Fair Treatment Act, or GEFTA, which President Donald Trump signed into law in 2019 during the last government shutdown. Both OMB and the Office of Personnel Management previously affirmed that under GEFTA, excepted and furloughed employees would be given back pay as soon as possible, once any current or future shutdown ends.”
  • In the FEHBlog’s opinion, this draft OMB opinion is a lead balloon.
  • Healthcare Dive shares six takeaways from CMS Administrator Mehmet Oz’s appearance on Monday before a Washington D.C. think tank audience.
  • Modern Healthcare reports,
    • “Federal regulators say they have made inroads into speeding up the process to resolve out-of-network billing disputes. It’s not enough for frustrated providers and health insurance companies.
    • “The No Surprises Act’s Independent Dispute Resolution, or IDR, process has been a punching bag for both camps since it launched in 2022, and a backlog of cases had piled up by the beginning of this year.
    • “But the share of IDR cases unsettled after 30 business days fell from 69% in January to 34% in July, the most recent month for which data are available, according to the Health and Human Services, Labor and Treasury departments. Likewise, 96.5% of disputes submitted since 2022 are either resolved or are less than 30 business days old, the departments wrote in a notice published Sept. 19.
    • “The departments’ efforts have delivered remarkable improvements in the throughput of cases compared to prior years,” the notice says. “IDR entities are now resolving disputes faster than they are submitted.”
  • STAT News informs us,
    • “The agreement between Pfizer and the Trump administration to lower drug prices has sent other companies scrambling to make a deal.
    • “Several major pharmaceutical firms that received letters from President Trump demanding lower prices have been hustling to show progress, with some hoping to announce a deal with the White House as soon as this week, according to five Washington representatives and lobbyists for the companies, granted anonymity to speak about private deliberations.”
    • “They have to now,” said one lobbyist of their clients’ thinking, noting the “anger”with Pfizer for effectively adding to their pressure to come to an agreement with the administration.
    • “The people cautioned that negotiations remain unfinished and several variables, including the government shutdown, could delay any announcements.
    • “The growing chatter around potential announcements signals the Trump administration’s pressure campaign may be paying off. But whether the deals will actually accomplish the administration’s objective — lowering prescription drug prices — remains unknown.”
  • Fierce Healthcare points out,
    • “The current state of the Medicare Part D market is a mixed bag, with premiums declining but many payers scaling back options, according to a new analysis from KFF.
    • “The report noted that the Centers for Medicare & Medicaid Services put an emphasis on “stability” in Part D when it announced premium estimates in late September, but KFF found that the total number of stand-alone Part D plans available will decrease in 2026, marking the third straight year of shrinking plan options.
    • “Some payers are trimming down their offerings, per the report. For example, Centene is ending three drug plans offered through WellCare and Health Care Service Corporation is discontinuing one of Cigna’s three Part D plans and pulling back from certain regions.
    • “Other insurers, such as Elevance Health, are exiting the stand-alone Part D plan market entirely.
    • “For 2026, beneficiaries in each state will be able to select from between eight and 12 stand-alone Part D plans, in addition to Medicare Advantage prescription drug coverage. Across the 34 Part D plan markets, a total of 360 plans will be made available by 17 parent organizations—a decrease of 22% from 2025.”
  • “As many major insurers scale back on Medicare Advantage,” Beckers Payer Issues takes a “look at the insurers that are fully backing out.”
  • NextGov/FCW explains how OPM Director Scott Kupor plans “to attract tech talent [to federal government employment] after months of workforce cuts.”
  • Per HR Dive,
    • “The U.S. Senate confirmed Brittany Panuccio, an assistant U.S. attorney for the Justice Department in Florida, as a commissioner for the U.S. Equal Employment Opportunity Commission in a 51-47 vote Tuesday. Panuccio’s confirmation was part of an en bloc vote on several nominations.
    • “Panuccio fills the seat vacated in December by Keith Sonderling, who was named deputy labor secretary in March, and gives Republicans a majority. Her term expires July 1, 2029. 
    • “Panuccio’s confirmation restores a quorum to EEOC, which has operated with only two commissioners since January, when President Donald Trump fired Democratic commissioners Charlotte Burrows and Jocelyn Samuels before the expiration of their terms.”

From the Food and Drug Administration front,

  • Healio adds,
    • “The FDA approved Zoryve cream 0.05% for the treatment of children aged 2 to 5 years with mild to moderate atopic dermatitis, according to a press release. 
    • “Currently, there are approximately 1.8 million children aged 2 to 5 years being treated with a topical therapy for AD. Zoryve (roflumilast, Arcutis) cream 0.05% is a once-daily, next-generation phosphodiesterase-4 inhibitor that offers a nonsteroidal option for children and their caregivers.
    • “It is essential to have safe and effective treatments for children, who are often diagnosed with atopic dermatitis at a young age and can live with the condition across their lifetime,” Lawrence F. Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children’s Hospital-San Diego and vice chair of the department of dermatology at University of California San Diego, said in the release. “Young children often experience widespread disease, affecting large portions of their skin. Although topical steroids have been the standard treatment for years, they are not appropriate for long-term use.”

From the public health and medical / Rx research front,

  • The Wall Street Journal reassuringly explains how to get a Covid booster vaccination under the CDC’s newly approved guidelines.
  • MedPage Today reports
    • “To prevent measles outbreaks, public health systems and clinicians should look below the 35,000-foot view of state- and county-level vaccination rates against measles, mumps, and rubella (MMR) and instead aim their focus on at-risk school districts and schools, according to a statewide analysis of Texas counties.”
  • and
    • “The pre-cooked pasta Listeria recall broadened to include pasta salads and prepared dishes at Kroger, Trader Joe’s, and more grocery stores.
    • “Some Hello Fresh meals may contain Listeria-tainted spinach, USDA’s Food Safety and Inspection Service warned.
    • “Chicken corn dog products from Foster Poultry Farms also were recalled after wood was found in the batter causing at least five injuries. (NBC News)”
  • Per Healio,
    • “Changing trajectories of heart health markers during young adulthood were associated with potentially increased risk for cardiovascular disease later in life, researchers reported.
    • “In addition, individuals who maintained higher levels of CV health through young adulthood had lower risk for incident CVD vs. those whose CV health was maintained at lower levels or declined, according to data published in JAMA Network Open.”
  • and
    • “Acupuncture needling greatly improved pain-related disability in older adults with low chronic back pain compared with usual care, a randomized controlled trial demonstrated.
    • “Acupuncture may be an effective and safe pain management tool for many older adult patients,” Lynn L. DeBar, PhD, MPH, a researcher at Kaiser Permanente Center for Health Research, told Healio. “While it is unlikely to take away all the pain, this study suggests that it can decrease pain-related disability substantively.”
  • The New York Times considers that “He was expected to get Alzheimer’s 25 years ago. Why hasn’t he? Scientists are searching for the secret in [76-year-old] Doug Whitney’s biology that has protected him from dementia, hoping it could lead to ways to treat or prevent Alzheimer’s for many other people.”
  • Per Health Day,
    • “Preschoolers who regularly overeat are likely swallowing their emotions as well, a new study says.
    • “Girls who overeat as preschoolers are more likely to develop anxiety, impulsivity and hyperactivity when they grow into teenagers, researchers reported in the journal BMC Pediatrics.
    • “The results indicate that children’s eating patterns could be early signs of mental health challenges, researchers said.
    • “Occasional overeating is normal, but if a child frequently overeats, it can be a sign of emotional struggles,” senior researcher Linda Booij, a professor of psychiatry at McGill University in Quebec, Canada, said in a news release.”
  • Per Genetic Engineering and Biotechnology News,
    • “A research team co-led by scientists at Institute for Bioengineering of Catalonia (IBEC) and West China Hospital Sichuan University (WCHSU), working with partners in the U.K., has developed a nanoparticle technology that studies showed can reverse Alzheimer’s disease (AD) in mice. Unlike other types of nanomedicine that rely on nanoparticles as carriers for therapeutic molecules, this approach employs nanoparticles that are bioactive in their own right, and which the team refers to as “supramolecular drugs.”
    • “Instead of targeting neurons directly, the therapy restores proper function of the blood-brain barrier (BBB), the vascular gatekeeper that regulates the brain’s environment. The BBB is a cellular and physiological barrier that separates the brain from the blood flow to protect it from external dangers such as pathogens or toxins. Through their newly reported research the investigators demonstrated that targeting a specific mechanism enables undesirable “waste proteins” produced in the brain to pass through this barrier and be eliminated in the circulation. In Alzheimer’s disease, the main waste protein is amyloid-β (Aβ), the accumulation of which impairs normal neuronal function.
    • “By repairing this critical interface, the researchers observed a significant reduction in brain amyloid-β (Aβ) levels and a reversal of Alzheimer’s pathology in the animal models, with cognitive benefits lasting up to six months following treatment.
    • “Study lead Giuseppe Battaglia, PhD, ICREA research professor at IBEC, principal investigator of the Molecular Bionics Group, and colleagues reported on their findings in Signal Transduction and Targeted Therapy, in a paper titled “Rapid amyloid-β clearance and cognitive recovery through multivalent modulation of blood–brain barrier transport,” in which they stated, “This innovative therapeutic paradigm offers a promising pathway for developing effective clinical interventions, addressing vascular contributions to AD, and ultimately enhancing patient outcomes…The therapeutic trilogy achieved—amyloid clearance, barrier restoration, and sustained cognitive recovery—establishes a blueprint for precision neurovascular medicine.”

From the U.S. healthcare business front,

  • Fierce Healthcare reports,
    • “It was a repeat performance for all 10 children’s hospitals named as the nation’s best in this year’s iteration of U.S. News & World Report’s ranking.
    • “The highly watched list, now in its 19th year, reviewed outcomes, practices and surveyed opinions for 198 children’s hospitals.
    • “Of these, 86 hospitals were named in some respect, whether that be a top-10 ranking for 10 different pediatric specialties and/or as one of 50 unranked facilities named as a high performer on pediatric and adolescent behavioral health.
    • “Among these, 10 children’s hospitals were named to the list’s honor roll for scoring well across multiple specialties. That unranked collection is identical to last year’s honorees.
      • “Boston Children’s Hospital
      • “Children’s Hospital Colorado, Aurora
      • “Children’s Hospital Los Angeles
      • “Children’s Hospital of Philadelphia
      • “Children’s National Hospital, Washington, D.C.
      • “Cincinnati Children’s
      • “Nationwide Children’s Hospital, Columbus, Ohio
      • “Rady Children’s Hospital, San Diego
      • “Seattle Children’s Hospital
      • “Texas Children’s Hospital, Houston”
  • and
    • “Providers are betting on artificial intelligence to ease the pain point of prior authorization, a new survey shows.
    • “Cohere Health, which provides clinical intelligence to insurers and risk-bearing providers, polled 200 clinicians and office administrators and found that 99% of clinicians report confidence in using AI to back prior authorization. Most (96%) office administrators said the same.
    • “Two-thirds of those surveyed said a completely digital prior authorization process would significantly improve their workflows. Across the board, the respondents said the process should have real-time tracking baked into the experience, allowing them to track the status of key requests.
    • “Providers are speaking loud and clear: they want and deserve a prior authorization process that is smarter, simpler and more transparent,” said Brian Covino, M.D., chief medical officer of Cohere Health, in an announcement.”
  • Healthcare Dive relates,
    • “Saint Peter’s Healthcare System and Atlantic Health abandoned plans to merge on Monday, citing impacts of the “rapidly evolving healthcare landscape nationally.”
    • “The New Jersey-based health systems first announced plans to combine in January last year and signed a definitive agreement to merge in June 2024. 
    • “The systems shared scant details about why the deal fell apart. However, in a joint statement issued Monday both Atlantic President and CEO Saad Ehtisham and Saint Peter’s President and CEO Leslie Hirsch called the deal’s end disappointing.”
  • STAT News informs us,
    • “Just a decade ago, a doctor with multiple medical licenses was an anomaly. Sometimes physicians would apply for credentials from a few states if they lived near a border and wanted the flexibility to practice on either side, since a doctor needs to be licensed where their patient is physically located. In-demand specialists might get a few more if they wanted to see patients virtually. But in the years since Covid began driving patients online, the number of physicians seeking multi-state licensure has ballooned to support the growing field of telehealth.
    • “Within that group, a STAT analysis of physician licenses shows that a small but powerful cohort of physicians is accumulating licenses in all 50 states, plus the nation’s capital and its territories. These physicians don’t max out on licenses just to practice across state lines. Often, they own the medical groups that are affiliated with nationwide telehealth companies. A doctor’s full roster of medical licenses can be leveraged for online businesses that provide specialty care, build patient funnels for pharma companies seeking to sell drugs directly to consumers, prescribe compounded meds — or sometimes, all of the above. 
    • “In 2016, just nine physicians in the U.S. held active licenses in all 50 states, according to data from the Federation of State Medical Boards. By 2024, 172 doctors had filled out their bingo card, and another 356 doctors had acquired at least 45 licenses — significantly outpacing the profession’s overall growth.”
  • As we approach Open Season, the American Diabetes Association offers “Health Insurance Aid for Diabetes. Access to medical care is key to managing your diabetes. Get more information on resources available to people living with diabetes.”

Thursday report

David Ermer–CDC, CMS, Congress, FDA, Medical / Rx research, Medicare, Mental health care, U.S. Healthcare–

From Washington, DC,

  • Roll Call reports,
    • “The partial government shutdown rolled on Thursday with both sides dug in and President Donald Trump using the funding lapse as an excuse to cut billions of dollars in “dead wood,” as he put it, throughout the executive branch.
    • “Trump said in a social media post that he’d meet with Office of Management and Budget Director Russ Vought to go over “which of the many Democrat Agencies” should be cut as the GOP seeks to make the shutdown more painful for Democratic leaders.
    • “Neither chamber had votes on Thursday as lawmakers observed the Yom Kippur holiday, with the House not returning until Tuesday. The Senate will get another opportunity to vote Friday at 1:30 p.m., but there were no signs of a bipartisan breakthrough yet.
  • Beckers Hospital Review tells us what the Centers for Medicare and Medicaid Services (“CMS”) said will and won’t continue during a lapse in appropriations. Here’s what will continue:
    • “CMS said it will have sufficient funding for Medicaid to fund the first quarter of fiscal 2026, which runs through Dec. 31. 
    • “The agency will maintain the staff necessary to make payments to eligible states for the Children’s Health Insurance Program.
    • “Federal marketplace activities will continue, including eligibility verification.
    • “Other non-discretionary activities, including Health Care Fraud and Abuse Control and the Center Medicare & Medicaid Innovation will also continue. 
  • You can look at the article to find out what’s not continuing.
  • Avalere Health points out that “Part D Choices Continue to Shrink with Fewer PDPs in 2026.”
    • “The Part D market will contract even further in 2026, with a 22% decrease in standalone PDP options and a 9% decrease in non-SNP MA-PDs.”
    • SNP MA-PDs are a type of Medicare Advantage plan for people who are eligible for both Medicare and Medicaid.
  • The American Medical Association News relates,
    • “The Centers for Medicare & Medicaid Services Sept. 30 issued a memo, through the Health Plan Management system, finalizing the Medicare Advantage Utilization Management Annual Data Submission requirements for MA organizations. CMS has limited the scope of the annual data collection to internal coverage criteria for MA services — including Medicare Part B drugs — that require prior authorization. Criteria used exclusively for other review types, such as concurrent or payment reviews, will not be collected. CMS decided not to finalize the proposed audit protocol and corresponding audit tools, citing concerns about duplicative audits, but may consider incorporating review of internal coverage criteria into future program audits.”

From the Food and Drug Administration front,

  • The Wall Street Journal reports,
    • The FDA approved a new generic version of the abortion pill mifepristone, a 200-milligram oral tablet, from Evita Solutions.
    • The FDA’s approval of the generic mifepristone comes as the Department of Health and Human Services reviews the drug’s safety.
    • Antiabortion lawmakers and groups criticized the approval, while abortion-rights groups emphasized the drug’s safety and effectiveness.
  • BioPharma Dive adds,
    • “The Food and Drug Administration, already reeling from layoffs and leadership changes under the Trump Administration, warned that the government shutdown will delay or pause important work at the agency.
    • “In a memo released before the shutdown began, the FDA said it expects to retain 86% of its staff, or 13,872 employees. The agency can continue reviewing existing applications for products, including drugs and medical devices that are funded by user fees, but will not be able to accept new submissions. 
    • “The FDA will also stop many regulatory activities that don’t address “imminent threats to the safety of human life.” For instance, food safety efforts will be reduced during the shutdown, and the agency won’t be able to support much of the work done to protect Americans from unsafe and ineffective compounded drugs, the FDA said.”
  • MedTech Dive notes,
    • “The Food and Drug Administration has released a list of the medical device guidance documents that it plans to develop or publish in its 2026 financial year.
    • “The agency said Tuesday that its top priorities include the finalization of guidance on the use of real-world evidence to support regulatory decisions and on predetermined change control plans for medical devices. 
    • “Three of the FDA’s four priority draft guidance documents are holdovers from the 2025 list. Like last year, the FDA has listed guidance on air purifying respirators and menstrual products among its top draft document priorities for 2026.”

From the public health and medical / Rx research front,

  • The University of Minnesota’s CIDRAP informs us,
    • “In its latest weekly update [Wednesday], the US Centers for Disease Control and Prevention (CDC) reported 30 more measles cases, putting the national total at 1,544, a record high since the United States eliminated the disease in 2000.
    • “Two more outbreaks were reported, bringing the total to 42. The CDC said 86% of cases are linked to outbreaks, and 92% of patients are unvaccinated or have an unknown vaccination status. The number of affected jurisdictions remained the same, at 42. 
    • “So far, 21 cases have been reported in international visitors.”
  • The American Medical Association lets us know what doctors wish patients knew about vitamins and supplements.
  • Beckers Hospital Review notes,
    • “Nursing homes in Vermont and Wyoming had the highest percentage of residents experiencing one or more falls with major injury between April 1, 2024, and March 31, 2025, according to CMS data published Sept. 24. 
    • “The District of Columbia and California had the lowest percentage for the same time period. 
    • “A recent HHS report found that nursing homes fail to report 43% of falls that resulted in major injury and hospitalization among Medicare-enrolled residents.
    • “The national percentage of nursing home residents experiencing one or more falls with major injury was 3.28%.” 
  • CNN relates,
    • “A new report ranks US states on rates of mental well-being and mental health care, and New York, Hawaii and New Jersey have outperformed the rest — in that order.
    • “The 2025 State of Mental Health in America report sizes up how all 50 states and Washington, DC, fared on 17 measures of mental health in 2022 and 2023, according to Mental Health America, which published the report on Wednesday. The nonprofit promotes mental health and illness prevention through education, research and advocacy.
    • “The 17 factors mainly concern adults and youth who experienced mental illness, suicidal thoughts or substance use disorder in the past year; adults and youth who didn’t receive necessary treatment, couldn’t afford it or were uninsured; people with insurance that didn’t cover mental or emotional problems; and the availability of mental health providers.
    • “Nevada had the worst rating, followed by Arizona and Alabama — marking the second time Nevada and Arizona have ranked the lowest, “underscoring a high need for strategic investment in mental health in these states,” MHA said in a news release.”
  • NBC News reports
    • “People who learn they have autism after age 6 — the current median age at diagnosis — are often described as having a “milder” form of autism than people diagnosed as toddlers.
    • “A new study challenges that assumption.
    • “A genetic analysis finds that people with autism spectrum disorder diagnosed in late childhood or adolescence actually have “a different form of autism,” not a less severe one, said Varun Warrier, senior author of a study published Wednesday in Nature.
    • “The “genetic profile” of people with late-diagnosis autism actually looks more like depression, attention-deficit/hyperactivity disorder and post-traumatic stress disorder than early childhood autism, said Warrier, an autism researcher at the University of Cambridge. 
    • “The study illustrates that autism is not a single condition with one root cause, but rather an umbrella term for a cluster of conditions with similar — although not identical — features, said Geraldine Dawson, founding director of the Duke Center for Autism and Brain Development, who wasn’t involved in the new report.”
  • STAT News adds,
    • “Researchers have found that patients with amyotrophic lateral sclerosis have autoimmune responses, a finding with the potential to reshape how scientists think of the devastating and complex neurologic disorder.
    • “A team led by scientists at La Jolla Institute for Immunology analyzed blood samples from 40 ALS patients and 28 people without the disease. They found that those with ALS had on average stronger immune cell responses than healthy controls to C9orf72, a protein active in neurons and associated with the rare condition. Other proteins linked to ALS, however, were not preferentially targeted by patients’ immune systems.
    • “The authors discovered that, among patients with responses against C9orf72, those with immune cells that produced signals known to tamp down inflammation were predicted to have longer survival times than ALS patients with more inflammatory responses.
    • “The findings, published in the journal Nature on Wednesday, suggest to Samuel Pfaff, an ALS researcher at the Salk Institute, that there is an autoimmune component to the disease. That’s something previous studies have suggested but have not conclusively shown. The results raise the possibility that researchers could one day treat ALS patients in new ways by targeting their immune system, and that scientists might monitor disease progression by tracking autoimmune cells.
    • “I think it’s giving us a greater appreciation of a variety of aspects of the disease,” said Pfaff, who was not involved in the study. “It is providing some new thinking about how to consider treating the disease.”
  • and
    • “Researchers have shut pregnant women out of gold-standard clinical trials in order to protect them and their babies. But the practice has had the opposite effect.
    • “Instead, women have to wade through a chaotic data landscape, and many may choose to suffer through untreated illnesses. 
    • “Besides sowing confusion, the lack of data makes it easier for people to obfuscate and misconstrue existing data. That dynamic was on full display last week as President Trump and Health and Human Services Secretary Robert F. Kennedy Jr. urged pregnant women to avoid Tylenol as they claimed, without clear evidence, that the active ingredient acetaminophen causes autism. 
    • “The existence of this data gap is well established. But it’s gained new relevance as federal officials zero in on the medical decisions of pregnant women, searching for evidence of harm to fetuses.” 
  • Per Health Day,
    • “The early warning signs of multiple sclerosis appear to be the same for everyone, regardless of their background.
    • “The pain, mood changes, brain decline and neurological problems associated with early MS can appear years before diagnosis but appear to affect all types of people in similar ways, according to a new study.
    • “Our study shows that the very earliest features of MS are similar regardless of someone’s ethnic or socio-economic background,” said researcher Ben Jacobs, a clinical lecturer in neurology at Queen Mary University of London.
    • “Efforts to detect MS earlier or identify people at high risk should therefore be inclusive and representative of the whole population,” Jacobs said in a news release.” * * *
    • “The new study appeared Sept. 24 in the Annals of Clinical and Translational Neurology.”
  • Per BioPharma Dive,
    • “Amgen’s cholesterol-lowering shot Repatha met its main goals in a large trial evaluating use as a “primary prevention” therapy, besting a placebo at reducing the risk of cardiovascular events or death in people who’d never had a heart attack or stroke, the company said Thursday.
    • “Repatha, a so-called PCSK9 inhibitor, is currently available as a “secondary prevention” therapy for those with a history of heart disease and at high risk of experiencing another. Though it’s sometimes also used “off-label” in the much larger primary prevention setting, an approval backed by the latest study results — which Amgen referred to as a “landmark” finding — could substantially widen use. 
    • “Once forecast to achieve tens of billions of dollars in annual sales, Repatha has fallen short of those lofty projections amid pushback from insurers and a modest benefit in those with established heart disease. Still, sales surpassed the $1 billion mark in 2021 and have grown since. The Food and Drug Administration also recently expanded use in those at higher risk of major cardiovascular events.”
  • The New York Times reports,
    • “Jane Goodall, who died on Wednesday at the age of 91, followed several principles that geriatricians recommend for a long and healthy life.
    • “A scientist, conservationist and author, Dr. Goodall stayed active, working until the day she died. She had a clear sense of purpose for her life. And she was an enduring optimist.
    • “Over a nearly seven-decade career, Dr. Goodall taught us about the intelligence of chimpanzees. But she left behind powerful teachings about aging — and living well — too.”
      • “Her work kept her active.”
      • “She had a ‘reason for being.’”
      • “She maintained a positive outlook on life.”

From the U.S. healthcare business front,

  • Beckers Payer Issues lets us know,
    • “Despite Cigna launching its downcoding policy on Oct. 1, the insurer is temporarily holding off on implementing it for California HMO plans, according to the California Medical Association and Cigna.
    • “The policy allows Cigna to adjust some higher-level evaluation and management codes if they do not meet certain complexity standards. Codes 99204-99205, 99214-99215 and 99244-99245 fall under this policy. After receiving questions over its legality, the reimbursement policy is awaiting review by the California Department of Managed Health Care.
    • “This approach also introduces avoidable friction with physician practices into the process, erodes trust between providers and plans, and exacerbates the challenges of delivering high-quality care in a resource-constrained environment,” the California Medical Association wrote in a letter to Cigna.
    • “Our new policy that ensures the limited number of impacted physicians are reimbursed appropriately for E/M services took effect as planned, with the exception of California HMO plans regulated by the state Department of Managed Health Care,” a Cigna spokesperson told Becker’s. “We anticipate that the policy will also take effect for these plans’ claims in California after the DMHC completes its review of the additional information that we have provided.”
  • Beckers ASC Review adds,
    • “On Oct. 1, a new UnitedHealthcare policy went into effect, cutting reimbursements to certified registered nurse anesthetists by 15%. 
    • “The policy update was issued on July 1 and applies to claims for anesthesia services rendered by CRNAs practicing independently. For claims billed under the QZ modifier — those rendered by CRNAs — the provider will now receive 85% of the allowable. 
    • “CRNAs in Arkansas, California, Ohio, Colorado, Hawaii, Massachusetts, New Hampshire and Wyoming are exempt from the new reduction. 
    • “The update has drawn criticism from the American Association of Nurse Anesthesiology, who told Becker’s in an Oct. 1 email that the policy “threatens patient care” and could lead to delayed procedures and strained access to care, particularly in rural and underserved communities where CRNAs are more heavily utilized for anesthesia services. 
    • ‘The AANA also claims the policy is in violation of a provider nondiscrimination provision outlined in the ACA. The organization has also written a coalition letter urging the secretaries at the Department of Labor, HHS and Department of Treasury to investigate and prohibit commercial payers from violating this nondiscrimination provision.”
  • The Healthcare Cost Institute tells us what preventive care costs.
  • STAT News reports,
    • “UnitedHealth Group has tapped a Duke University artificial intelligence expert to be its chief AI scientist as the health care giant ramps up the use of the technology across its sprawling network of businesses, according to a memo obtained by STAT.
    • “Michael Pencina, chief data scientist for Duke Health, stepped down from his role at Duke on Wednesday to take the job at UnitedHealth, according to the memo from Mary Klotman, dean of the Duke University School of Medicine.”
  • Per Modern Healthcare,
    • “Providence finalized Wednesday the second phase of a joint venture with Compassus to manage the health system’s home care operations in California.
    • “Under the terms of the deal, Compassus will manage approximately 20 home health, hospice, personal home care and palliative care locations under the name Providence at Home with Compassus.
    • “The deal is part of a broader initiative Renton, Washington-based Providence inked with Compassus last year to operate home care locations across Alaska, Texas, Washington, California and Oregon. Compassus began managing 14 locations in Alaska, Texas and Washington in March.”
  • Per Fierce Healthcare,
    • “NeueHealth officially ceased trading on the New York Stock Exchange after completing its go-private deal with an affiliate of New Enterprise Associates.
    • “The company, once known as Bright Health Group, was scooped up on Thursday by the NEA unit with an enterprise value of about $1.5 billion, following a series of financial struggles. Common stockholders in NeueHealth will receive $7.33 per share as part of the sale, according to an announcement.
    • “Certain shareholders in the company—including New Enterprise Associates and 12 other investors who hold all of its preferred stock—will instead enter into a rollover agreement, where they will exchange shares for equity interest in the now-private enterprise.
    • “In addition, NeueHealth’s leadership will continue in their roles and have similarly rolled their holdings into equity in the private company.”
  • and
    • “Startup SpotitEarly is pioneering an innovative early cancer screening test based on breath samples and powered by artificial intelligence and the strong scent detection of trained dogs.
    • “SpotitEarly launched in the U.S. market in May, armed with $20 million in funding. The company, initially founded in Israel, plans to roll out its breath-based, at-home early detection test in the U.S. next year. It’s preparing for an FDA pre-submission as part of a phased regulatory strategy, executives said.
    • “New Jersey-based Hackensack Meridian Health is teaming up with the startup to validate its non-invasive approach to early cancer detection.
    • “As part of the research collaboration, SpotitEarly will work with the Hennessy Institute for Cancer Prevention and Applied Molecular Medicine, part of the Hackensack Meridian John Theurer Cancer Center, and Hackensack University Medical Center.”
  • Beckers Hospital Review relates,
    • “Eight states tied for having the lowest rates of patients who left hospital emergency departments without being seen, at 1%, CMS data showed.
    • “CMS’ Timely and Effective Care dataset, updated Aug. 6, tracks the percentage of patients who left an ED before being seen between January and December 2023. The measures apply to children and adults treated at hospitals paid under the inpatient or the outpatient prospective payment systems, as well as hospitals that voluntarily report data on relevant measures for Medicare, Medicare-managed care and non-Medicare patients. Averages include data for Department of Veterans Affairs and Defense Department hospitals. Read the methodology here. 
    • “The national average showed 2% of patients left EDs before being seen in 2023. This is returning to prepandemic levels, after the rate went up to 3% in 2022.”

Midweek report

David Ermer–CDC, CMS, Congress, Medical / Rx research, Medicare, OPM, U.S. Healthcare–

From Washington, DC,

  • Roll Call reports,
    • “Amid tough talk from both sides of the aisle about who’s to blame for the partial government shutdown, bipartisan talks began to take shape as the rank-and-file sought a way out of the impasse.
    • “Various groups of senators were seen huddling on the floor Wednesday during a vote series, even as Democrats again mostly rejected the House-passed stopgap funding bill that would reopen the government through Nov. 21.
    • “The 55-45 margin on the procedural vote was the same tally as the night before, with the same three Democratic caucus members crossing the aisle to support it: Nevada’s Catherine Cortez Masto, Pennsylvania’s John Fetterman and Maine’s Angus King, an independent who caucuses with the party.
    • “That’s two more Democratic caucus members than voted for the measure 10 days ago, which Republicans believe demonstrates fissures in the ranks that will only grow as the shutdown’s impacts build. But it’s five votes short of the 60 needed to overcome a filibuster.”
  • The Wall Street Journal adds,
    • “During a huddle with a bipartisan group of senators on the floor Wednesday, Sen. Ruben Gallego (D., Ariz.) floated the idea of voting to reopen the government with a commitment from Republicans to negotiate on the healthcare subsidies by Nov. 1. Republicans reiterated they didn’t want to negotiate while the government was shut down, according to a person familiar with the conversation.
    • “This is us, just senators randomly getting together and spit balling, and then see if we can get to some kind of consensus,” Gallego said. “And then I think a lot of us would then go back to our leadership and then go from there.”
  • Federal News Network informs us,
    • “After congressional appropriations lapsed and a government shutdown began at midnight on Oct. 1, the Trump administration now warns that further federal employee layoffs are imminent.
    • “It’s unclear which agencies will move forward with potential layoffs, beyond at least one agency — the U.S. Patent and Trademark Office — that on Wednesday issued layoff notices. Vice President JD Vance doubled down on the Office of Management and Budget’s last week’s directive to terminate more federal employees in the case of a government shutdown.
    • “If this thing drags on for another few days, or, God forbid, another few weeks, we are going to have to lay people off,” Vance told reporters during a White House press conference Wednesday afternoon. “We’re going to have to save money in some places so that essential services don’t get turned off in other places.”
    • “OMB Director Russell Vought took a more immediate stance on how quickly he expected RIFs to take place. In a private call with House Republicans on Wednesday, Vought said agency RIFs would begin “in a day or two,” according to reporting from Politico.”
  • Fierce Healthcare offers a look at the major insurers’ 2026 Medicare Advantage plans and adds,
    • “On day one of the government shutdown, the Centers for Medicare and Medicaid Services (CMS) sent out a Medicare Learning Network Connects Newsletter offering guidance on Medicare billing and telehealth services during the lapse in appropriations. 
    • “CMS reaffirmed in the guidance that pandemic-era expanded telehealth flexibilities have ended for Medicare beneficiaries. Per standard course of action, CMS has directed Medicare Administrative Contractors (MACs) to implement temporary claims hold for 10 business days on telehealth claims. 
    • “Assuming the hold starts Oct. 1, claims will begin to be processed on Oct. 15. The guidance says that providers can still submit claims during the temporary hold, but they will not receive payment. 
    • “The claims hold is meant to avoid the reprocessing of claims in the event that Congress re-ups the flexibilities.” 
  • The White House posted a fact sheet about “the first agreement with a major pharmaceutical company, Pfizer, to bring American drug prices in line with the lowest paid by other developed nations (known as the most-favored-nation, or MFN, price).”
  • The Wall Street Journal explains “How Trump’s Drug-Buying Site ‘TrumpRx’ Will Work. If you are among the 90% of Americans who have health insurance, it’s unlikely to save you much money.”
    • “President Trump announced a deal with Pfizer to sell drugs at reduced prices via TrumpRx.gov and to Medicaid at Most Favored Nation prices.
    • “TrumpRx.gov, launching in early 2026, will offer Pfizer drugs, including Eucrisa and Xeljanz, with average savings of 50%.
    • “The initiative primarily benefits the 27 million uninsured Americans, as 90% with insurance likely save more using their plans.”

From the public health and medical / Rx research front,

  • The New York Times reports,
    • “Children and teenagers are twice as likely to develop long Covid after a second coronavirus infection as after an initial infection, a large new study has found.
    • “The study, of nearly a half-million people under 21, published Tuesday in Lancet Infectious Diseases, provides evidence that Covid reinfections can increase the risk of long-term health consequences and contradicts the idea that being infected a second time might lead to a milder outcome, medical experts said.
    • “Dr. Laura Malone, director of the Pediatric Post-Covid-19 Rehabilitation Clinic at Kennedy Krieger Institute in Baltimore, who was not involved in the study, said the findings echo the experience of patients in her clinic.
    • “Just because you got through your first infection and didn’t develop long Covid, it’s not that you are completely out of the woods,” she said.”
  • STAT News tells us “Leucovorin has a place in autism treatment, researcher says, but he tamps down parents’ expectations. ‘I haven’t seen a remarkable response,’ says Robert Hendron, who studied its use in kids with ASD.”
  • The Washington Post calls attention to “what you should know before buying folate and folinic acid supplements. Medical experts warn against treating over-the-counter supplements the same as leucovorin, the drug the Trump administration has touted as an autism treatment.”
  • Cigna, writing in LinkedIn, discusses the unique health needs of women.
  • Medscape lets us know that “A prospective cohort study found that a high intake of ultraprocessed foods (UPFs) was associated with an increased risk for overall colorectal cancer (CRC) and right-sided colon cancer.”
  • The Washington Post relates,
    • “Walmart will stop using synthetic dyes and certain preservatives, artificial sweeteners and fat substitutes in its private-label offerings, adding the world’s largest retailer to the growing contingent of brands moving to banish food additives amid questions about their health risks.
    • “The announcement Wednesday comes as consumers are pressing for healthier options, and as state and federal officials crack down on the use of petroleum-based dyes in cereals, condiments and a variety of other foods. Health and Human Services Secretary Robert F. Kennedy Jr. — who has likened such additives to “poisonous compounds” — said in April that the administration had reached an “understanding” with the food industry to phase out several colorings over the next few years. General Mills, Kraft Heinz and other foodmakers have since issued statements to that effect.”
    • “Walmart said it will excise nearly 30 additives from its private-label food portfolio by January 2027, including its Great Value, Freshness Guaranteed, Bettergoods and Marketside brands.”
  • Medscape points out what scientists are learning about laser tattoo removal.

From the U.S. healthcare business front,

  • Modern Healthcare reports,
    • “CommonSpirit is betting on ambulatory care expansion to shore up operations and putting hospital deals on ice.
    • “The Chicago-based system has added 90 ambulatory care sites to its footprint in its last two fiscal years, 34 of which opened across nine states in fiscal 2025, which ended June 30.
    • “At this point, we’re not focused on hospital acquisitions. We’re primarily looking at ambulatory growth to meet the needs of our consumers,” said CommonSpirit CEO Wright Lassiter III on a Wednesday earnings call. “We are very intentional about where we’re headed and what we believe we need to do to create the kind of success we want as a ministry.”
  • and
    • “Health insurance companies and health systems are familiar with heated contract battles, but the scramble to lock down favorable terms is rising.
    • “Hospitals, under pressure to operate within tight margins, are wrestling with the financial ramifications of looming federal healthcare cuts and coping with sustained labor shortages Insurers seek to clamp down on rising utilization and appease dissatisfied investors.
    • “Those dynamics have fostered an environment that’s led to more messy public contract fights than usual. “We’ve just never seen anything like it,” said Brandon Edwards, CEO of Unlock Health, a marketing agency for providers.
    • “There were 79 confirmed contract disputes between insurers and providers this year as of Sept. 1, according to an FTI Consulting analysis of publicly reported negotiations. Half related to Medicare Advantage, and 20% were unresolved at the beginning of September. The trend has been rising since last year, the analysis shows.”
  • Per Fierce Healthcare,
    • “General Catalyst’s Health Assurance Transformation Company (HATCo) has wrapped its acquisition of Summa Health, shifting the Akron, Ohio-based healthcare system from a nonprofit to a taxed subsidiary.
    • “The deal was first announced in early 2024 and underwent a lengthy regulatory review amid pushback from local residents. Ohio Attorney General Dave Yost gave the transaction a green light during the summer with certain conditions, including an increase in the sale price from $485 million to $500 million.
    • “Today is the culmination of months of collaboration between our organizations and marks the start of a new chapter for Summa Health and those we serve,” Cliff Deveny, M.D., Summa Health President and CEO, said in Wednesday morning’s announcement. “With HATCo, we can preserve our community roots, invest in our team and take bold steps to modernize and expand access to ensure Summa remains strong for decades to come.”
    • “Summa Health is among Ohio’s larger health systems. It employs more than 8,500 people across two acute care hospital campuses, 15 community medical centers, a rehab hospital, a health insurance arm, a multispecialty group practice and a research and medical education program. It reported about $2 billion in total revenue, but a narrow operating loss of $8 million in fiscal year 2024.”
  • and
    • “With $10 billion earmarked to grow its U.S. operations through 2035, AbbVie continues to lay out the particulars on its decade-long domestic investment strategy.
    • “The Chicago-area Big Pharma has kicked off work on a $70 million expansion of its bioresearch center in Worcester, Massachusetts, where the company conducts both manufacturing and R&D for biologic medicines.
    • “The project, which falls under the banner of AbbVie’s broader U.S. investment announced in April, will beef up capacity at the Worcester site that AbbVie plans to use for local production of current and upcoming drugs in cancer and immunology, according to a Sept. 30 press release.
    • “AbbVie is specifically building out additional biologics manufacturing areas at the site, as well as a new three-story building that will contain a laboratory, warehouse and office space. The company said it expects the project to hasten the production transfer of certain oncology meds from Europe to the U.S.”
  • The Wall Street Journal notes,
    • “Patients are increasingly managing their own healthcare due to doctor shortages and chronic diseases.
    • “Direct-to-consumer lab tests are expanding, with Quest Diagnostics, for instance, offering more than 150 tests.
    • “AI chatbots and wearable devices are emerging tools, but concerns exist regarding data privacy, misinformation and clinical validation.”

Tuesday report

David Ermer–CDC, CMS, Congress, FDA, NIH, OPM, U.S. Healthcare–

From Washington, DC,

  • The Wall Street Journal reports,
    • “The federal government was on course to shut down early Wednesday, as hopes of any last-minute deal evaporated and both Republicans and Democrats appeared content to trigger the first lapse in funding since President Trump’s first term.”
  • The Senate voted 55-45 on accepting the House Continuing Resolution this evening. A 60 vote in favor was required due to cloture rules. Three Democrats voted in favor and Sen. Rand Paul voted against due to his disdain for continuing resolutions. Roll discusses the vote and next steps in Congress.
  • Govexec adds,
    • “The Trump administration is planning to furlough around 550,000 federal employees on Wednesday if Congress fails to act before government funding expires late Tuesday evening, representing an unusually low less than one-quarter of the workforce. 
    • “The White House is also vowing to oversee large-scale layoffs if a government shutdown occurs, though that would play out through a separate process than the one that sends home certain employees only until funding is restored. In the last 15 years, administrations have typically prepared to furlough between 35% and 40% of the federal workforce.”
  • Federal News Network shares agency shutdown contingency plans.
  • OPM Director Scott Kupor writes in his blog about how he spent days leading to the end of federal fiscal year.
  • The NBC station in Washington, DC, reminds us,
    • “Tens of thousands of government workers are preparing to leave the federal workforce Tuesday, the final day for many who took the government’s “Fork in the Road” resignation offer earlier this year.
    • “Among those are as many as 60,000 retirees who will now anxiously wait for their federal retirement benefits to kick in – a process that could take months and is potentially impacted by the looming government shutdown.
    • “There’s no question there’s going to be a surge. We’re doing everything we can to try and address it,” Office of Personnel Management (OPM) Director Scott Kupor told the News4 I-Team. * * *
    • “Even though OPM knew months ago thousands of employees were leaving, he said their retirements can’t start processing until after they’re off the federal payroll. That’s because each department in the federal government has to wait for an employee’s final paycheck before finalizing their application and sending it to OPM.
    • “Now look, it sounds crazy to me, as well,” he told the I-Team. “And so, one of the things we’re looking at is we’re trying to just basically redesign the entire process from start to finish.”
  • The Wall Street Journal lets us know,
    • “President Trump unveiled plans Tuesday to launch a government-run website, dubbed TrumpRx, for consumers to buy drugs directly from manufacturers, and he said Pfizer plans to offer some of its drugs on the site at a reduced rate.
    • “Separately, Trump said Pfizer would offer all of its drugs to Medicaid at a reduced, “most favored nation” price, as well as introduce any new drugs to the U.S. market at the reduced prices. In return, the company gains a three-year grace period to exempt it from national-security-related tariffs, as long as the company invests in domestic manufacturing, the company said.
    • “The American consumers have been subsidizing research-and-development costs for the entire planet,” Trump said in the Oval Office, flanked by top health officials and Pfizer Chief Executive Albert Bourla.” * * *
    • “Pfizer also announced a $70 billion investment on research and development and manufacturing medications in the U.S.”
  • Per a Centers for Medicare and Medicaid news release,
    • “The Centers for Medicare & Medicaid Services (CMS) released final guidance for the third cycle of negotiations under the Medicare Drug Price Negotiation Program (Negotiation Program). This final guidance incorporates significant policy refinements based on public feedback, with a particular focus on increasing transparency, and implements expanded protections for orphan drugs enacted in the Working Families Tax Cuts Act (Public Law 119-21).” * * *
    • “[The] final guidance addresses how drugs payable under Medicare Part B will be eligible for negotiation, requirements and process for renegotiation.”
    • “The Fact Sheet for the Final Guidance for Initial Price Applicability Year 2028 and Manufacturer Effectuation of the Maximum Fair Price in 2026, 2027, and 2028 is available at: https://www.cms.gov/files/document/ipay-2028-final-guidance-fact-sheet.pdf.
    • “Additional information about the Medicare Drug Price Negotiation Program can be found at: https://www.cms.gov/priorities/medicare-prescription-drug-affordability/overview/medicare-drug-price-negotiation-program.” 
  • Per a Department of Health and Human Services news release,
    • “The U.S. Department of Health and Human Services’ (HHS) Administration for Community Living (ACL) today announced $60 million in new grant awards to states, territories, tribes, and local organizations supporting older adults and Americans with disabilities. These awards will strengthen existing programs that protect health, preserve independence, and support caregivers — key priorities of the Make America Healthy Again agenda.”
  • Per a National Institutes of Health news releases,
    • Anthony Letai, MD, Ph.D., was sworn in [yesterday September 29, 2025] as director of the National Cancer Institute (NCI), part of the National Institutes of Health (NIH), by Health and Human Services Secretary Robert F. Kennedy, Jr.
    • Dr. Letai takes the helm of the world’s most prestigious cancer research agency after serving as professor of medicine at Harvard Medical School and medical oncologist at the Dana-Farber Cancer Institute. He possesses decades of experience studying cell death in cancer, developing treatments, and identifying predictive biomarkers.
  • and
    • “The U.S. Department of Health and Human Services today announced a doubling of funding for its Childhood Cancer Data Initiative (CCDI) at the National Institutes of Health (NIH). The funding surge is designed to accelerate the development of improved diagnostics, treatments, and prevention strategies.
    • “President Trump in 2019 established the CCDI to collect, generate, and analyze childhood cancer data. Its budget will rise from $50 million to $100 million, giving the federal government stronger data for this effort. The initiative will also bring in private-sector partners to apply advanced artificial intelligence to speed up cures for pediatric cancer.
    • “Health and Human Services Secretary Robert F. Kennedy, Jr., NIH Director Jay Bhattacharya, and National Cancer Institute (NCI) Director Anthony Letai joined President Trump at the White House today to discuss their commitment to eradicating childhood cancer and to mark the signing of the president’s executive order, Unlocking Cures for Pediatric Cancer with Artificial Intelligence.“

From the Food and Drug Administration front,

  • FDA Director Marty Makary, MD, announced today,
    • “As part of the FDA’s broader strategy to combat the crisis of youth vaping, we are launching an initiative to increase voluntary compliance from retailers—including vape shops, convenience stores and gas stations—that play a key role in the distribution of both legal and illegal products into American communities.” * * *
    • “We have received questions from retailers about which tobacco products are legal to sell, so we’re mailing materials to more than 300,000 retailers nationwide containing: 
      • “A list of the 39 vapes and 20 nicotine pouch products that can be legally marketed in the United States, which features QR codes linked to the FDA real-time digital versions of these lists (www.fda.gov/authorizedecigs and www.fda.gov/authorizednicotinepouches); 
      • “Information on accessing FDA’s new Searchable Tobacco Product Database, a database of over 17,000 tobacco products—covering all categories, such as cigarettes, cigars, hookah, and e-cigarettes—that may be legally marketed in the United States; and  
      • “New tobacco retailer education materials, including a wall calendar of reminders focused on retailer requirements such as only selling tobacco products to those 21 and older and requiring a photo ID check of anyone under 30.” * * *
    • “Mailings will begin this fall. Retailers looking to order additional free materials—including a digital age verification calendar—can do so via FDA’s Tobacco Education Resource Library.”  
  • The American Hospital Association News tells us,
    • “The Food and Drug Administration today issued a request for public comment on a series of questions regarding current approaches to evaluating artificial intelligence-enabled medical device performance in real-world applications. This includes approaches to detect, assess and mitigate performance changes over time to help assure the devices remain safe and effective throughout their life cycle. The FDA is accepting comments at www.regulations.gov until Dec. 1. The notice follows a request by the Office of Science and Technology Policy issued Sept. 26 that seeks feedback on federal regulations that hinder AI development, deployment or adoption.”
  • Per MedTech Dive,
    • “The Food and Drug Administration has expanded its early alert communication initiative to cover potentially high-risk removals or corrections for all medical devices, the agency said Monday.
    • “Officials announced a pilot of the initiative late last year. Since then, the agency has issued early alerts shortly after companies have told customers about issues with certain medical devices. 
    • “The FDA said the pilot was successful, leading it to expand the program beyond the initial five therapeutic areas and include potentially high-risk safety events of all medical devices.”
  • BioPharma Dive points out five FDA decision to watch for in the fourth quarter of 2025. “The agency is set to decide by the end of the year whether to approve an obesity pill, a new kind of kidney disease drug and a long-awaited heart medicine.

From the public health and medical / Rx research front,

  • STAT News interviews “Lilly’s head scientist [about] its GLP-1 pill, Alzheimer’s strategy, and finding promising ideas and startups. CSO Daniel Skovronsky’s long-term vision: ‘We’re trying to invest in the babies’” 
  • Biopharma Dive reports,
    • “Metsera’s top obesity drug succeeded in a Phase 2 trial, helping enrollees treated with the highest dose lose an average of 14 percentage points more of their body weight than placebo recipients after 28 weeks, the company said Monday.
    • “Interim results from a separate trial also showed that a step-up, or “titrated,” dosing regimen limited the kind of gastrointestinal side effects that often lead people to stop taking GLP-1 drugs for obesity. That finding suggested Metsera’s drug, MET-097i, could have a tolerability profile “better than tirzepatide,” which Eli Lilly sells as Zepbound for weight loss, wrote Leerink Partners analyst David Risinger in a Tuesday client note.
    • “The announcement comes one week after Pfizer reached a deal to acquire Metsera for $4.9 billion. The buyout puts Pfizer back in the chase to develop obesity drugs, a market that could be worth more than $100 billion a year in sales by the next decade.”
  • Per Fierce Pharma,
    • “Two clinical trials of Merck’s pulmonary arterial hypertension (PAH) drug Winrevair were so conclusive that the studies were halted within the last year because the efficacy of the treatment was assured.
    • “Tuesday, Merck reported results from the phase 3 Hyperion study, which showed that Winrevair, when combined with background therapy, achieved its primary endpoint by reducing the risk of clinical worsening events by 76% compared with placebo in recently diagnosed adults.”
  • Per MedPage Today,
    • “Gabapentin prescribing rose sharply in recent years, with the generic drug becoming the fifth most dispensed product in retail pharmacies in 2024, a CDC analysis showed.
    • “From 2010 to 2024, prescriptions jumped from 79.5 to 177.6 per 1,000 people, according to Gery Guy Jr., PhD, of the CDC National Center for Injury Prevention and Control, and co-authors.
    • “The number of persons who received gabapentin soared from 5.8 million in 2010 to 15.5 million in 2024, Guy and colleagues reported in Annals of Internal Medicine. That represented an increase from 18.9 per 1,000 people in 2010 to 46.9 per 1,000 people in 2024.” * * *
    • “Gabapentin is approved for seizures and postherpetic neuralgia; gabapentin enacarbil is approved for restless legs syndrome. Despite limited indications, gabapentin and its cousin pregabalin are widely prescribed off-label for various other pain syndromes.
    • “Common side effects of gabapentin include drowsiness, dizziness, blurry or double vision, and difficulty with coordination and concentration. In 2019, the FDA warned about serious breathing problems that may occur in patients using gabapentin or pregabalin who have respiratory risk factors. These factors included taking opioids or other drugs that depress the central nervous system, conditions like chronic obstructive pulmonary disease that reduce lung function, and older age.”
  • Per Health Day,
    • “An invisible storm might rage for years inside the bodies of people at risk for rheumatoid arthritis, prior to any joint pain occurring, a new study says.
    • “These folks experience dramatic immune system changes long before they feel symptoms, researchers reported in the journal Science Translational Medicine.
    • “Overall, we hope this study raises awareness that rheumatoid arthritis begins much earlier than previously thought and that it enables researchers to make data-driven decisions on strategies to disrupt disease development,” senior researcher Mark Gillespie, an assistant investigator at the Allen Institute in Seattle, said in a news release.”
  • Pulmonary Advisory informs us, “Asthma risk in women has significant associations with body mass index (BMI), body roundness index (BRI), and white blood cell count (WBC), according to study findings published in BMC Pulmonary Medicine.”

From the U.S. healthcare business front,

  • The Wall Street Journal reports,
    • “Cardinal Health CAH is building a flagship pharmaceutical distribution center in Indianapolis to keep up with its growing customer base and the shifting needs of drug companies.
    • “The planned 230,000 square-foot plant is the healthcare company’s latest step in a 10-year plan to modernize and expand its distribution network. Pharmaceutical distribution remains Cardinal’s most lucrative business, and it is continuing to gain customers. The Dublin, Ohio, company added more than $10 billion of new business in the last fiscal year, said Debbie Weitzman, chief executive of Cardinal’s pharmaceutical and specialty solutions business.
    • “That comes with it a lot of volume that we need to be prepared for,” she said.”
  • Fierce Healthcare relates,
    • “Millie, a California-based hybrid women’s health clinic, is expanding its offerings with perimenopause and menopause care.
    • “The offering, available in person and virtually, includes hormone therapy, nonhormonal treatments, vaginal treatments and lifestyle strategies. Millie currently has two clinics in the Bay Area.
    • “The company, which launched in 2022, was originally focused on maternity care. Staffed with nurse-midwives and doulas, Millie provides care for low-risk pregnancies out of its clinic. Millie also partners with hospitals, where its providers support labor and deliver babies. Midwives drive lower caesarean section rates and higher patient satisfaction scores and can help fill crucial gaps in obstetrics care. As of 2024, more than a third of U.S. counties were designated maternity care deserts. 
    • “In 2023, Millie introduced preconception counseling and gynecology offerings, recognizing that optimizing these areas of health can support better maternal and overall health outcomes. It has now further expanded its continuum of care with menopause care, since many of its patients are becoming parents in their late 30s and navigating postpartum and perimenopause at the same time.” 
  • Beckers Hospital Review shares “the days cash on hand at 40 health systems as of June 30, according to their most recent financial reports.”
  • Beckers Payer Issues offers eight things to know about catastrophic health claims.

Monday report

David Ermer–CDC, CMS, Congress, FDA, Federal employment benefits, Medical / Rx research, Medicare, NCQA, OPM, U.S. Healthcare–

From Washington, DC,

  • The Wall Street Journal reports,
    • “Top Democrats made their case to President Trump for restoring billions of dollars in healthcare spending as part of any deal to avoid a government shutdown, but they said there was no breakthrough in talks, further dimming hopes of a last-minute deal.
    • “It was a frank and direct discussion” with the president and Republican leaders, “but significant and meaningful differences remain,” said House Minority Leader Hakeem Jeffries (D., N.Y.) after leaving the meeting at the White House.” * * *
    • “The open question headed into Monday’s meeting was whether Trump the dealmaker would show up, or if he was content to let Democrats go home empty-handed. Trump believes he is in a strong position and that Democrats will be blamed for shutting down the government, according to allies. A Republican close to the talks said that while Trump likes to be a dealmaker, there may not be much of a deal to be made.
    • “[Senate Minority Leader Chuck] Schumer [D., N.Y.] and Senate Majority Leader John Thune (R., S.D.) have signaled any deal would likely focus on extending health-insurance subsidies. Those enhanced Affordable Care Act tax credits, first passed in 2021 by Democrats, are set to expire at year’s end. Democrats and some Republicans want an extension, but Republicans are seeking some new income limits on who receives subsidies. They also say discussions should only take place after Congress passes the stopgap bill keeping the government funded through late November.
    • The Senate was set to vote again before the Wednesday deadline on the same GOP bill that Democrats had previously rejected. Republicans have a 53-47 majority, but they need 60 votes to pass most legislation. With the House out this week, that is currently the only option available.
  • Modern Healthcare adds,
    • “The federal government is on track to shut down at midnight EST Wednesday, when fiscal 2026 begins. President Donald Trump and the Republican-led Congress have failed to enact annual appropriations bills to finance government operations. Negotiations with Senate Democrats continued Monday.
    • “Medicare, Medicaid, the Children’s Health Insurance Program and the federal health insurance exchanges would continue operating for the immediate future, HHS announced. The first three programs are mandatory and not subject to annual appropriations and CMS would cover exchange expenses with insurance company user fees.”
  • Federal News Network reminds us,
    • “Even if an agency doesn’t pay health premiums on time to OPM, federal employees and other enrollees in the Federal Employees Health Benefits (FEHB) program, as well as participants in the Postal Service Health Benefits (PSHB) program, maintain coverage throughout the duration of a shutdown, OPM has said in shutdown guidance.
    • “Those same rules apply to coverage through the Federal Employees Dental and Vision Insurance Program (FEDVIP), the Federal Employees’ Group Life Insurance (FEGLI) program and the Federal Long Term Care Insurance Program (FLTCIP).
    • “While all FEHB and PSHB participants maintain health coverage during a shutdown, those who are excepted or furloughed are not expected to pay health premiums while a shutdown is ongoing. Enrollees, however, will have to make any payments for premiums that accumulate during a shutdown, once the shutdown ends.”
  • Govexec offers part 2 of a series of commentaries about OPM in the second Trump Administration while FedSmith reminds folks about five mistakes to avoid during the upcoming FEHB / PSHB / FedFlex Open Season.
  • Avalere Health calls attention to key health policy actions to watch for during the rest of this year.
  • Mercer Consulting informs us,
    • “The 2026 changes to the Medicare Part D drug benefit passed under the Inflation Reduction Act are generally modest compared to the significant adjustments made in 2025. However, new instructions related to determining the creditable coverage status of prescription drug coverage allow plan sponsors to utilize a revised methodology for 2026. Plan sponsors should review the new methodology as they determine the most suitable one for their particular group health plan.
    • “Prior to Oct. 15 each year, plan sponsors providing prescription drug coverage must notify Part D-eligible individuals enrolled, or seeking to enroll, in their group health plan about whether the plan’s drug coverage is creditable — generally, whether it’s expected to pay, on average, at least as much as the Part D standard prescription drug coverage. Additionally, plan sponsors are required to report the creditable coverage status of their prescription drug plans to the Centers for Medicare and Medicaid Services each year, within 60 days of the plan year’s start.
    • “The IRA significantly enhanced Medicare Part D beginning in 2025, raising concerns among some plan sponsors about whether their drug coverage would remain creditable.  Instructions provided by CMS for 2026 take into account the IRA’s enhancements and increased flexibility in how plan sponsors may determine whether their drug coverage is creditable going forward, updating their Simplified Determination Methodology for 2026. And for the first time, some Health Savings Account-qualifying High-Deductible Health Plans may be able to use the SDM to determine creditable coverage status.”
  • The American Hospital Association News tells us,
    • “The Office of Science and Technology Policy issued a request for information Sept. 26 seeking feedback on federal regulations that hinder AI development, deployment or adoption. The OSTP is requesting comments on regulations across all sectors, including health care, where the underlying assumptions, technical requirements or compliance frameworks may create unnecessary barriers to beneficial AI applications. The agency is accepting comments through www.regulations.gov until Oct. 27.”
  • and
    • “The AHA Sept. 29 sent recommendations to the Department of Health and Human Services and the Centers for Medicare & Medicaid Services to help ensure insurance plans adhere to the agencies’ health insurer pledge to reform prior authorization processes. They include monitoring plans’ progress in fully implementing existing regulations, such as the interoperability and prior authorization final rule and reforms issued in the 2024 Medicare Advantage final rule. “As a result of the enormous detrimental impact that certain prior authorization practices routinely place on patients, physicians and hospitals, the AHA has been actively pushing for reforms in this area for a long time and working with health plans to collaboratively reduce the burdens associated with these programs,” the AHA wrote.”
  • and
    • “The AHA Sept. 29 asked the Trump administration to provide exemptions for health care personnel from the proclamation issued Sept. 19 announcing changes to the H-1B visa program. The proclamation increases the fee to $100,000 for new H-1B petitions filed by employers, as well as implements other restrictions on the entry of certain nonimmigrant workers. Of nearly 400,000 H-1B petitions approved in fiscal year 2024, 16,937 of those, or 4.2% of the total filed petitions, were for medicine and health occupations, and half of those approved petitions were for physicians and surgeons.” 
  • The Labor Department’s Bureau of Labor Statistics issued its annual report
    • “Seventy-two percent of private industry workers had access to medical care plans and 45 percent of workers participated. Dental care was available to 30 percent of private industry workers in establishments with less than 100 workers, 50 percent of private industry workers in establishments with 100-499 workers, and 70 percent of private industry workers in establishments with 500 workers or more. Vision care benefits were available for 21 percent of workers in establishments with less than 100 workers, 34 percent of private industry workers in establishments with 100-499 workers, and 44 percent of private industry workers in establishments with 500 workers or more. on employee benefits in the United States.
  • Per Beckers Payer Issues,
    • “The National Committee for Quality Assurance has named Vivek Garg, MD, as its next president and CEO, effective Jan. 5.
    • “Dr. Garg succeeds NCQA founder and current president Margaret O’Kane, who will retire at the end of this year. He currently serves as chief medical officer at Humana’s CenterWell Senior Primary Care.
    • “Dr. Garg previously held leadership positions at CareMore and Aspire Health, Oscar Health and One Medical Group.”

From the Food and Drug Administration front,

  • Fierce Pharma lets us know,
    • “Kedrion Biopharma has scored an FDA approval for Qivigy for adults with primary humoral immunodeficiency (PI), a group of disorders that prevent the immune system from operating effectively. 
    • “As an intravenous immunoglobulin (IVIG) therapy, Qivigy provides patients with antibodies that are intended to help them ward off infections.
    • “Along with the approval, the Italian plasma collection specialist was quick to point out in a release that it plans to increase its investments in the United States. To support the production of Qivigy, Kedrion announced plans to invest more than $260 million in expanding its U.S. network with over 40 new plasma collection centers. 
    • “The company also said it will invest more than $60 million to expand capacity at its manufacturing facility in Melville, New York.”
  • and
    • “Johnson & Johnson’s Tremfya continues to expand its reach as now the FDA has approved the IL-23 inhibitor as a treatment for two pediatric patient populations.
    • “The agency endorsed Tremfya as a treatment for children 6 years and older who weigh at least 40 kg (88 pounds) with moderate to severe plaque psoriasis (PsO) who are candidates for systemic therapy or phototherapy.
    • “In addition, children 6 and older with active psoriatic arthritis are now eligible for the drug, provided they weigh at least 40 kg, J&J said in a Sept. 29 release.”

From the public health and medical / Rx research front,

  • MedPage Today reports,
    • “About 58 million pounds of corn dogs and other sausage-on-a-stick products were recalled across the U.S. because pieces of wood may be embedded in the batter. (AP)
    • Meanwhile, supermarket chain Albertsons recalled several of its store-made deli products because they may contain Listeria, shortly after federal health officials warned consumers not to eat certain pasta meals sold at Walmart and Trader Joe’s over Listeria concerns. (AP)
  • and
    • “Widespread HPV vaccination slashed infection risk and delivered protection for vaccinated and unvaccinated adolescent girls and young women alike, according to a cross-sectional analysis of six regional surveillance studies.
    • “Between 2006 and 2023, the adjusted proportion of vaccinated women in the six studies who were positive for the high-risk HPV-16 and HPV-18 types covered by the first FDA-approved 2-valent HPV vaccine (2vHPV) dropped 98.4%, said Jessica Kahn, MD, MPH, of Albert Einstein College of Medicine in New York City, and colleagues.
    • “In the 17-year period, the proportion of vaccinated women who tested positive for HPV types covered by the later 4-valent vaccine (4vHPV) dropped 94.2% and fell 75.7% for types covered by the current 9-valent vaccine (9vHPV).
    • “Those declines were paired with evidence of herd protection. The proportion of unvaccinated adolescent girls and young women who were positive for at least one HPV type covered by 2vHPV dropped 71.6%. The proportion positive for at least one HPV type covered by 4vHPV fell 75.8%, they noted in JAMA Pediatrics.”
  • and
    • “In the Southern Hemisphere, the adjusted flu vaccine effectiveness rates against outpatient visits and hospitalizations were 50.4% and 49.7%.
    • “Only 21.3% of flu outpatients and 15.9% of hospitalized flu patients were vaccinated.
    • “Health authorities in the Northern Hemisphere might expect similar levels of protection against influenza, experts said.”
  • STAT News notes,
    • “Heart attacks, heart failure, and strokes don’t come out of nowhere, a new study concludes. The first time they strike, patients, clinicians, and researchers might think there were no red flags.  
    • “But a prospective cohort study reports that more than 99% of people who experienced these illnesses had at least one of four risks for cardiovascular disease. They had “suboptimal” high blood pressure, cholesterol, or blood glucose, or they were current or former smokers. More than 93% of the more than 9.3 million people in two national cohorts followed for 20 years had more than one risk factor.
    • “Among women under 60, often considered to be at lowest risk, more than 95% had at least one nonoptimal risk factor before heart failure or stroke.
    • “This almost universal prevalence of warning signs is far higher than reported in other studies, the new paper asserted.
    • “Every practicing cardiologist has seen cases in which individuals without any known risk factors sustain an MI or develop significant coronary disease,” Neha Pagidipati of the Duke Clinical Research Institute wrote in a companion editorial, referring to myocardial infarction, or heart attack. “However, the prevalence of CVD without traditional risk factors may be significantly lower than previously described.”
  • MedPage Today adds,
    • “The increase in early-onset cancers is not necessarily due to a rise in clinically meaningful cancers, researchers argued, but may be due to increased diagnostic scrutiny and overdiagnosis.
    • “Of the eight fastest-rising cancers, only two — colorectal and endometrial cancer — have shown a slight increase in early-onset mortality.
    • “For the six other cancers, stable or declining mortality rates alongside rising diagnoses suggest that greater detection (rather than more disease) may account for the trend.”
  • Per Health Day,
    • “Acute cystitis may signal the presence of urogenital cancers in middle-aged adults, according to a study published online Sept. 16 in BMJ Public Health.
    • “Filip Jansåker, M.D., Ph.D., from Lund University in Sweden, and colleagues examined the subsequent risks for urogenital cancers in men and women aged 50 years and older diagnosed with acute cystitis. The analysis included roughly 1.67 million men and 1.89 million women, including 177,736 men and 427,821 women diagnosed with acute cystitis (first event) from 1997 to 2018.” * * *
    • “It is plausible that urogenital cancer, and perhaps even precancerous changes in the urogenital organ, might increase the risk of cystitis because of compromised urinary tract and host defense,” the authors write.”
  • Genetic Engineering and Biotechnology News relates
    • “Bispecific antibodies and chimeric antigen receptor (CAR) T cells demonstrate potent cancer immunotherapy in clinical use, yet most cancers remain poorly targetable. High-affinity antibodies needed to maximize cancer killing also detect low antigen expression in normal tissue, which causes toxicity in healthy tissue. Identifying cancer-restricted cell-surface protein antigens remains an ongoing challenge. 
    • “In a new study published in Cell titled, “Safe immunosuppression-resistant pan-cancer immunotherapeutics by velcro-like density-dependent targeting of tumor-associated carbohydrate antigens,” researchers from the University of California (UC), Irvine, have reported that targeting cancer-associated glycans with binding proteins can trigger tumor cell death without toxicity to surrounding tissue. The biologically engineered immunotherapies, known as glycan-dependent T cell recruiter (GlyTR) compounds, were shown to be safe and effective in models for a spectrum of cancers, including breast, colon, lung, ovaries, pancreas and prostate. 
    • “It’s the holy grail—one treatment to kill virtually all cancers,” said Michael Demetriou, MD, PhD, a professor of neurology, microbiology and molecular genetics at the UC Irvine School of Medicine and corresponding author of the study. “GlyTR’s velcro-like sugar-binding technology addresses the two major issues limiting current cancer immunotherapies: distinguishing cancer from normal tissue and cancer’s ability to suppress the immune system.”

From the healthcare business front,

  • STAT News reports,
    • “Perimenopause is the new buzzword in the business of women’s health.
    • “The menopause market has proved so successful that companies are increasingly pushing products aimed at younger women too.”
  • Beckers Hospital Review breaks down the massive 138-hosptial Common Spirit health system’s revenue by region for the fiscal year ending June 30 in 2025 and 2024.
  • MedPage Today points out,
    • “Among more than 3 million Medicare Advantage enrollees, value-based payment models outperformed fee-for-service models for all 15 clinical quality outcomes.
    • ‘The mean score differences for blood glucose control and blood pressure control indicated “markedly better performance” with value-based payment models.
    • “Clinical quality performance consistently improved as financial arrangements moved toward 2-sided risk sharing.”
  • The Brown & Brown consulting firm discusses “Practical Approaches for Employers to Manage High-Cost Claimants in Health Plans.”
    • “Managing high-cost claimants requires a delicate balance of cost control, care quality and employee experience. Employers who invest in data-driven decision making, proactive care management and thoughtful plan design are best positioned to reduce the financial impact of high-cost claimants without sacrificing the well-being of their workforce.
    • “By taking a strategic and holistic approach, employers can turn a major cost challenge into an opportunity to enhance healthcare delivery, improve outcomes and foster a healthier, more productive employee population.”
  • The Institute for Clinical and Economic Review (ICER) announced,
    • “today that it will assess the comparative clinical effectiveness and value of Comirnaty® (Pfizer, BioNTech), Spikevax® (Moderna), mNexspike® (Moderna), and Nuvaxovid® (Novavax) for the prevention of COVID-19, including both the short- and long-term effects of the infection.
    • “The assessment will be publicly discussed during a meeting of the New England CEPAC in June 2026, where the independent evidence review panel will deliberate and vote on evidence presented in ICER’s report.
    • “ICER’s website provides timelines of key posting dates and public comment periods for this assessment.”
  • The Wall Street Journal reports,
    • “Novartis NOVN said it is launching a direct-to-patient platform in the U.S. to sell a discounted version of its Cosentyx drug, the latest big pharma company to move to cut prices ahead of the Trump administration’s deadline.
    • “The Swiss pharmaceutical company said Monday that it would offer select units of Cosentyx—a drug treating immune-mediated inflammatory conditions like psoriasis and psoriatic arthritis—at a 55% discount to cash-paying patients with a prescription. The platform will come into effect on Nov. 1.
    • “Novartis’s launch of a direct-to-patient platform and the discount comes after President Trump said in a letter to pharmaceutical companies in July setting a deadline of Sept. 29 to impose cuts on drug prices.”
  • Fierce Pharma adds,
    • “As pharma companies face an imminent deadline from President Donald Trump related to his “Most Favored Nation” (MFN) drug pricing demands, the industry’s top U.S. lobbying group is touting three “major actions” by its members and calling for some policy shifts of its own.
    • “The timing of the Sept. 29 press release by the Pharmaceutical Research and Manufacturers of America (PhRMA) coincides with the deadline set by the president when he laid out the steps pharma companies “must take” to align certain U.S. prices with lower prices overseas. 
    • “But rather than directly addressing the core component of Trump’s demand, the PhRMA communication centers on its members’ infrastructure spending, patient financial assistance programs and a new website designed to compile drugmakers’ direct sales offerings.
    • “PhRMA members are planning $500 billion in U.S. investments over the next 10 years, including $100 billion in projects that haven’t been announced yet, PhRMA CEO Steve Ubl wrote in an accompanying Washington Post op-ed piece Monday.
    • “Besides the capital projects, the industry trade group also plans to launch a website compiling its members’ direct sales offerings. Over the last several months, Big Pharma players have been rolling out new direct-to-patient sales platforms that offer cash-paying patients steep discounts to list prices for certain medicines. This is one component of the president’s push to rein in U.S. prices, and pharmaceutical companies are happy to stick it to middlemen in the U.S. whenever possible.”
  • Per BioPharma Dive,
    • “Antibody drug specialist Genmab on Monday agreed to acquire Dutch biotechnology company Merus in an $8 billion deal centered around a drug that’s shown potential treating head and neck cancer.
    • “Per deal terms, Genmab will pay $97 per share in cash to acquire Merus, representing a 41% premium to the biotech’s closing price on Friday of about $68.  
    • “The deal hands Genmab a drug called petosemtamab and that’s in late-stage testing for head and neck cancer. Phase 2 data presented at the American Society of Clinical Oncology meeting in May showed that the drug helped extend survival when used alongside Merck & Co.’s immunotherapy Keytruda, a result that boosted shares and suggested it could change care for those tumors.”
  • and
    • “Emma Walmsley, the first woman to lead a big pharma company as CEO, will step down from that post Dec. 31, handing the reins of one of Britain’s premier drugmakers to commercial chief Luke Miels.
    • “In a statement Monday, GSK said Walmsley, who has been running GSK since 2017, will depart as part of a succession plan. Miels’ selection was the outcome of a “rigorous process” conducted over the last few months and that included consideration of “internal and external candidates.” He’ll start serving as GSK’s full-time CEO on Jan. 1.
    • “The CEO change ends a nine-year run for Walmsley atop GSK. During that time, Walmsley steered the big drugmaker through a turbulent period, during which it spun out its consumer health business to focus on innovative drugs while facing persistent investor pressure to boost its productivity and growth prospects.
    • “GSK also deepened its investment in oncology, expanded its HIV drug portfolio and brought to market the first vaccine for respiratory syncytial virus.
    • “Yet GSK missed an opportunity during the COVID-19 pandemic, when it decided against developing its own vaccine and partnerships with Sanofi and CureVac hit setbacks and delays.” * * *
    • ‘Miels joined GSK in 2017 after stints at AstraZeneca, Roche and Sanofi, in positions in Europe, Asia and the U.S. He will be paid a base salary of nearly 1.4 million pounds and qualify for bonuses of up to 300%, in addition to other incentives and benefits, according to GSK’s statement.
    • “Walmsley, meanwhile, will also step down from GSK’s board effective Dec. 31, but will remain with the company through Sept. 30, 2026, to support Miels “given the potential impact to GSK’s operating environment arising from geopolitics and new technologies.”

Weekend Report

David Ermer–CDC, CMS, Congress, COVID-19 vaccine, FDA, Medical / Rx research, Medicare, OPM, SCOTUS, U.S. Healthcare–

From Washington, DC,

  • Roll Call reports,
    • “The top four congressional leaders will head to the White House on Monday for a meeting with President Donald Trump in a last-ditch effort to prevent a partial government shutdown.
    • “The meeting, confirmed by sources familiar with the plans, comes after the president scrapped a separate discussion planned with just the two Democratic leaders.” * * *
    • “The Senate is back in session on Monday with 48 hours until agencies would have to start shutting down Oct. 1. The House, which on Sept. 19 passed a partisan GOP-drafted stopgap funding bill that would keep the government operating for seven weeks until the Thanksgiving recess, isn’t planning to return until at least Oct. 7.
    • “Speaker Mike Johnson wrote Friday on X that House Republicans “have done our job” and now it’s the Senate’s turn to act.” 
  • Here is link to the Congressional committee schedule for this week.
  • Roll Call notes,
    • “The Senate does have another option in the queue aside from leadership-driven proposals [for a continuing resolution], with a procedural vote expected Monday on a bill from Sen. Ron Johnson, R-Wis., to provide for automatic two-week continuing resolutions.
    • “My new bill simply provides for automatic two-week rolling continuing resolutions for any department for which an appropriation bill or longer-term continuing resolution hasn’t been passed. This would keep spending flat by prorating the previous year’s spending level,” Johnson wrote in a Sept. 21 Wall Street Journal opinion piece.”
  • SCOTUSblog informs us,
    • “Edward Lazarus, a former clerk to the late Justice Harry Blackmun, called it a “single marathon session.” Gregory Garre, who served as the U.S. solicitor general during the George W. Bush administration, described it as the place “where petitions go to die.” Lazarus and Garre were both referring to the “long conference” – a private meeting, taking place this year on Sept. 29, at which the justices will consider the roughly 2,000 petitions for review that have built up since their last regularly scheduled conference (on June 26) before their summer recess.
    • “The long conference is the unofficial start to the court’s new term, which by law officially begins on the first Monday in October. The tradition of a “long conference” at the end of September or in early October, before the justices take the bench to hear oral arguments, dates back to the early 1970s, according to a book by the late Chief Justice William Rehnquist. Until then, the court held its long conference during the first week in October and had oral arguments thereafter. But Blackmun suggested that the court should move its meeting to the last week in September, allowing it to begin oral arguments on the first Monday in October instead.”
  • Modern Healthcare lets us know,
    • “Medicare Advantage enrollment could slip next year, the Centers for Medicare and Medicaid Services announced Friday.
    • “Health insurance companies project Medicare Advantage membership will fall from 34.9 million this year to 34 million in 2026, CMS said in a news release. 
    • “That would mark the first annual decline in Medicare Advantage enrollment since at least 2007, according to CMS data analyzed by the health policy research organization KFF. The annual enrollment period runs Oct. 15-Dec. 7.
    • “Insurers also predict that Medicare Advantage will lose ground to fee-for-service Medicare next year. The privatized program surpassed traditional Medicare in 2023 but will cover 48% of beneficiaries in 2026, down from 50% this year, according to industry estimates reported to CMS.
    • “CMS offered a rosier assessment. “Based on recent historical experience and enrollment trends, CMS anticipates that enrollment in [Medicare Advantage] in 2026 will be more robust than the plans’ projections and that enrollment will be stable,” the agency said in the news release.”
  • Per MedTech Dive,
    • “The Food and Drug Administration has granted de novo classification to a continuous glucose monitor made by Biolinq for people with Type 2 diabetes.
    • “Biolinq says its device is the first CGM that does not require a needle to place the sensor beneath the skin, instead using a microsensor array that sits less deep in the skin.
    • “People with diabetes have a growing number of CGM options as the FDA has authorized new sensors in recent years, including the first over-the-counter sensors and implanted CGMs that can be worn for one year.“
  • P.S. The OPM Director did not add a new post to his Secrets of OPM blog on Friday.

From the public health and medical / Rx research front,

  • Healio tells us,
    • “A federal law required all new cars to be equipped with backup cameras after May 2018.
    • “The mandate was associated with a 62% reduction in back over injuries in a trauma center in Houston.”
  • and
    • “COVID-19 vaccination during pregnancy provides significant protection for mothers and their babies with no associated increase in risk, according to data from more than 1.2 million pregnancies presented at the AAP’s annual meeting.
    • “COVID-19 vaccination reduced admission, mortality and pregnancy-specific complications,” Nikan Zargarzadeh, MD, a postdoctoral research fellow in the division of fetal medicine and surgery at Boston Children’s Hospital, told reporters on Saturday. “On the neonatal side, it reduced NICU admission.”
  • and
    • “Many women suffer complications in the time between giving birth and the 6-week visit.
    • “A Women in Medicine Summit presenter discussed how her own journey informs her work and what she is doing to help new moms.”
  • NPR Shots reports,
    • “For more than four years, Lynn Milam’s life was bound by the pain that radiated from her swollen joints.
    • “My children could not hug me,” she says. “I couldn’t hold my husband’s hand.”
    • “Milam also couldn’t climb stairs or help raise her teenage son. She spent most days on the couch.
    • “The reason was rheumatoid arthritis, which occurs when the immune system starts attacking the lining of joints.
    • “Milam tried everything: physical therapy, acupuncture, steroids and even the latest immune drugs. Nothing worked.
    • “That changed in October of 2023, when a surgeon implanted an experimental device in Milam’s neck. For a minute each morning, it delivers pulses of electricity to her vagus nerve, which connects the brain with internal organs.
    • “Three weeks in, my elbow pain was completely gone,” she says. “Then my hands didn’t hurt anymore, the swelling started going away.”
    • “Eventually, all symptoms of rheumatoid arthritis had vanished. Milam, 60, says she and her husband have regained the life they enjoyed before she got sick.”
  • Per Medscape,
    •  “Tirzepatide was associated with improvements in body weight and body composition, and with lower insulin doses, in the first-ever randomized controlled trial (RCT) of the drug in people with type 1 diabetes (T1D).
    • “Tirzepatide may play a role in weight management in adults with T1D and obesity, even at low doses,” Jennifer R. Snaith, MD, of the Garvan Institute of Medical Research and St. Vincent’s Hospital Sydney, both in Darlinghurst, Australia, said at European Association for the Study of Diabetes (EASD) 2025 Annual Meeting.” * * *
    • [A]sked to comment, independent industry consultant Charles Alexander, MD, noted that, while the data look good, it’s a small study and that Lilly’s two much larger ongoing phase 3 trials of tirzepatide in T1D, SURPASS-T1D-1 (NCT06914895), and SURPASS-T1D-2 (NCT06962280), aimed at obtaining FDA approval, will produce more definitive results.
    • Alexander also pointed out that Novo Nordisk is not conducting a similar RCT of semaglutide in T1D. “At the end of the day,” if it’s approved, “all you’re going to have [in terms of incretin drugs] is tirzepatide licensed for T1D.” 
    • Snaith’s team is also conducting a further study, TIRTLE2, with insulin resistance as the primary outcome.

From the U.S. healthcare business front,

  • HR Dive reports,
    • “Amid rising healthcare costs, Amazon announced benefit updates Sept. 17 that include a “reduced-cost” healthcare plan for its fulfillment and transportation employees. Workers on the plan will only need to pay $5 a week and $5 for copays starting in 2026.
    • “Those costs amount to about $22 per month or $260 per year for employees. This results in reductions of weekly contributions by workers by 34% and copays for primary care, mental health and nonspecialist visits by 87%, Amazon said.
    • “The changes were made based on feedback offered by workers, Udit Madan, senior vice president of Amazon Worldwide Operations, said in the announcement.”
  • Fierce Pharma notes,
    • “Serial entrepreneur Robert Wessman, who has had a golden touch creating, acquiring and spinning off companies that primarily sell generic drugs, has brought together two of his fastest-growing enterprises as Lotus Pharmaceuticals has acquired a 100% equity stake in [U.S. based] Alvogen.
    • “The move, which transforms Alvogen into a subsidiary, catapults Taiwan-based Lotus into a top-20 specialty pharmaceutical company worldwide, according to a release. The deal has a total value of up to $2 billion.
    • The deal could also help shield Lotus—which does most of its business in Asia—from U.S. tariffs on pharmaceutical products. Thursday night, in a post on social media, President Donald Trump wrote that starting Oct. 1, the U.S. would impose a 100% levy on drugs imported by companies that aren’t in the process of building U.S. facilities.
    • “The transaction gives Lotus “access to U.S. R&D, manufacturing and commercial capabilities alongside our established strengths in Asia,” the company said in a release.”

Friday report

David Ermer–CDC, CMS, Congress, COVID-19, Medical / Rx research, Medicare, Mental health care, NCQA, U.S. Healthcare, Uncategorized–

From Washington, DC,

  • Govexec tells us,
    • “Federal employees have been asking a lot of questions since the White House put out guidance this week suggesting large swaths of them would face layoffs under a government shutdown if one occurs next week.
    • “So far the answer many of them are getting is: we are planning to send you home without pay, but only until the shutdown ends. That is to say, agency officials are telling employees they will face their normal shutdown furloughs, but not reduction-in-force notices. 
    • “We were told we won’t be RIF’d, regardless of whether we have to work,” said one General Services Administration employee, whose office is typically furloughed during a funding lapse. 
  • The Centers for Medicare and Medicaid Services announced,
    • [A]verage premiums, benefits, and plan choices for Medicare Advantage (MA) and the Medicare Part D prescription drug program are expected to remain stable in 2026. Average premiums are projected to decline in both the MA and Part D programs from 2025 to 2026.
    • CMS is committed to ensuring these programs work for Medicare beneficiaries while maintaining access to high-quality, affordable healthcare options, safeguarding taxpayer dollars, and making sure beneficiaries have the information they need to make informed choices about what is best for them. 
    • CMS releases this key information, including 2026 premiums, benefits, and access to plan options for MA and Medicare Part D prescription drug plans, ahead of the upcoming Medicare Open Enrollment, which runs from October 15, 2025, to December 7, 2025.
    • “Millions of Medicare beneficiaries will continue to have access to a broad range of affordable coverage options in 2026,” said CMS Administrator Dr. Mehmet Oz. “We want every beneficiary to take advantage of Open Enrollment—compare your options and choose the plan that gives you the right care at the best price.”
  • The American Hospital Association News informs us,
    • President Trump, late Sept. 25, announced that starting Oct. 1, the U.S. will impose a 100% tariff on any branded or patented pharmaceutical product, unless a company is building its pharmaceutical manufacturing plant in America. The president’s post on Truth Social said “is building” will be defined as “breaking ground” or “under construction” and that there would be no tariff on “these Pharmaceutical Products if construction has started.”   
    • As of 3 p.m. ET on Sept. 26, the administration has not released any official documents related to the tariff announcement.  
  • BioPharma Dive adds,
    • “The new pharmaceutical tariffs President Donald Trump announced on Thursday, which will go into effect on Oct. 1, could have a limited impact on the pharmaceutical industry due to multiple exemptions for generics, exports from Europe and companies already onshoring manufacturing.
    • “The tariffs, unveiled via a post on the social media platform Truth Social, haven’t been accompanied by legal documents, leaving key details unclear. However, the 100% levies, which are much smaller than the figure previously floated by the Trump administration, alleviate some uncertainty around U.S. drug pricing policy.
    • “The announcement comes days before the expected release of programs meant to align U.S. drug prices with what’s paid in Europe and elsewhere. Published reports have suggested those policies may be more modest than Trump originally proposed, however.”
  • FedWeek points out,
    • “A new bipartisan group of House members has been formed with a focus on the impact on jobs and delivery performance of the Delivering for America reorganization initiative.
    • “The Congressional Postal Service Caucus will focus on improving on-time delivery rates, protecting postal employees, and stopping harmful facility consolidations that reduce access in rural and underserved areas,” said a statement from the founding members. A caucus is a less formal organization than a congressional committee, typically focusing on issues—and trying to build consensus on them—that cross committee areas of jurisdiction.”
  • NCQA, writing in LinkedIn, lets us know about NCQA researchers sharing findings on emerging topics in health care.

From the public health and medical research front,

  • The Centers for Disease Control and Prevention announced today,
    • “COVID-19 activity has peaked and is declining in many areas of the country, but emergency department visits and hospitalizations are elevated nationally. Seasonal influenza and RSV activity is low.
    • “COVID-19
      • “The percentage of COVID-19 laboratory tests that are positive is declining nationally. The percentage of emergency department visits for COVID-19 are highest in children 0-4 years old. Hospitalization numbers and the percentage of emergency department visits are elevated in adults 65 years and older.
    • “Influenza
    • “RSV
      • “RSV activity is low nationally.
  • The University of Minnesota CIDRAP adds,
    • “The current COVID wave began in June, marked by a slow rise that never approached levels seen last summer.
    • “Wastewater SARS-CoV-2 detections are now at the moderate level and are highest in Northeast, followed by the West and the South.”
  • Prevention notes,
    • “The Stratus COVID variant, a.k.a. XFG, is currently the dominant strain of the virus in the U.S., causing 78% of cases in the country, according to CDC data.
    • “It’s an Omicron variant, and it’s a hybrid of two strains—LF.7 and LP.8.1.2,” says Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York.
    • Stratus has several mutations to the spike protein, which the virus uses to infect your cells and make you sick, per the World Health Organization (WHO). But the WHO also notes that the threat posed by Stratus is “low.”
  • The Wall Street Journal reports,
    • “President Trump’s return to office has supercharged the debate about childhood vaccinations. Trump himself recently stated that “children get these massive vaccines…like you give to a horse…they get like 80 vaccines,” while Health Secretary Robert F. Kennedy Jr. asserts that babies get up to 92 vaccine doses. In justifying Florida’s decision to end mandatory vaccine mandates for children, state surgeon general Joseph Lapado asked: “Who am I to tell you what your child should put in [their] body? I don’t have that right.”  
    • “These statements misstate the amount and number of vaccines administered to children. Over the course of 18 years, it’s typically 30 doses—in quantities about a tenth of a teaspoon—for about 16 different pathogens. But the critics raise important questions that parents have every right to ask. Why give vaccines so early in a baby’s life? And why shouldn’t parents just pick and choose what goes into their child?  
    • “The crucial context for this discussion is two facts. First, vaccines constitute only a minuscule fraction of the exposure to pathogens that children’s immune systems must contend with. Second, our bodies develop the most enduring antibodies in the early years of life.”
  • JAMA relates,
    • “For years, most observers attributed the higher number of Alzheimer disease cases among women to the simple fact that they live longer than men on average.
    • “Recently, though, scientists have come to recognize that the explanation for the sex gap in the prevalence of Alzheimer disease, the cause of most cases of dementia, is far more nuanced and complex, involving both biological and sociocultural factors.
    • “Research has focused on such potential contributors as women’s exposure to sex hormones, the genes in the X chromosome, the prevalence and effect of risk factors such as hearing loss, the apolipoprotein E ε4 (APOE4) variant, and diminished cognitive reserve related to lower education levels.
    • “Approximately 2 out of every 3 people living with Alzheimer disease in the US is a woman, Harvard neuropsychologist Rachel Buckley, PhD, noted. “Women actually tend to live with dementia for much longer than men.”
  • Per Health Day,
    • “An experimental pill can significantly reduce hot flashes and night sweats for women after menopause a new clinical trial has determined.
    • “Elinzanetant produced a nearly 74% reduction in the frequency and severity of these menopause symptoms within three months, researchers reported recently in JAMA Internal Medicine.
    • “Further, this relief lasted for a year, the trial found.
    • “This yearlong study not only confirmed the initial findings of rapid and significant reduction in the frequency and severity of hot flashes and night sweats but also provided evidence that these effects were sustained over a year, offering hope for longer-term relief,” researcher Dr. JoAnn Pinkerton said in a news release. She’s director of midlife health at University of Virginia Health in Richmond.”
  • and
    • “Routine screening can help find kids who are suffering from undiagnosed asthma in communities with high levels of the breathing disorder, a new study says.
    • “Asthma screening during well-child visits found that more than two-thirds (35%) of children with no previous diagnosis of asthma had at least one risk factor for the disease, researchers will report Monday at an American Academy of Pediatrics’ meeting in Denver.
    • “Further, about 24% of kids with risk factors were subsequently diagnosed with asthma, researchers said.”

From the U.S. healthcare business front,

  • Beckers Payer Issues reports,
    • “Commercially insured patients pay substantially different rates for the same procedure, with negotiated costs for inpatient procedures varying by an average ratio of 9.1, according to an August report from market intelligence firm Trilliant Health.
    • “The report reviewed health plan transparency data from Aetna and UnitedHealthcare, focusing on 11 inpatient and outpatient procedures.
    • “A coronary bypass without cardiac catheterization, excluding major complications or comorbidities, had negotiated rates ranging from $27,683 to $247,902. Another finding: Outpatient procedures at ambulatory surgery centers would often cost less than those taking place in a hospital’s outpatient department. Colonoscopies, for example, would cost 67.5% less on average than the median hospital rate.
    • “By reviewing a sample of 10 hospitals featured on a collection of “best hospitals” rankings, the researchers also found no correlation between cost and quality.”
  • and
    • “Regional, nonprofit health plans are falling behind large national insurers, with 71% recording an operating loss in 2024 and more than half having two years or less before regulatory intervention is triggered, according to a Sept. 24 report from HealthScape Advisors.
    • “Executives and boards of directors now face the most important decision of their leadership tenures: How do we survive?” the report said.” 
  • Kauffman Hall explains,
    • “The rise of ambulatory surgery centers (ASCs) marks a shift in how surgical care is delivered across the U.S. Amid soaring healthcare costs, tighter reimbursement and advancing surgical technology, health systems are rethinking where and how procedures are done. Many are moving complex surgeries like total joint replacement and spine out of hospitals and into ambulatory settings. Once limited in scope, ASCs are becoming key players in strategically important service lines like orthopedics.” * * *
    • “ASCs are not a magic wand for health systems. While they offer savings to payers, the economics are fragile for providers. Healthy margins require lean operations, smart sourcing and trusted partnerships.
    • “There’s a growing demand for more complex procedures in outpatient settings, but ASCs need to strategically position themselves to meet this demand in an operationally and financially sustainable way.
    • “With advances in surgical technology and care coordination, ASCs are ready to deliver on the promise of value-based care. The challenge for health systems isn’t just to shift where care is delivered, but to rethink how surgical care is structured, managed and financed for long-term performance.”
  • Optum, writing in LinkedIn, discusses how “breakthrough cancer drugs offer better outcomes – but soaring costs pose challenges.”
  • The Wall Street Journal reports,
    • “AstraZeneca AZN said it will offer its asthma and diabetes drugs at an up to 70% discount in the U.S. ahead of a Trump administration deadline for pharmaceutical companies to cut drug prices.
    • “The company said it would launch a direct-to-consumer platform on which eligible patients with prescriptions will be able to purchase its Airsupra and Farxiga drugs in cash at a discount. The platform will be available beginning Oct. 1.
    • “In July, President Trump sent pharmaceutical companies a letter setting a Sept. 29 deadline to propose cuts to their drug prices.
    • “In response, several drugmakers have rolled out direct-to-consumer platforms to offer discounted drugs. Earlier this week, Bristol Myers Squibb said it would offer its plaque psoriasis drug at an up to 80% discount, expanding on its discounted program for blood clot drug Eliquis, which it announced in July.”
  • Fierce Pharma adds,
    • “In an expansion of its previous moves to cut insulin prices, Sanofi will cap the price of each of its insulin products at $35 per month in the U.S. regardless of a patient’s insurance status.
    • “The move, which goes into effect at the start of next year, comes two years after the company slashed the price of its most popular insulin, Lantus, to $35 monthly for those with commercial insurance.
    • “Before that, in June of 2022, Sanofi reduced the price of an unbranded Lantus biologic from $99 per month to $35 for those in the U.S. without insurance.
    • “Sanofi’s cost-cutting efforts have mirrored those of the world’s other two primary sellers of insulin—Novo Nordisk and Eli Lilly—and come as advanced insulin products and insulin biosimilars are reaching the market.”


Thursday report

David Ermer–CMS, Congress, FDA, Generative AI, Medicare, OPM, U.S. Healthcare–

From Washington, DC,

  • The Wall Street Journal reports,
    • “The U.S. government is hurtling toward a shutdown in a matter of days with no exit ramp in sight, as Republicans and Democrats latch onto starkly different positions and the White House threatens to lay off more federal workers.
    • “Republicans are seeking a seven-week extension in federal funding at current levels, and they have dismissed Democrats’ demands for hundreds of billions of dollars in healthcare spending. In a move to raise the political pressure, President Trump’s budget chief late Wednesday vowed to use any lapse in funding to make deeper cuts in the federal workforce, a threat Democrats rejected as blackmail.
    • “Democrats see the funding deadline as a rare opportunity to shape legislation, and the party’s base voters are desperate for elected representatives to show more fight after months of demoralizing political defeats. Republicans are loath to offer any concessions, putting both parties on a collision course ahead of the Oct. 1 deadline.
    • “Democrats have “asked us to do something that’s totally unreasonable,” President Trump told reporters on Thursday. Asked about the possibility of a shutdown, he said: “Could be. Because the Democrats are crazed. They don’t know what they are doing.”
    • “Senate Minority Leader Chuck Schumer (D., N.Y.) has said he plans to stand firm this time and demand bipartisan talks, rather than acquiesce to a Republican plan to keep the government open, like he did in March. He said Democrats won’t be intimidated by the latest threat of federal layoffs.
    • “This is one of their threats, and their threats are not going to succeed,” Schumer said in an interview. “A lot of my colleagues who I’ve talked to today are very angry about this.”
  • Per Roll Call,
    • “Sources on both sides of the aisle and nonpartisan analysts agreed that, beyond the tough talk, top congressional Democrats have a weak hand to play and no discernible strategy for extracting the concessions from President Donald Trump and GOP leaders that they want on health care policy.
    • “A shutdown for the sake of a shutdown doesn’t help anyone,” a former Democratic congressional aide granted anonymity to speak candidly said. “If there is a shutdown, there also needs to be a plan to get out of it — and it will require a deal on all sides to end it, at a time when tensions would be even higher. It’s hard to turn back to bipartisan negotiations after that.”
  • Federal News Network adds,
    • “The Trump administration is taking a more aggressive approach than usual to what would happen in a government shutdown, after a White House memo Wednesday night told agencies to plan for further reductions in force if government funding lapses early next week.
    • “But with just days left before a government shutdown, many are questioning the ability for agencies to put together further RIF plans at all, since the reduction-in-force process is typically complicated and time-consuming, often taking months or longer.”
  • Bloomberg reports,
    • “The US will impose a 100% tariff on branded or patented pharmaceuticals, President Donald Trump announced Thursday.
    • “Starting October 1st, 2025, we will be imposing a 100% Tariff on any branded or patented Pharmaceutical Product, unless a Company IS BUILDING their Pharmaceutical Manufacturing Plant in America,” Trump said in a social media post.
    • “Trump said there would be no tariffs on pharmaceutical products if companies have broken ground on a US manufacturing plant, or if such a plant is under construction.”
  • and
    • “Pharmacy middlemen are working on a proposal to voluntarily change some of their business practices to avoid new regulation from the Trump administration.
    • “The proposals under discussion include ensuring patients don’t pay more than a pharmacy would charge to someone without insurance and increasing the use of lower-cost versions of expensive biologic drugs.
    • “The Pharmaceutical Care Management Association has drafted proposals to bring to the Centers for Medicare and Medicaid Services, according to a document viewed by Bloomberg News.”
  • The American Medical Association adds,
    • “The Department of Commerce Sept. 24 released a notice seeking public comment on an investigation it launched Sept. 2 on imports of personal protective equipment, medical consumables and medical equipment under Section 232 of the Trade Expansion Act of 1962. The provision authorizes the president to impose tariffs or other trade restrictions if an investigation determines that the importation of particular goods affects national security. The department is seeking comment on a range of criteria, including the current and projected demand for PPE, medical consumables and medical equipment; the extent to which production can meet demand; the role of foreign supply chains in meeting U.S. demand; the concentration of U.S. imports of those products and more. Comments are being accepted for 21 days following publication in the Sept. 26 Federal Register.”
  • Bloomberg tops it off with this,
    • “Three hours inland from Chennai, India, traffic crawls on a half-finished road past rice fields and cow crossings until it reaches a newer complex of neat white buildings. Among them is the cancer wing of a hospital founded over a century ago by American missionaries.
    • “By morning, the line of people waiting to be seen at Christian Medical College Vellore’s Ranipet Campus snakes from the parking lot to the front door. In a basement treatment room one day in May, several of those who’ve made it inside sit in beds getting an intravenous drip of a Bristol Myers Squibb Co. drug called Opdivo or a competing Merck & Co. drug, Keytruda. A single infusion might cost at least $7,000 at the standard dose in the US, and a year’s treatment more than $200,000. Here, by financial necessity, most of the patients are getting as little as one-sixth of that.  
    • “The remarkable thing is that the radically low doses may also be effective at keeping cancer sufferers alive, doctors here and in other hospitals across India say. The science isn’t settled, but hospitals in Israel, France, the Netherlands, Canada and the UK are all testing or implementing more modest dose reductions. A small trial in the US also found some benefits. The consequences could be dramatic, expanding access to cancer treatment in poor countries and bending the curve of skyrocketing drug prices in the developed world. Smaller doses could also help limit the serious side effects many patients endure, from diarrhea to thyroid problems.
    • “A broad reevaluation of dosing has the potential to benefit hundreds of thousands of people in developing countries who otherwise wouldn’t be able to afford the drugs. One obstacle has stood in the way: the drugmakers themselves. Paid per dose, they stand to lose billions of dollars if doctors prescribe less medicine to their patients.”
  • From ARPA-H news releases
    • The Advanced Research Projects Agency for Health (ARPA-H), an agency within the U.S. Department of Health and Human Services (HHS), today announced a new research and development opportunity through its Treating Hereditary Rare Diseases with In Vivo Precision Genetic Medicines (THRIVE) program. THRIVE intends to develop integrated platform technologies to accelerate precision genetic medicines (PGMs) and provide single-intervention precision treatments to slow, reverse, or prevent diseases at the genetic level. The program is designed to optimize affordability, scalability, and sustainability of lifesaving PGMs for patients through existing regional treatment centers and virtual clinics. This will allow patients to be seen and treated where they live.” * * *
    • “Learn more about THRIVE on its program page, including information about the solicitation and Proposers’ Day.” 
  • and
    • “The Advanced Research Projects Agency for Health (ARPA-H), an agency within the U.S. Department of Health and Human Services (HHS), today announced a new funding opportunity through its Genetic Medicines and Individualized Manufacturing for Everyone (GIVE) program. With cutting-edge production technologies, the program seeks to establish the U.S. as a frontrunner in advanced manufacturing methods for high-quality genetic medicines.” * * *
    • “Learn more about GIVE on its program page, including information about the ISO solicitation and Proposers’ Day registration.”
  • Per a U.S. Office of Personnel Management news release,
    • The U.S. Office of Personnel Management (OPM) today announced record levels of engagement and leadership from the Chief Human Capital Officers Council (CHCOC) under the Trump Administration, underscoring the Council’s critical role in driving forward personnel policy and workforce reform across the federal government. The Chief Human Capital Officers Council is the principal interagency forum for federal human capital leaders, bringing together the Chief Human Capital Officers from across the Executive Branch to coordinate policy, share best practices, and advance government-wide workforce initiatives.
    • Since January of this year, the Council has held 71 sessions, an increase of almost double compared to the 40 sessions held last year. These sessions cover everything from discussing the Deferred Resignation Program and return-to-office policies to SES performance and collective bargaining. Between January and March alone, the Council convened 34 times in just 50 workdays. Alongside these sessions, the Council has distributed more than 200 communications to federal agencies this fiscal year, including official memos, weekly updates, and special notices.
  • OPM also recently posted Benefits Administration Letter 25-102 about FEHB Enrollment Coordination for Married Federal Employees and Annuitants.
  • Avalere Health discusses an upcoming meeting at which new ICD-10 codes for 2026 will be selected.

From the Food and Drug Administration front,

  • BioPharma Dive relates,
    • “Capricor Therapeutics executives came out of a meeting with Food and Drug Administration officials confident that they can reverse a rejection of their experimental cell therapy for Duchenne muscular dystrophy. 
    • “The FDA turned down Capricor’s application for the drug, deramiocel, in July after questioning the research supporting its effectiveness. At the time, Capricor CEO Linda Marbán said the rejection was a surprise and that no major issues had been raised during the review.
    • “Now, FDA officials are indicating that they will reconsider the application with new data from a clinical trial called Hope-3 that’s already been completed, Capricor said Thursday. That’s important because Capricor won’t have to start all over with a new submission. “This is a giant win for us,” Marbán said during a conference call with analysts. Initial trial results are expected in the middle of the fourth quarter.”
  • and
    • “The Food and Drug Administration on Thursday approved a new medicine for breast cancer, clearing Eli Lilly’s Inluriyo for people with a specific genetic mutation.
    • “Previously known as imlunestrant, the drug has been cleared for use in a subgroup of adults whose metastatic, estrogen receptor-positive, HER2-negative breast cancer has progressed after at least one hormone therapy. The approval makes the treatment available specifically to people who fit that criteria and have mutations to a gene called ESR1 — an alteration Lilly believes to occur in about half of people with that form of the disease either during, or after, exposure to hormone therapy.
    • “The clearance was based on results published in the New England Journal of Medicine last year. Those findings, from a study called EMBER-3, showed that Inluriyo helped reduced the risk of disease progression or death among those with ESR1 mutations by 38% when compared to standard hormone-suppressing therapies. Inluriyo delayed tumor progression by a median of 5.5 months, or close to 2 months longer than those on typical drugs.”  
  • and
    • “Heartflow has received 510(k) clearance for an updated version of its plaque analysis algorithm, the company said Monday.
    • “The updated algorithm shows a 21% improvement in plaque detection, compared to the original version of the technology, the company said. 
    • “Heartflow disclosed the clearance alongside news that Cigna has become the second national insurer after UnitedHealthcare to update its policies to cover the plaque analysis product.”
  • MedPage Today points out,
    • “A risk evaluation and mitigation strategies (REMS) program is no longer required for the thyroid cancer therapy vandetanib (Caprelsa), the FDA announced on Thursday.
    • “The agency had required the safety program for vandetanib to ensure appropriate heart rhythm monitoring and safe use since its approval in 2011opens in a new tab or window as treatment for medullary thyroid cancer in patients whose disease has spread or cannot be surgically removed.
    • The approval of vandetanib was based on results from the phase III randomized ZETA trial in which patients randomized to receive vandetanib experienced a 65% reduction in the risk of disease progression compared to patients on placebo. A REMS was required for vandetanib due to potential for QT prolongation and reported cases of torsades de pointes and sudden death in patients taking the drug.
  • Fierce Pharma informs us,
    • “After nearly two decades in the endocrine scene, Crinetics is making its commercial debut with the approval of a game-changing treatment for the rare growth disorder acromegaly.
    • “The FDA on Thursday signed off on Crinetics’ paltusotine—now christened Palsonify—as a first-line treatment for adults with acromegaly for whom surgery didn’t work or isn’t an option.
    • “The drug is a selectively targeted somatostatin receptor type 2 (SST2) agonist. Unlike other somatostatin drugs that make up the bulk of current acromegaly care options, Palsonify is a small molecule, non-peptide therapy that can be taken orally, freeing up patients from frequent and often painful injections.
    • “The treatment marks the “next level of care for patients with acromegaly,” Scott Struthers, Ph.D., co-founder and CEO of Crinetics, said in a recent interview with Fierce Pharma, staking that claim on the drug’s ability to both help control patients’ hormone levels and address their symptoms in a once-daily treatment option.”
  • Per FDA news release,
    • “Today, the U.S. Food and Drug Administration authorized marketing of the Essilor Stellest eyeglass lenses to correct myopia, commonly referred to as nearsightedness, with or without astigmatism and to slow the progression of the disease in children 6 to 12 years old at the initiation of treatment.”

From the judicial front,

  • Modern Healthcare reports,
    • “A federal court has tossed a rule outlining how auditors must review Medicare Advantage insurance companies for overpayments, adding uncertainty to the federal government’s plan to audit every plan annually.
    • “On Thursday, Judge Reed O’Connor, of the U.S. District Court for the Northern District of Texas in Fort Worth, vacated the 2023 Medicare Risk Adjustment Data Validation, or RADV, rule, on the grounds that regulators violated the Administrative Procedure Act of 1946.”
    • “Under the rule, which was finalized in January 2023, the Centers for Medicare and Medicaid Services eliminated a key statistical tool, the fee-for-service adjuster, used to compare error rates in traditional Medicare versus Medicare Advantage. Regulators planned to apply the new audit method retroactively to insurers’ risk-adjustment code reviews dating back to 2018. When the rule was finalized, CMS estimated that the more stringent reviews would result in insurers returning $4.7 billion to the agency between 2023 and 2032. 
    • “Humana sued over the rule in September 2023, alleging the new audit methodology held private Medicare insurers to a higher standard than the fee-for-service program. 
    • “O’Connor sided with the insurer.  In a Thursday order, he ruled that CMS failed to adequately notify the industry that actuarial equivalence between traditional and Medicare Advantage plans no longer applied.
    • “Because there was no meaningful notice of defendants’ ultimate finding that actuarial equivalence does not apply to RADV audits, there was no meaningful dialogue regarding the costs and benefits of the surprise changes,” O’Connor wrote in the order.” 

From the public health and medical / Rx research front,

  • MedPage Today lets us know,
    • “Women who missed their first screening mammogram had a 53% higher risk of stage III breast cancer over the next 25 years and almost a fourfold higher risk of stage IV breast cancer.
    • “Breast cancer mortality was 40% higher among screening nonparticipants.
    • “Breast cancer incidence was nearly identical, suggesting the increased risk of later-stage diagnosis and breast cancer mortality resulted from delayed detection.”
  • Per Health Day,
    • “During August 2021 to August 2023, only 36.4 percent of U.S. adults had no cardiovascular disease (CVD) risk factors, according to a September data brief published by the National Center for Health Statistics.
    • “Catharine A. Couch, Ph.D., R.D., from the National Center for Health Statistics in Baltimore, and colleagues presented prevalence estimates for none, one, or two or more CVD risk factors (uncontrolled high blood pressure, uncontrolled high blood lipids, uncontrolled high mean blood glucose, and high body mass index) in U.S. adults from August 2021 to August 2023.
    • “The researchers found that 36.4, 34.9, and 28.7 percent of U.S. adults had no, one, and two or more CVD risk factors, respectively. More men than women had two or more CVD risk factors (31.7 versus 25.8 percent). With age, there was a decrease in the percentage of adults with no CVD risk factors, while a higher percentage of older adults had one or two or more CVD risk factors. Those with family income 350 percent or more of the federal poverty level had the highest percentage of adults with no CVD risk factors and the lowest percentage with two or more CVD risk factors. The percentage of adults with two or more CVD risk factors increased from 2013 to 2014 to August 2021 to August 2023.”
  • and
    • “Physical frailty may contribute to the development of dementia, according to a study published online Sept. 17 in Neurology.
    • “Xiangying Suo, from the School of Public Health of Zhengzhou University in China, and colleagues conducted a prospective cohort study based on U.K. Biobank participants without dementia to examine the link between physical frailty and dementia. Five criteria were used to define physical frailty (weight loss, exhaustion, physical inactivity, slow walking speed, and low grip strength).
    • “A total of 8,900 dementia cases were documented during a median follow-up of 13.58 years among 489,573 participants. The researchers found that the risk for dementia was significantly higher in those with prefrailty and frailty compared with nonfrail individuals (hazard ratios, 1.50 and 2.82, respectively). Compared with those with low genetic risk and nonfrailty, the highest risk for dementia was seen for participants with frailty and high genetic risk (hazard ratio, 3.87 for high polygenic risk score; 8.45 for APOE-ε carriers). A potential causal relationship was seen between physical frailty and dementia in the forward Mendelian randomization (MR) analysis (odds ratio, 1.79), while a null causal association was suggested in the reverse MR. Potential underlying mechanisms linking physical frailty to dementia include genetic background and neurologic and immunometabolic function.”
  • BioPharma Dive considers “Cancer patients are living longer than ever. Pain drugmakers haven’t kept up. Decades of slow-moving research, along with broader failures of the healthcare system, have left millions of people in daily pain. Doctors fear that’s bound to continue.”
  • BioPharma Dive also notes,
    • “Eli Lilly has canceled one clinical trial of an experimental muscle-sparing obesity drug, citing “strategic business reasons,” according to a federal database. The study was one of two Phase 2 trials testing the drug, known as bimagrumab, alone or with Lilly’s marketed medicine in people with obesity. The now-halted study included Type 2 diabetics as well.
    • “In an email to BioPharma Dive, a Lilly spokesperson said company executives “routinely evaluate our clinical development programs to optimize the potential for each product” and noted that a separate trial involving non-diabetic people with obesity is still underway. The trial stoppage was first reported by Bloomberg.
    • “Bimagrumab is among the drugs designed to preserve muscle in people taking weight loss drugs like Zepbound and Novo Nordisk’s Wegovy, which can cut lean mass as well as fat. But at least one biotech has said that additive weight loss effects are an approval requirement, suggesting higher clearance standards have been established by the Food and Drug Administration.”
  • The Washington Post explains why the brain hangs on to some memories but allows others to fade. Tying “fragile” memories to emotional events could help people remember them better in the future, researchers at Boston University believe.”
  • Per a National Institutes of Health news release,
    • “Today, the National Institutes of Health (NIH) announced the award of contracts for launching the Standardized Organoid Modeling (SOM) Center, a national resource that will be dedicated to using cutting-edge technologies to develop standardized organoid-based new approach methodologies (NAMs) that deliver robust, reproducible, and patient-centered research findings. With contracts totaling $87 million for the first three years, the center will be housed at the Frederick National Laboratory for Cancer Research (FNLCR), a facility supported by NIH’s National Cancer Institute (NCI). The center’s goal will be to leverage the latest technologies to enable real-time optimization of organoid protocols.
    • “This groundbreaking initiative will transform how we conduct biomedical research through innovative approaches to advancing human-based technologies,” said NIH Director Dr. Jay Bhattacharya. “By creating standardized, reproduceable, and accessible organoid models, we will accelerate drug discovery and translational science, offering more precise tools for disease modeling, public health protection, and reducing reliance on animal models.”

From the AI front,

  • STAT New reports,
    • “Artificial intelligence may help radiologists spot disease, but throwing the technology at millions of CT scans or mammograms is not without risks to patients and may drive up costs without showing much benefit. Katie Palmer reports on two efforts to prove out the potential.
    • “A large randomized controlled trial will explore the value of AI-aided mammography in screening for breast cancer. The technology is already widely used in the U.S., but the best evidence that it’s useful comes from Europe. The $16 million trial is funded by the Patient-Centered Outcomes Research Institute. Read more on what researchers may find here.
    • “Next month, NYU Langone Health will begin checking bone density in CT scans of people over 65 for osteoporosis, a condition that often goes undetected until someone breaks a bone. The health system may expand the work if it’s proven to help. This kind of opportunistic screening, which repurposes otherwise acquired scans, could be used to identify many treatable conditions. Katie’s interview is worth a read.”

From the U.S. healthcare business front,

  • Fierce Healthcare reports,
    • “CommonSpirit Health closed another fiscal year with operations in the red, with the large Catholic nonprofit pointing to expenses growth outpacing revenues “despite strong volume, salary cost management and higher productivity.”
    • “The 138-hospital system reported an as-recorded operating loss of $687 million (-1.8% operating margin) for the fiscal year ended June 30, 2025, as compared to the prior year’s $581 million operating loss (-1.5% operating margin).
    • “However, after adjustments to normalize delayed income from the California Provider Fee Program, CommonSpirit somewhat improved its stature with a $225 million operating loss (-0.6% adjusted operating margin) as opposed to fiscal 2024’s $875 million operating loss (-2.4% adjusted operating margin).
    • “Net income in fiscal 2025 was $1.1 billion as recorded and nearly $1.6 billion as adjusted, both increases over the prior year’s respective $797 million and $503 million.”
  • and
    • “Value-based cancer care navigation company Thyme Care raised $97 million in series D funding backed by major strategic investors across payers, employers, health systems and retail health.
    • “The latest funding propels Thyme Care’s valuation to north of $1 billion, a 2x increase from its valuation in July 2024 when it raised $95 million, according to a company spokesperson.
    • “The company plans to use the new funding to expand its business across verticals and to take on more breaking points in the oncology journey that drive up costs and cause friction in the patient experience, Robin Shah, CEO and co-founder of Thyme Care, told Fierce Healthcare.
    • “Thyme Care is now focused on tackling treatment denials, high drug costs and “the barriers that delay or prevent access to timely, affordable and appropriate care,” Shah said.’
  • and
    • “Medicare Advantage (MA) has been a consistent earnings booster for insurers, but recent challenges in this space are likely to ding profitability, according to a new report.
    • “Analysts at AM Best found that elevated utilization trends beginning in 2023 led to a $5.7 billion underwriting loss in 2024 for MA plans, while insurers reported gains in the previous five years. Underwriting gains in MA accounted for 40% of total gains from 2019 to 2022, but that dropped to 20% in 2023.
    • “The report found that close to three-quarters of companies with a significant concentration in MA reported underwriting losses in 2024.
    • “Medicare Advantage enrollment and premium continue to grow as more people are aging into the program. However, plans have experienced an increase in utilization and medical trends that have persisted longer than expected,” said Jason Hopper, associate director for industry research and analysis at AM Best, in a press release.“
    • “Changes to the risk-adjustment payment model by the Centers for Medicare and Medicaid Services, as well as lower Star Ratings across the industry, also have contributed to recent underwriting losses,” Hopper said.
  • MedTech Dive informs us,
    • “Guardant Health and Quest Diagnostics will collaborate to offer Guardant’s Shield blood-based colorectal cancer test through Quest’s distribution network, the companies said Wednesday.
    • “Physicians will be able to order the test through their Quest accounts and electronic health record starting in the first quarter of 2026.
    • “In an investor day presentation, Guardant Co-CEO AmirAli Talasaz also revealed plans to expand Shield to include multi-cancer detection. The multi-cancer offering will be available nationally in October.”
  • Modern Healthcare reports,
    • “As more upstarts strive to make a splash in the pharmacy benefit manager sector, RxBenefits CEO Robert Gamble thinks his company has devised something truly novel.
    • “Like other companies seeking to disrupt a market dominated by CVS Health subsidiary CVS Caremark, UnitedHealth Group division Optum Rx and Cigna unit Express Scripts, Illuminate Rx promises pharmacy benefits without spread pricing or hidden fees, and with transparency and a focus on generic and biosimilar drugs. The company launched Illuminate Rx this month.
    • “What Gamble said differentiates this offering is that RxBenefits has added an in-house PBM to its marketplace platform, where self-funded employers, brokers and benefits consultants can select among Illuminate Rx and other PBMs for the best deals.”
    • “RxBenefits, which serves 3 million insurance members and manages $3 billion in annual pharmacy spending, named veteran executive Gamble as CEO last December following Wendy Barnes’ departure to become president and chief executive of the pharmaceutical discount vendor GoodRx.”

Midweek update

David Ermer–CDC, CMS, FDA, Medical / Rx research, Patient safety, U.S. Healthcare–

From Washington, DC,

  • Federal News Network tells us,
    • “Despite being less than a week away from the government’s funding deadline, and with lawmakers still far from reaching a spending agreement, agencies have not published their plans for what would happen during a government shutdown.
    • “Often, leading up to a possible government shutdown, agencies will publish or update their shutdown contingency plans, which are made publicly available on the Office of Management and Budget’s website. Those plans typically detail how many federal employees at each agency would continue to work — and how many would be furloughed — if a shutdown were to happen.
    • “But even with the fast-approaching deadline for Congress to reach a spending agreement for fiscal 2026 appropriations, OMB’s webpage that usually hosts that contingency information is completely blank.
    • “OMB did not respond to multiple requests for comment from Federal News Network, asking if the Trump administration intends to publish agencies’ contingency plans, or if there were any alternative government shutdown planning efforts currently in the works.”
  • Politico adds
    • “The White House budget office is instructing federal agencies to prepare reduction-in-force plans for mass firings during a possible government shutdown, specifically targeting employees who work for programs that are not legally required to continue.
    • “The Office of Management and Budget move to permanently reduce the government workforce if there is a shutdown, outlined in a memo shared with POLITICO ahead of release to agencies tonight, escalates the stakes of a potential shutdown next week.
    • “In the memo, OMB told agencies to identify programs, projects and activities where discretionary funding will lapse on Oct. 1 and no alternative funding source is available. For those areas, OMB directed agencies to begin drafting RIF plans that would go beyond standard furloughs, permanently eliminating jobs in programs not consistent with President Donald Trump’s priorities in the event of a shutdown.
    • ‘The move marks a significant break from how shutdowns have been handled in recent decades, when most furloughs were temporary and employees were brought back once Congress voted to reopen government and funding was restored. This time, OMB Director Russ Vought is using the threat of permanent job cuts as leverage, upping the ante in the standoff with Democrats in Congress over government spending.”
  • Axios reports,
    • “Big drug companies so far are responding to President Trump’s demand they commit to his “most favored nation” pricing policy by raising prices abroad without cutting them in the U.S.
    • “That only gets halfway toward Trump’s goal of ending what he calls “global freeloading” and getting other developed countries to foot more of the cost while lowering costs for Americans.” * * *
    • “The pharmaceutical industry says it agrees with the goal of making other countries pay more and putting an end to “foreign freeloading.” But drastically cutting U.S. prices to match those abroad would hurt innovation, officials argue. 
      • “Industry is more receptive to other Trump ideas like offering sales directly to patients who pay on their own without insurance. 
      • “We must reject foreign price control models that ration care and suppress innovation,” PhRMA CEO Steve Ubl wrote in an op-ed in Stat in June. 
      • “If we instead required hospitals and [pharmacy benefit managers] to pass along the steep discounts they already receive — and ensured wealthy nations paid their fair share — U.S. prices could fall without jeopardizing our life sciences edge.”
  • Per an HHS press release,
    • “The Substance Abuse and Mental Health Services Administration (SAMHSA), a division within the U.S. Department of Health and Human Services (HHS), today announced it has awarded more than $45 million in new supplemental funding to State Opioid Response (SOR) program recipients to focus on sober or recovery housing among young adults. This investment advances President Trump’s Executive Order, Ending Crime and Disorder on America’s Streets, by providing sober housing and recovery support services, which are critical to combatting our Nation’s challenge of homelessness, addiction, and illness.
    • “President Trump has elevated this issue as a key public health and public safety priority,” said HHS Secretary Robert F. Kennedy, Jr. “All too often, young adults with opioid or stimulant use disorders lack safe housing to support their recovery. This funding can make a life-changing difference for young people working toward long-term recovery.”
    • “Firsthand experience has shown me that wraparound services, especially sober housing, play a vital role in breaking the cycle of addiction,” said SAMHSA Principal Deputy Assistant Secretary Dr. Art Kleinschmidt. “This supplemental funding will help expand that lifesaving care and help people pursue a fulfilling life in recovery.”
    • “Sober housing for those in early recovery is a safe and supportive alcohol- and drug-free residence where people can live, build stability and work toward independence. This therapeutic model allows people to actualize their hopes and dreams to live a fulfilling and self-directed life.”

From the Food and Drug Administration front,

  • Per MedTech Dive,
    • “Olympus told customers last week to stop using certain lots of its ViziShot 2 FLEX (19G) needles due to the risk that components may detach during procedures. 
    • “Olympus started the recall after receiving reports of patient injuries and one death. Olympus did not immediately respond to a request for comment or specify how many injury reports it had received.
    • “The medtech company has faced quality concerns in recent years, with the Food and Drug Administration sending multiple warning letters to Olympus in 2023 related to its endoscopes, and blocking some of the devices from entering the U.S. in June.”
  • and
    • “Johnson & Johnson has recalled certain automated controllers for its Impella heart pumps over a fault linked to five serious injuries, the Food and Drug Administration said Tuesday.
    • “The company’s Abiomed unit told customers to return the affected devices when contacted by its field servicing team because of potentially fatal purge pressure issues. Abiomed will make a design change during device servicing to correct the problem. Hospital inventory can continue to be used, according to the FDA’s alert.
    • “J&J’s recall, which triggered an FDA early alert, follows other recent safety actions to address two problems with Impella that were collectively linked to four deaths.”

From the judicial front,

  • Bloomberg Law reports,
    • “The full Fifth Circuit confronted the limits of agency rulemaking in arguments over a Biden administration rule for a surprise medical billing law.
    • “The en banc appellate court in New Orleans heard an appeal Wednesday on whether federal agencies exceeded their authorities in a rule on the calculation of a key figure under the No Surprises Act. That law is meant to protect patients from excessive medical bills.
    • “The billing law mandates that medical providers and health insurers settle out-of-network disputes through arbitration. The measure is aimed at protecting patients from medical bills stemming from out-of-network emergency care and from out-of-network clinicians’ care received at in-network facilities.
    • “Justice Department attorney Kevin Soter told the appellate court’s 17 active judges that the statute left it up to federal agencies—the Department of Labor, the Department of Health and Human Services, and the Office of Personnel Management—to come up with details on the arbitration process for surprise medical bill disputes.
    • “Judges Leslie Southwick and Catharina Haynes asked about impact of the US Supreme Court’s 2024 ruling in Loper Bright Enterprises v. Raimondo, which eliminated deference to agencies in interpreting vague laws. Soter said that through the statute, “Congress did clearly put this in the hands of the departments.” * * *
    • “The case is Texas Medical Association v. HHS, 5th Cir. en banc, No. 23-40605, oral argument 9/24/25.”

From the public health and medical / Rx research front,

  • The University of Minnesota’s CIDRAP tells us,
    • “In its weekly measles update, the Centers for Disease Control and Prevention (CDC) said there are now 1,514 confirmed measles cases in the United States reported this year, with 23 new cases reported in the past week. 
    • “Eighty-six percent of the cases have been part of 40 outbreaks reported to the CDC. Of note, 92% of case-patients are unvaccinated or have unknown vaccination status, 4% have only one measles, mumps, and rubella dose, and 4% were fully vaccinated. 
    • “Twelve percent of cases have required hospitalization, with 29% of those hospitalized aged 19 years or younger. There have been 3 confirmed measles deaths this year.” 
  • The Centers for Disease Control and Prevention announced,
    • “A new report from the Centers for Disease Control and Prevention (CDC), published in the Annals of Internal Medicine, highlights a dramatic increase in a dangerous type of drug-resistant bacteria called NDM-producing carbapenem-resistant Enterobacterales (NDM-CRE). 
    • “In a 2022 special report, COVID-19: U.S. Impact on Antimicrobial Resistance, CDC noted that in 2020 there were approximately 12,700 infections and 1,100 deaths in the U.S. due to CRE. The rise in NDM-CRE, documented in the new study, threatens to increase CRE infections and deaths.
    • “Between 2019 and 2023, NDM-CRE infections surged by more than 460% in the United States. These infections —including pneumonia, bloodstream infections, urinary tract infections, and wound infections—are extremely hard to treat and can be deadly. Detection is also challenging, as many clinical laboratories lack the necessary testing capacity.
    • “This sharp rise in NDM-CRE means we face a growing threat that limits our ability to treat some of the most serious bacterial infections,” said Danielle Rankin, an epidemiologist in CDC’s Division of Healthcare Quality Promotion. “Selecting the right treatment has never been more complicated, so it is vitally important that healthcare providers have access to testing to help them select the proper targeted therapies.”
  • Per MedPage Today,
    • “Sexually transmitted disease (STD) rates for U.S. adults fell last year, but syphilis in newborns continued to rise, according to new government data posted Wednesday.
    • “The CDC provisional data for 2024 showed a third consecutive year of fewer gonorrhea cases, and the second year in a row of fewer adult cases of chlamydia and the most infectious forms of syphilis.
    • “But congenital syphilis cases, in which infected moms pass the disease to their babies, aren’t seeing the same improvements. Such infections in infants can lead to deaths or lifelong health problems such as deafness, blindness, and malformed bones.”
  • and
    • “Drinking any amount of alcohol increased dementia risk, data from a combined observational and genetic study suggested.
    • “Light alcohol consumption was associated with low dementia risk in observational analyses, and genetic analyses showed a monotonic increasing dementia risk with higher alcohol intake, reported Anya Topiwala, DPhil, of the University of Oxford in England, and co-authors.
    • “Mendelian randomization suggested a causal role of alcohol consumption in increasing dementia risk with no evidence supporting a protective effect at any consumption level, Topiwala and colleagues wrote in BMJ Evidence-Based Medicine.”
  • BioPharma Dive informs us,
    • “UniQure said Wednesday it will ask the Food and Drug Administration next year to approve its gene therapy for the neurodegenerative disorder Huntington’s disease following positive data from a Phase 2 study that showed it slowed signs of disease progression by 75% after three years.
    • “Though from only 12 patients who’d received the highest tested dose of the therapy, AMT-130, and had been evaluated for at least 36 months, the effects were “greater than what we even anticipated and expected and hoped for,” said Sarah Tabrizi, director of the University College London Huntington’s Disease Center, on a conference call.”
  • and
    • “Acadia Pharmaceuticals is giving up on a drug to treat the insatiable hunger associated with Prader-Willi syndrome after a Phase 3 trial failed to prove the experimental medicine was more effective than a placebo.
    • “The 12-week study tested the effects of ACP-101 in 175 patients with the rare genetic syndrome. The main goal was improvement on a questionnaire measuring the hunger, known as hyperphagia. But the drug didn’t show advantages over a placebo on that primary endpoint or any secondary endpoint, Acadia said Wednesday.”
  • MedPage Today notes,
    • “Supplementing digital breast tomosynthesis (DBT) with molecular breast imaging (MBI) increased the detection of cancers in women with dense breasts, a prospective study suggested.
    • “In an analysis involving nearly 3,000 women with dense breasts, adding MBI to DBT led to incremental cancer detection rates of 6.7 and 3.5 cancers per 1,000 screenings in year 1 and year 2, respectively (both P<0.001), reported Carrie B. Hruska, PhD, of the Mayo Clinic in Rochester, Minnesota, and colleagues.
    • “Supplemental MBI also increased invasive cancer detection by more than 2.5 times that of DBT alone at both screening rounds, they noted in Radiology.
    • “Across both screenings, there were 30 cancers detected in 29 women with MBI only. Most of these incremental cancers (71%) were invasive. Additionally, 90% of the cancers detected only with MBI were node negative, “indicating that MBI screening provides early detection,” Hruska and colleagues wrote.”
  • Per Health Day,
    • “Providing immediate bedside hepatitis C virus (HCV) consultation at discharge from labor and delivery for women with HCV-affected pregnancies is associated with higher rates of treatment completion than referral for outpatient follow-up, according to a study published in the October issue of O&G Open.
    • “Leah Madeline McCrary, M.D., from Washington University in St. Louis (WashU), and colleagues evaluated the associations of a traditional postpartum outpatient referral (92 women) compared to an opportunistic inpatient consultation (33 women) for HCV treatment initiation on HCV treatment completion. 
    • “The researchers found that all individuals in the inpatient referral group had an inpatient consultation; however, a majority (55.4 percent) of those in the outpatient referral group did not present for consultations. Inpatient referral was associated with higher rates of HCV treatment completion (20 of 30) among women who were prescribed direct-acting antivirals compared with standard care (14 of 41). Inpatient treatment was associated with higher odds of treatment completion (adjusted odds ratio, 4.7).”

From the U.S. healthcare business front,

  • Healthcare Dive reports,
    • “Premier is going private through an acquisition by healthcare-focused investment firm Patient Square Capital, the companies announced Monday.
    • “The deal values Premier at roughly $2.6 billion and is set to take the company, which provides supply chain, technology and consulting services to thousands of U.S. providers, off the public markets after more than a decade.
    • “Premier and Patient Square expect the deal to close by the first quarter of 2026 subject to regulatory approval and other closing conditions.”
  • and
    • “Privia Health is acquiring a value-based primary care business from Evolent Health as the physician enablement company continues to expand its care delivery network into new geographies.
    • “Evolent has agreed to sell its accountable care organization business, called Evolent Care Partners, for $100 million in cash, the companies announced aftermarket Tuesday. Another $13 million is contingent on the ACO’s performance in traditional Medicare’s largest value-based care program in 2025.
    • “The transaction is expected to close in the fourth quarter and positively contribute to Privia’s adjusted earnings next year. Analysts said the deal is favorable for both parties.”
  • Fierce Healthcare relates,
    • “UnitedHealthcare is rolling out a new offering that aims to make it easier for employer plan members to shop for health and wellness solutions that meet their needs.
    • “The UHC Store is embedded in the insurer’s member portal and app and is now available to 6 million people enrolled in its employer-sponsored health plans. The payer giant plans to expand to 18 million members this year.
    • “Members who access the store are eligible for discounts of up to 15% of health and wellness programs of their choice, according to its announcement. The team initially focused on programs that fit within some of the most in-demand and high-cost areas, such as women’s health, musculoskeletal conditions and diabetes, according to Amy Jordan, vice president of consumer experience for UnitedHealthcare’s commercial business.”
  • and
    • “Harbor Health continues to expand its clinical footprint in Texas with the acquisition of 32 clinics from VillageMD.
    • ‘The deal expands the company’s reach into three new markets: San Antonio, El Paso and Dallas. Harbor Health also grew its established clinical footprint in its home base of Austin. Financial terms of the deal were not disclosed.
    • “The acquisition nearly quadrupled Harbor Health’s clinical presence, growing from 11 to 43 total clinics and adding more than 80 clinicians to its team of physicians and advanced practice providers. The acquisition also advances the company’s philosophy that having a denser network of clinics improves quality of care through enhanced accessibility.” 
  • Fierce Pharma informs us,
    • “Excitement around Fujifilm Biotechnologies’ massive new cell culture facility in Holly Springs, North Carolina, has been growing steadily since 2021, prompting a beefed-up investment from the company last April and a string of high-profile manufacturing contracts this year.
    • “Now, some four years since the project’s reveal, Fujifilm Biotechnologies is opening the doors to the facility, which might look familiar to anyone who’s worked with the CDMO in Denmark.
    • “The opening of the Holly Springs site, which will focus on antibody-based drugs, marks the debut of one of the largest cell culture biomanufacturing sites in the U.S., Fujifilm Biotechnologies said in a Sept. 24 press release.”
  • and
    • “Jiangsu Hengrui Pharmaceuticals’ dealmaking spree rolls on, with a potential $1.1 billion transaction on a rival to AstraZeneca and Daiichi Sankyo’s blockbuster Enhertu being the latest addition.
    • “Hengrui is licensing certain rights to its HER2 antibody-drug conjugate trastuzumab rezetecan to a subsidiary of India’s Glenmark Pharmaceuticals, the two parties announced (PDF) Wednesday.
    • “The deal is heavily back-loaded, as it features an upfront payment of $18 million and up to $1.09 billion in regulatory and commercial milestones, plus sales-based royalties.”
  • Beckers Payer Issues discusses an Experian Health report about the 2025 State of [Health Plan] Claims.
  • Avalere Health explains how “CMS Continues to Refine Value-Based Care Approach for Kidney Care.”
  • Radiology Business reports,
    • “Medical imaging accounts for 4 of the 5 most prevalent low-value healthcare services among Medicare beneficiaries, according to new research published Friday. 
    • “Imaging for plantar fasciitis” was the most frequently delivered unnecessary exam, occurring nearly 84 times per 100 Medicare beneficiaries, experts write in JAMA Health Forum. Low-value imaging for headache (76/100), syncope (72/100) and lower back pain (39/100) also made the top five, with vertebroplasty and kyphoplasty at No. 4. 
    • “The findings are based on a review representing claims from over 3.7 million Medicare beneficiaries treated between 2018 and 2020. Altogether, the payment program spent approximately $484 million on 15 different low-value imaging services, a figure that balloons to nearly $584 million when factoring in beneficiaries’ out-of-pocket costs.  
    • “Findings of this cross-sectional study highlight that reforms aimed at reducing spending for low-value services are feasible to achieve billions in savings without compromising patient health,” David D. Kim, PhD, and A. Mark Fendrick, MD, with the universities of Chicago and Michigan, respectively, wrote Aug. 1.”

Friday report

David Ermer–CDC, CMS, Congress, COVID-19, COVID-19 vaccine, FDA, Medical / Rx research, Medicare, NCQA, No Surprises Act, OPM, Patient safety, U.S. Healthcare–

From Washington, DC,

  • The Wall Street Journal reports
    • “Senate Democrats blocked Republicans’ stopgap measure that would keep the government funded until late November and insisted that major healthcare spending be added to the bill, raising the odds for a partial shutdown in less than two weeks.
    • “Friday’s vote in the Republican-controlled Senate was 44 in favor and 48 against, short of the 60 votes required. Sens. Rand Paul of Kentucky and Lisa Murkowski of Alaska were the only Republicans to vote against the measure, while Democratic Sen. John Fetterman voted in favor. Several Republicans were absent. 
    • “The GOP-led House narrowly passed the measure earlier in the day in a 217-212 vote largely along party lines.
    • “The failure of the bill in the Senate set the stage for a down-to-the-wire standoff, with both parties standing firm and saying the other one would take the blame for a fall shutdown. * * *
    • Democrats proposed an alternative that would fund the government through Oct. 31 and reverse hundreds of billions of dollars in cuts to Medicaid enacted under the Republican tax-and-spending legislation that Republicans have rebranded the “working families tax cut.” The Democratic alternative would permanently extend certain ACA subsidies that expire at the end of this year. * * *
    • Republicans rejected the Democratic proposal as unserious. It failed in its own vote with 47 in favor and 45 opposed, short of the 60-vote requirement. Republicans control the Senate 53-47.
    • “The Democrats want a ransom payment of more than $1 trillion to keep the government open for only four more weeks,” said Senate Majority Whip John Barrasso (R., Wyo.).
    • [Senator Lisa] Murkowski [(R. AK), who voted against both the Republican plan and the Democratic proposal, said she wants a continuing resolution that extends enhanced ACA subsidies for two years, in addition to addressing some fiscal year 2026 appropriations and funding for the public media.
    • “Both of these were messaging bills,” she said. “They both did what everybody predicted was going to happen, which was, they were going to go down.
  • STAT News reports good news from Atlanta,
    • “A government advisory committee voted unanimously Friday to recommend that individuals 6 months and older should discuss the risks and benefits of Covid-19 vaccines with their health care providers before deciding whether to get vaccinated.
    • “The decision, if signed off on by federal health leaders, would preserve insurance coverage for the shots, and is similar to the Food and Drug Administration’s approvals of the updated vaccines earlier this year. The Advisory Committee on Immunization Practices, convened by the Centers for Disease Control and Prevention, emphasized that for people under 65, the benefits of vaccination are most clear for people with risk factors for severe Covid-19.
    • “This vote provides for immunization coverage through all payment mechanisms including entitlement programs such as Children’s Health Insurance Program, Medicaid, and Medicare, as well as insurance plans through the federal health insurance marketplace,” a Health and Human Services spokesperson said.”
  • and
    • “A key government advisory committee voted Friday to postpone a vote on whether to delay infants’ first hepatitis B vaccine — temporarily alleviating fears that a new recommendation on shot timing could reverse the significant progress made in controlling the disease’s spread in recent decades.
    • “The decision followed a lengthy deliberation on Thursday by the newly reconstituted Advisory Committee on Immunization Practice, which pressed scientists from the Centers for Disease Control and Prevention on the necessity of the birth dose, and brought into question the veracity of the data presented on the risks and benefits of the vaccine. But ultimately, members voted to push the vote.”
    • “I believe that there’s enough ambiguity here and enough remaining discussion about safety, effectiveness, and timing that I believe that a vote today is premature,” Robert Malone, a member of the committee, said on Friday. All of the members of the committee, except its chair, Martin Kulldorff, voted to table the vote.”
  • Per a Congressional news release.
    • “Today, U.S. Senator Bill Cassidy, M.D. (R-LA), chair of the Senate Health, Education, Labor and Pensions (HELP) Committee, released a statement on the Advisory Committee on Immunization Practices (ACIP) postponing a vote to change the recommendation for the hepatitis B vaccine for newborns. If a recommendation for a vaccine is altered without a scientific basis, insurance companies may decide to no longer cover it for patients free of charge. Additionally, doctors will lack the necessary information to counsel families, so they make the best health care decisions for their children.
    • “At Wednesday’s hearing, Cassidy underscored the importance of families having access to the hepatitis B vaccine at birth.”
  • Here is an informative Blue Cross link to an article about No Surprises Act abusive practices by providers particularly in the arbitration / IDR process.  In my opinion, which supplements the Blue Cross recommendations, the NSA arbitration process would be more equitable if the Tri-Agencies added more substance from the AAA baseball / final offer rules to its IDR procedures. 
  • Beckers Payer Issues informs us,
    • “CMS has finalized a rule requiring Medicare Advantage plans to submit provider directory data for inclusion in the Medicare Plan Finder. 
    • “The change, aimed at improving transparency and beneficiary decision-making, takes effect January 1, 2026.
    • “Under the rule, MA plans must make provider directory information available to CMS in a standardized format for online publication, update the data within 30 days of becoming aware of changes, and attest at least once a year to the accuracy of the information.
    • “CMS said the move is designed to allow beneficiaries to more easily compare provider networks across plans without having to navigate multiple websites. The agency expects to publish an operational guide in the coming months with technical specifications for plans to follow, along with a testing period before the data appears publicly online.”
  • The American Hospital Association News explains that this CMS rule was part of a larger rulemaking.
    • “The Centers for Medicare & Medicaid Services Sept. 18 released a final rule on policy and technical changes to Medicare Advantage, the Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly for contract year 2026. Yesterday’s final rule follows one released in April on other changes for MA and prescription drug programs. In the latest final rule, CMS finalized a requirement aimed at increasing beneficiary access to provider directory data in the CMS Medicare Plan Finder platform.”
  • The Government Accountability Office released a report titled “Urban Hospitals: Factors Contributing to Selected Hospital Closures and Related Changes in Available Health Care Services.”
    • “About half of U.S. hospitals are in urban areas. More urban hospitals closed than opened from 2019 to 2023.
    • “All of the 5 hospitals in our review struggled financially before they closed, with inpatient volumes decreasing at 4 of them. The anticipated cost of upgrading or maintaining aging facilities also contributed to the closures of all 5 hospitals.
    • “After closure, 2 of the hospitals still provided outpatient services, while the other 3 stopped all services.
    • “Representatives from local hospitals, providers, and community organizations told us some community residents continued having trouble getting health care after all 5 hospitals closed.”
  • Last but not least, OPM Director Scott Kupor released his regular Friday blog post which concerns OPM’s mine in Boyers, PA, that holds paper personnel records.
    • “The Boyers mine is but one of many examples of opportunities for modernization across the federal government. None of these challenges are rocket science – maybe with the exception of our friends at NASA – but they have been plagued for too long by a system that doesn’t demand inventiveness and efficiency as first-class citizens in the government vernacular. OPM aims to create fluency in this new language – and we are starting with one retirement piece of paper at a time.”

From the Food and Drug Administration front,

  • The New York Times reports,
    • “The cancer medication Keytruda is the world’s best-selling drug. But with lower-priced competition set to arrive as soon as 2028, Keytruda’s manufacturer, Merck, is on the brink of losing tens of billions of dollars in sales.
    • “To keep Keytruda revenue flowing, Merck followed a well-worn playbook. It developed a new version of the drug, given as a shot under the skin, which the Food and Drug Administration approved on Friday.
    • “The company is talking up the new version as quicker and easier for patients than the original therapy, which is given through tubes as an intravenous infusion.
    • “Keytruda is approved to treat 18 types of cancer, including of the skin, lung, breast and colon. It has been given to 2.9 million patients and helped former President Jimmy Carter extend his life by nearly a decade. Since arriving in 2014, Keytruda has generated $146 billion in sales for Merck. The drug accounts for nearly half of Merck’s revenue.”
  • Per MedPage Today,
    • “The FDA approved the Altaviva implantable nerve stimulator for urge urinary incontinence (UUI), a common symptom of overactive bladder (OAB), Medtronic announced.
    • “Inserted near the ankle in a minimally invasive procedure, the device generates low-level electronic impulses that stimulate the tibial nerve to restore bladder-brain communication. The device is the third tibial neuromodulator for UUI, joining the eCOIN device approved in 2022opens in a new tab or window and the Revi System approved in 2023.
    • “The Altaviva device represents a significant advancement for patients with urge urinary incontinence who often weigh the invasiveness of a therapy and the potential side effects when considering treatment options,” Kevin Benson, MD, of Sanford Health in Sioux Falls, South Dakota, said in a statement. “I’m excited to offer my patients this simple experience and believe the Altaviva device has the potential to transform lives and bring new hope to more people.”
  • Per MedTech Dive,
    • “The Food and Drug Administration has published an early alert about risks posed by Abbott’s Tactiflex Ablation Catheter.
    • “Officials published the alert Thursday in response to Abbott writing to customers. The company updated its instructions after reviewing three reports of catheter tips detaching in patients. 
    • “Abbott had not received any reports of serious injuries or deaths as of Sept. 11. However, the potential for harm led the FDA to class the safety action as a potentially high-risk issue.”
  • Per an FDA news release,
    • “Today, the U.S. Food and Drug Administration granted accelerated approval to Forzinity (elamipretide) injection as the first treatment for Barth syndrome, in patients weighing at least 30 kg. Barth syndrome is a rare, serious and life-threatening disease of the mitochondria (the energy-producing parts of cells).
    • “The FDA remains committed to facilitating the development of effective and safe therapies for rare diseases and will continue to work diligently to help ensure patients with rare diseases have access to innovative treatments,” said George Tidmarsh, M.D., Ph.D., Director of the FDA’s Center for Drug Evaluation and Research.
    • Barth syndrome primarily affects males, typically starts with severe heart failure in infancy, and causes premature death. Patients who survive into adolescence and adulthood often have fatigue, poor stamina, and exercise intolerance. The quality of life and daily functioning of patients with Barth syndrome are significantly affected throughout their lives.”

From the public health and medical/Rx research front,

  • The Centers for Disease Control and Prevention announced today,
    • “COVID-19 activity has peaked and is declining in many areas of the country, but emergency department visits and hospitalizations are elevated nationally. Seasonal influenza activity is low, and RSV activity is very low.
    • “COVID-19
      • “The percentage of COVID-19 laboratory tests that are positive is declining nationally. Emergency department visits for COVID-19 are highest in children 0-4 years old and elevated in adults 65 years and older. Hospitalization numbers are elevated in adults 65 years and older.
    • “Influenza
    • “RSV
      • “RSV activity is very low nationally.
  • The AHA News points out,
    • “The Department of Health and Human Services Sept. 18 announced it will take new actions to help improve care for individuals with long COVID. They include a public awareness and education campaign; the launch of an online platform for physicians, researchers and health systems to share best practices and clinical insights; and an Agency for Healthcare Research and Quality report also released Sept. 18 that covers the sources of health coverage for adults with long COVID.” 
  • Fierce Pharma lets us know,
    • “The Centers for Disease Control and Prevention (CDC) has come out with a strong recommendation for the use of Gilead Sciences’ twice-yearly HIV pre-exposure prophylaxis (PrEP) med Yeztugo, representing a step forward on the road to wider U.S. adoption of the med. Still, work remains to increase access for all who need it, advocacy groups warn. 
    • “The CDC PrEP Guidelines Work Group issued its clinical recommendation in a Sept. 18 Morbidity and Mortality Weekly Report (PDF), pointing to Gilead’s Purpose 1 and Purpose 2 trials. The studies, which also formed the backing of the FDA’s June approval, showed a respective 100% efficacy among females and 96% efficacy among a mostly male trial population compared with background HIV incidence.
    • “Based on the studies, the CDC “strongly recommends” Yeztugo (lenacapavir) as an HIV PrEP option in those who would benefit from PrEP, noting that the drug “has the potential to improve PrEP adherence and thus enhance HIV prevention.”
  • Per Health Day,
    • “Aspirin can cut by more than half the risk that colon cancer will come back following initial treatment, a new clinical trial has found.
    • “Daily aspirin reduced by 55% the risk of cancer recurrence in patients whose colorectal cancer is driven by a genetic mutation, researchers reported Sept. 17 in the New England Journal of Medicine.
    • “Aspirin is a drug that is readily available globally and extremely inexpensive compared to many modern cancer drugs, which is very positive,” lead researcher Anna Martling, a professor of molecular medicine and surgery at Karolinska Institute in Sweden, said in a news release.
    • “The study focused on people whose colon cancer was driven by a mutation of the PIK3 gene, which helps regulate cell growth and division in the human body.
    • “Every year, about 107,320 new cases of colon cancer and 46,950 cases of rectal cancer are diagnosed in the United States, according to the American Cancer Society.”
  • NBC News reports,
    • “Wildfire smoke is responsible for tens of thousands of deaths each year and will do more harm to U.S. residents by midcentury than any other threat driven by climate change, including extreme heat. 
    • “That’s the conclusion of a new research paper that provides some of the most extensive modeling of the growing health toll of wildfire smoke on public health in the U.S. 
    • “The study, which was published in the journal Nature on Thursday, found that each year, on average, wildfire smoke is causing more than 41,400 excess deaths, or more than would be normally expected without smoke given the demographics of the U.S. That figure is more than twice what was previously recognized in other studies. 
    • “By midcentury, the study’s authors expect that number to grow by an additional 26,500 to 30,000 deaths as human-caused climate change worsens and the risk of wildfires igniting increases. 
    • “Wildfire smoke is a much larger health risk than we might have understood previously,” said Marshall Burke, a professor of environmental social sciences at Stanford University and a study author.”

From the U.S. healthcare business front,

  • Modern Healthcare reports,
    • “Health systems are working directly with employers to improve cancer care and lower costs as demand — and employers’ healthcare expenses — surge.
    • “Providers are gearing up to treat more cancer patients, hoping to ease employers’ mounting frustration with steep premium increases, long appointment wait times and unnecessary treatment, health system and care navigation company executives said. Cutting out insurers through direct contracts could add transparency to employers’ healthcare costs and help standardize treatment strategies, they said.
    • “Employers and unions have no choice but to take a really hard look at solutions that are going to steer patients to high-quality and lower-cost care,” said Emily Kauff, executive director of Memorial Sloan Kettering Cancer Center’s MSK Direct. “Employers are in crisis — they need lower costs and better value in cancer care.”
  • Beckers Payer Issues adds,
    • “Patients who get primary care from older adult-focused, value-based care organizations are more likely to use these services regularly, according to a study published in NEJM Catalyst: Innovations in Care Delivery, a digital journal published by The New England Journal of Medicine. 
    • “The study, produced by Humana Healthcare Research and Suhas Gondi, MD, attending physician at Boston-based Massachusetts General Hospital, covered 3.2 million Medicare Advantage members and included six older adult-focused facilities, most full-risk practices, according to Humana Chief Medical Officer Kate Goodrich, MD. The team found value-based care — as opposed to physicians offering a greater volume of services — is linked to increased use of primary care services.
    • “The exciting thing about this paper is that it shows that in those higher or more mature types of practices that are focused on seniors, they’re getting more primary care, and they’re getting more consistent primary care,” Dr. Goodrich told Becker’s.
    • “This research builds from a 2024 study on how older adult-focused organizations can increase access to primary care, particularly among underserved populations.”
  • Per Modern Healthcare,
    • “UnitedHealth Group has named Sandeep Dadlani CEO of its Optum Insight technology arm, Dadlani announced in a social media post Thursday. 
    • “Dadlani previously served as UnitedHealth’s executive vice president and chief digital and technology officer. He succeeds Dhivya Suryadevara, who had served in that role and CEO of the Optum Financial healthcare banking division since May.
    • “In a LinkedIn post, Dadlani wrote that it was his first week as CEO of Optum Insight, which includes the Change Healthcare claims processing division.” 
  • and
    • “VillageMD is selling 32 Texas clinics to Harbor Health, an Austin-based primary and specialty clinic group that also offers health plans.
    • “The deal includes 10 clinics in Austin, 10 in San Antonio, six in El Paso and six in Dallas. More than 80 clinicians will join Harbor as part of the transaction, according to a Thursday news release. 
    • “Financial details were not disclosed.”
  • Beckers Payers Issues looks into why Blue Cross of Massachusetts consistently achieves a very high NCQA scorecard.