Drug Costs Archives - 麻豆女优 Health News /tag/drug-costs/ 麻豆女优 Health News produces in-depth journalism on health issues and is a core operating program of 麻豆女优. Wed, 03 Jun 2026 17:39:32 +0000 en-US hourly 1 https://wordpress.org/?v=6.8.5 /wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=32 Drug Costs Archives - 麻豆女优 Health News /tag/drug-costs/ 32 32 161476233 Telehealth Booms as Demand for GLP-1s Surges and Questions Mount About Safety, Oversight /health-industry/glp1-weight-loss-drugs-telehealth-oversight-regulation-compounded-semaglutide/ Mon, 01 Jun 2026 09:00:00 +0000 /?p=2236393 Within 24 hours of injecting the first dose of a weight loss medication she received following a visit with a telehealth doctor, Karleigh McClain was admitted to the hospital, she said.

The 31-year-old compliance consultant from Hendersonville, Tennessee, said she couldn’t stop vomiting.

“Sunday morning, it all hits,” McClain recalled, as she described what happened that weekend in January. “I can’t keep anything down.”

McClain said she thought the dosage the telehealth company had prescribed seemed too high. She tried to contact her doctor, but when she didn’t get an immediate response, she said she called the company and a “care team” representative confirmed the instructions — which said to inject 2.21 milligrams of the semaglutide medication once a week — were correct.

It turned out, however, that was nearly nine times the amount patients are typically told to take for their first dose.

Nearly a month after she was diagnosed with an overdose, McClain said she was “still dealing with the residual side effects,” including an elevated heart rate and vision problems she felt were tied to the medication.

Most patients who have taken a GLP-1 received their prescription through a primary care doctor or a specialist, shows. But as the uptake of telehealth has grown substantially since the start of the covid pandemic, McClain is one of millions of Americans who have used online companies to meet a variety of their medical needs.

Many of the companies have started offering GLP-1 medications for weight loss as demand for these drugs has exploded. But certain medication errors tied to GLP-1s have exploded too, according to a 麻豆女优 Health News review of Food and Drug Administration data, and physicians and telemedicine researchers worry that adverse experiences tied to telehealth companies are becoming more common.

Bad outcomes aren’t unique to telehealth providers or to the compounded weight loss drugs many of them offer. In fact, product liability lawsuits alleging patient injuries have been filed overwhelmingly against pharmaceutical giants Eli Lilly and Novo Nordisk, which manufacture name-brand weight loss drugs, court data shows. The drugmakers have defended their products.

However, some critics are also concerned that getting a weight loss prescription online is usually much easier than getting one through an in-person appointment. Not only do many telehealth companies write quick prescriptions for GLP-1s, but they often sell the medications, too, allowing patients to bypass in-person pharmacy visits. This one-stop shopping isn’t necessarily a good thing, according to critics who say some telehealth providers are writing prescriptions for people who should not be taking GLP-1s and then providing little or no follow-up care.

“It gives a black eye to telemedicine,” said Elizabeth Krupinski, an experimental psychologist at Emory University who has conducted research on the effectiveness of telehealth.

Telemedicine stands to benefit “so many people,” Krupinski said, particularly when the technology is integrated within a larger healthcare system. That way, patients benefit from the convenience of telehealth while maintaining a connection with their in-person providers.

But some telehealth companies are marketing GLP-1s as an easy way to lose weight — sometimes with the help of paid celebrity endorsements — without emphasizing the importance of healthy eating and exercise, she said.

They may be following the letter of the law, Krupinski said. But writing prescriptions while skimping on care “is not in the Hippocratic oath.”

A woman's hand holds a small vial of liquid GLP-1 medication on a table.
McClain says she overdosed on an injectable weight loss medication in January after following dosing instructions from a telehealth provider. (Arielle Weenonia Gray for 麻豆女优 Health News)

The Perfect Storm

Starting around 2020, many states loosened restrictions on telehealth, which allowed online companies to proliferate. This helped accommodate patients who could not, or chose not to, be seen in person at the height of covid transmission.

Expanded telehealth access was also intended to lower barriers in rural communities, as well as mitigate doctor and nurse shortages. In many places, telehealth doctors and nurses are legally allowed to treat patients across state lines. But the way telemedicine is practiced , and state laws largely dictate rules that telehealth providers must follow.

Some companies, such as Mochi Health, require patients to meet virtually with a provider, such as a doctor, nurse practitioner, or physician assistant, before they can get a GLP-1 prescription.

But others, including Ro, sometimes require nothing more of patients than an “asynchronous” evaluation, which does not include a live conversation with a healthcare provider. During this type of evaluation, customers are typically asked to fill out an intake form and answer a medical history questionnaire before they are evaluated for a prescription. Ro requires a conversation in real time when required by state law, or when requested by a patient or clinician, said Nicholas Samonas, a spokesperson for the company.

“Every patient is counseled by their provider on the potential benefits and risks of treatment based on their individual medical history,” Samonas said. Ro’s clinicians can order lab work when necessary and, when appropriate, may recommend patients seek in-person care, he said.

But some medical experts are concerned that virtual care may be insufficient for prescribing weight loss drugs.

Patients with a history of pancreatitis, for example, should be counseled about potential complications, medical studies show. The same goes for people with a condition called gastroparesis, which affects stomach nerves and muscles, and those susceptible to medullary thyroid cancer.

Some patients may also benefit from blood work or muscle mass screening before starting a GLP-1.

But not all telehealth companies are adequately evaluating patients before writing prescriptions, said Marc-Andre Cornier, an endocrinologist at the Medical University of South Carolina and the immediate past president of The Obesity Society.

When it comes to parsing the good from the bad, “whose job is it to police that?” he asked. The problem, he said, is there aren’t criteria written by a government agency or a medical society to determine which providers are treating patients appropriately and which aren’t.

While the first GLP-1 was approved by the FDA more than 20 years ago, to treat Type 2 diabetes, the use of these drugs took off in 2021 when Novo Nordisk received approval for a semaglutide drug to treat obesity, with the brand name Wegovy. In a 2025 麻豆女优 poll, said they had taken a GLP-1.

In a in The New England Journal of Medicine, physician Amanda Banks noted that the proportion of GLP-1 prescriptions written for people who were not diabetic, obese, or overweight increased from 4.5% in 2018 to 17% in 2023.

In the paper, Banks called it “troubling” how easy it is to obtain a prescription for weight loss drugs and worried they might exacerbate existing eating disorders or cause new cases, including of anorexia.

Cornier, who has received compensation from Novo Nordisk for serving as a consultant, echoed some of Banks’ concerns. “It’s not just filling out a form online and then having some random healthcare provider sign off on it,” he said. “There are concerns with some of these online programs that there’s not a proper evaluation, there’s not a baseline, and there’s not proper supervision.”

The American Telemedicine Association, which advocates for the expansion of “digitally enabled care,” has not addressed how telehealth providers prescribe GLP-1s, spokesperson Gina Cella said.

“This is a bit out of our scope,” Cella said, when asked if the association had addressed the topic of telehealth providers and GLP-1 prescriptions.

The lack of clarity makes choosing a company potentially confusing for patients, and the medical profession is partly to blame, said Jamy Ard, an obesity doctor and researcher at Wake Forest University School of Medicine in Winston-Salem, North Carolina.

Doctors have historically done a bad job counseling patients about weight loss, and many people aren’t comfortable talking to their primary care doctor about it, Ard said. Patients think, “Why would I go to my doctor and have them say, ‘Eat less and move more,’ when I have heard that a million times and I don’t want to have that lecture again?” Ard said.

This problem, combined with past shortages of name-brand versions of GLP-1s, such as Ozempic, Mounjaro, and Trulicity, has created a “perfect storm” for telehealth companies to flourish, said Ard, who has received support from pharmaceutical and telehealth companies.

While some telehealth companies prescribe only name-brand weight loss drugs, many also offer cheaper, compounded versions. They act as intermediaries between customers and mail-order compounding pharmacies, which create GLP-1s by mixing active ingredients, such as semaglutide, with additives. The ingredients for compounded drugs are commonly sourced from overseas suppliers, and the formulations are not reviewed by the FDA for safety.

The environment is “very much uncontrolled and poorly, if at all, regulated,” Ard said. “There is just no standard of care.”

Emily Hilliard, a spokesperson for the Department of Health and Human Services, told 麻豆女优 Health News that compounded drugs “should only be used in patients whose medical needs cannot be met by an FDA-approved drug.”

Hilliard said the agency urges “consumers to be vigilant and know the source of their medicine.”

Understanding the Risks

While weight loss drugs have helped millions of people lose weight, they’re not without risk, the data shows.

A 麻豆女优 Health News data analysis of the FDA’s Adverse Event Monitoring System found that medication errors made by providers or patients with popular weight loss drugs exploded from just over 2,000 reports in 2020 to over 25,000 in 2025. Those self-reported events involved semaglutide, tirzepatide, dulaglutide, and liraglutide, the generic names for leading GLP-1s.

Among frequent issues cited in the adverse event reports were administration of an extra or incorrect dose, issues with communication about a product, and prescribing errors.

Reports of GLP-1 Errors Explode (Column Chart)

Since 2019, the National Poison Data System has fielded a related to overdoses or side effects from injectable weight loss drugs. The data does not distinguish between overdoses tied to a telehealth prescription and those stemming from an in-person medical appointment, but it is a reflection of how prevalent these drugs have become.

Yet data on potential medication errors and adverse reactions to GLP-1 medications is incomplete, because many issues are never reported to federal officials.

For example, in a , the FDA accused drugmaker Novo Nordisk, the maker of Wegovy and Ozempic, of failing to report some adverse events to the federal government, including suicidal ideation and death.

Nobody knows how often adverse events occur, said Kristen Nixon, a Johns Hopkins University researcher who has studied posts about weight loss drugs on Reddit, a popular online forum.

Her team analyzed hundreds of Reddit posts from 2020 through last August and identified frequent mentions of drug reactions and user errors, such as patients’ not knowing how to correctly dose and inject the medication.

But another finding also stood out to her.

“Wow, there are a lot of people talking about telehealth,” Nixon recalled thinking. Reddit commenters said they got GLP-1 prescriptions from scores of telehealth platforms, Nixon found. Commenters also mentioned several dozen compounding pharmacies — often in the same posts about telehealth.

Pharmacies are typically required to counsel patients on medications they receive. But Nixon’s research found that telehealth companies often mail the medications directly, meaning patients do not need to go to a pharmacy.

“Anecdotally, it seems like the telehealth companies are really facilitating access to compounded medications,” Nixon said.

A collage of 6 advertisements for online GLP-1 medication.
A collage of weight loss drug advertisements on social media from telehealth companies. In recent months, the Trump administration has sent warning letters to online companies for false or misleading claims related to compounded versions of GLP-1 medications. (Collage by 麻豆女优 Health News)

Leslie Gammon, 54, an office manager from Wendell, North Carolina, said she turned to a telehealth company called Amble Health for a weight loss drug prescription. She was given a GLP-1 after filling out an online form, she said.

Like McClain, when she received her mail-order compounded medication in late October, she thought the dosage that accompanied it seemed too high. She’d received a box of semaglutide earlier in the month with a much lower dose. But the refill she received was a stronger formulation, and the instructions told Gammon to inject three times the volume she had been taking in previous weeks.

Even though she injected slightly less than that recommended amount before bed on a Sunday evening, she woke up in the middle of the night “throwing up every 20 to 25 minutes,” she said. And it didn’t stop until Tuesday. She was eventually admitted to a hospital in Raleigh and now owes the hospital over $9,000, a medical bill shows.

Amble Health did not respond to questions for this article.

The delivery system for injectable versions of weight loss drugs is more complicated than for a pill. In its National Poison Data System alert, America’s Poison Centers noted that some people reported “accidentally taking 10-times the recommended dose due to confusing measurement units while using a syringe.”

And people who are eager to lose extra weight — before a wedding or a vacation, for example — may choose to self-administer a higher-than-recommended dose, said Arthur Caplan, a bioethics professor at New York University’s Grossman School of Medicine.

Some telehealth companies aren’t doing enough, he said, to make sure patients understand the risks or the complex delivery system associated with the injectable drugs.

“The consent is not adequate,” Caplan said. “There’s no probing to see if you understood anything.”

Cella, with the American Telemedicine Association, said the group has not addressed the difficulty of educating patients about the risks of injecting weight loss drugs. But she pointed to the association’s “,” which states that telehealth business models “must put the patient first.”

Proceed With Caution

Pharmaceutical companies must list potentially harmful side effects when they advertise the name-brand versions of their FDA-approved medications. Potential include nausea, vomiting, changes in vision, low blood sugar, and, in rare cases, thyroid cancer. Meanwhile, telehealth companies have not historically followed the same rules that drugmakers have in disclosing medication risks in advertisements. But the FDA has started cracking down on misleading drug ads.

A national shortage of weight loss medications in 2022 opened the door for compounding pharmacies to manufacture these drugs. But since the FDA declared the shortage over last year, companies that offer compounded drugs are increasingly facing legal and regulatory challenges related to their marketing tactics.

Mounjaro manufacturer Eli Lilly and other drugmakers are suing multiple telehealth companies for promoting compounded versions of their drugs. In one legal complaint, Eli Lilly alleged Mochi Health had engaged in “deceptive” business tactics. In a motion to dismiss the lawsuit last year, lawyers for Mochi Health called the complaint part of a “nationwide campaign to bolster Lilly’s profits by dictating patient care through the elimination of compounded drugs as a treatment option for weight management.” The lawsuit is ongoing.

Eli Lilly spokesperson Michael Jamison said in a written comment that telehealth companies sued by the drug manufacturer threaten “patient safety by falsely promoting supposedly ‘personalized’ compounded tirzepatide” and mislead “consumers about the safety, clinical testing, and effectiveness of their compounded knockoffs.”

Meanwhile, Novo Nordisk has filed 130 lawsuits against “entities engaged in unlawful marketing and sale of knockoff semaglutide drugs,” said Liz Skrbkova, a spokesperson for the drugmaker.

She said the company is committed to “protecting patients from unapproved knockoff drugs made with foreign, inauthentic active pharmaceutical ingredients that pose significant safety and efficacy risks.”

The Trump administration sent a in September and February to online companies such as , , , and . The FDA said these and other companies had made false or misleading claims related to compounded versions of weight loss drugs.

“Your claims imply that your products are the same as an FDA-approved product when they are not,” the agency’s Center for Drug Evaluation and Research on Sept. 9. HHS later referred the company to the Department of Justice after it announced the launch of a $49 version of Novo Nordisk’s Wegovy pill.

When asked about the FDA warning, Abby Reisinger-Moley, a spokesperson for Hims & Hers, pointed to a announcing a shift away from compounded weight loss drugs. The company said in the press release that it had entered into an agreement with Novo Nordisk to sell name-brand versions.

Alex Smith, CEO of Join Josie, an online platform that helps women in menopause lose weight by prescribing GLP-1s, said his company also made changes in response to an FDA letter, to include removing Join Josie’s name from medication vials. “Which I agree with,” Smith said, “because you don’t want patients thinking you’re the compounding pharmacy.”

SkinnyRx and Genesis Health International did not respond to requests for comment.

But these warnings aren’t the first time the federal government has stepped in to ensure that telemedicine is being used appropriately, said Mei Wa Kwong, executive director of the Center for Connected Health Policy.

Prior cases involved attention-deficit/hyperactivity disorder medications and other controlled substances prescribed by telehealth providers, she said. While those drugs pose more risk to patients than GLP-1s, the companies were also accused of improperly screening potential customers.

The onus still falls on consumers to research companies before signing up for their services, Kwong said.

“Always approach anything on the internet with a hint of skepticism,” Kwong said.

A woman stands beside her kitchen counter and dining table and faces the camera.
McClain was admitted to the hospital after injecting nearly nine times the amount of semaglutide that patients typically take as a first dose of the popular weight loss drug. That’s what her prescription from a telehealth provider had dictated. (Arielle Weenonia Gray for 麻豆女优 Health News)

‘Keeps Getting Worse’

McClain, the Tennessee woman hospitalized this year after a GLP-1 overdose, said she lost 50 pounds a few years ago by taking a name-brand GLP-1 prescribed by her doctor.

At the time, the medication was covered by her health insurance. This year, when she was ready to take a GLP-1 again following a pregnancy, the drug was no longer covered for weight loss.

To save money by obtaining a cheaper, compounded GLP-1, McClain signed up for Mochi Health after doing her own research. “That was just the most affordable option,” she said.

But within hours of her first dose, she said, she found herself on the phone with poison control.

After her overdose, McClain said, she spoke to a clinical director at Mochi Health, once by phone but mostly via email, about her lingering symptoms before communication paused.

David Pilip, a spokesperson for Mochi Health, said in a statement that the company would not discuss individual patients due to privacy obligations. But he said adverse events are “immediately flagged” and “investigated with extreme precision.”

“Mochi Health takes patient safety extremely seriously,” Pilip wrote in an email. “We promptly initiated a review and have been in direct and ongoing communication with the patient to reach a resolution. We remain committed to doing so.”

McClain anticipates her healthcare bills related to the hospital stay will total at least $900. She said that to get the $159 refund for her three-month membership and reimbursement for the hospital expenses, she has been asked to sign a document saying she won’t take legal action against the company. Her experience, she said, “just keeps getting worse.”

NBC News producer Jessica Herzberg and 麻豆女优 Health News senior correspondent Fred Schulte contributed to this report.

Do you have an experience using an online company for healthcare services or medicinal products that you think others should know about? Click here to contact our reporting team.

麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

This <a target="_blank" href="/health-industry/glp1-weight-loss-drugs-telehealth-oversight-regulation-compounded-semaglutide/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2236393&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2236393 Trump Bought Stock in Eli Lilly as His Policies Gave the Drugmaker a Big Boost, Documents Show /health-industry/the-week-in-brief-trump-eli-lilly-stock-pharmaceuticals/ Fri, 22 May 2026 18:30:00 +0000 /?p=2241506&preview=true&preview_id=2241506 President Donald Trump has long bantered about GLP-1s, the breakthrough medicines that have changed care for diabetes and obesity. Sometimes he calls them “the fat drug.” In an interview with the in January, he mused that “I probably should” take them.

A few days before the Times published that story, Trump invested in Eli Lilly, the nearly $1 trillion drugmaker whose fortunes are closely tied to its blockbuster GLP-1s, Zepbound and Foundayo 鈥 and to government reimbursement for the medicines.

This week we reported on several Lilly stock purchases made by Trump or his brokers from January to March, totaling as much as $680,000, according to a disclosure signed by the president. He also purchased stock worth $250,000 to $500,000 in West Pharmaceutical Services, a company that manufactures devices for injectable drugs. It, too, is benefiting from the GLP-1 surge.聽

As the purchases occurred, the Trump administration was undertaking an agenda that boosted the GLP-1 market, including advancing Medicare reimbursement for the drugs to treat obesity, a long-held goal for Lilly. The deadline for drug manufacturers to get involved in a reimbursement project was Jan. 8.聽

The administration also intensified a crackdown on “compounded” GLP-1s 鈥 cheaper, copycat medications made by pharmacies that critics (and brand-name drugmakers) claim are unsafe. That knocked out competitors to Lilly’s products. Trump’s FDA also rapidly approved Lilly’s GLP-1 pill, Foundayo.聽

The timing of the Lilly purchases 鈥 among more than 3,600 trades Trump or his representatives made in the first quarter of the year 鈥 troubled government ethics experts.聽

“A president who buys or sells the stock of a company whose value is affected by his administration’s actions undermines the public’s trust in two ways,” said Kathleen Clark, a legal ethicist at Washington University in St. Louis.

First, she said, the public should believe government actions are motivated by common good, not personal enrichment. Second, the public should believe that those within government aren’t benefiting from inside information.

The disclosures have also intensified criticism from Trump opponents who say he’s trying to profit from the presidency.

Congressional Democrats are calling for legislative action. “Trump is the ultimate con man 鈥 rig the game, manipulate the rules, and reap the benefits,” Sen. Andy Kim (D-N.J.) , highlighting our report. “It’s long past time we ban presidents from owning and trading stocks.”聽聽

Democrats might have their shot at a bill in 2027. Public opinion is increasingly swinging in their direction, and taking both chambers of Congress is a possibility. (Of course, even if Democrats claimed those majorities and passed a bill, it would have to be signed by Trump.) If they were determined to pursue anti-corruption measures relating to health issues, they would have targets beyond Trump’s stock trading. Democrats have also questioned corporate contributors’ influence on changes in FDA tobacco regulation, for example.聽

麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

This <a target="_blank" href="/health-industry/the-week-in-brief-trump-eli-lilly-stock-pharmaceuticals/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2241506&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2241506 Journalists Unpack Latest on Vaccines, Vaping, and TrumpRx /on-air/on-air-may-16-2026-vaccines-vaping-mifepristone-trumprx/ Sat, 16 May 2026 09:00:00 +0000 /?p=2238301&preview=true&preview_id=2238301

麻豆女优 Health News chief Washington correspondent Julie Rovner discussed federal policy on vaccine research, vaping, and drug access on Science Friday on May 8. Rovner also discussed the Supreme Court decision on the abortion pill mifepristone on NPR’s Morning Edition on May 5.

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Céline Gounder, 麻豆女优 Health News’ editor-at-large for public health, discussed the rising cost of drug prices, despite hopes about TrumpRx, on CBS News’ The Daily Report on May 7.

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麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

This <a target="_blank" href="/on-air/on-air-may-16-2026-vaccines-vaping-mifepristone-trumprx/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2238301&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2238301 That Discount at the Pharmacy Counter May Pack Hidden Costs /health-care-costs/pharmacy-discount-coupons-hidden-costs/ Thu, 07 May 2026 09:00:00 +0000 /?p=2230769 Next time you go to the pharmacy, you might be offered a coupon on your prescription drugs. While it may sound like a great deal 鈥 with the prospect of saving hundreds of dollars 鈥 the decision to accept it is complicated, especially for people with insurance.

Even as prescription drug costs rise, patients with commercial insurance have slowed their use of manufacturer-sponsored drug coupons in recent years, according to April 6 by the Journal of the American Medical Association.

Manufacturers are offering just as many of them, “but still, we see a lot of affordability issues among this commercially insured population,” said So-Yeon Kang, the study’s main author, who is an assistant professor of health management and policy at Georgetown University.

“Patients are at the intersection and battle place between these payers and manufacturers,” she said.

Drug manufacturers distribute copay coupon cards to consumers online or in person at the pharmacy counter. These manufacturer-sponsored coupons are not the same as discount card services from companies like GoodRx, which negotiate lower bulk pricing for prescription drugs, then pass those savings along to the consumer.

Manufacturers issue the coupons to keep their drugs competitive by offering patients short-term savings. Consumers pay less out-of-pocket, often for brand-name drugs. This encourages patients to use the brand-name version of the drug, even when a cheaper, generic version might be available.

Some insurers say this unfairly puts them on the hook for pricier drugs. They say monthly premiums are higher as a result, punishing consumers and patients, not the manufacturers.

So, should you use manufacturer-sponsored prescription drug coupons when they are offered?

The short answer: It depends.

Here are five things to consider:

1. What if you do not have insurance?

If you are uninsured, using a coupon can be a great way to save money, especially if there is no generic version of the drug.

TrumpRx is a new federally funded initiative that acts as a prescription drug coupon dashboard for patients. Some of the coupons come from manufacturers, while others do not. Not every drug has a coupon offer, but the portal will save consumers money on drugs for those that do, especially in the short term.

Michelle Long, a senior policy manager at 麻豆女优 who studies patient and consumer protections, said people without insurance can save money by using TrumpRx or manufacturer coupons. (麻豆女优 is the health policy research, polling, and news organization that includes 麻豆女优 Health News.)

“I wouldn’t brush it off entirely because it’s got Trump’s name on it,” Long said. “For a lot of people who take certain medications, there really could be some real savings.”

Still, Long said, TrumpRx lists only about 85 drugs, among thousands approved by the FDA. It is important to note that drug coupons have limitations and guidelines. They do not last forever. When they are exhausted, uninsured consumers may have to pay full price for the drug.

2. What if you have commercial health insurance?

For people with insurance, the answer is a little more complicated.

If the drug isn’t covered by your insurance plan or if you intend to pay cash, then the coupon may be the way to go. If not, be wary.

Insurance coverage varies for certain kinds of drugs, such as GLP-1 obesity drugs. Kang’s study found that coupon use by commercial insurance holders on obesity drugs dropped from 54.6% of prescriptions in 2017 to only 2.5% in 2024, even though use of the drugs has been rising in the United States.

She said this reflects the growing number of patients paying cash for the drugs as prices decline, along with insurers’ reluctance to cover them and manufacturers’ shifting focus from coupon distribution to marketing campaigns.

3. What should you do if you expect high medical costs this year?

If you have insurance and anticipate meeting your deductible for the year through health care visits and treatments, consider using the coupons.

Coupons let you pay less out-of-pocket when you visit the pharmacy, but your insurer likely won’t count the value of the coupon toward your deductible. Only use a coupon if there is no generic option available and if you know you’d otherwise hit your deductible.

4. What if you have insurance but low overall medical costs?

The answer will almost always be: Don’t use the coupon.

Unless the drug you are looking for is not covered by your insurance plan, using coupons will put you at risk for higher indirect costs. It’s also often more advantageous to spend toward your deductible.

Watch out for copay adjustment programs that insurers use to discourage the use of drug coupons. They come in two common forms, Long said.

“” allow the use of drug coupons up to their full value, but the amount of the coupon won’t count toward patients’ deductibles or out-of-pocket maximums. That makes it harder for them to reach the threshold at which insurers will pitch in on prescriptions and other medical care. It can also mean a patient will eventually start paying the full cost of the drug because they haven’t yet met their annual deductible.

“Copay maximizers” use a similar technique that also prevents the coupon value from counting toward deductibles. Maximizer programs use a third party to over the course of a year to match the amount of the manufacturers’ coupons.

Insurers sometimes offer the programs to consumers under euphemistic names like “Employee Savings Program” that sound good in theory, but, in reality, take away some of the value of the coupons, Long said.

Initially, consumers will see savings at the pharmacy counter, but they may end up paying more in the long run.

5. What if you’re on Medicaid or Medicare?

Medicare and Medicaid beneficiaries are prohibited from using manufacturer-sponsored coupons.

A federal anti-kickback law makes it illegal to give someone anything of value to influence their decision to purchase something that will ultimately be paid for by a federal health care program. The law also prevents remuneration, which includes waiving copays and charging less than fair-market value for a product.

Manufacturer drug coupons categories.

Some states, notably California and Massachusetts, prohibit or limit the use of manufacturer drug coupons when a generic version of the drug is available 鈥 highlighting the tension among manufacturers, health plans, and the government.

麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

This <a target="_blank" href="/health-care-costs/pharmacy-discount-coupons-hidden-costs/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2230769&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2230769 Trump Promised Cheaper Drugs. Some Prices Dropped. Many Others Shot Up. /health-care-costs/trumprx-reality-check-drugs-not-always-cheaper/ Thu, 07 May 2026 09:00:00 +0000 /?p=2233819 Since his second term started, President Donald Trump has announced, negotiated, or floated a flurry of initiatives aimed at taming the excesses of the pharmaceutical industry.

No surprise. About are “worried about being able to afford prescription drug costs for themselves or their families,” a recent 麻豆女优 nationwide poll showed. More than 80% consider the price of prescription drugs “unreasonable,” and most support increased regulation to lower costs. Americans pay about three times as much as people in other countries for the same prescription drugs.

Last July, Trump sent letters to 17 drugmakers, demanding they voluntarily lower drug prices. Then the president said he’d negotiated one by one at the White House. In December, that he had compelled them to agree to on Medicaid, the government coverage for low-income Americans.

Then came the , a site where cash-paying patients could find discounted medicines, and a promise to speed biosimilar products — generic versions of certain high-priced specialty drugs — by cutting through FDA red tape.

The scope of these grand gestures remains uncertain. But it’s certainly less than what the announcement promised, partly because many details of the negotiations, even which drugs are covered, are hazy.

White House spokesperson Kush Desai did not answer queries about TrumpRx.

Medicaid already buys drugs at deep discounts. And other patients may well have better options through commercial drug discount programs, which offer far more products, or through their insurance and associated drug company copayment cards.

So, for all Trump’s showmanship, the share of Americans likely to benefit from these options remains slim, even if some people do come out ahead.

“If it makes a difference to any patient, it’s a win,” said Mark Cuban, a billionaire investor on his own mission to bring down drug prices. He pointed to discounted pricing on TrumpRx for branded fertility drugs and GLP-1 weight loss drugs for people without insurance or whose plans don’t include coverage. Cuban launched the Mark Cuban Cost Plus Drug Co., known as Cost Plus Drugs, in 2022 to sell drugs cheaply by eliminating middlemen — buying from factories and selling directly to consumers. Most of the drugs he sells are generics.

Aaron Kesselheim, a professor of medicine at Harvard Medical School whose research focuses on drug prices, said the Trump announcements are “one-off agreements made for publicity purposes. They don’t change anything about the way drugs are priced.”

He added: “The agreements are opaque and unenforceable.”

It was unclear, for example, which drugs would be sold at “most favored nation” prices or how exactly that was defined. But, clearly, not all were.

Doing the Math

46brooklyn, a consulting firm and data project that tracks brand-name drug prices, found that close to 1,000 brand drugs went up in price in January 2026. What’s more, 2025 had the highest number of list price increases ever. “This is not a material change, it’s business as usual,” said Antonio Ciaccia, the company’s co-founder.

In the first week of 2026, Pfizer raised the list prices of 71 drugs by an average of 5% and lowered the price of only one, by 9.8%, the data project found.

The biggest win for patients has likely been the Trump administration’s quiet continuation of a Biden administration program: Medicare drug price negotiation for expensive drugs. The negotiated discounts on the — from blood thinners to insulins to medicines for inflammatory disorders — went into effect Jan. 1. With reductions in price of on some products, the estimated $6 billion in annual savings allowed the program to cap Medicare patients’ out-of-pocket spending on Part D prescription drugs at $2,000 for 2025 and beyond.

What Patients Will Find in the Mix-and-Match World of American Pricing (Table)

An additional 15 high-priced drugs — including popular weight loss and cancer drugs — were subject to negotiation in 2025, with discounted Medicare prices taking effect next year. And 15 more high-priced drugs are . All told, the 40 negotiated drug prices are expected to save Medicare well over $20 billion a year.

Even as these discounts take effect, drug industry lobbyists have been working to limit the impact, with some success. For example, the One Big Beautiful Bill Act from negotiations.

Still, “this is historic because it’s the first time the United States has negotiated prices, like every other developed country,” Kesselheim said. “And guess what? Innovation didn’t stop.”

Of course, these discounts benefit only Medicare enrollees. The newer Trump administration initiatives help some other patients, but they are limited and require knowledge of how to access the discounts.

What Patients Will Find in the Mix-and-Match World of American Pricing (Table)

Trump’s One-on-Ones

The president’s televised appearances with the heads of major drug companies resulted in deals, but few, if any, will mean much to patients. For example, after Trump met with Albert Bourla, CEO of Pfizer, the company announced discounts on 30-plus drugs. Bourla “a win for American patients, a win for American leadership, and a win for Pfizer.”

The discounts are offered via TrumpRx, which, in turn, offer coupons co-branded on GoodRx.com, which already offers discount coupons for many hundreds of medicines.

Pfizer made hay of the deal, announcing it was part of Pfizer’s broader, landmark with the U.S. government, enabling patients to pay lower prices for their prescription medicines “while strengthening America’s role as the global leader in biopharmaceutical innovation.”

Pfizer spokesperson Steven Danehy cited a press release from September noting that the TrumpRx site offers patients savings that “range as high as 85%.”

Most of the list features brand-name drugs, competing with far cheaper generic versions from other manufacturers, such as the cholesterol-lowering drug Colestid, which TrumpRx lists for “50% off” at $127.91. Generic versions cost about $17 on the Cost Plus site.

This means the branded companies aren’t making a sacrifice by offering them at lower costs as reflected on Trump’s portal, said Sean Tu, a patent law expert at the University of Alabama. “That’s a sale they would not have made if not for TrumpRx.”

Others are very old drugs, such as Cortef, or hydrocortisone, whose 5-milligram branded Pfizer version is listed at $45 on TrumpRx, half its list price of $91.80. It sells for far less on Cuban’s Cost Plus site. Still others, such as the $607.20 HIV treatment Viracept, are useful only in combination with other drugs that are not discounted.

Last week, TrumpRx added AbbVie’s Humira, for years the world’s best-selling drug, at $950 a dose, down from a list price of nearly $7,000. But Humira lost its patent protection in 2023, and biosimilars — essentially generic equivalents — have since come to market. More to the point, two of those biosimilars are listed on TrumpRx for as little as $207.60 a dose.

Since most of the TrumpRx products are available only to customers without insurance who pay cash, the arthritis drug Xeljanz’s drop from $2,277 to $1,518 a month would still leave it unaffordable.

A Few Notable Deals

The much-touted TrumpRx site, launched Feb. 6, consists largely of Pfizer’s 30 drugs (30 of roughly 85) with a smattering of discounts likely to generate headlines.

These include three fertility drugs from EMD Serono, a subsidiary of the pharmaceutical giant Merck KGaA, the most expensive of which, Gonal-F, has a list price of $966 but is only $168 per IVF cycle using a TrumpRx coupon.

They will save women thousands of dollars — although the overall cost of fertility treatment will continue to put them beyond the reach of many, since drugs represent only a portion of the payment.

The TrumpRx discounts could reduce the $15,000-to-$25,000 cost of a single fertility treatment cycle — women typically need two or three cycles to become pregnant — by about 10%, said Sean Tipton, spokesperson for the American Society for Reproductive Medicine. In some European countries, each cycle costs about $3,000.

In exchange for lowering those prices, EMD Serono got tariffs lifted on its mostly overseas-produced medications. It also won the right to a sped-up FDA approval process for a fertility drug it’s been marketing heavily in Europe.

Another newsworthy offering on the site resulted from a deal with Novo Nordisk for Wegovy, its GLP-1 drug for weight loss and diabetes, with the price reduced to as little as $199 a month for the pen. (Many insurers cover such drugs only for diabetes, leaving those who are interested in losing weight paying out-of-pocket. Zepbound, Wegovy’s Lilly & Co. competitor, is also on the list, at $299.)

Pressure has been building on Novo and Lilly to lower the U.S. price of their GLP-1 drugs. The compounds have lost patent protection in India, and pressure from customers buying overseas will likely increase when generic Wegovy goes on sale in Canada, for as low as $73 a month, possibly this year.

In the United States, meanwhile, dozens of patents should keep Wegovy generics off the market until 2039, said professor Robin Feldman, a patent expert at the University of California Law-San Francisco. A from the research group I-Mak delved into several ways patent manipulation keeps generics off the U.S. market long after they are available in European countries and Canada.

And while the Trump administration has vowed to approve biosimilars more rapidly to ensure more competition and lower prices, that may not have much impact. The big hurdle in getting generics and biosimilars to market is often not FDA approval, but the time it takes to override the thickets of patents that U.S. law allows manufacturers to deploy to protect their intellectual property.

For example, in 2021, the FDA approved a generic of Otezla, a popular drug for psoriatic arthritis, but it will not hit the market until 2028. Its entry would to Medicare if they charged the program more than other developed countries for “single source” drugs and biologics. That would essentially allow the Medicare program to piggyback on other countries that negotiate the prices of some of the most expensive medicines. Those programs are still going through the rulemaking process and, again, would benefit only those covered by the Medicare program and only indirectly.

The average patient-consumer, if willing to pay cash, may find some bargains. But getting the best deal could take a lot of mixing and matching, forcing patients to become choosy shoppers, eyeing deals for essential medicines as they would for a carton of milk or eggs.

Data reporter Maia Rosenfeld contributed to this article.

麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

This <a target="_blank" href="/health-care-costs/trumprx-reality-check-drugs-not-always-cheaper/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2233819&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2233819 A New Medicare Option for Weight Loss Drugs: What Older Americans Should Know /medicare/cheaper-glp-1-weight-loss-medicare-bridge-wegovy-zepbound-foundayo/ Wed, 06 May 2026 09:00:00 +0000 /?p=2232451 Starting in July, Medicare beneficiaries may be able to get a GLP-1 prescription for weight loss for $50 a month. It’s a notable shift for Medicare, which has long been barred from covering weight loss treatments.

The drugs, such as Wegovy and Zepbound, are effective but can be expensive without insurance coverage. They’re available in injection or pill form. Even with discounts, current cash prices typically range from $149 to $699 per month.

About half of GLP-1 users say these drugs were difficult for them to afford, according to . A quarter said they were “very difficult” to afford.

But the new Medicare benefit comes with caveats, particularly around clinical guidelines and what happens when the short-term program ends.

What Is This Program?

The initiative, announced by the , is a short-term pilot program known as the Medicare GLP-1 Bridge. It will run from July 1, 2026, through Dec. 31, 2027. It’s meant to “bridge” the gap before a longer-term program that might 鈥 or might not 鈥 begin in 2028.

The pilot program will offer coverage for the following GLP-1 medications approved for weight loss: the pill and injectable formulations of Wegovy, the KwikPen formulation of Zepbound, and the Foundayo pill.

Who Can Participate?

To get access to these weight loss medications, you must be enrolled in a Medicare Part D plan, which covers prescription drugs. After that, eligibility is based mainly on body weight and health status. People will qualify if they have a of 27 or higher and have a condition such as heart disease or prediabetes, among others. People with BMIs of 35 or higher automatically qualify. About are clinically obese, with a BMI of 30 or higher, according to the Centers for Disease Control and Prevention.

How the Program Works (It’s a Bit Unusual)

This is not your typical Medicare benefit. Even though Part D enrollment is required, the Bridge program itself works differently.

Instead of going through your regular Part D plan, you will need prior authorization. Your doctor will send the prescription to a central system run by CMS contractor Humana, using a system already in place for another Medicare drug program. Doctors don’t need to be enrolled as Medicare providers to write a prescription or submit a prior authorization request under this program. Once they get approval, patients will pay the flat $50 copayment at the pharmacy when they pick up the prescription.

What Are the Benefits?

The cost savings could make these drugs accessible to patients who simply couldn’t afford them before. Even with discounts, the prices can be daunting without insurance coverage. TrumpRx, a new government website, provides links to direct-to-consumer prescription drug discounts for patients not using their health insurance. On that site, Wegovy injectables range in price from $199 for a lower dosage for the first two months to $399 for a higher dosage. The KwikPen formulation of Zepbound costs up to $699 per month. At the highest dosages, the daily Wegovy pill costs up to $299 while Foundayo tops out at $349.

Most people who use these drugs will need a higher dose to maintain weight loss. The Bridge program is unique in that it offers a predictable $50 copayment that does not go up as dosages increase.

What Are the Downsides?

Like many pilot programs, there are trade-offs. The $50 copay will not count toward the Part D deductible, nor does it count toward the $2,100 annual out-of-pocket cap on prescription drug costs. The pilot program will also end in December 2027. Most that many people who stop using the GLP-1 drugs regain weight they lost while taking them.

Still Obstacles for Those With Low Incomes

If you receive the low-income subsidy, also known as the Medicare program, you cannot use that assistance for the drugs covered by the GLP-1 Bridge program. For beneficiaries accustomed to paying a $5 or $10 copay for their pharmaceuticals, a $50 copay could still be a big financial barrier.

“Fifty dollars a month sounds like a great deal compared to paying the discounted prices through TrumpRx and these other direct-to-consumer options, but it’s a lot of money for somebody who’s living on a $750-a-month Social Security check,” said Juliette Cubanski, deputy director of the Program on Medicare Policy at 麻豆女优, a health information nonprofit that includes 麻豆女优 Health News.

The $50 Copay Is Only for Weight Loss

If you’re already taking one of these medications for a qualifying condition such as Type 2 diabetes, cardiovascular disease risk reduction, or sleep apnea, you’ll continue to get it through your regular Part D plan. That means you’ll pay your plan’s price, which may be higher than the $50 Bridge copay, meaning the same drug could cost different amounts depending on the reason it is prescribed.

If you’re already on a GLP-1 for weight loss, you may qualify for the Bridge program. Your prescriber will need to attest that you met the clinical criteria when you first started the medication. For example, if you started a GLP-1 in September 2024 with a BMI of 37 but in July 2026 you’ve lost weight and now have a BMI of 34, the prescriber should attest in the prior authorization request that you met the BMI criteria of 35 or over when the GLP-1 therapy started.

What Happens After 2027?

The Trump administration had proposed a two-step approach to expand coverage of GLP-1s for obesity in Medicare. The Bridge program was initially planned to last six months 鈥 after that, the idea was to launch a longer-term program that would shift the cost of the drugs from the government to insurers. A found the long-term program would have cost insurance companies billions of dollars in the first year. Not enough insurers signed on for the voluntary plan by the April deadline, so CMS instead announced it would extend the Bridge program to 18 months, with a new end date of December 2027.

The move will give insurance companies more data on how many people with Medicare get GLP-1 drugs during the Bridge program and more time to negotiate with the Trump administration.

But extending the Bridge program will be “really expensive” for Medicare, Cubanski said, because the program heavily subsidizes the cost of the drugs.

“There’s no sense right now of the cost of the Bridge model, but it is likely to be billions of dollars a year in additional spending for Medicare,” Cubanski said.

The cost to Medicare will depend largely on how many people use the Bridge program. CMS has not provided any projections publicly, but a estimated that in 2020 close to 14 million Medicare beneficiaries were overweight or obese.

“This will just cost additional money, and we don’t know how much, because they haven’t disclosed it,” Cubanski said.

Are you on Medicare and interested in getting a GLP-1 for weight loss? Is a $50 copay manageable? Click here to contact 麻豆女优 Health News’ reporting team.

麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

This <a target="_blank" href="/medicare/cheaper-glp-1-weight-loss-medicare-bridge-wegovy-zepbound-foundayo/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2232451&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2232451 The Supreme Court Case That Could Slow Generic Drugs /podcast/an-arm-and-a-leg-supreme-court-generic-drugs-skinny-labels/ Tue, 05 May 2026 09:00:00 +0000 /?p=2232952&post_type=podcast&preview_id=2232952 The Supreme Court has heard a about “” on generic drugs. It could shape the future of affordable prescriptions in America.

The same medication can be used to treat many conditions. And each use can have its own patent, even though the drug itself never changes. When patents expire, companies can make their own generic versions 鈥 but only so long as they make it clear that it can’t be used for anything else that still has a patent. This is what’s called a “skinny label.”

But in , one patent holder says generic manufacturers aren’t playing by the rules. The petitioners allege some drugmakers are writing skinny labels with a wink to doctors that their cheaper generic pill can be swapped in for more expensive patented ones.

An Arm and a Leg senior producer Emily Pisacreta talks with legal experts and doctors about how this case got to the highest court in the land and what a ruling could mean for how many and how quickly new generic drugs reach the market.

Dan Weissmann Host and producer of "An Arm and a Leg." Previously, Dan was a staff reporter for Marketplace and Chicago's WBEZ. His work also appears on "All Things Considered," Marketplace, the BBC, 99% Invisible, and "Reveal," from the Center for Investigative Reporting.

Credits

Emily Pisacreta Producer
Claire Davenport Producer
Adam Raymonda Audio wizard
Ellen Weiss Editor
Click to open the Transcript Transcript: The Supreme Court case that could slow generic drugs

Note: “An Arm and a Leg” uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Dan: Hey there鈥 

Dr. Anmol Gupta is a resident physician at the University of Michigan. One day a week, he drives thirty miles north of Ann Arbor to a rural clinic and for a lot of his patients there, it’s the only doctor they can get to within an hour.

Dr. Gupta: They have to travel the furthest. They’re often the ones that are uninsured or on Medicaid. They often are coming and seeking care later than you’d wish they had access to care.

Dan: So they’re sicker. And the cost of prescription drugs comes up in like every single visit.

Dr. Gupta: I’m meeting patients who are just now being able to afford medications who maybe weren’t able to five, 10 years ago who needed it then.   

Dan: Take statins, the cholesterol-lowering drugs. One of the most popular brand-name versions, Crestor, finally went generic in 2016. Before that, a lot of patients like Dr. Gupta’s simply couldn’t afford it.. So now he wants generic versions for today’s expensive drugs to reach his patients as soon as possible. 

Dr. Gupta: We’re trying to prevent long term risks here. The faster we can start these medications, the better the outcomes in hopefully preventing devastating things like heart attacks and strokes.

Dan: Which is why what’s about to happen at the Supreme Court matters so much to him 鈥 and to millions of patients like his.

This spring 鈥 actually, this week 鈥 the court is hearing arguments in a case that could make it harder, and slower, for cheaper generic drugs to become available to patients.

This is An Arm and a Leg, a show about why health care costs so freaking much, and what we might be able to do about it. I’m Dan Weissmann, I’m a reporter, and I like a challenge. So the job we’ve chosen here is to take one of the most enraging, terrifying, depressing parts of American life, and bring you something entertaining, empowering, and useful.

Our show’s senior producer, Emily Pisacreta, flagged this Supreme Court case for us months ago.

Emily, you’ve been reporting the heck out of it ever since. 

Emily: Dan, I talked with lawyers. I talked with doctors. I talked with one guy who is both a lawyer and a doctor. And the good news is, you don’t need to be any of those things to understand what’s going on here.

Dan: Great 鈥 take it away.

Emily: Let’s start with the basics. When a drug company invents a new medicine, they get a patent 鈥 basically an exclusive right to sell it for about twenty years 鈥 sometimes a couple extra years.  Exclusive, without competition. That’s part of why brand-name drugs cost so much.

But when the patent expires, other companies can make a generic version of the exact same drug. Those generics usually sell for much cheaper. The legal rules of this brand vs. generic deal got hashed out back in 1984, in a law called Hatch-Waxman. We talked all about that in our last episode 鈥 but don’t worry if you missed it.

Sean Tu: Hatch-Waxman made this balance between giving protection to brand-name manufacturers to innovate and create new drugs, but then once their patents expire, the idea is we open it up for generic competition.

Emily: That’s Professor Sean Tu. He teaches law at the University of Alabama. He also has a PhD in pharmacology and a history working in the biotech industry. Sean helped write a legal brief in this case on the side of the generic drug maker.

He says this case is about that balance that Hatch Waxman tried to create. Because, drug companies don’t just file one patent and leave it at that. They file a whole stack of them鈥 Starting with a patent on the drug itself 鈥  the “molecule” 鈥 And then a second patent on how the drug is used. So when the first patent runs out, they might still have years of protection left on the second one. 

But it doesn’t end there. They can also patent new uses of that drug.

Sean Tu: Here’s an example and I’m just gonna make one up. I have a drug X that was first approved for diabetes. But let’s say the patent expires in 2000. And then later on I get a new patent for that same drug to treat cancer but that patent doesn’t expire until 2020.

Emily: Hatch-Waxman’s rules say generic drugmakers don’t have to wait until 2020 to sell a generic for treating diabetes. 

But they do have to be careful with their generic drug’s label. 

In the world of Hatch Waxman, the label is not just the white sticker on the orange bottle you get from the pharmacy.  

The label means all that folded-up paperwork full of small type that comes with your prescription.

It’s full of technical information about the drug. So if a generic drug-maker sells a version of Sean Tu’s made-up drug for diabetes, they have to make sure that “label” doesn’t mention that the drug can also treat cancer. In the industry they call this a 鈥榮kinny label” 

And skinny labels are a BIG part of getting generic drugs to market 鈥 making them available鈥 quickly. The industry says four out of ten generics get launched with a skinny label.

So, skinny labels are the big legal idea at the heart of this supreme court case. 

Now let’s talk about the specific drug in this legal tug-of-war. It’s called Vascepa.

Commercial voiceover: Discover the science of prescription VASCEPA proven in multiple clinical trials.

Emily: Vascepa’s made by a company called Amarin,  and it’s their only product. It comes from fish oil, and it’s been approved by the FDA for two different uses 鈥 well, kind of different. 

First, in 2012, to treat a rare condition involving dangerously high levels of a certain kind of fat in the blood. 

A few years later, Vascepa got approved for another condition, one that affects a lot more people: people with only slightly too much of that fat in their blood. 

Commercial voiceover: Prescription power. Proven to work now with a new indication. Ask your doctor about Vascepa.

Emily: That second approval meant a second patent for the second use. Meanwhile the patent on the first use was set to expire. When that happened, a generic manufacturer called Hikma jumped at the chance  to come to market with a cheaper, generic version. 

Newscaster: ??Finally talk quickly about Hikma Pharmaceuticals. London listed under the code HIK, but founded in Jordan [fade under] 鈥

Emily: In 2020, Hikma launched their generic with a skinny label on the packaging. They say that skinny label was carefully written: That it only described the unpatented original use. That they definitely left out any mention of the second use鈥 the one that’s still patented.

But Amarin 鈥 the brand name manufacturer 鈥 didn’t see it that way鈥nd they sued them.

Amarin’s argument has two parts. First, they say Hikma’s label, even though it left out the patented use, still referenced a study that was only conducted for that still-patented use. Second, they say that in press releases, on their website, and on investor calls, Hikma described their product a little too broadly,  including calling it, quote, “the generic version of Vascepa.”

Amarin says: put those two things together, and Hikma was effectively encouraging doctors to prescribe it for the use that’s still under patent. 

The legal term for this is 鈥榠nducing infringement’.

There’s a pretty-famous Supreme Court case about inducing infringement 鈥揳t least maybe famous to legal nerds:  It involved a file-sharing service called Grokster. The whole product was basically built to help people swap pirated music and movies. But instead of my entire high school graduating class getting sued for copyright infringement, Grokster did. For inducing it.

Sean Tu says induced infringement means YOU didn’t infringe the patent yourself, but you nudged someone else into doing it. On purpose.

Sean Tu: You have to have the intent to induce somebody to actually infringe the patent. Looking at the label, looking at these fairly innocuous marketing statements, I don’t think any of them induce a doctor to prescribe for the patented indication.

Emily: And here’s the thing, some of the people who agree with Sean Tu 鈥 they aren’t who you’d expect.

Greg Chopskie: Yeah. Amarin would have you believe that doctors pay attention to investor relations calls when making their prescribing decisions.

Emily: Greg Chopskie is a patent attorney who works mostly for brand-name drug companies. About a decade ago, he was part of a team that won a $2.15 billion settlement. It was one of the biggest brand-versus-generic lawsuits ever. So, he’s not exactly a cheerleader for generic drug makers.

But he says, until recently, a case like Amarin’s wouldn’t have legs. Except things took a big turn in 2021. 

That year a big brand-name drug company, GlaxoSmithKline, 鈥 we’ll call them GSK for short 鈥 they won $235 million in damages from a generic maker called Teva. The accusation: Induced infringement. Greg Chopskie says GSK’s victory really shook things up.

Greg Chopskie: What it did was make mundane market activities potential bases for infringement claims.

Emily: Mundane marketing activities like calling your drug the generic version of something. Saying it’s been rated equivalent by the FDA. Normal things generic companies say all the time. But now鈥

Greg Chopskie: The focus is on what’s printed on the label, what’s being said in the market, what your detailers are telling physicians, what you’re telling investors鈥 a much bigger scope of activities could be used to find infringement.

Emily: Teva appealed their case to the Supreme Court, but the court took a pass on hearing it. Greg thinks the Court taking up the Hikma vs. Amarin case is a sign they regret that decision.

Greg Chopskie: I think this is a little bit of buyer’s remorse from the Supreme Court that they did not take the GSK case.

Emily: So just how important is this case? And what could it mean for us? That’s next.

Emily: This episode of An arm and a Leg is produced in partnership with 麻豆女优 Health News. That’s a nonprofit newsroom covering health issues in America. The folks at 麻豆女优 Health News are amazing journalists 鈥 their work wins all kinds of awards, every year, and we’re honored to work with them.

Emily: How big of a deal is Hikma versus Amarin?

Sara Koblitz: So it’s, it’s a pretty big deal.

Emily: Sara Koblitz is a lawyer whose firm works with both brand-name and generic drug companies. She’s been watching this case closely, because however it goes, she says it changes how everybody in the industry operates.

And Sara says part of the reason it’s a big deal is because of how early in the process this case is being heard. No jury has weighed in. There hasn’t even been any discovery, no documents exchanged, there haven’t been any depositions. 

The question before the court is: Should this case just get tossed out without even having a trial?

Sara Koblitz: So it is deciding whether the case can continue and Amarin can continue to make those allegations against Hikma.

Emily: ?If it rules for Hikma, the generic company, the court could say, this KIND of a case just shouldn’t be a thing: Claiming “induced infringement” over what experts like Sara and Greg Chopskie say have been totally normal skinny-label practices for decades. 

The court could say: there’s no “there” there 鈥 and not just to Amarin.

Sara Koblitz: Theoretically, other companies should be on notice that they can’t bring induced infringement cases on such little evidence.

Emily: On the other hand, if the court rules AGAINST Hikma, that would be a big worry for every generic drug maker

Sara Koblitz: the idea that you can have a case go with very little evidence about what has been said to induce infringement will mean that it’s really easy to bring litigation against these generic companies. 

Emily:  Easy to bring litigation that would cost those generic companies millions of dollars to fight, Big money. And that’s just the cost if they win. If they lose鈥 

Sara Koblitz: The ramifications for being found guilty of induced infringement are really significant. It’s treble damages, so it’s three times the amount that the company would have made, but for the introduction of the generic drug. 

Emily: Which raises the big question here: If the Supreme Court rules against Hikma, and opens the door to lots of “induced infringement” cases, would generic companies keep trying to use a skinny label at all, or would they decide it’s just not worth the risk? 

And if they decide it’s not worth the risk and instead wait for all the patents to expire, does that mean we have to wait longer for generics?  

A 2019 study estimated that skinny labels come out an average of 3 years earlier than generics that come out after all of the patents have expired. And as Sara points out, that’s the average. Not the limit.

Sara Koblitz:  In some situations you, it could save you 10 years. You could be getting a product 10 years earlier than you would’ve gotten it if you had otherwise ?waited until the product was off patent to come to market.

Emily: And Sara is not the only one worried. In 2024, the FDA warned Congress that the GSK decision 鈥 the earlier case that set the stage for this fight 鈥 could “significantly impact the timely availability of generic drugs.” 

There’s already SOME data, from a very small study, suggesting generic companies are pulling back. Before the GSK ruling in 2021, about 43 percent of eligible drugs came to market with a skinny label. By 2023, researchers from Harvard found that only one out of five eligible drugs did so. 

Sara thinks that trend is the result of uncertainty after the GSK decision. And that Hikma vs. Amarin 鈥 no matter how the court rules 鈥 will clear away some confusion.

Sara Koblitz: ?I think that this case in particular is really important for generic companies so they can have certainty about what they’re doing and saying.

Emily: And if the Supreme Court rules in Amarin’s favor, Sean Tu worries that brand companies will get more creative about blocking skinny label competition 鈥 by filing more patents on how the drug is used鈥  patents that are so similar to each other that it’s almost impossible to write a label for just one of them.

Sean Tu: In the Amarin v Hikma case, the actual indication is  鈥榬eally bad heart disease’ and 鈥榮lightly bad heart disease’ 鈥 and then 鈥榩reventing heart disease.’ That’s the kind of games I think are going to happen in the future.

<<<Music>>>

Emily: Oral arguments are Wednesday, April 29th. We’ll be listening. 

And you know who else will be listening? Dr. Gupta 鈥搕he hospital resident we met at the very beginning of this episode. Along with his job practicing medicine, he volunteers with a group called Doctors for America 鈥 thats a group advocating for access to affordable health care. Including drugs.   

And he’s hoping the justices understand just what’s at stake for his patients.

Dr. Gupta: You know, as a doctor, when I’m sitting in front of a patient, right, I’m trying to figure out what’s the best medication for your disease. I see the benefit of generics when they come around. I’m seeing that now, but there’s still so many common medications that aren’t generics yet that people struggle to afford.

And if we can find a medication that you can afford, that’s best, right? 

Dan: Emily, thank you so much for getting us this story. 

Emily: Yeah, you bet. 

Dan: We’ll be back with another episode in a few weeks. Until then Take care of yourself.

This episode of An Arm and a Leg was produced by Emily Pisacreta, with help from Claire Davenport and me, Dan Weissmann鈥 and edited by Ellen Weiss. 

Adam Raymonda is our audio wizard.

Our music is by Dave Weiner and Blue Dot Sessions. 

Claire Davenport is our engagement producer.

Sarah Ballema is our Operations Manager. Bea Bosco is our consulting director of operations. 

An Arm and a Leg is produced in partnership with 麻豆女优 Health News. That’s a national newsroom producing in-depth journalism about health issues in America and a core program at 麻豆女优, an independent source of health policy research, polling, and journalism.

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This <a target="_blank" href="/podcast/an-arm-and-a-leg-supreme-court-generic-drugs-skinny-labels/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2232952&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2232952 Abortion Pills, the Budget, and RFK Jr. /podcast/what-the-health-441-mifepristone-trump-budget-request-hhs-april-9-2026/ Thu, 09 Apr 2026 19:00:00 +0000 /?p=2181013&post_type=podcast&preview_id=2181013 The Host
Julie Rovner photo
Julie Rovner 麻豆女优 Health News Read Julie's stories. Julie Rovner is chief Washington correspondent and host of 麻豆女优 Health News’ weekly health policy news podcast, "What the Health?" A noted expert on health policy issues, Julie is the author of the critically praised reference book "Health Care Politics and Policy A to Z," now in its third edition.

At the Trump administration’s request, a federal judge in Louisiana this week agreed to delay a ruling affecting the continued availability of the abortion drug mifepristone. That angered anti-abortion groups that want the drug, if not banned, at least more strictly controlled. But the administration clearly wants to avoid big abortion fights in the run-up to November’s midterm elections.

Meanwhile, the administration’s proposed budget for fiscal year 2027 calls for more than $15 billion in cuts to programs at the Department of Health and Human Services. It’s a significant number, but less drastic than cuts it proposed for fiscal 2026.

This week’s panelists are Julie Rovner of 麻豆女优 Health News, Lauren Weber of The Washington Post, Alice Miranda Ollstein of Politico, and Maya Goldman of Axios.

Panelists

Maya Goldman photo
Maya Goldman Axios
Alice Miranda Ollstein photo
Alice Miranda Ollstein Politico
Lauren Weber photo
Lauren Weber The Washington Post

Among the takeaways from this week’s episode:

  • The Trump administration says it is conducting a thorough scientific review of the abortion pill mifepristone at the Food and Drug Administration. Yet advocates on both sides of the abortion debate think the administration is just trying to buy time to avoid a controversial decision about medication abortion before November’s midterm elections.
  • It’s budget time on Capitol Hill. With the unveiling of the president’s spending plan for fiscal 2027, Cabinet secretaries will make their annual tour of congressional committee hearings. HHS Secretary Robert F. Kennedy Jr., whose Hill appearances have been few during his tenure, is scheduled to testify before six separate House and Senate committees before the end of the month.
  • Back at HHS, Kennedy appears to be trying to reconstitute the Advisory Committee on Immunization Practices in a way that will enable him to restock it with vaccine skeptics without running afoul of a March court ruling that he violated federal procedures with his replacements last year.
  • Continuing his efforts to promote his Make America Healthy Again agenda, Kennedy announced this week that he will launch his own biweekly podcast. He also announced efforts to combat microplastics in the water supply and to get hospitals to stop serving ultraprocessed food to patients.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: The Atlantic’s “,” by Katherine J. Wu.

Maya Goldman: 麻豆女优 Health News’ “Trump’s Personnel Agency Is Asking for Federal Workers’ Medical Records,” by Amanda Seitz and Maia Rosenfeld.

Lauren Weber: CNN’s “,” by Holly Yan.

Alice Miranda Ollstein: Politico’s “,” by Simon J. Levien.

Also mentioned in this week’s podcast:

  • JAMA Internal Medicine’s “,” by Lauren J. Ralph, C. Finley Baba, Katherine Ehrenreich, et al.
  • 麻豆女优 Health News’ “Immigrant Seniors Lose Medicare Coverage Despite Paying for It,” by Vanessa G. Sánchez, El Tímpano.
  • The New York Times’ “,” by Ellen Barry.
  • Stateline’s “,” by Nada Hassanein.
  • The Washington Post’s “,” by Lena H. Sun.
Click to open the transcript Transcript: Abortion Pills, the Budget, and RFK Jr.

[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.] 

Julie Rovner: Hello, from 麻豆女优 Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, April 9, at 9:30 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. 

Today, we are joined via video conference by Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hi, everybody. 

Rovner: And my fellow Michigan Wolverine this national championship week, Maya Goldman of Axios. Go, Blue! 

Maya Goldman: Go, Blue. 

Rovner: No interview this week, but plenty of news. So let’s get right to it. We’re going to start with reproductive health. On Tuesday, a federal judge in Louisiana ruled for the Trump administration and against anti-abortion forces in a lawsuit over the availability of the abortion pill mifepristone. Wait, what? Please explain, Alice, how the administration and anti-abortion groups ended up on opposite sides of an abortion pill lawsuit. 

Ollstein: Yeah. So this has been building for a while, and it is not the only lawsuit of its kind out there. There are several. A bunch of different state attorneys general, who are very conservative and anti-abortion, have been suing the FDA in an attempt to either completely get rid of the availability of the abortion pill mifepristone or reimpose previous restrictions on it. So right now, at least according to federal rules, not according to every state’s rules, you can get it via telehealth. You can get it delivered by mail. You can pick it up at a retail pharmacy. You don’t have to get it in person handed to you from a doctor like you used to. So these lawsuits are attempting to bring back those restrictions or get the kind of national ban that a lot of groups want. And so you have other ones pending: Florida, Texas, Missouri, you have a bunch of ones. So this is the Louisiana version. And the Trump administration, it’s important to note, they are not defending the FDA or the abortion pill on the merits. They are saying, we don’t want this lawsuit and this court to force us to do something. We want to go through our own careful process and do our own internal review of the safety of mifepristone, and then we may decide to impose restrictions. But they’re asking courts to give them the time and space to complete that process and saying, you know, This is our power we should have in the executive branch. And so, in this case, the judge, in ruling for the Trump administration, basically just hit pause. This doesn’t get rid of the case. It just puts a stay on it for now, and that’s important. In some of these other cases, the Trump administration has asked the courts to throw out the case, but that was not the situation here. So this doesn’t mean that abortion pills are going to be available forever. This doesn’t mean nothing’s going to happen, and they’re going to be banned. This just means, you know, we’re kicking the can down the road.  

Rovner: I was saying, just to be clear. I mean, we know that this FDA quote-unquote “study” 鈥 whether it is or isn’t going on 鈥 is part of, kind of, a delaying tactic by the administration, because they don’t want to really make abortion a big front-and-center issue in the midterms. So they’re trying to sort of run the clock out here. Is that not sort of the interpretation that’s going on right now?  

Ollstein: That’s what people on both sides assume is going on. It’s really been fascinating how everyone is being kept in the dark about what’s happening inside the FDA 鈥 and if this review is even happening, if it’s real, if it’s in good faith, what is it based on? And so it’s become this sort of Rorschach test, where people on the left are saying, you know, They’re laying the groundwork to do a national ban. This is just political cover. They just want to wait until after the midterms, and then they’re going to go for it. And people on the right are saying, you know, The administration is cowardly, and they aren’t really doing anything, and they’re just trying to get us to shut up and be patient. We don’t know if either of those interpretations or neither of them are true.  

Rovner: Lauren, you want to add something? 

Weber: I just think it’s pretty clear this is also just on a [Health and Human Services Secretary Robert F.] Kennedy [Jr.] priority. I mean, let’s go back. The man 鈥 comes from one of the top Democratic political families originally. You know, there’s obviously been a lot of chatter around his anti-abortion beliefs. Now, obviously, he’s on a Republican ticket. I think some of that plays into this as well. And he already has his hand on the stove on so many other hot issues that, [if] I had to guess, I don’t think that they’re trying to rock the boat on this one. 鈥 I think, some background context too, to some of what’s going on.  

Rovner: We’ll get to some of those hotter issues. But, meanwhile, the Journal of the American Medical Association [Internal Medicine] has a  suggesting that medication abortion is so safe that it could be provided over the counter 鈥 that’s without any consultation with a medical professional, either in person or online. This doesn’t feel like it’s going to happen anytime soon, though, right? While we’re still debating the existence of medication abortion in general. 

Ollstein: That’s right. I mean, there are a lot of people who can’t get this medication prescribed by a valid doctor right now, let alone over the counter. I will say it is common in a lot of parts of the world to get it over the counter, whereas in the United States, the most common way to have a medication abortion is with a two-pill combination, mifepristone and misoprostol. In a lot of parts of the world, people just use misoprostol alone, and it is effective and it is largely safe. It’s slightly less safe than using both pills together. And so I think there’s a lot of international data out there, and people point to that and advocate for this. And I will say there are activist groups in the United States who are setting up networks, underground networks, to get these pills to people with no doctor’s involvement. And so that is already going on. I think that a lot of people would prefer to get it from a doctor if they could. But because of bans and restrictions, they can’t. And so people are turning to these activist groups. 

Rovner: I will point out, as a person who covered the entirety of the fight to have emergency contraception 鈥 which is not the abortion pill 鈥 made over the counter, it took like, 15 years. It shortened my life covering that story. Lauren, did you want to add something?  

Weber: Yeah, I just wanted to say I find it really interesting. Obviously, reproductive issues end up taking 15 years, as you pointed out, to make it over the counter. But there are a lot of things that are considered potentially more dangerous that you can order up in a pretty basic telehealth visit or even just buy in not-so-sketchy ways that the administration is also even looking to deregulate. So I think the differences of access of this compared to other less studied, potentially more unsafe medication is quite striking. 

Goldman: Part of [President Donald] Trump’s “Great Healthcare Plan” is making more medications available over the counter. So this is certainly something that they have said they want to do, in general. This is a political nightmare, though, to do that for abortion. 

Ollstein: Yeah, and people have been pointing to this and a lot of other policies for a while to argue about something they call abortion exceptionalism, in which people apply a different standard to anything related to abortion, a different safety standard, a different standard of scrutiny than they do to medications for lots of other purposes. And you’ve seen that, and that comes up in lawsuits and political arguments about this. And I think, you know, people can point to this as another example. 

Rovner: So last week, we talked about the federal family planning program Title X, which finally got funded after months of delays. But Alice, you warned us that the administration was planning to make some big changes to the program, and now those have finally been announced. Tell us what the plan is for a program that’s provided birth control and other types of primary and preventive care since the early 1970s. 

Ollstein: Well, the changes have sort of been announced. They’ve more been teased. What we are still waiting for is an actual rule, like we saw in the first Trump administration, that would impose conditions on the program. And so what we saw recently, it was part of a wonky document called a “Notice of Funding Opportunity,” or NOFO, for those in the D.C. lingo. And basically it was signaling that when groups reapply 鈥 they just got this year’s money, but when they reapply for next year’s money 鈥 it sets up sort of new priorities and a new focus for the entire program. And what was really striking to me is, you know, this is a family planning program. It was created in the 1970s and it is primarily about delivering contraception to people who can’t afford it around the country, providing it to millions of people who depend on this program, and the word “contraception” did not appear in the entire 70-page document other than an assertion that it is overprescribed and has bad side effects. And instead, they signaled that they want to shift the program to focus on, quote, “family formation.” So this is really striking to me. I think we saw some signs that something like this was coming. You know, about a year ago, there was some Title X money approved to focus on helping people struggling with infertility. But that was sort of just a subset of the program, and now it looks like they want to make that, you know, an overriding focus of the program. So I think when the actual rule to this effect drops, and we don’t know when that will be 鈥 will they wait till after the midterms to, you know, avoid blowback? Who knows? I think there will certainly be lawsuits then. But I think right now, this is just sort of a sign of where they want to go in the future. And it’s important to note that it came very quickly on the heels of a big backlash from the anti-abortion movement over the approval of this year’s funding going out to all of the clinics that got it before, including Planned Parenthood clinics. The anti-abortion groups were agitating for Planned Parenthood to be cut off at once, you know, not in the future, right now. 

Rovner: Just to remind people that the ban on Planned Parenthood funding from last year was for Medicaid, not for the Title X program. 

Ollstein: Right.  

Rovner: And that’s why Planned Parenthood got money. 

Ollstein: Yes, and Planned Parenthood is not allowed to use any Medicaid or Title X money for abortions, but the anti-abortion groups say it functions like a backdoor subsidy, and so they wanted it to be cut off. So they were very pissed that this money went out to Planned Parenthood. And so very quickly after, the administration put out this document, saying, Look, we are taking things in another direction, and it is not the direction of Planned Parenthood. 

Rovner: Lauren, you want to add something? 

Weber: Oh, I just wanted to say Alice has really been owning the beat on all the Title X coverage, so 鈥 

Rovner: Absolutely.  

Weber: 鈥 glad we are able to have her explain it to us. But just wanted to throw out a kudos for breaking all the news on that front.  

Goldman: Yeah, great coverage. 

Rovner: Yes. Very happy to have you for this. Turning to the budget, which is normally the major activity for Congress in the spring, we finally got President Trump’s spending blueprint last week. It does propose cuts to discretionary spending at the Department of Health and Human Services to the tune of about $15 billion, but those cuts are far less deep than those proposed last year. And, as we have noted, Congress didn’t actually cut the HHS budget last year by much at all. And many programs, like the National Institutes of Health, actually got small increases. Is this budget a reflection of the fact that the administration is recognizing that cuts to Health and Human Services programs aren’t actually popular with the public or with Congress, for that matter, going into a midterm election? 

Weber: I think it’s that last little piece you mentioned there, Julie. I think it’s the “going into the midterm election.” I think you hit the nail on the head there. Cuts are also not good economically for many Republicans. You know, we saw Katie Britt be one of the 鈥 the Alabama Republican senator 鈥 be one of the most outspoken senators in general about some of the cuts that were floated for the budget for HHS last year. So I think what you’re hinting at, and what we’re getting at, is that it’s not politically popular, it can be economically problematic, on top of the scientific advances that are not found. So I suspect you are right on that. 

Ollstein: The administration knows that this is “hopes and dreams” and will not become reality. It did not become reality last year. It almost never becomes reality. And I think you can see the sort of acknowledgement that this is about sending a message more than actually making policy in things like Title X, because at the same time they put out this guidance from HHS about the future of Title X, moving away from contraception, in the president’s budget he proposed completely getting rid of Title X, completely defunding it, which he has in the past as well. And so why would they put out guidance for a program that doesn’t exist? 

Goldman: I think, also, this is the second budget that they’re putting out in this administration, right? So now they are just a little more used to what’s going on, and they have more of their feet under them. 

Weber: As a preview for listeners, too, I’m sure we will have Kennedy asked about this budget when he appears in a series of so many hearings next week and the week after. And there were a lot of fireworks last year with him and various members of Congress about the budget. So I am sure that we will hear a lot more on this front in the weeks to come. 

Rovner: Yeah, I would say that’s one thing that the budget process does, is when the president finally puts out a budget, the Cabinet secretaries travel to all of the various committees on Capitol Hill to, quote, “defend the president’s budget,” which is sometimes or, I guess in the case of Kennedy, one of the few chances that they get to actually have him in person to ask him questions. But in the meantime, you know, we have the budget, then we have the president himself, who at an Easter lunch last week 鈥 that was supposed to be private, but ended up being live-streamed 鈥 said, and I quote, “It’s not possible for us to take care of day care, Medicare, Medicaid, all these individual things.” The president went on to say that states should take over all that social spending, and the only thing the federal government should fund is, quote, “military protection.” Did I just hear a thousand Democratic campaign ads bloom? 

Goldman: I think this is a prime example of when you should take Trump seriously, but not literally. I don’t think that there’s any world, at least in the foreseeable future, where the federal government isn’t funding Medicare. But, you know, you certainly have to watch at the margins. It’s like, it’s not a secret that this is something that they’re interested in cutting back spending on. It’s super politically difficult to do that, and they know that, and that’s part of why, which I’m sure we’ll talk about in a little bit, they bumped up the payment rate for 2027 to Medicare Advantage plans.  

Rovner: Which we will get to. 

Goldman: Yeah, so I mean, it’s certainly an eye-opening statement, and you should remember it. But I don’t think that we’re in immediate jeopardy here. 

Rovner: This is the president who ran in 2024, you know, saying that he was going to protect Medicare and Medicaid. I mean, it’s been, you know, against some of the recommendations of his own administration. I was just sort of shocked to see these words come out of his mouth. Lauren, you wanted to say something?  

Weber: I mean, it’s not that surprising, though. I mean, look at what the One Big Beautiful Bill [Act] did to Medicaid. He’s already pushed through massive Medicaid cuts, which are essentially being offloaded to the states. So, I mean, I think this ideology has already borne out and will continue to bear out, and obviously it’s happening amid the backdrop of a war. So that plays into, obviously, the commentary as well.  

Rovner: Well, meanwhile, Republicans are still talking about doing another budget reconciliation bill, the 2.0 version of last year’s Big Beautiful Bill, except this time it’s essentially just to fund the military and ICE [Immigration and Customs Enforcement] and border control, because Democrats won’t vote for those things, at least they won’t vote for additional military spending. What are the prospects for that to actually happen? And would Republicans really be able to do it if those programs are paid for with more cuts to Medicare and/or Medicaid, as some have suggested? 

Goldman: You know, my co-worker Peter Sullivan wrote about this last week, and there was a lot of blowback from politicos, from advocates, from, you know, kind of across the spectrum of groups there. I think that it would be extremely politically unpopular, especially going into the midterms, to use health care as an offset. But I would say that Republicans are pretty good at rhetoric, right? That’s one of the things that they’re known for right now, and there’s always a way to spin it. 

Rovner: Alice and I spoke to a group earlier this week, and I went out on a limb and predicted that I didn’t think Republicans could get the votes for another big budget reconciliation this year. I mean, look at how close it was last year. The idea of cutting any deeper seems to me unlikely, just given the margins that they have. 

Goldman: And I think that is something that you do in between election years. That’s not something you do in an election year. 

Rovner: That’s true, yes 鈥 you do tend to see these bigger bills in the odd-numbered years rather than the even-numbered years, but 鈥 

Ollstein: And I think it’s important to remember that the reason Republicans are in this bind and that they feel like they have to keep reconciliation nearly focused on funding immigration enforcement is because Democrats refuse to fund immigration enforcement. And so they feel pressured to put all their effort and political capital towards that, and don’t want to mess that up by adding a bunch of other health care things that could cause fights and lose them votes.  

Goldman: The money has got to come from somewhere. 

Rovner: And health care is where all the money is. Speaking of Medicare and Medicaid, where most of the money is, there is news on those fronts, too. Maya, as you hinted on Medicare, the administration is out with its payment rule for private Medicare Advantage plans for next year. And remember, we talked about how HHS was going to really go after overbilling in Medicare Advantage and cut reimbursement dramatically? Well, you can forget all that. The final rule will provide plans with a 2.48% pay bump next year. That’s compared to the less than 1% increase in the proposed rule. That’s a difference of about $13 billion. The final rule also eliminated many of the safeguards that were intended to prevent overbilling. What happened to the crackdown on Medicare Advantage? Are their lobbyists really that good? 

Goldman: Their lobbyists are pretty good. This was a year where there were 鈥 I think CMS [the Centers for Medicare & Medicaid Services] said there were a record number of public comments on their proposed rate, flat rate increase, flat rate update. But I think it’s also not that surprising. Historically, the final rate announcement for Medicare Advantage is almost always a little higher than the proposed because they incorporate additional data from the end of the previous year that wasn’t available when first rate is proposed, the initial rate is proposed. But certainly they backed away from a big change to risk adjustment, or, like, the way to adjust payment based on how sick a plan’s enrollees are. You get more pay 鈥  

Rovner: Because that’s where the overbilling was happening, that we’d seen a lot of these wonderful stories that plans were basically, you know, inventing diagnoses for patients who didn’t necessarily have them or didn’t have a severe illness, and using that to get additional payments. 

Goldman: Right. And they did move forward with a plan to prevent diagnoses that are not linked to information that’s in a patient’s medical chart from being used for risk adjustment. But a lot of plans had said, like, Yeah, this is, that’s the right thing to do, and it’s not going to be that impactful for us. You know, overall, this is a win for health insurance. I think one thing to note is that Chris Klomp, the director of Medicare, said, We’re still really focused on trying to right-size this program. That’s still a priority for us as an administration, but we also want to safeguard it. And so I think insurers are not off the hook entirely. There’s still going to be a lot of scrutiny, but their lobbyists are pretty good. And you know, no one wants to be seen as the candidate that cuts Medicare. 

Rovner: And we have seen this before, that when Congress cuts “overfunding” for Medicare Advantage, the plans, seeing that they can’t make its big profits, drop out or they cut back on those extra benefits. And the beneficiaries complain because they’re losing their plans, or they’re losing their extra benefits, and they don’t really want to do that in an election year either, because there are a lot of people, many millions of people, who vote who are on these plans. So, in some ways, the plans have the administration over a political barrel, in addition to how good their lobbyists are.  

Well, apparently, one group that HHS is still cracking down on are legal immigrants with Medicare. Most of the publicity around the health cuts in last year’s budget bill focused on the cuts to Medicaid. But we at 麻豆女优 Health News have a story this week about legal immigrants who’ve paid into the Medicare system with their payroll taxes for years and are now being cut off from their Medicare coverage. This is apparently the first time an entire category of beneficiaries are having their Medicare taken away. I’m surprised there hasn’t been more attention to this, or if it’s just too much all happening at once. 

Ollstein: I mean, there’s a lot happening at once, and even just in the space of immigrants’ access to health care, there is so much happening at once. And so this is obviously having a huge impact on a lot of people, but so are 100 other things. And I think, you know, the zone has been flooded as promised. And really, state officials who are also dealing with a thousand other things, Medicaid cuts, you know, these federal changes, work requirements, are grappling with this as well. 

Rovner: Lauren, you wanted to add something? 

Weber: Yeah. I mean, I thought it was, there was a striking quote in the story from Michael Cannon, who basically said, The reason this isn’t resonating is because this won’t upset the Republican base. And I think that’s a striking quote to be considered. 

Rovner: Michael Cannon, libertarian health policy expert, just kind of an observer to this one. But yeah, I think that’s true. I mean, or at least the perception is that these are not Republican voters, although, you know, as we’ve seen, you know, Congress has tried to take aim at people they think aren’t their voters, and it’s turned out that those are their voters. So we will see how this all plays out.  

Well, at the same time that this is all going on, the folks over at the newsletter “Healthcare Dive” are reporting that the Centers for Medicare & Medicaid Services are trying to embark on all these new initiatives on fraud, and work requirements, and artificial intelligence with a diminished workforce. While CMS lost far fewer workers in the DOGE [Department of Government Efficiency] cuts last year than many other of the HHS agencies 鈥 it was in the hundreds rather than the thousands 鈥 CMS has long been understaffed, given the fact that it manages programs that provide health insurance to more than 160 million Americans through not just Medicare and Medicaid, but also the Children’s Health Insurance Program and the Affordable Care Act. I know last week, FDA Commissioner Marty Makary said he wants to hire more workers to replace the 3,000 who were RIF’ed or took early retirement there at the FDA. And CMS does have lots of job openings being advertised. But it’s hard to see how replacing trained and experienced workers with untrained, inexperienced ones are going to improve efficiency, right? 

Goldman: Tangentially, I was talking to a health insurance executive yesterday who was saying that his team is so much bigger than CMS, and they cover a fraction of the market, and they’re often the ones coming to CMS and proposing ideas and working with CMS on it. I don’t, I think that is a dynamic that far predates this administration, but 鈥 

Rovner: Oh, absolutely. 

Goldman: But it’s certainly interesting. And 鈥 CMS has very ambitious plans, and not that many people to carry them out. But, you know, I think one thing that I also want to note is that when I talk to trade associations and stakeholders about this CMS, they are generally like, pretty support- 鈥 like, they say that they think they’re being heard, and they think that CMS and the career staff are doing, you know, the same kind of caliber of work that they’ve been doing, which I think is notable. 

Rovner: And as we have mentioned many times, you know, Dr. [Mehmet] Oz, the head of CMS, is very serious about his job and doing a lot of really interesting things. It’s just, it’s hard, you know, in the federal government, if you don’t have the resources that you want to 鈥 if you don’t have the resources to match your ambitions. Let’s put it that way.  

Well, meanwhile, on the Medicaid front, we’re already seeing states cutting back, and some of the results of those cutbacks.  on how psychiatric units are at risk of being shut down due to the Medicaid cuts, since they often serve a disproportionate number of low-income people and also tend to lose money. And The New York Times has a  of an Idaho Medicaid cutback of a program that had provided home visits to people living in the community with severe mental illness, until those people who lost the services began to die or to end up back in more expensive institutional care. Now the state has resumed funding the program, but obviously will end up having to cut someplace else instead. I know when Republicans in Congress passed the cuts last year, they said that people on Medicaid who were not the able-bodied working-age populations wouldn’t see their services cut. But that’s not how this is playing out, right?  

Weber: I just think the story by Ellen Barry, who you should always read on mental health issues in The New York Times, “,” is such an illustrative example of unintended consequences from these cuts. And the reason that they’re being reversed 鈥 by Republican legislators, no less 鈥 in Idaho, is because it’s more expensive to have cut the money from it than it is efficient. I mean, what they found was, is that after they cut the money to the schizophrenia program, they saw this massive uptick in law enforcement cases and hospitalizations, uninsured hospitalizations, that this avoided. And I think it’s a real canary in the coal mine situation, because we’re only starting to see these states cut these things off. And this was a pretty immediate multiple-death consequence. And I think we’re going to see a lot of stories like this, of a variety of programs that we all don’t even have any idea that exist in the safety net across the country that are being chipped away at.  

Rovner: Well, turning to other news from the Department of Health and Human Services, we’re getting some more competition here at What the Health? Health secretary Kennedy has announced he’ll be unveiling his own podcast, called The Secretary Kennedy Podcast, next week. He promises to, according to the trailer posted online on Wednesday, quote, “name the names of the forces that obstruct the paths to public health.” OK then, we look forward to listening.  

Meanwhile, in actual secretarial work, the secretary this week also unveiled changes to the charter of the Advisory Committee on [Immunization] Practices after a federal judge last month invalidated both the replacement members that he’d appointed last year and the changes made to the federally recommended vaccine schedule. So what’s going to happen here now? Will this get around the judge’s ruling by watering down the expertise that members of this advisory committee are supposed to have in vaccines? And why hasn’t the administration appealed the judge’s ruling yet? 

Goldman: You know, I don’t have actual answers to this, but I do wonder and speculate that this is going to end up being some kind of legal whack-a-mole situation where the secretary and HHS says, OK, you don’t like it that way? We’ll do it this way, and then they’ll do it another way, and advocates will sue, and we’ll see how this plays out going forward in the courts. I think this is not the end of the story. Even though the judge’s decision was a big win for vaccine advocates, it’s just we’re in the midpoint, if that. 

Rovner: And Lauren, speaking of vaccines, your colleague Lena H. Sun has  on HHS and vaccine policy. 

Weber: Yeah, Lena Sun is always delivering. She found out that the acting director of the CDC [Centers for Disease Control and Prevention] at the time delayed publication of a report showing that the covid-19 vaccine[s] cut the likelihood of emergency department visits and hospitalizations for healthy adults last winter by about half. So even though Kennedy is not talking more about vaccines, it appears that, based on this reporting, that some of his underlings are not necessarily touting the benefits of vaccine, so to speak. And I’m very curious, going back to Kennedy’s podcast, I found the rollout of that so interesting because the teaser was very leaning into the Kennedy that got elected, you know, someone who speaks about, you know, dark truths that are hidden from the public, and so on. And then the press team had these statements of, like, Kennedy will investigate the affordability of health costs and food and nutrition. And I think this dichotomy of who Kennedy is and who the White House and the press secretary and HHS want Kennedy to be before the midterms really could come to a head in this podcast. So I think we will all be listening to hear how that goes. 

Rovner: Yeah, we keep hearing about how the secretary is being, you know, sort of put on a leash, if you will. And, you know, told to downplay some of his anti-vaccine views and things like this. And that seems quite at odds with him having his own podcast. Alice, do you want to 鈥? 

Weber: I guess, it depends on who’s editing the podcast and who they have on. I’m just very 鈥 you could even tell from the trailer to how his press secretary presented it, there was an interesting differential in framing, and I am curious how that plays out as we see guests on it. 

Ollstein: I mean, it’s also worth noting that this is an administration of podcasters. I mean, you have Kash Patel, you have so many of these folks who have a history of podcasting, clearly have a passion for it, just can’t let it go while working a full-time, high-pressure government job.  

Rovner: We shall see. Meanwhile, HHS, together with the Environmental Protection Agency, is waging war on microplastics, those nearly too impossible to detect bits of plastic that are getting into our lungs and stomachs and body tissues through air and water and food. The plan here seems to be to find ways to detect exactly how much microplastics we are all getting in our water and what the health impacts might be, since we don’t have enough information to regulate them yet. I would think this would be one of those things that pleases both MAHA [Make America Healthy Again] and the science community, right? Or is it just, as one MAHA supporter called it, theater? 

Goldman: I think this is a great example of the, you know, part of the reason why MAHA is so interesting to such a wide swath of people. Like, there’s a lot of legitimate concern, not that other concerns aren’t necessarily legitimate, but there’s a lot of concern over, from the scientific community, over microplastics. I’m honestly surprised that we’re this far into the administration with this announcement. I would have thought that this is something they would have done sooner, but they obviously had other priorities as well. 

Rovner: Well. Finally, this week, speaking of other priorities, HHS Secretary Kennedy and CMS Administrator Dr. Oz are declaring war on junk food in hospitals. Again, this seems like a popular and fairly harmless crusade; hospitals shouldn’t be serving their patients ultraprocessed food. Except, almost as soon as the announcement came out, I saw tons of pushback online from doctors and nurses who worried about patients for whom sugary food or drinks are actually medically indicated, or who, because of medications they’re taking, or illnesses they have, can only eat, or will only eat, highly palatable, often processed food. Nothing in health care is as simple as it seems, right?  

Weber: I think what’s also interesting is one of my favorite examples in the memo they put out was they hope that every hospital, as an example, could serve quinoa and salmon. And I just am curious to see how fast that gets implemented. And it’s a very valid 鈥 a lot of people complain about hospital food. It’s a very valid thing to push for better food. But I also question, as I understand it, this seems more like a carrot than a stick when it comes to the regulation they put out. 

Rovner: As it were. 

Weber: As it were. And so I’m curious to see how it gets implemented. That said, there are hospitals that have taken it upon themselves 鈥 the Northwell [Health] example in New York is a good example 鈥 to really improve their hospital food. And frankly, it’s a money maker. If your food’s better, people come to your hospital, especially in an urban area where there is hospital competition. So you know, like most MAHA topics, there’s a lot of interesting points in there, and then there’s a lot of what’s the reality and what’ actually going to happen. And so I’ very curious to see how this continues to play. 

Rovner: I did a big story, like, 10 years ago on a hospital chain that had its own gardens, that literally grew its own healthy food. So this is not completely new but, again, interesting. 

All right, that is this week’s news. Now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Alice, why don’t you start us off this week? 

Ollstein: I have a piece from my co-worker Simon [J.] Levien, and it is called “.” This is about thousands of doctors around the country who are from other countries that are placed on, you know, a list by the Trump administration of places where they want to scrutinize and limit the number of immigrants coming from there. And so these are people who are already here, already practicing, have poured years into their training, have been living here, and, in some cases, are the only folks willing to work in certain areas that have a lot of medical shortages, and they just can’t practice because their paperwork isn’t getting processed in time. And so they’re sort of in this scary limbo, and that’s putting these hospitals and clinics that they work in in a really tough bind. And so they’re hammering the Trump administration to give them answers about what their fate is. You know, they’re not trying to deport them yet, but they’re not allowing them to continue working either.  

Rovner: For an administration that’s been pushing really hard to improve rural health care, this does not seem to be a way to improve rural health care. Maya. 

Goldman: My extra credit this week is called “Trump’s Personnel Agency Is Asking for Federal Workers’ Medical Records.” It’s a great 麻豆女优 Health News scoop from Amanda Seitz and Maia Rosenfeld. It’s a really great example of the administration, you know, sort of moving in silence, doing these small regulatory announcements that could have big impact. Basically, the Office of Personnel Management is asking for personally identifiable medical information from health insurers, and its reasoning is to analyze costs and improve the health system, but they could get very detailed medical information from federal employees, including things like, did they get an abortion? Are they undergoing gender-affirming care? And, obviously, there is a strong concern that that could be used against them.  

Rovner: Yeah 鈥 this was quite a scoop. Really, really interesting story. Lauren. 

Weber: Mine was a pretty alarming story by Holly Yan at CNN: “.” And basically there’s this type of drug test that the scientists have found is not that effective, and it’s led to things like bird poop being scraped off a man’s car appearing on a drug test as cocaine, a great-grandmother’s medication testing positive for cocaine, and a toddler’s ashes registering as meth or ecstasy, and horrible legal and other consequences of this kind of misdiagnosis in the field. And the reason these drug tests are often done is because they’re cheaper. There’s a more expensive, more accurate version, but these are cheaper. They’re done in the field. But the potential side effects and horrible, wrongly accused effects are quite large, and so Colorado has passed this law to try and move away from this. And it’s curious to see if other states will follow suit. 

Rovner: Yeah, this was something I knew nothing about until I read this story. My extra credit this week is from The Atlantic by Katherine [J.] Wu, and it’s called “.” And it’s about how some of the very top career officials from the NIH [National Institutes of Health], the CDC, and other agencies have, after having been put on leave more than a year ago, finally been reassigned to far-flung outposts of the Indian Health Service in the western United States. They got news of their proposed reassignments with little description of their new roles and only a couple of weeks to decide whether to move across the country or face termination. Now, if these officials’ skills matched those needed by the Indian Health Service, this all might make some sense. But what the IHS most needs are active clinicians: doctors and nurses and social workers and lab technicians. And those who are now being reassigned are largely managers, including 鈥 and here I’m reading from the story, quote 鈥 “the directors of several NIH institutes, leaders of several CDC centers, a top-ranking official from the FDA tobacco-products center, a bioethicist, a human-resources manager, a communications director, and a technology-information officer.” The Native populations who are ostensibly being helped here aren’t very happy about this, either. Former Biden administration Interior Secretary Deb Haaland, a Native American who’s now running for governor in New Mexico, called the reassignment proposals, quote, “shameful” and “disrespectful.” Also, and this is my addition, not a very efficient use of human capital. 

OK, that’s this week’s show. Thanks this week to our fill-in editor, Mary-Ellen Deily, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts 鈥 as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can find me on X , or on Bluesky . Where do you guys hang these days? Maya. 

Goldman: I am on LinkedIn under my first and last name, , and on X at . 

Rovner: Alice. 

Ollstein: I’m on Bluesky  and on X . 

Rovner: Lauren. 

Weber: Still @LaurenWeberHP on both  and . 

搁辞惫苍别谤:听We will be back in your feed next week.聽Until then, be healthy.

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<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2181013&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2181013 New Flu Vax? FDA Says No Thanks /podcast/what-the-health-433-fda-flu-vaccine-rejected-moderna-abortion-pill-february-12-2026/ Thu, 12 Feb 2026 19:50:00 +0000 The Host
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Julie Rovner 麻豆女优 Health News Read Julie's stories. Julie Rovner is chief Washington correspondent and host of 麻豆女优 Health News’ weekly health policy news podcast, "What the Health?" A noted expert on health policy issues, Julie is the author of the critically praised reference book "Health Care Politics and Policy A to Z," now in its third edition.

The Food and Drug Administration is back in the headlines, with a political appointee overruling agency scientists to reject an application from the drugmaker Moderna for a new flu vaccine, and FDA Commissioner Marty Makary continuing to take criticism from anti-abortion Republicans in the Senate for alleged delays reviewing the safety of the abortion pill mifepristone.

Meanwhile, in a very unlikely pairing, Sen. Elizabeth Warren, the Massachusetts Democrat, and Sen. Josh Hawley, the conservative Republican from Missouri, are co-sponsoring legislation aimed at breaking up the “vertical integration” of health care 鈥 when a single company owns health insurers, drug middlemen, and clinician practices.

This week’s panelists are Julie Rovner of 麻豆女优 Health News, Jackie Fortiér of 麻豆女优 Health News, Lizzy Lawrence of Stat, and Alice Miranda Ollstein of Politico.

Panelists

Jackie Fortiér photo
Jackie Fortiér 麻豆女优 Health News
Lizzy Lawrence photo
Lizzy Lawrence Stat
Alice Miranda Ollstein photo
Alice Miranda Ollstein Politico

Among the takeaways from this week’s episode:

  • A top FDA official overruled agency staff in refusing to consider Moderna’s application for a new flu vaccine. The rejection, which Moderna is challenging, comes after the company consulted with the agency under President Joe Biden on how to develop the clinical trial for the vaccine and then spent considerable time and money. Clear, consistent federal guidance is important to maintaining the drug development ecosystem, and the decision stands as a warning to other companies developing new treatments.
  • With measles cases rising and trust in federal vaccine recommendations falling, the Vaccine Integrity Project, based at the University of Minnesota’s Center for Infectious Disease Research & Policy, and the American Medical Association are launching their own vaccine review process 鈥 a parallel vaccine recommendation project offering an alternative to what are seen as ideologically driven federal recommendations.
  • President Donald Trump unveiled the new TrumpRx website, billed as helping people save money on prescription drugs. But the site’s offerings are limited and offer limited benefits: It serves only those trying to buy drugs without insurance coverage, and some of the biggest savings are on popular obesity drugs rather than other commonly needed treatments. Nonetheless, it offers Trump a chance to stamp his name on an effort to lower drug prices.
  • And more reporting is illuminating the health-related side effects of Trump’s immigration crackdown, including infectious disease outbreaks at detention centers. While at least some of the problems are not new to immigration enforcement, the large numbers of people being detained are intensifying the problems.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too: 

Julie Rovner: ProPublica’s “,” by Mica Rosenberg.  

Alice Miranda Ollstein: Politico’s “,” by Amanda Chu.  

Lizzy Lawrence: 麻豆女优 Health News’ “” by Rachana Pradhan.  

Jackie Fortiér: Stat’s “,” by Ariana Hendrix.  

Also mentioned in this week’s episode:

  • Stat’s “,” by Lizzy Lawrence.
  • 麻豆女优 Health News’ “,” by Amy Maxmen.
  • 麻豆女优 Health News’ “,” by Claudia Boyd-Barrett.
Click to open the transcript Transcript: New Flu Vax? FDA Says No Thanks

[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.] 

Julie Rovner: Hello from 麻豆女优 Health News and WAMU public radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Feb. 12, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go. 

Today, we are joined via videoconference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Lizzy Lawrence of Stat News. 

Lizzy Lawrence: Hi.  

Rovner: And up early to join us from California, my 麻豆女优 Health News colleague Jackie Fortiér. Welcome, Jackie.  

Jackie Fortiér: Hey, everyone. 

Rovner: No interview this week, but plenty of news. So let’s jump right in. We will start this week at the Food and Drug Administration, where things are 鈥 why don’t we call it 鈥 newsmaking. The biggest FDA story that broke this week was controversial vaccine chief Vinay Prasad outright rejecting an application for a new flu vaccine from Moderna, maker of the mRNA covid vaccine that so many anti-vaxxers have criticized. Lizzy, you . Congratulations. What happened exactly? And why is this such a big deal beyond the flu vaccine? 

Lawrence: This is a big deal because to refuse to file is a pretty rare occurrence in general, because in general the FDA and industry like to have agreed-upon standards for clinical trials before companies embark on them and pour millions of dollars into them. So that was surprising. And then鈥 

Rovner: And refuse to file means that they said that they’ve got the application and said: Yeah, we’re not accepting that. We’re not going to review this. Right? 

Lawrence: Yes, yes. And Prasad wrote that the grounds for this was that it wasn’t an adequate, controlled trial. Well, Moderna is saying that actually the FDA greenlit this trial back under the Biden administration in 2024. They acknowledged that there was basically a control vaccine that the FDA say they would prefer that Moderna use for the older population. But they said, however, it’s acceptable if you don’t do that. 

Rovner: And I want to make sure I understand this. The complication here is that this is supposed to be a better vaccine for older people, but right now there’s vaccines for older people that start at age 65 and this is a vaccine that’s supposed to start at age 50, right? So it was unclear who they were going to test it against, whether it was going to be the 50-to-64s or the 65s and older. Because there isn’t a vaccine right now that’s approved for 50 and up, right? 

Lawrence: Exactly, exactly. So it was there’s the high-dose vaccine, which is recommended for the above-65s, but that is not recommended for the 50-to-64, which is part of why Moderna didn’t use that high-dose vaccine, because the population that they were studying was broader than this over-65s. So anyway, so yeah, so refusing to file is already rare, and then for there to be an overriding refuse to file, where the, I was told, basically, while there may have been individuals who agreed with Dr. Prasad’s assessment, the review team, every discipline, thought that it was reviewable. And the head of vaccines wrote a memo explaining why he thought it was viable, so that the career staff kind of documented their thoughts here. It’s not clear whether this will be made public ever, but one would hope, with radical transparency, but we’ll see. Despite that, Dr. Prasad still refused to review Moderna’s application. 

Rovner: So obviously it’s a big deal for the flu vaccine, but it’s a big deal beyond this. Moderna’s CEO was on cable news this morning, said that, as you said, after consulting with the FDA officials about the trial, they spent a billion dollars on this trial. How do we expect companies to invest in new medicines like this if the FDA is basically acting on vibes? 

Lawrence: I don’t know. Yeah. And it’s interesting. It doesn’t seem like there’s a ton of sympathy from this administration. Even back last year, [FDA] Commissioner [Marty] Makary tweeted something 鈥 this was when they were limiting, wanted to require more data for covid vaccines for the under-65 crowd. And I think he said something like: Our goal is not to save companies money. That’s not something we 鈥 which of course that isn’t. The FDA’s goal is to promote public health. But it’s definitely a change in tune. I think that in the past, the FDA has understood that you’re really only going to get innovation if you have clear, consistent guidance and that it’s a really worst-case scenario for a company to spend a billion dollars on a clinical trial and then there’s nothing to show for it and nothing for it to benefit patients, either. So. 

Rovner: Is this over? What happens now? 

Lawrence: So now Moderna has requested a meeting to challenge this decision, and now there begins a kind of negotiation. It might be possible that the FDA would, in fact, would review at least the 50-to-64 cohort, because they don’t have any objections there, seemingly. But we’ll have to see. On a call yesterday, a senior FDA official talked about Moderna kind of coming to the agency with humility and acknowledging that the FDA had recommended this high-dose vaccine. And so I don’t know. I think companies are definitely 鈥 it’s a lesson that they’re, especially if you’re in the vaccine space, you have to tread very carefully. 

Rovner: Yeah. And I would think others in the drug space, too. It’s not just 鈥 that’s the point of this 鈥 it’s not just vaccines. Alice, you wanted to say something. 

Ollstein: Oh, yeah. Not only the monetary investment, which we’ve touched on a bunch, but companies spend years. So it’s the time investment as well. And why would you dedicate years of effort to something that you’re not sure if a political appointee is going to swoop in and override career scientific officials’ assessment, if you can’t trust the regulatory system to work as it’s always worked. There really is just a lot of risk there, and you might see people not making these submissions on all kinds of fronts. Of course, this is coming as we’ve had a really bad flu season. I’ve had people in my life get really sick and say it’s been really, really bad. So the prospect of having something that works better to prevent, or even just make it milder, not coming to fruition is rough. 

Rovner: Yeah. And this year, as we know, this year’s flu vaccine was not very well matched to the strains that ended up circulating. And that’s kind of the point of this Moderna vaccine, this mRNA vaccine, is that they say it would be much faster for them to match strains to what’s going around. If it works as the clinical trials suggest it would actually be a better flu vaccine than we have now. 

Well, meanwhile, cases of measles are also continuing to multiply, as they do when people aren’t vaccinated, and not just in the places we’ve talked about, like Texas and South Carolina, but also all around us here in the nation’s capital, apparently, as a result of people traveling here for the anti-abortion March for Life in January. There have been more than 730 confirmed cases of measles in the U.S. already this year. That’s four times more than have been typical for a full year, and it’s not yet the middle of February. Yet that doesn’t seem to be deterring the administration from its anti-vaccine activities. So now, the American Medical Association and the University of Minnesota Vaccine Integrity Project have announced they’ll convene a parallel group of experts to make vaccine recommendations, basically saying they are done following the Centers for Disease Control and Prevention. This has been brewing for a while. Right, Lizzy? 

Lawrence: Yes. As soon as the secretary fired all of the experts who served on the advisory panel to the CDC on vaccines, I think there’s been unease. And now, as you said, there’s an active parallel public health establishment that’s trying to spread credible information and provide an alternative resource, because it’s clear that HHS [the Department of Health and Human Services] has become compromised when it comes to vaccine recommendations. And yet, you’re seeing the spread of infectious diseases right now. 

Fortiér: Having kind of this rival court is not surprising, because they’ve refused to participate in any of the Advisory Committee on Immunization Practices meetings for months and months. I do wonder if this will maybe change some of the tone. We do have an upcoming ACIP meeting in February. Normally we would have a agenda out by now. Before Secretary [Robert F.] Kennedy [Jr.] we would have them weeks in advance, and we haven’t seen one yet, so we’re really not totally sure what they’re going to be talking about. But Dr. [Mehmet] Oz did say this week that he finally advised people 鈥 he’s the CMS [Centers for Medicare & Medicaid Services] director鈥 to take the vaccine. And there’s been over 933 cases in just South Carolina during this outbreak that started last October. And so when I talk to people on the ground who are treating folks in South Carolina and have been treating them for months, and they’ve been doing vaccine clinics and things like that, they were just so fed up with Dr. Oz and the administration, because they partially blame them for these various outbreaks. And I had one of them tell me, like, well, it’s like a band-aid on a bullet hole. Like, now they’re finally encouraging people to get vaccinated when we could have had this months ago. 

Rovner: And, of course, the CDC doesn’t have a director at the moment, because the Senate-approved director was summarily fired and/or quit, not clear which, after refusing to basically rubber-stamp the immunization panel’s recommendations that had not been made at the time. So the American Academy of Pediatrics is suing to stop this February ACIP meeting. I did not hear what the last decision was on that, but I know that there’s still a lot of movement around here. I guess the big worry is: Who should the public trust now? Is it going to be this sort of grouping of medical societies led by the AMA, or the CDC, which people and doctors are used to following the advice of? 

Ollstein: And there’s all these state alliances forming to do the same thing. And so I think, yeah, the more competing recommendations the average person hears, the more they just sort of throw their hands up and say: I don’t even know who to trust anymore. I’m not listening to any of these people. And the trust that’s eroded in the federal government, that’s going to be really hard to recuperate in the future. You can’t just flip a switch and say: OK, it’s a different government. We trust them again. Once those seeds of doubt are planted in people’s minds, it’s really hard to unearth. And so, if not permanent damage, all of this is doing at least very long-term damage to the idea of expertise and authoritative information. 

Rovner: And science, which this administration insists it wants to follow. Well, turning to FDA-related “MAHA” [“Make America Healthy Again”] news, the agency said last week it would relax enforcement of its food additive regulations to make it easier for manufacturers to say they’re not using artificial dyes. Now this was a huge deal when the agency announced the phaseout of artificial coloring. Looking at you, fancy-colored Froot Loops. Now the administration says it’s going to allow foodmakers to say they’re not using artificial colors as long as they’re not using petroleum-based dyes. Apparently, natural dyes are OK. But even that is controversial, and it appears that this whole effort really relies on manufacturers’ willingness to comply rather than, you know, actual regulation, which is kind of what the FDA does for a living. It’s a regulatory agency. 

Ollstein: Well, every time the word “natural” comes up, I always laugh because there is no definition of that. And there are plenty of things that are natural that could kill you or hurt you very badly. And there are plenty of things that are synthetically manufactured that are helpful and fine for you. And so it has this veneer of safety, veneer of health with no actual substance. So my red flags go up whenever I hear that word, and I think everyone should be skeptical. 

Rovner: But it goes with RFK Jr.’s quest now that you should, quote, “eat real food.” 

Lawrence: Right. Yeah. I was going to say same with “chemical.” I feel like, “chemical” abortion drug, “chemical.” And it’s like, a lot of things are chemicals. That’s not鈥 

Ollstein: Yeah, like in your own body, naturally. 

Lawrence: Yeah. 

Ollstein: You have chemicals. 

Lawrence: We are chemicals. 

Ollstein: We are chemicals. 

Rovner: You guys are all too young to remember the Dow Chemical advertising line “Better Living Through Chemistry,” which at the time, in the ’60s and ’70s, was true. There was, there 鈥 we’ve had a lot of better living through chemistry. And some of it has turned out to be maybe not so good for us, but a lot of it has turned out to be pretty darn good for us. 

Well, finally, in FDA land, Commissioner Marty Makary this week met with anti-abortion senators about that ongoing review of the abortion pill mifepristone, which senators want the FDA to remove from the market. Alice, how’d that meeting go? 

Ollstein: Not great for the FDA, from what I was told. I got on the phone with Sen. Josh Hawley after it, and he was extremely frustrated. He said he didn’t get answers to any of the questions he’s been sending in public letters to the FDA for months and now asking in this briefing behind closed doors that they held on Capitol Hill this week. He said he didn’t get answers about what the timeline is for this review of the abortion pill mifepristone, what the review consists of, whether it’s even begun, really, whether it’s even underway. And so he is sort of concluding that this is not going anywhere, and he wants Congress to step in and take action. Now, Congress has tried to step in and take action before. They’ve tried to put restrictions on mifepristone in the FDA funding bill. That didn’t pass. So I don’t know if this is even plausible in this environment where Congress can’t really pass much of anything anymore. 

But Hawley is not just another Republican senator. He is very intertwined with the anti-abortion movement. His wife is an extremely prominent anti-abortion lawyer who’s led a lot of the major cases trying to restrict or ban mifepristone. They founded their own anti-abortion advocacy group. And so it really shows that the tensions, clashes, whatever we want to call them, between the anti-abortion movement and the Trump administration, so after backing the Trump administration for years and years, they’re really getting fed up. And they’re fed up that even after they achieved their grand goal of overturning Roe v. Wade, there are actually more abortions happening now than before, and that’s largely through these pills and people’s ability to get them. And so they’re getting increasingly impatient with the Trump administration, who has been sort of stringing them along and saying: Yeah, we’re working on it. We’re working on it. But they want to see results. Now, of course, if there were some sort of restrictions imposed, that could have a big political effect. And so a lot of Republicans are very torn about that. But not Sen. Hawley. Sen. Hawley wants to see it.  

Rovner: That’s right. Well, moving to what I call FDA-adjacent news, one of the many thorny issues that FDA has been dealing with is the compounding of those very popular and very pricey obesity drugs. When the drugs were in shortage, it was legal for compounders to make their own copies. But now the shortage for both of the leading medications 鈥 semaglutide, made by Novo Nordisk, and tirzepatide, made by Eli Lilly 鈥 is over, and those cheaper copycats were supposed to be pulled from the market. So it was a bit of a surprise when the company Hims, one of those direct-to-consumer drug sites, announced the unveiling of a semaglutide tablet just weeks after the first such drug was approved by the FDA, by Novo Nordisk. The FDA promptly referred the company to the Justice Department for possible violation of federal drug laws, after which Hims said, Oh, maybe we won’t start selling the drug after all. Oh, and Novo is suing for patent infringement. But I would think that the war over the “fat” drugs, as President [Donald] Trump likes to call them, is likely to lower prices just as effectively as government regulation might. Or am I misreading that? Lizzy, this has been quite the sideshow, if you will. 

Lawrence: Yeah. It might. I think that the compounding, the FDA’s crackdown on Hims was very interesting to me because I think before the commissioner had come into his role, there was some speculation. He had worked for a telehealth company that prescribed compounded drugs. And there’s also, I think compounders have tried to tap into a little bit of the MAHA medical freedom aspect. But clearly that’s not been the case, at least at the FDA. They are clearly very upset about this and mean business, and I think it’s tying into their crackdown on direct-to-consumer drug advertising as well. But as far as price, yeah. I think the deals that Trump has managed to strike with the companies could actually be reducing price for patients. I think we’ll have to see. I know there’s obviously drug pricing programs as well that they could pursue. So, yeah, we’ll have to see.  

Rovner: All right. Well, we’re going to take a quick break. We will be right back. 

OK. We’re back. And speaking of President Trump, there’s also drug news this week that’s not directly related to the FDA. That’s the official unveiling of TrumpRx, the website the president says will lower drug prices like no one’s “ever seen before.” That’s a direct quote, by the way. Except it turns out that’s not quite the case. First, these discounts are only for people who are paying out-of-pocket, not those with insurance, which makes them valuable mostly for people who have no coverage or people who take drugs that insurance often doesn’t cover, like those for obesity or infertility. Yet of the 43 drugs so far that are promoted on the TrumpRx website, about half already have cheaper generic copies available through sites like GoodRx and Mark Cuban’s Cost Plus Drugs. And really, the website just points people to already existing manufacturer websites that were already offering those lower prices. So what is the point of TrumpRx? 

Lawrence: Great question. Yeah. This administration has been very focused on, obviously, media and wins and attaching President Trump’s name to things. So it accomplishes that goal. Maybe it does raise awareness for these other sites that already exist. But that’s a theme of a lot of the movement on health care so far, has been 鈥 there’s been a lot of chaos, and then there’s also sometimes things that they announce as like a grand, brand-new, no-one’s-ever-thought-of-it-before policy, but then there are already, of course, existing programs or avenues for that. 

Rovner: And to be fair, Trump has jawboned down some prices, including some prices for the obesity drugs, by basically dragging in the CEOs of these companies and saying, You will lower prices. 

Lawrence: Yeah, yeah. The dealmaking has been effective. And I think the question is: Will this last beyond his administration? Will there be a legacy there? 

Ollstein: I think there’s also some danger in overpromising, because he’s out there saying things that don’t comport with how math works. He’s basically suggesting prices will come down so many percents that we’ll be getting paid to take drugs, because that’s what more than 100% is. And people who are hearing that, voters who are hearing that, if they aren’t seeing that show up in their bills, if they’re not actually seeing those drastic, drastic drops that they’re being promised by the president, are they going to get upset? And is that going to impact how they vote? So yes, there has been some, on the margins, improvements, but when you’re out there promising 600% reductions and not delivering, there’s a risk to that. 

Rovner: Jackie, you wanted to add something. 

Fortiér: Well, I was going to say, I think it’s also confusing for a lot of people, from a consumer perspective, because you log on and I think people, they hear these huge promises, like Alice is talking about, and then they think that they can, necessarily, buy the drugs through there and immediately get them shipped, what these third parties like Hims and Weight Watchers are doing a lot of with the GLP-1s. And that’s not how this works. You still have another step of getting a prescription and then going to the pharmacy and using these to potentially get discounts and lower prices, in the same way that these have been available from pharmaceutical manufacturers and other things like GoodRx for years. But it’s that disconnect between, even if you can get a discount, actually getting the discount and crediting the Trump administration for that that I think is going to be really difficult for a lot of voters to make that connection in the way that the administration wants them to. 

Rovner: And this was ever the case with rebates 鈥 for other consumer products, not just talking about drugs. We’ll give you a $15 rebate, but you have to fill out 87 forms and send it to this place and get it exactly right, do it before the end date, and we’ll send you back $15. Because they count on most people not being able or willing to follow all of the various steps. So instead of giving everybody the discounted price, they make you really basically work for your discount, which is a consumer thing, but it’s pretty popular in the drug space as well. Rather than just lowering prices, they’re going to say, We will give you a discount, but you’re going to have to do this, that, and the other thing in order to get it. 

Fortiér: Right. But when you’re president and you want credit for it, it’s going to be a little more 鈥 it’s harder in order to make that connection. Sorry. 

Rovner: Yes, that’s true. That is a good point. All right, moving on. We have talked a lot about consolidation in the health care industry, particularly companies like UnitedHealthcare, which used to be just an insurer, now owns its own PBM [pharmacy benefit manager], its own claims processing company, and thousands of medical practices around the country. Well, now an extremely unlikely pair in the Senate, Massachusetts Democrat Elizabeth Warren and Missouri Republican Josh Hawley, have joined to introduce something called the Break Up Big Medicine Act, which would basically outlaw so-called vertical integration, like that of United and, to a somewhat lesser extent, Cigna and CVS Health, which owns Aetna, the insurer. Some are referring to this as the health version of the 1932 Glass-Steagall Act, which separated commercial from investment banking 鈥 and, side note, whose repeal in 1999 is considered a major factor setting off the financial crisis of 2008. But that was a risk thing. It was done to prevent another stock market crash like the one in 1929. This is a cost thing. This is to go after high health care costs. Could it work? Could it pass? And is this the beginning of the next big thing in health reform? 

Lawrence: Perhaps. Yeah. Last year, I worked with my colleagues on  kind of examining UnitedHealth Group and the effects of consolidation on doctors and patients. And at the time, I think, there were some vocal lawmakers on either side of the aisle who were criticizing this, especially in the wake of the murder of the UnitedHealth CEO, and which had a surprising 鈥 the public sort of had this reaction and to鈥 

Rovner: Not in United’s favor. 

Lawrence: Not in United’s favor. And so I think that there is, this is a political issue that affects everyone, Republican and Democrat, the, well, cost in general, but I think there’s a lot of resentment and anger, and it seems like that is bringing together these unlikely and pretty powerful senators. I’m not an expert on the Hill. I don’t know if this has a chance. Especially, it’s targeting massive, powerful companies with hands in every part of the health care system. So it’s something that you would imagine the entire health care industry would fight against. But, yeah, I don’t know. 

Rovner: And I will point out that Sen. Josh Hawley, in addition to all his anti-abortion activities, last year, when Congress was debating the Medicaid cuts, kept vowing not to vote for those Medicaid cuts. So he’s 鈥 which, of course, in the end, he did 鈥 but he’s been sort of on the consumer side of health care for a while now. It’s just this is not brand new to him. 

Lawrence: Right. And I’m not sure how many other Republican senators would follow him down this path. But it’s definitely a noteworthy development, and curious to see where it goes. 

Rovner: Yeah, I’m curious to see sort of if the populist part of health care costs sort of rises to the fore. We’ll have to, we will have to watch that space. Well, finally this week, more on the impact of the Trump administration’s immigration crackdowns and health. My 麻豆女优 Health News colleague Amy Maxmen has  about health professionals in the U.S. Public Health Service Commissioned Corps actually resigning rather than accepting postings to Guantánamo Bay, Cuba, where some immigrants are being detained in prisons that used to hold al-Qaida suspects. Another  by Claudia Boyd-Barrett describes how when people detained by ICE [Immigration and Customs Enforcement] end up in the hospital, often their immediate families and their lawyers aren’t even allowed to know where. And remember, last week we talked about cases of measles in some immigration detention facilities. Well, now there are two confirmed cases of tuberculosis at the ICE facility at Fort Bliss in El Paso, Texas. I’m thinking maybe the health part of this is starting to kind of get to people as much as the whole depriving-civil-liberties part. 

Fortiér: Yeah, and there’s also been cases of covid-19, which makes sense. You’re going to have respiratory viruses as you get hundreds of people grouped together. That makes sense. A judge in California a couple days ago ordered that there had to be adequate health provided to detainees in one specific California 鈥 it was a prison and now it’s an ICE detainee facility. That’s specific to there, but it’s 鈥 more and more senators, I think, are also looking at this and pointing out that they’re just not providing the health facilities that people need. And especially ongoing care 鈥 a lot of folks need diabetes treatment, and that treatment just isn’t really happening in many cases. 

Rovner: Yeah, we’ve talked about this at some length, over many weeks, that people in detention are not getting health care, even though it is required, that we keep hearing stories about people not getting needed health care. I didn’t know until I read this story that people who actually end up being hospitalized, that their family members are not allowed to know. That’s allegedly, well, it is because of security, because the idea is that if somebody who’s in detention is in a hospital, you don’t necessarily want bad people knowing that and being able to come to the hospital. But these are people often who are, as we have documented at length, do not have criminal records, and it’s hard to find out where they are. Alice, you wanted to add something. 

Ollstein: Yeah. So there was a recent GAO [Government Accountability Office] report about this, and it found that people were not getting evaluated when they entered a facility to see if they were medically vulnerable and at risk of having a really bad episode or emergency, and that even children, pregnant women, vulnerable populations weren’t getting that initial evaluation, which then led to problems down the road. And it also said that people upon their release 鈥 either deportation or release within the United States if that’s what a court ordered 鈥 they weren’t being given their medical records, their prescriptions. And so the continuity of care was disrupted. And it’s important to note that that GAO report was about a few years ago under the Biden administration. So this isn’t new. These problems aren’t new, but they’re getting much worse, because the number of people detained is at record levels and so everything’s just getting multiplied. 

Rovner: Yeah, it is. Well, we will keep watching that space. OK, that’s this week’s news. Before we get to our extra credits, I am pleased to present the winner of our annual 麻豆女优 Health News Health Policy Valentine contest. It’s from [Andrew Carleen] of Massachusetts, based on a story about Medicare Advantage overpayments. And it goes like this: “I thought it was love. My heart felt spring-loaded. Turns out our relationship was significantly upcoded.” Congratulations, and happy Valentine’s Day to all. 

OK, now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Alice, why don’t you start us off this week? 

Ollstein: Sure. So I have a kind of fun story [“”] from my co-worker Amanda Chu about how the Oura ring has taken over D.C. They have been heavily lobbying the Trump administration and Congress to prevent tough regulations. Basically, there’s a debate about whether it should be regulated as a medical device or not. 

Rovner: Tell us again what it does. 

Ollstein: It’s a ring you wear on your finger that monitors different health metrics. And so the Trump administration MAHA movement has gone all in on this. They love it. The Pentagon has a huge contract with them. Other government agencies are looking at it, too. I think it’s interesting because it is this very sort of conservative mindset of individual responsibility in health care and, oh, if you could just track your own metrics and do the right things. That’s an approach that is sort of counter to the idea of public health and government protecting your health through policy. 

Rovner: And we know HHS Secretary Kennedy is a big fan of wearables. 

Ollstein: Exactly, and this is one of the most popular ones right now. And so this story does a good job digging into all the lobbying and also into concerns about data privacy and pointing out that these technologies are moving much faster than government can regulate them. And that is leaving some lawmakers really concerned about who could have access to this data. 

Rovner: Jackie. 

Fortiér: Mine is by Ariana Hendrix. She’s a writer based in Norway. It’s entitled “.” It was published in Stat. And she writes eloquently about being a parent in Norway and knowing that her children wouldn’t go to day care until they were about 16 months old, because Norway has paid parental leave. And she points out, beyond the vaccine debate there’s a bigger issue, that the U.S. lacks universal health care and federal paid parental leave. So changes in infant vaccines in the U.S. have a large effect, because babies in the U.S. often go to day care, when they’re around a lot of other kids when they’re just a few weeks old. So she points to the, in January, the infant RSV [respiratory syncytial virus] vaccine was moved to the high-risk category of shots, so now it isn’t routinely recommended for all babies in the U.S. And RSV, of course, is the most common cause of hospitalizations for infants, and that’s due to the fact that they’re exposed to the virus in day care a lot earlier than other children in other countries like Norway and Denmark whose vaccine schedules U.S. officials are now kind of trying to emulate. So she does a really great job of laying out how families face greater health and financial risks in the U.S. without the same safety net that other countries have. 

Rovner: Or just the same social policies that other countries have. 

Fortiér: Yeah, it reminded me鈥 

Rovner: It’s hard to, right, it’s hard to import another country’s 鈥 part of another country’s 鈥 policies without importing all of them. It is really good story. Lizzy. 

Lawrence: Yeah. So my piece is by Rachana Pradhan and 麻豆女优 Health News, and it’s about the “” And I thought this piece was very interesting, just because in general I’ve been fascinated by 鈥 politicization of medicine isn’t new 鈥 but just like right-wing-coded products and left-wing-coded products. And in this piece, Rachana talks about NIH [National Institutes of Health] Director Jay Bhattacharya kind of talking about how, It’s the people’s NIH and if a lot of people are using it, well, we want to investigate it. So she just, she does a really good job of kind of unpacking why this is problematic, that they’re kind of just choosing a random medication and there’s not really any scientific reason to be investing in it as much as they are. And she got a response from NIH after the fact as well, kind of where they were trying to defend this decision to pour this much investment. And so, yeah, I think it’s just a really interesting development in NIH land. 

Rovner: It is. My extra credit this week is from ProPublica, by Mica Rosenberg, and it’s called “.” It’s about what immigration detention looks like from the point of view of children being held at a family facility in Dilley, Texas. That’s the one where the two cases of measles were diagnosed earlier this winter. The story includes some pretty wrenching letters and video calls from kids who were living elsewhere in the U.S., while their parents were mostly working within the immigration system. And these kids had been ripped from their daily lives, their other parents and siblings in some cases, their schools and their classmates, and in many cases, from hope itself. Wrote one 14-year-old from Hicksville, New York, quote: “Since I got to this Center all you will feel is sadness and mostly depression.” It really is a must-read story. 

OK. That is this week’s show. As always, thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, . Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can find me on X, , or on Bluesky, . Where are you folks hanging these days? Jackie. 

Fortiér: Bluesky mainly, . 

Rovner: Alice. 

Ollstein: Mainly on Bluesky, , and still on X, . 

Rovner: Lizzy. 

Lawrence: On X, . On Bluesky, . 

Rovner: We’ll be back in your feed next week. Until then, be healthy. 

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<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2155188&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2155188 Health Spending Is Moving in Congress /podcast/what-the-health-430-congress-hhs-funding-health-policy-bill-january-22-2026/ Thu, 22 Jan 2026 19:25:00 +0000 /?p=2144642&post_type=podcast&preview_id=2144642 The Host
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Julie Rovner 麻豆女优 Health News Read Julie's stories. Julie Rovner is chief Washington correspondent and host of 麻豆女优 Health News’ weekly health policy news podcast, "What the Health?" A noted expert on health policy issues, Julie is the author of the critically praised reference book "Health Care Politics and Policy A to Z," now in its third edition.

Congress appears ready to approve a spending bill for the Department of Health and Human Services for the first time in years 鈥 minus the dramatic cuts proposed by the Trump administration. Lawmakers are also nearing passage of a health measure, including new rules for prescription drug middlemen known as pharmacy benefit managers, that has been delayed for more than a year after complaints from Elon Musk, who at the time was preparing to join the incoming Trump administration.

However, Congress seems less enthusiastic about the health policy outline released by President Donald Trump last week, which includes a handful of proposals that lawmakers have rejected in the past.

This week’s panelists are Julie Rovner of 麻豆女优 Health News, Sandhya Raman of CQ Roll Call, Sheryl Gay Stolberg of The New York Times, and Paige Winfield Cunningham of The Washington Post.

Panelists

Sandhya Raman photo
Sandhya Raman CQ Roll Call
Sheryl Gay Stolberg photo
Sheryl Gay Stolberg The New York Times
Paige Winfield Cunningham photo
Paige Winfield Cunningham The Washington Post Read Paige's stories.

Among the takeaways from this week’s episode:

  • Congress is on track to pass a new appropriations bill for HHS, with the current, short-term funding set to expire next week. The bill includes a slight bump for some agencies and, notably, does not include deep cuts requested by Trump. But with the administration’s demonstrated willingness to ignore congressionally mandated spending, the question stands: Will Trump follow Congress’ instructions about how to spend the money?
  • A health package with bipartisan support is set to hitch a ride with the spending bill, after falling by the wayside in late 2024 under pressure from then-Trump adviser Musk. However, the president’s newly released list of health priorities largely isn’t reflected in the package. The GOP faces headwinds in the midterms after allowing expanded Affordable Care Act premium tax credits to expire, a change that’s expected to cost many Americans their health insurance.
  • One year into the second Trump administration, its policies are particularly evident in the political takeover of the nation’s public health infrastructure, the growing number of uninsured Americans, and creeping brain drain in U.S.-based scientific research.
  • And Health and Human Services Secretary Robert F. Kennedy Jr. has fired members of a panel overseeing the federal government’s vaccine injury compensation program. Kennedy is expected to remake the panel in an effort to expand the list of injuries for which the government will compensate Americans. The current list does not include autism.

Also this week, Rovner interviews oncologist and bioethicist Ezekiel Emanuel to discuss his new book, Eat Your Ice Cream: Six Simple Rules for a Long and Healthy Life.

And 麻豆女优 Health News’ annual Health Policy Valentines contest is now open. You can enter the contest here.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too: 

Julie Rovner: CIDRAP’s “,” by Liz Szabo.

Sheryl Gay Stolberg: Rolling Stone’s “,” by Katherine Eban.

Paige Winfield Cunningham: Politico’s “,” by Amanda Chu.

Sandhya Raman: Popular Information’s “,” by Judd Legum.

click to open the transcript Transcript: Health Spending Is Moving in Congress

[Editor’s note: This transcript was generated using transcription software. It has been edited for style and clarity.] 

Julie Rovner: Hello from 麻豆女优 Health News and WAMU public radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Jan. 22, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Sandhya Raman of CQ Roll Call. 

Sandhya Raman: Good morning, everyone. 

Rovner: Sheryl Gay Stolberg of The New York Times. 

Sheryl Gay Stolberg: Hello, Julie. Glad to be here. 

Rovner: And Paige Winfield Cunningham of The Washington Post. 

Paige Winfield Cunningham: Hey, Julie. 

Rovner: Later in this episode, we’ll have my interview with Dr. Ezekiel Emanuel, whose new book, Eat Your Ice Cream, is both a takedown of the wellness industrial complex and a kinder, gentler way to live a more pleasant and meaningful life. But first, this week’s news. 

So, and I don’t want to jinx this, it looks like Congress might pass a spending bill for the Department of Health and Human Services that will become law 鈥 meaning not a continuing resolution 鈥 for the first time in years. And attached to that spending bill, scheduled for a vote in the House today, is a compromise health extenders deal that was dropped from the final spending bill in 2024 and which we’ll talk about in a minute. But first, the HHS appropriations bill. Sandhya, what are some of the highlights? 

Raman: So I think overall we just see a little bit of a slight increase for HHS compared to last year. Some agencies get a little bit of a bump: NIH [the National Institutes of Health], SAMHSA [the Substance Abuse and Mental Health Services Administration], HRSA [the Health Resources and Services Administration], Administration for Community Living. CDC [the Centers for Disease Control and Prevention] is kind of the same as last year. But then we do see some cuts in some places. Something that was getting watched a little bit was refugee and entrant assistance, given some of the different national news related to refugees and immigrants, and so that’s getting cut by about a billion. And some of the back-and-forth there is, some conservatives wanted more than that, some Democrats didn’t want that to be cut. I think the big thing in health care that we were waiting on on this was whether or not they would prohibit NIH forward funding, which is something the administration has been pushing for, just giving out a lump sum for grants through NIH rather than over a multiyear period. And the concern the Democrats had on that was that if you’re doing the lump sum all at first, fewer groups would get money for research. And so there is a prohibition on that, on doing the forward funding. 

Rovner: But just to be clear, the president, the administration, had asked for deep, deep cuts to the Department of Health and Human Services, and Congress is basically saying: Yep. Nope. 

Raman: Yeah. I think even if you look at what the House had proposed last year, they had cut a lot of programs, or proposed to cut a lot of, and that was not there. I think a lot of times, what we’ve seen is that even in Trump 1, there’d be a lot more proposed cuts in their proposal, when the White House puts out their blueprint, and then Congress comes to more of a medium point, kind of similar to previous years. So I think that was something that a lot of the health groups had celebrated, that they weren’t going to get the steep cuts that they thought could be part of the process. 

Rovner: Of course, the big question here is: Does the administration actually spend this money? We saw in 2025 them refusing to spend money, cutting grants, cutting off entire universities. And this is money that Congress had appropriated and that the administration is supposed to spend. Are they going to do it this time, is Congress? Have they put anything in this bill to ensure that the administration is going to do it this time? 

Raman: There’s a little bit here and there on some of that. I don’t think there’s quite the sweeping things that some Democrats would have wanted to prevent some of that. Just last week, we had the back-and-forth with SAMHSA grants getting pulled and then unpulled. And so there’s a little language related to that in there, just because that was such a big 24-hour issue. And then education funding is coupled with HHS, and there there is specific language saying you can’t transfer the money that would be for education into another department to dismantle it. So鈥 

Rovner: And, I would say, and basically, you can’t cut the Department of Education unless Congress says you can. 

Raman: Yeah. So there’s some things in there that are like that, but to get appropriations done, it has to be a bipartisan thing to get that to the finish line. So no one is going to get everything they wanted, not even President [Donald] Trump. 

Rovner: Yes, and I will point out that they are not there yet. The House has to pass this. The Senate has to pass this when they come back next week. We’ve got, apparently, a gigantic snowstorm coming towards Washington, D.C. So it’s moving in the right direction, but it’s not there yet. All right. Now onto the health package that’s catching a ride on this spending bill. What’s in it? And how close is it to the package that got stripped from the 2024 bill after Elon Musk tweeted that the bill was too many pages long? 

Raman: I think it’s fairly similar. We have a lot of the same PBM [pharmacy benefit manager] language that we had when that got dismantled, and a lot of these same kind of extenders that we see from time to time whenever we get an appropriations deal, extending things that are pretty bipartisan but just never have a place to ride elsewhere 鈥 National Health Service Corps, Special Diabetes Program, things like that. I think that since this time we haven’t had that pushback, we don’t have Elon Musk weighing in and kind of pulling the strings in the way that we did before, these have been very bipartisan provisions that both chambers have been saying that they want to get this done, they want to get this done as soon as possible, even in the beginning of last year. So I don’t sense that something’s really going to derail language targeting PBMs and stuff like that. 

Rovner: I would say the big piece of this is the deal that Congress came up with in 2024 to require more transparency on the part of these pharmacy benefit managers that everybody on both sides is accusing of pocketing some of the savings that they’re getting from drug companies and therefore making drug prices more expensive for employers and consumers. 

Raman: So I think that this has been such a priority that this is their shot to get it done. And it seems like as long as nothing derails appropriations in the next day and a half, then this is their chance to do that. 

Rovner: So what’s not in either of these packages are most of the pieces of the legislation that President Trump called for last week in his self-titled Great Healthcare Plan, with the PBM provisions being a major exception. What else is in Trump’s plan? And what are the prospects for passing it in pretty much any form this year? 

Winfield Cunningham: I would say not great. Yeah. A couple of things that struck me about this plan, which I would note was one page long: This is very Trumpy. Trump obviously loves, he’s a lot more into hauling pharmaceutical CEOs into the White House to make deals than he is crafting detailed policy. Because if you’re actually trying to do health care reform, this is not the way that you would do it. What you would do is actually spend a lot of time on the Hill seeing what Republicans can sign onto, and working with staff to craft detailed policies and etc., etc. But, yeah, so most of this stuff 鈥 yet I guess another big thing that struck me was a lot of this actually goes after insurers. There are some things in here that drugmakers don’t like, but Trump goes so far as to propose bypassing insurers entirely and sending money to people. And of course he doesn’t detail how that would work. And then there’s a lot of stuff in here about transparency by insurers. I would note the Affordable Care Act had some insurer transparency provisions already. 

So I think what this plan, if we want to call it a plan, reflects is just Trump’s desire to have something that he can call a “great” health care plan that he’s promised for a long time and which he’s going to talk a lot about. But yeah, I don’t think we’re going to see Republicans in Congress do much on this. Yeah, with the exception of the PBMs, which is pretty notable, and I think actually represents a really big win for the pharmaceutical industry, which has obviously felt under fire in this administration and has struck these deals with the White House, which they really don’t like. But they had been threatened that the administration would go further in trying to do this “most favored nation” price caps. And so it’s interesting because insurers are kind of Trump’s new target. That’s what I kind of read in this. And of course I would mention today that major insurers are testifying on the Hill because they’re under fire for raising insurance premiums. 

Rovner: Although, as we’ve noted many times, they’re raising insurance premiums because the cost of health care is going up. Yes, Sheryl. 

Stolberg: Julie, I think the political context of the Great Healthcare Plan, the so-called Great Healthcare Plan, is important. First of all, Republicans have had trouble for decades coming up with some kind of health plan, even before the Affordable Care Act was passed and signed into law in 2010. They weren’t able to do it then. President Trump famously said “nobody knew” that health care was “so complicated.” He’s in a situation now where Republicans have stripped many Americans of their health insurance by letting the extended Obamacare credits expire, and we’re going into a midterm election season in which his party and he have promised repeatedly that they were going to come up with a plan. He said he had a concept of a plan. I think this plan, so to speak, is not even a concept of a plan, and its primary provision actually lifts from what Sen. [Bill] Cassidy was promoting, which was to steer money away from insurance companies and toward consumers. Trump kind of latched onto that. He doesn’t say that explicitly in this 325-word proposal, but it seems clear to me that that is his idea, and that is just not a workable idea. 

He wants, they want, to move money into health savings accounts. I cracked up my elbow earlier this year. I had surgery to repair it. I saw the bill. The bill was $122,000. I am very blessed to have good health insurance through my company. There is no way that the government is going to steer that kind of money into a health savings account for an uninsured person. These are accounts that are meant to be sort of supplemental to spend on relatively small expenditures. And if you are an uninsured person, there is really no way that you can cover yourself. And that’s basically what this so-called “great” American health care plan is proposing, which I suspect, if most Americans really looked at it, they would say, is not so great. 

Rovner: Yeah. I also, I broke my wrist this summer. I also had surgery, although I had outpatient surgery, and it cost $30,000. So it’s, yeah, health care is really expensive, which, as I said, is why insurance premiums are going up. So, this week marks a year since the start of Trump 2.0, and it would take us the rest of the year to detail all that has changed in health policy. But I did want to hit a few themes, some of which you’ve started to talk about, Sheryl. One is the administration’s effort to basically end the federal public health structure as we know it. The Centers for Disease Control and Prevention in Atlanta has basically been taken over by political appointees, most of them without health experience or expertise. Sheryl, you’re our public health expert here. What does it mean for public health to be basically ceded back to the states? 

Stolberg: Well, I think this is kind of a novel experiment here. The core of the CDC is its infectious disease programs. Now, over the decades, since the 1970s, the CDC has greatly expanded its remit to cover things like chronic disease and gun violence prevention and auto safety, etc. But its core is infectious disease. And we know that infectious disease knows no borders. So what we risk having here is a patchwork of state-by-state vaccine recommendations, where some states will follow the CDC’s recommendations, presumably those that are red states. This was never political before. And we’re seeing some states, like blue states like New York and Massachusetts and other New England states, kind of coming together to put forth their own vaccine recommendations. I think this has implications for what vaccines will be covered and what vaccines will be offered by the Vaccines for Children Program, which was created by [President] Bill Clinton to cover poor kids and make sure they get vaccinated. I don’t think we know how that’s going to play out. 

I saw [Health and Human Services] Secretary [Robert F.] Kennedy [Jr.] yesterday in Harrisburg, Pennsylvania, and he insisted that he’s not taking any vaccines away from anyone. If you want your vaccines, you can get them. But the truth is that for decades, the American public and the medical establishment have relied on the CDC to provide guidance. The CDC doesn’t mandate anything, but it provides really important guidance to the country, and the agency is crippled now. Its guidance is not going to be followed. And I think we’re in uncharted territory here. We’re already seeing measles is on the rise. The country’s about to lose its measles elimination status, which we acquired in 2000. Whooping cough is on the rise. 

Rovner: Basically things we know we can prevent with vaccines. 

Stolberg: Exactly, exactly. 

Winfield Cunningham: One of the things I keep thinking about is, Kennedy says over and over again that if you’re a mom, you should do your own research. And it seems like a lot of the effects here is stepping away from this broad recommendation to now this patchwork of recommendations. So when you go to your pediatrician, you might hear guidance based on AAP’s [the American Academy of Pediatrics’] guidance, for example. States are doing different things. And as a parent, when you go to your pediatrician, it all of a sudden, I think, becomes a lot more confusing, especially if you’re someone who maybe already has a little bit of hesitancy about vaccines. 

I was in with our pediatrician last week and asked her what they’re seeing, and people are coming in with a lot more questions. And interestingly, they actually are changing their policy for mandatory vaccines. They actually had required every patient to be up to date by age 2 with the CDC-recommended vaccines. Now those vaccines that are under shared clinical decision-making, they’re no longer going to require those. And it’s not, and they’re going to continue to recommend them, but I think they’re concerned that patients are going to come in and they’re saying: Hey, the CDC doesn’t necessarily recommend these now. I’m worried about them. So it’s put pediatricians in a difficult place. But, yeah, it’s, as a parent, you’re having to make a million decisions about your children, and this just kind of makes that more complicated and confusing, potentially, for parents. 

Rovner: And takes time away from doctors who would like to counsel about other things, too. 

Stolberg: I just want to add one thing about that. Kennedy says do your own research. And if you read the package inserts on a vaccine, you’re going to see that vaccines have side effects, just like any drug. But that information needs context around it, and the parents who are weighing those side effects need also to be told about the risk of the diseases that those vaccines are intended to prevent. And my kids are grown. I’m wondering how pediatricians are having that conversation, or if they’re having that conversation, in talking to parents about: These are the risks of the vaccine. But should your child get measles, these are the risks. Before vaccination was widespread for measles, 450 kids died on average every year. Many more were hospitalized. So I think those conversations need to be had. 

Winfield Cunningham: And I think it’s hard for pediatricians sometimes to illustrate that, because we’re so far removed from people having examples or knowing anyone who had these. 

Rovner: Not anymore. 

Winfield Cunningham: Not anymore. But largely, right? I have a lot of parent friends, and I don’t know a child who’s had measles. Our pediatrician was telling me that when she was in medical school, it was still common for pediatric hospitals to be filled with babies with rotavirus. She said you could smell it down the hallway. And now, actually, the people in medical school, they’re not experiencing that, because of widespread vaccination. 

Rovner: All right. Well, the second big thing I want to hit on is, as Sheryl already mentioned, people losing their health insurance. Last summer’s big budget bill would cut nearly a trillion dollars from the Medicaid program and make it more difficult for people to maintain their coverage through the Affordable Care Act. Republicans refusing to extend the expanded Affordable Care Act subsidies from the Biden era is already prompting people to drop coverage that they can no longer afford. What does it mean to the health care system as a whole that the number of Americans without health insurance is going to begin to rise again? 

Raman: I think it’s a multipronged thing. There are some aspects of these things that might not be felt immediately, that might be later this year or early next year as different provisions of the [One] Big Beautiful Bill kind of come into play 鈥 work requirements, things like that that might affect how many people have insurance. But also, I think it kind of goes back to some of the things that Sheryl and Paige were saying about, just, if fewer people are vaccinated, it increases the risks for everyone. And if fewer people have health insurance, regardless of what they have, it also makes it more difficult. If people are not getting treated for things, they get exacerbated into more serious conditions. So I think there are a lot of issues at play. Some of them have just, we’re kind of waiting to see how the effects are.  

You know, people that may have skipped out on ACA insurance this year, maybe they haven’t needed to go to the doctor yet. We’re in the first month. People might not go every month. But that doesn’t mean they’re not going to be hit with something big, even tomorrow, next month, month after that. And so I think all of these things kind of compound together to make it a lot more difficult of a situation, and just a lot of the complexities, I think it’s kind of in both of them where you’re not sure. Oh, is this renewed? Is this not renewed? It’s, I think, a lot more difficult for the average person to follow this national conversation as much as people that are really plugged in, so that by the time that it trickles down to them, it’s like: Can I sign up for health insurance still? Are the costs high? Am I still eligible? It gets more and more confusing. And then people who might be eligible might kind of be scared away with some of that chilling effect. 

Stolberg: I should say, I think emergency rooms will also bear the brunt of the reduction in insurance, because without, people who don’t have health insurance will forgo going to the doctor until their [conditions are] unable to be ignored. And then they will wind up in the emergency room. 

Rovner: And then those, I was going to say, and then those emergency rooms will end up passing the bills that they can’t pay鈥 

Stolberg: Exactly. 

Rovner: 鈥攐nto others who can, or in鈥 

Stolberg: Exactly. It will drive up costs鈥 

Rovner: Paige, started鈥 

Stolberg: 鈥攊n the end. 

Winfield Cunningham: I think a lot of this is going to become clearer over the next couple of months. We still don’t really know the effects of those extra subsidies expiring. I was actually surprised to see that the ACA marketplace enrollment figures they released, I believe last week, were not actually that much lower than last year. But people aren’t kicked off their plan until they haven’t paid their premium for three months. So I think we need to wait until April or so to see how many people were, say, auto-enrolled in a plan which they can no longer afford, and now they’re kicked off. And maybe it’s fewer people than we think. Maybe it’s more people than we think. But I think we just don’t know that yet, and we’re going to have to wait for a couple months to see. 

Rovner: Yeah, I think you’re exactly right. I had the same reaction to seeing those numbers. Like, Wow, those are pretty high. And then it’s like, yeah, but those aren’t necessarily people who’ve had to pay their bills yet. Those are just the people who I think may have signed up hoping that Congress was going to do something. So, yeah, we will have to see how many people, I think it’s called “effectuated enrollment,” and we won’t get those numbers for a little while. 

Well, finally, dismantling the federal research enterprise. As I said, we’ve talked about this a lot, but I didn’t want to let it sort of go unstated. This administration appears to like to keep people guessing by cutting and then restoring research grants, refusing to spend congressionally appropriated funding until they’re ordered to do it by the court, and firing or laying off workers only to call them back weeks or months later. All that makes it difficult or impossible for researchers and universities to plan their projects and personnel needs. Combined with new limits on federal student loans for a lot of graduate students, are we at risk of losing the next generation of researchers? We’re already talking about seeing people moving to Europe to continue their research. 

Stolberg: Yes. I think the answer to that is an unequivocal yes. I am hearing from scientists who are having trouble filling their postdoctoral slots. Or young scientists. It’s really the next generation, right? People who are here already and who have families are trying as best they can to sort of stick it out, or maybe they’ll go into industry if they have to leave academia because they’ve lost their grant funding, or if they’ve left NIH. But it really is the next generation of researchers. I hate to draw this comparison, but we did see during World War II, the United States absorbed a lot of European researchers. This is how we got Albert Einstein, right? So I don’t know that we’ll see necessarily a reversal of that, of scientists fleeing, but we might see more young people choosing not to go into academic biomedicine. 

Rovner: And we’re already seeing, it’s not just Europe. It’s China and India鈥 

Stolberg: Yeah. Right. 

Rovner: 鈥攐ffering packages. 

Stolberg: And they’re recruiting. Those countries are recruiting. Yeah, they’re recruiting young scientists, especially China.  

Rovner: Yeah. 

Stolberg: And that’s a good point. David Kessler, the former FDA [Food and Drug Administration] commissioner, has argued that this is really a national security threat for the country. China is a main adversary of the United States, certainly of President Trump. And if we’re at risk of losing highly qualified biomedical researchers to China, then we are giving them an advantage. 

Rovner: Yeah, something else we will keep an eye on, I think, for the rest of the year. OK, we’re going to take a quick break. We will be right back. 

Meanwhile, back to this week’s news. The American Academy of Pediatrics is leading a coalition of public health groups that are suing to reverse the changes to the childhood vaccine schedule made by the CDC earlier this month. The suit claims that the administration violated portions of the law that oversees federal advisory committees that require membership on those panels to be, quote, “fairly balanced,” and not, quote, “inappropriately influenced.” Among other things, the lawsuit asked the court to ban the CDC’s Advisory Committee on Immunization Practices from further meetings. That would basically stop any further changes to the vaccine schedule, I assume? 

Raman: At the end of the day, what ACIP does is just a recommendation to CDC, and they can choose whether or not to go with that recommendation. So I’m not really sure what would happen next, but it is kind of a whack-a-mole situation where just because you stop this does not mean that changes above that aren’t going to happen. 

Stolberg: Yeah. The Advisory Committee on Immunization Practices is just that. It’s an advisory committee. So this lawsuit takes issue with appointments to that committee and also complains that the committee was not consulted before the decision was made public to change the vaccine recommendations. I’m not exactly sure what the legal authority is for that. There’s apparently a federal law requiring federal advisory committees to be, quote, “fairly balanced” and not “inappropriately influenced.” But this isn’t 鈥 it’s an executive action 鈥 right? 鈥 to appoint committee members. It comes out of the executive branch. So I don’t know of any situation in the past where the judiciary has weighed in and said, You can appoint these people or not these people, or You have to redo a committee. So it’s hard to predict what the courts will say about this. 

Rovner: Meanwhile, it’s not just the ACIP that HHS Secretary RFK Jr. is taking aim at. Following his remaking of that advisory committee, he’s now fired some of the members of a separate panel, the Advisory Commission on Childhood Vaccines, which oversees the federal Vaccine Injury Compensation Program, which Kennedy has said he also wants to revamp. That’s the program that compensates patients who can demonstrate injury from side effects of vaccines. How big a deal could this be if he’s going to go after the vaccine compensation program?  

Stolberg: Julie, this is a big deal, and I’ll tell you why. That committee sets what is known as the table of vaccines. Which injuries does the federal government compensate for? And the federal government does not compensate for autism as a vaccine injury. And I have no evidence of this, but if I were betting, that is where Kennedy wants to go. He does not like the 1986 law that created the National Vaccine Injury Compensation Program because it offered liability protection to pharmaceutical companies. He wants to strip away the liability protection, but as I understand it, he does not want to do away with the law. He does not want to do away with the compensation program. So he may be trying to lay the foundation for the compensation program to be more expansive and cover injuries or allow claims for injuries that are not currently considered vaccine injuries, like autism. 

Rovner: Which of course would collapse the program because it’s paid for by an excise tax on vaccines. That was the original deal back in 1986. The vaccine manufacturers said: We’ll pay you this tax, from which you, the federal government, will determine who gets compensated. And in exchange, you’ll relieve us of this liability, because we’re getting sued to death. And if you don’t do this, we’re going to stop making vaccines entirely. That was the origin of this back in 1986. And I was there. I covered it. 

Stolberg: Yeah, exactly. I have read a lot of this history, and the CDC was really over a barrel. The companies were writing to CDC, saying, We’re going to pull the plug on our vaccines. And the CDC was worried that American kids were going to go without lifesaving vaccines because companies were going to quit making them. So they pushed this bill. [President Ronald] Reagan didn’t like it. He signed it into law anyway. And it’s created this program, which is actually imperfect. A lot of people who actually legitimately have vaccine-injured children have trouble getting compensated through this program., and I think many people on all sides of this issue would say that it does need to be overhauled. But it will be interesting to see who Kennedy picks for those committee slots. 

Rovner: Yeah, I think we’re going to learn a lot more about it. We’re going to learn a lot more about it this year. Well, finally, in vaccine land this week, Texas attorney general and U.S. Senate candidate Ken Paxton on Wednesday announced what his office is calling a, quote, “wide sweeping investigation into unlawful financial incentives related to childhood vaccine recommendations.” His statement says that there is a, quote, “multi-level, multi-industry scheme that has illegally incentivized medical providers to recommend childhood vaccines that are not proven to be safe or necessary.” Actually, one of the reasons that Congress created the Vaccines for Children Program back in the 1990s, Sheryl, as you mentioned earlier, is because most pediatricians lost money on giving vaccines. And today, many people can’t even get vaccines from their doctors, because it’s too expensive for the doctors to stock them. What does Paxton think he might find here? 

Stolberg: This is like stump the panelists. No one knows. 

Rovner: I see a lot of people’s鈥 

Raman: I’m not sure what he thinks he might find, but I do think that he is one of the attorneys general that is generally on the forefront of trying things, to throw spaghetti at the wall and see if it sticks on a variety of issues. So it might be the sort of thing where if he finds something, then it could be kind of a jumping point for other conservative attorneys general. And of course just that he’s primarying Sen. John Cornyn for Senate, so if it raises his profile for more folks. But I’m not sure if there’s a specific thing that he’s looking for. 

Rovner: So he’s trying to curry favor with the anti-vaxxers in Texas, of which we know there are a lot. 

Raman: That would be my best read. 

Stolberg: Austin is, actually, the state capital in Austin is a hot spot for anti-vaccine activism. Andrew Wakefield, who wrote the 1998 Lancet article that’s been retracted, is in Austin. Del Bigtree, who runs the Informed Consent Action Network, is in Austin. There’s a group that I have  called Texans for Vaccine Choice that is one of the early parent-driven groups seeking to roll back vaccine mandates, is based in Austin. So there’s a lot of sentiment there that Ken Paxton might be trying to appeal to. 

Rovner: See? You’ve answered my question. Thank you. All right, that is this week’s news. Before we get to my interview with Dr. Zeke Emanuel, a couple of corrections from last week. First, I misspoke when I said House Republicans were becoming a minority in name only. Of course, I meant they were becoming a majority in name only. I also incorrectly said the lawsuit that helped get the Title X family planning money flowing back to clinics was filed by Planned Parenthood. It was actually filed by the ACLU [American Civil Liberties Union] on behalf of the National Family Planning and Reproductive Health Association. Apologies to all. OK, now we will play my interview with Dr. Zeke Emanuel about his new wellness book, and then we’ll come back and do our extra credits. 

I am so pleased to welcome back to the podcast Dr. Ezekiel Emanuel. Zeke is an oncologist and bioethicist by training and currently serves as vice provost for global initiatives and professor of medical ethics and health policy at the University of Pennsylvania. He formerly worked at the National Institutes of Health before he helped write and implement the Affordable Care Act while his brother Rahm was serving as President [Barack] Obama’s White House chief of staff. Zeke’s latest book, Eat Your Ice Cream: Six Simple Rules for a Long and Healthy Life, is out now. Zeke, welcome back to What the Health? 

Ezekiel Emanuel: Oh, it’s my great honor and pleasure. 

Rovner: So I feel like the subtitle of this book could be How to Keep Yourself Healthy Without Making Yourself Crazy or Broke and that it’s a not so thinly veiled attack on what many of us refer to as the “wellness industrial complex.” What’s gone wrong with the wellness movement? Isn’t it good for us to pursue wellness? 

Emanuel: It is good for us to pursue wellness. I think that there are probably three things that are seriously wrong with the movement. The first one is that they make wellness an obsession that you have to focus all your energy on, which is totally wrong. Wellness should be a habit that sort of works in the background while you focus on the really important things of life. I think the second thing is they tend to overcomplicate things. Part of that is they’ve got to send out an email every day or every other day. They’ve got to do a video, a podcast, what have you. And so they make it complicated so that they have something to report on. And the third thing is they make it oversimple. They’re reductionist. They talk about diet and exercise and sleep, and leave out other very, very important parts of wellness, maybe the most important part of wellness, which is your social interactions. And almost all these experts ignore it. 

And the last thing I would say 鈥 I guess I have four points 鈥 the last thing I would say is they have huge conflicts of interest. The wellness industrial complex is between $1- and $2 trillion a year, depending on what you want to include in that bucket, which means that there’s lots of people chasing lots of money trying to sell you lots of crazy items. So there’s money to be had and Them thar hills and people make all sorts of exaggerations. I want to emphasize for your listeners, I’m selling nothing, absolutely nothing. 

Rovner: I will say, I went to your book party. I’ve been to a lot of book parties over the years. Yours is the first one where I actually was not expected to buy the book. You actually gave the book away. 

Emanuel: Yeah, I can’t stand that. Oh, I hate that. 

Rovner: I would say, I assume you were making a point with that. I also ate the ice cream, which was very good. 

Emanuel: Yes. 

Rovner: I feel like your underlying message here is that it’s not enough to make yourself biologically healthy 鈥 you have to do things that make you happy, too. Is that a fair interpretation? 

Emanuel: Yes, that’s a very fair interpretation. Look, if you’re going to do wellness right, you’re going to be doing it for years and decades of your life. You cannot will yourself to do something for decades. You can will yourself to do something for a few weeks and a few months, but then, unless it becomes a habit that you actually enjoy, you’re simply not going to continue to do it. And so if you want to eat well, you want to exercise, you want to have social interactions, you actually have to make them something that’s pleasurable for your life, something that you find meaningful, even. That’s, again, I think something that’s seriously missing from a lot of these wellness influencers, because they make a lot of wellness about self-denial, about: You should deprive yourself. You should fast. Maybe you should fast. That’s OK if you can do it and you can work it into your schedule. Actually today is one of my fast days, so I am working it into my schedule. But that’s not for everyone, and it’s not essential to wellness and living a long and happy life. 

Rovner: So what are your six simple rules, in two minutes or less? 

Emanuel: The first one is: Don’t be a schmuck. Don’t take unreasonable risks. Don’t climb Mount Everest. Don’t go BASE jumping. Don’t smoke. Don’t do a lot of other stupid things. The second is: Engage people. A rich social life is the most important thing for a long, healthy, and happy life, and having close friends who you get together with regularly, talk to every week, have dinners with, acquaintances, very, very important. And then casually talking to people who you happen to interact with, either when you get your coffee, you go to the grocery store, you go to the restaurant, you hop in an Uber or a cab. Those are very important social interactions that we tend to ignore and tend to downplay. The third rule is: Keep your mind mentally sharp. And there are important aspects of that. Don’t retire. Take on new cognitive challenges. 

The fourth is: Eat well, and make sure you get rid of the unhealthy eating part and eat important, non-processed items. The fifth is: Exercise. Do the three kinds of exercise: aerobic exercise, strength training, and balance and flexibility with yoga. And the last one is: Sleep well. It’s the one you cannot will yourself to begin doing. You can only sort of prep the bedroom and then hope it happens. 

Rovner: So this whole thing didn’t really need to be book length, but you spent a lot of time reviewing the literature on various aspects of health and wellness, like, you know, a scientist would. Are you trying to make a point here about the current state of science and how the public views it? 

Emanuel: I am. I am a data-driven guy. I like data. I think when you have more than 3 million people that have been surveyed and followed in terms of social interactions and their impact on your wellness and your physical health, that’s worth noting, and it’s worth noting what those studies come to. And they all come to the same basic thing, which is you can reduce your risk of death and mortality in the subsequent six, 10, 12 years, depending upon the study, by about 20% to 30% by greater social interaction, more robust friendships. That’s a pretty impressive number, if you ask me. So I’m trying to emphasize the data and get people to understand and be motivated by the data. And I think I’m pretty clear about moments when I, say, interpret the data differently than a lot of other people do, because I think that’s part of science. 

So, for example, the PSA [prostate-specific antigen] test. Most guidelines say you should get a PSA test. I’m against the PSA test because, yes, it will reduce your risk of dying from prostate cancer, but it does not reduce your overall mortality. I think I don’t much care what’s written on my death certificate. I care about the length and wellness of my life, and the PSA isn’t going to affect that. But others disagree, and then I’m very frank about those kind of disagreements. 

Rovner: So in 2014 you rather famously wrote an Atlantic article called “.” Has writing this book changed your mind about this? And I will say, I’m only a year younger than you, so I have a stake in this, too. 

Emanuel: No, writing this book didn’t change my mind. It did change some things that I do. I will say, what really changed my mind, to the extent that anything changed my mind, was covid and the idea of getting vaccines after 75, I think, is a good thing, especially if whatever’s going around is targeting older people. It seems easy to protect yourself, whether from the flu or something like covid, with a vaccine. So that, I have changed my mind. Researching this book made me put a little more emphasis on, for example, strength training, which I had not done a whole lot of, directly. I’d done it because I ride a bicycle and I strengthen my lower half, my quads and my hamstrings and my gluteal muscles, but I hadn’t really focused on the upper body. 

Rovner: You should do Pilates. It’s great. 

Emanuel: Noted. 

Rovner: Zeke Emanuel. It is always fun to chat with you. And congratulations on the book. 

Emanuel: Thank you, Julie. This has been wonderful and very rapid-fire, more rapid-fire than anyone, because you get right to the heart of things. 

Rovner: Well, we have a lot more that we’re going to talk about this week. Thank you, Zeke. 

Emanuel: Take care, Julie. Bye-bye. 

Rovner: OK, we’re back. It’s time for our extra-credit segment. That’s where we each recognize the story we read this week we think you should read, too. Don’t worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Sandhya, why don’t you go first this week? 

Raman: My extra credit is called “,”and it’s by Judd Legum for Popular Information, his newsletter. And I thought this was really interesting, because, I think, for me, I look very much at HHS and major health agencies, but his piece kind of looks at how ICE [Immigration and Customs Enforcement] has not been paying third-party providers for medical care for detainees since October and that ICE, last week, the agency kind of quietly announced that it would not be processing any of the claims for medical care until April of 2026. And so doctors are instructed to kind of hold on that. And that’s kind of a downward spiral of providers denying services to detainees because they know they’re not going to get paid for a while. And so I thought this was a really interesting piece looking at that. 

Rovner: Yes, indeed. And kind of scary. Paige. 

Winfield Cunningham: Yeah, mine is a piece in Politico called “,” and it’s by Amanda Chu. And this really caught my eye because it was a look at how RFK’s demonization of food and pharma is motivating trial lawyers representing consumers who are saying they’ve been harmed by these products 鈥 one example, of course, is the lawsuit against the maker of Tylenol 鈥 and how this really kind of goes against where Republicans have usually been, against trial lawyers representing consumers who say they’ve been harmed by big, bad companies. And so, yeah, it was a really interesting look at that and just at how RFK’s kind of populist, pro-consumer streak has fueled all of this. 

Rovner: The world indeed turned upside down. Sheryl. 

Stolberg: So my extra credit is from Rolling Stone. The headline is “,” and it’s by Katherine Eban. She’s a terrific journalist. And this is about the study in Guinea-Bissau. When CDC pulled back its recommendation for children to be vaccinated at birth against hepatitis B, HHS gave this grant to these Danish researchers to conduct this study in Guinea-Bissau, which would compare vaccinated infants to unvaccinated infants. And there was a huge howl of protest. This study would never be done in this country. The idea of withholding a vaccine from an infant that has been proven to be safe and effective is highly unethical. It evokes memories of the Tuskegee study, in which government doctors withheld treatment for syphilis. So there was this huge uproar, and it turns out that the researchers who got the grant are these Danish statisticians who have a really questionable research history. And the story documents, through emails, how they got basically this no-bid grant by coordinating with some of Kennedy’s allies from his movement, from his vaccine advocacy days. And it was kind of an inside deal, basically. So I just think that this study has generated a lot a lot of complaints. I should say that the researchers have amended the protocol, and now I think they’re going to give shots to one group at age 6 weeks. But still, it’s a very problematic study, and the story exposes how it came to be. 

Rovner: Yeah, it is quite the story. Well, I also have an immigration story. It’s from my former colleague Liz Szabo at the University of Minnesota’s Center for Infectious Disease Research and Policy, and it’s called “.” And it’s not just undocumented people avoiding medical care, as Liz details. U.S. citizens with serious health needs are also scared of getting caught up in the ICE dragnet that’s now all around the city. And ICE officials have even been entering hospitals and other health facilities 鈥 which in previous years they had not been allowed to do. In the dead of winter in Minneapolis, with a particularly severe flu year, this is threatening to become a health crisis as well as an immigration crisis. 

OK, that’s this week’s show. Before we go, it’s almost February. That means our annual 麻豆女优 Health News Health Policy Valentine contest is open. Please send us your clever, heartfelt, or hilarious tributes to the policies that shape health care. I will post a link to the formal announcement in the show notes. As always, thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcast, as well as, of course, kffhealthnews.org. Also as always you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can find me still on X, , or on Bluesky, . Where are you folks hanging these days? Sandhya. 

Raman:  and , @SandhyaWrites. 

Rovner: Sheryl 

Stolberg: I’m  and , @SherylNYT. 

Rovner: Paige. 

Winfield Cunningham: I’m on X, , and Bluesky, . 

Rovner: We will be back in your feed next week. Until then, be healthy. 

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