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John Cox, a Republican business owner who has tried and failed for nearly two decades to win elected office, snagged a spot in the November runoff for California governor with the help of President Donald Trump, but that support could hurt him in the winner-take-all race with Democrat Gavin Newsom. Cox got about a quarter of the votes counted so far in Tuesday's election to easily outdistance former Los Angeles Mayor Antonio Villaraigosa for second to Newsom, who won by a comfortable margin. Cox had been struggling to break clear of fellow Republican Travis Allen until Trump tweeted his endorsement two weeks ago — 273 characters that rallied the president's fans but set up a hyper-partisan battle with Newsom. (Cooper, 6/6)

“It looks like voters will have a real choice this November — between a governor who is going to stand up to Donald Trump and a foot soldier in his war on California,” Mr. Newsom told hundreds of supporters at a San Francisco nightclub, as he pledged to push for guaranteed health care for all and “a Marshall Plan for affordable housing.” Mr. Cox, speaking to friends and donors in San Diego, continually painted Mr. Newsom as “part of the status quo” and knocked the Democrat's attacks on Mr. Trump. (Nagourney and Burns, 6/6)

Gov. Scott Walker's latest television ad released Tuesday features a doctor touting the Republican's support for a plan to stabilize the health insurance market but ignores his yearslong attempt to undercut the federal law designed to broaden access to insurance coverage. Democrats accuse Walker of being a hypocrite for supporting the plan to stabilize insurance markets after he's spent years trying to repeal the federal health care law championed by President Barack Obama. (Bauer, 6/5)

Even health insurers that don't expect many of their plan members to drop insurance coverage after the individual mandate penalty is zeroed out still may have to raise individual market premiums in 2019 as their payments from the ACA's risk adjustment program change thanks to the mandate loss. Buffalo, N.Y.-based insurer Independent Health doesn't expect a large number of its 5,000 ACA exchange members to drop their coverage when the individual mandate penalty is effectively repealed starting in 2019. Its population skews older and sicker, and most members need their insurance coverage. Its average member is about 49 years old, and about half receive federal premium subsidies. (Livingston, 6/5)

House Republicans late Tuesday signaled that they were open to putting at least $1.1 billion more into veterans health care funding when the chamber takes up a three-bill "minibus" spending package this week. It’s not clear whether the GOP is planning to cut other programs to offset the increase, which would address an unanticipated shortfall in 2019 after the passage of a major overhaul of private care access for veterans (S 2372). President Donald Trump is expected to sign that bill on Wednesday. (Mejdrich, 6/5)

Department of Veterans Affairs inspectors uncovered multiple issues in a new review of the Phoenix VA hospital that was ground zero for a national crisis in veterans health care four years ago. The Office of Inspector General report comes a day before President Donald Trump is scheduled to sign reform legislation in a White House ceremony, with Phoenix VA Health Care System Director Rima Nelson in attendance. (Wagner, 6/5)

The Food and Drug Administration on Tuesday morning outlined a framework for cracking down on illegal opioid sales on the internet. Hours later, FDA Commissioner Scott Gottlieb delivered results: a list of nine online operators, running a combined 53 websites, to which it had sent formal warnings for having engaged in illegal marketing and sales of highly controlled opioid painkillers. “The FDA is taking additional steps to protect U.S. consumers from illicit opioids by targeting the websites that illegally market them and other illicit drugs,” Gottlieb said in a statement. “The internet is virtually awash in illegal narcotics and we’re going to be taking new steps to work with legitimate internet firms to voluntarily crack down on these sales.” (Facher and Swetlitz, 6/5)

The FDA warned 53 websites Tuesday that they must stop "illegally marketing potentially dangerous, unapproved and misbranded versions of opioid medications," including tramadol and oxycodone. "The internet is virtually awash in illegal narcotics and we’re going to be taking new steps to work with legitimate internet firms to voluntarily crack down on these sales," FDA Commissioner Scott Gottlieb said in a statement. Gottlieb warned that it will take action against firms whose websites "deliberately break the law." (Hellmann, 6/5)

“These sites are always going to exist. There’s going to be new ones that pop up,” FDA Commissioner Scott Gottlieb told POLITICO. “As we continue to take enforcement action and following through those actions with more vigorous enforcement, I think it’s going to send a strong deterrent.” (Pittman, 6/5)

Voters in this struggling Rust Belt region in upstate New York, backed Donald Trump in the 2016 presidential election, hoping he could help turn back a relentless tide of factory and business closures. But the starkest symptom of decline there - an opioid epidemic that has claimed the lives of hundreds in and around the city of Binghamton - rages on, and voters are demanding that candidates for public office address the loss of life. (Gibson, 6/5)

A report released on Tuesday from the University of New Hampshire is shining a light on those living in the shadows of the state’s opioid epidemic: the children who live with their parents’ addictions. The study says the number of children or youths removed from parental care increased by nearly 200 from 2012 to 2016, and cases that included a substance-related allegation doubled from 30 percent to 60 percent. The Carsey School of Public Policy conducted the research and consulted several child welfare organizations, including the Division for Children, Youth and Families, and more than 40 experts from New Hampshire. (6/6)

State Rep. Kim Moser will transition from her role as former executive director to member of the Drug Control Policy Board as her responsibilities in the Kentucky General Assembly continue to grow. ... Meanwhile the Drug Control Policy Board will expand, bringing more allies to the battlefield to combat this growing epidemic of drug addiction. (Reinert, 6/5)

Seeking to revive a $15 billion plan to pare back spending that has languished on Capitol Hill, the White House on Tuesday dropped a proposal to cut $252 million in leftover funding to fight the Ebola virus in Africa. The move came as President Donald Trump took to Twitter to pitch the package of spending cuts, which still faces an uphill struggle in Congress. "The HISTORIC Rescissions Package we've proposed would cut $15,000,000,000 in Wasteful Spending! We are getting our government back on track," Trump tweeted. (Taylor, 6/5)

The proposal was part of a broader package the Trump administration sent to Congress last month aimed at rescinding $15 billion in unspent funding Congress appropriated years ago. But public health groups and Democrats raised an uproar, pointing at the ongoing Ebola outbreak in the Democratic Republic of the Congo that has killed 27 people. The $252 million is all that's left from the $5.4 billion in emergency funding appropriated in 2015. (Hellmann, 6/5)

The United States has set up a task force to help coordinate a response to unexplained health problems affecting a number of U.S. diplomats and their relatives in Cuba and China, U.S. Secretary of State Mike Pompeo said in a statement on Tuesday. The group, set up on May 23, will handle "identification and treatment of affected personnel and family members, investigation and risk mitigation, messaging, and diplomatic outreach" for the 25 U.S. government workers and family members confirmed to have been affected so far, the statement said. (Heavey and Landay, 6/5)

MyHeritage, one of the nation’s most popular online genealogy sites, said a security breach had affected the email addresses and hashed passwords of 92 million users, raising concerns about the security of more sensitive data that the company collects. The website allows users to create family trees, search historical records, and look for possible relatives. It also operates MyHeritage DNA, a genetic testing service that lets users to send in their spit and have their genetic information analyzed. (Thielking, 6/5)

A bipartisan group of House and Senate lawmakers are raising concerns about how the Department of Health and Human Services (HHS) is implementing a cyber law that aims to boost security by providing digital threat data. In a letter on Tuesday, the top lawmakers on the House Energy and Commerce Committee and the Senate Health, Education, Labor, and Pensions (HELP) Committee pressed HHS Secretary Alex Azar to provide more information about executing the Cybersecurity Information Sharing Act (CISA).  (Beavers, 6/5)

The death of Kate Spade has renewed discussions of mental health awareness, with celebrities mourning the fashion designer’s death with missives about depression and suicide prevention. Spade, whose colorful handbags, bold prints and cheerful sayings once dominated American fashion, was found dead on Tuesday in her New York apartment in an apparent suicide, according to the Associated Press. A former accessories editor at the now-defunct magazine Mademoiselle, Spade founded her fashion label in 1993 with her husband, Andy, who was involved with his own fashion label, Jack Spade, and now has the branding venture, Partners & Spade. (Saad and Paniogue, 6/5)

Drugs that activate the immune system to fight cancer have brought remarkable recoveries to many people in recent years. But one of those drugs seems to have had the opposite effect on three patients with an uncommon blood cancer who were taking part in a study. After a single treatment, their disease quickly became much worse, doctors reported in a letter to The New England Journal of Medicine. (Grady, 6/5)

For many years, the death rate from cancer climbed steadily, and the focus of big cancer meetings was the quest for better treatments to bring malignancies under control. Cancer death rates have been falling in recent decades, and that's allowed researchers to ask another important question: Are some people getting too much treatment for their cancers? The answer, from the American Society of Clinical Oncology meeting in Chicago these past few days, is an emphatic yes. (Harris, 6/5)

Wanted: fecal matter from healthy adults with a regular constitution and a good heart. Screening is rigorous. Reimbursement is modest but can add up for those willing to make daily donations of waste that would otherwise be flushed away. Fecal transplants are being used increasingly to treat Clostridium difficile, an often intractable and debilitating bacterial infection. The potential for expanding the therapeutic applications of fecal transplants sent Canadian researchers on a quest to pinpoint what precisely motivates stool donors and how they might recruit more volunteers. (Rabin, 6/5)

In a clinic on a side street in Kiev, the capital of Ukraine, doctors are doing something that, as far as is publicly known, is being done nowhere else in the world: Using DNA from three different people to create babies for women who are infertile. "If you can help these families to achieve their own babies, why it must be forbidden?" Valery Zukin, director of the Nadiya Clinic, asks as he peers over his glasses. "It is a dream to want to have a genetic connection with a baby." (Stein, 6/6)

Lifting weights might also lift moods, according to an important new review of dozens of studies about strength training and depression. It finds that resistance exercise often substantially reduces people’s gloom, no matter how melancholy they feel at first, or how often — or seldom — they actually get to the gym and lift. There already is considerable evidence that exercise, in general, can help to both stave off and treat depression. A large-scale 2016 review that involved more than a million people, for instance, concluded that being physically fit substantially reduces the risk that someone will develop clinical depression. Other studies and reviews have found that exercise also can reduce symptoms of depression in people who have been given diagnoses of the condition. (Reynolds, 6/6)

A total of 12 patients have died since 2016 due to weight loss balloon surgery, the Food and Drug Administration reported Monday. ... Officials are keeping an eye on the Orbera Intragastric Balloon System from Austin, Texas-based Apollo Endosurgery and San Clemente, California-based ReShape Lifesciences’ ReShape Integrated Dual Balloon System, according to Monday’s news release. (Pirani, 6/5)

It's 3:30 a.m., and Jose Wesley Campos giggles nonstop as his mother plays with the toddler's thick glasses while preparing to take him to a doctor's appointment three hours away. "Sometimes, it is as if he swallowed a clown," said his mother, Solange Ferreira. That is a stark contrast from a few years ago, when Jose, who was born with an abnormally small head amid an outbreak of the Zika virus in northeast Brazil, would shriek uncontrollably. Desperate, Ferreira would calm the boy by putting him in a bucket of water. (6/6)

On Tuesdays, 18-month-old Joaquim Santos spends an hour sitting by himself in a corner of a special needs classroom in this small city in northeast Brazil, one of the country's poorest regions and one hit hard by the Zika virus. Two harried teachers look on as other toddlers play around Joaquim, who has severe developmental delays after being born with a small head. As limited as Joaquim is in the early education classroom, his family and doctors say he is lucky to be there. (6/6)

Three years ago, Brazil experienced a major Zika outbreak that led to the revelation that the virus can cause severe birth defects in babies whose mothers were infected during pregnancy. Here's a look at what scientists know today about Zika and its effect on developing fetuses. (6/6)

Louisiana’s ethics laws, written by the Legislature, allow lawmakers to author, advocate for and cast votes on bills that would enrich themselves, their relatives and their clients, as long as others in the same affected industry would benefit similarly. Regardless of the law, political watchdogs say, such advocacy is troubling. (Allen, 6/6)

One of the country’s largest immigration detention centers had no psychiatrist on staff, “chronic shortages” of almost all medical positions and was described by its own staff as a “ticking bomb” because noncriminal detainees were mixed with high-security offenders. Federal records obtained by Reveal from The Center for Investigative Reporting and Atlanta NPR station WABE show the U.S. Department of Homeland Security’s Office of Inspector General found widespread problems at Stewart Detention Center in southwest Georgia, including drug smuggling and staffing shortages that employees said endangered detention officers and detainees. (Yu, 6/5)

A transgender woman filed a discrimination lawsuit Tuesday against the state of Alaska, saying she was denied coverage for medically necessary surgical treatment. The federal lawsuit, filed on behalf of Jennifer Fletcher, claimed the state health insurance plan excludes coverage for surgical treatment for gender dysphoria. (6/5)

Texas Health and Human Services spent almost $30 million in seven months on overtime and contract labor at its institutions for people with disabilities because the state can’t find enough people to work at them. The cost of overtime pay and contract labor will likely hit $50 million this fiscal year, for the third year in a row. (Ball, 6/5)

The surprise announcement on April 30 that the hospital here in Kennett, Missouri is closing has left this rural part of southeast Missouri without an OB-GYN. That’s left expectant mothers like Welton scrambling to change their birth plans at the last minute, a dangerous proposition in an area with the worst birth outcomes in the state and one of the highest infant mortality rates in the country. The hospital in Kennett, Twin Rivers Regional Medical Center, is just the latest (84th) rural hospital in the U.S. to close from dwindling financial margins. Locally, it’s sparked an unprecedented 60 days in this poor, rural region known as the Bootheel. Now five soon-to-be displaced physicians, the State of Missouri and a hospital in a neighboring county are all banding together to keep vital health care services in the area. (Sable-Smith, 6/5)

Plenty of room at the “hotel influenza.” Any time of year, you can catch it here. Call it a “sickation” — a 10- to 12-day hotel stay to help St. Louis University researchers test the effectiveness of flu vaccines. Volunteers will get a flu shot or a placebo, and then they’ll get a dose of a flu virus delivered through a nasal spray. The participants will be watched around the clock for symptoms of the flu — fever, runny nose, sneezing, cough. Their blood and mucus will be repeatedly tested for signs of the virus, and those who do come down with the flu must test negative for two consecutive days before checking out. (Bernhard, 6/6)

A Connecticut mother who withheld food from her autistic teenage son until he died weighing just 84 pounds was sentenced Tuesday to 11 years in prison. Katiria Tirado, 34, of Hartford, was also sentenced to five years of probation by a judge who said the mother "failed to provide her son with the basics necessary for life." (6/5)

A new eye care center will help people see more clearly and serve as a training ground for nearby optometry students. Massachusetts College of Pharmacy and Health Sciences University (MCPHS) has teamed up with Manchester Community Health Center (MCHC) across the street to open The Eye Care Center at MCHC at 1245 Elm St. The clinic hopes to treat those who have difficulty going to the eye doctor because of transportation, language or income limitations, said Kris McCracken, president and CEO at the health center. (Cousineau, 6/5)

Hurricane Maria has reignited a small movement in Puerto Rico aimed at strengthening the local food system so the island can survive and thrive without dependence on the mainland U.S. Before the hurricane struck in September 2017, Puerto Rico imported about 85 percent of its food. (Miller, 6/5)

Icilma Cornelius was weeks away from her wedding in 2016 when she visited a gleaming brick medical office atop a hill in suburban Atlanta, home of the practice of Windell Davis Boutté, a dermatologist who describes herself as a “nationally and internationally known” cosmetic surgeon. Cornelius, then 54, had gone in to inquire about Botox and other anti-aging facial fillers, according to court documents. But while there, Boutté and the staff reportedly persuaded Cornelius to return for several cosmetic surgeries before her nuptials: A standard panniculectomy would remove fat and skin from her lower abdomen, and “SmartLipo,” a type of laser liposuction, would remove fat from her upper abdomen, love handles, bra roll, lower back and upper third of her buttocks. (Wang, 6/5)

In 2017, at least 195 homeless people -- and probably over 200 -- died in Orange County. While most were claimed by their families, at least 17 were not. These are the people who the county classifies as "indigent," meaning their families could not afford or refused to claim their bodies. (Wiley, 6/5)

Even though the number of insured emergency room visits has stayed about the same in recent years, the cost to step inside the door has nearly doubled, according to new data released by a health care policy group. In 2016, the average amount spent nationally by insurers and patients for emergency room visits was $247 per insured person. In 2009 it was $125, the Health Care Cost Institute research shows. (Deam, 6/5)

Floridians allowed to use medical marijuana are one step closer to being able to smoke it. Leon County circuit court Judge Karen Gievers on Tuesday lifted a stay on her May 25 ruling that the Florida Legislature's provision banning smokable medical marijuana is unconstitutional. The state's Department of Health had filed an appeal of Gievers' ruling, which automatically put it on hold. Attorney John Morgan and two patients with terminal illnesses then filed an appeal of that stay. (6/5)

A mobile health unit will be making weekly stops at select Metro Transit stations to provide screenings, insurance help and other health care needs. ...The mobile unit is part of an effort to bring health care to people who live in transit-dependent areas in St. Louis. (Fentem, 6/5)

Shortly after the School District of Philadelphia learned of alarming levels of asbestos fibers on the floor of a highly traveled hallway inside Olney Elementary School, officials said, they sent an environmental team to fix the problem. But four months later, the hazard is not gone. (Ruderman, Laker and Purcell, 6/6)

A baby born in jail to an Ellis County inmate who admitted using meth while she was pregnant has died, and county officials say they are not to blame. "We are confident there was no fault by Ellis County jail staff or medical staff," the county Sheriff's Department said in a prepared statement Tuesday. In March, deputies arrested Shaye Marie Bear and charged her with possession of a controlled substance, some of which authorities say she hid in her vagina. (Ramirez, 6/5)

Seventeen years ago, Shantanu Gaur, a freshman at Bethel Park High School, sat in his former middle school principal’s office to be nominated for an outstanding leadership award. Upon entering the office, he noticed that Nancy Aloi, his former principal, was wearing a hand brace for carpal tunnel syndrome. He asked to examine her wrist and inquired about her treatments while suggesting his own ideas to alleviate pain, she said. (Benninghoff, 6/5)

Bayfront Health Brooksville and Bayfront Health Spring Hill are among a handful of Florida hospitals that saw a sharp rise in the number of MRSA infections, which can be deadly to patients if not treated, according to federal officials. The trend is one of the takeaways from a body of new data compiled by the Agency for Healthcare Research and Quality, which studied a number of conditions patients often develop before and after surgery or during other hospitalized treatment. (Griffin, 6/5)

The Kansas Legislature voted at the end of April to exclude CBD with no THC from the the state's definition of marijuana, effectively making it an unrestricted substance. The state's decision to dip its toe into the shallowest end of the medical marijuana pool came with surprisingly little resistance. (Marso, 6/6)

Estradiol has been around for decades, but the price of the various creams, vaginal rings and tablets that contain the drug has climbed steadily in recent years, according to an analysis by the consumer website GoodRx. And insurance coverage is spotty — many plans refuse to cover some products or require that patients pay high out-of-pocket costs. While women privately fume about the costs, drug makers have been able to raise their prices without a public outcry in part because the topic — women’s sex lives and their vaginas — is still pretty much taboo. (Thomas, 6/3)

Many consumers know of pharmacy benefit management companies through their brand names, such as Express Scripts, CVS Caremark and OptumRX. The companies, sometimes referred to as pharmacy benefit managers, manage prescription drug plans and serve as go-betweens for pharmacies and health insurance companies. The gag clauses are inserted into contracts with pharmacies by pharmacy benefit management companies, and they prohibit druggists from telling patients or caregivers about lower prices or cheaper drug options, such as generic drugs. Patients never know that there could be a less expensive way to get their medicines, because their neighborhood pharmacist can’t talk about it lest she violate those contracts. (Povich, 6/4)

A recently adopted tactic by U.S. health plans to limit the financial assistance drugmakers provide directly to consumers for prescription medicines is taking a toll on drug prices, according to a new analysis released on Tuesday. Real U.S. drug prices, including discounts and rebates, fell 5.6 percent in the first quarter of this year, compared to a 1.7 percent drop in the same period a year ago, according to Sector & Sovereign research analyst Richard Evans. (Erman and Humer, 6/5)

The growing use of copay accumulators — a new weapon against widely used but controversial copay assistance cards that drug makers distribute to consumers — is causing average net prices for medicines to fall, according to a new analysis. In the first quarter of 2018, net prices after concessions made by drug makers declined 5.6 percent, compared with a 1.7 percent drop in the corresponding quarter a year ago. This occurred even though increases in average wholesale — or list — prices more or less held steady at 6.2 percent versus 6.8 percent in the first quarter of 2017, according to Sector & Sovereign Research, which tracks the pharmaceutical industry. (Silverman, 6/5)

They are among the most promising new cancer therapies available, but they come with sky-high prices to match. And now the Trump administration is grappling with just how the federal government, through Medicare and Medicaid, will pay for them. The government’s payment policies for CAR-T treatments — which cost hundreds of thousands of dollars — are just beginning to take shape, but will likely have trickle-down effects on insurance coverage decisions throughout the country. They will also likely affect how enthusiastically doctors and hospitals start offering the therapies to patients. (Mershon, 6/5)

Allergan Plc faced a skeptical appeals court Monday as the company defended its use of an American Indian tribe’s sovereign immunity to avoid challenges to its patents from generic-drug makers. Two of three judges on the U.S. Court of Appeals for the Federal Circuit in Washington questioned whether Allergan was seeking to circumvent review by the Patent and Trademark Office. The reviews are widely used by technology companies, banks and insurers who say it offers a way to weed out bad patents. (Decker, 6/4)

Appaloosa and Senator Investment Group LP had previously telegraphed those desires to Allergan, but are turning the screws on the company by making their demands public. In a letter Tuesday to Allergan’s board of directors, released publicly, the activists call for a split of offices both held by Brent Saunders, and hire an outside candidate for either role. They also want to replace at least two additional directors on the board, and upgrade management personnel in critical operating units. (Al-Muslim, 6/5)

As Allergan stock continues to languish, two large hedge funds wrote a blistering letter to the drug maker’s board, urging them to split the roles of chairman and chief executive into separate positions, overhaul top management, and abandon an acquisition strategy. In harsh language, Appaloosa Management and Senator Investment Group criticized Allergan chief executive Brent Saunders and his board for “token measures” to revive the stock. Allergan shares are down about 33 percent in the past 12 months, although the stock was up nearly 1 percent at midday. (Silverman, 6/5)

Two of Allergan Plc's shareholders, hedge funds Appaloosa Management and Senator Investment Group, asked the drugmaker's board to split the role of chief executive officer and chairman as well as reconsider its acquisition strategy. The company has spent billions of dollars in deals in the past years, ballooning its debt to $26.6 billion, more than half of its current market value. (Mishra, 6/5)

Kaiser Health News: Price Check On Drug Ads: Would Revealing Costs Help Patients Control Spending?

President Donald Trump wants to control spending on drugs. One of his big ideas: include prices in advertisements, just like warnings about side effects. That’s not as simple as it sounds. Apart from legal questions about whether the Food and Drug Administration has the authority to require pricing in ads, other uncertainties arise. For example, what is the right number to use? (Appleby and Lupkin, 6/5)

Amid heated controversy over drug prices, Sanofi (SNY) is the latest large pharmaceutical company to release top-line numbers indicating average prices for its medicines fell last year, after accounting for rebates and discounts. Specifically, the company posted a brief summary stating the average wholesale — or list— price for its drugs increased 1.6 percent in 2017, but pricing actually declined by 8.5 percent when subtracting rebates and discounts paid to pharmacy benefit managers, or PBMs, and health plans. In 2016, the average price hike was 4 percent, but the net price fell 2.1 percent. (Silverman, 6/4)

Drug prices fell more than 5 percent in the first quarter, a new analysis found. But what caused the decrease can actually increase costs for patients in the long run. If it sounds wonky, that's because it is.List price, or the advertised amount, of drugs increased 6.2 percent, according to SSR Health. Meanwhile, real net price declined 5.6 percent, compared with 1.7 percent in the same period last year, the firm found. (LaVito, 6/5)

Investors spent the weekend chewing over cancer drug data presented at the American Society of Clinical Oncology annual meeting. It’s Monday, so time to see how the markets are reacting. Looking for ASCO Monday trading winners? Two stocks stood out early: Loxo Oncology and Merck. Loxo posted strong tumor response rates with LOXO-292 in patients with tumors containing a mutated protein known as RET. (Feuerstein, 6/4)

Vulnerable Senate Democrats have found a common villain: the pharmaceutical industry. They're highlighting both drug prices and the opioid epidemic as they try to make their cases to voters. The big picture: Democrats already think health care is a strong issue for them this year, given the unpopularity of the GOP's repeal and replace effort. Opioids and drug prices both resonate deeply with voters, and some Democratic incumbents do have long track records on one or both issues. (Owens, 6/4)

Josh Cox says that CVS will go pretty far in trying to wrest the lucrative business of filling cancer-drug prescriptions away from oncology clinics. The company, which operates a retail pharmacy chain and manages prescription-drug payments for millions of Americans, has long sent unsolicited faxes to cancer doctors, using confidential patient information, in an attempt to steer business to its own pharmacies, said Cox, pharmacy director for the Dayton Physicians Network. (Schladen, 6/3)

Insurers and their pharmacy-benefit managers like to tout mail-order operations as a convenient alternative. But in the world of expensive cancer drugs, the companies use their clout to force patients away from hospital- or clinic-based pharmacies and into their own mail-order operations. It creates another revenue stream for pharmacy benefit managers, or PBMs, the little-known middlemen in the health-care system. (Candisky and Schladen, 6/3)

The intersection of Ames and Main Streets in Cambridge's Kendall Square is perhaps the best place to stand if you want to see the biotech industry boom that has overtaken this region since the turn of the century. ... Although the San Francisco Bay Area competes with this region as the top spot for biotech, experts say the industry is much more concentrated here. (Weintraub, 6/4)

Several drug pricing scandals have grabbed headlines in recent years in cases in which companies hiked the prices of old drugs or jacked up the cost of blockbuster drugs little by little year after year. Another case hasn't garnered the same attention—and maybe that's because people just don't like to talk about vaginas. Branded versions of estradiol, a female sex hormone that treats vaginal atrophy related to menopause—a condition that can cause painful intercourse and other complications—have climbed in price for years, according to an analysis from drug pricing website GoodRx. (Sagonowsky, 6/4)

Amid a reckoning over the representation of women on the drug industry’s most prominent stages, this year’s BIO International Convention will feature a 30 percent increase in female speakers compared with last year. But in a sign of how male-dominated such events remain, the conference will also have 25 panels made up entirely of men. That’s according to a count from GenderAvenger, a group that tracks gender diversity at events. (Robbins, 6/1)

[I]n medical school, they never teach us how to tell our patients or their grieving family members that an “inability to afford medications” is a possible — if not common — cause of death. Neither does the Maryland Department of Health allow us to list “inability to pay” as a cause of death on death certificates. Yet, in this patient’s case, there was no truer underlying cause of death than the blatant unaffordability of her prescription medications. She had been admitted to a different hospital exactly one week before I met her. (Nicky J. Mehtani, 6/4)

The first question often asked when learning someone has cancer is, “What kind of cancer is it?” In the era of immunotherapy, our view of cancer is changing. Today, the patient’s immune system is as important as the type of cancer when treating the tumor. We no longer treat patients using a one-size-fits-all approach that subjects them to physically and financially debilitating treatments that may not work. Modern clinicians attempt to optimize the treatment for the patient using tumor-based biomarkers. This approach is called precision medicine (PM). Even when a PM approach is used, there can be failures. (Raymond J. Tesi, 6/4)

President Trump’s plan to lower prescription drug costs uses a surgeon’s scalpel to address a range of issues, offering nearly 30 policy recommendations to modernize payment policies, weed out counter-productive regulations, improve price transparency, and expand competitive price negotiations. The plan reflects the complexity of the industry and the regulatory system that governs government approval and payment for prescription drugs. While it has some barbs, the blueprint respects the need to provide incentives for companies to continue to invest in research, to protect intellectual property rights, and provide the greater transparency and lower costs consumers are demanding. (Grace-Marie Turner, 6/4)

Don't say I didn’t warn you. Shares of Nektar Therapeutics Inc. plunged some 40 percent Monday morning after a disappointing weekend data update on a combination trial of its lead medicine with Bristol-Myers Squibb & Co.’s immune-boosting cancer drug Opdivo. This is just the latest in a series of roadbumps for such combo cancer treatments, which, as I have pointed out, offer as much risk and uncertainty at this stage as they do promise. (Max Nisen, 6/4)

Have you heard the oft-repeated “fact” that it takes at least 10 years from initial discovery for a new drug to enter the marketplace? Take it with a grain of salt. The drug development journey is closer to 30 years. I’ve experienced the lag time between discovery and commercial success as the co-founder of a biotech startup, and now I study it at the Center for Integration of Science and Industry at Bentley University. (Fred D. Ledley, 6/6)

After years of struggling with the politics of Obamacare, Democrats now view health care as a winning issue. A candidate in Orange County, California, has a chance of winning a primary on Tuesday while running on explicit support for Medicare for All. Single-payer-friendly Democratic candidates are not just running in deep-blue states; they are campaigning in places like New Jersey, Pennsylvania and Illinois as well as Nebraska and Texas. Across the country, Democrats are making health care a top messaging and policy priority, with some red state Democrats running on Obamacare for the first time. (Peter Suderman, 6/5)

Lesbian, gay, and bisexual (LGB) youth are nearly five times more likely to report attempting suicide in the past year relative to their heterosexual peers, and LGB adults are nearly twice as likely as heterosexual adults to report mental distress. These health disparities are not inevitable; they are closely tied to LGB rights. (Julia Raifman and Michael Ulrich, 6/5)

Americans agree on one thing: health care costs too much, both individually and to our nation. In 1960, the average U.S. health care cost per person was $146. As a nation, we expended $27.2 billion, which represented 5 percent of GDP. Fast forward to 2016 when average per capita spending on health care was $10,348, an increase of more than 7000 percent in fifty-six years. In 2016, the U.S. expended $3.4 trillion on health care, note the “tr” instead of “b,” or 18 percent of GDP. While there is consensus that we are spending more than we can afford, people disagree about what to do about it. Some tout price transparency as a method to encourage consumer shopping and thereby lower costs. The idea is gaining traction, but is it a sound concept or merely a sound bite? (Deane Waldman, 6/5)

It’s a practice that has not received much attention, but some employers have moved to "progressive," or wage-related, health benefits in recent years. That's where their lower wage employees pay a smaller share of insurance premiums, deductibles or health account contributions than higher-wage employees do. Why it matters: Unlike consumers in the Affordable Care Act marketplaces, lower wage workers in the far larger group market don’t get any help with premiums or cost sharing. With premiums and deductibles rising and wage growth stubbornly flat, progressive benefits are one way for employers to help their low wage employees with their health care costs. (Drew Altman, 6/6)

Authors try to avoid writing the same book twice. I couldn’t. My book “Pain Killer” first came out in 2003. It was the first one to tell the story of OxyContin; its maker, Purdue Pharma; and the company’s wealthy and secretive owners, the Sackler family. The book appeared at the dawn of the opioid epidemic and the sun quickly set on it. A year after publication, it went out of print. To say I was disappointed is an understatement. I thought “Pain Killer” told an important story about the chaos unleashed when the best intentions of doctors to solve a problem — in this case, pain — get hijacked by the drug industry. The book’s account alone of Raymond Sackler, a little-known but pivotal figure who transformed drug marketing and compromised medical practice in the process, struck me as worth the price of admission. (Barry Meier, 6/6)

As a former Navy SEAL officer turned veterans advocate, I hope our lawmakers who professed their gratitude and condolences during last week’s Memorial Day ceremonies to those who made the ultimate sacrifice in defense of our nation will be inspired to redouble their support of those who have been fortunate to come home. While VA physicians are quick to prescribe powerful drug cocktails (opiates and benzodiazepines) in response to these and other service-related conditions, the federal government continues to deny veterans legal access to a demonstrably safer alternative treatment option — medical cannabis. (Nick Etten, 6/6)

In 1971, when Richard M. Nixon declared war on cancer, “conquering this dread disease” must have seemed like an ambitious but reasonable goal. Within his lifetime, man had split the atom and walked on the moon; now it was time to turn our wealth and our growing knowledge inward, to expand our control over our bodies. But 40 years later, we were still pinned down by a wily enemy, advancing by millimeters through hostile terrain. In 1975, the U.S. mortality rate for all cancers stood at 199 per 100,000 people. In 2015, after decades of money and human effort had been poured into research, that figure stood at 159. (Megan McArdle, 6/5)

Hurricane season is descending once again on the Caribbean, while Puerto Rico is still struggling to recover. Thousands on the island remain without power, a testament to Maria’s long-lasting effects and the island’s poverty.Members of Congress must focus on directing aid to Puerto Rico to prepare it for another potentially damaging season of storms. Congress should also hold hearings on the adequacy of the federal response and whether more could have been done to prevent unnecessary deaths. (6/5)

The hospital was already showing signs of just how woefully unprepared Puerto Rico’s health-care system was to face the unfolding emergency that Hurricane Maria’s winds, rains and floods had brought. Outside the hospital, one of San Juan’s premier institutions situated in the wealthy Condado neighborhood, the tropical sun shone brightly. During the daytime, it almost looked like a nice day to sprawl out on the powdery white sands of the nearby beach. But inside it was a wholly different story. (Armando Valdés Prieto, 6/5)

Have you heard the oft-repeated “fact” that it takes at least 10 years from initial discovery for a new drug to enter the marketplace? Take it with a grain of salt. The drug development journey is closer to 30 years. (Fred D. Ledley, 6/6)

Using candy flavorings to entice young people to start vaping is a bad idea. So is putting menthol in ordinary cigarettes (it makes them more addictive). Yet in the name of preserving “adult choices,” San Francisco voters are being asked to overturn a citywide ban on selling flavored tobacco products. The campaign for repeal — bankrolled by the R.J. Reynolds Tobacco Company, maker of Newport menthol cigarettes — argues that a ban would only drive the products underground, hurting small tobacco retailers. That’s a weak argument for protecting access to “bubble pop,” “strawberry cotton candy” and countless other flavorings that clearly are meant to get youth started on nicotine. (6/5)

Four mass shootings since last October, each with double-digit death tolls, has us all searching for solutions. Although the venues were varied — two high schools, a Texas church and an open-air music festival — the common denominator to these massacres is, of course, the use of firearms and an ample supply of ammunition. In response, we hear the usual conflicting proposals: more gun restrictions or simply more guns to ward off attackers. The debate gets louder and increasingly contentious after each episode of senseless carnage. There is, however, one goal that apparently most can support, regardless of position on the gun-control/gun-rights continuum: taking firearms away from those who are considered dangerous to themselves or others. (James Alan Fox, 6/5)