�鶹Ů��

Demand for a drug called Avonex has declined every year for the past 10. Not a problem for its manufacturer. U.S. revenue from the drug has more than doubled in that time, to $2 billion last year. The key: repeated price increases. The multiple sclerosis drug’s maker, Biogen Inc., raised its price an average of 16% a year throughout the decade—21 times in all. (Walker, 10/5)

Colchicine, a gout remedy so old that the ancient Greeks knew about its effects, used to cost about 25 cents per pill in the U.S. Then in 2010 its price suddenly jumped 2,000 percent. That’s just one of the side effects of a U.S. Food and Drug Administration plan to encourage testing of medicines that have been around longer than the modern FDA itself, and so have never gotten formal approval. Companies that do the tests are rewarded with licenses that can temporarily give them monopoly pricing power as most rivals are eased or kicked off the market. The result has been a surge in the cost of drugs used in treatments from anesthesia to heart surgery and eye operations. (Langreth and Koons, 10/6)

UAW President Dennis Williams said in a Monday morning Facebook posting to Fiat Chrysler U.S. union members that he will not shift health care costs to workers from the Detroit Three automakers as he tries to lower costs by creating a pool of covered employees from the companies. (Woodall, 10/5)

Drug companies appear to have lost their fight to include longer-term protection against cheaper copies of some of their products in the historic trade pact reached Monday by the United States and 11 other Pacific Rim nations. While all the details weren’t immediately available, initial reports of a compromise struck between US and foreign negotiators said the sweeping Trans-Pacific Partnership won’t provide the 12 years of commercial protection the US-based biopharma industry had sought. (Weisman, 10/5)

Part of the agreement requires the countries to extend data protection for biologic medicines—drugs produced by living matter—for at least five to eight years. The pharmaceutical industry had hoped for a minimum of 12 years, and some consumer groups had hoped for no minimum exclusivity. ... Biologics currently have 12 years of data exclusivity in the U.S. under federal law, and that's unlikely to change regardless of the trade agreement. The biggest impact will be felt by the partnership's other countries; Australia, Brunei, Vietnam, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru and Singapore. At least five of the partnership countries now don't have any exclusivity for biologics, meaning the agreement would require them to pass laws granting at least five years of exclusivity. (Schencker, 10/5)

The biotechnology industry, whose ranks include Gilead Sciences and Amgen, criticized the deal struck by negotiators for the Trans-Pacific Partnership agreement to let drugmakers keep data secret for at least five years, saying negotiators should have extended protection for 12 years. "BIO strongly believes that 12 years of data exclusivity is a prerequisite to attract the investment required to continue medical innovation and develop new biological cures and therapies," Jim Greenwood, president and chief executive officer of the lobbying group Biotechnology Industry Organization, said in an emailed statement. (Edney and Bloomfield, 10/5)

Trade officials from 12 countries agreed Monday to shrink the length of time that pharmaceutical companies can receive monopoly rights for certain drugs, a provision that is already threatening to incite a Big Pharma rebellion on Capitol Hill. Brand-name companies would receive up to eight years of monopoly rights for drugs known as biologics — a decrease from the current 12 years provided under U.S. law, according to officials involved. The final language of the deal has not yet been released. (Ferris, 10/5)

Before free trade supporters get too exuberant about the outcome of the Trans-Pacific Partnership talks, they might want to listen to the chairman of the Senate Finance Committee. “Closing a deal is an achievement for our nation only if it works for the American people and can pass Congress by meeting the high-standard objectives laid out in bipartisan Trade Promotion Authority. While the details are still emerging, unfortunately I am afraid this deal appears to fall woefully short,” Chairman Orrin G. Hatch said in a statement. (Lesniewski, 10/5)

Five years after the Affordable Care Act became law, debate rages about whether one of its final provisions will do more harm than good. While most of the law's major elements have already taken effect, a final provision — the "Cadillac tax" — looms on the horizon. (Zdechlik, 10/6)

The Obama administration may need the help of congressional Republicans to shore up a risk management program established by the 2010 health care law. The program is already running a $2.5 billion shortfall that may otherwise land on insurers. Sen. Marco Rubio and GOP colleagues, who last December narrowed the administration’s room to maneuver to close the gap in the insurer-funded program, are now seeking to build on that by forcing insurers to adjust prices to reflect costs. (Young, 10/5)

Chronically ill people enrolled in individual health plans sold on the Affordable Care Act insurance exchanges pay on average twice as much out-of-pocket for prescription drugs each year than people covered through their workplace, according to a study published Monday in the Health Affairs journal. Patients with at least one chronic condition such as diabetes or asthma pay on average $621 out–of-pocket for prescription costs on the popular, mid-priced silver exchange plans compared to $304 for those with employer coverage, researchers at Emory University in Atlanta found. (Galewitz, 10/5)

When Jackie McMann-Oliveri started as human-resources director at the Meatball Shop in July 2014, she knew the company had to act quickly to prepare for the requirements of the Affordable Care Act. The six-restaurant chain would shortly be responsible for providing health benefits to even its lowest-wage workers—dishwashers, busers and other kitchen staff. (LaMantia, 10/5)

Gov. Gary Herbert said Monday there may need to be changes made to the latest Medicaid expansion plan he and legislative leaders came up with after months of private meetings. "There are concerns I have about it. There's nothing that's perfect," the governor told the Deseret News. He said, however, that shouldn't prevent action on a plan to provide health care coverage to low-income Utahns. (Riley Roche, 10/5)

Gov. Gary Herbert weighed in on a new plan that would expand Medicaid to Utah’s poor and uninsured. He expressed cautious optimism that something would get done for thousands of Utahns waiting for Medicaid coverage. During an interview at FOX 13 News studio Monday, Herbert summed up his strategy sessions with fellow governors and health care leaders at the National Governor’s Association retreat in Salt Lake City over the weekend. ... The governor said this plan could be a tough sell to House Republicans. (Vaifanua, 10/5)

Colorado's nonprofit health cooperative says its future has been jeopardized by an unexpectedly low payment from a federal program intended to help more people acquire health insurance. The federal Centers for Medicare and Medicaid Services informed health cooperatives nationwide Thursday that a "risk corridor" plan, one of three programs meant to help insurance companies widen their coverage nets, was short of money. (Olinger, 10/5)

Iowa’s dominant health insurer has agreed to start selling policies a year from now that qualify for Obamacare subsidies. Wellmark Blue Cross & Blue Shield has not participated in the Affordable Care Act’s online health insurance marketplace, which launched in the fall of 2013. The main effect of the company’s decision was that moderate-income Iowans could not choose Wellmark insurance if they wanted to purchase policies that qualified for new federal subsidies to help pay premiums. (Leys, 10/5)

Any chance of a quick and bloodless transition to a new slate of GOP leaders ended Monday when outgoing House Speaker John A. Boehner (Ohio) postponed elections for the party’s No. 2 and No. 3 posts for weeks pending the outcome of the speaker’s race — which itself remains in doubt. Closed-door, secret-ballot elections for all three posts — to nominate a speaker ahead of a decisive floor vote of the entire House, and to select a majority leader and party whip — had been set for Thursday amid the widespread presumption that Majority Leader Kevin McCarthy (Calif.) would claim the speaker’s chair. (DeBonis, 10/5)

A top federal official on Monday made a case for preserving the little-known Agency for Healthcare Resources and Quality health agency, which focuses on improving the practice of medicine, and rejecting efforts by House Republican appropriators to terminate the agency in order to gain flexibility in a tight budget year. "Your work is not a nicety, " Mary Wakefield, acting deputy secretary of the Department of Health and Human Services, said at a Monday agency conference attended by many of its staff members. "Your work is a necessity." (Young, 10/5)

Kasich touted his job-growth record in Ohio as well as his efforts to improve mental health services and his decision to expand Medicaid in the state. He also pledged to boost defense spending and gives states more control over Medicaid and welfare programs. Kasich, who’s struggling to stay in the nomination race, said his multifaceted economic approach is “why some people just don’t get me.” (Durkin, 10/5)

The three leading candidates in the Democratic presidential contest each laid out proposals for new gun-control efforts on Monday, injecting fresh energy into the push for restrictions, which have faced heavy resistance from Republicans. ... Mr. Sanders, who has a mixed record on backing gun-control measures, laid out a set of proposals on Monday afternoon that have considerable support among Democrats, including Mrs. Clinton. They include requiring background checks for sales by unlicensed dealers at gun shows, banning assault-style semi-automatic weapons and providing better mental-health care. (Meckler, 10/5)

As evidence of dysfunction in Washington, she pointed to Republican efforts to end the president's health care law, which would jeopardize Medicaid expansion, and the fact that people can't refinance their student loans. (10/5)

In a rare personal message, California’s 77-year-old governor provided insight into his deliberations before deciding to sign a bill allowing terminally ill Californians to legally take their own lives, reflecting on religion and self-determination as he weighed an emotionally fraught choice. Gov. Jerry Brown, a lifelong Catholic and former Jesuit seminarian, said he consulted a Catholic bishop, two of his own doctors and friends “who take varied, contradictory and nuanced positions.” (Williams, 10/5)

The California law will permit physicians to provide lethal prescriptions to mentally competent adults who have been diagnosed with a terminal illness and face the expectation that they will die within six months. The law will take effect 90 days after the Legislature adjourns its special session on healthcare, which may not be until next year — January at the earliest, November at the latest. (McGreevy, 10/5)

Brown’s signature concludes a hotly contested debate that elicited impassioned testimony from lawmakers, cancer patients who fear deaths marked by uncontrollable pain and suffering and religious and disability advocates who fear coercion and abuse. (Dembosky and Gorman, 10/5)

One of the measure’s most prominent opponents has been Los Angeles Archbishop José Gomez. When the bill passed the legislature last month, Mr. Gomez said the legislation would put pressure on the state’s poorest communities. (Lazo, 10/5)

Brown's signature concludes a 23-year effort to pass a "right-to-die" law in a state of 39 million, more than quadrupling Americans' access to life-ending drugs, with one in eight people living in states where it is now legal. (10/5)

Advocates, including some terminally ill people, framed the bill as a matter of compassion in hours of emotional testimony at the Capitol. Opponents said they feared legalizing assisted death would exert pressure on frail and elderly people to end their lives to avoid burdening others. (Siders and Koseff, 10/5)

The California bill was inspired by Brittany Maynard, the 29-year-old San Francisco Bay Area resident who gained national attention for her decision to move to Oregon to take advantage of the state's longstanding aid-in-dying law. Maynard had been diagnosed with terminal brain cancer, but as a California resident, could not pursue end-of-life options at home. (Reilly, 10/5)

Connecticut’s Department of Insurance is playing a major role in a deal that could create the nation’s largest health insurer, leading a 26-state review of Anthem Inc.’s proposed merger with Bloomfield-based Cigna. (Haigh, 10/3)

Hartford HealthCare and the parent company of Day Kimball Hospital say they have suspended plans to consider an affiliation because of “severe and unexpected” cuts in Medicaid payments, a reference to $192 million in funding reductions Gov. Dannel P. Malloy made to hospitals last month. (Levin Becker, 10/5)

Hartford HealthCare has broken off merger talks with Day Kimball Healthcare, blaming Gov. Dannel P. Malloy's plan to cut Medicaid reimbursement payments. The groups had announced in July they were exploring an affiliation. The merger would have had the 122-bed Day Kimball Hospital in Putnam join the network that includes Hartford, Backus and Windham hospitals, MidState Medical Center and The Hospital of Central Connecticut. (10/5)

Three New Hampshire health systems are partnering with an insurer to create a new company that will analyze clinical, financial and operational data to improve the quality and efficiency of patient care. Benevera Health brings together Dartmouth-Hitchcock, Elliot Health System, Frisbie Memorial Hospital and Harvard Pilgrim Health Care. The project builds on ElevateHealth, a limited insurance product and network they created in 2013. Like the earlier venture, the new project is focused on care coordination — helping patients navigate the health care system more efficiently — in hopes of both improving outcomes and lowering costs. Health advocates will connect with patients before and after appointments, serving as a link to providers, and the partners will share data so best practices can be spread to other providers. The data analysis also will allow providers to identify patients who might need extra care before their conditions become a crisis. (Ramer, 10/5)

Contentious labor negotiations are underway — again — between nurses and administrators at Brigham and Women’s Hospital. (Bailey, 10/5)

For Flint-based insurance company HealthPlus of Michigan, its proposed merger into the much larger Health Alliance Plan (HAP) represents a shotgun marriage of financial necessity. HealthPlus has been hemorrhaging money for the past two years and was placed under state financial supervision this winter because reserves dipped below the required threshold. The insurer reported losing $23.5 million in 2014 on $502 million in revenue, following an $11.1-million loss the prior year, according to state regulatory filings. Its deficit stood at $4.8 million. (Reindl, 10/5)

Dartmouth-Hitchcock, Elliot Health System and Frisbie Memorial Hospital will jointly own a new company with Harvard Pilgrim Health Care that will share clinical information and financial risk for 80,000 New Hampshire residents. The joint venture, called Benevera Health, will bring together financial and clinical data to give the partner providers access to analytics that can help them manage care for all of the New Hampshire members in Harvard Pilgrim's fully insured plans. (Sandler, 10/5)

Since January 2013 more rural hospitals have closed than in the previous decade combined, according to the National Rural Health Association. Factors contributing to these closures are many and varied. Some pertain to demographics: Rural populations are, generally speaking, dwindling and aging, and the younger people who stay around are more apt to opt to drive to urban hospitals. (Sisk, 10/6)

Arkansas has been granted a three-month extension, until Dec. 31, to finish checking the incomes of 600,000 Medicaid recipients who have been enrolled for at least a year, the director of the state Department of Human Services said Monday. Human Services Director John Selig told the Legislature's public health committees that the state also is exploring changes, including using additional data sources, to speed up the processing of applications and annual income verifications. (Davis, 10/5)

Arkansas has asked the federal government for permission to change the state’s procedures for checking Medicaid eligibility in the interest of greater efficiency and accuracy, Department of Human Services Director John Selig said Monday. Selig also said the federal government has allowed an extension of the state’s deadline for re-verifying the eligibility of about 600,000 Arkansans enrolled in Medicaid programs, including the private option. Originally set at Oct. 1, the deadline has been moved to Dec. 31. (Lyon, 10/5)

When one of the millions of people enrolled in California’s low-income health program has a complaint or needs help, there’s a number they can call. But for more than a year, that phone line was unreliable — tens of thousands of calls went unanswered. (Guzik, 10/5)

Three losing bidders have filed a protest over the state’s selection of vendors for a multibillion-dollar Medicaid and PeachCare contract. Last month, four companies – Amerigroup, Peach State, WellCare and CareSource — were picked as winners of the contract to serve lower-income adults and children in Georgia. (Miller, 10/5)

Iowa can forge ahead with a quick-moving plan to privatize management of its annual $4.2 billion Medicaid program despite ongoing allegations that nepotism, fraud and inaccuracies played into the state’s selection of for-profit companies to take over the system, a Polk County judge ruled late Friday. Aetna Better Health of Iowa filed a petition last month seeking a court injunction to prohibit the state from signing contracts on Oct. 9 with four companies in line to take over Medicaid management. Aetna wanted to postpone the signings until after questions about the bidding process are resolved. (Clayworth, 10/5)

Wait times to get an abortion in Texas have grown in some metropolitan areas, a trend that could be felt statewide if the U.S. Supreme Court allows the strictest provision of the state’s 2013 abortion law to take effect. That's according to a new report by the Texas Policy Evaluation Project at the University of Texas at Austin. About half of Texas abortion clinics have closed their doors following the passage of House Bill 2, elements of which have been tangled up in court since lawmakers approved it. (Ura, 10/5)

The U.S. Supreme Court is back in session, and its upcoming term will feature at least two cases that have percolated up from Texas — on voting rights and affirmative action — and possibly a third if the justices end up hearing arguments over House Bill 2, the state's 2013 abortion law. (Rudner, 10/6)

Texas attorney general Ken Paxton on Monday asked the U.S. Supreme Court to turn away a legal challenge to the state's abortion restrictions filed by a coalition of abortion providers. The abortion providers appealed to the high court almost a month ago, and justices have not yet decided whether to hear the case. (Ura, 10/5)

Arkansas has filed its notice to appeal a decision from a federal judge that blocked the state from suspending Medicaid funding for three women who sued over the state’s cancellation of its contract with Planned Parenthood. (10/5)

Arkansas is fighting a federal judge’s decision that the state cannot defund Planned Parenthood by canceling its Medicaid contracts. The solicitor general of Arkansas announced Monday that he would appeal the judge’s ruling, which was handed down on Friday. The move escalates an ongoing national legal battle over allegations that Planned Parenthood has mishandled aborted fetal tissue. (Ferris, 10/5)

The Planned Parenthood clinic in Thousand Oaks reopened Monday after an arsonist set fire to the building last week. The West Hillcrest Drive facility had been closed since Wednesday, when an arsonist threw a stone into a window, then splashed gasoline inside and ignited it. The small fire was doused by the building's sprinkler system. (Rocha, 10/5)

Supporters of a controversial anti-abortion bill that has languished in the Ohio Senate for the better part of a year have started posting videos online that target individual senators they view as hypocrites. Their complaint: Republican lawmakers who say they are against abortion won't advance a bill that would ban abortion once a heartbeat has been detected in the fetus. (Higgs, 10/5)

[T]he largely symbolic [Planned Parenthood] fight betrays a pretty significant truth about the larger abortion debate. And that is this: Republicans have been winning this battle big-time at the state level...From 2011 to 2013, Republican-led state legislatures enacted more restrictions on abortion than in the entire previous decade. (Phillips, 10/5)

The U.S. Supreme Court will not hear a challenge to New York state's requirement that all children be vaccinated before they can attend public school, upholding an appeals court ruling that said the policy does not violate students' constitutional right of religious freedom. (10/5)

The District would become the most generous place in the country for a worker to take time off after giving birth or to care for a dying parent under a measure supported by a majority of the D.C. Council. (Davis, 10/5)

New York's attorney general and the federal Employee Benefits Security Administration have agreed to share information and address violations of laws covering health insurance offered as worker benefits. They say the five-year memorandum enables them to conduct joint investigations and assist each other with enforcement, whether those covered are members of plans offered by insurance companies or self-insured plans created by private employers. (10/5)

In a debate at Christopher Newport University, Senate Majority Leader Thomas K. Norment Jr. (R-James City County) and Senate Minority Leader Richard L. Saslaw (D-Fairfax) — who have a combined nearly 60 years of service in the Senate — spent more than an hour sparring over issues such as Medicaid expansion, gun control and climate change that have sharply divided the two parties during the first 20 months of Gov. Terry McAuliffe’s administration. (Portnoy, 10/5)

It wasn’t his first broken condom, so Rafael didn’t worry. But three weeks later, the man he’d met in a bar called to say that he had “probably been exposed” to H.I.V. Rafael, a muscular, affable 43-year-old, went to a clinic and within 45 minutes learned he was infected. Although it was already closing time, a counselor saw him immediately and offered him a doctor’s appointment the next day. (McNeil Jr., 10/5)

Two Baltimore institutions will share in $11 million in funding from the U.S. Centers for Disease Control and Prevention aimed at preventing the spread of germs — a deadly and costly problem in hospitals and other health care settings. The University of Maryland School of Medicine and Johns Hopkins Medicine have long been involved in developing technology and protocols to control infections in patients and health care workers. Each will get just over $2 million over three years. Four other facilities will split the remainder. (Cohn, 10/5)

Hospitals aren't typically associated with fine dining. And even though hospitals are in the business of health care, the beverages and foods they offer — especially when the cafeteria is closed — often lean more toward junk food than healthy fare. But a group of Kansas hospitals is out to change that. The initiative is called Healthy Kansas Hospitals. The three-year effort, which runs through June 2016, is sponsored by the Kansas Hospital Education and Research Foundation, a branch of the Kansas Hospital Association. Harold Courtois, administrator of Russell Regional Hospital in central Kansas, is enthusiastic about the program. (Thompson, 10/5)

The Illinois Department of Public Health will no longer provide testing of sexually transmitted infections for dozens of county health departments and other facilities, saying resources must be shifted to more complicated testing to identify disease outbreaks and biological threats. The service was discontinued Monday, though providers were first notified of the change in an August letter citing "decreased financial and human resources." Agency spokeswoman Melaney Arnold said the decision was permanent and was not related to the budget impasse that has prevented some programs from receiving funding. (Garcia, 10/5)

As living proof that stem cell therapy can repair damaged heart muscle, Noel Zuniga leapt onto a treadmill for a brisk run and followed with a set of weighted push ups inside the cardiac rehabilitation room at University of Miami Hospital Friday. Two years ago, he barely survived what cardiologists call a “widow maker” heart attack, a complete blockage of a major coronary artery. Few expected Zuniga to recover this well without a heart transplant. But last year, when he could hardly run and felt fatigued just walking in the mall with his wife, Zuniga enrolled in a clinical study at the University of Miami Health System’s Interdisciplinary Stem Cell Institute. UHealth doctors had saved his life in 2013 — shipping off at a moment’s notice to Panama to implant a special catheter with a pump into his heart, staving off massive organ failure after the heart attack. Now they held out the hope of helping Zuniga’s heart recover much of the function it had lost. (Chang, 10/5)

It is fitting that Gov. Jerry Brown wrote a thoughtful and unusually personal message when he signed the historic piece of legislation known officially as ABx2 15. This is the so-called right to die bill, which allows doctors, under tightly defined circumstances, to write lethal prescriptions for patients who have been diagnosed with less than six months to live. Brown, a former seminarian, wrote about the many people he had consulted, including a Catholic bishop, and the many pleas he had read on both sides. "In the end," he wrote, "I was left to reflect on what I would want in the face of my own death. I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn't deny that right to others." (10/5)

A lot of the news coverage last week, after Hillary Rodham Clinton announced she’d like to see the [Cadillac] tax repealed, focused on the fact that repealing the tax could cause the federal government to lose $87 billion in revenue over the first eight years it’s in effect. Mrs. Clinton has said any repeal should be offset with other measures to close that gap. But the revenue effects of the Cadillac tax are minor compared with the tax’s much larger effects on health care spending. It would be harder for Mrs. Clinton to replicate those cost-control benefits than to replicate the revenues. (Josh Barro, 10/5)

While the severely mentally ill commit only a tiny fraction of violent crimes, an FBI study from last year found that mental illness is frequently a factor in shootings with the highest number of fatalities. And all too often, the laws on the books fail to bar these individuals from purchasing weapons used to carry out their deadly acts. An outsized number of these high-casualty shootings have occurred in states like Ohio, Colorado, Connecticut and Virginia, where more lenient gun laws make it easier for the mentally ill to obtain firearms. (James Dudley, 10/5)

In the food fight over school lunches, let’s stipulate a few facts. One of every three children in the United States is overweight or obese. About 27% of young Americans are too overweight to join the military. Children who are obese are at higher risk for serious diseases — from high blood pressure and joint problems now to heart disease, diabetes and cancer later in life. hose facts alone are enough to prove that taxpayers have a vested interest in providing nutritious school lunches. (10/5)

Federal nutrition standards for meals in schools have brought many positive changes to cafeterias, but Congress must address unintended consequences that weaken school meal programs and efforts to better serve students. Congress should protect caps on calories and unhealthy fats, reasonable salt and whole grain requirements, and mandates to offer a greater quantity and variety of fruits and vegetables. ... But some rules have backfired. (Jean Ronnei, 10/5)

Four years of nation-wide testing by The Centers for Medicare and Medicaid Services (CMS) has now proven that the current shared savings payment models do not work effectively for low-cost Accountable Care Organizations (ACOs). High-cost ACOs have more room to improve and therefore more opportunity for savings. For those organizations that have already developed efficient, low-cost care delivery systems, Shared Savings is retrogressive. ... we studied the issues and are proposing a global risk-adjusted payment system. (David Krueger and John Toussaint, 10/5)