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Aetna became the latest health insurer to cast doubt upon its future in the Affordable Care Act's insurance exchanges after it called off a planned expansion Tuesday and suggested it could abandon that market completely. A departure by Aetna, the nations' third-largest insurer, could further reduce the number of choices for customers and eventually push insurance prices higher. Competition by insurers is a key feature of the exchanges, designed to keep a lid on prices, but several insurers are abandoning them because they are losing enormous amounts of money. (Murphy, 8/2)

Aetna said it would re-evaluate its participation in the 15 state exchanges where it currently sells plans, and cancel a planned expansion into more. The moves come in the wake of recent confirmations by UnitedHealth Group Inc. and Humana Inc. that they would pull back sharply from the ACA’s exchanges amid deepening losses, and a disclosure by Anthem Inc. that it now expects losses on its ACA business in 2016. “We will look at the financial performance of the business over time, its trajectory and volatility” and the review will be market-by-market, said Aetna Chief Executive Mark T. Bertolini. (Wilde Mathews, 8/2)

Bertolini said big changes are needed to make the exchanges viable. Risk adjustment, a mechanism that transfers funds from insurers with healthier clients to those with sick ones, “doesn’t work,” he said. Rather than transferring money among insurers, the law should be changed to subsidize insurers with government funds, Bertolini said. “It needs to be a non-zero sum pool in order to fix it,” Bertolini said. Right now, insurers “that are less worse off pay for those that are worse worse off.” (Tracer, 8/2)

Chief Executive Mark Bertolini said he is pleased with Aetna's overall results, but following an updated 2016 projection of individual products and "significant structural challenges" facing the Affordable Care Act exchanges, he said Aetna will abandon plans to expand public exchange plan offerings in 2017. Bertolini told investor analysts on a conference call that Aetna expects a loss of more than $300 million in Affordable Care Act business this year. Aetna had previously said it was a break-even operation. (Singer, 8/2)

The grim prediction from Aetna is the latest blow to the Obama administration as it looks to stabilize the three-year-old marketplace. Federal health officials had previously touted Aetna's commitment to the marketplace last November, after UnitedHealthGroup announced it planned to exit the exchanges entirely. (Ferris, 8/2)

Aetna, the third-largest health insurer in the US, said Tuesday that it was reconsidering its offerings on the state exchanges that make up the backbone of the Affordable Care Act, the healthcare law more commonly known as Obamacare. ...In a conference call following the company's earnings announcement, CEO Mark Bertolini said the firm had halted its plans to expand into New Jersey and Indiana in 2017 and was looking into the reasons for losses in the exchanges it was already participating in. (Bryan, 8/2)

Exchanges have lately received one piece of bad news after another. Most of Obamacare’s co-op insurers have failed, and some areas are requesting double-digit increases in 2017. Aetna is only the latest insurer to express hesitation about whether it will continue to offer insurance plans through the marketplaces. (Owens, 8/2)

Aetna and Humana will sell certain Medicare Advantage assets to Molina Healthcare as the insurers prepare to defend their merger against a U.S. Justice Department lawsuit. In addition, Aetna said its worsening performance on public exchanges has forced the company to rethink its 2017 expansion plans and evaluate all of its individual plans in 15 states where it currently sells Obamacare, company chairman Mark Bertolini said Tuesday. Humana has already said it is pulling off most ACA exchanges for next year. (Japsen, 8/2)

Aetna also has partnered with Humana to sell some Medicare Advantage plans to rival Molina Healthcare in an effort to clear anti-trust obstacles to the proposed $37 billion merger between Aetna and Humana, the companies announced Tuesday. (Barkholz, 8/2)

Aetna and Humana said Tuesday they have an agreement to sell Medicare Advantage business covering 290,000 people to rival insurer Molina if their planned merger is allowed to be completed. But that may not be enough to win over the Justice Department, which has sued to block the merger. Aetna also said it is halting 2017 plans to expand participation on public exchanges and is reviewing all of its current participation on Affordable Care Act exchanges. (Radelat, 8/2)

Federal health officials, scrambling to fund efforts to combat the spread of the Zika virus in the United States, said on Tuesday they have provided more stopgap money to various locales while calls grew for Congress to cut short its recess and act. Concern is mounting about the threat posed by the mosquito-borne virus after authorities in Florida last week reported the first signs of local transmission of Zika in the continental United States. (Grover and Clarke, 8/2)

The Centers for Disease Control and Prevention (CDC) on Tuesday doled out $16 million in new grants to help local health officials keep track of birth defects caused by the Zika virus. The Obama administration has now spent about $201 million out of the $374 million it repurposed in April to fight Zika — leaving about half of its funding still available. The CDC, specifically, has also spent about half of its $222 million in available funding. (Ferris, 8/2)

Sen. Bill Nelson is urging Senate Majority Leader Mitch McConnell (R-Ky.) to use one of the Senate's brief summer sessions to pass funding to fight the Zika virus. The Florida Democrat sent a letter to McConnell Tuesday saying he could use what's called a pro-forma meeting, which normally last for a few minutes at most, to avoid bringing every senator back to Washington. (Carney, 8/2)

The Virginia Department of Health will get $560,000 from the federal Centers for Disease Control and Prevention to support its ongoing efforts to prevent Zika from spreading in the state. The Department of Health’s website reports that 50 Virginians had been infected with the mosquito-borne virus as of Thursday. (Demeria, 8/2)

California will receive federal help this week to help identify and treat babies born with microcephaly, the devastating neurological defect caused by the Zika virus. The U.S. Centers for Disease Control and Prevention will give the state $720,000 to gather more information about microcephaly, refer more infants and families to health and social resources, and track outcomes down the line for infants born to Zika-infected mothers. In total, 40 states and U.S. territories will receive federal Zika grants in this round of between $200,000 and $720,000. (Caiola, 8/2)

State officials have nearly $1 million in new funds at their disposal to fight the Zika virus after receiving a pair of federal grants from the Centers for Disease Control and Prevention. The CDC is giving the Connecticut Department of Public Health two grants – a $579,000 grant announced Monday and a $400,000 grant announced Tuesday – to protect Connecticut residents from the Zika virus and monitor existing cases. Florida’s governor announced Monday as many as 14 cases of the Zika virus in his state may have been locally transmitted – the first cases of the virus transmitted in the continental United States. (Constable, 8/2)

A minority of women and girls living in states where there is a risk the Zika virus could spread use highly effective birth control methods, a new study published Tuesday reports. And in some states, nearly a quarter of girls and a third of women of childbearing age don’t use any birth control at all, the data suggest. The report, from scientists at the Centers for Disease Control and Prevention, said states could remove barriers that impede access to what’s known as long-acting reversible contraception — intrauterine devices and contraceptive implants — as a means of increasing use of these highly effective forms of birth control. (Branswell, 8/2)

Liz Tracy, 36, pregnant and worried, has had a long few days. When news came last week about a handful of locally transmitted Zika cases in Miami, she called her doctor right away, eager to get tested for the virus. “It wasn’t easy,” said Tracy, a grant writer for the Perez Art Museum, which is near the neighborhood where authorities confirmed Monday that the outbreak had grown by 10 cases. “You had to be a real pushy person to get a Zika test.” (Alvarado and Dennis, 8/2)

There are strong parallels between Zika and rubella, also known as German measles. An outbreak of rubella rocked the United States in the winter of 1964 and spring of 1965. More than 12 million people were infected with rubella. Like Zika, rubella is generally a minor illness. It causes a distinctive red rash, low fever, and symptoms resembling a bad cold that usually last a few days. For developing babies, however, infection can be a major catastrophe, causing a variety of birth defects, including blindness, deafness, heart damage, cataracts, internal organ damage, and intellectual disability. (Jennifer A. Reich, 8/2)

Under the eye of a microscope, Oxitec scientists use incredibly thin glass needles to inject two genes: a fluorescent marker for tracking the mosquitoes it releases into the wild and a "self-limiting" gene. The latter is essentially a death gene, and strangely simple. Oxitec releases nonbiting male mosquitoes with double copies of this gene, meaning they will pass the gene along to all their offspring, which will then die. (Gartner, 8/3)

Some Georgia blood banks will begin testing donors for the Zika virus. It comes as officials in Florida investigate several cases of the virus, which are believed to be the first transmitted by mosquitos on the U.S. mainland. ...Donors are tested for Zika at the same time they're tested for other infectious diseases, Evans said, and the tests don't delay the blood collection process. (Stokes, 8/1)

Schools and school districts are among those reacting to news of 14 locally-acquired cases of the Zika virus confirmed in South Florida. With the first day of school still weeks away, Miami-Dade County Public Schools sent out an automated voicemail to parents last week reinforcing basic anti-mosquito measures. (8/2)

Health insurer Anthem Inc, which is fighting the government to save its merger with rival Cigna Corp, asked a judge on Tuesday to decide on the deal by the end of the year and to split its case off from the government's challenge of a second merger of insurance companies. The Justice Department filed lawsuits on July 21 asking a federal court to stop Anthem's deal for Cigna as well as Aetna Inc's planned acquisition of Humana Inc. This means that a judge will decide if the deals can go forward. (Bartz, 8/2)

Virginia’s Bureau of Insurance says a proposed merger between health insurance giants Anthem and Cigna would be bad for consumers. The bureau issued recently issued its analysis ahead of a decision by the State Corporation Commission whether to approve Anthem’s $54 billion acquisition of Cigna. (8/3)

The CareMore clinic is the most extensive Iowa example of a new health care model: Health insurance companies that pay medical bills also employ the doctors, nurses and other professionals who provide the care...The state last year hired three national companies to run the $4 billion program, which insures more than 500,000 poor or disabled Iowans. The clinic is owned by the corporate parent of one of those three companies, Amerigroup. (Leys, 8/2)

Projected premium increases for the two largest providers of health insurance in New Hampshire range from 4.2 percent to nearly 10 percent for individual plans, according to preliminary rate information filed by insurance companies with the federal government. The final rates for 2017 are still not approved, but the data released late Monday night on healthcare.gov predicts relatively small increases for the state’s two largest insurers, Anthem and Harvard Pilgrim, and much larger increases for Minuteman and Maine Community Health Options. (Solomon, 8/2)

The Children’s Health Insurance Program, better known as CHIP, is a somewhat obscure initiative created nearly 20 years ago to help children get health insurance. Last week, it became an unexpected star at the Democratic National Convention, where speakers name-dropped it repeatedly as an example of Hillary Clinton’s efforts to improve children’s lives. In their remarks, Tim Kaine and Howard Dean and Bill Clinton and Barack Obama all gave Clinton credit for helping CHIP become reality. In her own speech, Clinton touted her work to “help create the Children's Health Insurance Program that covers 8 million kids in our country.” (Guo, 8/2)

A prominent anti-abortion group is piling pressure on Hillary Clinton's running mate, Tim Kaine, to clarify how he would vote if he were needed to break a tie in the Senate on a crucial abortion bill. “Hillary Clinton’s plan to repeal Hyde is profoundly unpopular — even among Democrats," said Susan B. Anthony List President Marjorie Dannenfelser, referring to the Hyde Amendment, a longstanding law that limits the use of federal funds to pay for abortions. (Swan, 8/2)

Tim Kaine on Tuesday accused Donald Trump of failing to lead in the fight against the Zika virus. "If you look at what Donald Trump has said on Zika, it's kind of crickets, it's like nothing," Kaine said at a rally in Daytona Beach, Fla. — a state that facing a travel warning over the Zika outbreak...Kaine also accused House Republicans of sinking a Senate compromise by tying anti-Zika money to a measure defunding Planned Parenthood. (Kamisar, 8/2)

Democratic vice presidential nominee Tim Kaine called on Republican leadership to reconvene Congress to pass new Zika legislation after Democrats blocked a GOP proposal earlier this summer. ... He did not mention the Zika virus during his first solo rally in Richmond, Virginia, on Monday, but made sure to focus on it here at Daytona State College. (Everett, 8/2)

Senior citizens need more medical care than anyone else in the United States. And the Internet is chock full of health information. Yet seniors are far less likely than other adults to tap into it, new research shows. A report published Tuesday in the Journal of the American Medical Assn. found that only about 18% of participants in the National Health and Aging Trends Study got health information online in 2014. That pales in comparison with the approximately 60% of adults of all ages who have told the Pew Research Center that they consult Dr. Google at least once a year. (Kaplan, 8/2)

A small corner of the neuroscience world was in a frenzy. It was mid-June and a scientific paper had just been published claiming that years worth of results were riddled with errors. The study had dug into the software used to analyze one kind of brain scan, called functional MRI. The software’s approach was wrong, the researchers wrote, calling into doubt “the validity of some 40,000 fMRI studies” — in other words, all of them. The reaction was swift. Twitter lit up with panicked neuroscientists. Bloggers and reporters rained down headlines citing “seriously flawed” “glitches” and “bugs.” Other scientists thundered out essays defending their studies. (Vlasits, 8/3)

On the morning of May 14, 2013, while it was still dark, Suzanna Simpson strapped on a headlamp and shot her husband. She then shot and killed her two children, ages 5 and 7. Afterward, Simpson, 35, drove her car off the road near her home in Dacusville, S.C., and into a tree, in what she would later say was a suicide attempt. A neighbor called the police. The same day, Simpson admitted to the shootings. (Her husband was severely injured, but not dead.) Simpson also shared her motives: The world was evil, so by killing her family, Simpson had sent them to a better place. (Jacewicz, 8/2)

Six weeks after the worst mass shooting in modern U.S. history, the mental-health toll of the Pulse nightclub massacre is barely beginning, authorities say. And in a state already ranked worst in the nation for mental-health resources, Central Florida agencies are trying to beef up now to prepare for the months — and even years — ahead. (Santich, 8/2)

Mario Perez lives in Miami, but he was in Orlando for a housewarming party Saturday, June 11. After the party, the 34-year-old went to the Pulse nightclub for Latin night. At 2 a.m., he heard gunshots. Loud. He knew it was real. ... The gunshot wound on his side is purple and swollen, and he has nerve damage from the bullet fragment. He cut his elbow from glass on the floor of the nightclub and needed six stitches. Perez doesn't know how much bills coming from specialists, X-rays and tests might cost him. But his bill from Orlando Regional Medical Center's emergency department is $20,000. "$20,000," Perez said. "That's the quote, that's what they told me." Perez has no health insurance. He's working for a temp agency right now and doesn't have the money to be seen by a doctor for follow-up care in Miami. (Aboraya, 8/3)

Idaho has advanced its anti-abortion stronghold once again by publishing a list of places where pregnant women considering abortions can get free ultrasounds. Lawmakers in the Republican-dominated Statehouse pushed for the list earlier this year during the legislative session, where anti-abortion legislation is common and almost always receives the governor's signature. The state's GOP supermajority refused requests from minority Democratic members to ensure the information given by the ultrasound providers was medically accurate. (Kruesi, 8/2)

Missouri must pay more than $156,000 in attorneys’ fees after losing a court battle against Planned Parenthood over the revocation of its abortion license in Columbia, Missouri, a federal judge has ruled. U.S. District Judge Nanette Laughrey on Monday awarded Planned Parenthood Great Plains (formerly Planned Parenthood of Kansas and Mid-Missouri) all but $157.50 of the legal fees and expenses it sought after it prevailed in the case. (Margolies, 8/2)

In an effort to improve care and lower costs, Ohio's Medicaid program will begin paying more to primary care doctors who recommend preventative services, coordinate physical and mental health care, offer extended hours and provide other supports shown to improve the health of their patients. The idea is to "reward value rather than volume," said Greg Moody, director of the Governor's Office of Health Transformation. (Candisky, 8/2)

In his mid-30s, Jonathan Hensley was unemployed and caring for some disabled family members. He needed to take care of himself, too, because his teeth hurt. Historically in Kentucky, someone like Hensley — a single, able-bodied adult with no job — would likely not have had health insurance. But because the state expanded its Medicaid program under the Affordable Care Act in 2013, Hensley and some 400,000 other Kentuckians got taxpayer-funded medical, dental and vision coverage. ... That routine dental coverage is now at risk, as Gov. Matt Bevin seeks to overhaul the state's Medicaid system. (Beam, 8/2)

[Kentucky] Gov. Matt Bevin is delaying submitting changes to the state’s Medicaid program, which were initially due to the federal government on Monday. Adam Meier, Bevin’s deputy chief of staff for policy, said the extension is due to the large number of comments the state received regarding the proposal. (Gillespie, 8/2)

The CMS has a denied a request from Indiana to lock people out of Medicaid coverage for six months if they fail to complete a renewal process. In April, the state requested federal approval to lock out beneficiaries who fail to complete the renewal process in a timely manner. The measure would impact people above and below poverty and is meant to ensure enrollees would return required documents by the state-determined deadline. (Dickson, 8/2)

After a strong push from Connecticut’s health insurance exchange, about 5,600 low-income parents and caregivers transitioned to new health coverage through the state exchange before losing their state-sponsored Medicaid at the end of July. However, this means that 8,224 others who lost coverage either enrolled in a new plan independent of the exchange or, more likely, did not find new coverage at all by Aug. 1. About 14,000 parents and caregivers on HUSKY A – the state-sponsored Medicaid program for low-income parents, caregivers and children – lost their coverage on July 31 after legislators made eligibility requirements more stringent in 2015. (Constable, 8/2)

The state Department of Health and Human Services did not provide proper oversight of payments related to Medicaid durable medical equipment claims, according to a State Auditor’s report. The equipment includes wheelchairs, hospital beds and oxygen tanks. (Craver, 8/3)

Chicago's Northwestern Memorial Hospital is the best in the state for the fifth year in a row and among the top 10 in the country, according to U.S. News & World Report rankings released Tuesday. U.S. News ranked Rush University Medical Center, also in Chicago, second in the state. University of Chicago Medical Center earned third place. (Schencker, 8/2)

For the first time in its 27-year history of healthcare rankings, U.S. News & World Report has listed a Colorado hospital on its Best Hospitals Honor Roll — a list of the top hospitals in the country. The University of Colorado Hospital muscled its way onto the 20th and final spot on the list, distinguishing itself among 5,000 hospitals considered nationally. (Wenzel, 8/2)

Boston hospitals are among the best in the nation overall and in several specialty areas, according to the newest rankings from U.S. News and World Report. In the magazine's overall ranking of the best hospitals, two Boston facilities make the top 20 list. Massachusetts General Hospital ranked No. 3 and Brigham and Women's Hospital ranked No. 13. But for cancer treatment, in particular, the Dana-Farber/Brigham and Women's Cancer Center is ranked No. 4. Massachusetts General earned the top ranking in adult psychiatry and a fourth-place ranking in the nation for cardiology and heart surgery. (8/2)

The Mayo Clinic in Jacksonville is ranked the top hospital in metro Jacksonville and is tied for first among Florida hospitals in U.S. News & World Report’s annual evaluation of hospitals, released online Tuesday. (Patton, 8/2)

The Medical University of South Carolina was again named the top hospital in the state by U.S. News and World Report. Five specialities at MUSC, including cancer, gynecology and urology, also ranked nationally among the best programs in the United States. “These rankings reflect not just reputation but patient outcomes, teaching the next generation of care providers, developing new innovations to improve health, and health care leadership,” said Dr. Patrick Cawley, CEO of Medical University Hospital, in a prepared statement. (Sausser, 8/2)

For the fifth straight year, St. Francis Hospital ranked highest among Long Island hospitals on the U.S. News & World Report Best Hospitals list, released Tuesday. In its 27th annual survey of nearly 5,000 hospitals, St. Francis was ranked fifth in the metropolitan area, which includes New York City, Long Island, Westchester County and northern New Jersey. The hospital was ranked sixth in the region last year. (Uda, 8/2)

It’s hospital ratings season in America, that time of year when marketing executives kick it into high gear to trumpet — and spin — the way their hospitals are graded by outside organizations. This year, their workload has been especially heavy. In addition to annual rankings released Tuesday by U.S. News & World Report, the federal Centers for Medicare and Medicaid Services (CMS) just released its star-rating system for hospitals nationwide. While the ratings offer some valuable information to consumers, here’s why you shouldn’t put too much stock in the results. (Ross, 8/2)

Community Health Systems posted an eye-popping $1.43 billion loss from continuing operations in the second quarter as the hospital giant took a noncash write-down of goodwill of its assets, the company announced Tuesday.The $1.43 billion, or $12.90 per share, loss compared with a profit of $117 million, or $1.01 per share, for the same period last year. (Barkholz, 8/2)

UCF is looking for a partner to build a teaching hospital in Lake Nona next to the medical school, officials said Tuesday. The plan still has to be approved by the university’s Board of Trustees later this week, but Dr. Deborah German, founding dean of the medical school, said the timing is right to put the wheels in motion. (Miller, 8/2)

Business is booming in Texas for free-standing emergency departments. But just because the state is home to more of them than any other place in the country doesn't mean there's equal access for all. Your ZIP code may determine whether there will be one available near you. The centers are emerging in wealthier neighborhoods, where patients are privately insured and are less likely to have Medicaid or Medicare, finds a study published in July in the Annals of Emergency Medicine. (Rice, 8/2)

Maryland's top health official told a Baltimore judge Tuesday that he should have asked for more money in this year's state budget to relieve a bed shortage that has prompted his department to turn away patients from state mental hospitals. Van T. Mitchell, secretary of the Department of Health and Mental Hygiene, was summoned to court to explain why he and five other top department officials should not be held in civil contempt for failing to carry out court orders to admit criminal defendants in a timely manner. (Dresser, 8/2)

The state human services department must hire an independent consultant to track how quickly it completes mental competency evaluations for inmates facing criminal charges as part of a new federal agreement. The department and Disability Law Colorado, which accused the state of letting inmates “languish in jail, in dangerous and debilitating conditions” as they waited months for mental health evaluations and treatment, have filed a joint motion to dismiss their latest legal dispute after settling in mediation. (Brown, 8/2)

A Hawaiian Airlines flight attendant was among the people in Hawaii infected with Hepatitis A. The state Department of Health says the attendant was on 33 flights from Honolulu to California, Nevada, Australia and Hawaii's neighbor islands in July and served food and drinks to passengers. The risk of airline passengers contracting Hepatitis A from a flight attendant is extremely low because flight attendants are well trained in terms of maintaining hygiene, said Sarah Park, state epidemiologist. (8/2)

Three abandoned babies found in Central Florida in recent months have drawn attention to the state's "Safe Haven" law and led to questions about the way the program is publicized...The law allows new mothers to drop off an infant 7 days old or younger with a person at a "safe haven" — a fire station, EMS facility or hospital — no questions asked. (Harris, 8/2)

The contract impasse between Piedmont and UnitedHealthcare has now entered its second month, and the two sides have very different versions of where things stand. ...Their former contract ended July 1 without a new deal in place, meaning that five Piedmont hospitals and hundreds of the system’s doctors went “out of network” for tens of thousands of United’s members in Georgia. Contract renewal disputes are usually settled in time, though often at the last minute. (Miller, 8/2)

Based in Burlington, torchlight is an online service that provides family members with tools and information to help care for a relative with special medical needs. The service is bought by companies and provided to employees as a free benefit. Founded to help parents of special needs children, torchlight recently launched a new offering for adult children who need help with their elderly parents. Families can get an assessment of the care that’s needed and be pointed to treatment options and assistance programs. (Bray, 8/2)

It’s been a long road with more than a few bumps, but Boston’s first medical marijuana dispensary is finally ready for its expected grand opening Wednesday. The Milk Street shop, across from the historic Old South Meeting House, is equipped with infrared security cameras, a foyer, and a waiting area for overflow crowds, and will probably have Boston police working special details “quite a bit” to ensure safe operations, according to company officials. Even before it opened its doors, more than 200 state-certified patients had preregistered with Patriot Care to shop in the dispensary, and company leaders said they were prepared to handle at least 150 customers a day. (Lazar, 8/3)

From the start, the campaign to make California the fifth state allowing adult marijuana use has sought to reassure skeptical parents by emphasizing safeguards to prevent those under the age of 21 from partaking. The first sentence of proponents’ case in a state voter guide promises Proposition 64 will create a well-regulated system “while protecting our children.” ...The initiative that will go before voters in November would block selling or advertising pot near schools and youth centers, mandate child-proof packaging, allow for stripping licenses from businesses that sell to people younger than 21 and use the green revenue stream to fund youth prevention and programming. (White, 8/2)

The mania surrounding Valeant Pharmaceuticals International hit its peak a year ago. Strange as it may seem today after all that has happened, on Aug. 5, 2015 — two weeks after a dazzling second-quarter earnings report — the drug company’s stock closed at $262.52. J. Michael Pearson, Valeant’s chairman and chief executive at the time, took a victory lap when he announced those earnings. “We once again exceeded our guidance and delivered our fourth consecutive quarter of greater than 15 percent organic growth,” he said. (Morgenson, 7/29)

CVS Health Corp. is embracing new, cheaper copies of biotech medicines in an attempt to combat rising prescription drug costs. CVS, whose Caremark unit administers drug-benefit plans for employers and insurers, said Tuesday it would drop coverage of two higher-priced medicines used in diabetes and cancer treatments. It will instead cover their replica versions, sometimes called biosimilars, for many of its drug-plan members. (Walker and Ziobro, 8/2)

Despite all the emphasis being put on the cost of prescription drugs, outpatient spending is expected to be the largest driver of premium increases in 2017, according to an analysis by Avalere Health, an independent consulting firm. The research found that outpatient spending accounts for 29.9 percent of rate increases and makes up 27.4 percent of insurance plans’ spending. Contrary to recent headlines and claims from insurers that prescription drugs are to blame for rising insurance costs, the analysis found that prescription drug spending represents a smaller portion of rate increases. (Owens, 8/2)

For many patients ..., especially those with high-deductible insurance plans, the price of filling a prescription is largely unknown until they get to the pharmacy. That can leave some patients shocked at the register, sometimes unable or unwilling to pay. That's not good for patients or for healthcare. When people don't take their drugs or take less than the prescribed dose, the result can be disastrous. ... A number of insurers, pharmacy benefit managers and technology companies are developing smartphone and computer apps to provide that information for patients and physicians. They provide coverage information before patients reach the pharmacy, inform patients where their prescription can be filled at the lowest cost, and offer alternatives that may be cheaper. (Rubenfire, 7/30)

Democratic politicians made a few jabs at the pharmaceutical industry at their convention this week, but viewers tuning in at home saw something of a counterargument during commercial breaks: a stream of ads promoting drugs — and the drug industry. Pfizer, for instance, ran 25 ads across all six major networks carrying the Democratic National Convention, according to the media research firm iSpot.tv. (Robbins, 7/29)

Here’s what K Street’s powerhouse drug lobby wants you to know: PhRMA is back, PhRMA is big and PhRMA is ready to defend drug prices after the presidential election. The group’s playbook for 2017 includes adding new members, raising dues and retooling a lobbying machine that insiders say atrophied since achieving many of its top goals with Obamacare’s passage six years ago. Now it’s ready to shout its message not just inside the corridors of power but beyond the Beltway, with a massive campaign expected to cost a few hundred million dollars — easily eclipsing the $20 million that health insurers spent on the iconic “Harry and Louise” campaign credited with sinking Hillary Clinton’s health reform plan in the early 1990s. (Karlin-Smith, 8/2)

The clamor over prescription drug pricing is weighing more heavily on biotech managements. A recent review of risk factors cited by the 100 largest companies listed in the Nasdaq Biotechnology Index found 89 percent cited worries over pricing pressures, according to the BDO advisory and consulting firm, which examined filings with the US Securities and Exchange Commission. And concern has been steadily rising. In 2015, the firm noted that 79 percent of biotechs cited anxiety over pricing as a risk factor to their businesses, while 68 percent did so in 2014 and 66 percent in 2013. Thanks to increased controversy over the cost of medicines, pricing is now the 16th most worrisome issue. (Silverman, 8/1)

Federal regulators this spring boosted the profile of a once-small academic institute that compares the value and price of prescription drugs, and now the group is coming under attack from pharmaceutical companies and allied patient groups. The pharmaceutical companies are threatened by a potential drop in payments for their drugs by the federal government, and the patient groups — often subsidized in large part by drug companies — say they're worried life-saving drugs may get delayed or rationed. (Crescente and O'Donnell, 7/28)

In the latest bid to control prescription drug spending, the nation’s largest pharmacy benefits managers are again excluding dozens of medicines from their lists of products that are covered by health insurance, which are known as formularies. PBMs, you may recall, are crucial, behind-the-scenes middleman who negotiate drug prices on behalf of companies, unions, and government agencies. On Monday, Express Scripts notified its customers that next year, 85 medicines will be excluded from its national formulary, and, as a result, the PBM hopes to recognize about $1.8 billion in savings, up from $1.3 billion this year. (Silverman, 8/2)

With consumers and federal and state health care providers reeling from the staggering cost of expensive miracle drugs for treating the deadly hepatitis C virus, Congress has been under pressure to either rein in pharmaceutical companies’ prices or provide increased government funding to cover the expanding costs. State Medicaid officials recently turned to Congress for assistance in meeting the fast-rising demand for the drugs, which can cost as much as $95,000 for a 12-week treatment. Many state officials worry about the implications of a recent federal court ruling in Seattle that Washington state’s Medicaid system must rescind a year-old policy limiting the treatment only to patients with the most severe cases of hepatitis C infections. (Pianin, 7/27)

The path that prescription drugs take from the lab to your medicine chest is a long and complicated one. And the journey is made still more complex by the role of a very important, but little understood middleman known as the pharmacy benefits manager. These companies fill a crucial role by negotiating with drug makers on behalf of health plans, unions, and some employers to get the best price, which is particularly critical as the cost of medicines is ever-rising. Yet PBMs also stir controversy over concerns they may not always pass along savings — called rebates — they negotiate for their clients, but instead pocket those funds to fatten their own bottom lines. (Ed SIlverman, 8/2)

When Gilead Sciences Inc.’s Sovaldi became the first of the more effective medicines to hit the market, in 2013, its $84,000 list price — $1,000 a pill — caused sticker shock for payers nationwide. Fearing their budgets would be drained by a rush of people who wanted to get well instead of living with uncertainty, many insurers limited access to Sovaldi. Even from a cold-blooded accountant’s perspective, it was a foolish policy — providing months or years of medical care for someone suffering from cirrhosis costs much more. (7/29)

In a May article in Health Affairs, we proposed that the federal government consider using an existing law to negotiate or compel lower drug prices in the United States for certain important drugs with excessive prices. We’ve been gratified at the interest the proposal has generated on Health Affairs Blog and elsewhere. We believe it illuminates a significant opportunity to improve access to important medicines, and also to more efficiently allocate our health care dollars. (Amy Kapczynski and Aaron Kesselheim, 7/28)

Amy Kapczynski and Aaron Kesselheim proposed in Health Affairs that the federal government reduce the price of on-patent prescription drugs using an obscure federal law (codified as 28 USC 1498) to either threaten to, or actually, seize patent rights to drugs in a manner similar to eminent domain. The idea is that the federal government would “produce or import low-cost versions of patented medicines” itself, while paying the drug company that previously controlled the patent “reasonable and entire compensation” according to some vaguely measure. (Robert Book, 8/1)

In a recent guest piece on STAT entitled “Say what you will about Donald Trump. He’s right about drug companies,” Dr. Charles D. Rosen enthusiastically supports Mr. Trump’s negative views on the pharmaceutical industry. Dr. Rosen, a clinical professor of orthopedic surgery at UC Irvine, believes that the Republican presidential nominee is correct on some key issues including: allowing Medicare to negotiate prices with drug companies; [and] allowing cheaper pharmaceutical drugs manufactured abroad to be sold in the U.S. (John LaMattina, 8/1)

The quality of many of our lives has been dramatically improved by prescription drugs. Unfortunately, these improvements come at a price – the increased price of prescription drugs. According to a recent AARP study, retail prescription drug prices have increased six times faster than the general inflation rate since 2006. Premiums and out-of-pocket costs reflect this increasing cost. That’s a big problem for everybody, but especially for seniors, many of whom haven’t seen a comparable increase in their income. (Pam Zerba, 7/27)

More than 1 million people in Georgia live with diabetes and are at risk for developing chronic, debilitating and potentially permanent nerve pain, known as diabetic peripheral neuropathy (DPN). Currently, the American Diabetes Association estimates that more than 60 percent of Americans with diabetes also suffer from diabetic peripheral neuropathy. ... Left untreated or uncontrolled, DPN can cause irreversible damage, including complete loss of lower extremity sensation that can result in amputation. Fortunately, Georgia lawmakers are recognizing the seriousness of DPN. Last month, the General Assembly held Diabetic Peripheral Neuropathy Alert Day in order to raise awareness of this dangerous condition. (Jonathan Ownby, 7/28)

We hear from the legislature that North Carolina’s Medicaid program is broken and needs to be radically changed. Therefore we cannot expand it. Bunkum. North Carolina has one of the best Medicaid programs in the nation, one that actually is providing quality health care while controlling costs. ... The cost of North Carolina’s knee-jerk opposition has been more than dollars, jobs or GDP. Access to adequate health care in rural communities has suffered. The decision to forego the Medicaid expansion has been a contributing factor in the closing of several rural hospitals in our state. (8/3)

Two southern states, Louisiana and Kentucky, have reversed positions on Medicaid expansion–after electing new governors. This shift is a reminder, as the presidential contest draws so much focus, that down-ballot races also matter. When it comes to health policy, governors can make a huge difference. (Drew Altman, 8/3)

Health insurers have been taking a financial beating for the ages on ObamaCare, but Aetna was always more bullish than the rest of the industry—until now. The entitlement’s keenest corporate patron announced Tuesday that it is cancelling its ObamaCare expansion plans for 2017 and may withdraw altogether. Aetna posted fabulous second-quarter earnings, though the exception is its Affordable Care Act line of business that the company expects will lose more than $300 million this year. (8/2)

On Monday, Illinois citizens were jolted by a piercing pain in the wallet as federal officials unveiled proposed Obamacare insurance premium rates for 2017. Insurers plan to dial up rates as much as a heart-stopping 45 percent for those who buy plans on the Obamacare marketplace when open enrollment starts Nov. 1. (8/2)

Another day, another investigation into Mayor Bill de Blasio’s administration. While the mayor likes to boast that his administration is competent, transparent and accountable, the facts occasionally suggest an entirely different set of adjectives. A report released Monday by the office of Comptroller Scott Stringer examines the saga of Rivington House, a building on the Lower East Side that the city sold in 1992 to a nonprofit that ran it as a nursing home for people with H.I.V. and AIDS. The city recognized at the time that this was a valuable use of the property. It put a restriction on the deed requiring that the building be used as a nonprofit residential health care facility forever. But forever lasted only until 2015. (8/2)

It wasn't one of the high-profile policy issues sorted out on Beacon Hill before the legislative session ended late Sunday, but for thousands of nursing aides doing vital work at roughly 400 nursing homes in Massachusetts, a last-day vote by lawmakers means they’ll get an overdue pay increase. The Legislature put back into the state budget a $35.5 million appropriation to boost the wages of aides whose average starting rate is just $11 an hour. Most of them are women between the ages of 18 and 44, and many are single parents. (8/3)

Zika has arrived in the United States, spreading via our own homegrown mosquitoes. And that is a game-changer. The Centers for Disease Control has confirmed 14 cases in the Miami area that were almost certainly contracted through the bite of locally infected mosquitoes, and the number is climbing fast. President Obama has dispatched CDC teams to Florida to marshal the public health response. Federal officials are advising a travel ban for pregnant women in the area north of Miami. (Michele Barry and Katherine States Burke, 8/2)

The Zika virus is only beginning to hit the U.S. mainland, but its political exploitation is already an epidemic. To wit, the Obama Administration that is sitting on money and methods to reduce the Zika outbreak is using the virus as a political bludgeon to elect more Democrats. A Zika outbreak hit Miami this week, and the Centers for Disease Control on Monday advised pregnant women to get checked for possible exposure. (8/2)

Like many Kentuckians, I am concerned about the growing threat of Zika virus in this country. As we head deeper into the summer, infected mosquitos are expected to transmit and spread the virus throughout the southern United States, including potentially Kentucky. Anyone can contract this mosquito-borne illness, but it is especially troubling for expectant mothers and their babies. (Senate Majority Leader Mitch McConnell, R-Ky., 8/1)

The Centers for Disease Control did a remarkable thing Monday. For the first time in its history, it issued a travel warning over health conditions in the continental United States. What led the federal medical experts to take such a step? Local transmission of the Zika virus in the Wynwood neighborhood of Miami. (Scott Martelle, 8/2)

In places where mosquitoes are carrying the virus, the number of people with Zika is growing rapidly, including pregnant women. Despite this crisis and pleas from the medical community, Republicans in Congress have chosen to put politics above public health and restrict certain family planning providers from being part of the solution to address the Zika virus. This is just the latest instance in a long list of relentless attacks by Republican lawmakers intended to deny women’s access to reproductive health care. (Mary Nolan, 8/2)

The outbreak of mosquito-spread Zika in Florida should impel Congress to stop its bitter partisan bickering, return to Washington and pass a funding measure sufficient to stop this terrifying, mosquito-borne virus in its tracks. Each hour that Congress delays gives Zika a stronger foothold, raising the probability that American infants will be born with shrunken skulls and other serious birth defects. (8/3)

Zika has hit Florida. At least 14 cases of infection with the mosquito-borne virus are now confirmed, with more certain to come, and federal health officials are warning against visiting the Miami neighborhood where transmission occurred. Meanwhile, top athletes in golf and cycling, citing reluctance to travel to a Zika-afflicted area, have opted out of the Rio Olympic Games that begin in Brazil on Friday. Federal health officials have been touting the rapid progress in developing a Zika vaccine to protect against the virus, which can cause birth defects when pregnant women are infected, as well as a progressive paralysis called Guillain-Barré syndrome. (Henry I. Miller, 8/2)

So far, the only mosquitoes in the continental U.S. carrying the Zika virus are confined to one neat square mile north of downtown Miami. And public health officials seem confident that they will be able to keep most of them there. (8/2)

On Friday the Florida department of health reported four cases of Zika, and on Monday, another 10. All were probably contracted locally from mosquitoes in Wynwood, a northern Miami neighborhood. The CDC is advising pregnant women not to travel to the area. Meanwhile hundreds of women have tested positive for Zika virus in Puerto Rico. At least 2% of blood donors in Puerto Rico have recently been infected with Zika: another ominous sign the infection is spreading rapidly. (Celine Gounder, 8/2)