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The White House stepped up its push on Tuesday to revive legislation to repeal the Affordable Care Act by placating the most conservative House members, but the effort risked alienating more moderate Republicans whose votes President Trump needs just as much. Vice President Mike Pence met for about two hours on Tuesday night with lawmakers, including leaders of three groups of House Republicans. But lawmakers leaving the conclave in the basement of the Capitol said that no deal had been reached and that talks would continue on Wednesday. (Pear and Kaplan, 4/4)

The lack of a resolution complicates a White House push for a House vote on a healthcare proposal before Friday, when lawmakers return to their districts for two weeks. “Good talk, good progress,” Pence told reporters without providing details. Freedom Caucus leader Mark Meadows said the meeting had focused on an amendment to create a "backstop" to ensure individuals with chronic illnesses in high-risk pools do not see spikes in insurance premium costs if other aspects of Obamacare, also known as the 2010 Affordable Care Act, are repealed. (Morgan and Abutaleb, 4/5)

The crux of the new proposal would be to allow states to seek exemptions from certain mandates established under the Affordable Care Act — including a requirement that insurers cover 10 “essential health benefits” as well as a prohibition on charging those with preexisting medical conditions more than the healthy. While the largely behind-the-scenes effort generated optimistic talk, no clear path has emerged toward House passage of the Republican bill. On Tuesday evening, key players said they were still waiting to see new proposals in writing, and some lawmakers said they were wary of rushing the process. (DeBonis and Wagner, 4/4)

Conservatives’ latest Obamacare repeal proposal amounts to a sneak attack on one of the health care law’s most popular safeguards for people with pre-existing conditions. White House officials and members of the House Freedom Caucus are discussing giving states the option of a waiver from a key Obamacare protection — called community rating — as part of their last-ditch effort to revive the repeal effort. (Haberkorn, 4/4)

Pence told hard-line Freedom Caucus members Monday night that changes to the bill would allow governors to opt out of Obamacare’s “community rating” provision, which prohibits insurers from charging higher premiums to people who are sick, are older or based on their gender. Without it, insurers could charge more to people with cancer or other medical conditions, though supporters say it would drive down premiums for healthy people. Meadows said they were told governors would be allowed to opt out for “all community ratings with the exception of gender. ”But moderate GOP members who met with Pence the same day say they were under the impression that governors would only receive “community rating” flexibility based on a person’s age — not their illness or other factors. (Bade and Dawsey, 4/5)

But the attempt to move the bill further to the right threatens to erode support among moderate members who were turned off by the previous version of the American Health Care Act. “While we haven’t picked up any votes yet, this concept is already showing signs of losing a ton of them,” a senior Republican source said. (Sullivan and Hellmann, 4/4)

At the White House, Pence said he and President Donald Trump "remain confident that working with the Congress we will repeal and replace Obamacare. "But there was no evidence that the proposal won over any GOP opponents who'd forced Trump and party leaders to beat an unceremonious retreat on their bill on March 24, when they canceled a House vote that was doomed to failure. (Fram, 4/4)

[C]hances remain slim that Republican leaders can build consensus among the GOP factions — the conservative House Freedom Caucus and more centrist Tuesday Group — that doomed the last effort. House Speaker Paul D. Ryan (R-Wis.) lowered expectations that a deal could be struck soon. “Look, the president would like to see this done,” White House Press Secretary Sean Spicer told reporters during an off-camera briefing Tuesday. “I'm not going to raise expectations,” Spicer said. “But I think that there are more and more people coming to the table with more and more ideas about [how] to grow that vote.” (Mascaro and Bierman, 4/4)

House Speaker Paul D. Ryan on Tuesday cast doubt on the possibility that the chamber would vote this week on a revised bill to repeal and replace the 2010 health law. While the Wisconsin Republican noted there are ongoing conversations among lawmakers regarding potential changes to the legislation (HR 1628), he cautioned that those discussions were still in the conceptual stage. “We don’t have bill text or an agreement yet, but these are the kinds of conversations we want,” Ryan told reporters following a closed-door House GOP conference meeting. “That is not to say that we are ready to go because we want to make sure that when we go we have the votes to pass this bill.” (Williams, 4/4)

When asked if there will be a health vote by the end of the week, Ryan said he didn’t know. “I don’t want to put some kind of artificial deadline because we’re at that conceptual stage,” Ryan said. “We have very productive conversations occurring with our members. But those are productive conversations; it doesn’t mean we have language and text that’s ready to go and the votes are lined up.” (Wong, 4/4)

Even if members of the Freedom Caucus were to reach an agreement with the administration, GOP leaders would still need to shore up support among more centrist House Republicans who have objected to some of the changes sought by conservatives. “That would not move me to the ‘yes’ column,” said Rep. Leonard Lance (R., N.J.), who said he favored retaining the requirement that most insurers offer specific health benefits such as maternity care or hospitalization. (Peterson and Andrews, 4/5)

Jim Renacci, a Republican member of the Ways and Means Committee, had supported the previous version of the measure, which was pulled from a floor vote, despite some reservations about its contents. Now he says he’s withholding support until he sees the outlines of the most recent changes, which were presented to some members Monday night by Vice President Mike Pence. “I’m a big believer in the process, I’m a big believer in hearings, I’m a big believer in having the authorizing committees to have the opportunities, as well as members from outside, to hear what’s going on, and that process will actually bring a better resolution,” Renacci said. “We have actually broken that process, with no hearings.” (Edgerton and House, 4/4)

White House officials privately said they don't expect a deal anytime soon on health care. That’s despite direct entreaties from some of the White House’s heaviest hitters — Vice President Mike Pence, chief of staff Reince Priebus and budget director Mick Mulvaney — who are darting between the Capitol and the West Wing to meet with conservatives and centrists to test the chances for reviving the so-called American Health Care Act. (Cheney, Bade and Dawsey, 4/4)

Republicans have little space on the calendar to hold a new vote this month. They are scheduled to begin a two-week recess on Friday, and when they return they will have five days to pass a spending measure to keep the government funded after April 28. (Edgerton, John, House and Sink, 4/4)

The same firebrand conservatives who helped derail the GOP's long-awaited legislation to repeal and replace key parts of the Affordable Care Act are now trying to breathe new life into the bill with a long shot effort to bring it back for a vote in May. Or at least keep it on life support through the two-week April recess when they'll otherwise have to explain the bill's derailment back home. "We're on the eve of going home and spending two weeks with our constituents ... and they know they're going to get questions about this," said Rep. Steve Womack, R-Ark. "And for the people who were 'no' they'll have justification to deal with." (Davis, 4/4)

Powerful health industry groups shut out of the first failed GOP Obamacare repeal effort say the second version will collapse even faster. (Cancryn and Demko, 4/4)

Shares of U.S. hospital operators dropped on Tuesday as Republicans sought to revive plans to dismantle the Affordable Care Act that has benefited the companies. Shares of HCA Holdings, the largest publicly traded hospital operator, fell 3.2 percent, while Tenet Healthcare was off 4.8 percent and Community Health Systems dropped 6.3 percent. (Krauskopf, 4/4)

“We had no votes from the Democrats. They weren’t going to give us a single vote, so it’s a very difficult thing to do,” lamented President Donald Trump to reporters about 90 minutes after House Speaker Paul D. Ryan canceled the floor vote on the Republicans’ health care bill on March 24. But if Trump wanted Democrats, why didn’t he approach those who’d opposed President Barack Obama’s signature health care law in 2010? (Curry, 4/5)

Now that the GOP effort to repeal and replace the Affordable Care Act is in limbo, is there a way to make it work better? Democrats and Republicans don’t agree on much when it comes to the controversial federal health law, but some party leaders from each side of the aisle agree it needs repairs. (Rovner, 4/4)

Most young Americans want any health care overhaul under President Donald Trump to look a lot like the Affordable Care Act signed into law by his predecessor, President Barack Obama. But there's one big exception: A majority of young Americans dislike "Obamacare's" requirement that all Americans buy insurance or pay a fine. (Kellman and Swanson, 4/5)

More than half of Americans approve of the Affordable Care Act (ACA), according to a Gallup poll out Tuesday, marking the first time the law has gained majority support since Gallup began tracking public opinion on it in 2012. Fifty-five percent of Americans say that former President Barack Obama's signature healthcare reform law should remain in place, though 40 percent say it needs significant changes. Still, the new rate is up significantly from November, when only 42 percent said they approved of the law.  (Greenwood, 4/4)

A vast majority of Americans want the Trump administration to try to find a way to save ObamaCare, according to a new poll released Tuesday. The Kaiser Health Tracking Poll found that 75 percent respondents said the current administration "should do what they can" to make the healthcare law functional. Only 19 percent of responders said President Trump should do what it can to make the law fail. (Vladimirov, 4/4)

Ownership of the Affordable Care Act has officially been transferred from President Barack Obama and Democrats in Congress to President Donald Trump and congressional Republicans, according to a new poll. In the monthly tracking poll from the Kaiser Family Foundation, 61 percent of respondents said any problems with the law moving forward are the responsibility of Trump and Republicans in Congress, while only 31 percent said future problems are the fault of the Democrats who passed it. (Rovner, 4/4)

Is Georgia’s health insurance exchange heading for another big insurer pullout? A research report last week indicated that the parent company of Blue Cross and Blue Shield of Georgia may be moving toward withdrawing from a large percentage of exchange markets nationally. (Miller, 4/4)

Iowa’s insurance commissioner is urging customers with individual health insurance policies to stay calm after Wellmark Blue Cross and Blue Shield decided to stop selling individual plans. Insurance Commissioner Doug Ommen said he is disappointed with Wellmark's decision. It affects more than 21,000 Iowans who bought individual Obamacare-compliant plans from Wellmark after the start of 2014. Those customers will have to find a new insurance plan for 2018. (Sostaric, 4/4)

The [GOP] bill’s failure left Obamacare intact while Republicans regroup on how to address rising insurance costs and other weaknesses with health care delivery. The issues are particularly acute in Alaska, the fourth most expensive state in the U.S., where a standard knee replacement might cost five times what it does in Seattle and pricey air ambulance rides are common in emergencies. Individual health insurance premiums here climbed almost 40 percent annually after the ACA went into effect, and high health care costs drove all but one provider, Premera Blue Cross Blue Shield, out of the market in 2017. (Aleccia, 4/5)

The failed veto override also crushed hospital executives and community clinic directors who had hoped against hope for a Medicaid expansion, which would have brought in a flood of federal dollars to help pay for the care they now often deliver for free. The expansion would have covered an estimated 150,000 Kansans. ...When he vetoed expansion [of] the Medicaid expansion late last month, Governor Sam Brownback said the proposal was riddled with flaws: “I am vetoing this expansion of Obamacare because it fails to serve the truly vulnerable before the able-bodied, lacks work requirements to help able-bodied Kansans escape poverty, and burdens the state budget with unrestrainable entitlement costs.” (Martin, 4/4)

Democratic legislators and left-leaning health care advocacy groups again called Tuesday for the General Assembly to move forward with Medicaid expansion. Sen. Floyd McKissick, D-Durham, Sen. Erica Smith-Ingram, D-Northampton, and Health Action North Carolina, an organization comprised of grassroots and health care-related advocacy groups, said the legislature should move forward with Medicaid expansion in the wake of Congress' recent failure to repeal the Affordable Care Act. (Nunn, 4/4)

Most people know that smokers rack up higher healthcare costs than non-smokers do. But the Richard M. Fairbanks Foundation wanted to know just how much more smokers on Medicaid cost the state of Indiana. The answer? More than half a billion dollars. (Rudavsky, 4/5)

Dr. Scott Gottlieb has been preparing for this job his whole life. He’s a physician and a conservative policy wonk. He’s been a federal regulator scrutinizing new drugs. He’s a writer. An investor. And a consultant: He’s made a lot of money advising biopharma executives on how to get through the bureaucratic thickets of the Food and Drug Administration. (Kaplan, 4/5)

Dr. Scott Gottlieb makes no apologies for his work with the pharma industry. He’s proud to say he’s helped launch a bevy of biotech startups. And he believes that his experience financing and advising drug companies can help him be a smarter, savvier commissioner of the Food and Drug Administration. He’ll get a chance to make that case on Wednesday at his confirmation hearing. (Kaplan, 4/5)

Sen. Chris Murphy will introduce Scott Gottlieb, a Westport resident and candidate to head the Food and Drug Administration, to fellow members of the Senate panel that’s key to his confirmation – but that won’t keep the nominee from having a bit of a rough ride among Democrats. (Radelat, 4/4)

Two Democratic senators announced Tuesday that they oppose President Donald Trump’s nominee to run the Food and Drug Administration, saying that he is too close financially to the pharmaceutical industry and unlikely to strengthen regulation of the opioid painkiller industry. Sens. Edward J. Markey (D., Mass.) and Sherrod Brown (D., Ohio) are the first senators known to have publicly opposed the nominee, Dr. Scott Gottlieb. (Burton, 4/4)

In less than three months in office, President Trump has made abundantly clear he will not approach health and medicine the same way his predecessor did. He is proposing dramatic funding cuts to the National Institutes of Health. He has already tried — and so far failed — to repeal much of the Affordable Care Act, Barack Obama’s signature legislation. The early signals of how he’ll handle the opioid crisis have recovery advocates on edge. ... Three months ago, STAT looked at five key areas and assessed whether Trump was likely to diverge from Obama — or not. Now we’re revisiting those issues, focusing on the new president’s record so far. (Scott, 4/4)

Dr. Robert Califf, the former commissioner of the Food and Drug Administration, on Tuesday called President Trump’s budget blueprint “ridiculous” and implored the scientific community to “speak out against it.” Califf made the remarks while moderating a panel at a meeting on how clinical trial data should be shared within and beyond the research community. The two-day meeting was hosted by the New England Journal of Medicine, one of the top peer-reviewed medical journals. (Swetlitz, 4/4)

As delivery system reform experts puzzle over what makes accountable care organizations successful, they might want to pay more attention to the physicians in those organizations, suggests a study published Monday in Health Affairs. The study found significant physician churn from year to year, as well as an uneven distribution of patients among physicians in one Medicare Pioneer ACO. The results raised questions about the structure of ACOs—a payment model touted by many and supported by the CMS—and their ability to achieve the goals of lowering costs while improving quality. (Whitman, 4/4)

A settlement with a digital advertising company bars the firm from using a technology called geofencing to direct anti-abortion messages toward women entering reproductive health facilities in Massachusetts, the state attorney general said Tuesday. The agreement was reached after Attorney General Maura Healey investigated whether Copley Advertising or John Flynn, a Brookline man identified as the firm’s manager and sole employee, was violating the state’s consumer protection laws. Copley denied any wrongdoing. (Salsberg, 4/4)

Republican strategist Ed Gillespie opposes abortion except in cases of rape, incest and when the mother’s life is at risk. That was his position in 2014, when he nearly unseated Sen. Mark R. Warner (D). And that’s his stance now, as he seeks the governor’s mansion. But abortion rights groups contend that Gillespie is taking a harder line because he recently said he would like to see abortion “banned.” (Vozzella, 4/4)

But in the throes of an opioid epidemic that killed more than 33,000 people in 2015 alone, the nation’s supply of residential treatment slots falls far short of the number needed to serve everyone who walks in, gets dropped off by police, or is transferred from a hospital or crisis center. Waitlists persist almost everywhere, primarily because of a growing number of people addicted to heroin and prescription painkillers. To boost the number of beds available for low-income residents, the federal government has granted California, Maryland, Massachusetts and New York a waiver of an obscure Medicaid rule that prohibits the use of federal dollars for addiction treatment provided in facilities with more than 16 beds. (Vestal, 4/5)

House lawmakers have unanimously approved legislation aimed at ensuring that people struggling with drug addiction get the help they need. Supporters of the bill say denial of insurance coverage for substance abuse treatment is a major source of failed treatment efforts by people seeking help, and also a cause of the shortage of adequate treatment facilities in Delaware. (Chase, 4/4)

Requiring doctors to register with state database programs that track patients' opioid prescriptions reduced the amount of addictive painkillers Medicaid patients receive — and saved money, according to a new study. Simply mandating that physicians register with the state databases led to a nearly 10 percent reduction in prescriptions for the most potent painkillers, the researchers reported in the April issue of Health Affairs, using data collected from 2011 to 2014. (Sapatkin, 4/4)

Declaring drug addiction “a common enemy,” Ohio Gov. John Kasich announced in his State of the State address Tuesday night that he is requesting up to $20 million in funding to help develop promising treatments and technologies to tackle the state’s opioid crisis. (Ludlow and Siegel, 4/5)

One in 10 pregnant women in the continental United States with a confirmed Zika infection had a baby with brain damage or other serious birth defects, according to the most comprehensive report to date on American pregnancies during the Zika crisis. (Belluck, 4/4)

Women infected during the first trimester of pregnancy had an even higher risk of birth defects, about 15 percent, according to the analysis by the Centers for Disease Control and Prevention. These estimates are higher than what U.S. health officials have previously reported and underscore the serious risk for birth defects posed by Zika virus infection during pregnancy. With warm weather, a new mosquito season and summer travel approaching, prevention is crucial to protecting the health of mothers and babies, said Anne Schuchat, the CDC's acting director. (Sun, 4/4)

"Although Zika may seem like last year's problem, or an issue confined to Brazil, there have been more than 1,600 cases in pregnant women reported here in the U.S.," says the acting director of the Centers for Disease Control and Prevention, Dr. Anne Schuchat. (Doucleff, 4/4)

About 5 percent of infants born to women who were exposed to the Zika virus while pregnant in 2016 had birth defects, the Centers for Disease Control and Prevention said Tuesday. The study of U.S. pregnancies affected by the virus is the largest of its kind in the short time that Zika has been a priority for national researchers. The CDC hopes it will send a message about the risks posed to pregnant women who travel to areas with active Zika transmission. (Siddons, 4/4)

Stephanie Milbhauer is four and a half months pregnant with her third child and is seriously considering “temporarily relocating” to her family home in Ohio as the rainy season approaches and the Zika virus is expected to resurface. (Teproff, 4/4)

Saying she was alarmed by a new superbug outbreak, a U.S. senator on Tuesday asked Olympus for data showing its redesigned medical scope was safe. In a letter, Sen. Patty Murray (D-Wash.) asked the Japanese device manufacturer for more information about a recent outbreak that sickened five patients in Europe. (Peterson, 4/4)

And when a woman’s heart starts to feel a tad different with every beat (even occasionally) or they can’t get rid of that annoying little tingle in their arm, too often a woman will find an excuse not to see a doctor about it. What they seldom consider is that it might be the beginning of heart disease. And for millions of women, that’s exactly what it is...In fact, the American Heart Association states that one in three adult women are living with some form of cardiovascular disease and may or may not realize it. The disease remains the number one killer of women in the U.S. (Despres, 4/4)

The U.S. military is trying to figure out whether certain heavy weapons are putting U.S. troops in danger. The concern centers on the possibility of brain injuries from shoulder-fired weapons like the Carl Gustaf, a recoilless rifle that resembles a bazooka and is powerful enough to blow up a tank. (Hamilton, 4/5)

Texas House members endorsed a bill Tuesday that would prevent health insurance companies from offering mental health benefits differently from medical benefits and offer more help for consumers who believe their insurance is wrongly denying them coverage. (Evans, 4/4)

The House tentatively approved legislation Tuesday that would ensure Texans have equal insurance coverage for mental and physical health care. The legislation, authored by Rep. Four Price, is the first of several that he has filed on mental health care following a series of interim committee hearings on the issue. Price, R-Amarillo, told colleagues Tuesday that insurance companies are not adequately covering mental health services despite parity laws. (Cobler, 4/4)

House Public Health Committee members heard testimony on three measures — House Bill 2466, House Bill 2604 and House Bill 2135 — that would aim to increase access to postpartum depression screenings and treatment for mothers. (Evans, 4/4)

A yoga instructor. A fortune teller. A political consultant. Under current Texas law, all three could call themselves “psychologists” because of some of the services they each provide and because doing so is protected speech. (Rocha, 4/5)

The assets of a financially troubled provider of mental-health services for people in Delaware and Morrow counties have been sold to a Columbus agency that does similar work, leaving some patients uncertain about who will treat them. (Narciso, 4/4)

Some state lawmakers will pay more for their health insurance under a bill approved unanimously in the Iowa House today, after an earlier unanimous vote in the Senate. (Russell, 4/4)

Leaders of safety-net hospitals from across the state gathered Monday at the Capitol to argue against potential cuts in Medicaid payments. The House last week released an initial budget that included $672.3 million in Medicaid reimbursement cuts, while a Senate plan included about $309.1 million in cuts. Safety-net hospitals include public, teaching and children's hospitals and serve large numbers of Medicaid patients and uninsured people. (4/4)

More than seven in 10 people in one of the nation's largest tobacco-producing states support a statewide smoking ban in most public places. It's the highest level of support ever recorded in polling by the Foundation for a Healthy Kentucky since the group first asked the question in 2011. Anti-smoking advocates hope the numbers will fuel a renewed push for a public smoking ban in a state that leads the country in the number of tobacco-related cancer cases per 100,000 people. (4/4)

The New York attorney general joined a whistleblower lawsuit accusing an AstraZeneca unit of defrauding Medicaid by obtaining confidential data on infants in order to boost sales of a key medicine. From 2007 through 2011, the lawsuit alleges that the MedImmune unit worked closely with a specialty pharmacy called Trinity Homecare to generate prescriptions for Synagis, which is given to premature infants to protect them from contracting a severe respiratory virus known as RSV. At the time, Trinity actively dealt with many New York City public hospitals, where infants were insured by Medicaid. (Silverman, 4/4)

What's the first statistic that medical professionals mention when they talk about patients? It's the patient's age, Rebecca Trotta, a Ph.D.-level nurse, pointed out in a lecture Monday to colleagues at the Hospital of the University of Pennsylvania. She urged them to consider how differently they would think about these two patients: a 57-year-old man who had fallen and had a change in mental status, and an 87-year-old man with the same symptoms.  Chances are, she said, that they would instantly make unconscious assumptions about where those two patients were headed.  They were much more likely to assume that the older man was frail, had dementia, and would wind up in a nursing home.  Could it be that what she called "intrinsic ageism" makes such a negative outcome more likely? (Burling, 4/4)

A 41-year-old man who cheated public and private health insurance plans and the Internal Revenue Service out of $2.5 million over seven years at his father's eye clinic should spend at least 2 1/2 years in federal prison, a prosecutor argued Tuesday. But a defense lawyer countered that Anthony Curtis Neal suffers from autism spectrum disorder and was acting as a "servant'' for his "manipulative,'' "monstrous'' and "distorted'' father. Dr. Dean Elton Neal, 80, died from a stroke in May 2015 before federal prosecutors could charge the ophthalmologist. (Bernstein, 4/4)

Intermedix is acquiring WPC Healthcare to strengthen its data analytics and machine learning capabilities. Intermedix, which moved most of its top executives to Nashville in 2015, expects the deal to help fuse clinical, financial and operational data into the decisions that health care providers make about revenue cycle management, or the complex health care billing process, said CEO Joel Portice. WPC Healthcare is a Brentwood-based company that collects data for a variety of uses in health care, ranging from technology that helps clinicians identify people with sepsis earlier to helping cities think about where mosquito populations might surge during warm months. (Fletcher, 4/4)

Multnomah County health officials are investigating two hepatitis A cases among workers at a pair of Portland Cup & Saucer Cafes.The first of the cases was reported to the county health department on March 20, and the other was reported Monday, said county spokeswoman Julie Sullivan-Springhetti. Officials advise people who ate or drank at the cafes on specific dates in late March to contact their health care provider, she said.Hepatitis A is a contagious liver disease usually spread when someone ingests the virus from drinks, food or other things contaminated by an infected person's fecal matter, according to the Centers for Disease Control and Prevention. It can be a mild sickness, lasting a few weeks, or be more severe and last several months, the CDC said. (Ryan, 4/4)

Shortly before his company won the right last week to sell a new drug for severe eczema, Dr. Len Schleifer made a brash promise. He vowed to price the medicine “responsibly” and avoid the anger that high drug prices have stirred. “You’ll get to judge me and see how we do,” he told me. To his credit, Schleifer appears to have delivered. The drug, called Dupixent, has a list price of $37,000 a year. This isn’t cheap. But Regeneron Pharmaceuticals could have charged still more, since other companies charge roughly $50,000 a year for older, less effective psoriasis treatments. (Silverman, 4/3)

Two new drugs were cleared to hit the market last week: an eczema drug that will cost $37,000 per year and one for multiple sclerosis that will cost $65,000. The drugs drew both praise and criticism for their five-digit price tags. Researchers and patient organizations applauded the prices, which were cheaper than similar drugs on the market. They hoped the prices would please insurers and make the drugs more widely available. (Nedelman, 4/3)

On the same day the stockbroker for then-Georgia Congressman Tom Price bought him up to $90,000 of stock in six pharmaceutical companies last year, Price arranged to call a top U.S. health official, seeking to scuttle a controversial rule that could have hurt the firms’ profits and driven down their share prices, records obtained by ProPublica show. (Faturechi, 3/31)

President Donald Trump’s pick to head the U.S. Food and Drug Administration is among the most vigorous advocates of lowering drug costs by approving cheap generics faster, an initiative aimed directly at the profit centers of major companies. Scott Gottlieb, a former FDA deputy commissioner, would make streamlining approvals his top priority, according to a person familiar with the administration’s thinking. He’s particularly focused on complex medications that combine old drugs with newer delivery devices, as well as those with unusually complicated formulations. (Langreth and Edney, 3/29)

Dismissing drug-price concerns could leave investors with a surprise bill. Sixteen Senate Democrats sponsored the Improving Access to Affordable Prescription Drugs Act, a new legislative proposal that was introduced last week. It contains a familiar list of policy prescriptions such as enabling Medicare to dictate pricing more aggressively than is currently allowed, relaxing rules that govern importation of drugs and eliminating tax breaks for direct advertising to consumers. There are new wrinkles as well: The bill would require more disclosure from charities that help patients pay for high-cost medicines. (Grant, 4/3)

No surprise here: Breakthrough drugs remain expensive. But the latest round of regulatory approvals suggests that the pricing trend is moderating. Regeneron Pharmaceuticals and Sanofi announced Food and Drug Administration approval for their new dermatitis drug, Dupixent, on Tuesday morning. Later in the day, Roche announced it won FDA approval for the multiple sclerosis treatment Ocrevus. Analysts expect both drugs could top $4 billion in annual revenues by 2022, according to a recent analysis from the forecasting firm Evaluate Pharma. (Grant, 3/29)

Politicians have heaped fire and brimstone upon pharmaceutical companies for increasing the price of their products, some of which were approved decades ago. But far less ire has been directed at price tags on newly approved treatments — many of which continue to rise. New cancer drugs cost about 17 times more than they did 40 years ago, according to Kaiser Health News, and a drug for spinal muscular atrophy approved in 2016 is one of the most expensive products on the market, the Boston Globe reported. (Swetlitz, 3/30)

Big changes could be coming to the way new drugs are approved by the Food and Drug Administration. The Trump administration and incoming new leadership at the FDA, coupled with the implementation of the 21st Century Cures Act, signed into law by President Obama in December, may shake up the status quo for the prescription drug approval process. The Cures Act enables faster drug approvals by expanding the kinds of evidence, beyond traditional clinical trials, that the FDA can consider when reviewing drug applications. (4/3)

Newer cancer drugs that enlist the body's immune system are improving the odds of survival, but competition between them is not reining in prices that can now top $250,000 a year. The drugs' success for patients is the result of big bets in cancer therapy made by Bristol-Myers Squibb Co, Merck & Co Inc and Roche Holding AG, among others in big pharma. The industry's pipeline of cancer drugs expanded by 63 percent between 2005 and 2015, according to the QuintilesIMS Institute, and a good number are reaching the market. (Beasley, 4/3)

Pharma stayed out of the bruising fight over Obamacare repeal, but the bill’s demise could turn into the industry’s worst nightmare: a big bipartisan fight over drug prices, with President Donald Trump leading the charge. Trump, who has repeatedly promised action on drug prices, is looking for a policy win after the repeal debacle — and drug pricing is an issue that Republican and Democratic voters care about. (Karlin-Smith, 3/31)

Over the past six months, more drug makers have begun posting their policies for gaining greater access to experimental medicines, according to a new analysis. However, more than half of all pharmaceutical manufacturers have yet to take this step to improve disclosure. Specifically, 47 percent of 98 drug makers have posted a compassionate use policy on their web sites, compared with 19 percent last October. However, 84 percent of the 25 companies with a market capitalization of greater than $10 billion posted policies. This was up from 52 percent last fall. (Silverman, 4/4)

A Nevada lawmaker has introduced a bill to fight the rising cost of medicines, one of dozens state legislators to attempt such a move. But this one has a twist — the legislation targets only companies that make diabetes drugs and insulin. Specifically, the bill requires drug makers to report pricing histories; disclose a slew of costs, such as research, manufacturing, and patient assistance; and notify state officials and insurers at least 90 days before prices are increased above the inflation rate for the preceding year. (Silverman, 3/30)

U.S. Senator Maggie Hassan was in Nashua Friday highlighting her new proposal to lower the cost of prescription drugs. Under the measure, the U.S. Department of Health and Human Services would be required to monitor pricing spikes to ensure drug costs aren’t rising unfairly. (Sutherland, 3/31)

In what some observers are calling a misguided effort, Arizona has become the first state in the nation to pass a law allowing drug makers to promote their medicines for so-called off-label uses — so long as the information given doctors is truthful. Interestingly, the law was hatched by the Goldwater Institute, the same think tank that spearheaded the controversial Right to Try laws designed to give patients early access to experimental medicines. And the think tank is vowing to duplicate that campaign by introducing off-label bills around the country. (Silverman, 3/29)

When President Trump nominated Scott Gottlieb for commissioner of the Food and Drug Administration, you could almost hear the sigh of relief that rippled through the health care community. That’s because Gottlieb isn’t Jim O’Neill, whose name had also been floated for commissioner. O’Neill has no background in health care except as a venture capitalist, and thinks that the way to speed new drugs to the market is for the FDA to drop any requirements that drug makers demonstrate that their products actually work. Gottlieb, in contrast, is an internal medicine physician and a drug company insider, who presumably knows you need at least some scientific evidence for efficacy. (Judith Garber and Shannon Brownlee, 4/4)

Sanofi, Regeneron Pharmaceuticals Inc. and Roche Holding AG are doing something very un-pharma: They're leaving pricing power on the table. Let's be clear: Sanofi and Regeneron are charging $37,000 a year for their skin-clearing drug Dupixent, and Roche is charging $65,000 a year for its Multiple Sclerosis (MS) drug Ocrevus, both of which the FDA approved earlier this week. That's not exactly chump change. (Max Nisen, 3/30)

Drug pricing is once again being debated in Washington and in state capitals. One of the proposals on the table – importation of medicines from Canada – poses dangerous patient risks. This proposal is intended to reduce the price Americans pay for medicines. But the risks to patient safety far outweigh any cost savings – which are likely to be minimal anyway. That is why four former commissioners of the U.S. Food and Drug Administration (FDA) sent a letter to Congress on March 16 cautioning against such an approach. (Ronald T. Piervincenzi, 3/31)

When the nation’s largest pharmacy benefit manager (PBM), Express-Scripts, and the insurance giant Anthem, Inc. sued each other last year over how much each company made in profits, the curtain was raised on the oversized role PBMs play in determining what consumers pay for their prescription drugs. (Stacey Worthy, 4/5)

Jokes about doctors delivering good news and bad news are common. I have good news and bad news to deliver, but it is no joke. The good news is that your prescription medicine costs can be contained by greater generic drug competition. The bad news is that our attorney general is doing all he can to kill that competition. There is a bill backed by Attorney General Brian Frosh, House Bill 631, moving through the Maryland General Assembly propelled by an unhealthy mixture of bad economics and political theater. It threatens the one sector of our health care economy that is saving all of us money — generic medicines. (Steve Hershey, 4/3)

Now that the Trump-Ryan alternative to Obamacare has failed, the administration and Congress are turning their attention to other matters. But significant work remains in order to shore up our national health care system. Chief among the challenges is the rising cost of prescription drugs. A recent Kaiser Family Foundation poll even found that 60 percent of Americans — including a majority of Republicans — think lowering prescription drug prices should be a top priority for President Donald Trump and Congress. (Raja Krishnamoorthi, 4/3)

When it comes to cancer drugs, monogamy is overrated. Incyte Corp. recently announced an expanded collaboration with Merck & Co. on late-stage studies of combinations of immune-oncology (IO) drugs, which use a patient's immune system to fight cancer. Two days later, Incyte said it would also run similar late-stage trials with Merck's bitter IO rival Bristol-Myers Squibb Co. It already had earlier-stage trials ongoing with similar medicines from Roche Holding AG and AstraZeneca PLC. (Max Nisen, 4/4)

President Trump and House Republican leaders want to take another crack at a health-care reform deal that went up in flames last month. Except it looks as though they're not really sure how to fix what went wrong — that is, a total implosion of their attempt to build a single-party coalition of moderate Republicans (who thought the original bill would take away too much coverage) and conservative Republicans (who thought it wouldn't go far enough). (Amber Phillips, 4/4)

Republicans have spent most of the past seven years vowing to protect people with pre-existing conditions, even as they have pledged to get rid of the Affordable Care Act. ... Now Republicans are trying to bring back Obamacare repeal. And the emerging deal would make a mockery of those promises ― by forcing people with medical problems to pay more for their health care, and in many cases leaving them unable to get insurance at all. It would be a breach of faith, but also a revealing window into what Republicans who support this measure think the world should look like. (Jonathan Cohn, 4/4)

It can be hard to know which of President Trump’s tweets to take seriously sometimes, but evidently, his claim that the White House and Republicans in Congress are still working on health care reform after last month’s debacle with the American Health Care Act was true. (Robert Garver, 4/4)

When I became a doctor, I went to work in an emergency room that admitted and treated the kind of hard-working, low-income farmworker families I grew up with. For many of them, the ER was their first and last resort after avoiding the doctor for years because they had no health insurance. We didn’t check a patient’s political affiliation before treating them. I didn’t check the party affiliation of the other doctors and nurses, either, and they didn’t ask me for mine. Rather, we worked together as a team, following through on the Hippocratic Oath we had taken to treat patients to the best of our ability and, above all, to “do no harm.” ... If only politicians were required to take an oath to do no harm. (Raul Ruiz, 4/5)

Deprive 24 million people of health insurance. Or don’t. If you’re President Donald Trump, it would seem, either outcome is just fine. During an interview with Financial Times that appeared over the weekend, Trump said he hadn’t given up on repealing the Affordable Care Act, even though House health care legislation fell apart last month when it didn’t have the votes to pass. ... In the FT interview, Trump said he hoped Freedom Caucus members would come around. But if they don’t, Trump said, he’ll simply cut a deal with Democrats instead. ... The idea that Trump could so easily toggle between appeasing the Freedom Caucus or working with Democrats is difficult to fathom, given what each side wants. (Jonathan Cohn, 4/3)

As the state with the highest poverty rate and the lowest median income, it should be no surprise that Mississippi has the highest medical debt of all states. ... Medical debt in our state remains the leading cause of personal bankruptcies, according to the Mississippi Health Advocacy Program. State leaders chose not to expand Medicaid to adults in poverty, so we continue to have a large number of people without health insurance. (Lynn Evans, 4/2)

‘If we had put a war on neurologic diseases at the same time we declared a war on cancer, we probably would not be having this conversation.” Those are the wise words of Janet Woodcock, director of the Food and Drug Administration’s Center for Drug Evaluation and Research, before Congress last month. Dr. Woodcock is correct. While the past two decades have brought breakthrough treatments for cancer, HIV and heart disease, no new treatments for Alzheimer’s disease have been approved in nearly 15 years. (George Vradenburg and Howard Fillit, 4/4)

At the retail end of the global heroin trade, local heroin rings repackage pounds of the drug into single-serve doses and push the product to its final destination: the user. From there, the next stop is often a hospital emergency room or a morgue, as an epidemic of heroin-related overdoses and deaths continues its creep across the country. In Virginia, an intensive crackdown on heroin rings has shed new light on the relationship between drug dealer and user, providing insight into why that last link in the heroin trafficking chain has become so deadly. (Courtland Milloy, 4/4)

Gov. John Kasich’s new rules limiting the amount of narcotic painkillers that doctors can prescribe — to seven days’ worth for adults and five days for minors — is a pragmatic approach toward fighting Ohio’s devastating plague of drug addiction and fatal overdoses. We need to do something and fast; Ohio led the nation in 2015 with 3,050 lives lost to opioid overdose deaths. This is an addiction that can happen to anyone: teens, professionals, suburban moms. A person gets injured, gets a painkiller from a well-meaning doctor, then gets addicted. When they can no longer get the drug through legal means, they turn to street drugs, typically cheap and plentiful heroin. Or kids find a stash of unused painkillers in Grandma’s medicine cabinet. (4/5)

We all want breakthroughs in medicine. I've never met someone who doesn't. Even with all the progress we have seen in medicine, millions of people suffer, or have family members who suffer, from diseases that are making their lives worse or threatening their lives. Time means something different to these people. They do not have the luxury of waiting patiently while researchers test new drugs. (Harlan M. Krumholz and Joseph S. Ross, 4/4)

Jewish scripture tells the story of the people of Israel standing on the edge of the promised land. Before they enter and create a new nation, Moses gives them one final challenge: “I have set before you life and death. … Choose life so that you and your descendants may live” (Deuteronomy 30:19, NRSV). Today, Iowa faces a choice. We can continue to underfund mental health care services, which for too many Iowans will mean death. Or we can have the courage to fix a broken system and give life. (Rev. Dr. Dave Switon and Rev. Travis Stanley, 4/4)

Should insurance cover breast augmentation, the procedure commonly known as a boob job? Most people would say “no, of course not.” That’s a cosmetic procedure, and health insurance shouldn’t pay for a procedure done to make someone look better. But what if it is part of breast reconstruction after breast cancer surgery, or part of gender reassignment surgery for a transgender patient? (Jules Lipoff, 4/4)

A Texas teen was killed early Sunday morning in Houston after a van hit her. Nobody wanted that. Nobody intended to put her in a foster care situation she would run from. To try to house her temporarily in a state office building. Or to have her running with a gaggle of kids walking down a Houston street shortly before 3 o’clock on Sunday morning. (Ross Ramsey, 4/5)