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Mylan NV raced Thursday to counter a firestorm of criticism over its pricing of lifesaving EpiPens, saying it would help more patients cover their out-of-pocket costs. But the drugmaker didn’t lower the list price, and its stranglehold on the market means it is unlikely to face competitive pressure to do so. (Rockoff, 8/25)

But the moves did not mollify critics of Mylan because the company did not lower the list price of the EpiPen, which has risen to $600 for a pack of two from about $100 in 2007. So the total cost to the health system, a cost borne largely by insurers, the federal government and school districts, will remain the same. (Pollack, 8/25)

Although the company said that the savings card would halve the cost of the drug to commercially insured patients who pay full price, outside experts said the overall impact will likely be small and that it did not amount to a solution to the broader problem. Such savings cards are a classic public relations move by the pharmaceutical industry, said Harvard Medical School professor Aaron Kesselheim, and it will only be used by a fraction of the people who need the drug. For example, such savings cards are illegal in government health programs such as Medicaid. (Johnson, 8/25)

The device's manufacturer, Mylan NV, announced Thursday that it will offer coupons worth as much as $300 off a two-pack. The move is a reaction to harsh criticism from consumers and several lawmakers over repeated price increases that have boosted the cost of the medication to more than $600 from less than $100 just a few years ago. ... But coupons may not be enough to tamp down anger over the price hikes. (Kodjak, 8/25)

The maker of EpiPens announced Thursday that it is reducing the price of the device following an uproar in Washington over the cost of the treatment for serious allergic reactions. Mylan, the company that makes EpiPen, said it will provide a savings card worth up to $300 for people who had been paying the full price out-of-pocket, effectively reducing the cost by 50 percent. The company is also making it easier to qualify for its patient assistance program, which eliminates out-of-pocket costs for uninsured and underinsured people. (Sullivan, 8/25)

Mylan, the embattled drug company whose price hikes of an anti-allergy product sparked calls for a government investigation and a congressional hearing has announced plans to broaden discounts offered to consumers on its EpiPen. The company said Thursday that it will increase the value of a savings coupon offered on an epinephrine auto injector to $300 from $100 and double the eligibility for subsidies that eliminate out-of-pocket costs to uninsured or underinsured patients. (Spencer, 8/25)

Today the CEO of Mylan responded to the uproar over her company's price increases for EpiPens, the life-saving anti-allergy injectors. A pack of two EpiPens now costs $600, up from $100 in 2007. CEO Heather Bresch said Mylan will offer more financial assistance to help people pay their out-of-pocket costs — the piece that health insurance doesn't cover. But she did not offer to take back any of the price increases. Instead, Mylan blames rising health care premiums and deductibles. But Robert Weissman, president of the watchdog group Public Citizen, says that’s not it at all.  “The problem is that Mylan has jacked up their price,” he said.  (Douban, 8/25)

[Mellini Kantayya] went online to Petition2Congress.com, a service that collects signatures and then sends them to designated lawmakers, and created the petition “Stop the EpiPen Price Gouging,” which went live on July 11. Then Ms. Kantayya shared the link with her 836 Facebook friends, with a post that began, “Stupid pharmaceutical company!” What happened next is a lesson in the power of social media to help create a groundswell, particularly among a group as committed and motivated as the parents of children with food allergies, who must often buy multiple pens for home, school and day care. In just 45 days, Ms. Kantayya’s petition grew from a few dozen signatures to more than 80,000 people who sent more than 121,000 letters to Congress. (Parker-Pope, 8/25)

America has a new pharmaceutical villain. Her name is Heather Bresch. As the chief executive of Mylan, the owner of the severe allergy treatment EpiPen, Ms. Bresch is at the center of the latest public outrage over high drug prices, excoriated for overseeing a fourfold price increase on EpiPen while taking a huge pay raise. (Thomas, 8/26)

Heather Bresch, the Mylan CEO under fire for skyrocketing EpiPen costs, believes Americans should redirect their anger toward a "broken" health care system. Mylan (MYL) was forced to respond to the national outrage over a more than 400% increase in price for the lifesaving allergy treatment by pledging on Thursday to make it more affordable. But Bresch argued that a lack of transparency in the complex health care system -- with bigger cuts for everyone along the supply chain -- "incentivizes higher prices" in the industry. She pointed out that copays and deductibles are on the rise, too. (Egan, 8/25)

In response to intense criticism over the past few days, Mylan acted Thursday to expand assistance programs that help patients with high out-of-pocket expenses -- but didn’t go as far as cutting the treatment’s list price. Health insurers and U.S. lawmakers, along with Democratic presidential candidate Hillary Clinton, criticized the effort as an attempt to cover a 400 percent price hike that won’t make the drug more affordable. Mylan has been under fire for increasing the price to about $600 for a two-pack from $57 for a single pen in 2007. (Koons and Edney, 8/25)

Amid a chorus of criticism over the rising cost of EpiPens — a furor that has sent her company’s stock down more than 10 percent — Mylan CEO Heather Bresch went on CNBC on Thursday to manage a crisis. But her appearance may have raised more questions than it answered. Mylan is not lowering the price of EpiPen, though it is expanding a program to help patients with the cost. Some of Bresch’s sharpest critics — including members of Congress and Hillary Clinton — have made clear that’s not enough. (Garde, 8/25)

Some Congressional Democrats are criticizing a pharmaceutical company's effort to curb the rising cost of a drug used to combat severe allergic reactions as a public relations move rather than a solution. ... “This step seems like a PR fix more than a real remedy, masking an exorbitant and callous price hike," Sen. Richard Blumenthal said in a statement. "This baby step should be followed by actual robust action." (Bowman, 8/25)

The debate over the cost of EpiPens isn't just politics for some lawmakers. It's personal. Democratic Sens. Amy Klobuchar of Minnesota and Mark Warner of Virginia both have adult daughters who rely on the drug injector. Klobuchar's daughter, Abigail, 21, keeps one with her because of a nut allergy. A spokeswoman for Warner said the senator's youngest daughter, Eliza, 22, is so prone to allergic reactions that she actually needs to use EpiPens regularly — and the Warner family keeps them around the house. (Lesniewski, 8/26)

Under fire for aggressively hiking the price of the EpiPen device, Mylan Pharmaceuticals has now lost an influential advocate: Sarah Jessica Parker. The actress said on her verified Instagram account Thursday that she has ended her relationship as a paid spokeswoman for the drug maker “as a direct result” of the price increases. Parker wrote that she is “disappointed, saddened and deeply concerned by Mylan’s actions” and called on the company to “take swift action to lower the cost to be more affordable for whom it is a life-saving necessity.” (Robbins, 8/25)

EpiPen’s rising price is particularly notable because state and federal legislation have been key to the drug’s rapid growth. Annual prescriptions for EpiPen products have more than doubled in the past decade to 3.6 million, according to IMS Health data. Mylan benefited from factors including failed competitors, patent protections and laws requiring allergy medications in schools. Having a virtual monopoly has facilitated the rapid price hike. Mylan reached $1 billion in sales for the second time last year. (Johnson and Ho, 8/25)

While anger is directed at Mylan Pharmaceuticals over the rising cost of its EpiPen device, some lawmakers wonder whether the US Food and Drug Administration should share some of the blame for the high prices paid by consumers. How so? They want to know if the agency made it possible for Mylan to dominate the market and charge whatever price it wants. (Silverman, 8/25)

The controversy surrounding skyrocketing prices over the EpiPen emergency allergy shots has nothing to do with what's in the devices. That's the 100-year-old chemical epinephrine, which costs just pennies. It's the device that Mylan is charging so much for. So why not replace cartridges of epinephrine that have expired with new ones? (O'Donnell, 8/25)

As the makers of EpiPen battle a firestorm surrounding price increases, a new federal lawsuit seeking class-action status argues that the company is engaging in price gouging by forcing consumers to buy the pens in packs of two. The lawsuit was filed Tuesday in the Eastern District of Michigan on behalf of six EpiPen purchasers, three of them based in Michigan. It says there is little evidence doctors ever recommended the pens be sold in packs of two — and yet by 2011, EpiPen’s maker Mylan did just that. (Bethencourt, 8/25)

Mylan Pharmaceuticals has come under intense fire for massive price hikes of EpiPens over the last week, facing scrutiny from lawmakers and industry groups. It is less well known, however, that while Mylan markets and prices the drug, Pfizer Inc. actually manufactures the drug and has seen increased revenues from EpiPens over the last few years. The financial relationship between the two drug companies is unclear, and Pfizer declined to elaborate. Mylan did not respond to a request for further comment about EpiPens or how the two companies divide revenues. (Owens, 8/26)

The firestorm over steep price increases for the EpiPen — which can rescue people having life-threatening allergic reactions  — is just the latest in a long line of controversies over high prescription drug prices. A decade ago, much of the concern over prescription drug prices involved new high-tech cancer drugs, used by only a few thousand patients a year. In recent years, the prices for decades-old generic drugs have soared, as well, as pharmaceutical companies purchase the rights for drugs with no competition. Here's a recap of some of the most eye-popping prices. (Szabo, 8/25)

Outrage over the massive EpiPen price hike feels like deja vu. A year ago, America was in shock when a drug called Daraprim that's used by some AIDS and transplant patients skyrocketed overnight from $13.50 to $750 a pill. ... Hillary Clinton tweeted that the 5,000% spike was "outrageous" and amounted to "price gouging." Nothing about the drug itself had changed except this: a new company -- Turing Pharmaceuticals -- had bought the rights to distribute it. The Daily Beast dubbed Turing's CEO "the most hated man in America." (Long, 8/25)

In a statement more remarkable for who said it than for what he said, Sen. Joe Manchin (D., W. Va.) said he shares the concerns of other senators and the public about “skyrocketing prices of prescription drugs.” Sen. Manchin’s daughter is Heather Bresch, chief executive of Mylan NV and the central figure in the current national furor over the skyrocketing cost of Mylan’s auto-injector product called the EpiPen. (Burton, 8/25)

Sen. Joe Manchin said Thursday that he shares the concerns his colleagues have voiced about how a pharmaceutical company run by his daughter prices a life-saving medicine it produces. The West Virginia Democrat’s daughter is Heather Bresch, the CEO of Mylan, the company that makes the EpiPen, a product that delivers the life-saving drug epinephrine for people with allergies to bee stings or certain foods. Mylan has come under fire in recent days for raising the price of the EpiPen by 548 percent since it acquired the rights to the product in 2007. (Nelson, 8/25)

Sen. Joe Manchin (D-W.Va.), whose daughter Heather Bresch is the CEO of the company that makes EpiPens, said Thursday that he shares his colleagues' concerns about the recent price hike in the emergency allergy medication. "I am aware of the questions my colleagues and many parents are asking, and frankly I share their concerns about the skyrocketing prices of prescription drugs," Manchin said in a statement.  (Sullivan, 8/25)

As insurers push large premium increases for 2017 Obamacare plans, some of the steepest hikes have been requested by insurers in crucial swing states that could determine control of the Senate. In nine of 11 states with competitive Senate races, at least one insurer seeks to hike rates for Obamacare customers by at least 30 percent next year: Highmark Blue Cross Blue Shield in Pennsylvania wants to jack up average premiums by more than 40 percent. In Wisconsin, three insurers have asked for rate hikes of more than 30 percent. In New Hampshire, two of the five carriers want to sell plans with rate increase above 30 percent. (Pradhan and Demko, 8/26)

The Affordable Care Act enrollment period doesn't begin until November, but the recent departure of several health insurance providers from federal and state marketplaces is raising concerns of fewer choices and higher premiums. But federal officials emphasized that consumers will still have affordable coverage options during a Wednesday conference call. Even if insurance premiums increase by 25 percent, 60 percent of Indiana consumers would be able to purchase coverage for less than $75 per month, according to a report from the U.S. Department of Health and Human Services. (Lazerus, 8/25)

States that allow nearly all poor adults to enroll in their Medicaid health coverage programs saw prices on Obamacare private insurance marketplaces about 7 percent lower than states that haven't expanded Medicaid eligibility, the federal government said Thursday. The findings reflect the fact that poorer people tend to be less healthy than people with higher incomes, who make up the lion's share of Obamacare enrollees in expansion states. (Mangan, 8/25)

The Obama administration for years has been pleading with states to expand their Medicaid programs and offer health coverage to low-income people. Now it has a further argument in its favor: Expansion of Medicaid could lower insurance prices for everyone else. A new study published by in-house researchers at the Department of Health and Human Services compared places that have expanded their Medicaid programs as part of Obamacare with neighboring places that have not. They found that, in 2015, insurance in the marketplace for middle-income people cost less in the places that had expanded Medicaid. (Sanger-Katz, 8/25)

Under the expanded program, people within 138 percent of the federal poverty level are eligible for Medicaid. In states that did not expand Medicaid, people within 100 percent and 138 percent of the federal poverty level are eligible for subsidized coverage on the federal exchanges. People within that range make up, on average, 40 percent of the marketplace population in non-expansion states, as opposed to 6 percent in states that expanded Medicaid, the report says. Typically, low-income people have poorer health than people with higher incomes, meaning low-income and potentially sicker people make up a greater part of the exchange risk pools in states that have not expanded Medicaid. (McIntire, 8/25)

The Alabama House of Representatives narrowly approved Gov. Robert Bentley's proposed state lottery Thursday night after 10 hours of contentious debate and two vote attempts. ... The Republican governor, seeking to end the Deep South state's historic opposition to gambling as a revenue source, proposed a lottery as a way to provide money to the state's perpetually cash-strapped Medicaid program. (Chandler, 8/26)

On a second vote, the House approved the amendment 64 to 35, one vote more than it needed to go over the top. ... It goes to the Senate for concurrence or a conference committee. Senate President Pro Tem Del Marsh, R-Anniston, said Friday morning he planned to move for a conference committee or concurrence on Friday. "We are just happy to know will have something for the people of Alabama to vote on," he said. (Lyman, 8/26)

The legislation is Gov. Robert Bentley's plan to boost funding for the General Fund and Medicaid. "We came out with a victory from the House," Bentley said, speaking to reporters after midnight. "Not us, but a victory for the people of this state. "This is about people. The lottery is just part of that process. The lottery is only a way that we can have money to fund the essential services of this state, particularly Medicaid." ... If the legislation can win final approval, it would go to voters as a proposed constitutional amendment. (Cason, 8/26)

Despite delays from the Legislature in addressing the proposal to expand the federal health insurance program for needy people, health care industry officials said they would push for expansion in 2017. At a meeting in Sioux Falls, representatives from the governor's office, health care organizations from across the state including Avera, Sanford and Rapid City Regional as well as a handful of legislative candidates met to discuss how they'd again make the argument for expansion in the Legislature. (Ferguson, 8/25)

Doctors who make house calls may seem like something from America’s Norman Rockwell past. But they never disappeared entirely, and there is new evidence that home visits can play an important role in providing health care to the aged and chronically ill — while saving taxpayers millions. The federal Centers for Medicaid and Medicare Services (CMS) said this month that a demonstration project has shown that delivering comprehensive primary care services at home helped to keep Medicare recipients with multiple chronic illnesses or disabilities out of hospitals, emergency rooms and nursing homes. (Ollove, 8/25)

Groups of hospitals, doctors and other health providers that agree to coordinate patient care as part of an Obamacare program generated $466 million in savings to the federal Medicare program in 2015, officials said Thursday. The groups, known as accountable care organizations, provide care for a total of about 7.7 million beneficiaries of Medicare, the program that covers primarily senior citizens. (Mangan, 8/25)

The mixed results for Medicare accountable care organizations continued last year with fewer than one-third of them qualifying for bonus payments, the CMS said Thursday. The news comes as the administration is preparing providers for the new Medicare reimbursement program known as MACRA, which is set to begin collecting data in January. It shifts away from fee-for-service payments and toward value-based payments, thus promoting the use of programs like ACOs. (Muchmore, 8/25)

Medicare accountable care organizations have saved more than $1.29 billion since 2012, the Centers for Medicare and Medicaid Services announced Thursday. All Medicare ACOs, which number more than 400 including both shared savings program participants and pioneer ACOs, saved a total of $466 million in 2015, the agency said. The administration has sought to enroll more providers in ACOs as part of its goal to tie more medical reimbursements to quality, rather than quantity. (McIntire, 8/25)

Growth in overall health-care spending is slowing, but middle-class families’ share of the tab is getting larger, squeezing households already feeling stretched financially. Overall, health-care spending across the economy reached 18.2% of gross domestic product as of June, up from 13.3% in 2000, according to Altarum Institute, a health research group. (Sussman, 8/25)

Despite a slowdown in the growth rate of overall national health expenditures, Americans are seeing more of their paychecks go to health-care costs. The increase is largely thanks to cost-shifting through higher deductibles in plans offered by employers, which cover the majority of workers and their families. The trend has hit middle-income households the hardest. Here are five things to know about trends in U.S. health-care spending. (Sussman, 8/25)

As prescription drug costs continue to rise, ensuring that consumers have access to the drugs they need is a growing concern. Insurers blame the drug companies for high prices while drug companies blame insurers for restrictive plans. Consumers are stuck in the middle picking up a higher tab. Now a new study highlights strategies for states to help consumers in this tug of war. (Andrews, 8/26)

From the ashes of this defeat emerged a chastened Hillary Clinton whose caution has, over the years and as she seeks to become the nation’s first female president, become a hallmark of her identity. The 21 months from the dawn to the demise of the Clinton health plan showed the first lady as the Washington neophyte that she was, overvaluing her own ideas, misreading power relationships, crusading for a complex plan that would have disrupted many Americans’ health care. She has not attempted anything as daring again. (Goldstein, 8/25)

There’s at least one politician who can legitimately claim that he knows what Hillary Clinton is going through as a target of wild speculation about her health: Michael S. Dukakis. ... Dukakis told STAT that he believes that accusations about his health hurt him in his race against George H. W. Bush. (Scott, 8/26)

NPR's Robert Siegel talks to Rob Darling, a former White House physician, about how much voters have a right to know about the medical histories of presidential candidates. (8/25)

One of Donald Trump’s top transition team members is a pharmaceutical executive described by friends and political foes as disciplined, press adverse and focused on policy — in other words, the complete opposite of the Republican nominee. Gov. Chris Christie tapped his former chief of staff Rich Bagger to help run the Trump transition team, which has already started its work at 1717 Pennsylvania Ave. to develop a policy agenda for a possible administration and build out a staff. (Haberkorn, 8/25)

Sen. Bernie Sanders backed Colorado’s Amendment 69 Wednesday, lending his support to the ballot initiative while launching Our Revolution, a new organization aimed at continuing the “movement” Sanders says was launched through his campaign for president, capitalizing on his newfound political capital. It will back candidates and ballot initiatives that back Sanders’ left-leaning priorities. (McIntire, 8/25)

Officials say a second person in Palm Beach County, Florida, has contracted the Zika virus through a local mosquito. Florida's Department of Health said in a statement Wednesday that a 24-year-old Lake Worth woman has been confirmed to have contracted the virus. (8/25)

Florida officials announced a new locally transmitted Zika case Wednesday—this time in Palm Beach County. It’s the second case stemming from local mosquitos in the county, but officials say the two cases aren’t connected.During an interview on Fox News, Governor Rick Scott attempted to put the state’s Zika cases in context. (McCarthy, 8/25)

Florida Gov. Rick Scott (R) is headed back to D.C. next month amid an escalating battle with the federal government over its lack of response to the spread of the Zika virus in Florida.Scott said Thursday that he will arrive at the Capitol on Sept. 6, the first day lawmakers return from their seven-week summer break. (Ferris, 8/25)

In Little Haiti, Liberty City, and a number of other neighborhoods in Miami, canvassers are now walking door to door to spread the word about the risks of Zika, one household at a time — hoping to reach 25, 000 people the next six weeks. In some neighborhoods, these workers aren't sponsored by federal or state health agencies, but by Planned Parenthood. (Allen, 8/26)

The U.N. health agency says reports from national authorities indicate no confirmed laboratory cases of the Zika virus in anyone associated with the Rio Olympics. The World Health Organization announced the findings Thursday in its weekly situation report on Zika. (8/25)

No one appears to have caught Zika at the Olympics, the World Health Organization said Thursday. WHO and other experts predicted the Olympics would not be a big source of Zika spread to the rest of the world. August is winter in Rio de Janeiro, and the Zika-bearing mosquitoes are less active then. Nonetheless, several athletes withdrew from the games, citing Zika worries. In its latest update on Zika, WHO said so far there had been no cases although cases could still be reported. (Fox, 8/25)

As summer drew near, the nation’s health officials took stock of whether they could handle a surge in demand for Zika diagnostic tests if disease-carrying mosquitoes began to proliferate. A survey of state and local laboratories found enough capacity to perform 3,500 to 5,000 tests a week for the Zika virus. But that wouldn’t be enough to meet demand under the Centers for Disease Control and Prevention’s worst-case scenario for a domestic Zika outbreak. (Evans, 8/25)

More surprises from the world of Zika research this week: The virus can hide in vaginal tissue and the bloodstream of infected infants much longer than anyone expected, with dangerous consequences. In most people, Zika lives in the blood for about seven days and then resolves. It can last a bit longer in urine and saliva, but even that goes away after a couple of weeks, leaving antibody testing of the blood as the only way to determine whether you've had the virus. (LaMotte, 8/25)

The vagina is a welcoming home for Zika. In a new study published today, researchers at Yale University found that Zika reproduced in the vaginas of pregnant mice four to five days after infection and that the virus spread from the vagina to the fetal brain. ... We already know that Zika can spread through sex. The second documented case of sexually transmitted Zika was in Dallas earlier this year. In that case, the virus was spread through sex between two men. Last month, the first case of a woman spreading Zika to a man through sex was reported. (Yasmin, 8/25)

The rate of HPV vaccination among teen boys in the United States surged in 2015, suggesting that more parents and physicians are embracing the message that it's as important for boys to be vaccinated against the human papillomavirus as it is for girls. The Centers for Disease Control and Prevention reported Thursday that 49.8 percent of boys ages 13 to 17 had gotten at least one of the recommended three doses as of 2015, up 8 percentage points from 2014. The rate for teen girls rose more slowly: Almost 63 percent had gotten at least one dose, compared to 60 percent in 2014. (McGinley, 8/25)

New federal data show Rhode Island is having unparalleled success immunizing teenagers with a shot that has been a hard sell elsewhere — the vaccine against HPV, human papillomavirus. Rhode Island health officials sparked a firestorm last year by requiring that students get the HPV vaccine before entering seventh grade. The mandate was in effect for only the last few months of 2015, and applied to children younger than those in the federal study, a survey conducted in 2015 and released Thursday. Still, Rhode Island health officials said they believe the requirement contributed to the surge in adolescent vaccinations — and Massachusetts officials are watching the Ocean State’s experience as they seek to improve their own record. (Freyer, 8/26)

Exposure to gunfire, assaults and other violence may negatively impact the health of children born with HIV, according to a new Harvard University study. Researchers analyzed the medical records of 268 youths ages 8 to 15 and then asked them about their exposure to violence within the previous year. Fifty-three said they had heard gunshots on their block, for example, and 23 said they lived in a neighborhood where there had been a murder. Twenty reported that a neighbor had been hit by a police officer. (Kelly, 8/25)

Opioids cause more than 1,000 emergency room visits and kills 78 people every day. ... Now, to tackle this health crisis, Dr.  (Vivek) Murthy is taking the unprecedented step of mailing letters to the 2.3 million prescribers in America, urging them to to do three things. (8/25)

Surgeon General Vivek Murthy is sending a letter to physicians around the U.S. asking for help in addressing the opioid crisis, the first time his office has done so for a public health crisis. The letter will be sent to 2.3 million health care providers this week, and acknowledges that providers have played a role in the increase of available opioids by prescribing more of the addictive drugs with “good intentions.” Providers were encouraged to treat patients’ pain with opioids, but not educated properly on how to do so safely, and were on the receiving end of heavy marketing campaigns for opioids, he says. (McIntire, 8/25)

The widespread abuse of the potent opioid fentanyl appears to be largely the result of illicit manufacturing of the synthetic drug as opposed to the misuse of legally prescribed versions of the painkiller, according to two US government studies released Thursday. That represents a dramatic change in the way opioids have traditionally been abused, and means public health officials will likely have to adjust their response to the two-decade-long crisis. (Armstrong, 8/25)

Federal data suggest illegally manufactured fentanyl, a drug that is 50 to 100 times stronger than morphine, is behind an increase in synthetic opioid deaths. A report from the Centers for Disease Control and Prevention says that there was a 426 percent increase in seized drug products that tested positive for fentanyl from 2013 to 2014. And separate data show the number of deaths involving synthetic opioids, a class that includes fentanyl and tramadol but not hydrocodone, rose 79 percent during that same period. (Hobson, 8/25)

When paramedics arrived at downtown’s skid row last Friday in response to a 911 call, they found dozens of people who looked as if they’d overdosed. Many were on the ground, passed out.  ... “I’m walking down the street — it looks like a war zone,” said Georgia Berkovich, who works at the Midnight Mission, a block from the intersection. Thirty-eight people were transported to the hospital, many suspected of ingesting the synthetic drug “spice.” (Karlamangla, 8/25)

Across Ohio, someone died from a drug overdose every two hours and 52 minutes on average all year long in 2015. That's 8 people a day.  Drug overdoses killed a record 3,050 people in Ohio last year, more than one-third of them from fentanyl, a super-potent opiate often mixed with heroin. The annual report on unintentional drug overdose deaths released today by the Ohio Department of Health showed the increasing toll from all drugs was 20.5 percent higher than 2014, a disappointment to state officials who have worked for years on many fronts to curb the drug-related carnage. (Johnson, 8/25)

A medical examiner in Ohio has issued a public warning about a dangerous drug that hit the streets this summer. Far more powerful than heroin, it has sent dozens to the hospital -- and dozens more to the morgue. ... Carfentanil is so deadly, it is not even prescribed for humans -- it’s typically used to tranquilize large animals like elephants. The drug is 100 times more potent than the similar drug prescribed for humans, fentanyl, and 10,000 times more potent than morphine. But carfentanil abuse is spreading. Authorities say at least 30 people have died from these overdoses in the Akron, Ohio area since the July 4th weekend. (8/25)

EMS officials said the uptick of K2-related cases started Wednesday. Dozens of people who used the synthetic drug commonly known as K2 or Spice required medical attention in downtown Austin on Wednesday and Thursday as part of what emergency crews described as one of the largest upticks in adverse reactions to the drug they’ve seen. On Thursday, several ambulances staged at several points across the downtown area — including at the Austin Resource Center for the Homeless at Seventh and Red River streets — to respond as quickly as possible to the number of calls they were receiving, said officials with Austin-Travis County Emergency Medical Services. (Hall, Martinez-Cabrera and Wilson, 8/25)

You shouldn't put illegal drugs in your body, and you shouldn't let neighborhood bodies of water ingest them, either. A new study suggests that aquatic life in Baltimore is being exposed to drugs, and it's having an impact. And these aren't soft drugs; they include methamphetamine and amphetamine. They're messing with the growth and development of organisms in local streams. (Christensen, 8/25)

Some arrive on their own, worried about what was really in that bag of heroin. Some are carried in, slumped between two friends. Others are lifted off the sidewalk or asphalt of a nearby alley and rolled in a wheelchair to what’s known as SPOT, or the Supportive Place for Observation and Treatment, at the Boston Health Care for the Homeless Program. Nine reclining chairs have been full most days, especially during peak midday hours. It may be the only room in the country where patients can ride out a heroin or other high under medical supervision. (Bebinger, 8/26)

A task force established to combat a heroin epidemic in the Seattle metropolitan area has endorsed a strategy of establishing places where addicts would be allowed to take drugs without fear of being arrested. At these sites, called safe consumption facilities, addicts would receive clean needles and syringes and would be permitted to inject heroin, smoke crack cocaine and take other addictive drugs under the supervision of trained authorities. (Bromwich, 8/25)

Two proposals meant to ease burdens faced by California’s rural patients and their health care providers are breezing through the state legislature as lawmakers finish up for the year. One measure passed Wednesday requires Medi-Cal to cover patients’ transportation to medical appointments. Another bill would allow small rural hospitals to hire doctors directly, which supporters say could reduce health care costs and make it easier to keep physicians in areas where there are few. (Bartolone, 8/25)

Texas officials are working to understand why more women across the state have been dying either during pregnancy or shortly after. A study published this month has found that maternal mortality rates doubled in Texas between 2011 and 2012 compared to the years before and a new state task force is attempting to understand why the increase occurred. Dr. Daniel Grossman, Professor at Department of Obstetrics, Gynecology and Reproductive Sciences at University of California San Francisco and Investigator at the Texas Policy Evaluation Project, said the findings gave him pause. (Mohney and Mehta, 8/25)

An appeals court Wednesday upheld a ruling that cleared Tampa General Hospital from potential liability in a medical-malpractice case stemming from the death of a patient during surgery. The case focused heavily on Tampa General's relationship with the University of South Florida, which employed two physicians involved in the surgery. Tampa General is the primary teaching hospital for the university's College of Medicine. The estate of Annie Godwin sued Tampa General, the university and physicians Jaime Sanchez and David Shapiro after Godwin died on the operating table during a 2009 surgery to remove a cancerous tumor, said Wednesday's ruling by a panel of the 2nd District Court of Appeal. (8/25)

The chiefs of Nashville General Hospital at Meharry and Meharry Medical College want to improve the health of the city's African American community and on Thursday they formally invited about two dozen ministers and community leaders to join a collaboration that will fuse health and education into pulpits and fellowship halls across Nashville. To tackle an unwieldy amount of poor health outcomes and disparities in education, income and access to care Nashville General CEO Joseph Webb and Meharry President Dr. James Hildreth unveiled the Congregational Health and Education Network in a packed room of faith, education and community leaders on the Meharry campus. (Fletcher, 8/25)

A federal report released last year shows in 2014, for-profit companies managing part of Iowa’s three billion dollar Medicaid program made far fewer faulty payments than the state-run portion of the program. Governor Branstad says that shows fraud and abuse will go down, now that for-profit companies are in charge of most of Iowa’s Medicaid patients. The report issued last November by the Centers for Medicare and Medicaid services covered 2014 when about 10 percent of Iowa’s Medicaid program was run by for-profit companies. (Russell, 8/25)

Some Central Texas parents are complaining about the wording used in a flu vaccine consent form sent home with students this week, saying it tries to shame families who opt out. ... The forms, created by Florida-based Healthy Schools, LLC, were distributed to a number of Central Texas school districts in partnership with the E3 Alliance, a local nonprofit that researches education trends. Filling out and returning the forms was optional, though that was unclear to some families. (Taboada, 8/25)

For Chirlane McCray, New York City’s first lady, mental illness is not an abstract concern. It’s deeply personal. Both of her parents suffered depression, something she describes openly; and, in 2013, McCray’s daughter Chiara went public about her own battle with depression and substance abuse. It’s a pressing health problem for many of her constituents, too. In New York City, about one-in-five people are believed to have depression at any given time. Less than 40 percent get treatment. (Luthra, 8/26)

Orlando Regional Medical Center has treated 44 victims of the shooting — more than any other hospital. The center's parent company, Orlando Health, says it will not charge victims for their treatment, reports Abe Aboraya of member station WMFE. Instead, the hospital will look at federal and state funds, victims' funds like the One Orlando fund, and private funds raised for victims," Aboraya reports for our Newscast unit. "The hospital will bill insurance if a patient has it, but it will not go after a patient's copays." (Domonoske, 8/25)

East Bay Regional Park District has had warning signs up around the park on the San Joaquin River for a few months now as it continues monitoring the water for a naturally occurring toxin. What is commonly known as blue-green algae is actually a type of bacteria that reproduce quickly when the conditions are right -- hot weather, long hours of daylight, calm water. Add nutrients such as phosphorus and nitrogen to the mix and they form dense concentrations of "blooms" that are typically bright green and can produce toxins that pose serious health risks to people and pets alike. (Coetsee, 8/25)

The city's top health official is recommending anyone who has come in contact with raw sewage in their homes during the recent heavy rains to contact their doctor after two cases of infection with the hepatitis A virus have been reported to the city's health department. The Detroit Health Department and Michigan Department of Health and Human Services identified the two cases and said both of the individuals had come in contact with sewage following recent basement backups on the city's east side. (Helms, 8/25)

At least several people with hepatitis A, plus many who have been vaccinated, are in the process of suing Tropical Smoothie Cafe, a food chain that served frozen strawberries from Egypt that caused an outbreak of at least 28 cases of the liver disease in Virginia. Law firms in Seattle, Wash., and Washington, D.C., are in the process of filing multiple lawsuits against Tropical Smoothie Cafe on behalf of customers inflicted with hepatitis A, as well as a class-action lawsuit on behalf of people who got vaccines after consuming frozen strawberries from Tropical Smoothie Cafe. (Shulleeta, 8/25)

New federal data show that 90 percent of Minnesota mothers breastfeed their newborns. That's seventh best among all states. The Centers for Disease Control and Prevention said Minnesota ranks fifth for mothers who are still breastfeeding at six months. ...The Minnesota Department of Health's Linda Dech said the state already has strong laws that support breastfeeding mothers. She says her department is now focusing on getting hospitals to do more to facilitate breastfeeding. (Benson, 8/25)

Per capita prescription drug spending in the United States exceeds that in all other countries, largely driven by brand-name drug prices .... prescription medications now comprise an estimated 17% of overall personal health care services. The most important factor that allows manufacturers to set high drug prices is market exclusivity .... The availability of generic drugs after this exclusivity period is the main means of reducing prices in the United States, but access to them may be delayed by numerous business and legal strategies. The primary counterweight against excessive pricing during market exclusivity is the negotiating power of the payer, which is currently constrained by several factors .... Another key contributor to drug spending is physician prescribing choices when comparable alternatives are available. (Kesselheim, Avorn and Sarpatwari, 8/23)

[Researchers sought to] evaluate the association of receiving primary care in integrated team-based care (TBC) practices vs traditional practice management (TPM) practices ... [among patients] who received primary care at 113 unique Intermountain Healthcare Medical Group primary care practices .... In this observational study, receipt of primary care in TBC practices compared with TPM practices was associated with significantly higher rates of some quality of care measures, reductions in some measures of acute care utilization, and decreased actual payments to the delivery system from all payers and patients. Compared with TPM, TBC also was associated with improved quality of care for patients with depression and diabetes, but with decreased quality for patients with hypertension. (Reiss-Brennan et al., 8/23)

Interventions to address overuse of health care services may help reduce costs and improve care. Understanding physician-level variation and behavior patterns can inform such interventions. ... [Researchers used] retrospective study of patients 66 years and older diagnosed with cancer between 2004 and 2011, using population-based Surveillance, Epidemiology, and End Results (SEER)-Medicare data to assess physician-level variation in 5 nonrecommended services. ... The total proportion of patients receiving each service varied from 14% for imaging in staging early breast cancer to 41% in early prostate cancer. ... Physicians’ utilization of nonrecommended services that tend to be overused exhibit patterns that suggest consistent behavior more than personalized patient care decisions. (Lipitz-Snyderman et al., 8/15)

The Affordable Care Act’s risk adjustment, reinsurance, and risk corridors programs were designed to work together to mitigate the potential effects of adverse selection and risk selection [on insurers]. ... while the programs have similar goals, they are designed to be complementary. Specifically, risk adjustment is designed to mitigate any incentives for plans to attract healthier individuals and compensate those that enroll a disproportionately sick population. Risk corridors were intended to reduce overall financial uncertainty for insurers, though they largely did not fulfill that goal following congressional changes to the program. Reinsurance compensated plans for their high-cost enrollees .... Premium increases are expected to be higher in 2017 in part due to the end of the reinsurance program. (Cox et al., 8/17)

This infographic offers key facts about the Zika virus, tracks the increasing number of countries reporting local transmission over the past year, and breaks down how key U.S. government agencies are responding to Zika. (8/9)

Fewer U.S. nursing home patients with dementia are getting feeding tubes as mounting evidence suggests it may not help them live longer or make them more comfortable, new research suggests. Researchers focused on the sickest dementia patients who tend to have difficulty chewing and swallowing as they near the end of life, a point when they may also struggle to speak, recognize loved ones, get out of bed or go to the bathroom independently. The proportion of these advanced dementia patients who got feeding tubes when they couldn’t eat on their own dropped from 12 percent in 2000 to 6 percent in 2014, according to an analysis of data on 71,000 nursing home residents published in JAMA. (Rapaport, 8/16)

More than 80 percent of U.S. mothers breastfeed their newborns, a new survey finds, but fewer than a third keep doing so for the recommended minimum of one year, a new survey finds. Many studies support breastfeeding for as long as possible, and the American Academy of Pediatrics recommends that babies get nothing but human breast milk until the age of six months — and that they continue to breastfeed for at least a year. (Fox, 8/22)

It’s a dilemma more and more cancer patients will face as genetic testing becomes part of everyday health care: When a DNA test indicates low risk of a tumor spreading, but traditional tests show a high risk, which do you believe? According to a large European study of 6,693 patients published on Wednesday, many women with early breast cancer can safely believe the genetic test. (Begley, 8/24)

While a higher percentage of black children show the symptoms of attention-deficit/hyperactivity disorder (ADHD) than white kids, they are less likely to be diagnosed or treated for the disorder, researchers report. The new study showed a similar trend when it came to Latino children: They were as likely as their white peers to exhibit the signs of ADHD, but less likely to be diagnosed or treated for it. (Bernstein, 8/24)

Soaring drug prices are again drawing the ire of the American public. The problem and any potential solution lies more in the U.S. health-care system rather than in the greed of any particular drug company or executive. (Charley Grant, 8/25)

Mylan, the profiteering, tax-dodging drug company currently taking immense heat for jacking up the price of its Epipen by 500%, announced Thursday that it will help more patients cover their soaring out-of-pocket costs for the allergy drug device. That’s good for some individual patients and families. But at heart it’s a cynical move that actually protects the company’s profits and harms the healthcare system. As I explained last year, that's because such moves are often marketing schemes dressed up to look like altruism. (Michael Hiltzik, 8/25)

Pharmaceutical heavyweight Mylan, the latest poster child for drug-industry greed, finally stuck up for itself Thursday. It argued that “the system,” not avarice, was to blame for the company jacking up the price of EpiPens, a common (and life-saving) allergy remedy, by over 400%. “Look, no one’s more frustrated than me,” Mylan Chief Executive Heather Bresch declared on CNBC. Actually, millions of people — those with chronic medical conditions or other illnesses — are more frustrated than her. (David Lazarus, 8/26)

In the latest in a recent series of controversies over prescription drug prices, Mylan Pharmaceuticals has come under well-deserved fire for jacking up the price of a package of EpiPens — devices that deliver an emergency shot of epinephrine to someone suffering a potentially fatal allergic reaction — 550% since acquiring the right to sell the devices in 2007, from $94 to $608. That may seem modest in comparison to the more than 5,000% increase that Turing Pharmaceuticals quickly imposed on Daraprim, an anti-malarial drug also used by HIV patients, or the more than 3,000% increase that Valeant has extracted for Syprine, a blood-cleaning agent. But given the life-saving nature of EpiPens, their widespread use and Mylan’s effective monopoly, the company’s profiteering is outrageous. (8/26)

But in 2007, Mylan pharmaceutical company won a near-monopoly on the device. The company used its new power to raise the price of EpiPens by more than 400 percent in recent years. Because it could. Now many families will have to make huge sacrifices to scrounge up more than $500 every year. (They expire.) And some children will have to go back to school without this medication because their families can’t afford it. That is unconscionable. (Chirlane McCray, 8/25)

On Thursday, Mylan said it would boost programs that help patients pay for the EpiPen but would not reduce the price. Stay tuned for Capitol Hill hearings and investigations. Mylan, welcome to Shkreli-Land. Among the defenders of Mylan's pricing is ... you guessed it: Martin Shkreli. We don't begrudge Mylan its profits. And no, we can't say if the price of the EpiPens is too high. That's for the market to decide. What we do know is that when Shkreli spiked the price of his company's drug, Daraprim, competitors emerged to offer similar drugs at lower prices. The same could happen here. That's the way the market works. (8/25)

EpiPens offer a lifeline for those of us with life-threatening allergies, making the debate on their soaring price all the more pivotal. EpiPen is the brand name for Mylan’s epinephrine auto-injector, a shot that delivers the exact amount of adrenaline my body needs after an allergy attack. That medicine, stored in what looks like an oversized yellow pen, opens my throat up and gives me time to get to a hospital for further treatment. (Ben Kamisar, 8/25)

Here's one figure to focus on when thinking about Aetna's extortion of the federal government for the Justice Department (DOJ) decision to fight its merger with Humana: $1 billion. That's the amount Aetna will owe Humana if the merger falls through. One billion dollars of health insurance premiums collected from businesses and individuals as part of Aetna's drive to become a bigger near-monopoly and maximize profits. The impact on Americans' access to health be damned. (Richard Kirsch, 8/25)

The hand-wringing over insurer pullouts and premium spikes in the Affordable Care Act exchanges is growing frantic since Aetna announced last week it would exit from the marketplaces in 11 of the 15 states where it currently sells plans. ... Earlier this week, the prominent health economist Henry Aaron of the Brookings Institution offered what he called “simple way” to reduce the risk of more insurers leaping off the exchange ship. “Make the Obamacare exchange one big marketplace for everyone buying individual health insurance coverage,” he wrote in an op-ed piece in the Washington Post. “Nationwide, this would merge the 12 million people who get their insurance through Obamacare with the roughly 9 million who buy their policies outside the exchanges.” It's an approach that insurers almost certainly would fight. But it's something that state leaders around the country might consider because they could do it on their own without waiting for a deadlocked federal government to act. (Harris Meyer, 8/24)

Recently, when attending a medical talk about the connection of unhealthy diets to obesity, heart disease and cancer, I was caught by surprise. “When I want to discuss this issue with patients,” the speaker, a physician, said, “I ask permission.” Permission? I said to myself. Since when do doctors with proven strategies for improving health ask for permission? (Dr. Barron H. Lerner, 8/25)

Dietary risk factors remain the leading cause of death in our country, but neither candidate has talked about food policy. We know about their personal food preferences, but where do the candidates stand on reforming legislation, like the Supplemental Nutrition Assistance Program (SNAP)? We hear about funding and restrictions, but we don’t hear about transforming the system. What foods are in? Which food-like substances are out? What position will the candidates take? Nobody knows. (Dr. Agustina Saenz, 8/25)

The U.S. Constitution is silent about dogging — the practice of following people down a sidewalk like a pesky canine in an effort to communicate with them against their will. But Chicago-area anti-abortion activists insist that the First Amendment's guarantee of freedom of speech implicitly gives them a right to dog, and they filed suit in federal court Tuesday in an attempt to overturn a limit on protest activity outside city health care facilities. ... In a rare misfire, the American Civil Liberties Union, which is otherwise a strong proponent of abortion rights, is supporting the anti-abortion protesters, saying the 8-foot privacy bubble "substantially burdens leafleting" on any issue at all outside of hospitals or clinics. Nonsense. The Constitution is not offended by a prohibition on the thrusting of leaflets into unwilling hands. (Eric Zorn, 8/25)

On June 22, the Governor of Kentucky unveiled a Medicaid reform plan to replace its highly successful Medicaid expansion. The new Kentucky Medicaid plan is not innovative, instead relying on policies that have been shown to be counterproductive, decreasing coverage and access while increasing the health disparities that affect poor and vulnerable populations. (Roy Grant, 8/25)

Kentucky Youth Advocates supports Medicaid expansion in Kentucky because children are more likely to have health insurance when their parents have health insurance, and health insurance is a vital component of access to health care. ... The Bevin administration recently submitted its revised 1115 Medicaid Waiver proposal to the federal Centers for Medicare and Medicaid Services (CMS) for approval. We at Kentucky Youth Advocates appreciate that some of our recommendations were incorporated in the final waiver proposal. ... However, we believe that the 1115 Medicaid Waiver creates several barriers for parents to maintain their health insurance and still have outstanding concerns. (Terry Brooks, 8/25)

In the more than two months since California’s End of Life Option Act took effect, an unknown number of terminally ill patients have signed up for a lethal prescription to take control of their final days. We won’t know exactly how many until the state makes its first annual report next year. Anecdotally, however, about 30 people are known to have requested the lethal prescription since June 9, according to Compassion & Choices, an aid-in-dying advocacy group. But this option may be denied other terminally ill people as soon as Friday, when a legal challenge to the new law comes up for a key court hearing. Riverside County Superior Court Judge Daniel Ottolia is expected to decide whether to put the law on hold until the case is resolved. (8/25)

Currently, a person will have to wait nearly two months before seeing a provider and get prescribed medications — even if they are having a medication issue or are in crisis. The lack of available outpatient services has led to people seeking emergency mental health treatment. If outpatient services were more readily available to those in need and could be accessed easier and with less of a wait then some, not all, hospitalizations could be avoided. (Nicole, Lepley, 8/25)

The opposition to Prop. 61, funded mainly by the drug companies’ lobbying group, has contributed $69.6 million to defeat the measure, according to campaign contributions reported to the secretary of state as of Aug. 5. The proposition’s supporters, which include AARP and the California Nurses Association, have raised about $9.5 million. Supporters say they hope highly publicized cases like EpiPen will spur action. In the nine years since Mylan purchased EpiPen, an epinephrine auto-injector developed in the ’70s and used by millions of Americans, the price spiked more than 400 percent, from $57 per shot to more than $600 for a package of two. But patient groups, including San Francisco’s Project Inform and the Bonnie Addario Lung Cancer Foundation in San Carlos, are concerned Prop. 61 would impede access to needed medications. (Victoria Colliver, 8/25)

The opioid painkiller epidemic, leading directly to use of cheaper and even more dangerous heroin, is all too real in every state of the union, [Robert Valuck, an epidemiologist, professor at the University of Colorado Denver] warned his evening audience on the opening night of the Colorado Health Symposium 2016. Valuck elicited audible gasps from the crowd when he offered a math lesson in modern opioid prescribing—enough scripts are now written in the United States each year to give every adult a Vicodin every four hours for an entire month. In Colorado’s rural southern counties, where overdose death rates are climbing at an alarming rate, the destruction is all the more visible, said Freddie Jacquez, executive director of the San Luis Valley Area Health Education Center. “We know these people,” Jacquez said. “We’re going to a lot of funerals.” (Michael Booth, 8/25)

The Affordable Care Act (ACA) increased access without cost to highly effective contraceptive methods, despite a legal challenge that was adjudicated by the Supreme Court, and it may help reduce unintended and teenage pregnancies. ... It is important for health care professionals and public health workers to educate women about the availability without cost of these highly effective methods. Clinicians should offer the full range of contraceptive services to patients who wish to delay or prevent pregnancy and work with them to select an effective and appropriate method. Reducing unintended pregnancy has taken on an increased urgency as the Zika virus has been linked to birth defects and is anticipated to spread to the continental United States. (Jared Fox and Wanda Barfield, 8/23)

A National Research Council report on “precision medicine” explains that the term “refers to the tailoring of medical treatment to the individual characteristics of each patient.” ... The new tools for tailoring treatment will demand a greater tolerance of uncertainty and greater facility for calculating and interpreting probabilities than we have been used to as physicians and patients. (David J. Hunter, 8/25)