Tuesday report

Medicare

Tuesday report

David Ermer–CMS, Congress, FDA, Federal employment benefits, Medical / Rx research, Medicare, No Surprises Act, OPM, Telehealth, U.S. Healthcare–

From Washington, DC,

  • Fierce Healthcare reports,
    • “A prominent physician voice in the House of Representatives has introduced a new bill that would compel insurers to apply the cost for drugs purchased from direct-to-consumer platforms to deductibles and out-of-pocket maximums.
    • “North Carolina Republican Greg Murphy, M.D., on Tuesday unveiled the Every Dollar Counts Act, a bill that aims to lower patients’ out-of-pocket costs for pharmaceuticals. Murphy, a consistent critic of insurers and pharmacy benefit managers, notes in an announcement that consumers have increasingly embraced DTC offerings as costs rise.
    • “Using these platforms, patients can often find prices that cost far less out-of-pocket, especially for branded drugs, per Murphy’s office.”
  • The American Hospital Association News adds,
    • “The AHA and dozens of other organizations April 14 sent a letter of support to Reps. Suzan DelBene, D-Wash., and Mike Kelly, R-Pa., for their introduction of the Chronic Care Management Improvement Act. The bill would waive beneficiary cost-sharing requirements for Medicare beneficiaries receiving chronic care management services. Beneficiaries are currently required to pay a 20% coinsurance fee to receive such services. “This cost-sharing requirement creates a barrier to care, as beneficiaries are being billed for services that do not always include interfacing with their provider, thus creating confusion for patients,” the organizations wrote. “Also, many of these beneficiaries consider any additional out-of-pocket expense for healthcare services untenable.”
  • CMS has posted MMSEA Section 111 GHP User Guide Version 7.8 – April 13, 2026 (PDF)
    • “The GHP User Guide * * * is your primary source for Section 111 GHP reporting requirements.”
  • OPM Director Scott Kupor has added a new post titled “Merit Matters” to his Secrets of OPM blog.
    • “If we want the best talent in the federal government – which I think we do – we should not refuse to hire college dropouts, unless dropping out of college is somehow representative of their ability to work successfully on behalf of the American people. And, if they are in fact world-class engineers, then we should pay them at the level at which they are performing versus force-fitting them into a lower pay level because they have no prior work experience.
    • “Once again, merit matters.”
  • Per an OPM news release,
    • “US Office of Personnel Management (OPM) Director Scott Kupor joined Fox News’ Saturday in America with host Kayleigh McEnany to highlight the launch of EarlyCareers.gov, a new initiative to recruit more early career Americans into federal service and strengthen the government’s talent pipeline.”

From the Food and Drug Administration front,

  • Fierce Pharma reports,
    • “Even as Eli Lilly gets underway with its next major obesity launch in Foundayo, an FDA document related to the oral treatment shows lingering reservations about multiple “unexpected serious” risks potentially related to the drug.
    • “In the FDA’s approval letter (PDF) for GLP-1 pill Foundayo, the agency tasks Eli Lilly with obtaining more information about the med’s potential link to major adverse cardiovascular events and drug-induced liver injury. In addition, the agency wants to gain more info about delayed gastric emptying associated with the drug and its potential effects in lactating women.
    • “In its assessment of the medicine’s data, the FDA “determined that only a clinical trial (rather than a nonclinical or observational study) will be sufficient to assess a signal of a serious risk of retained gastric contents and to identify an unexpected serious risk for major adverse cardiovascular events (MACE), drug-induced liver injury (DILI), and exposure to [Foundayo] during lactation,” the letter says.”
  • STAT News adds,
    • “In a bid toward greater transparency, the Food and Drug Administration sent reminder letters to more than 2,200 companies and researchers that they are required to report clinical trial results to a federal government database or they may face fines.
    • “FDA officials disclosed that an internal analysis found results were not submitted for nearly 30% of studies that were “highly likely” to fall under mandatory reporting requirements. The agency also noted that the letters were sent to companies and researchers associated with more than 3,000 registered trials, some of which were publicly funded.
    • “In explaining its move, the regulator acknowledged a long-standing complaint from researchers who have argued that without access to specific data, trial results cannot be easily duplicated, and this inhibits greater understanding of how medicines might work. They also contend this can adversely affect treatment decisions and health care costs.”
  • MedTech Dive relates,
    • “Medline is removing certain angiographic syringes from the market due to problems with the devices becoming loose or disconnected.
    • “Medline began the recall in February, and it was posted to the Food and Drug Administration’s website last week. The problem was the subject of a warning letter that Medline received in March, also recently posted to the FDA’s website.” 
  • Per an FDA news release,
    • “The U.S. Food and Drug Administration today issued a draft guidance for sponsors seeking approval of human gene therapy products involving genome editing technologies. When finalized, this guidance will provide recommendations for standardized methods for comprehensively assessing the safety of genome editing therapies to bring effective treatments to patients sooner.
    • “Genome editing holds extraordinary promise for treating previously incurable genetic diseases, and today’s announcement represents the FDA’s forward approach to drive innovation and advance the development of genome editing therapies,” said FDA Commissioner Marty Makary, M.D., M.P.H. “This guidance provides sponsors with clear, scientifically-grounded recommendations for evaluating off-target editing risks using state-of-the-art sequencing technologies. We are serious about moving this ball forward.”  
    • “The draft guidance, issued by the Center for Biologics Evaluation and Research, supports the FDA’s framework for accelerating development of individualized therapies for ultra-rare diseases launched in February. The framework revolutionizes how the FDA engages with industry and promotes a path for transformative rare disease treatments.
    • “The “Safety Assessment of Genome Editing in Human Gene Therapy Products Using Next-Generation Sequencing” guidance provides specific recommendations on sequencing strategies, sample selection, analysis parameters, and reporting.”

From the judicial front,

  • Healthcare Dive reports,
    • “A federal [magistrate] judge has tossed an Elevance subsidiary’s lawsuit against billing intermediary HaloMD and several California-based providers alleging they’re abusing the out-of-network billing dispute process set up by the No Surprises Act.
    • “[Magistrate] Judge Karen Scott of the Central District of California dismissed the suit on Monday, finding that Anthem Blue Cross, Elevance’s California subsidiary, failed to prove that the companies were gaming the law’s independent dispute resolution, or IDR, in order to inflate their reimbursement.
    • “It’s a major win for HaloMD, which is facing similar lawsuits from Elevance in three other states and has found itself in hot water over its status as the No. 1 submitter of IDR disputes. The Texas-based company cheered the court’s decision, while Elevance said it plans to appeal.”
    • Yesterday, Anthem Blue Cross did appeal the court’s decision to the U.S. Court of Appeals for the Ninth Circuit.
  • Bloomberg Law reports,
    • “A Delaware judge threw out lawsuits seeking to link the heartburn drug Zantac to cancer, freeing makers of the product from facing trials in the state over the cases.
    • “Superior Court Judge Francis “Pete” Jones concluded Monday lawyers for ex-Zantac users couldn’t produce legitimate evidence backing up claims the over-the-counter product caused cancer. Zantac is currently made by French drugmaker Sanofi.” * * *
    • Because former Zantac owners GSK Plc, Pfizer Inc., Sanofi and Boehringer Ingelheim Pharmaceuticals already have settled thousands of Zantac suits over the last several years, it’s unclear how many Delaware cases will be dismissed by Jones’ order. GSK paid more than $2 billion in 2024 to resolve what it said was more than 90% of its pending cases.

From the public health and medical / Rx research front,

  • Fierce Healthcare reports,
    • “Seven in 10 U.S. adults gamble, according to a survey from the National Council on Problem Gambling (NCPG). Commercial gaming revenue broke records at $78.7 billion in 2025, with over $18 billion in tax revenue going into state and local coffers. All gaming segments, from casinos to sports betting to online games (iGaming), are growing. Throw in prediction markets, which allow users to speculate on the outcome of real-world events but are not legally considered gambling platforms, and the betting buffet becomes basically limitless. 
    • “This menu of options is creating an addiction crisis yet to be widely recognized by the public, policymakers and the healthcare sector, experts caution. Current national problem gambling prevalence is unknown due to a lack of research and funding dedicated to the issue. States that measure and publish their own prevalence rates see anywhere from 1% to 6%. Those most at risk include young adults, men and online gamblers. Gambling-related harms can be dire, from financial stress to co-occurring behavioral health conditions to suicide, which a fifth of individuals with gambling addiction attempt.
    • “To understand problem gambling, what’s driving it and efforts underway to address it, Fierce Healthcare talked to two dozen providers, researchers, advocates and regulators. This story is also based on a review of research, as well as exclusive data from Komodo Health analyzed on Fierce Healthcare’s behalf.
    • “It’s a small but mighty group of us that have been in this field, treating,” said Jody Bechtold, L.C.S.W., president of the International Problem Gambling and Gaming Certification Organization (IPGGC). “We call it the next opioid epidemic.” 
  • Healio tells us,
    • “The risk for subsequent fractures is similar for older adults, regardless of whether they had an initial major osteoporotic fracture or nonmajor osteoporotic fracture, researchers reported.
    • “In findings published in Journal of Bone and Mineral Research, researchers found that sustaining a major or nonmajor osteoporotic fracture raises the risk for subsequent fractures and mortality.”
  • Infectious Disease Advisor informs us,
    • “Rhinovirus and enterovirus are associated with severe clinical outcomes among hospitalized patients, including mechanical ventilation and death, highlighting the need for expanded respiratory virus surveillance among high-risk patient populations.”
  • MedPage Today points out,
    • “A dual deprescribing intervention for proton pump inhibitors (PPIs) targeting patients and their primary care doctors proved effective in reducing potentially inappropriate use, a cluster-randomized trial in France found.
    • “At 1 year, the combined approach — where patients got educational material about reducing PPI use mailed to them and their physicians received a letter detailing a deprescribing algorithm — resulted in twice as many patients cutting their PPI use in half (14.9%) versus usual care (7%) or physician-targeted intervention alone (7.7%, P<0.001 for both).
    • “The results underscore “the value of prioritizing patient-facing deprescribing strategies,” wrote researchers led by Jean-Pascal Fournier, MD, PhD, of Nantes Université in France, in JAMA Internal Medicineopens in a new tab or window. Furthermore, the interventions were not associated with a resurgence in gastroesophageal reflux disease (GERD) symptoms.
    • “PPIs in the U.S. are frequently prescribed for inappropriate indications and sometimes prescribed indefinitely, according to Fournier and colleagues.” * * * Potentially unnecessary PPI spending — reimbursements in 2015 hit $12 billion in the U.S.

From the U.S. heathcare business and artificial intelligence front,

  • Modern Healthcare reports,
    • “The Purchaser Business Group on Health, which represents large companies, launched a project to combine federally required data with claims data culled from its biggest members to provide insight into costs and quality in employer-sponsored health plans.
    • “This has the potential to supply employers with unprecedented access to healthcare pricing data that could help curb escalating employee health benefit costs, said Purchaser Business Group on Health President and CEO Elizabeth Mitchell.
    • “There is employer demand for this information that is unmet in the market,” Mitchell said during a Purchaser Business Group on Health webinar on healthcare transparency in February.
    • “The Purchaser Business Group on Health has found that normal market forces that should be expected to link prices to quality don’t function in healthcare. Prices often fluctuate wildly based more on the size and market power of health systems or insurers than on the quality of services rendered.
    • “For instance, its data reveal prices at hospitals in the same markets do not correlate with scores from the Leapfrog Group, which assesses hospital quality and safety. Often, low-rated hospitals charge more. Or the same hospital charges vastly different prices for the same procedures depending on the insurance plans, not any differences in the service.” 
  • and
    • “Health systems are increasing their investments in concierge medicine to meet patient demand and keep burned-out doctors practicing.
    • “Though typically a small percentage of a health system’s operations, concierge medicine — where patients pay thousands of dollars in membership fees for increased access to primary care physicians — helps diversify revenue and creates growth opportunities in new and existing markets.
    • “Still, it’s a controversial model that raises questions about equal access to care because it historically has appealed to wealthier, often older individuals looking for more personalized primary care. Health systems say patient demand has expanded beyond that demographic.”
  • Fierce Healthcare relates,
    • “Anthem and Mount Sinai have reached a new multi-year contract agreement, restoring coverage for thousands after the system went out-of-network last month.
    • “Anthem Blue Cross and Blue Shield of New York said in a statement Monday that the three-year deal returns Mount Sinai’s hospitals, physicians and other providers to its network. The health plan said that the contract “reflects both organizations’ commitment to delivering quality care while helping control healthcare costs for New York workers, families, employers and taxpayers.”
    • “The contract also includes updated reimbursement models that aim to reward quality and outcomes, while continuing to support accurate billing and payment.”
  • The Wall Street Journal lets us know ,
    • Healthcare giant Johnson & Johnson JNJ reported nearly 10% revenue growth for the latest quarter on strong cancer drug sales that offset a steep decline from one of its bestselling drugs, Stelara.
    • J&J said its first-quarter sales rose to $24.06 billion, topping the mean estimate of $23.62 billion from analysts surveyed by FactSet. Adjusted quarterly earnings also beat Wall Street expectations.
    • On the back of those results, the drug and medical-device maker boosted its full-year financial forecast. So far, disruptions from the war in Iran haven’t materially hurt J&J.
    • “There’s a lot of macro uncertainty out there,” J&J Chief Financial Officer Joseph Wolk said in an interview. “We think the fact that we’re not only maintaining but raising” the forecast is a sign of the company’s strength, he added.
    • J&J has been working to ensure consistent growth after losing patent protection for Stelara, a treatment for skin and digestive conditions. Competitors introduced lower-cost alternatives last year, leading to a 60% drop in first-quarter sales of the brand-name version of the drug.
    • Strong sales of J&J cancer medications like multiple-myeloma treatment Darzalex helped make up for those declines. The company’s cancer-drug sales rose more than 22% for the quarter. J&J is in a stronger position than some of its peers, which face even bigger patent cliffs in coming years.
  • BioPharma Dive tells us,
    • “Eli Lilly is again turning to dealmaking to boost its oncology portfolio, reaching a deal Tuesday to acquire a biotechnology company, CrossBridge Bio, that’s developing newer types of targeted cancer medicines.
    • “Lilly will pay up to $300 million in cash for CrossBridge, a Houston-based startup making antibody-drug conjugates for cancer. That total includes an unspecified upfront payout and subsequent payment tied to a development milestone, CrossBridge said in a statement.
    • “The deal hands Lilly technological capabilities that have become increasingly desirable to major pharmaceutical firms. Antibody-drug conjugates, or ADCs, are now a pillar of cancer care, a method of precisely delivering a toxic blow to malignant cells. Over 20 ADCs are currently available to treat tumors of the breast, lung, bladder and more. Many are working their way into earlier treatment lines, in some cases supplanting decades-old chemotherapy approaches.”
  • MobiHealth informs us,
    • “New York-based virtual women’s health provider Maven Clinic announced a strategic collaboration with care concierge company Wellthy to combine clinical care and caregiving support for employees.
    • “Maven Clinic is a digital reproductive health and family platform that offers fertility and family planning services, pregnancy and postpartum care, parenting and pediatric support, and menopause-related care.
    • ‘Wellthy offers a care concierge service that connects employees with care teams to help them navigate the healthcare system, including finding in-home support, understanding benefits, accessing legal resources and obtaining financial assistance.
    • “The company also offers Backup Care services to help employees find emergency care for family members, including daycares, on-site childcare facilities and other community-based programs.    
    • “The aim of Maven and Wellthy’s partnership is to help employees in the “sandwich generation, – those in the period of starting a family and caring for an older loved one – navigate the process from fertility, growing a family and overseeing eldercare.
    • “This partnership is about building a system that reflects how people live, with clinical care and caregiving support together in one place. When technology makes that support intuitive, you don’t just improve outcomes – you make it possible for people to ask for help in the first place,” Kate Ryder, founder and CEO of Maven Clinic, said in a statement.”
  • The Wall Street Journal informs us,
    • “Novo Nordisk NOVO.B said it would work with ChatGPT maker OpenAI on how to leverage artificial intelligence to discover new drugs, the latest AI partnership in the medical field as healthcare companies seek to harness the technology to get ahead of the competition.
    • “The Danish drugmaker said it would integrate OpenAI’s models across its operations to help its workforce analyze complex datasets and reduce the time it takes to move from research to delivering treatments to patients.
    • “The group said the partnership would boost efficiency across manufacturing, distribution, the supply chain and corporate, with pilot programs initially launching in research and development, manufacturing and commercial operations ahead of a full AI integration by the end of the year.” * * *
    • “Drugmakers are turning to AI companies and their increasingly powerful models to improve operations and cut repetitive tasks for employees, giving them more time to focus on R&D in a bet that advancements in the technology will help them identify promising new drugs and treatments.”
  • Modern Healthcare adds,
    • “Health systems and payers are making big investments in artificial intelligence to improve their operations by reducing administrative burden, beefing up clinical prediction capabilities and increasing access to care. 
    • “A case in point: This year alone, UnitedHealth Group is investing $1.6 billion into its AI efforts. Companies also are realigning executive roles by adding chief AI officers or adding AI responsibilities to C-suite executives overseeing data and innovation.” * * *
    • “Mike Baker, chief operating officer, UnitedHealthcare
    • “UnitedHealth Group, our parent, has embedded the use of AI across our business to simplify healthcare and improve how people access care, information and support. UnitedHealth Group is investing $1.6 billion this year with the aim of making experiences more personalized, reducing administrative friction for clinicians, increasing transparency around cost and coverage, and supporting better care decisions.” 

Monday report

David Ermer–CMS, Congress, FDA, Generative AI, HSA, Medicare, NIH, OPM, Rx coverage, U.S. Healthcare–

From Washington, DC,

  • The Washington Post lets us know,
    • “The White House will make the case Monday to Congress — and to voters — that it has developed a strategy to address frequent frustrations involving U.S. medical care, such as too few physicians and too much paperwork.
    • “The Trump administration casts its physician-focused agenda as a fix for a strained health care system — pointing to a $50 billion funding program for rural health it contends will boost the number of doctors in remote areas, efforts to reduce payment distortions that favor hospitals rather than doctors, and regulatory changes intended to speed insurance approvals for tests and follow-up care.
    • “Together, these reforms will enable faster, more affordable, and higher-quality physician services for Americans,” the White House writes in the Economic Report of the President [WhiteHouse.gov link], an annual document previewed with The Washington Post and set to be transmitted to Congress on Monday.
    • “The economic report, which does not offer new proposals, is best understood as a distillation of White House economists’ thinking ahead of this year’s midterm elections, in which voters’ frustrations regarding health care costs and access are set to play a central role. Past administrations have often used the report, which is written by the president’s Council of Economic Advisers, as a messaging document to rally support for their initiatives. This year’s report addresses health care affordability, a key focus for President Donald Trump and his advisers, and says it is working to “unleash” more competition in health care markets to lower costs and improve quality.”
  • Bloomberg Law informs us,
    • “Senate Republicans aren’t planning to include Medicare and Medicaid changes in the next partisan spending package—instead focusing it largely on ending the partial government shutdown.
    • “Top Republicans plan to use a bill that advances through the simple-majority budget reconciliation process to fund immigration enforcement and US Border Patrol and would not require Democrats’ support.
    • “Though some Republicans have been pushing for including Medicare and Medicaid policies in the package, the narrow focus does not leave room for other priorities, Senate Majority Leader John Thune (R-S.D.) said Monday. He said budget instructions will not be sent to the Senate Finance Committee.” * * *
    • “But he didn’t rule out returning to other health care policies. For instance, he mentioned a provision blocking federal Medicaid payments from going to Planned Parenthood, which was included in the 2025 tax-and-spending law and sunsets in July, as a possible candidate for inclusion.”
  • Beckers Hospital Review reports,
    • “CMS on April 10 proposed a 2.4% pay increase for hospitals under the fiscal 2027 Inpatient Prospective Payment System, but hospitals are concerned that the update does not keep pace with the mounting financial challenges.
    • “CMS has proposed another inadequate update to inpatient payment rates, another extremely high productivity cut, and reductions to disproportionate share payments — in the face of rising need for care and higher uninsured rates,” Ashley Thompson, the American Hospital Association’s vice president of public policy analysis and development, said in an April 10 statement. 
    • “Beth Feldpush, America’s Essential Hospitals’ senior vice president of policy and advocacy told Becker’s in an April 11 statement that the proposed DSH payment cuts “fails to acknowledge the growing number of uninsured individuals due to recent Congressional actions.” 
    • ‘Charlene McDonald, president and CEO of the Federation of American Hospitals, said in an April 10 statement that CMS’ proposal is a step in the right direction, but added it “does not negate the compounding effects of rising inflation, record levels of uncompensated care and a growing uninsured population.”
    • “National hospital group leaders also raised concerns about another aspect of the proposal: the introduction of the first mandatory nationwide episode-based payment model.”
  • Fierce Healthcare informs us,
    • “The Centers for Medicare and Medicaid Services picked 150 digital health companies and healthcare providers to participate in the launch of its tech-enabled chronic care model.
    • “The Center for Medicare and Medicaid Innovation (CMMI) announced in December the Advancing Chronic Care with Effective Scalable Solutions (ACCESS) Model as a 10-year payment program to encourage the use of technology to treat chronic diseases. CMS aims for the ACCESS Model to provide stable, recurring payments for technology used to treat diabetes, hypertension, chronic kidney disease, obesity, depression and anxiety. The model will help pay for telehealth software, wearables and wellness apps that address the conditions.
    • “The CMMI plans to use outcome-aligned payments to cover the cost of technology for Medicare providers if a patient with a qualifying chronic condition achieves clinically significant outcomes, such as lowering their blood pressure.” 
  • Citeline points out,
    • An April 1, 2026, proposal [Federal Register link] from the US Treasury Department would allow whistleblowers who alert the government to certain financial crimes to collect 10%-30% of any monetary penalties collected, creating a new risk for healthcare firms – especially those with overseas business partners. The public comment period ends on June 1, 2026.

From the Food and Drug Administration front,

  • Fierce Pharma reports,
    • “For the first time, the FDA has approved generics for AstraZeneca’s Type 2 diabetes blockbuster Farxiga. The U.S. regulator has given thumbs up to 14 companies, including Teva, Sandoz and a host of Indian drugmakers including Aurobindo, Biocon, Cipla, Lupin and Zydus to produce 5 mg and 10 mg tablets of dapagliflozin.
    • “The treatment is indicated for glycemic control and to reduce the risk of hospitalization for heart failure for those with Type 2 diabetes who also have established cardiovascular disease or multiple cardiovascular risk factors.Farxiga generated sales of $8.5 billion last year, including $1.7 billion in the U.S.
    • “The FDA originally approved the SGLT2 inhibitor in 2014. Generic versions of Farxiga became available (PDF) in the U.K. and Japan in the second half of last year.”
  • and
    • “From a negative phase 3 readout and a seemingly tightening regulatory climate to a grueling three-month review extension, the path for Travere Therapeutics in its first-in-disease bid was anything but certain. Yet, the company has defied the odds, securing Filspari a landmark FDA approval in focal segmental glomerulosclerosis (FSGS) and delivering the first treatment for the rare kidney disease.
    • “Monday’s FDA approval makes Filspari the first therapy specifically indicated for FSGS, a condition that represents a $1 billion-plus sales opportunity, according to Leerink Partners analysts. The drug was originally approved in 2023 for the treatment of IgA nephropathy, another kidney disease.
    • “FSGS is estimated to affect more than 40,000 patients in the U.S. The disorder is characterized by scarring in the kidney’s filtering units as protein keeps leaking into the urine, often leading to further disease progression and kidney failure, sometimes quite rapidly.” 
  • Cardiovascular Business relates,
    • “Anumana, a Massachusetts-based artificial intelligence (AI) company co-founded by nference and Mayo Clinic, has received U.S. Food and Drug Administration (FDA) clearance for a new algorithm designed to detect signs of cardiac amyloidosis (CA). This represents Anumana’s second FDA clearance in just two weeks, highlighting the company’s growing impact in the world of cardiovascular care. 
    • “CA is a life-threatening condition that often leads to heart failure complications, but it remains critically underdiagnosed. Anumana sees this clearance as a way to help care teams identify CA early so patients can receive timely treatment.
    • “The newly cleared algorithm, which previously received the FDA’s breakthrough device designation, was designed to evaluate standard 12-lead electrocardiograms (ECGs) and flag patients at increased risk of CA. 
    • “Each of our FDA-cleared algorithms addresses a specific and frequently missed cardiovascular condition, and cardiac amyloidosis represents an important addition to that portfolio,” Maulik Nanavaty, CEO of Anumana, said in a prepared statement. “The more conditions we can identify from a single ECG, the more valuable the test becomes in clinical practice. That’s what Anumana is working toward with each new clearance as we continue to advance our rigorous clinical evidence approach.”

From the census front,

  • The Wall Street Journal reports,
    • “The first of the youth-obsessed baby boomers turn 80 this year, including President Trump, and they want to shake up old age.
    • “Having reached octogenarian levels, a generation that shaped much of our past is shaping the future of aging for themselves and those who follow. They want better healthcare and housing, cures for dementia and a say in when to die. New professions and products will appear. Their massive spending will shift and innovators will follow.
    • “They are reinventing old age,” says Joseph Coughlin, director of the Massachusetts Institute of Technology AgeLab. Unlike the patient Silent Generation, boomers had high expectations and used their sheer numbers as well as financial and political clout to make them happen, which isn’t necessarily a bad thing.
    • “If you don’t have expectations of getting better, then you simply become satisfied with what is,” says Coughlin.”

From the public health and medical / Rx research front,

  • NBC News reports,
    • “Protein-hungry shoppers are buying more meat with their health top of mind. Health experts, however, wish they’d think beyond the butcher counter.” * * *
    • “Meat is indeed packed with protein, but it comes with some well-established health drawbacks.
    • “Saturated fat we’ve known about for decades,” said Dr. Sarah C. Hull, a cardiologist at Yale Medicine. It’s common in red meat and contributes to increasing LDL cholesterol levels, hardening the blood vessels and, in turn, raising the risk of heart attack or stroke.” * * *
    • “Hull said that many common plant-based proteins are particularly high in fiber, which 95% of Americans don’t get enough of, and they’re generally associated with better overall health outcomes than animal proteins. Her research suggests that increased consumption of certain plant-derived nutrients may help counter some negative effects of red meat and ultra-processed foods.”
  • Health Day relates,
    • “Influenza vaccination may offer cardiovascular protection even when it does not prevent infection, according to a study published online April 2 in Eurosurveillance.” * * *
    • “Hospital admissions for heart attack and stroke were more frequent in the first week after testing positive for influenza than during any other period in the year before and after their test,” the authors write. “This increased risk was about half as high among people who tested positive for influenza but had received the influenza vaccine that season.”
  • and
    • “Children with ADHD are more apt to have a bright future if they’re diagnosed in their early elementary years rather than as high schoolers, a new study says.
    • “Kids diagnosed with ADHD at an earlier age are more likely to have better grades and go on to college, researchers reported April 8 in JAMA Psychiatry. They’re also less likely to drop out of school.
    • “ADHD diagnosis during the first years of school was associated with better school performance, more academic track choices and lower probability of school dropout,” concluded the research team led by Lotta Volotinen, a doctoral researcher at the University of Helsinki in Finland.
    • “The findings support the recommendations for earlier diagnosis, and screening for ADHD before age 12 years should be considered,” the team wrote.”
  • The American Medical Association lets us know “what doctors wish patients knew about managing food allergies.”
    • Once a food allergy is diagnosed, learning how to avoid triggers, recognize warning signs and when to seek medical care are key. Two physicians share more.
  • Per Cardiology Advisor,
    • “Maternal stroke is associated with significantly higher rates of maternal mortality and severe delivery complications, including cardiac arrest and acute renal failure.”
  • Per Pulmonology Advisor,
    • “The increased risk for asthma attacks among those using marijuana was consistent regardless of whether individuals vaped or smoked cannabis or did both.”
  • Per an Oregon State University news release,
    • “Researchers at Oregon Health & Science University have uncovered a key reason why immunotherapy has largely failed in pancreatic cancer — and identified a promising strategy to overcome that resistance. 
    • “The study, published in the journal Immunity, shows that pancreatic tumors actively reshape their immune environment by co‑opting regulatory immune cells that normally shut down tumor-killing cells. By reprogramming those cells, the research reveals a potential pathway to make immunotherapy effective against one of the deadliest and most treatment‑resistant cancers. 
    • “Pancreatic cancer is incredibly resistant to most therapies,” said the study’s senior author, Katelyn Byrne, Ph.D., assistant professor of cell, developmental and cancer biology in the OHSU School of Medicine and member of the OHSU Brenden‑Colson Center for Pancreatic Care. “Even when we know the immune system is capable of long‑lasting protection, it’s been very difficult to get that response to work in this disease.” 
    • “In the new study, Byrne and team tested an experimental immunotherapy in mouse models known as agonistic CD40, which works differently from standard checkpoint inhibitors. Rather than targeting a single immune signal, the therapy broadly activates the immune response upstream. 
    • “Byrne said the researchers were surprised to find out that activating the immune system this way didn’t just stimulate tumor‑killing cells — it also reprogrammed regulatory T cells, converting them from immune suppressors into cells that support anti‑tumor activity. 
    • “We didn’t expect this,” Byrne said. “The therapy doesn’t directly target Tregs, but as a secondary effect of turning on the immune response, those Tregs changed their behavior. Cells that were shutting down the immune reaction suddenly started supporting tumor killing.” 
    • “The team’s findings help explain one reason why many immunotherapies haven’t worked in pancreatic cancer and point to a possible solution: Treatments may need to both turn on the immune system and overcome the tumor’s own ability to shut it down.” 
  • Per an NIH news release,
    • “A National Institutes of Health (NIH)-funded research team has discovered an enhanced CRISPR gene-editing system that could enable targeted delivery inside the human body — a key step toward broader clinical use. Researchers identified a naturally occurring enzyme, Al3Cas12f, that is small enough to fit into adeno-associated virus vectors, a leading targeted delivery method for gene therapies. They then engineered an enhanced version that dramatically improved gene-editing performance in human cells. 
    • “The advance addresses a major limitation in CRISPR technology. Commonly used gene-editing proteins are too large for targeted delivery systems, restricting clinical applications to cells modified outside the body, such as blood and bone marrow. 
    • “Smart delivery of gene editing systems is a powerful notion with broad clinical implications, and this basic science finding takes us a significant step toward that future,” said Erica Brown, Ph.D., acting director of NIH’s National Institute of General Medical Sciences (NIGMS).” 
  • BioPharma Dive adds,
    • “Revolution Medicines said Monday its experimental pancreatic cancer drug hit every goal at an early checkpoint in a Phase 3 trial, helping people who got it live nearly twice as long as those who got standard chemotherapy.
    • “Enrollees who got daraxonrasib lived a median of 13.2 months after treatment, compared with 6.7 months for those who got chemo, a finding that equates to a 60% reduction in the risk of death among those who got the experimental drug. Daraxonrasib achieved its other objectives at an interim look at the results, findings so striking that the company ended the trial early. Revolution enrolled people whose metastatic pancreatic cancer had returned after an earlier treatment.
    • “The Food and Drug Administration has already awarded daraxonrasib a “national priority” voucher that could help Revolution gain an approval within weeks of an official submission. Revolution shares rose nearly 40% in early trading, adding $7 billion to the company’s already hefty valuation.”
  • BioPharma Dive also informs us,
    • “An experimental therapy from Allogene helped eliminate signs of cancer better than standard treatment in a Phase 3 trial in first-line large B-cell lymphoma, results suggesting the biotechnology company may have found a role to use donor-derived cell therapy against the deadly blood cancer.  
    • “After 45 days of treatment, seven of the 12 patients given Allogene’s therapy in the study were negative for “minimal residual disease,” meaning that diagnostic tests could no longer detect signs of cancer. By comparison, only 2 of 12 placebo recipients hit that mark, a roughly 42-percentage-point difference that clears an important bar published literature has suggested is crucial for delaying a relapse. 
    • “The results come from an early “futility” analysis. Allogene is enrolling 220 people in the study and expects to report in 2027 results showing whether treatment staved off cancer’s return.
  • and
    • “In experimental drug from Spyre Therapeutics helped lower signs of disease activity and improve remission rates in a Phase 2 study of people with ulcerative colitis. 
    • After 12 weeks of treatment, patients who received “SPY001” in the trial had a statistically significant, 9.2-point reduction on a scoring system that assesses the severity of their disease, meeting the study’s primary objective. Notably, treatment was also associated with a 40% remission rate and a 51% improvement on endoscopic imaging. One severe adverse event was reported — chest pain in a 68-year-old male with a history of cardiovascular disease — but was deemed unrelated to treatment.
    • Spyre said the findings were “clinically meaningful” and support SPY001’s “best-in-class profile.” The drug is one of multiple therapies the company is evaluating in Phase 2 trials in inflammatory bowel disease. Proof-of-concept data for two other therapies in the trial are expected later this year. Data from a placebo-controlled portion of the study are on track for 2027.” 
  • Per Fierce Pharma,
    • “Eli Lilly has chalked up another victory in the chronic lymphocytic leukemia (CLL) space, as its BTK inhibitor Jaypirca delivered its fourth positive phase 3 readout in the blood cancer. 
    • “Monday, Lilly said its phase 3 Bruin CLL-322 trial in patients with previously treated CLL or small lymphocytic lymphoma (SLL) has met its primary endpoint. In an industry first, the study showed that adding Jaypirca to a fixed-duration regimen of venetoclax and rituximab significantly extended progression-free survival (PFS) compared with the standard combo alone. 
    • “As Lilly pointed out, Bruin CLL-322 is the first phase 3 in CLL to utilize and outperform a venetoclax-based regimen. Roche and AbbVie sell venetoclax, an oral BCL-2 inhibitor, under the brand name Venclexta.” 

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

  • Beckers Payer Issues reports,
    • “Houston-based Memorial Hermann Health System and BCBS Texas agreed on a contract April 11, bringing the health system back in network.
    • “The agreement ensures “access to quality care at cost-effective prices,” BCBS Texas said in an April 13 statement shared with Becker’s. It covers both commercial and Medicare Advantage members. The previous contract expired April 1, affecting commercial members. The health system had beenout of network for Medicare Advantage plans since Jan. 1.”
  • Fierce Healthcare offers a look at how Evernorth’s new Delaware specialty pharmacy facility highlights a broader care coordination approach.
  • Beckers Hospital Reports ranks 83 health systems by their most recent revenue.
    • “Revenue growth continued across the hospital industry in 2025, with many of the nation’s largest health systems posting mid- to high-single-digit gains fueled by stronger patient volumes, improved payment rates and the expansion of ambulatory and pharmacy operations. 
    • “But the gains were far from uniform. Some systems grew revenue by double digits through mergers, acquisitions and new payer arrangements, while others saw declines as they shed hospitals and restructured their portfolios.”
  • and tells us,
    • “The world’s two main GLP-1 drug manufacturers, Eli Lilly and Novo Nordisk, are taking different approaches with rolling out their recently approved GLP-1 pills for weight loss. 
    • “Two oral GLP-1s, two very different commercial strategies. Health systems operating metabolic programs or making formulary decisions need to understand both.
    • “While both companies offer their recently approved GLP-1 pills through pharmacies and direct-to-consumer platforms that circumvent pharmacy benefit managers, they are diverging in other routes. 
    • “Eli Lilly is betting on retail and digital access, as it’s offering its weight loss GLP-1 pill through GoodRx, telehealth firm Ro and same-day delivery with Amazon Pharmacy. 
    • “By contrast, Novo Nordisk launched a Wegovy subscription program through WeightWatchers, LifeMD, Ro and Hims & Hers — with which the drugmaker previously had a strained relationship. With the 12-month subscription plan, Novo Nordisk said patients can save up to $600 per year on the Wegovy pill.” 
  • and informs us,
    • “Large language models may help identify drug safety signals in clinical notes, though their performance remains below thresholds required for clinical decision support.
    • “Researchers evaluated three models — GPT-3.5, GPT-4 and GPT-4o — using clinical notes from 100 patients at Nashville, Tenn.-based Vanderbilt Health, 70 patients at the University of California—San Francisco and 272 patients from seven Roche-sponsored trials, according to an April 6 Vanderbilt news release.
    • “For detecting immune-related adverse events at the patient level, GPT-4o achieved F1 scores of 56%, 66% and 62% across the respective datasets. The F1 score reflects how well a model balances correctly identifying real safety issues while avoiding false alarms. At the individual note level, the model reached an average F1 score of 57% across 667 notes.
    • “An F1 score of 90% or more is considered excellent, while 80% or higher may support clinical decision-making.”
  • STAT News points out,
    • “Every day, more than 40 million people ask ChatGPT about health care, according to OpenAI. They’re asking questions about diet, exercise, insurance — and in some cases, serious symptoms that would typically get discussed on a 911 call or in a doctor’s office.
    • “For some health systems, that’s creating an imperative. A small number of hospitals are trying to recapture some of those clinical conversations from commercial large language models like ChatGPT, Claude, and Gemini. They’re implementing their own patient-facing chatbots, ones that draw directly from their existing medical records and can funnel patients toward care in their own system. 
    • “Hartford HealthCare this week will launch PatientGPT, a chatbot engineered by clinical AI company K Health, to its patients in Connecticut. Two health systems — California-based Sutter Health and Reid Health, serving Indiana and Ohio — have announced pilot versions of Emmie, the chatbot built by medical record mammoth Epic. The list is likely to grow rapidly.
    • “Health systems need to do this, either through a vendor or building it themselves,” said Mount Sinai chief AI officer Girish Nadkarni, the senior author of a recent study that found ChatGPT Health missed high-risk emergencies when used to triage patients.”
  • The Wall Street Journal cautions,
    • “The artificial intelligence gold rush is rapidly drying up the supply of computing power, leading to product issues and reliability problems.
    • “Anthropic experiences frequent outages and limits user token usage, while OpenAI scrapped its Sora app to free up compute.
    • “CoreWeave raised prices over 20% and extended contracts, as spot-market Nvidia GPU rental costs rose 48% in two months.” * * *
    • “All of it points to a classic problem that has popped up in technology booms throughout history, from the 19th-century railroad expansion to the telecom and internet explosion of the early 2000s. Demand is growing far faster than companies are able to access resources and build out infrastructure. Historically, price increases have been among the only ways to address a supply crunch, but such a move could be perilous for frontier AI companies, which are in a ferocious competition to gain users.”
  • Per MedTech Dive,
    • “Stryker said Monday that it has agreed to buy intravascular lithotripsy firm Amplitude Vascular Systems. The companies did not disclose the terms of the acquisition. 
    • “Intravascular lithotripsy is a procedure to treat artery disease. Boston-based Amplitude Vascular Systems, or AVS, uses pressure waves generated by carbon dioxide through a balloon catheter to break up calcified plaque.
    • “The acquisition is expected to bolster Stryker’s peripheral vascular portfolio once AVS’ device is cleared in key markets.”
  • and
    • “GE HealthCare has provided an update on the integration of its bkActiv intraoperative ultrasound technology with Medtronic’s Stealth AXiS surgical navigation system.
    • “The integrated product is now available commercially, GE HealthCare said Thursday. Medtronic said it had integrated bkActiv into Stealth AXiS when the surgical system received regulatory clearance last month.
    • “Integrating the technologies gives surgeons real-time ultrasound images, helping them to assess mid-procedure anatomy changes that could affect the preoperative plan.”

Friday report

David Ermer–CDC, CMS, COVID-19, FDA, Federal employment benefits, Medical / Rx research, Medicare, OPM, Patient safety, U.S. Healthcare, Uncategorized–

From Washington, DC,

  • Federal News Network offers an interview with Tammy Flanagan about how “health‑coverage decisions in retirement can shape when and how federal retirees tap their money.”
  • Govexec reports,
    • “The percentage of federal employees who are classified as “thriving” decreased by 10 points between 2024 and 2025, according to a recent report from Gallup, which sheds light on how civil servants are reacting to cuts and other reforms that President Donald Trump has made to agencies since the start of his second term. 
    • “By taking the average of responses from quarterly surveys conducted respectively in both years, the analytics firm found that the percentage of “thriving” feds dropped from 58% in 2024 to 48% in 2025.” * * *
    • “While the “thriving” rate for federal employees held steady at around 60% from 2022 to 2024, the latest data puts them on par with the average for U.S. workers in general, which also stood at 48% in 2025. That broader group, however, saw a smaller decline, going from 51% in 2024.”
  • OPM has brought the Director’s Secrets of OPM blog posts up to date on the agency’s website, which may be more easily accessible than Substack.
  • Per a CMS email,
  • This reporting requirement applies to FEHB and PSHB plans.
  • The American Hospital Association News informs us,
    • “The Centers for Medicare & Medicaid Services April 9 held a demonstration showcasing the first series of products intended to push the health care industry toward a more connected ecosystem. The event highlighted tools and applications from more than 50 companies supporting the Medicare App Library that was initially announced in February. Tools intended to promote digital data access and eliminate manual check-in forms were featured, along with personalized health apps providing tailored guidance for nutrition, wellness and chronic disease management.” 
  • Fierce Healthcare reports,
    • “The Centers for Medicare & Medicaid Services has proposed a 2.4% payment rate bump for inpatient services for fiscal year 2027 as well as the first mandatory, nationwide test of an episode-based payment model. 
    • “The plans were outlined Friday in the annual release of CMS’ Inpatient Prospective Payment Systems (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System proposed rule. 
    • “Other planned changes, according to a fact sheet from the agency and the proposed rule’s summary, include various measure additions or modifications to measures in the Hospital Inpatient Quality Reporting Program; adjustments to the Transforming Episode Accountability Model (TEAM) alternative payment model controversially finalized in last year’s rule; and changes to graduate medical education payments to implement discrimination requirements aligned with the administration’s view of diversity, equity and inclusion practices.” 
  • A CMS news release adds,
    • “Medicare beneficiaries undergoing knee, hip, and ankle replacements, among the most frequent surgeries for people with Medicare, could soon experience more coordinated care and lower costs under a new Centers for Medicare & Medicaid Services (CMS) proposal. CMS is looking to implement these improvements by expanding the Comprehensive Care for Joint Replacement (CJR) Model nationwide through the Fiscal Year (FY) 2027 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) proposed rule.
    • “Every year, Medicare funds thousands of knee, hip, and ankle replacements that help seniors keep up with their speedy little grandkids,” said CMS Administrator Dr. Mehmet Oz. “This proposed expansion of our successful joint replacement pilot program would better align financial incentives with improved health outcomes—protecting taxpayer dollars while ensuring patients get the care they need before, during, and after surgery.” * * *
    • “To learn more about the CJR-X Model, including independent evaluation reports, visit: https://www.cms.gov/priorities/innovation/innovation-models/cjr-x“
    • “The FY 2027 IPPS and LTCH PPS proposed rule can viewed on the Federal Register at: https://www.federalregister.gov/public-inspection/current. 
    • “For a fact sheet on FY 2027 IPPS and LTCH PPS proposed rule, visit: https://www.cms.gov/newsroom/fact-sheets/fy-2027-hospital-inpatient-prospective-payment-system-ipps-long-term-care-hospital-prospective.”
  • Fierce Healthcare relates,
    • “The Trump administration has issued a proposed rule that aims to significantly overhaul prior authorization for pharmaceuticals.
    • “Through the Interoperability Standards and Prior Authorization for Drugs rule, the Centers for Medicare & Medicaid Services said it would establish deadlines for payers in government insurance plans, setting the timeline at 24 hours for urgent requests and 72 hours for standard determinations.
    • “In addition, the rule would require insurers to publicly report certain metrics around prior authorization, including approval and denial rates; outcomes for appeals; and decision timeframes, according to an announcement from the agency.”
    • “The rule also builds on a 2024 regulation that took aim at prior authorization for non-drug services as well as payers’ 2025 pledge to significantly overhaul their approach to prior auth, an agreement brokered in part by CMS officials.” * * *
    • “CMS would also push to adopt Fast Healthcare Interoperability Resources (FHIR)-based standards for the small number of plans still using older models, making it easier for real-time electronic workflows to thrive.”
  • and
    • “Despite encountering a legal roadblock last month in his effort to rework the U.S. vaccine infrastructure, HHS secretary Robert F. Kennedy Jr. is continuing to reshape the Centers for Disease Control and Prevention’s vaccine advisory panel in a way that’s setting off alarm bells for some experts.
    • “In the new charter for the Advisory Committee on Immunization Practices (ACIP), the focus of the group—which helps advise the CDC on vaccine schedules and recommendations—seems to be shifting more toward concerns around vaccine safety and side effects. 
    • “In particular, the panel will now work on identifying “gaps in vaccine safety research, including adverse effects following vaccination.” The language is new in the updated charter and will likely appease the vaccine skeptic crowd, which has long used the potential for vaccine injuries and erroneous links to the development of neurological disorders like autism to further their cause.
    • “The group will also now specifically be tasked with reviewing new vaccine platforms such as mRNA shots, which have become a frequent bugbear in anti-vaccine rhetoric following the COVID-19 pandemic.”

From the Food and Drug Administration front,

  • BioPharma Dive reports,
    • “The Food and Drug Administration has, for the second time, turned back a medicine for a tough-to-treat skin cancer in a decision that marks a major setback for the therapy and its developer, biotechnology company Replimune.
    • “The agency on Friday rejected the treatment, vusolimogene oderparepvec or “RP1,” which had been under review for people whose advanced melanoma progresses despite treatment with a widely used cancer immunotherapy. In a letter made public Friday, the agency claimed that the review team, as well as multiple agency leaders and subject matter experts, determined the data are “insufficient to conclude substantial evidence of effectiveness.”
    • “The decision comes eight months after U.S. regulators spurned RP1, arguing that the company’s findings couldn’t be “adequately interpreted.” Replimune claimed to have been blindsided by the rejection and afterwards provided the FDA with additional information and analyses to boost its case. The agency, though, argued in its letter that its feedback to Replimune has remained consistent through years of communications and that its issues weren’t addressed.”
  • The Wall Street Journal relates,
    • “GSK withdrew its application for a drug touted last year by President Trump as a potential treatment for autism symptoms, just months after the company submitted it at the request of health officials.
    • “The U.K. drugmaker asked the Food and Drug Administration to pull its application for the drug leucovorin calcium because it doesn’t market the medicine, according to a regulatory filing posted Thursday. 
    • “The FDA had just approved leucovorin last month. Generic forms of the medicine will still be available. * * *
    • “GSK hadn’t sold the drug since 1999. At the request of the Food and Drug Administration, GSK said in September it would submit its application for patients with cerebral folate transport deficiency—a rare genetic condition with similarities to autism—in a move that allowed the agency to update the label for the drug and its generic counterparts. 
    • “FDA officials last month announced they had approved the drug for that condition based on a review of existing studies, but said in a call with reporters that they hadn’t found enough evidence to merit OK’ing the drug’s use to treat autism more broadly.
    • “Senior FDA officials said they examined scientific studies to see whether they could approve leucovorin to treat autism, but didn’t come up with enough strong scientific evidence to do so.
    • “A spokesman for HHS said GSK’s withdrawal on Thursday doesn’t affect generic versions of the drug, which already have updated labels for the genetic condition.”
  • Cardiovascular Business tells us,
    • :The U.S. Food and Drug Administration (FDA) is warning the public that certain sizing catheters from Indiana-based Cook Medical should no longer be used due to an increased risk of cracking or breaking.
    • “The agency’s warning covers specific lots of Cook Medical’s Centimeter Sizing Catheters, Aurous Centimeter Sizing Catheters and Beacon Tip Centimeter Sizing Catheters. These devices are used for a variety of angiographic procedures, aortic interventions, peripheral interventions and vascular interventions. They are made in a variety of sizes and multiple configurations.
    • “Potential adverse events that could result include increased procedural time, harms associated with device fragmentation/separation and vessel injury,” according to the FDA. “In a worst-case scenario, device fragmentation and separation could cause life-threatening harm or death.”
    • “At this time, the FDA noted, no serious injuries or deaths have been linked to this issue. The agency is still reviewing the situation.
    • “The FDA’s early alert can be read in full here. It also includes a full list of all affected product lots.”

From the public health and medical / Rx research front,

  • The University of Minnesota’s CIDRAP reports,
    • “Even as the US respiratory illness season continues to ebb, it remains deadly, with the Centers for Disease Control and Prevention (CDC) documenting 12 more pediatric deaths in its FluView update today. 
    • “So far this season, 139 children have died from the virus, and about 85% with a known vaccination status were unvaccinated. While the CDC has classified this flu season as moderate for adults, it’s been high-severity for children.
    • “For comparison, in the previous three flu seasons the CDC logged 187, 210, and 296 flu-related deaths for the complete season. The 289 pediatric deaths in 2024-25 was the most since the 2009-10 H1N1 flu pandemic.
    • “Only four jurisdictions were reporting moderate flu activity last week, and none saw high activity. Flu accounted for 8.2% of viral respiratory diseases, down from 9.8% the previous week. A total of 2,589 people were hospitalized, compared with 3,050 the week before. The proportion of outpatient visits for flu declined to 2.4% from 2.6% the previous week.” * * *
    • “The level of acute respiratory illness causing people to seek medical attention is very low. Rates of respiratory syncytial virus (RSV) remain elevated, but the virus is past peak in many areas of the country, the CDC said in its weekly respiratory virus activity update today.
    • “COVID-19 levels are low in most parts of the country, and viral wastewater concentrations are low for RSV and very low for COVID-19 and influenza A.” 
  • The American Hospital Association adds,
    • “The Utah measles outbreak has increased to 583 cases, the state’s Department of Health and Human Services reported April 7. Of those, 386 cases have been diagnosed this year. Nationwide, there have been 1,714 confirmed measles cases so far in 2026, according to the latest data from the Centers for Disease Control and Prevention. Of those, 94% of cases are outbreak-associated and 6% of cases have been hospitalized. The vaccination status of 92% of cases is unvaccinated or unknown.” 
  • Harvard Professor of Pediatrics Dr. David S. Ludwig opines in STAT News
    • “Targeting ultra-processed foods would make packaged foods less tasty and appealing, but no less fattening.
    • “Ironically, many products now emblematic of ultra-processed foods were developed in response to calls from nutrition scientists and government to replace dietary fat with carbohydrates, a misguided campaign that did more harm than good. We can’t afford another sweeping restructuring of the food supply based on imprecise interventions and uncertain science.
    • “Instead, focusing on processed carbohydrates offers a more precise and pragmatic solution, one that could invite collaboration with, rather than opposition from, the food industry.
    • “Delicious, calorie-rich food — whether home-prepared or packaged — isn’t the problem. What matters is how long we stay satisfied (satiety) relative to calories consumed. A 100-calorie snack or a sugary beverage isn’t better for our waistline than 200 calories from nuts if the lower-calorie option leaves us hungry and craving more soon after.
    • “By targeting the dietary drivers of weight gain, rather than misleading notions about food palatability and pleasure, we can have our (low-carb) cake and eat it, too.”
  • STAT News also tells us,
    • “With thousands of illegal e-cigarettes for sale in the U.S., both the Trump and Biden administrations have vowed to crack down on the illicit fruit- and candy-flavoredvapes that hold particular appeal to minors. But a new government report suggests law enforcement efforts by the Department of Justice lag far behind the scope of the problem. 
    • “Most DOJ enforcement actions between fiscal year 2022 and fiscal year 2025 — 50 out of a total of 88 — were to add the names of remote e-cigarette sellers to a list of unauthorized businesses, according to the report from the Government Accountability Office. The second-most common type of enforcement actions (20 out of 88) noted in the report were injunctions to stop legal violations. 
    • “The GAO report was focused on actions that involved the DOJ, so those tallies do not take into account enforcement actions like the seizure of more than 6 million illegal products by the Food and Drug Administration and U.S. Customs and Border Protection between 2024 and 2025. To put those seizures in context, a large seizure of $76 million worth of products in 2024 — 3 million vapes — equated to about 4% of China’s e-cigarette exports to the U.S. in a single month, said Steven Xu, an adjunct assistant professor at the University of Waterloo who studies e-cigarettes.
    • “Sen. Dick Durbin (D-Ill.), who requested the report, said it shows that much more work needs to be done to combat the public health threat posed by illegal vapes.”
  • Health Day informs us,
    • “Standard cognitive tests may fail to capture early brain changes in women 
    • “Women’s brains often show a steeper and more widespread decline than men’s when moving from mild impairment to Alzheimer’s
    • “Sex-specific standards may be needed to interpret brain scans and screening results accurately.”
  • and
    • “Cardiovascular health may impact fracture risk in women after menopause, according to a study published online March 27 in The Lancet Regional Health-Americas.” * * *
    • “Many of the same factors that protect your heart — regular physical activity, a balanced diet rich in calcium and vitamin D, not smoking and managing conditions like diabetes and high blood pressure — also help protect your bones,” Hossain said in a statement. “If you’ve been told you have intermediate or high cardiovascular risk, particularly if you are a postmenopausal woman, it may be worthwhile to talk to your doctor about bone health screening, given the many effective treatments available that reduce fracture risk.”

From the U.S. healthcare business front,

  • Beckers Payer Issues shares a boatload of Blue Cross Blue Shield updates.
  • Healthcare Dive reports,
    • “Menopause has come out of the shadows and into the public spotlight in recent years. Celebrities have become more eager to dish about hot flashes and night sweats, and a flurry of telehealth start-ups promising relief from a broad constellation of symptoms have given rise to a $17 billion menopause market.
    • “But demand for treatments still far outpaces the science, as persistent structural barriers confound the women’s health space. 
    • “People have taken up the charge and are trying to make an impact in a specific area,” said Kim Dalla Torre, an EY Global and Americas Health leader.” * * *
    • “More also needs to be done to raise women’s awareness that menopausal symptoms shouldn’t be something they need to tolerate in silence, Dalla Torre said. Some 80% of women experiencing these symptoms don’t reach out to their doctors for help, according to the Mayo Clinic. Drugmakers also need to play a role.” 
       
  • Cigna, writing in LinkedIn, tells us,
    • “Mental fitness is essential for stress management, resilience, and workplace productivity, helping employees achieve work/life harmony.
    • “When organizations truly care about mental fitness, employees feel more supported and valued—which leads to higher engagement, fewer days missed from work, and meaningful reductions in healthcare costs for everyone.
    • “By thoughtfully weaving together mental and physical wellness programs, organizations can nurture a more vibrant and supportive workforce—leading to lasting success, greater employee retention, and the ability to attract exceptional talent.”
  • Healthcare Innovation points out,
    • “Sentara Health’s navigators are trained professionals with expertise in behavioral health, community resources, and motivational interviewing, working closely with ED teams and patients.
    • “The program started with pilot phases at select hospitals, expanding to 10 sites over a year, with ongoing data collection to measure impact and guide future improvements.
    • “Early results indicate significant reductions in readmission rates, demonstrating the program’s effectiveness in connecting patients to appropriate community-based care.”
  • Radiology Business informs us,
    • “In a bid to offer more services outside of Manhattan, Weill Cornell Medicine is planning to build a $57 million new radiology clinic in Brooklyn.
    • “The New York City academic system officially applied for the necessary state Department of Health approvals on Monday. Located in South Brooklyn’s Bay Ridge neighborhood on 86th Street, the clinic is expected to include three MRI machines, a CT scanner and ultrasound and mammography offerings, Crain’s New York Business reported. 
    • “The outpatient radiology clinic will be housed inside the NewYork-Presbyterian Bay Ridge Primary Multispecialty center and marks a significant expansion for the hospital system outside of Manhattan.
    • “While it’s premature to talk about the services of this location, we are always striving to meet the healthcare needs of New Yorkers in their own neighborhood,” Robert J. Min, MD, radiology chair and president and CEO of the Weill Cornell Physician Organization, told Radiology Business by email April 9. “We are still in the planning stages and will share details in the coming months.”
    • “Weill Cornell hopes the new center will help alleviate demand for radiology services in Brooklyn and the surrounding communities, according to the state application. The project is part of a bigger push by Weill Cornell and NewYork Presbyterian to expand their outpatient footprint across the city, local news outlet Hoodline reported Thursday.” 

Tuesday report

David Ermer–CDC, CMS, FDA, Medical / Rx research, Medicare, Rx coverage, Telehealth, U.S. Healthcare, Uncategorized–

From Washington, DC

  • Avalere Health breaks down yesterday’s CMS Medicare Advantage premium announcement.
  • Per an HHS news release,
    • “The Health Resources and Services Administration (HRSA) today announced more than $135 million in new funding opportunities to expand nutrition services and strengthen the rural health workforce. Secretary of Health and Human Services Robert F. Kennedy, Jr., alongside HRSA Administrator Tom Engels and Representative Juan Ciscomani (AZ-06), announced this important investment during a Preventative Care Roundtable with key stakeholders.
    • “Preventative care cuts costs, improves outcomes, and drives our mission to Make America Healthy Again,” said Secretary Kennedy. “These investments expand access to high-quality, affordable care—especially in rural communities that need it most.”
    • “HRSA is committed to strengthening the health workforce, advancing preventative care, and expanding access to essential nutrition services,” said HRSA Administrator Engels. “By supporting new rural residency programs to deliver evidence-based nutrition services, we are creating a stronger, more sustainable system of care that helps prevent chronic disease, improves health outcomes, and advances HHS and Make America Healthy Again priorities for communities across the country.”
  • Beckers Hospital Review tells us,
    • AbbVie and Genentech are the latest drugmakers to sell prescription medications on TrumpRx, CBS News reported April 6.
    • “They are the 10th and 11th drugmakers to offer discounted medications on the website. 
    • TrumpRx now lists AbbVie’s best-selling anti-inflammatory drug Humira — in syringe or pen form — for $950, representing an 86% discount off the list price. Genentech’s antiviral medication Xofluza is also available for $50, down from a list price of $168.” * * *
    • “Since launching in February, TrumpRx’s list has expanded from 43 medications to 69. Amgen also recently added its arthritis treatment Enbrel and plaque psoriasis drug Otezla to the platform.”
  • Bloomberg Law reports,
    • “President Donald Trump is in no hurry to tap a permanent attorney general to replace Pam Bondi following her ouster, according to people familiar with the matter, allowing Todd Blanche time to settle into his role as the US Justice Department’s acting chief.”
  • NewsNation relates,
    •  “Acting Attorney General Todd Blanche revealed key details Tuesday about the Department of Justice’s newly created National Fraud Enforcement Division.
    • “Our vision is to build a robust fraud-fighting squad capable of investigating and prosecuting the full spectrum of fraud against taxpayer dollars,” Blanche explained. 
    • “Blanche said the division will be staffed with some of the DOJ’s “best prosecutors,” including experts in health care, tax, benefits and corporate fraud.
    • “There will be an additional 93 prosecutors in every district across the country devoted to the mission of combating fraud,” Blanche added.”

From the Food and Drug Administration front,

  • Fierce Pharma reports,
    • “One year into his tumultuous tenure as the FDA’s commissioner, Marty Makary, M.D., has laid out ambitious internal goals and perhaps a more ambitious legislative wish list in his fiscal year 2027 budget proposal (PDF) to Congress.
    • “Alongside the justification of a $7.2 billion budget request, including $3.3 billion from congressional appropriations and $3.9 billion in industry-paid user fees, Makary is asking for a broad set of legislative actions. 
    • “The proposed changes would, among other things, create a new clinical trial initiation pathway as an alternative to the existing Investigational New Drug (IND) pathway, allow the FDA to disclose more information to the public in complete response letters, remove the interchangeability determination for biosimilars, give domestic generic manufacturers an upper hand and permanently authorize the rare pediatric disease priority review voucher program.”
  • The Wall Street Journal relates,
    • “Novo Nordisk NOVO.B launched its higher-dose Wegovy weight-loss shot in the U.S. after the new treatment gained regulatory approval there last month.
    • ‘The Danish drugmaker said Tuesday that Wegovy HD is now available nationwide through more than 70,000 pharmacies, its online pharmacy, certain telehealth providers and other outlets.
    • “Wegovy HD is a once-weekly injection that contains 7.2 milligrams of active ingredient semaglutide, offering the highest weight-loss of any Wegovy injection so far, the company said.” * * *
    • “In a trial of adults with obesity but without diabetes, patients taking a 7.2 milligram dose of Wegovy over about a year and a half lost 21% of their body weight on average, while around one in three people lost 25% or more of their body weight.
    • “Prior to the launch of Wegovy HD, the highest available injectable dose was 2.4 milligrams of semaglutide, which has shown to help patients lose around 18% of their body weight on average.
    • “The higher dose of Wegovy was approved by the Food and Drug Administration nearly three weeks ago under an accelerated approval process based on the results of the trial.”
  • Beckers Hospital Review tells us,
    • “Pfizer and BioNTech have halted a U.S. study of their updated COVID-19 vaccine in adults ages 50-64 due to slow enrollment, a Pfizer spokesperson confirmed to Becker’s.
    • “We can confirm our communication to the FDA about the status of the Pfizer-BioNTech COVID-19 vaccine postmarketing activities, including our intent to stop study C4591081,” the spokesperson said. “Notably, this study is not ending as a result of any safety or benefit-risk concerns.”
    • “The spokesperson added that the companies “intend to stop the study due to slow enrollment and therefore the inability to generate relevant postmarketing data.”

From the public health and medical / Rx research front,

  • The American Hospital Association News reports,
    • “A Centers for Disease Control and Prevention report published April 7 found that 47.2% of all U.S. adults met federal guidelines for aerobic physical activity in 2024. The report found that 52.3% of men and 42.4% of women met the standards. The CDC found that the prevalence of meeting the guidelines increased with education level. Aerobic physical activity was higher among adults without disabilities (49.8%), those with a healthy weight (54.8%), and those with excellent or very good health (57.8%). The analysis was based on data from the 2024 National Health Interview Survey.” 
  • Healio adds,
    • “Modest real-world weight loss may significantly reduce a person’s risk for cancer, according to results of a retrospective observational study.
    • “The risk reduction conferred by nonsurgical weight loss appeared consistent over multiple time intervals.
    • “The benefits became apparent quickly, with each 1% reduction in BMI equating to an approximately 1% reduction in cancer risk after as little as 3 years of follow-up.
    • “I definitely was surprised by the results, especially that we saw them as early as we did,” Daniel M. Rotroff, PhD, chairman of the department of quantitative health sciences and Eddie J. Brandon Endowed Chair for Diabetes Research at Cleveland Clinic, told Healio. “A 1% BMI reduction for a 1% reduction in risk may not sound like a lot but, when you think about some interventions achieving 5% weight loss pretty rapidly — and [some GLP-1 or dual GLP-1/GIP receptor agonists] achieving 10% or greater — that is a really meaningful reduction in cancer risk.”
  • Infectious Disease Advisor points out,
    • “The significant burden of respiratory syncytial virus-associated hospitalization in older adults, particularly those with underlying conditions, underscores the need for targeted vaccination strategies.”
  • MedPage Today adds,
    • “Influenza vaccines were effective in preventing related hospitalizations and outpatient visits among U.S. kids in recent years, but vaccine uptake remained low.
    • “Vaccine effectiveness against hospitalization ranged from 28% during the 2021-2022 flu season to 67% in the 2023-2024 season, and against outpatient visits ranged from 28% during the 2021-2022 season to 56% in the 2023-2024 season.
    • “Experts pointed to a need to properly communicate the benefits of influenza vaccines, especially as “distrust in vaccines grows.”
  • Health Day tells us,
    • “Cancer risk is higher for people battling autoimmune diseases, but the danger declines after they start taking anti-inflammatory medications, a new report finds.
    • “Italian researchers reporting in the journal Cancers found a 32% increase in the odds for cancer in the first year after a diagnosis for an autoimmune disease such as lupus, rheumatoid arthritis or psoriasis.
    • “However, after patients start taking drugs to ease the runaway inflammation that characterizes these illnesses, their cancer risk declines.
    • “The peak risk observed in the early stages suggests that chronic inflammation, rather than treatments, is a key factor in cancer development,” said Daniela Marotto, co-senior author of the study. She is head of rheumatology at the Local Health Authority of Gallura, in Italy.”
  • Health Day adds,
    • “Catching tumors early is crucial to lung cancer survival
    • “New robotic technologies, along with other innovations, is making early detection safer and easier on patients
    • “Often, detection, staging and treatment are done during the same procedure.”
  • Per STAT News,
    • “For some advanced cancers, sequencing the tumor genome should be one of the first steps patients and physicians take. But a new study finds that many patients never receive genomic testing and so never get the chance to know if they might have benefitted from newer, more targeted therapies.
    • “The study, published on Tuesday in JAMA Network Open, examined how many patients diagnosed with one of five different metastatic cancers received genetic sequencing for the cancers. For most cancers in the study, roughly half of patients in the cohort received genetic sequencing. Patients with low income, Medicare or Medicaid coverage, and Black or Hispanic race or ethnicity were also less likely to receive sequencing.”
  • MedPage informs us,
    • “Under physician supervision, 26% of older adults successfully stopped levothyroxine while maintaining stable thyrotropin and free thyroxine levels for a year.
    • “Discontinuation was more common in patients taking lower levothyroxine doses at baseline.
    • “Researchers urged clinicians to reassess thyroid therapy in older adults to avoid overtreatment and its associated risks.”

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

  • Fierce Healthcare reports,
    • “Last summer, the insurance industry broadly agreed to reform a major healthcare pain point: prior authorization.
    • “Now, two of the industry’s leading organizations are offering a look at progress toward those goals. AHIP and the Blue Cross Blue Shield Association released a report on Tuesday that found leading health plans reduced prior authorizations for an array of services by 11% since the pledge was made.
    • “This equates to 6.5 million fewer prior auth requests for patients, according to the report. Reductions in Medicare Advantage specifically were 15%, it reads.
    • “Health plans have taken important initial steps to support patients and are working toward the shared goal of delivering answers at the point of care whenever possible—a goal that will require both plans and providers to eliminate manual processes and adopt real-time electronic data sharing,” said Mike Tuffin, AHIP President and CEO, in the announcement.”
  • Physicians’ Practice adds,
    • “Access to affordable health care has displaced administrative burden as the single biggest policy concern among U.S. physicians, according to athenahealth’s fifth annual Physician Sentiment Survey. The shift signals the industry’s growing concern over systemic cost and coverage pressures, stretching well beyond the exam room.
    • “The survey, conducted online by The Harris Poll in October 2025 among 1,045 primary care physicians and specialists nationwide, found that 52% of physicians now consider access to affordable health care to be the most pressing issue they want policymakers to address. That figure was 44% in the 2025 survey and 38% in 2024, a 14-point climb in just two years. For the first time in the survey’s five-year history, the issue overtook minimizing excessive documentation requirements, which fell to 46% from 49% in 2024.”
  • The Wall Street Journal charts the weight loss drug frenzy ongoing in our country.
    • “The market for weight loss drugs is exploding and patients may have several new options in coming years.”
  • The Journal also relates,
    • “Gilead Sciences GILD agreed to buy German biotechnology company Tubulis for $3.15 billion to expand its portfolio of a cancer technology that aims to better guide chemotherapies to tumors.
    • “Tubulis’s lead drug is a targeted cancer therapy known as an antibody-drug conjugate. It is in mid-stage trials for ovarian and lung cancers. The German company has another antibody-drug conjugate in earlier stages of development that is being tested across several tumor types.”
    • “The deal, announced Tuesday, is expected to close by the end of June and includes up to $1.85 billion in potential milestone payments. Gilead already had a two-year research partnership, signed in 2024, with Tubulis.”
  • Per an Institute for Clinical and Economic Review news release,
    • “The Institute for Clinical and Economic Review (ICER) today released a Draft Evidence Report assessing the comparative clinical effectiveness and value of Comirnaty® (Pfizer, BioNTech), Spikevax® (Moderna), mNexspike® (Moderna), and Nuvaxovid® (Sanofi) for the protection against Covid-19, including both the short- and long-term effects of the infection. 
    • “This preliminary draft marks the midpoint of ICER’s eight-month process of assessing these treatments, and the findings within this document should not be interpreted to be ICER’s final conclusions.“
  • Per Fierce Healthcare,
    • “Alloy Health, a virtual platform serving women in midlife, is expanding its weight care program with two new offerings: micro-dosing and the Wegovy pill.
    • “Micro-dosing will allow for more personalized dosing for women who, for whatever reason, do not tolerate the manufacturer-made doses. The Wegovy pill introduces a daily oral GLP-1 option for women who prefer an alternative to injections. The company hopes to keep adding more brand-name products, including the Zepbound KwikPen, as they become available. 
    • “The products build on Alloy’s existing weight care program, launched last year, which aims to offer menopause-specialized weight care. The program offers physician-led hormonal expertise with personalized care plans designed for midlife women. Alloy is an entirely asynchronous, text-based provider.” 
  • and
    • “Artificial intelligence-enabled virtual care company Counsel Health is building out its clinical offerings to include lifestyle and chronic condition services. 
    • “The expansion will first focus on lifestyle conditions, including hair loss and sexual health, with plans to broaden its scope to chronic conditions later in 2026, including services to address high cholesterol and obesity. 
    • “If its chatbot recommends consultation with a physician, users can pay $29 to schedule follow-up care. Counsel Signature members, the company’s annual membership plan, will be able to use the expanded capabilities at no extra cost, according to a company announcement.”
  • Beckers Payer Issues lets us know,
    • “Cigna Healthcare offers the best digital experience to commercial members, while UPMC Health Plan provides the best experience to Medicare Advantage enrollees, according to J.D. Power’s 2026 U.S. Healthcare Digital Experience Study. Both plans topped their respective segments in last year’s ranking as well.
    • “Overall, the segment average for commercial plan digital experience is 658 on a 1,000-point scale. For MA, the segment average is 645. Both figures represent an improvement over the 2025 study, which recorded averages of 653 for commercial plans and 597 for Medicare Advantage.
    • “The study measured satisfaction across visual appeal; navigation; information/content; speed; and telehealth. The 2026 study included evaluations from 7,687 members of the 17 largest MA plans and 16 largest commercial plans, fielded from August through December 2025.”
    • More results are available in the article.
  • Modern Healthcare reports,
    • “Health systems and health plans are embracing performance-based contracts with digital health vendors. 
    • “In 2025, 75% of health plans and 61% of health systems implemented performance-based contracts with digital health vendors, according to a 2025 survey conducted by Peterson Health Technology Institute. In addition, the majority of the organizations that didn’t use performance-based contracts last year expressed interest in doing them.
    • “The contracts can ensure that payment is tied to return on investment and measurable outcomes. That makes formulating them tricky.”

Monday report

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

From Washington, DC,

  • The Wall Street Journal reports,
    • “The Trump administration will raise payments to Medicare insurers by 2.48% next year, a dramatic increase after a preliminary proposal holding the line on payments drew fierce criticism from the industry and torpedoed shares of the largest companies.
    • “The final 2027 rates for Medicare Advantage, the private-insurer version of the federal program for seniors and the disabled, came in above some analysts’ expectations. Several had suggested a rate increase would likely be finalized at around 1% or slightly higher, with a “bull” case closer to 2% to 3%. 
    • “The final increase represents about $13 billion in additional payments to the insurers.
    • “The announcement marks a stunning turnaround for an industry that has been battered by a series of financial setbacks across multiple lines of business, particularly in the Medicare plans that had long been a major engine of growth.” * * *
    • “Chris Klomp, the Medicare program director, said in an interview with The Wall Street Journal that the Centers for Medicare and Medicaid Services is trying to balance the interests of enrollees and taxpayers. 
    • “We have to be wise stewards of the tax dollar,” said Klomp, who is also now a top official at the Department of Health and Human Services. But “we need to make sure that plans aren’t pulling out of markets, that they’re not cutting benefits that beneficiaries are relying on.”
    • “Trends in Medicare plans’ billing will raise the overall 2027 payment increase to 4.98% with the final rate changes added in, the agency said.”
  • AHIP adds,
    • “AHIP issued the following statement after the Centers for Medicare and Medicaid Services (CMS) issued the final 2027 Medicare Advantage (MA) and Part D rate notice.
    • “More than 35 million seniors and Americans living with disabilities choose Medicare Advantage because it provides them with better care at lower costs than fee-for-service. As health plans incorporate the policies released in recent days, they will continue to focus on keeping coverage and care as affordable as possible during this time of sharply rising medical costs.” – Chris Bond, AHIP spokesperson.”
  • and
    • “A new report by The Wall Street Journal examines why “Americans spend more on health care than anyone else in the world,” underscoring “the high prices Americans pay for surgeries and drugs” compared to consumers in other nations. Some key excerpts: 
    • “Americans spend more on healthcare than anyone else in the world. Just insuring a family here costs nearly $27,000 a year, enough to buy a car. The main cause: Prices are far higher in the U.S. for the same medical products and services, from surgeries to drugs.”
    • “Big hospitals can charge higher rates because of consolidation … Many cities and communities are now dominated by a single hospital system, partly because hospitals have been merging in recent years. The consolidation has given hospital systems leverage to command higher rates during negotiations with health insurers. The insurers would lose business if powerful hospitals shut them out.”
    • “Of note, an analysis  by KFF provides some additional context on the significance of pricing: “The U.S.’s higher spending on providers is driven more by higher prices than higher utilization of care. Patients in the U.S. have shorter average hospital stays and fewer physician visits per capita, while many hospital procedures have been shown to have higher prices in the U.S.” 
  • On a related note, MedPage Today offers an interview with “William Schpero, PhD, a healthcare economist at Weill Cornell Medicine in New York City, explains — among other things — why he thinks consumer-focused price transparency in healthcare won’t work, but putting the onus on physicians might.”
  • Modern Healthcare informs us,
    • “The Federation of American Hospitals’ new President and CEO, Charlene MacDonald, has her work cut out. 
    • “MacDonald, who succeeded longtime CEO Chip Kahn in January, is charged with steering a trade group that supports more than 1,000 for-profit hospitals and health systems as they navigate steep funding cuts and a rapidly evolving care delivery landscape.
    • “MacDonald joined the federation in 2023 as executive vice president of public affairs and oversaw government affairs, advocacy, communications, finance and operations. 
    • “In an interview, MacDonald said the changes coming in the next two years are dire for hospitals, and members can play a critical role in shaping policy. The interview has been edited for length and clarity. 
    • “What are your top priorities for 2026 and beyond?
    • “The first is affordability. That’s not just premiums, but out-of-pocket costs and whether coverage translates into access. The second is stability in coverage programs. Medicaid financing is obviously critical, but so is the stability of the individual market. The third is transparency and accountability on how premium dollars are being used.
    • “Our role is to bring that on-the-ground perspective to the policy conversation and ensure the conversations we’re having are not just academic but are reflective of the patient experience.”
  • Govexec and Federal News Network discuss OPM’s March 31, 2026, call letter for 2026 benefit and rate proposals from FEHB and Postal Service Health Benefits carriers. It is unfortunate that OPM continues to pile new benefit mandates on top of the many older ones.

From the Food and Drug Administration front,

  • MedTech Dive reports,
    • “VDyne said the Food and Drug Administration approved an investigational device exemption for a pivotal clinical trial of its transcatheter tricuspid valve replacement system. The approval, announced last week, moves VDyne a step closer to competing with Edwards Lifesciences’ Evoque tricuspid valve replacement device.
    • “The TRIVITA trial will evaluate the safety and efficacy of the VDyne device to treat symptomatic severe tricuspid regurgitation, where the valve fails to close properly and leaks, making the heart work harder to pump blood. The artificial valve is intended to restore normal blood flow.
    • “VDyne said there is a significant unmet need for minimally invasive tricuspid regurgitation treatments, noting most of the 1.5 million patients in the U.S. with the condition are too frail for open heart surgery. Tricuspid valve surgery is associated with high mortality and poor outcomes, the company added.”
  • Fierce Pharma relates,
    • “In response to a warning letter from the FDA that accused the company of making “false or misleading” claims about its bladder cancer drug Anktiva, ImmunityBio is implementing enhanced measures aimed at ensuring that all promotional communications relating to the drug are “accurate, balanced and compliant with FDA regulations,” the company said in a release.
    • “Among the measures ImmunityBio has implemented are “expanded promotional review protocols,” executive training and external regulatory oversight, the company said. The moves follow a “comprehensive review of all promotional materials and external communications” with its legal and regulatory teams, ImmunityBio explained.
    • “ImmunityBio added that it has removed from its corporate website a podcast identified by the U.S. regulator in its March warning letter. The company has also requested the removal of the podcast from all third-party platforms, it said.” 

From the public health, medical and Rx research front,

  • HealthDay reports,
    • “Many folks think it’s OK to belt back a few extra rounds on Saturday night if they stay mostly sober during the week.
    • “But saving up your drinks for a single sitting could be a recipe for liver problems, new research suggests.
    • “A team at the University of Southern California’s Keck School of Medicine linked occasional heavy drinking to triple the risk of advanced liver fibrosis — a dangerous type of scarring that can lead to liver failure. 
    • “Their findings — published April 2 in Clinical Gastroenterology and Hepatology — indicate that the way you drink may be just as important as how much.
    • “Occasional binge drinking could be changing liver tissue in profound ways.
    • “This study is a huge wake-up call because traditionally, physicians have tended to look at the total amount of alcohol consumed, not how it is consumed, when determining the risk to the liver,” lead author Dr. Brian Lee, a hepatologist at Keck Medicine, said in a news release.”
  • The American Medical Association lets us know “what doctors wish patients knew about rheumatoid arthritis.”
    • “Among chronic conditions, one stands out for its enigmatic nature and debilitating impact: rheumatoid arthritis (RA). 
    • “This condition presents an array of challenges and wreaks havoc on the lives of those who live with it. And while there are effective treatments that can prevent or slow the progression of rheumatoid arthritis, many questions remain unanswered, leaving patients and their families searching for better strategies to manage this life-altering condition.”
  • Drug Topics relates,
    • A growing body of evidence suggests that the choice of glucose-lowering therapy may play a critical role in colorectal cancer prevention.
    • For pharmacists managing the complex needs of patients with type 2 diabetes (T2D), a growing body of evidence suggests that the choice of glucose-lowering therapy may play a critical role in colorectal cancer prevention. A trial emulation published in Diabetology and Metabolic Syndrome reveals that dual therapy combining sodium-glucose cotransporter-2 (SGLT2) inhibitors with glucagon-like peptide-1 (GLP-1) receptor agonists is associated with a 21% lower risk of colon cancer in high-risk patients with a history of polypectomy. This finding, derived from a large-scale analysis of over 57,000 patients, suggests that the combination of these 2 drug classes may offer additive chemopreventive effects that surpass the benefits of monotherapy alone.
  • MedPage Today adds,
    • “Commonly prescribed antibiotics and non-antibiotic drugs were associated with significantly increased odds of Clostridioides difficile infection in a case-control study.
    • “Non-antibiotic drugs with the greatest observed risks for C. difficile infection were antidiarrheals, analgesics, and corticosteroids.
    • Considering how frequently these medications are used, prudent prescribing decisions are needed, researchers said.
  • Healio notes,
    • “Approximately half of patients with the highest-risk brain metastases did not receive palliative care consultations, according to results of a study of nearly 500 patients.
    • “Those who received palliative care had significantly higher rates of advance directive completion and hospice enrollment, without any compromise in overall survival.
    • “Palliative care consultation is not end-of-life consultation,” Rohit Singh, MD, medical oncologist and assistant professor at University of Vermont Larner College of Medicine, told Healio. “It should be a part of patients’ multidisciplinary team.”
  • Genetic Engineering and BioTechnology News tells us,
    • “Biomedical researchers headed by a team at the Lampe Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill/North Carolina State University, have developed an injectable microgel to help reduce bleeding in infants who require surgical care. Tests in an animal model showed that the hemostatic microgels, known as B-knob-triggered microgels (BK-TriGs), reduced bleeding by at least 50%.
    • “Research lead Ashley Brown, PhD, who is the Lampe Distinguished Professor of Biomedical Engineering, is co-corresponding author of the team’s published paper in Science Advances, titled “Hemostatic B-knob-triggered microgels (BK-TriGs) to address bleeding in neonates.” In their paper the team concluded “This study highlights the potential of BK-TriGs, designed for neonatal-specific clotting mechanisms, to address the heightened bleeding and thrombosis risks in neonates, who face 4.4 times higher postsurgery mortality … Our findings support BK-TriGs as a promising approach for improving hemostasis in neonates, offering a tailored, effective solution for this vulnerable patient population.”
  • BioPharma Dive informs us,
    • “Amgen said an injectable version of its blockbuster eye disease drug Tepezza hit both goals in a key late-stage trial that could help the company fend off competition from an emerging rival. 
    • “According to Amgen, a form of the thyroid eye disease drug Tepezza that’s delivered via an on-body injector instead of an intravenous infusion met its main objective as well as a key secondary endpoint in the study. Notably, the newer version, Tepezza OBI, appeared comparable to the marketed medicine, displaying “IV-like efficacy,” said research chief Jay Bradner, in the statement.”  

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

  • Healthcare Dive reports,
    • “Centene has created two new executive leadership positions to consolidate oversight of its Medicaid, Medicare and Affordable Care Act businesses as the insurer copes with rising costs and looming policy challenges.
    • “Centene has hired longtime health insurance executive Daniel Finke as its inaugural group president of markets and commercial, the company announced Monday. Centene also named Michael Carson, the CEO of its Medicare business, as group president of Medicare and specialty.
    • “Both executives will report to Centene CEO Sarah London. Centene did not respond to a request for comment about when the appointments are effective.”
  • Per a recent Health Care Cost Institute issues brief,
    • “Imaging services made up 24% of outpatient visits and were the second largest category of outpatient spending (17%) in 2022. The most common imaging services were for screening mammography and chest x-rays, which are used for routine screening and diagnosing certain conditions. Other imaging services such as CT scans of the abdomen, echocardiography (ultrasound for the heart), and MRI of the brain occurred less often but had higher costs, making them some of the highest spending imaging services.
    • “One way to better understand prices in employer-sponsored insurance is to compare negotiated rates paid in ESI to Medicare payments for the same services. On average the commercial prices of x-rays were 314% of Medicare, MRIs were 307% of Medicare, CT scans were 257% of Medicare, and Ultrasounds were 245% of Medicare. HCCI estimated that, if commercial prices were equal to Medicare prices, ESI spending would be $6B lower for MRIs, $3.1B lower for CT scans, $2.7B lower for ultrasounds, $1.5B lower for nuclear imaging, and $1.2B lower for x-rays.”
  • MedCity News relates,
    • A new report is providing some much needed validation for those in the women’s health industry.
    • Women’s health has long been under-represented, under-researched and under-funded. About 5% of total healthcare R&D and investment funding goes towards women’s health. But a shift is taking place as research shows that increasing investor dollars are starting to flow into women’s health, and not just reproductive health, according to a report released this month from consulting firm PwC. Which means a wholesale modification of the very categories that define women’s health — traditionally thought of only as reproductive health and women specific-conditions such as menopause or endometriosis — is in order.
    • The traditional definition of women’s health only represents a $195-205 billion market, according to PwC. But there are medical conditions that affect women differently — like asthma, cardiovascular diseases, diabetes and mental health. Then there are conditions that affect women disproportionately, including Alzheimer’s, autoimmune diseases and migraines.
    • “When this broader definition is considered that includes a woman’s entire life cycle through all its varied stages, the women’s health industry represents a $430-440 billion global market across pharmaceuticals, devices and diagnostics, providers, payers and consumer health solutions, according to PwC. 
    • “And this is projected to reach $600 billion by 2030, and that’s “if we do nothing,” according to Glenn Hunzinger, PwC’s health industries leader.
    • “If we continue to have a focus, I could see those opportunities getting much wider and much bigger,” he said in an interview.
    • “Investors, advocates and entrepreneurs were encouraged by the report’s call to action.”
  • MedTech Dive tells us,
    • “Boston Scientific has closed its acquisition of incontinence device maker Valencia Technologies, the company said on LinkedIn last week.
    • “The buyout gives Boston Scientific control of eCoin, a tibial nerve stimulator that competes with Medtronic’s Altaviva for the urge urinary incontinence market. Boston Scientific announced the deal in January.
    • “RBC Capital Markets analysts welcomed the deal in a note to investors in January, explaining that the takeover moves Boston Scientific into a high-growth area.”
  • Fierce Pharma informs us,
    • “Neurocrine Biosciences, forever a possible M&A target in the biopharma industry, is making a major acquisition itself.
    • “Neurocine has reached a deal to acquire Soleno Therapeutics for $2.9 billion, bagging recently FDA-approved Vykat XR (diazoxide choline), the first therapy for hyperphagia in patients with the rare genetic neurodevelopment disorder Prader-Willi syndrome (PWS).
    • “Hyperphagia is an insatiable hunger, which can lead to co-morbidities such as obesity and other cardiometabolic diseases and death.
    • “The announcement of the Soleno deal comes a few months after Neurocrine unveiled an obesity pipeline led by a preclinical CRF2 agonist.” 
  • Fierce BioTech points out,
    • “AI powerhouse Anthropic is continuing its push into the healthcare arena with the acquisition of previously stealth AI biotech startup Coefficient Bio in a $400 million stock deal, according to reporting from The Information and Eric Newcomer.
    • “TechCrunch also confirmed the acquisition through sources close to the deal, and Coefficient’s PitchBook page reflects the $400 million transaction as well. Anthropic and Coefficient have not yet responded to Fierce Biotech’s requests for confirmation.”
  • MedCity News adds “Uma Veerappan of Flare Capital Partners thinks the healthcare AI startups that will come out on top will be companies that integrate seamlessly into workflows, build proprietary datasets and quickly determine how to sell their technology.”

Weekend update

David Ermer–CMS, Congress, Federal employment benefits, Medical / Rx research, Medicare, Mental health care, Obesity, OPM, U.S. Healthcare–

Happy Easter!

From Washington, DC,

  • Congress remains on a State/District work break this week. Both Houses of Congress return to Capitol Hill on April 13.
  • Govexec reports,
    • “President Trump’s fiscal 2027 budget proposal, released Friday morning, would freeze federal civilian employees’ pay in 2027, all while granting a sizeable raise for members of the armed services.
    • “An Office of Management and Budget spokesperson told Government Executive that under Trump’s budget, civilian workers would receive no pay increase next January. But under the plan, members of the military would receive between a 5% and 7% pay increase, with the highest raises going to the lowest ranked personnel.”
  • The U.S. Office of Personnel Management has released its Fiscal Year 2027 Congressional Budget Justification.
    • Worth noting on page 84
      • The FEHB Protection Act of 2025 (FPA) requires OPM to strengthen eligibility verification and oversight of the FEHB Program. OPM is directed to issue regulations and implement verification processes by July 4, 2026, conduct a comprehensive family member eligibility audit between July 4, 2026 – July 4, 2029, and establish a process for removal of ineligible individuals (completed in December, 2025 per statutory deadline).
    • FEHBlog observation — Any improvement in eligibility verification should begin with adding the HIPAA 820 electronic enrollment roster transaction to OPM’s enrollment system. That transaction would allow carriers to reconcile premium payments to individual enrollments. What is the sense of performing this family member audit if carriers don’t know if the individual with self and family or self and family coverage (or half of the enrollment with self only coverage) is paying the correct premium?
  • Healthcare Dive reports,
    • “Antitrust regulators are warning Tennessee not to terminate an agreement giving its health department oversight of Ballad Health, a hospital monopoly in the state.
    • “The Tennessee legislature is considering bills that would allow Ballad’s certificate of public advantage, or COPA, to expire in 2028. Balled was formed in 2018 under the COPA, a controversial mechanism that allows potentially anticompetitive hospital mergers to go through in exchange for increased state oversight for a period of time.
    • “Without the COPA, all state supervision of Ballad’s care quality, availability and access, along with population health initiatives, would end.
    • “That could have steep consequences for Tennessee patients, including higher healthcare costs and poorer quality of care, the Federal Trade Commission said in the letter sent Wednesday.”
  • MedTech Dive relates,
    • “The Trump administration is adjusting how Section 232 tariffs on steel, aluminum and copper imports and derivative products are calculated, according to a proclamation President Donald Trump signed Thursday. 
    • “Under the new rules, which go into effect April 6, goods made almost entirely of aluminum, steel or copper, including steel coils and aluminum sheets, will face a 50% tariff for the value of the item. 
    • “However, derivative articles “substantially made” of steel, aluminum or copper will incur a 25% levy, per a White House fact sheet. Such goods include steel cooking appliances, silverware, diesel-engine trains and semi-trailer hauling trucks, according to a list provided by the White House.” 

From the public health, medical / Rx research front,

  • The Washington Post reports,
    • “Uri Alon was long puzzled by a textbook statistic: longevity, the thinking went, was about 20 percent in our genes.>” * * *
    • “The original studies that were used to estimate how much of lifespan was inherited were studies of Scandinavian twins from the tail-end of the 19th century.
    • “During that era, “extrinsic” mortality was high — deaths that aren’t related to the deterioration of aging, such as accidents, violence or deaths from infections that are now uncommon because of better nutrition, therapies and hygiene.
    • “His team examined a database of Swedish twins born later, between 1900 and 1935, and found that these extrinsic deaths were masking the inherited component of lifespan. When they applied their model, designed to remove extrinsic deaths, to databases of Scandinavian twins and the siblings of centenarians who lived to at least 100, the heritability of lifespan markedly increased — to about half.” * * *
    • “Thomas Perls, a longevity researcher at Boston University and the founding director of the New England Centenarian Study, agrees that genetics play a major role in lifespan, but that it depends on what age you are talking about.
    • “At the very extremes of old age — people who live to 105 or even 110 — genetics play a major role in lifespan. But Perls points to a 2018 study in the journal Circulation that suggests that even without winning the genetic lottery, an average person can probably get to about 88 years old as a man, and 93 years old as a woman. That depends on embracing good health-related behaviors. He also notes that socioeconomic advantages contribute — access to health care, education, healthy food.”
  • and
    • “Joseph Buxbaum was initially unconvinced. When early hints of a connection between autism and Alzheimer’s began to appear in the medical literature a few years ago, they struck him as implausible — one a condition of early brain development, the other driving decline in old age.
    • “But the signals kept accumulating, and over time, his skepticism gave way to a new line of inquiry that could transform scientists’ understanding of the two diseases.
    • “I came to this kicking and screaming. I didn’t want to believe it,” Buxbaum, a professor of psychiatry, neuroscience, and genetics/genomic sciences at the Icahn School of Medicine at Mount Sinai, said.” * * *
    • “The idea that two conditions at opposite ends of life might be biologically linked is beginning to upend long-standing assumptions in brain science, blurring a divide that has shaped the field for decades. Now, some researchers have begun to see the two as intertwined: that understanding Alzheimer’s may require looking back to how the brain develops, and that insights into autism might, in turn, reshape how we understand Alzheimer’s itself.”
  • Medscape tells us,
    • “For decades, clinical dietetics has been based on standardized nutritional recommendations for the general population: food pyramids, and Italy’s nutrient reference values, and dietary indications applied uniformly for conditions such as hypercholesterolemia or hypertension.
    • “In routine practice, however, physicians have increasingly observed that patients with the same caloric intake and physical activity can show different outcomes in terms of weight change, glycemic control, or lipid profile.
    • “This interindividual variability, once considered a clinical anomaly, is now supported by scientific literature. Response to diet does not depend exclusively on energy balance but also on a series of individual biological characteristics that influence nutrient metabolism and the interaction between diet and the body’s physiology.”
    • “Precision nutrition frames diet from a simple quantitative tool of nutrients to a personalized metabolic intervention.
    • “Applications of precision nutrition extend beyond body weight management. It has potential relevance in numerous clinical conditions, including gastrointestinal disorders such as irritable bowel syndrome, food intolerances, kidney stones, and various cardiometabolic conditions.”
  • and
    • “Analysis of real-world pharmacovigilance data shows that GLP-1s demonstrate distinct adverse event patterns across indications, primarily related to metabolic, nutritional, gastrointestinal, and psychiatric disorders, with different profiles observed across treatments.” * * *
    • “As millions of patients are taking GLP-1s for weight control and obesity treatment worldwide, clinicians should be vigilant in monitoring for unanticipated long-term adverse effects,” the authors of the study wrote.”
    • “The study was led by David Stone, Departments of Oncological Sciences and Biomedical Informatics, University of Utah, Salt Lake City. It was published online in Obesity.”

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

  • Beckers Payer Issues reports,
    • “The Blue Cross Blue Shield Association submitted a wide-ranging letter to CMS on March 30 in response to the agency’s information request on its Comprehensive Regulations to Uncover Suspicious Healthcare, or CRUSH, initiative. 
    • [Three of] Seven BCBSA Recommendations
      • “1. CMS should notify Medicare Advantage plans in real time when it suspends payments to a provider over suspected fraud because bad actors are exploiting the current information gap by shifting billing from original Medicare to MA after CMS acted on suspected fraud in fee-for-service.
      • “2. CMS should remove any contractual or policy language that requires MA plans to continue paying claims when fraud is suspected, regardless of whether CMS has paid its portion. The association also recommends that suspect claims be tagged with a unique code or priced at zero member liability at the time of a CMS payment suspension, so MA plans can identify those claims before payment.” * * *
      • “6. Overall, the association says the independent dispute resolution process under the No Surprises Act is broken and needs structural fixes. BCBSA recommends CMS launch the IDR Gateway as soon as possible, implement baseline eligibility screening before payment or review, establish an upfront eligibility fee to deter bad-faith submissions, and create performance metrics.”
  • The Health Care Cost Institute relates,
    • “The prevalence of depression and anxiety has increased steadily since 2019. Previous research, including a report from HCCI,  has identified a concurrent steady increase in the use of antidepressant and anxiolytic medications. Previous studies have found that most people receive prescriptions for psychotropic medications from their primary care providers. This finding describes national prescribing patterns, but few analyses have examined sub-national patterns and whether there is variation at a state level.” * * *
    • “Nationally, approximately three quarters of antidepressant and anxiolytic prescription fills are prescribed by a primary care provider. The remaining quarter of fills are prescribed by psychiatrists and psychiatric NPs, and a small fraction (<1%) are prescribed by other mental health professionals.” * * *
    • “At the state level, there is variation in the proportion of antidepressant and anxiolytic fills prescribed by each provider type. The proportion of fills prescribed by a PCP range from 55% in Washington, D.C. to nearly 86% in West Virginia.  Likewise, Washington D.C. has the highest proportion of fills prescribed by a psychiatrist or psychiatric NP (44%) while West Virginia has the lowest (14%).  The proportion of prescriptions from other mental health providers is highest in Rhode Island (5%) and lowest in Mississippi (0.2%).”
    • “At a national level, the proportion of antidepressant and anxiolytics prescribed by a psychiatrist or psychiatric NP increased by about 2 percentage points from 2018-2022.”
    • “More research is needed to understand the implications of high levels of PCP prescribing. One study found that patients who are treated by PCPs were less likely to be adherent to antidepressant treatment than patients who are treated by psychiatrists, and that patients treated by multiple providers had lower odds of nonadherence than patients treated by a single provider. Future studies should investigate why patients are receiving antidepressant and anxiolytic prescriptions from PCPs. This phenomenon could be related to mental health provider shortages or could indicate integration of mental health care into primary care, which is an objective of collaborative care models. Additional areas of research should include the role of other mental health providers, including allied health professionals, in prescribing medication, and outcomes associated with these prescribing provider types. Understanding how and why people are prescribed medications to treat mental health conditions is foundational for making informed decisions and effective policy to promote mental health care access.”
  • “The Wall Street Journal explains how a consumer can obtain healthcare advice from a AI tool.  The journalist does so in consultation with a human doctor.”

Friday report

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

From Washington, DC,

  • Per an OPM news release,
    • “The US Office of Personnel Management (OPM) released its Plan Year 2027 Carrier Call Letter for the Federal Employees Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) Programs, outlining a clear shift toward prevention, wellness, and long-term health outcomes.
    • “The guidance calls on FEHB and PSHB carriers to help advance a healthcare approach that prioritizes prevention, improves health outcomes, and supports long-term affordability.
    • “The Plan Year 2027 priorities emphasize empowering individuals to take a more active role in their health while encouraging carriers to expand access to non-pharmaceutical interventions and digital therapeutics, promote cost-effective sites of care, and reduce unnecessary or low-value services. Over time, these changes are expected to prevent chronic conditions and drive meaningful cost savings.
    • “This year’s carrier letter reflects this administration’s commitment to WellCare and prioritizing the health and longevity of federal workers,” OPM Associate Director for Healthcare and Insurance Shane Stevens said. “Today’s health decisions shape outcomes for years to come.  By focusing on prevention and giving individuals the tools to take ownership of their health our participants have enhanced opportunities to improve their health while ensuring a more sustainable program for federal employees, retirees, and taxpayers.”
    • “OPM will continue working with carriers to implement these changes and strengthen a healthcare system centered on wellness and prevention. Read the letter to carriers here.”
  • FEHBlog Observation — While the call letter does include a boatload of new mandates, those mandates sit on topic of ideas from the Obama and Biden administrations because OPM rarely looks back. It’s high time to offset new spending by cleaning house on earlier mandates.
  • The American Hospital Association reports,
    • “President Trump April 3 submitted to Congress his budget request for fiscal year 2027. The top-line request proposes a 10% decrease ($73 billion) in non-defense discretionary spending. The budget requests $111.1 billion in discretionary funding for the Department of Health and Human Services, a 12.5% ($15.8 billion) reduction from FY 2026 enacted. The HHS proposal does not include any new mandatory spending proposals. While this proposal is not binding, it serves as a preliminary framework for both Congress and the administration as they determine federal funding levels and shape health care policy this year.”  
  • STAT News relates,
    • “The Trump administration is slashing the number of quality and care measures that Medicare Advantage plans will be graded on, a move that will funnel an extra $18.6 billion toward health insurers over the next decade.
    • “The final regulation, released Thursday by President Trump’s Centers for Medicare and Medicaid Services, is significantly more beneficial for the insurance industry than originally expected. CMS previously estimated these changes to star ratings would cost $13.2 billion between 2028 and 2036 when the rule was proposed in November.
    • “The extra funding from star ratings provides a sizable buffer for Medicare Advantage insurers, which are awaiting final payment rates for 2027 and experiencing higher medical claims. Insurers have lobbied Trump officials for more money in their baseline payments, and to scale back changes in how they record the sicknesses of their members. The government is supposed to release that regulation no later than April 6.”
  • Bloomberg Law adds,
    • “President Donald Trump’s plan to cover weight-loss medications for some people in the Medicare program for the elderly would cost the health insurers billions in its first year, a new analysis found. 
    • “The Trump administration has argued that the lower prices it negotiated with drugmakers last year would offset the cost of adding coverage for millions of new patients. The plan will “expand access and lower prices for obesity GLP-1 medication without passing the bill to taxpayers,” Mehmet Oz, director of the Centers for Medicare and Medicaid Services, said in a video promoting the plan. 
    • “But a new analysis undercuts that claim. Savings of more than $900 million during the program’s first year would only cover the costs for an estimated 4.4% of the patients who would become newly eligible for the drugs, according to researchers led by Vanderbilt University Professor of Health Policy Stacie Dusetzina.
    • “The findings published in the Journal of the American Medical Association come ahead of a crucial April 20 deadline for health insurers to decide whether they will join the optional program next year. The Trump administration has said it won’t proceed with the plan unless insurers covering 80% of the Medicare population join.
    • “All of the major insurers participating in Medicare’s drug benefit program would need to opt-in to hit that threshold. Dusetzina said she doesn’t see any clear path for the plans to increase access without a significant financial hit.”
  • FEHBlog Observation: This Medicare program would benefit the FEHB and PSHBP which currently covers these GLP-1 drug expenses for federal and Postal annuitants over age 65.
  • Fierce Pharma notes,
    • “The U.K. can officially declare itself free of tariffs on drug exports to the U.S. after its government signed off on the landmark U.S.- U.K. pharmaceutical partnership that first came to be in December. 
    • “In exchange for the tariff reprieve, the U.K. will boost the net price its National Health Service (NHS) pays for novel treatments by 25%. The arrangement lasts at least three years and makes the U.K. the first in the world to secure 0% tariffs on U.S. pharma exports, U.K. officials said in a Thursday press release. 
    • “First announced in December, the partnership protects a UK pharmaceutical industry that added £28.5 billion to the UK economy in 2025, employs over 50,000 people in highly skilled, well-paid jobs, and exported almost £21 billion in pharmaceutical products worldwide last year,” the government explained.” 

From the public health, medical and Rx research front,

  • The University of Minnesota’s CIDRAP reports,
    • “US flu activity keeps trending downward, according to the latest FluView report from the Centers for Disease Control and Prevention (CDC).
    • “Flu cases are declining across most of the country, the CDC said, with influenza A viruses waning and influenza B viruses showing varying levels of activity. That trend follows the typical seasonal flu virus patterns. The proportion of tests that were positive for flu fell to 9.8%, down from 11.5% the previous week, and the proportion of outpatient visits for flu remained below the national baseline for the second straight week, falling from 2.8% to 2.6%.
    • “For the season overall, influenza A viruses have been the most frequently reported. Of the influenza A viruses collected so far, 92.7% have belonged subclade K, which contains mutations that developed after this season’s flu vaccine strains were selected.
    • “Weekly hospital admissions for flu also declined, dropping from 5,640 the previous week to 3,050 this week. But an additional four pediatric deaths were reported this week, bringing the total for the season to 127. Although the CDC has classified the current flu season as moderate for adults, for children it’s been a high severity season.
    • “The CDC estimates there have been 30 million illnesses, 370,000 hospitalizations, and 23,000 deaths from flu so far this season.”
    • “Overall, the amount of acute respiratory illness causing Americans to seek health care is low, the CDC said in its respiratory illness update. But respiratory syncytial virus (RSV) activity picked up later than normal this year and is currently at elevated levels, though it appears to have peaked in most regions, and the virus isn’t making people sicker than in previous seasons. Emergency department visits and hospitalizations for RSV are highest among children aged 4 and under.
    • “COVID-19 levels are low across most of the country.
    • “The CDC also noted that human metapneumovirus (HMPV) activity is rising across the country, which is typical for this time of year. Symptoms of HMPV include cough, fever, nasal congestion, and shortness of breath.“
  • Beckers Clinicial Leadership adds,
    • “The new “Cicada” variant identified in more than half of U.S. states may be more likely to infect children than adults, CNN reported April 2.
    • “The variant, BA.3.2, earned its nickname because it has largely remained undetected or “underground” — like its insect namesake — since first discovered in a five-year-old boy in South Africa in November 2024.” 
  • The American Hospital Association relates,
    • “Cases in the Utah measles outbreak have increased to 559, the state’s Department of Health and Human Services reported March 31. The agency said 362 cases have been diagnosed so far this year during the outbreak, which began in June 2025. The Centers for Disease Control and Prevention reported today that there are 1,671 measles cases nationwide across 33 jurisdictions. There have been 17 outbreaks reported this year, with 94% of confirmed cases being outbreak-associated. The vaccination status of 92% of cases is unvaccinated or unknown.” 
  • KFF Health News points out,
    • “This week, the Centers for Disease Control and Prevention posted online its first large tranche of advanced genetic data from measles viruses spreading last year. Scientists with knowledge of the operation expect the agency to post heaps more in weeks to come, revealing whether the U.S. has lost its hard-won measles elimination status.” * * *
    • “The CDC did not answer queries from KFF Health News on its timeline for publishing measles data or analyses. However, once all the data is public, researchers can run quick initial analyses that will signal whether outbreaks across the U.S. last year resulted from the continuous spread of the disease between states, rather than separate introductions from abroad.
    • “If there was continuous transmission for a year, that means the U.S. has lost its status as a country that has eliminated measles. That status, which the U.S. has held since 2000, reflects a country’s vaccination rates: Two doses of the measles-mumps-rubella vaccine prevent most infections and so stop outbreaks from growing.
    • “More careful analyses take weeks.”
  • Reuters tells us,
    • “Medetomidine, which is also known as ‘rhino tranq,’ or ‘dex’, is ​not approved for human use but is approved for sedation ​and analgesia in dogs.
    • “The agencies said it has increasingly been detected in law enforcement drug seizures, drug product and paraphernalia samples and wastewater samples, ​with the highest concentrations in the Northeast region.
    • “The CDC said ​stopping medetomidine after regular use can trigger severe withdrawal, with symptoms including hypertension, ‌anxiety, ⁠nausea, vomiting and fluctuating alertness, which may require emergency or intensive care. It can also cause profound sedation, slow heart rate and hypotension.
    • “Because fentanyl is involved in most overdoses involving medetomidine, opioid ​overdose reversal medications ​like naloxone ⁠should be administered to restore normal breathing, the agencies said.”
  • Health Day tells us,
    • “A new rapid urine test could lead to more targeted and effective treatment of urinary tract infections (UTI), researchers say.
    • “It currently takes labs two to three days to determine which antibiotic would work best against an individual’s UTI.
    • “But the new test can turn around results in just under six hours, creating the potential for same-day antibiotic prescriptions for a UTI, researchers reported in this month’s issue of the Journal of Antimicrobial Chemotherapy.”
  • Medscape informs us,
    • “A group of diabetes professionals is proposing a change from the term prediabetes to the use of a three-stage classification of type 2 diabetes (T2D), with the aim of promoting earlier treatment and risk reduction.
    • “When is it too early to start to intervene in the process of diabetes?” said Moshe Phillip, MD, director of the Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center, Petah Tikva, Israel, co-author of a comment paper on the topic published earlier this year in the Lancet Diabetes & Endocrinology.
    • “One of the mistakes that “we as a community have done in the past” is to label people as having prediabetes “because ‘prediabetes’ means that you are healthy,” he told Medscape Medical News.
    • “Actually, many of those that are defined as having prediabetes have a higher risk for all complications, mainly cardiovascular, he explained.” * * *
    • “Yet there is no drug approval process for prediabetes, despite the evidence that agents such as metformin, pioglitazone, and GLP-1 drugs can prevent progression to T2D and reduce cardiovascular risk.”

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

  • Modern Healthcare reports
    • “Elevance Health will apply its policy deducting pay from hospitals that refer some members to out-of-network providers to facilities in New York.
    • “Starting July 1, Elevance Health’s Anthem Blue Cross Blue Shield subsidiary may reduce New York hospitals’ pay by 7.5% or terminate facilities from its network if hospitals refer commercial members to inpatient or outpatient providers without a contract.
    • “Hospitals cannot pass the monetary penalty onto patients, according to an April 1 notice sent to providers.
    • “Rural, critical access and safety-net hospitals are exempt. Hospitals will also not be penalized for referring patients to emergency services or an out-of-network pre-approved provider. Additionally, the penalty will not apply when no in-network providers are available to provide the same care within the same geographic area.”
  • Healthcare Dive offers a commentary from Dr. Catherine Gaffigan is the president of health solutions at Elevance Health in which Dr. Gaffigan explains how this practice holds down health care costs.
  • Medical Economics relates,
    • “Medical Economics spoke with Shannon Sims, M.D., Ph.D., FAMIA, chief product officer at Vizient, and Matthew Bates, M.P.H., managing director at Kaufman Hall, about Vizient’s 2026 State of the Industry Report and what it describes as a reset moment for U.S. health care. When asked what changes physicians will feel first, both pointed to the same two shifts: artificial intelligence (AI) moving into everyday workflow and advanced practice providers (APPs) taking on a larger share of clinical care.
    • “Bates framed the AI transition as a move out of the hype cycle and into practical use. Ambient listening — tools that generate clinical notes from recorded patient encounters — is the clearest example. “It is moving from a niche to really changing the way we practice, particularly in clinic and office settings,” Bates said.
    • “Sims explained that, “what most physicians will see day to day is the use of AI tools to automate or reduce the burdens they feel,” pointing specifically to documentation, billing, medication refills and patient access as areas where meaningful improvement is already within reach. Now, he says the window for sitting it out is closing. “If [physicians] do not [embrace these tools], they risk falling behind and losing some of the relevance and ability to practice in the way they would like to.”
    • “On APPs, Bates was equally blunt. The physician shortage is real, it isn’t resolving quickly, and APPs are filling the gap. How health systems build effective, high-quality teams around that reality, rather than just plugging holes, is one of the central operational questions of the moment.”
  • Radiology Business adds,
    • “A Harvard University economist claims that imaging volumes are falling in the U.S., blunting the need for more radiologists. 
    • “David M. Cutler, PhD, a noted researcher and professor, shared the thought in an editorial published Thursday by JAMA Health Forum. He cited research including 2019 study published by the Radiological Society of North America showing that imaging use stabilized or declined between 2010 and 2016.
    • “Dipping utilization combined with lower reimbursement per procedure has led to a “sustained slowdown in imaging spending growth,” Cutler wrote. 
    • “In addition to helping with cost concerns, the reduction in imaging use has helped to minimize a potential shortage of radiologists,” he wrote April 2. “For some time, economists were worried about a looming radiologist shortage. The decrease in imaging has allowed the U.S. to meet the need for imaging without an increase in radiologists.”
    • “The claims appear to contradict both anecdotal and numerous published academic reports stating the contrary. Another RSNA-published study last year found that emergency departments’ use of CT imaging has increased substantially since 2013. Another JACR study published in January estimated that radiology exam caseloads climbed 31% since 2018. A third shared by Health Affairs in 2024 said overall spending on radiology services leapt almost 36% between 2010 and 2021.”  

Notable Death

  • The Wall Street Journal reports,
    • “By the time patients seek therapy for post-traumatic stress disorder, many have spent years suppressing their worst memories and avoiding the places and situations they associate with the most difficult moments of their lives. 
    • “Edna Foa asked them to get closer to those moments.
    • “She asked women who had survived rape to recount what happened, and encouraged soldiers to explain what they had seen in war. It wasn’t an easy ask, but patients had been avoiding so many things for so long that their worlds had gotten smaller and many were willing to try something, even if it felt drastic. 
    • “At first, revisiting memories and places that they feared could be distressing. Over time—typically eight to 15 sessions—the prolonged exposure therapy could make the memories of the traumatic events approachable and turn them into something they could emotionally process and ultimately take power over.
    • “Foa, a clinical psychologist who died March 24 at the age of 88, didn’t just pioneer prolonged exposure therapy, one of the most effective, evidence-based therapies used for treating PTSD in the U.S.; she also created an ecosystem to get it into practice. She trained thousands of healthcare professionals on how to treat patients, and trained others how to do the training. She also wrote books, manuals and patient workbooks to make sure that the training was implemented correctly.”
  • RIP

Thursday report

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

From Washington, DC

  • Govexec reports,
    • “President Trump on Thursday said he plans to sign an executive order to pay all Homeland Security Department workers, after the House failed again to pass legislation ending the partial government shutdown, now in its 48th day.” * * *
    • “TSA workers were granted four weeks’ worth of back pay Monday following the signing of the more targeted edict last week, while ICE and CBP workers have been paid on time since the beginning of the department-wide appropriations lapse using funds from the One Big Beautiful Bill law. Still working without pay within the department are employees at the Federal Emergency Management Agency along with support staff and other non-immigration-related DHS components. 
    • “Observers had anticipated Thursday to serve as the potential end of the six-week impasse. After the House rejected a Senate-passed bill to fund DHS—minus ICE and CBP—through the end of September last week, senators again passed the bill with the expectation that the House would approve it via unanimous consent that morning. But when the House convened its pro forma session, lawmakers did not bring the measure up for consideration, reportedly due to pressure from conservative GOP members.
    • “The next possible opportunity for Speaker Mike Johnson to advance the DHS legislation would be Monday. The House is not set to return to Washington until April 14.”
  • Roll Call relates,
    • “President Donald Trump ousted Pamela Bondi as attorney general Thursday, closing out a tumultuous tenure punctuated by rolling controversies and attacks against the Justice Department’s traditional independence from the White House.
    • “Trump, who made the announcement in a social media post, said his former personal attorney, Deputy Attorney General Todd Blanche, would lead the department as acting attorney general. The president described Bondi as a “loyal friend.”
    • “Bondi, in a statement on social media, said that over the next month she would be working to transition the office of attorney general to Blanche “before moving to an important private sector role.”
    • “She said she would continue “fighting for President Trump and this Administration” in the new role.”
  • The Wall Street Journal tells us,
    • “The U.S. will impose tariffs of as much as 100% on branded pharmaceuticals, the White House said Thursday, though nations or drugmakers that strike deals with the Trump administration or commit to build manufacturing facilities in the U.S. can receive lower levies. 
    • “The 100% tariff will apply to patented imported pharmaceuticals from companies that haven’t committed to invest in the U.S. and haven’t entered into “most favored nation” agreements to match their U.S. prices to the lowest they charge in other developed countries, a senior administration official said Thursday.
    • “But the full 100% tariff might apply to only a few drugmakers or none at all. If a company pledges to invest in U.S. drug manufacturing in the coming years, its tariff rate will fall to 20%, the senior administration official said. The company would have to complete the factory by the end of President Trump’s term in the White House, the official said, or tariffs could be increased.
    • “Additionally, if a company that has made a U.S. manufacturing pledge also strikes a most-favored-nation agreement with the Trump administration, its tariffs can fall to zero, the official said.”
  • Lotsa Medicare news today. Bloomberg Law reports,
    • “The Trump administration announced changes to patient cost-sharing in Medicare’s prescription drug benefit and will update the methodology used to rate private Medicare Advantage plans.
    • “The final rule (RIN 0938-AV63), released Thursday by the Centers for Medicare & Medicaid Services, implements changes to Part D enacted under the Inflation Reduction Act in 2022 and will update the methodology used to calculate insurers’ “star ratings,” which are quality scores that determine bonuses and marketing privileges. The changes would take effect in 2027.
    • “The new rule finalizes the Inflation Reduction Act’s elimination of Medicare Part D’s coverage gap as part of a broader overhaul of how the program is financed. The law’s $2,000 annual out-of-pocket cap for prescription drugs took effect last year.
    • “The agency chose to hold off on finalizing a previous proposal that would have allowed Medicare Advantage members a special enrollment period when their doctor leaves their network.”
  • and
    • “The Trump administration proposed new transparency measures for hospices under Medicare amid a focus on fraud led by Centers for Medicare & Medicaid Services Administrator Mehmet Oz.
    • “The proposed rule (RIN 0938-AV78), released Thursday by the CMS, also includes updates to the hospice wage index, which adjusts daily Medicare hospice payments based on differences in labor costs across geographic regions. 
    • “The measure proposes a new analysis of non-hospice spending in an effort to better identify fraud and overutilization, as well as to require hospices to list for patients what services are not covered under Medicare’s hospice benefit.
    • “Hospices exist to help Americans die peaceful, dignified deaths, not to line the pockets of fraudsters,” Oz said in a statement. “These new transparency measures will make it easier for CMS and others to identify hospice providers that misuse Medicare dollars, cut off their funding, and refer them to law enforcement for criminal prosecution.”
    • “The proposal would also increase payment rates in fiscal year 2027 by 2.4%, or $785 million, and seeks comment on developing a hospice-specific wage index.”
  • The American Hospital Association News informs us,
    • The Centers for Medicare & Medicaid Services April 2 issued a proposed rule for the skilled nursing facility prospective payment system for fiscal year 2027. The proposal would increase aggregate payments by 2.4%, which reflects a 3.2% market basket update and a 0.8 percentage point cut for productivity. CMS also included in this proposed rule a request for information on how to address perceived case-mix upcoding. For the SNF Quality Reporting Program, CMS proposes to remove two measures focused on COVID-19 vaccination for patients and health care personnel. CMS also proposes to shorten the timeframe for data submission at the end of each quarter from 4.5 months to 45 days beginning with FY 2029. CMS suggests this change would reduce the lag in public reporting and give SNFs access to more timely data for quality initiatives. CMS will accept public comments on the proposed rule through June 1, 2026. 
  • and
    • The Centers for Medicare & Medicaid Services April 1 released the fiscal year 2027 prospective payment system proposed rule for inpatient rehabilitation facilities. The rule would increase payments by 2.8% overall, which includes a 3.2% market basket update, reduced by a 0.8 percentage point productivity adjustment. CMS is also proposing a slight decrease in the outlier threshold, which would increase payments by 0.4 percentage points. Further, CMS proposes changes and clarifications to the IRF coverage rules, including that all therapies must be initiated within 36 hours of admission to the IRF, current functional status be documented at admission, and the initial interdisciplinary team meeting occur on or before the fourth day of admission. Finally, CMS has also included a request for information on modernizing the IRF PPS, including more closely aligning methodologies with those used for skilled nursing facilities. 
  • and
    • “The Centers for Medicare & Medicaid Services April 2 issued a proposed rule for the inpatient psychiatric facility prospective payment system for fiscal year 2027. CMS proposes to increase IPF payments by a net 2.3%, equivalent to $50 million, in FY 2027. The payment update reflects a proposed market basket update of 3.1% minus a productivity adjustment of 0.8 percentage points. CMS also proposes to update the outlier threshold so that estimated outlier payments remain at 2.0% of total payments. 
    • “For the IPF Quality Reporting Program, CMS proposes to remove two measures focused on alcohol and tobacco use screening and treatment effective with the calendar year 2026 reporting/FY 2028 payment periods. CMS also proposes to implement the standardized IPF Patient Assessment Instrument that is mandated by the Consolidated Appropriations Act of 2023. IPFs would be required to collect IPF-PAI data on all patients age 18 years and older regardless of payer beginning Oct. 1, 2027. CMS will accept public comments on this rule through June 1.”
  • and
    • “The Centers for Medicare & Medicaid Services March 31 released a request for applications for its new accountable care organization model, the Long-term Enhanced ACO Design Model, or LEAD. The model is designed to accommodate a wide range of health care providers, including those who have not previously participated in an ACO and providers who care for specialized patient populations. CMS said ACOs interested in the voluntary, 10-year payment model must apply by May 17. The model will launch Jan. 1, 2027.” 
  • Tammy Flanagan writing in Govexec asks “Traveling soon? What federal health plans actually cover.”
    • “Peak travel season is here, but most federal workers don’t know what happens if they need care abroad. From upfront costs to medical evacuations, here is what your FEHB plan does and doesn’t cover when you are out of the country.”
  • Per an OPM news release,
    • “The US Office of Personnel Management (OPM) today announced a cross-government hiring action to recruit Project Managers for critical roles across federal agencies.
    • “Project management has long been identified as an area where the federal government faces a critical skills gap. OPM is tackling that skills gap with this cross-government hiring action. Selected candidates will lead major initiatives in areas such as artificial intelligence, healthcare, defense, energy, financial technology, and infrastructure, increasing on-time, on-budget delivery through professionalized project management practices. Applicants will be screened for qualifications and must complete project management and writing assessments to determine skills levels.
    • “Like the Tech Force program, OPM will use a shared certificate allowing several agencies to hire qualified candidates from the same pool for one year. The effort supports a goal to hire about 250 professionals in project management and data science roles across government.
    • “Delivering on complex national priorities requires strong project management at every level of government,” OPM Director Scott Kupor said. “This effort helps agencies identify and hire professionals who can drive execution, manage risk, and ensure results for the American people.”
    • “Click here to view the job posting and contact CrossGovHiring@opm.gov for more information.”
  • Per an ARPA-H news release,
    • “New STOMP program will uncover how microplastics build up in the body—and drive new ways to protect people from their potential health impact
    • “The Advanced Research Projects Agency for Health (ARPA-H), an agency within the U.S. Department of Health and Human Services (HHS), today announced STOMP: Systematic Targeting Of MicroPlastics, a nationwide $144 million program to create the definitive toolbox for measuring, researching, and affordably removing microplastics and nanoplastics (MNPs) in the human body. 
    • “Today, HHS is taking decisive action to confront microplastics as a growing threat to human health,” said HHS Secretary Robert F. Kennedy, Jr. “Americans deserve clear answers about how microplastics in their bodies affect their health. Through ARPA-H’s STOMP program, we will measure microplastic exposure, identify sources of risk, and develop targeted solutions to reduce it.”  

From the judicial front,

  • Thompson Reuters reports,
    • “Whittemore v. Cigna Health & Life Ins. Co., 2026 WL 777418 (1st Cir. 2026)
    • “The First Circuit has affirmed the dismissal of a lawsuit challenging a health plan’s exclusion of weight-loss drugs, holding that a participant did not plausibly allege she had a disability simply by stating she had been diagnosed with obesity and prescribed medication to treat it. The participant filed a proposed class action lawsuit against a health insurer, alleging disability discrimination under Affordable Care Act (ACA) Section 1557. The participant asserted that her obesity was a disability and that the insurer discriminated against her by designing and administering health plans that categorically excluded coverage for prescription weight-loss medications. (Section 1557 prohibits discrimination on grounds specified in several federal laws, including Section 504 of the Rehabilitation Act, which bars discrimination based on disability.) The district court dismissed the case, ruling that the participant had not plausibly shown that she was disabled merely as a function of her body mass index, nor that the insurer had ever regarded her as disabled.
    • “The First Circuit affirmed the dismissal, but on different grounds. The court explained that to state a disability discrimination claim, the participant had to show she was disabled as defined by the Americans with Disabilities Act (ADA). The ADA defines disability as a physical or mental impairment that “substantially limits one or more major life activities.” The participant’s complaint alleged that her obesity substantially limited her in major life activities such as walking, standing, and sleeping. The court, however, concluded that these allegations were conclusory “threadbare recitals of the elements of a cause of action.” The court also rejected the participant’s argument that any individual diagnosed with obesity and prescribed medication for it is, by definition, substantially limited in the operation of major bodily functions, reasoning that such general statements about obesity’s potential health impacts do not plausibly support an inference that every person in that category is disabled under the ADA.”

From the public health and medical / Rx research front,

  • The American Hospital Association News reports,
    • “Flu and COVID-19 vaccination rates among all health care workers for the 2024-25 respiratory virus season was 76.3% and 40.2%, respectively, according to a Centers for Disease Control and Prevention report released April 2. Coverage was higher for personnel whose employers offered on-site flu and COVID-19 vaccinations, at 73% and 42.9%. Lower figures were found among personnel with employers that did not offer on-site vaccinations, at 41.4% and 19.8%. The CDC said that increasing vaccination coverage by implementing workplace policies, including offering on-site vaccinations, could increase coverage and reduce flu- and COVID-19-related morbidity among health care providers.” 
  • The University of Minnesota CIDRAP adds,
    • “Respiratory syncytial virus (RSV) vaccination coverage among older US adults remained low through the end of the 2024–25 respiratory virus season, according to a new study published in Vaccine. In 2024, the Advisory Committee on Immunization Practices recommended RSV vaccination for adults aged 60 to 74 years who are at increased risk of severe RSV and for all adults aged ≥ 75 years.
    • “Analyzing data from approximately 64,000 adults surveyed from September 2024 through April 2025, researchers from the Centers for Disease Control and Prevention found that, by the end of the 2024–25 respiratory virus season, 38.3% of adults ages 60 to 74 who were at increased risk of severe RSV and 41.5% of those 75 and older had received an RSV vaccine.”
  • Cardiovascular Business shares “Key clinical takeaways from ACC.26” * * * “in New Orleans highlighted advances that will likely impact patient care for years to come. Key topics included pulmonary embolism (PE), lipid management and noninvasive coronary assessment.”
  • Genetic Engineering and Biotechnology News relates,
    • “The ALS Therapy Development Institute (ALS TDI), LifeArc, and Axol Bioscience launched the Patient induced pluripotent stem cell (iPSC)-based Research to Improve Sporadic ALS Modeling (PRISM) initiative, a collaborative effort to expand access to patient-derived stem cell models.
    • ‘ALS is a heterogeneous disease. While 10-15% of cases are linked to inherited mutations, nearly 85% are sporadic, according to a PRISM ALS official, who adds that much of ALS drug discovery has relied on models representing a limited number of rare genetic subtypes. This mismatch has constrained target discovery, limited therapeutic testing across patient populations, and contributed to the high failure rate of clinical trials, maintains the spokesperson.
    • “This initiative plans to provide a high-quality and accessible source of sporadic ALS/MND models for use in research. PRISM ALS aims to develop, evaluate, and make available a diverse panel of well-characterized, patient-derived induced pluripotent stem cell (iPSC) models that capture both genetic and sporadic forms of ALS.
    • “For researchers and drug developers, those standardized, human-relevant models are expected to allow them to better understand disease mechanisms, identify therapeutic targets, and evaluate treatments across distinct biological subtypes. For people living with ALS, it might lead to the development and testing of therapies in models that more closely mirror their own biology, increasing the likelihood that discoveries will translate into meaningful treatments.”
  • Per Healio,
    • ‘A short walk around the block, a 30-minute bike ride, or an intense 1-hour lifting session at the gym each can benefit patients with breast cancer undergoing chemotherapy.
    • “A meta-analysis of more than 20 clinical trials showed women randomly assigned to exercise interventions, whether aerobic, strength or a combination of both, during treatment had more than a 60% greater likelihood of reporting improved quality of life than those who received standard care alone.”
  • Per Fierce Pharma,
    • “Another green light appears increasingly within reach for AstraZeneca’s Emerald program after a combo regimen featuring the company’s immunotherapy duo, Imfinzi and Imjudo, showed benefit in certain liver cancer patients. 
    • “Results from the phase 3 Emerald-3 trial showed that the combination, paired with transarterial chemoembolizaton (TACE) and Lenvima, significantly improved progression-free survival (PFS) versus TACE alone in patients with unresectable locoregional hepatocellular carcinoma. Lenvima is a multikinase inhibitor sold by Merck & Co. and Eisai.
    • ‘But whether AZ has struck gold with Emerald-3 remains to be seen. Overall survival (OS), a secondary endpoint that will be a key consideration for the FDA, was immature at the interim analysis, although AZ highlighted a trend toward improvement in its April 2 announcement.”

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

  • Modern Healthcare reports,
    • “Henry Ford Health is adding to its rapid expansion across Southeast Michigan with the acquisition of Clinton Township-based Cornerstone Medical Group. 
    • “Terms of the deal were not disclosed, but Cornerstone’s 25 locations across the region will be rolled into Henry Ford Medical Group, which employs 3,400 physicians and researchers.
    • “The locations — which include family and internal medicine, pediatrics, endocrinology, hospitalist care, podiatry and colorectal surgery — have been renamed Henry Ford Cornerstone.”
  • Radiology Business point out.
    • nterventional radiology vendor Merit Medical is acquiring a rival imaging-focused firm for $140 million, the two announced Wednesday. 
    • The South Jordan, Utah-based company plans to merge with View Point Medical, which manufactures the OneMark Detection Imaging System. Cleared by the U.S. Food and Drug Administration in 2024, the device uses ultrasound guidance to detect and remove cancer. 
    • Merit Medical—a leading manufacturer of disposable devices such as catheters and guide wires—said it made the move to help expand its portfolio of therapeutic oncology products. 
    • View Point’s ultrasound-based technology is “highly innovative,” it noted, allowing physicians to localize more lesions at the time of biopsy. This represents a market opportunity of 1.3 million procedures annually in the U.S. alone, Merit estimated. 
  • and
    • “The chief executive of America’s largest public hospital system says he is prepared to start replacing radiologists with artificial intelligence in some circumstances, once the regulatory landscape catches up. 
    • ‘Mitchell H. Katz, MD, president and CEO of NYC Health + Hospitals, recently spoke during a panel discussion held by Crain’s New York Business. The trained internal medicine specialist noted how AI is increasingly being used to interpret mammograms and X-rays. 
    • “This presents an opportunity to save on how much hospitals spend on radiologists, who have become more costly amid rising demand for imaging, Crain’s reported Thursday. 
    • “We could replace a great deal of radiologists with AI at this moment, if we are ready to do the regulatory challenge,” Katz said at the forum, held on March 25.” 
  • Healthcare Dive relates,
    • “Community Health Systems has closed the sale of another hospital as the for-profit health system makes progress paying down its debt.
    • “On Wednesday, nonprofit Huntsville Hospital Health System acquired Huntsville, Alabama-based Crestwood Medical Center from CHS for $459 million.
    • “The purchase price is higher than the initial $450 million deal proposed in January, when the two health systems signed a definitive agreement. The final amount was subject to a post-closing working capital adjustment, according to a release, an amount that can fluctuate based on the acquisition target’s assets and liabilities.”
  • Beckers Hospital Review tells us,
    • “Oakland, Calif.-based Kaiser Permanente has broken ground on a new hospital tower at Kaiser Permanente Sunnyside Medical Center in Clackamas, Ore.
    • “The seven-story, 615,000-square-foot tower is slated to open in 2029 and will be Oregon’s first fully electric hospital, according to an April 2 health system news release. The facility is also targeting LEED Gold certification and will become Kaiser Permanente’s 87th LEED-certified building.
    • “Features will include private patient rooms; in-room telemedicine capabilities, advanced robotics and image-guided surgical equipment; expanded emergency department capacity to reduce wait times; and green spaces, walking paths and healing gardens.”
  • and
    • “Farmington, Conn.-based UConn Health has shared plans to integrate Middletown, Conn.-based Solnit Hospital, a children and adolescent psychiatric facility, into a satellite location of its UConn John Dempsey Hospital in Farmington.
    • “This collaboration reflects our shared commitment to delivering exceptional, high-quality, and specialized care for Connecticut’s youth while optimizing resources across agencies,” UConn Health CEO, Andrew Agwunobi, MD, said in an April 2 statement shared with Becker’s. 
    • “Solnit Hospital is a state-administered psychiatric facility for children ages 13 to 17. It offers care to children and adolescents with “severe mental illness and related behavioral and emotional problems who cannot be safely assessed or treated in a less restrictive setting,” according to  the state’s website.” 
  • Fierce Healthcare informs us,
    • “Sunfish, a family-building software platform, is launching what it says is the first AI-powered egg-freezing success program in the fertility space.
    • “The goal of the program is to solve the uncertainty that comes with fertility preservation, from a lack of financial transparency to outcomes that are unknown and not guaranteed. Based on a patient’s biodata, Sunfish’s proprietary algorithm predicts the optimal amount of matured eggs that should be frozen as well as the cost of the cycle. 
    • “Sunfish is really focused on helping people to navigate the full fertility journey,” Angela Rastegar, co-founder and CEO of Sunfish, told Fierce Healthcare in an advanced interview. “Patients shouldn’t have to be an unpaid project manager for their own family planning.” 

Tuesday report

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

From Washington, DC

  • OPM Director Scott Kupor created another post in his Secrets of OPM blog today. This post is titled “Trust but verify,” which has always been the FEHBlog’s favorites Reaganism. Director Kupor concludes,
    • “We have a lot of work to do to ensure the federal government can continue to attract all of the skills needed to deliver on our promises to the American people. While “In America we trust,” in federal hiring we will “trust, but verify.”
  • Modern Healthcare informs us,
    • “A bipartisan House bill that lawmakers plan to introduce this week would cap annual Medicare physician reimbursement cuts at 2.5% while giving regulators more leeway to set annual payment updates.
    • “The Provider Reimbursement Stability Act of 2025 is far from the Medicare payment system overhaul doctors have failed to win for years and it does not include a raise for 2027. But the measure would address underlying aspects of the rate-setting process that medical societies say contributed to pay cuts and modest increases in recent years. 
    • “Under the legislation, CMS would gain financial flexibility, could consider medical inflation in narrow circumstances when calculating fees, and would make changes to the base values it uses to set rates and correct errors that the American Medical Association estimates have cost doctors billions.”
  • STAT News tells us,
    • “Sellers of health savings accounts see an opening for expanding their market, and they’re ramping up lobbying efforts to seize the opportunity.
    • “A group of companies and organizations tied to the HSA industry this year formed a nonprofit called the Great American Health Alliance, or GAHA, a riff on Make America Healthy Again, or MAHA. * * *
    • “Members of GAHA include HealthEquity, one of the largest administrators of HSAs, and the American Bankers Association, which represents institutions holding about 90% of HSAs. GAHA is run by brothers Keith Nahigian, who is the group’s president and has worked for multiple GOP presidential campaigns, and Ken Nahigian, who led the Trump transition in 2017 and was health secretary Robert F. Kennedy Jr.’s liaison to senators during his confirmation process.”
  • American Hospital Association News reports,
    • “The Department of Health and Human Services March 31 announced that it is reverting a 2024 reorganization of health IT leadership and services. The dually titled Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT will now restore ONC as a singularly titled office. The HHS Chief Technology Officer, HHS Chief Artificial Intelligence Officer and HHS Chief Data Officer roles and responsibilities will move back under the HHS Office of the Chief Information Officer. HHS said the changes reinforce OCIO’s responsibility for enterprise IT, cybersecurity and data operations, while ONC will focus on health IT policy, standards and certification.”
  • and
    • “The Centers for Medicare & Medicaid Services March 20 released a memorandum reinforcing hospital nutrition service obligations for hospitals. The memo reminds hospitals of the Medicare conditions of participation that require hospitals to ensure menus and diets meet individual patient nutritional needs in accordance with recognized dietary practices. It also asks hospitals to review and revise their food and nutrition service policies, standard menus, therapeutic protocols and other practices to align with the recently released 2025-2030 Dietary Guidelines for Americans. CMS makes several recommendations for hospital inpatient menus, including limiting ultra-processed foods; eliminating sugar-sweetened beverages unless clinically appropriate in limited scenarios; eliminating refined grains and replacing them with 100% whole grains; prioritizing minimally processed protein sources, including plant-based options; and emphasizing vegetables, fruits, legumes, nuts, seeds, seafood and healthy fats.” 
  • The Wall Street Journal adds,
    • “New nutrition guidance from the American Heart Association advises getting protein from plants rather than meat, choosing low-fat or fat-free dairy and using olive, soybean and canola oils instead of beef tallow and butter. 
    • “The recommendations, released Tuesday by the association, contrast with dietary guidelines that the Trump administration introduced earlier this year.
    • “The differences add to disagreements between the federal government and mainstream medical groups on medicine and nutrition advice, after the Health and Human Services Department under Health Secretary Robert F. Kennedy Jr., for instance, sought to dial back vaccine recommendations and President Trump told pregnant women to minimize Tylenol use.
    • * * * “The association’s latest recommendations are mostly unchanged from the guidelines that it released in 2021 and that the federal government had issued before this year.
    • “Like the federal government, the AHA defines a healthy diet as rich in vegetables and fruits and low in added sugars and ultraprocessed foods. 
    • “Dr. Stacey Rosen, AHA’s president, who is a cardiologist and a senior vice president of women’s health at Northwell Health in New York, said the government’s encouragement to eat red meat and full-fat dairy products could hurt people’s health. “It has been shown repeatedly to be a not healthy way to eat,” she said.”

From the Food and Drug Administration front,

  • Fierce Pharma reports,
    • “Amgen’s rare disease drug Tavneos is under mounting regulatory scrutiny, with the FDA warning of serious liver injuries, including some fatalities, among patients who received the drug. 
    • “From the drug’s approval in 2021 through October 2024, 76 cases of drug-induced liver injury with “reasonable evidence” of a causal association to Tavneos were reported to the FDA Adverse Event Reporting System (FAERS), according to a Tuesday safety communication.
    • “The medicine is available as an adjunct treatment for severe active anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis. But the FDA is looking to change that with a request for Amgen to withdraw the product, which the company has so far resisted.”
  • Reuters relates,
    • “The U.S. Food and Drug Administration has approved a higher dose of Biogen’s (BIIB.O), opens new tab spinal muscular atrophy drug Spinraza, the company said on Monday, after rejecting it last year.
    • “The approval for a potentially ​more effective treatment marks a boost for the U.S. drugmaker battling intensifying competition ​from therapies such as Roche’s (ROPC.S), opens new tab oral drug Evrysdi and Novartis’ (NOVN.S), opens new tab gene therapies ⁠Zolgensma and Itvisma.”
  • Cardiovascular Business tells us,
    • “Anumana, a Massachusetts-based artificial intelligence (AI) company co-founded by nference and Mayo Clinic, has secured U.S. Food and Drug Administration (FDA) clearance for its advanced pulmonary hypertension (PH) algorithm. The algorithm, which previously received the FDA’s breakthrough device designation, was designed to detect signs of PH in standard 12-lead electrocardiograms (ECGs).
    • “PH is a life-threatening condition that can be difficult for care teams to diagnose. It directly impacts the arteries in a patient’s lungs as well as the right side of their heart. While there is no cure, treatments are available once a diagnosis is confirmed. 
    • ‘Anumana’s newly cleared AI model was built with data from more than 250,000 de-identified Mayo Clinic patients. It runs entirely within the care team’s own hospital or health system environment.
    • “According to Anumana, the algorithm was linked to a sensitivity of 73% and specificity of 74.4% in adult patients presenting with dyspnea. A separate study found that it was able to identify more than 85% of patients presenting with pulmonary arterial hypertension as well as 78% of patients presenting with chronic thromboembolic pulmonary hypertension.”
  • and
    • “A new-look embolic protection device for reducing the risk of stroke after transcatheter aortic valve replacement (TAVR) is associated with clinical outcomes comparable to Boston Scientific’s Sentinel Cerebral Protection System, according to new data presented at ACC.26 in New Orleans.
    • “The device in question is the Emboliner Embolic Protection System from California-based Emboline. Features include a double-wall, cylindrical mesh filter made of Nitinol and a self-sealing port that allows devices such as TAVR delivery systems to pass through when necessary. 
    • “The ProtectH2H clinical trial was a head-to-head comparison of the Emboliner and Sentinel devices. It is believed to be the first head-to-head analysis of any two embolic protection devices for TAVR. More than 500 TAVR patients with a mean age of 79 years old were enrolled out of the United States, Germany and Brazil. Patients were excluded if they had experienced a stroke in the previous six months.”

From the public health and medical / Rx research front,

  • The Centers for Disease Control and Prevention reminds us,
    • “Chronic kidney disease (CKD) affects more than 37 million U.S. adults. That’s more than 1 in 10 people. The risk is even higher for people with diabetes or high blood pressure. Nearly 4 in 10 adults with diabetes and 2 in 10 adults with high blood pressure have CKD. 
    • “Most people with CKD—about 9 in 10—do not know they have it. CKD often has no early symptoms, but simple blood and urine tests can help find it early. Knowing your risk and getting tested could help protect your kidneys.”
  • Avalere Health marks “National Kidney Month with An Outlook in the 2026 Kidney Care Policy, Payment, and Treatment Landscape.”
    • “Evolving kidney transplant regulations, payment reforms, and accelerated innovation in treatments are opening new opportunities across the kidney care landscape.”
  • This week’s issue of NIH Reseach Matters covers the following topics:
    • SuperAgers show unique cell signatures in the brain
      • “Researchers linked neuron creation to exceptional recall and memory in older adults.
      • “Understanding how new neurons are created in adulthood could help lead to interventions that promote healthy aging.”
    • Scientists identify proteins tied to food tolerance
      • “Scientists identified parts of proteins that interact with immune cells and allow mice to tolerate certain foods rather than have an allergic reaction.
      • “The findings enhance our current understanding of food tolerance and may lead to new therapies for people with food allergies.”
    • Using RNA to treat heart attacks
      • “An RNA-based lipid nanoparticle therapy helped the heart recover from a heart attack in animal studies.
      • “The results suggest a new strategy for treating heart attacks and repairing damage to the heart.”
  • MedPage tells us,
    • “Significant incidental findings detected on low-dose CT lung cancer screening were associated with an increased risk of an extrapulmonary cancer diagnosis over the following year.
    • “Risk differences were significantly higher for urinary cancers, as well as lymphoma and leukemia.
    • “Certain significant incidental findings should be assessed as potential indicators of undiagnosed cancers, researchers said.”
  • Healio adds,
    • “MRIs may be a reasonable option for high-risk patients with extremely dense breasts.
    • “A simulation study found MRIs moderately reduced breast cancer mortality in this group but increased rates of false positives.”
  • and
    • “In stable patients without heart failure, discontinuing beta-blockers 1 year after a heart attack was noninferior to continued use for all-cause death, recurrent MI or HF hospitalization, researchers reported. 
    • “The SMART-DECISION trial is the first randomized study to demonstrate the noninferiority of beta-blocker discontinuation in post-MI patients without left ventricular systolic dysfunction or heart failure,” Joo-Yong Hahn, MD, a cardiologist at Samsung Medical Center in Seoul, South Korea, said during a press conference at the American College of Cardiology Scientific Session. The results were simultaneously published in The New England Journal of Medicine.”
  • The Wall Street Journal reports,
    • “AstraZeneca AZN reported mixed results from three late-stage clinical trials of an experimental treatment for a rare metabolic disease, but remains confident the drug can generate annual peak sales of $3 billion to $5 billion.
    • “The U.K. drugmaker expects to be able to launch the medicine, efzimfotase alfa, in more markets than its predecessor treatment, Strensiq, the chief executive of AstraZeneca’s rare-disease unit Alexion, Marc Dunoyer, said in an interview Tuesday. It plans to submit data to regulators as soon as possible, Dunoyer added.
    • “AstraZeneca said the results of the studies support the drug’s potential to transform the treatment of hypophosphatasia, a rare, chronic disease caused by deficient activity of an enzyme that is important for building healthy bones and supporting proper muscle function.”

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

  • Modern Healthcare reports,
    • “Kurt Small has been named as president and CEO of CareFirst BlueCross BlueShield, effective May 4. 
    • “Small is the president of Medicaid for Elevance Health. 
    • He will succeed Ja’Ron Bridges, who has been serving as interim president and CEO since Brian Pieninck left the company in September to become president and CEO of GuideWell and its insurer subsidiary Florida Blue, a CareFirst spokesperson said Tuesday. * * *
    • “Bridges will return to his former role as CareFirst’s executive vice president and chief financial officer. 
    • “Small held several leadership roles at Blue Cross and Blue Shield of Minnesota, Highmark and Aetna prior to joining CareFirst, an independent licensee of the Blue Cross Blue Shield Association.”
  • Healthcare Dive adds,
    • “Elevance announced a slate of mid-level executive appointments on Tuesday as the company continues to shuffle its leadership roster to try to combat waning profits.
    • “The insurer named two new executives to its health benefits division, including a new president of government business after the previous president was promoted to lead Elevance’s broader insurance arm.
    • “Carelon, Elevance’s health services division, added four new executives, including its first chief growth and strategy officer as the company seeks to accelerate Carelon’s expansion.”
    • “The appointments are effective immediately.”
  • The Wall Street Journal informs us,
    • “Eli Lilly LLY has agreed to buy clinical-stage company Centessa Pharmaceuticals CNTA for an initial payment of about $6.3 billion in a deal that expands the drugmaker’s neuroscience portfolio and capabilities into sleep medicine.
    • “Eli Lilly on Tuesday said it will pay an initial $38 a share in cash for Centessa, a 38% premium to Monday’s closing price of $27.58 for the U.K.-based company.
    • “Centessa investors will also receive nontransferrable contingent value rights worth up to an additional $9 a share, bringing the total potential deal consideration to about $7.8 billion, or $47 a share.
    • “The deal is slated to close in the third quarter.’
  • Fierce Pharma adds,
    • “Despite a healthy roster of late-stage assets and a revenue turnaround in 2025, it’s no secret that Biogen has been seeking near-term sales drivers ahead of its planned product rollouts later in the decade. 
    • “Now, the company is responding by bulking up in immunology—and paving the way for its future ambitions in kidney diseases—with an M&A play that adds two ongoing launches to its marketed drugs portfolio.
    • “On Tuesday, Biogen unveiled a deal to acquire Apellis Pharmaceuticals for $41 per share in cash, representing a total transaction value of roughly $5.6 billion. For Biogen, the deal grants access to the approved Apellis meds Syfovre for the eye condition geographic atrophy (GA) and Empaveli, approved by the FDA last year in the rare kidney diseases complement 3 glomerulopathy (C3G) and primary immune complex membranoproliferative glomerulonephritis (IC-MPGN).” 
  • The Wall Street Journal notes,
    • “Big drugmakers are pursuing smaller acquisitions, typically under $10 billion, reflecting a more cautious approach to dealmaking.
    • “Deals between $1 billion and $10 billion represent 76% of pharmaceutical transactions by value this year to date.
    • “Companies like Eli Lilly and Biogen are making smaller deals to bolster pipelines and avoid risks associated with large acquisitions.”
  • Per an Institute for Clinical and Economic Review news release,
    • “The Institute for Clinical and Economic Review (ICER) today releaseda Final Evidence Report assessing the comparative clinical effectiveness and value of sibeprenlimab (Voyxact®, Otsuka Holdings Co., Ltd.), atacicept (Vera Therapeutics, Inc.), and delayed-release budesonide (“Nefecon”, Tarpeyo®, Calliditas Therapeutics AB) for IgA nephropathy.
    • “ICER’s report on this therapy was the subject of the February 2026 public meeting of the California Technology Assessment Forum (CTAF), one of ICER’s three independent evidence appraisal committees. 
    • “Downloads: Final Evidence Report | Report-at-a-Glance | Policy Recommendations“
  • Beckers Hospital Review informs us,
    • “Retail and e-commerce giants are rapidly expanding their presence in pharmacy services, prompting new concerns among hospital and health system leaders about losing ground in patient access and workforce recruitment.
    • “Amazon, for example, is significantly scaling its pharmacy footprint. The company plans to expand its same-day prescription delivery service to 4,500 U.S. cities and towns by the end of 2026 — adding nearly 2,000 new communities as it targets patients affected by pharmacy closures, staffing shortages and transportation barriers.
    • “Walmart is taking a different approach, focusing heavily on its workforce. The retailer recently promoted 3,000 pharmacy technicians into pharmacy operations team lead roles while also increasing pay. Technician wages now average $22 per hour, with some earning as much as $40.50 depending on certification and location. The newly created team lead roles average $28 per hour, with potential earnings up to $42.”
  • and
    • “Novo Nordisk has launched a multimonth subscription program for Wegovy, which claims to offer more predictable, lower pricing for eligible self-pay patients who enroll through select telehealth providers.
    • “The program is currently available through Ro, WeightWatchers and LifeMD. Additional platforms, including Hims & Hers and Sesame, are expected to join, according to a March 31 news release from Novo. Patients can choose three-, six- or 12-month subscriptions, with longer terms offering lower monthly costs.
    • “Under the program, Wegovy injections are priced at $329 per month for a three-month subscription, $299 per month for six months and $249 per month for 12 months — representing savings of up to $1,200 annually. Oral formulations are priced at $289, $269 and $249 per month across the same timeframes, respectively, with savings of up to $600 annually.
    • “The subscription model aims to reduce cost uncertainty and support adherence for patients managing obesity, a chronic condition that requires ongoing care, according to the release.”
  • Healthcare Innovation considers the “Link Between Ambient Scribes and Increased Coding Intensity.”
    • “Allison Oakes, Ph.D., Trilliant’s chief research officer, discusses how AI-enabled documentation may intersect with coding activity.”
    • “According to Trilliant, AI scribing tools have been associated with an increase in high-intensity outpatient billing codes across six health systems.
    • “The increase in higher-intensity billing codes may reflect improved documentation accuracy rather than intentional overbilling.
    • “Enhanced transparency and auditability of AI-driven billing are crucial for detecting potential issues and ensuring fair reimbursement practices.”
  • Radiology Business has a different outlook.
    • “Imaging interpretation times have more than doubled over the course of a decade, according to new Neiman Health Policy Institute research published Tuesday. 
    • “Current workforce shortages in the specialty are being spurred by increasing per-patient demand for imaging, an aging population and the limited supply of radiologists. As hiring challenges persist, there are growing concerns about the impact on patient care, experts write in JACR. 
    • “Researchers recently aimed to assess how turnaround times—or the period between when a scan is performed and a radiologist reads the images—have changed in recent years. They found that the length of this window leapt by 113% between 2014 and 2023, with worsening wait times beginning two years after the COVID-19 pandemic. 
    • “The potential negative clinical impact of growing turnaround time for the interpretation of imaging must be closely monitored, especially if the trend worsens,” study co-author Cindy Yuan, MD, with the Indiana University School of Medicine, said in a statement March 13. “We think these results are an early indicator of a worsening problem. If the sudden change in 2022 reflects that there is no remaining capacity for the radiology workforce to absorb new workload, then continued imaging growth will eventually impact patients.”
  • MedTech Dive points out,
    • “Whoop, the wearable company that sparked a debate on wellness regulations, has raised $575 million.
    • “The series G round values Whoop at $10.1 billion, the company said on Tuesday. Abbott joined as a strategic investor.
    • “Whoop plans to put the funds toward its U.S. and international growth, as well as personalized health features.”
  • Fierce Healthcare relates,
    • “eMed pocketed $200 million in funding to build out its AI agentic platform and offer new models for employers, including programs for GLP-1 medications.
    • “The funding round boosts the company’s valuation to $2 billion. AON Consulting led the round along with prominent investors former NFL player Tom Brady, founding chief wellness officer, Jeff Aronin, founder, chairman and CEO of Paragon Biosciences; Ara Cohen, co-founder and co-managing Member of Knighthead Capital Management; Antonio Gracias, founder and CEO of Valor Equity Partners; Joe Lonsdale, founder and managing partner at 8VC and co-founder of Palantir; R.J. Melman, CEO, Lettuce Entertain You Restaurants; Tom Ricketts, chairman of the Chicago Cubs; and former X CEO and current eMed CEO Linda Yaccarino. 
    • “The company plans to use the fresh capital to support and fund a new capitated model designed to help employers bend the healthcare cost curve. GLP-1 medications are the most requested workplace benefit, yet only one in five companies provide the benefit, according to the company.”

Tuesday report

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

From Washington, DC,

  • The Wall Street Journal reports,
    • “Oklahoma Republican Gov. Kevin Stitt on Tuesday selected Alan Armstrong, an energy executive, to fill the seat being vacated by Sen. Markwayne Mullinuntil a new election takes place in November.
    • “The announcement came a day after Mullin was confirmed Monday by the Senate as secretary of the Department of Homeland Security. The appointment of Armstrong as a temporary seat holder keeps the Senate’s GOP majority at 53-47.
    • “Armstrong, the chairman of Williams Companies, focused in remarks Tuesday morning on permitting reform, the cost of energy and infrastructure.” * * *
    • “President Trump has endorsed Oklahoma Rep. Kevin Hern for the Senate seat in the coming election, calling him a “true friend of MAGA.” The Republican primary in the deep-red state is scheduled for June 16.
    • “Armstrong said he had a positive meeting with Trump before his selection. Oklahoma state law prohibits Senate appointees from running for the seat in a subsequent election.” 
  • and
    • “Senate Republicans offered Tuesday to fund all of the Department of Homeland Security except for the unit that carries out immigrant arrests and deportations, moving to end a nearly six-week funding standoff that has caused security snarls at airports nationwide. 
    • “Democrats reacted coolly to the proposal, which didn’t include the new restrictions on immigration enforcement practices they have demanded, but said that they were engaged in negotiations. President Trump indicated he wasn’t pleased with the direction of the talks, muddying the prospects of a quick resolution.”
  • The Hill adds,
    • “House Republicans are pushing back stiffly against the idea of splitting up legislation to fund the Department of Homeland Security (DHS), despite the White House and Senate Republicans saying President Trump is open to doing just that.”
  • Roll Call notes,
    • “As a deadline arrives this week to nominate a Centers for Disease Control and Prevention director, some Republicans are skeptical the administration will find someone who can check all the boxes necessary for confirmation.
    • “The candidate will need the “Make America Healthy Again” mindset of Secretary Robert F. Kennedy Jr.’s Health and Human Services Department, while also appeasing a set of stick-to-science senators increasingly unhappy with Kennedy’s direction.” * * *
    • “HHS senior adviser Chris Klomp, in an interview last week with Stat News, said the agency has interviewed “dozens” of potential candidates. Though there is a structured process to name top candidates, Kennedy will ultimately make the final decision.
    • “Klomp also said that if the White House hasn’t named a nominee Wednesday, HHS would shift to delegate responsibilities, but getting a qualified nominee “is a top priority.”
  • The Washington Post points out,
    • “The nascent Make America Healthy Again movement got one of its biggest wins last spring: Casey Means was selected to be the nation’s top doctor.
    • :But more than 10 months later, the controversial surgeon general pickhas yet to assume the position advising Americans on how to improve their health. Her nomination has stalled as some Republicans question her stance on vaccines, her medical credentials and her pushes against the medical establishment.
    • “Means probably cannot afford to lose the support of a single Republican on the Senate health committee, which has yet to schedule a vote to advance her nomination to the full Senate. The panel’s chairman, Sen. Bill Cassidy (R-Louisiana), repeatedly pressed Means on her views on immunizations during a late February hearing — questions she largely dodged — and Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska) afterward publicly said they still have questions.”
  • The New York Times relates,
    • “Dr. Robert Malone, vice chair of the federal committee that recommends vaccines to Americans, angrily resigned his position on Tuesday.
    • “The panel, called the Advisory Committee on Immunization Practices, or ACIP, is currently in judicial limbo. A federal judge ruled last week that the advisers, appointed by Health Secretary “Robert F. Kennedy Jr., did not have the expertise needed to make vaccine recommendations and prevented them from meeting as planned this month.
    • “The judge also blocked all of the committee’s actions to date, including decisions to rescind recommendations for some childhood vaccines.
    • “The Department of Health and Human Services has indicated that it will appeal the ruling but has not said when. Dr. Malone indicated that he would not rejoin the committee even if the ruling were to be overturned or if Mr. Kennedy announced a new slate of advisers.”
  • FedManager observes,
    • “With the cancellation of the Federal Employee Viewpoint Survey (FEVS) for 2025, the Partnership for Public Service conducted its own version of FEVS. The goal: check the pulse of the workforce in a year of major workforce changes, including deferred resignations, returns to office, the cancellation of union contracts, and other changes. 
    • “The revamped survey was modeled after FEVS but was developed and deployed by the Partnership. While it’s not directly comparable, it contained similar questions. The survey was conducted on a smaller scale with 11,000 feds responding, compared to the 500,000 or so who respond to the official FEVS. Responses were collected in November and December 2025.
    • As for the results, employee engagement and satisfaction governmentwide was measured at a score of 32 out of 100, with 58 percent of respondents saying engagement has gotten worse since 2024. 
    • “We have every red light blinking across the federal government,” said Partnership President and CEO Max Stier. “Morale is as low as imaginable.”
  • Govexec informs us,
    • “As the U.S. Postal Service contemplates service cuts due to the prospect of running out of money as soon as fall 2026, President Donald Trump recently nominated three additional individuals to the postal agency’s Board of Governors. Several unions and other stakeholders, however, reported that they are largely unfamiliar with his picks. 
    • “[The National Association of Letter Carriers] is closely monitoring these unknown nominees and will actively work to ensure they have the best interests of the employees and the network before they are confirmed,” the union said in a press release responding to the nominations announcement. 
    • “The postal board nominees are: Robert Steffens of Texas, Jeffrey Brodsky and William Gallo, both of Florida.” * * *
    • “There are currently four governors on the USPS board — two Democrats, one Republican, one independent — leaving five vacancies. No more than five of them can be from the same political party. 
    • “NALC noted that the Senate has traditionally advanced postal nominees in bipartisan pairs, but all of Trump’s picks, so far, have been Republicans. The president has attempted to remove Democratic members of several bipartisan agency boards, prompting legal challenges that have reached the Supreme Court.” 
  • Modern Healthcare lets us know,
    • “The Accelerating State Pediatric Innovation Readiness and Effectiveness, or ASPIRE, Model is designed for children and young adults with complex physical and behavioral health needs.
    • “The demonstration will test wraparound Medicaid and Children’s Health Insurance Program payments to promote care coordination.
    • “CMS will distribute $125 million to up to five states over 10 years.”
  • KFF analyzes the BALANCE Model for GLP-1s in Medicare and Medicaid.
    • “GLP-1s, a class of drugs used to treat type 2 diabetes, obesity, cardiovascular disease, and other conditions, have exploded in popularity in recent years due to their demonstrated effectiveness, but are often not covered by insurance, particularly for the treatment of obesity. According to KFF polling, about half (56%) of GLP-1 users say these drugs were difficult to afford, including one in four who say they were “very difficult” to afford.
    • “The Trump administration is pursuing various approaches to lowering the cost and expanding coverage of these medications. These approaches include striking “most-favored nation” deals with GLP-1 manufacturers Novo Nordisk and Eli Lilly, providing access to discounted prices for GLP-1s through TrumpRx, and implementing a new demonstration program called the BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model to expand Medicare and Medicaid coverage of GLPs for obesity, which is currently subject to statutory limitations (prohibited in Medicare, permissible but not required in Medicaid). In addition, the GLP-1 drug semaglutide (branded as Ozempic, Wegovy, and Rybelsus) was selected for Medicare drug price negotiation in 2025, with a negotiated price set to take effect in 2027.
    • “This brief describes current coverage of GLP-1s in Medicare and Medicaid, the Centers for Medicare & Medicaid Services’ (CMS) efforts to expand access and lower costs for GLP-1s through temporary demonstration programs including the BALANCE Model, and potential impacts on beneficiaries and program budgets.”
  • The American Hospital Association tells us,
    • “The Administration for Strategic Preparedness and Response March 24 announced an investment to expand the domestic manufacturing of propofol and metoprolol. Propofol is a sedative used for anesthesia and intensive care unit sedation, while metoprolol is a medication used to treat cardiovascular conditions such as arrhythmias and hypertension, and can also reduce lung inflammation in ICU settings. ASPR said the API Innovation Center, based in St. Louis, was awarded $8.3 million to produce both ingredients. The investment is the latest in a series of projects by ASPR and the Department of Health and Human Services to reduce reliance on foreign resources and increase the domestic production of essential medications and their active pharmaceutical ingredients.”

From the Food and Drug Administration front,

  • MedTech Dive reports,
    • “GE HealthCare has received 510(k) clearance for its spectral photon-counting CT technology, the company said Monday.
    • “The Food and Drug Administration clearance positions GE HealthCare to compete with Siemens Healthineers’ Naeotom Alpha, the first photon-counting CT machine to reach the U.S. market.
    • “Citi Research analysts said in a note to investors that GE HealthCare’s Photonova Spectra is differentiated by its use of a detector designed to produce high-contrast spectral images with detailed visualization.”
  • Cardiovascular Business adds,
    • “Medtronic has received an expanded U.S. Food and Drug Administration (FDA) approval for its OmniaSecure defibrillation lead. 
    • “The lead was originally approved for placement in the right ventricle in April 2025. This expanded indication covers the left bundle branch (LBB) area, meaning it can now be used for conduction system pacing and even LBB optimized cardiac resynchronization therapy (LOT-CRT). This is the first time the FDA has approved a defibrillation lead for placement in the LBB area.
    • “Conduction system pacing is a rapidly growing therapy for patients who need a pacemaker,” Trevor Cook, vice president and general manager of Medtronic’s defibrillation solutions business, said in a statement. “Now, patients who require a defibrillator and pacing have an option that can safely deliver life-saving defibrillation therapy and activate the heart’s natural electrical system to enable a more synchronous, physiologic pattern. This approval underscores the versatility of the OmniaSecure defibrillation lead and supports its use across a variety of implant approaches to best serve a broad range of patients.”

From the judicial front,

  • Healthcare Dive reports,
    • “CVS Health has reached a proposed settlement with the Federal Trade Commission in the agency’s sweeping case against major pharmacy benefit managers for allegedly inflating the cost of U.S. insulin.
    • “The proposed consent agreement was disclosed Monday in a joint motion from the FTC and CVS for the company’s subsidiaries, PBM Caremark and group purchasing organization Zinc, to withdraw from the case while antitrust regulators consider the deal.
    • “The filing did not include the terms of the potential settlement, but analysts expect it would be similar to the deal the FTC secured with Cigna’s PBM Express Scripts earlier this year. If CVS reaches a settlement, that would leave UnitedHealth as the lone holdout in the high-profile suit.”

From the public health, medical research and Rx research front,

  • The AP reports,
    • “Whether they’re using weekly shots or daily pills, more Americans than ever are turning to anti-obesity drugs to lose weight and boost health.
    • “About 1 in 8 U.S. adults say they are taking a GLP-1 drug, according to a recent surveyby the health research group KFF.
    • “Just since January, more than 600,000 prescriptions have been written for Novo Nordisk’s new Wegovy pill, the company said. Early analysis suggests that more than a third of users are new to the drugs, according to Truveta, a health care data company. 
    • “But medication alone isn’t the answer, experts caution. It also takes lifestyle changes — healthy diet, exercise, adequate sleep and stress management — to reap the biggest benefits from the drugs known as GLP-1s.
    • “The biggest mistake people make with GLP-1 medications is thinking the prescription is the treatment,” said Dr. Katherine Saunders, an obesity medicine expert at Weill Cornell Medicine and co-founder of FlyteHealth, a weight-loss treatment company.
    • “GLP-1s can spur weight loss and health benefits on their own, but the effects are larger and last longer when the drugs are combined with lifestyle changes, a recent review of nearly three dozen studies found.”
  • Beckers Clinical Leadership relates,
    • “The CDC is tracking a new SARS-CoV-2 variant — BA.3.2 — that has been identified in 23 countries, including the U.S.
    • “Here are [four] things to know:
      • “1. The variant was first identified in South Africa in November 2024. Detections began increasing in September 2025, with the highest number reported during the week of Dec. 7, 2025.
      • “2. BA.3.2 was first detected in the U.S. in June 2025 at San Francisco International Airport through traveler-based surveillance. As of mid-February, it had been found in clinical samples from five patients across four states and 132 wastewater samples from 25 states. Prevalence among sequenced specimens remains low at 0.19%. Two of the five patients were hospitalized older adults with comorbidities, and all five survived.
      • “3. BA.3.2 carries about 70 to 75 mutations in its spike protein compared to JN.1 and its descendant LP.8.1, the antigens used in the most current COVID-19 vaccine. Lab studies show BA.3.2 evades antibodies more effectively than other circulating variants. The 2025–26 COVID-19 vaccine demonstrated the lowest antibody neutralization against BA.3.2 among seven variants tested. The CDC said real-world vaccine effectiveness data is still needed and that current vaccines continue to protect against the predominant circulating strains.
      • “4. Data from several European countries show BA.3.2 has not rapidly overtaken other strains. Instead, the strain has cocirculated with other JN.1 descendent lineages at 10% to 40% prevalence. Two lab studies also found BA.3.2 had reduced lung cell entry compared with other variants, potentially limiting its ability to become dominant. However, further evolution or seasonal transmission increases could enable broader circulation, the CDC noted.”
  • The American Journal of Managed Care tells us,
    • “AMD [Age related macular degeneration] affected more men than women and was higher in White vs Black individuals; Rhode Island reached ~7214 per 100,000. 
    • “Diabetic retinopathy clustered in Black and Hispanic populations and in southern states, with Mississippi ~3607 per 100,000 and marked male predominance. 
    • “DME [diabetic macular edema] prevalence remained low overall yet disproportionately higher in Black individuals (712 per 100,000) than Hispanic (578) and White (155), supporting targeted screening within diabetes care. 
    • “RVO [retinal vein occlusion] was least prevalent but showed higher rates in White individuals and in Rhode Island; analyses assumed age-related increases, potentially influencing estimates. 
    • “Specialist access and costs were substantial: California had 918 retina specialists vs 3 in Wyoming; annual payer costs were ~$13.4B AMD, $6.2B DR, $4.4B DME, $6.4B RVO.”
  • Cardiovascular Business informs us,
    • “Exercise and using medications to reduce a patient’s cardiovascular risk factors are not associated with significant improvements in cognitive function, according to new findings published in JAMA Neurology. The study’s authors focused on older patients with a family history of dementia and/or self-reported signs of possible cognitive decline. 
    • “Exercise combined with pharmacological management of cardiovascular risk factors is the evidence-based strategy for maintaining cardiovascular health,” wrote first author Rong Zhang, PhD, a researcher with the University of Texas Southwestern Medical Center and Texas Health Presbyterian Hospital Dallas, and colleagues. “However, its effects on cognitive function remain unknown.”
  • “Today’s issue of Research Matters from the National Institutes of Health discusses Treating addiction.”
    • “Alcohol and drug addiction can cause many harms. This Research in Context feature looks at research into the causes of addiction and new ways to treat it.”
  • Per Health Day,
    • “Higher combined consumption of fruits, vegetables, legumes, and potatoes may reduce the risk for Crohn disease (CD), according to a study published in the March issue of the American Journal of Gastroenterology.
    • “Antoine Meyer, M.D., Ph.D., from Université Paris-Saclay in France, and colleagues assessed the risk for developing CD and ulcerative colitis (UC) based on intake of individual fruits, vegetables, legumes, and potatoes. The analysis included 341,519 individuals completing food frequency questionnaires who were followed for a median 13.4 years.”

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

  • Plan Advisor reports,
    • “Rising health care costs are reshaping how employees choose workplace benefits, even when those selections expose workers to significant future financial risk.
    • “Nearly two-thirds of employees reported cost as their top priority during open enrollment, according to Securian Financial’s annual workplace benefits study, “The Affordability Trap: Why Cheaper Choices Cost Employees More.” The focus on cost leads many employees to choose lower-premium plans with higher deductibles; skip supplemental coverage; or scale back voluntary benefits, a pattern identified by the report as an “affordability trap.”
    • “While these decisions may reduce payroll deductions in the short term, the study found they often leave employees vulnerable to sizable out-of-pocket expenses when medical events occur.”
  • Per Healthcare Dive,
    • “Cencora has agreed to acquire EyeSouth Partners’ retina business for $1.1 billion as the drug distributor continues to expand its specialty medical arm.
    • “Once the transaction closes, EyeSouth’s physicians will join Cencora’s management services organization Retina Consultants of America, according to the Monday announcement.
    • “Cencora expects the deal to close after the company’s fiscal year ends on Sept. 30 and be slightly accretive to Cencora’s earnings.”
  • Fierce Healthcare relates,
    • “Highmark posted a $175 million net loss in 2025 as its insurance arm weathered cost pressures that strained the industry nationwide.
    • “The company said Tuesday morning that full-year revenue $32.4 billion, up 11%. Revenues were up across business units, with Highmark Health Plans posting a 12% increase, Allegheny Health Network reporting an 11% increase in revenue and the diversified business unit—which includes United Concordia Dental and its stop-loss business, HM Insurance Group—seeing revenue up 7%.
    • “The insurance division posted a $609 million operating loss in 2025, and executives told reporters during a briefing that the performance of other businesses helped to offset some of that downturn. Allegheny Health Network, the company’s provider arm, posted $90 million in operating income, up from $237 million in 2024.”
    • “We are not immune to the strong headwinds experienced across the entire insurance industry,” Carl Daley, Highmark’s chief financial officer, said during the briefing. “About half of the industry has had credit ratings or outlooks downgraded, including some of the largest players.”
  • BioPharma Dive tells us,
    • “Gilead Sciences will acquire autoimmune drugmaker Ouro Medicines, the companies said Monday afternoon, spending nearly $1.7 billion on the young startup and a T cell engager it licensed from a Chinese biotechnology firm.
    • “Ouro launched in early 2025, backed by GSK and Monograph Capital. Its bispecific antibody, called OM336 or gamgertamig, is designed to bind to a pair of immune cell proteins, BCMA and CD3, that have been popular targets for drugmakers.
    • “Many bispecific antibodies have been approved for cancers, but over the past decade, a flurry of research has shown these treatments hold promise in autoimmune diseases as well. The multipronged drugs eliminate B cells much like cell therapies, but cost less to manufacture, don’t require harsh chemotherapy conditioning and can be dosed multiple times.”
  • Fierce Pharma informs us,
    • “UCB plans to build a $2 billion manufacturing facility near its U.S. headquarters in Atlanta, Georgia. It will become the first plant in the U.S. for the Belgium-based company and will produce biologics.  
    • “The 460,000-square-foot factory will sit on a 79-acre plot of land in the Rowen innovation district, a mixed-use development designed to attract corporate investment. The project is modeled after North Carolina’s Research Triangle Park (RTP). 
    • “Officials from Gwinnett County signed off on UCB’s application on Tuesday afternoon. It becomes the largest investment a company has made in county history, according to the Atlanta Journal-Constitution. The site is near Dacula, Georgia, which is 35 miles northeast of downtown Atlanta. UCB’s U.S. headquarters is in Smyrna, which is in Atlanta’s northwest suburbs, about 45 minutes away.”
  • The Wall Street Journal lets us know,
    • “Finance chiefs once questioned the returns on investing in artificial intelligence. Those days are gone.
    • “Speaking at The Wall Street Journal’s CFO Council Summit in Palo Alto, Calif., finance chiefs from the tech, retail and financial services sectors said their companies are seeing big gains in efficiency and productivity—in some cases worth millions of dollars—from their investments in generative AI. Nudging employees to embrace AI also has yielded new ideas about how to accomplish time-consuming tasks, CFOs said.
    • “Finance chiefs say they are playing a leading role in their company’s AI transformation efforts, evaluating performance, pushing for productivity gains and clearly articulating the value to reluctant employees.”