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Congress is headed for a showdown on whether to insert several pressing health measures in year-end bills, reviving partisan fights that threaten to derail Republicans’ goal to close out the year with a raft of legislative successes. The looming health-care issues include funding for a children’s health program, the possible delay of certain taxes by the Affordable Care Act and the fate of a bipartisan plan to bolster fragile insurance markets. (Armour and Peterson 11/29)

Senate Republicans took a significant step toward passing a sweeping tax overhaul on Tuesday, with a key panel giving its approval and several wavering senators indicating they would support the tax package, helping clear the way for full Senate consideration later this week. ... Senator Lamar Alexander, Republican of Tennessee, said that Senate Republicans were increasingly united about repealing the requirement that most people have health insurance or pay a penalty. (Rappeport and Kaplan, 11/28)

President Donald Trump told Republican senators on Tuesday he supports an Obamacare market stabilization bill offered by Republican Lamar Alexander and Democrat Patty Murray, which may help bolster support for the tax-cut legislation headed for a vote this week. Senator Mike Rounds of South Dakota quoted Trump as telling Republican senators, “I support the Alexander-Murray bill.” (Kapur and Edney, 11/28)

President Trump at a closed-door meeting with GOP senators on Tuesday said he would support two proposals meant to stabilize ObamaCare’s insurance markets in exchange for a repeal of the law's individual mandate, several Republicans in attendance said. The two bills would fund key ObamaCare insurer payments, and provide billions to help states create reinsurance programs for high-cost patients. (Hellmann, 11/28)

In a private meeting with [Sen. Susan] Collins before lunch, and again in front of the larger group of Republicans, Trump signaled openness to Collins’s demands, which include paying federal subsidies to help lower-income Americans afford health coverage and allowing Americans to continue deducting up to $10,000 in property taxes from their taxable income. “It’s certainly progress,” said Collins, who played a central role in derailing GOP health-care bills this year. (DeBonis, Werner and Paletta, 11/28)

News organizations examine how specific tax bill proposals could impact the health industry —

A coalition of 19 patient groups warned Republican senators on Tuesday against repealing ObamaCare’s individual mandate as part of tax reform. The coalition's letter, signed by groups including the American Cancer Society Cancer Action Network, the American Diabetes Association and the American Heart Association, warns of “coverage losses and higher premiums” from repealing the mandate.(Sullivan, 11/28)

Both versions of the Republican-led Congress' tax overhaul levy a new tax on the endowments of major private health-research institutions, and critics say it could have a lasting impact on these facilities and the broader U.S. health research landscape. Republicans have proposed a 1.4% "excise" tax on the net investment income from large endowments of private institutions. Endowments at public universities—including any privately funded endowments for certain research centers at those public universities—will not be affected by the bill. (Luthi, 11/28)

The state stands to lose up to $115 million a year if Congress doesn't renew a program that helps to cover nearly 118,000 children here. The Children's Health Insurance Program, or CHIP, expired on Sept. 30 because of Congress not acting to reauthorize it, and the money in the program is beginning to run out. (Stein, 11/28)

Gov. Greg Abbott’s administration is trying to avoid mailing health insurance cancellation notices to nearly half a million children three days before Christmas. Unless it can get $90 million more in federal funding, though, Texas will end its Children’s Health Insurance Program on Jan. 31. It would send notices about the program’s termination to affected families on Dec. 22. More than 400,000 children of the working poor currently are covered under CHIP, as the state-federal program is known. (Wang, 11/28)

To Republicans, President Donald Trump’s pick for Health and Human Services secretary is competence personified — an able manager who can get the agency back on track after the tumult of Tom Price’s brief tenure and forced resignation. To Democrats, Alex Azar is a pharmaceutical industry shill who knows a lot more about raising drug prices than lowering them. (Cancryn, 11/29)

Skeptical Democratic senators are getting a chance to question President Donald Trump’s pick for health secretary about what he’ll do about rising drug prices and the future of “Obamacare.” Alex Azar’s first confirmation hearing — before the Senate Health Education, Labor and Pensions Committee — was scheduled for Wednesday. The former drug company and government executive has the support of committee Republicans. He’s signaling that he wants to shift away from partisanship, and some prominent Democrats seem to be willing to give him a chance. (Alonso-Zaldivar and Kellman, 11/29)

Alex Azar on Wednesday will make his first public appearance since being nominated by President Trump to lead the Department of Health and Human Services (HHS), the agency tasked with managing ObamaCare. Democrats on the Senate Health Committee are certain to bombard Azar with questions about how he plans to implement ObamaCare, his tenure as a pharmaceutical executive and how he’d lower the rising price of prescription drugs. (Roubein, 11/29)

When Alexander M. Azar appears before a Senate panel Wednesday, the nominee for Health and Human Services secretary will likely face numerous questions about how a former executive of a company that more than doubled the price of a critical diabetes treatment can be President Donald Trump's point man for addressing high drug prices. Azar led U.S. operations for Eli Lilly and Co., the Indiana-based company behind products like Humalog, an insulin that increased in price from $100 in 2010 to $250 in 2016. (Siddons, 11/28)

The Senate Republican tax bill includes the repeal of the Affordable Care Act’s individual mandate, the requirement that all Americans purchase qualifying health insurance or pay a penalty. The move could deal a serious blow to the health law. The repeal of the mandate could result in an estimated 13 million more people without insurance within 10 years, but may potentially lead to federal savings of $338 billion, money that would be used to help pay for broad tax cuts for individuals and businesses. Here’s who pays the mandate’s penalty and how much it costs. (Lai and Parlapiano, 11/28)

In a health care system teeming with fine print, here’s an oddity that middle-class people who buy insurance on their own, rather than through an employer, need to know: You might want to take a pay cut next year. (Boulton, 11/28)

The health insurance industry has long been a target for private equity firms looking for places to stash their cash. Some major health insurers have turned the tables and are pumping money into innovative healthcare startups. Cambia Health Solutions, Blue Cross and Blue Shield companies and Humana are just a few with VC arms that are injecting millions into early stage companies promising to disrupt the industry. Now UnitedHealth's Optum business unit is branching into venture capital with a $250 million fund focused on investing in startups that improve the healthcare delivery and payment systems, along with consumers' access to care. (Livingston, 11/28)

Some Americans may unexpectedly find themselves cut off from tax credits to help buy health insurance under a new proposal by the Trump administration. Currently, the government cannot terminate a consumer’s tax credits, used to get coverage through the 2010 health care law’s exchanges, unless it first notifies the person of the exact reason why and how to appeal the decision. (Williams, 11/28)

The Trump administration’s plan to roll back a requirement for employers to include birth control in their health insurance plans is an unconstitutional endorsement of religion, a group of 19 Democratic state attorneys general said. Allowing employers with religious or moral objections to contraception to block their employees from receiving coverage violates the constitutional separation of church and state and encourages illegal workplace discrimination against women, the states said in a brief filed Tuesday in federal court in Philadelphia. More than 55 million women in the U.S. have access to birth control with no out-of-pocket costs through the Affordable Care Act , the states said. (Larson, 11/28)

Aside from a fax machine and landline telephone, Dr. Anna Konopka, 84, doesn't have much technology in her office. Instead, her patients' records are tucked into two file cabinets, which sit in a tiny office next door to her 160-year-old clapboard house in New London, N.H. Records are meticulously handwritten, she said. ... Konopka said she felt forced to surrender her medical license in September after New Hampshire Board of Medicine officials challenged her record-keeping, prescribing practices and medical decision-making, according to court documents. She is specifically accused of leaving the dosage levels of a medication up to a young girl's parent and failing to treat the girl with daily inhaled steroids. (Eltagouri, 11/29)

Do you need computer skills to be a competent doctor? That's one of the central questions surrounding a difficult case unfolding in New Hampshire this month: Anna Konopka, an octogenarian doctor who eschews computers and has been practicing medicine for the better part of six decades, surrendered her license under a September agreement with the state's board of medicine — partly because of multiple complaints related to her record keeping, Merrimack Superior Court Judge John Kissinger said. (Dwyer, 11/28)

For the past decade, Eli Lilly allegedly relied on a scheme in which nurses were used to illegally promote its diabetes medicines to physicians. A recently unsealed lawsuit describes how the company hired nurses to talk up its treatments to doctors and their patients, an arrangement that purportedly violated federal kickback laws. By doing so, Lilly avoided concerns that sales reps might get little to no face time with doctors and simultaneously helped save physicians from the expense of providing followup care, according to the lawsuit. The approach is sometimes known as “white coat marketing,” which the lawsuit noted is considered problematic by authorities because it may blur trust between doctors and patients. (Silverman, 11/28)

Kaiser Health News: Doctors Make Big Money Testing Urine For Drugs, Then Ignore Abnormal Results
Medicare and other insurers pay for urine tests with the expectation that clinics will use the results to detect and curb dangerous abuse. But some doctors have taken no action when patients are caught misusing pharmaceuticals, or taking street drugs such as cocaine or heroin. Federal pain guidelines say doctors should discuss test results with patients and taper medication if necessary. (11/29)

Two years ago, Margaret O’Neill brought her 5-year-old daughter to Children’s Hospital Colorado because the band of tissue that connected her tongue to the floor of her mouth was too tight. ... During a pre-operative visit, the surgeon offered to throw in a surprising perk. Should we pierce her ears while she’s under?O’Neill’s first thought was that her daughter seemed a bit young to have her ears pierced. Her second: Why was a surgeon offering to do this? ... Only months later did O’Neill discover her cost for this extracurricular work: $1,877.86 for “operating room services” related to the ear piercing — a fee her insurer was unwilling to pay. (Allen, 11/28)

Experts in reducing charges for medical services say patients need to push for detailed answers up front about the true costs of their care. (Allen, 11/28)

Backers of the value movement believe the entire medical system — and every transaction within it — must be based on this seminally important five-letter word. But a survey released Wednesday by the University of Utah shows that, in health care, value has no universal meaning — 88 percent of doctors equated value with quality care, while patients and employers provided a more nuanced definition, mixing in measures of cost, customer service, and worker productivity. (Ross, 11/29)

Three former Drug Enforcement Administration officials urged Democratic lawmakers Tuesday to repeal a 2016 law that effectively took away the agency’s most potent weapon against distributors and manufacturers of prescription opioids. The trio said the authority to instantly freeze shipments of powerful painkillers was the DEA’s most effective tool against giant companies that ignored legal requirements to report suspicious orders of the pills by pharmacies, doctors and others who diverted them for illegal use. Those “immediate suspension orders” not only protected the public from the most egregious abuse but deterred other companies as well, they said at a session held by Senate Democrats. (Bernstein and Higham, 11/28)

At a congressional field hearing on opioids held Tuesday in Baltimore, Republicans, Democrats and health care officials agreed about the scope of the problem, but there appeared to be little agreement about who should do what. The House Oversight and Government Reform Committee came to Baltimore, where opioids have been a particular scourge, at the behest of Rep. Elijah E. Cummings, its ranking Democrat. (Cohn, 11/28)

[Katie] O’Leary, who works for the North Suffolk Mental Health Association, belongs to a new profession whose role is expanding amid the opioid crisis. But as the use of recovery coaches grows, so do the questions: Who are they exactly? What qualifies them to do this work? What are the boundaries of their practice? (Freyer, 11/28)

The illegal use of prescription painkillers is decreasing, but heroin and synthetic fentanyl have grown in popularity among drug users here, says the new U.S. attorney for the Northern District of Georgia. ...very day, 91 Americans die from opioid overdoses. (Miller, 11/28)

DeKalb Medical Center was threatened this month with losing its Medicare provider status after a patient died from an overdose. It was the second time in recent months the hospital has been in trouble with federal officials. (Sharpe, 11/28)

U.S. Rep. Jim Renacci, a Republican from Wadsworth running for governor, said Tuesday that suing drug manufacturers over the opioid epidemic was not a solution to the ongoing drug problem in Ohio. ...Instead, Renacci said the state should focus on education, harsher penalties for drug dealers and community solutions through local organizations and churches. (Richardson, 11/28)

Progress in the global fight against malaria has stalled amid signs of flatlining funding and complacency that the mosquito-borne disease is less of a threat, the World Health Organization said on Wednesday. Malaria infected around 216 million people in 91 countries in 2016, an increase of 5 million cases over the previous year, the WHO said in its annual World Malaria Report. It killed 445,000 people, about the same number as in 2015. (Kelland, 11/28)

Progress toward the global elimination of malaria has stalled, according to a report to be published Wednesday by the World Health Organization. The world made big gains against malaria from 2000 to 2015, with annual infections falling 18% and annual deaths dropping 48%. The WHO was so encouraged by the declines that in 2015 it announced a goal of cutting malaria infections and deaths worldwide by at least 40% by 2020. (Simmons, 11/28)

Half of the Americans recently diagnosed with HIV had been living with the virus for at least three years without realizing it, missing out on opportunities for early treatment and in some cases spreading it to others, according to a new report by the Centers for Disease Control and Prevention. (Healy, 11/28)

If 50 men run 3,510 marathons over the course of three decades, will their heart health suffer or improve? A new study delving into precisely that question concludes that the answer is simultaneously reassuring and complicated, with long years of endurance training seeming not to harm runners’ hearts, but also not necessarily to benefit them in the ways that the runners themselves probably expected. (Reynolds, 11/29)

What happens when a clinical trial fails? This year, the Food and Drug Administration approved some 40 new medicines to treat human illnesses, including 13 for cancer, three for heart and blood diseases and one for Parkinson’s. We can argue about which of these drugs represent transformative advances (a new medicine for breast cancer, tested on women with relapsed or refractory disease, increased survival by just a few months; a drug for a type of leukemia had a more lasting impact), but we know, roughly, the chain of events that unfolds when a trial is positive. ... Yet the vastly more common experience in the life of a clinical scientist is failure: A pivotal trial does not meet its expected outcome. What happens then? (Mukherjee, 11/28)

What many hope will be the final chapter in an unfortunate saga in multiple sclerosis research appears to have been written by the scientist who started the affair in the first place. Italian physician Paolo Zamboni has publicly acknowledged that a therapy he developed and dubbed “the liberation treatment” does not cure or mitigate the symptoms of MS. A randomized controlled trial — the gold standard of medical research — he and other Italian researchers conducted concluded the procedure is a “largely ineffective technique” that should not be recommended for MS patients. (Branswell, 11/28)

Gov. Rick Snyder’s administration is planning to require the replacement of every underground lead service pipe in Michigan within 20 years while delaying by four years a deadline to implement the nation’s toughest lead limit for drinking water, in the wake of the Flint lead crisis. Under draft rules that environmental regulators want to finalize early next year, Michigan’s “action level” for lead in drinking water would gradually drop to 10 parts per billion by 2024, not 2020 as initially proposed. The current federal threshold of 15 ppb has been criticized by the governor as too weak. (Eggert, 11/29)

The former utilities director in Flint, Michigan, has pleaded no contest to a misdemeanor in an investigation of the city’s lead-tainted water. (11/28)

And from California -

Environmental activists sued Tuesday to halt a plan to pump water from beneath the Mojave Desert and sell it to Southern California cities and counties. The lawsuit takes aim at the U.S. Bureau of Land Management for allowing Cadiz Inc. to build a 43-mile pipeline to transfer the water from its desert wells into the Colorado River Aqueduct so it can be sold to water districts. (Jablon, 11/28)

Connecticut state officials heard a renewed call on Tuesday for legislative action to avoid another disruption in health care like the one caused by the contract standoff between Hartford HealthCare and Anthem that lasted seven weeks starting Oct. 1. The Legislature’s Insurance and Real Estate Committee had scheduled a hearing before the two sides came to an agreement on Nov. 18, but decided to go forward with it despite the settlement. (Rigg, 11/28)

Two debt ratings agencies offered different takes this week on bonds issued for the University of Maryland Medical System as it’s poised to break ground Thursday on a new hospital in Prince George’s County. S&P Global Ratings announced that it has raised its ratings on the Maryland Health & Higher Education Facilities Authority's health care revenue bonds issued for the state medical system to A from A- with a “stable” outlook for the future. Fitch Ratings, however, downgraded UMMS bonds to A- from A as the authority is about to issue nearly $175 million in new bonds for UMMS to pay for its share of the new hospital and other projects. (Dinsmore, 11/28)

Blossom Philadelphia said Tuesday in a letter to families that it will transition its residential services for adults with intellectual disabilities to four providers, with the goal of completing the move by the end of the year. It did not identify the new providers of services for Blossom’s 89 residents. The letter from Blossom’s chief executive, Paula Czyzewski, emailed at about 5:30 p.m., said the Chestnut Hill nonprofit would work closely with city and state officials and the new providers to ensure a smooth transition. “We understand that any change can be difficult, but remaining with Blossom Philadelphia for residential services is not an option,” the letter said. (Brubaker, 11/28)

Florida’s leading cancer treatment center is setting up shop in Pembroke Pines under a new partnership with South Broward’s public hospital network, Memorial Healthcare System, to provide clinical care of leukemia and lymphoma and to establish the county’s only blood and marrow transplant cellular therapy program. (Chang, 11/28)

Inspectors arrived Tuesday at Osawatomie (Kansas) State Hospital to determine whether the state-run psychiatric facility can regain its federal certification and, with it, its Medicaid funding. Osawatomie State Hospital lost its certification in December 2015 after a patient attacked a staff member, prompting an investigation that revealed staffing shortages and other issues that put patients and staff at risk. (Fox, 11/28)

And a New York hospital improperly bills sexual assault survivors for rape exams —

A Brooklyn Hospital violated state law when it charged dozens of patients for sexual-assault evidence kits, New York Attorney General Eric Schneiderman said at a news briefing Tuesday. The Brooklyn Hospital Center conducted 86 forensic rape examinations—better known as rape kits—from January 2015 to February 2017. In 85 of those cases, the center billed the patient directly or their private insurance plan without letting the patient know they could receive the exam without charge. (Kanno-Youngs, 11/28)

Dozens of sexual assault survivors were improperly billed for their rape exams by a New York City hospital, the state’s attorney general said Tuesday. Attorney General Eric Schneiderman said that under an agreement with his office, the Brooklyn Hospital Center will reimburse patients who paid out of pocket for a rape kit and will inform rape survivors going forward that under a 2005 New York state law the rape kits can be billed to the state’s Office of Victim Services. (Matthews, 11/28)

Gov. Kim Reynolds defended Iowa's privatized Medicaid program Tuesday, the day after state officials announced that some Medicaid recipients again will see a change in their coverage options. ... Iowa shifted to a privatized Medicaid system in 2016 under former Gov. Terry Branstad, hiring three private companies to manage benefits and coordinate care for Iowans. Last month, AmeriHealth, the largest of those three companies, threw a wrench in the system when it announced it would withdraw from the program on Thursday. That left 215,000 Medicaid recipients looking for coverage from one of the two remaining companies: Amerigroup and UnitedHealthcare. (Pfannenstiel, 11/28

Although the Iowa Department of Human Services has been embroiled in several controversies over the past year, director Jerry Foxhoven gave a glowing assessment of his agency Tuesday in a budget presentation to Gov. Kim Reynolds. Foxhoven, who has been on the job fewer than six months, described Iowa's Medicaid health care program for low-income patients as having high levels of customer satisfaction. He said it's one of the best states in the country for overall child well-being and for mental health treatment. (Petroski, 11/28)

Arkansas has once again cut off Medicaid funding to Planned Parenthood following a recent court ruling. The state's Department of Human Services said it terminated Planned Parenthood's status as a Medicaid provider last week when the court's ruling formally took effect, according to The Associated Press. (Hellmann, 11/28)

A deeply divided federal appeals court in New Orleans refused Tuesday to reconsider a ruling that lets Planned Parenthood facilities in the state continue to receive Medicaid funding. The vote was 7-7 among the 14 active judges on the 5th U.S. Circuit Court of Appeals, which currently has three vacancies. (McGill, 11/29)

In other Medicaid news -

New legislation from Sen. Bernie Sanders (I-Vt.) would lift the federal cap on Medicaid funding for Puerto Rico and the U.S. Virgin Islands in an attempt to put the territories on equal footing with the rest of the country. The provision is part of a $146 billion recovery plan for Puerto Rico and the Virgin Islands that Sanders unveiled Tuesday, and could help the territories overcome a major Medicaid funding crisis. (Weixel, 11/28)

Milwaukee's police chief and a former executive at A.O. Smith called on Congress to act quickly and re-up funding for a home visiting programs for at-risk mothers. ... A key initiative of the program is the voluntary Nurse-Family Partnership that connects at-risk mothers with a nurse, who serves as a mentor on child-rearing until the baby reaches age 2. (Luthern, 11/28)

Human papillomavirus is preventable through a routine vaccine recommended by the CDC for adolescents, but Texas currently has the fifth-lowest vaccination rate in the country, says the study, released Wednesday by the University of Texas System Office of Health Affairs. ...According to the report, just 39.7 percent of women and 26.5 percent of men in Texas were up-to-date with the vaccine in 2016. (Arraiga, 11/29)

The Central Arizona Dental Society Foundation is looking for additional dentists and volunteers to be part of its sixth annual Dental Mission of Mercy event to provide free care to adults and children in need. The foundation estimates that dental professionals will provide $2 million in free care to more than 2,000 adults and children on a first-come, first-served basis on Dec. 8 and 9 at Veterans Memorial Coliseum in Phoenix. (Carbajal, 11/28)

Among the many issues that need to be addressed: Local hotels need to be equipped appropriately to handle patients recuperating from various types of treatments. Hospitals need to train their doctors to be culturally sensitive to patients coming from different parts of the world. They may need more translators. Or special prayer rooms. Or luxury cars to ferry patients to and from the hospital. Their cafeterias need to brush up on global flavors and culinary favorites, as well as faith-based dietary restrictions. (Keshavan, 11/29)

An Orleans Parish inmate diagnosed with multiple mental illnesses who told jail staff he was "hearing voices and seeing spirits" was moved last year from a psych ward to the jail's general population as a punishment for minor infractions, a lawsuit claims. Five months after the transfer, the suit says, deputies found 23-year-old inmate Colby Crawford dead in his cell after overdosing on cocaine that another inmate in the general population housing unit smuggled into the jail. (Lane, 11/28)

Within the next week, Rise is scheduled to begin selling a variety of cannabis products, such as flowers, patches and oils. Four of the state’s other eight dispensaries — including Potomac Holistics in Rockville — say they expect to have medical pot delivered and available for sale by Friday, marking the official launch in Maryland of an industry that is worth billions nationwide. Two said they expect to receive their initial batch of marijuana from Curio Wellness in Baltimore County, which did not return messages seeking comment. (Siegel and Nirappil, 11/28)

Cannabis dispensaries in San Francisco will be allowed to operate closer to schools under rules the Board of Supervisors approved Tuesday. The new regulations, passed on a 10-1 vote with Ahsha Safai in dissent, will reduce the school buffer zone from 1,000 to 600 feet, the amount recommended by the state. (Swan, 11/28)

Standing amid stacks and stacks of boxes of condoms, Scott Petinga made his pitch Tuesday to about 50 advertising and public relations professionals gathered in a restaurant meeting room. His message: Men, especially young men, need to take care of their sexual health. The entrepreneur and philanthropist wasn’t trying to sell the boxes of his company’s prophylactics brand, Rouse. He gave away 50,000 of the condoms to the South Jersey AIDS Alliance. (Urgo, 11/28)

The Montana Supreme Court on Tuesday ordered the creation of a special court to oversee hundreds of claims filed on behalf of people who became ill or died following exposure to asbestos from the now-closed W.R. Grace Inc. vermiculite mine in northwestern Montana. With at least 540 lawsuits pending and Grace’s bankruptcy proceedings complete, justices said there was sufficient need to create the Asbestos Claims Court under an act passed by lawmakers in 2001. (Hanson and Brown, 11/29)

Minnesota farmers and rural residents who need financial guidance or emotional support again have a place to go: The Farm and Rural Helpline. The Minnesota Department of Agriculture launched the service this fall, replacing an earlier farm crisis line. (Weber, 11/28)

Since one of every four deaths in the U.S. is due to cancer, a lot of lives could be saved if that drug development time could be cut down to just a year. Cancer researchers at UCSF and computer scientists at Lawrence Livermore National Laboratory are partnering with researchers from the National Cancer Institute’s Frederick National Laboratory and pharmaceutical giant GlaxoSmithKline (GSK) in an attempt to do just that. (Snow and Venton, 11/28)

Kaiser Health News: Teaching Teens The Perils Of Pot As Marketplace Grows
After Yarly Raygoza attended the drug prevention program at the Boys & Girls Club here last year, she used what she learned to talk a few friends out of using marijuana. The 14-year-old took the class again this year but worries that counseling her friends will become more difficult. Recreational marijuana is now legal in California, which could bring a massive boom in drug sales and advertising when stores can begin selling the drug to adults without a prescription in January. (Gorman, 11/29)

“Do you support reproductive choices of all shapes and sizes?” the flier had read, posted online in early April. “Become an abortion doula.” More than 50 women had seen the flier on Facebook or Twitter and responded to the email address at the bottom, not entirely sure what an abortion doula was. Twenty-five had been selected for a weekend-long training at a Virginia abortion clinic, and now, one Saturday morning in May, they’d arrived to see whether they were right for the work. (Hesse, 11/28)

When Tribal Chief Eric Thompson first heard about a new venture to get the Saint Regis Mohawks into the business of intellectual property, he was hesitant. "I had never heard of an IPR," Thompson recalled, referring to a system of challenging patents called inter partes review. Most people haven't — IPR resides among the intricacies of patent law that generally don't surface outside legal circles — but the system has been steadily increasing in popularity since it was introduced in 2011, championed by giants of the technology industry, such as Apple, Google and Facebook. They see it as a more efficient way of dismantling bad patents, often held by so-called patent trolls. It's come to be despised by many big pharmaceutical companies. (Tirrell, 11/27)

In a case with major implications for the drug industry, Supreme Court justices appeared divided Monday along partisan lines on the constitutionality of the Patent and Trademark Office’s system for handling patent challenges outside the courts. Liberal justices during oral arguments appeared to favor keeping the agency’s process known as inter partes review, while conservative justices expressed concern with the process. (Karlin-Smith, 11/27)

Kaiser Health News: The Ratcheting Cost Of The Pneumococcal Vaccine: What Gives?
Every November, like clockwork, she gets the same letter, said Dr. Lindsay Irvin, a pediatrician in San Antonio. It’s from the drug company Pfizer Inc., and it informs her that the price tag for the pneumococcal vaccine Prevnar 13 is going up. Again. And it makes her angry. 'They’re the only ones who make it,” she said. “It’s like buying gas in a hurricane — or Coke in an airport. They charge what they want to." (Luthra, 11/29)

Pharmaceutical Research and Manufacturers of America, the drug industry's leading trade group, urged the high court to put a stop to patent cancellations. "The pharmaceutical industry invests hundreds of billions of dollars in researching and developing new treatments to improve the health and welfare of the public across the globe. Those investments make sense only because the resulting intellectual property is respected as property," PhRMA said in a brief. (Baker, 11/27)

Normalcy hasn’t been the norm at Valeant for a while. The company has been Exhibit A of corporate turbulence since 2015, a span when its drug-price increases and accounting were attacked, top executives ousted and market cap nosedived 94%. That erased about $84 billion in worth, more than the equivalent of Caterpillar Inc. [CEO Joseph] Papa, the low-key drug-industry veteran hired 18 months ago to turn around Valeant, said it has returned to pharmaceutical-business-as-usual and is now on a path to recovery. The company noted recent growth in its Bausch & Lomb eye-care and Salix gastrointestinal-drug businesses, which combined represent about three-quarters of the company’s revenue. (Rockoff, 11/28)

Facing a huge debt, pricing pressures, and various missteps, the new Teva Pharmaceutical (TEVA) chief executive on Monday overhauled his management team and reorganized key business units in a Hail Mary bid to revive the beleaguered drug maker. Underscoring the severity of the situation, those exiting at the end of next month include three key executives: R&D chief Michael Hayden; Rob Koremans, who headed the global specialty medicines group; and Dipankar Bhattacharjee, who ran the global generic drug business. (Silverman, 11/27)

Express Scripts Holding Co. is trimming some of its ties to a $35,000-a-vial medicine made by Mallinckrodt Plc by selling a unit that helps patients access some high-priced drugs. Avista Capital Partners, a private equity firm, will buy Express Scripts’ United BioSource division, the firms said in a statement. United BioSource’s website says it helps “maximize product access and commercialization,” helps drug companies “overcome access and adherence challenges” and provides drug testing services. (Rausch and Langreth, 11/27)

Express Scripts Holding Co. said that it has reached an agreement to sell its subsidiary, United BioSource, to private-equity firm Avista Capital Partners.  Financial terms of the deal were not disclosed. UBC provides pharmaceutical and support services. The company was founded in 2003 and is located Blue Bell, Pa. Express Scripts acquired the firm as part of its blockbuster purchase of Medco in 2012. (Liss, 11/27)

Scott Gottlieb, the commissioner of the Food and Drug Administration, this morning announced plans to speed generic versions of treatments that combine a drug and a device – treatments like EpiPen, which became controversial last year because its price had quintupled. One of the weirdest things about the EpiPen fracas was that it could happen at all. Teva, the generic drug firm, had tried to bring a cheaper copy to market. Copycat versions had been launched by other drug companies, but were not considered true generics, that is, they couldn’t be substituted at the pharmacy and required their own prescriptions. When a generic was finally introduced, it was by EpiPen’s maker, Mylan Pharmaceuticals. (Herper, 11/28)

Kaiser Health News: Heated And Deep-Pocketed Battle Erupts Over 340B Drug Discount Program
A 25-year-old federal drug discount program has grown so big and controversial that it faces a fight for survival as federal officials and lawmakers furiously debate the program’s reach. The program, known as 340B, requires pharmaceutical companies to give steep discounts to hospitals and clinics that serve high volumes of low-income patients. (Tribble, 11/28)

Responding to rising concerns over drug prices, the Netherlands health minister wants to explore compulsory licensing in order to obtain certain medications at a lower cost. By putting this on the table, the Netherlands becomes at least the fourth country in little more than a year to consider this option, which typically riles the pharmaceutical industry over concerns that such moves may eviscerate patent rights. (Silverman, 11/27)

President Trump swept into office threatening to bring the hammer down on high drug prices, accusing pharmaceutical companies of “getting away with murder.” Over the past few weeks, his administration has tweaked how Medicare reimburses hospitals for certain drugs and sought feedback on a radical idea to pass prescription drug rebates directly to seniors. All of this could ultimately lower out-of-pocket drug prices for some. But there's one part of the health-care system so far being spared any real pain: the drug companies themselves. (Carolyn Y. Johnson, 11/24)

The productivity crisis that has challenged the pharmaceutical industry for years shows no sign of abating. Contrary to the popular opinion that the industry simply doesn’t spend enough on research, budgets for research and development have actually increased over the last 10 years. Yet R&D productivity continues to stagnate. (Steve Arlington, 11/29)

It’s a diagnosis that no parents want to hear - their child has acute lymphoblastic leukemia (ALL). While a treatable cancer of the bone marrow and blood, traditional drug treatment regimens can be brutal and not always successful. But, in August the FDA announced the approval of a new gene therapy to treat ALL. Known as Kymriah (tisagenlecleucel), this Novartis product is the first gene therapy approved in the U.S., thereby opening a new era in medicine. (John LaMattina, 11/28)

A court case over an obscure fracking patent could put an end to one of the pharmaceutical industry's biggest irritants. The Supreme Court heard arguments Monday in two patent cases that could determine the future of inter partes review (IPR) -- an expedited patent-challenge process that has knocked out thousands of patents and has been turned against several blockbuster drugs. It was thrust into the headlines after Allergan PLC tried to avoid it by taking advantage of a Native American tribe's sovereign immunity. (Max Nisen, 11/28)

It's not looking good for Eylea, Regeneron Pharmaceuticals Inc.'s best-selling medicine. Earlier this month, Novartis AG reported strong trial results for a possible competitor to the blockbuster eye drug. And on Monday, Regeneron announced it was giving up trying to combine Eylea with another medicine -- an effort that might have helped defend against Novartis's entry.  (Max Nisen, 11/27)

Last April, Gov. Susana Martinez vetoed legislation that could have saved New Mexico millions of dollars a year in prescription drug costs for state agencies and its employees and retirees. Senate Bill 354, which passed the Legislature with strong bipartisan support, would have required all New Mexico state agencies that purchase pharmaceutical drugs to work together to aggressively seek a better deal on drug prices. (Jeff Steinborn, 11/24)

The costs of prescription drugs are rising at an alarming rate – during just one 12-month period, drug prices increased by an average of nearly 10 percent. Though prescription drugs can play a critical role in everything from managing chronic health conditions to treating previously incurable diseases, an anticipated spike in prescription drug spending – from $450 billion in 2016 to $610 billion by 2021 – clearly signals a national healthcare crisis that must be addressed. (Kim Keck, 11/23)

Today, the merger of Luxottica and Essilor threatens to create a vision care monopoly and you don’t need a corrected prescription to clearly see it will harm consumers with higher prices and less choice. The question remains: When will we be tough enough to prevent harmful consolidation? It’s easy to see why the merger of Essilor and Luxottica should be denied. The merger would combine the world’s largest eyewear company with the world’s largest manufacturer of optical lenses. But that is an oversimplification. The merger also involves the U.S.’s second largest vision insurance company, owned by Luxottica, and the U.S.’s largest optical retailer, composed of many companies all owned by Luxottica. (David Balto, 11/28)

The Department of Defense has long sought to make free-dried blood plasma available to treat seriously wounded military personnel on the battlefield, to increase the likelihood that they survive to reach more suitable medical care. Freeze-dried plasma was used in World War II and the Korean War, but was abandoned because of concern over transmission of blood-borne diseases such as hepatitis, which at that time could not be detected in donated blood. Since then, French and German companies have developed safer freeze-dried plasma products. They have been available in Europe since 1991, but have not been approved by the Food and Drug Administration (FDA). ... Even 10 years after the application for the French product was filed, the FDA still has not approved it, which limits military use to a restricted set of circumstances. The more recent product developed by the U.S. Army is even farther behind in the approval process. (Robert Book, 11/28)

Why would Christian conservatives in good conscience go to the polls Dec. 12 and vote for Judge Roy Moore, despite the charges of sexual misconduct with teenagers leveled against him? Answer: That Alabama Senate race could determine whether Roe v. Wade is overturned. The lives of millions of unborn may be the stakes. Republicans now hold 52 Senate seats. If Democrats pick up the Alabama seat, they need only two more to recapture the Senate, and with it the power to kill any conservative court nominee, as they killed Robert Bork. (Patrick Buchanan, 11/28)

In September, House Speaker Paul Ryan let the Community Health Center Fund lapse. Now, unless Congress acts to renew this funding, our health centers are bracing for a 70 percent budget cut. (Barbara Lee, 11/28)

The Children’s Health Insurance Program (CHIP) usually flies under the radar, but this year it’s about to blow a massive hole in California’s budget. ... This year, Congress blew its Oct. 1 deadline to renew CHIP funding, mostly because it was focused on a lamentable effort to repeal the Affordable Care Act. (11/28)

There is a signature issue to guide the Democrats forward in 2018, 2020, and beyond. It is an issue that Americans are passionate about — one that has clear, distinct policy proposals. And, as we have seen in recent weeks, it is a winning issue: gun violence prevention. ... The NRA has lost ground largely because the “passion gap” between pro-gun voters and gun violence prevention voters has all but evaporated. Voters — both Democrats and Republicans — are tired of the NRA’s extreme, dangerous agenda, they are voicing their outrage, and leaders are listening. (Josh Horwitz, 11/28)

Missourians enjoy the right to own and carry firearms though the Second Amendment of the U.S. Constitution, the Missouri Constitution, and state statutes, but firearms safety should be an important part of firearms ownership for the armed citizen. (Aaron Evans, 11/28)

It’s official. The for-profit insurers contracted to manage Iowa's Medicaid program can do anything. They are calling the shots while the Iowa Department of Human Services appears to have lost control over the $4 billion program it is supposed to oversee. Isn’t DHS director Jerry Foxhoven tired of scrambling to cobble together "fixes" in response to the demands and whims of private insurers? Iowans are sure tired of it. (11/28)

This week, the Bipartisan Policy Center will release a report summarizing research linking affordable housing, the majority of which is financed through [the Low-Income Housing Tax Credit], to improvements in health behaviors and outcomes. The evidence is building that housing affordability, the neighborhood’s environment and conditions within the home are all important determinants of health. This has stimulated states and affordable housing development agencies to begin looking at ways LIHTC may be used to improve health. Therefore, we strongly support greater federal investment in this important program. (Anand Parekh and Caitlin Krutsick, 11/27)

This return to the criminalization of drug users will set back efforts to solve this epidemic. I know this not only because of what almost every measurement shows us about the failure of the war on drugs, but because of my own life. When I was addicted to heroin, I avoided treatment for years in fear of being labeled an addict or treated like a criminal, the way I saw my friends were--most of whom eventually relapsed due to the pressure of that stigma. Kids (and adults) can say no to drugs all they want—but that’s not going to help us solve the addiction problem we already have on our hands. (Elizabeth Brico, 11/28)

For thousands of Californians suffering from chronic and persistent illnesses, access to quality, affordable medical care is essential to their overall health. Yet, these patients have a one-in-four chance of being denied coverage by their insurance provider, according to a recent poll. (Seth Ginsberg, 11/28)

Early-career health professionals may feel like a cog in a gargantuan unchangeable machine. That feeling, if left untreated, can devolve into cynicism and disillusionment. It can lead to higher rates of job turnover, and subsequently poorer care coordination and patient outcomes. With the Health Activist Network, we want to show young professionals that they control the lever. We want to harness the passion that guided them toward the medical field in the first place and use it for real-world improvements in the communities where they work and live. If you say you want a health care revolution, we don’t want to “change your head”—we want to help you make it happen. (Karen Wolk Feinstein, 11/28)