Tagged Health Care Costs

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Has everyone recovered from their daylight saving time jet lag? Every year we get a whole host of articles about why changing the clocks is outdated, terrible and really quite bad for our health, and yet! Here were are, still grumpy and tired. But it’s almost the weekend, so let’s soldier on.

Here’s what you may have missed in your spring-forward daze.

President Donald Trump released his $4.75 trillion budget plan this week, which included a big increase in military funding and deep cuts to other domestic spending. Although the proposal will be dead on arrival in Congress, it still serves as a good road map for the administration’s priorities and Trump’s re-election campaign.

There were some health care wins, but there were also some blows, as well. At the heart of it all, critics say, are contradictions that undercut Trump’s talk about supporting certain public health causes. Take the $291 million budgeted for HIV, for example. Trump’s proposal allocates hundreds of millions toward the cause domestically, but then cuts global aid and chips away at programs like Medicaid, which HIV patients rely on.

Some of the health care highlights in the budget:

• Shaving $818 billion from projected spending on Medicare over 10 years and calling for belt-tightening within the popular program to combat “waste, fraud and abuse”;

• Cutting nearly $1.5 trillion from projected spending on Medicaid and transforming the program into a block grant system (a controversial idea that has received a lot of criticism in the past, even from Republican governors);

• Slashing spending on the National Institutes of Health, a longtime favorite of lawmakers of both parties, by $4.5 billion, with the National Cancer Institute absorbing the largest chunk of that cut;

• Increasing funding for pediatric cancer research by $50 million;

• Cutting HHS funding to $87.1 billion, which would be 12 percent less than in the spending plan Congress adopted for this fiscal year;

• Charging the e-cigarette industry $100 million a year in user fees that would go toward the FDA and its oversight efforts;

• And raising funding for VA medical care by nearly 10 percent.

Another interesting tidbit comes out of Politico’s reporting: HHS would be directed to steer $20 million toward a small children’s health program sought by one of Trump’s golfing buddies, Jack Nicklaus.

The New York Times: Trump Proposes a Record $4.75 Trillion Budget

The Washington Post: Springing Forward to Daylight Saving Time Is Obsolete, Confusing and Unhealthy, Critics Say

The Washington Post: Trump Pledges Support for Health Programs but His Budget Takes ‘Legs Out From Underneath the System’

Politico: Trump’s Budget Would Steer $20M to Jack Nicklaus-Backed Hospital Project

Democrats were less than pleased with the suggested budget. Lawmakers warned HHS Secretary Alex Azar — who bore the brunt of their ire at a hearing on Tuesday — that if Medicaid were transformed into a block grant system the change would face “a firestorm” of opposition.

The New York Times: Congress Warns Against Medicaid Cuts: ‘You Just Wait for the Firestorm’

Meanwhile, the “Mediscare” game went another round with Democrats saying that the “unbelievable” cuts fulfill long-standing Republican ambitions “to make Medicare wither on the vine.” If the accusations sound familiar to ones you’ve heard in the past, you’re not mistaken. They just might have been coming from Republicans. The Washington Post Fact Checker untangles it all to show that everyone is guilty of playing this particular scare game.

The Washington Post Fact Checker: Democrats Engage in ‘Mediscare’ Spin on the Trump Budget

Following FDA Commissioner Scott Gottlieb’s surprise resignation announcement, Dr. Ned Sharpless has been named as the acting chief of the agency. Sharpless’ current work as the director of the National Cancer Institute has focused on the relationship between aging and cancer, and the development of new treatments for melanoma, lung cancer and breast cancer.

The appointment was a bit of a curveball for some agency watchers. Some Republicans had been chafing at the way Gottlieb embraced his pro-regulation side as commissioner and were hoping for a sea change. But Sharpless is a Democrat who has spoken out before about how his worries over the e-cigarette industry keep him up at night, so the direction of the agency may not be changing soon. (HHS Secretary Alex Azar has said this is a temporary appointment and the search for a permanent commissioner is underway, but there are also hints that Sharpless could step into the role.)

Colleagues were quick to praise the cancer doctor and research veteran for his breadth of experience and his “approachable, objective” demeanor.

Stat: How Ned Sharpless, Biotech Veteran, Vaulted to the Top of the FDA

No one can accuse Gottlieb of getting whatever the professional version of “senioritis” is, despite the fact that he’ll be departing in a few weeks. The FDA has issued a proposal that would sequester flavored e-cigarettes to areas off-limits to anyone under age 18. The stores can still sell tobacco, mint and menthol e-cigarettes, which the FDA says are more popular among adults than minors.

The New York Times: F.D.A. Moves to Restrict Flavored E-Cigarette Sales to Teenagers

Beto O’Rourke is the latest Democrat to throw his hat in the ring for 2020, but can the moderate Texan overcome his baggage when it comes to his past opposition to the Affordable Care Act? In terms of his current stance, he has said that he supports universal health care, but has, like other moderates in the race, taken pains not to name “Medicare-for-all” in particular.

The Wall Street Journal: Beto O’Rourke’s Past GOP Ties Could Complicate Primary Run

The Connecticut Supreme Court has now cleared the way for Sandy Hook families to sue gunmakers over wrongful marketing. In the lawsuit, the families pointed out ads with slogans like “Consider your man card reissued,” which they say is specifically targeted for troubled young men like Adam Lanza. The ruling is fairly narrow and limited to marketing — the justices dismissed other aspects of the lawsuits — but could have far-reaching ramifications because it strips away some of the blanket immunity offered to gun manufacturers by Congress.

The New York Times: Sandy Hook Massacre: Remington and Other Gun Companies Lose Major Ruling Over Liability

Lawyers are starting to warn their clients who have filed disability claims with the government to clean up their social media because Uncle Sam might start snooping for fraud. “You don’t want anything on there that shows you out playing Frisbee,” one said. Advocates for people with disabilities say using social media sites in such a way would be irresponsible, as it’s impossible to gauge just from the pictures people post if they need disability aid.

The New York Times: On Disability and on Facebook? Uncle Sam Wants to Watch What You Post

In the miscellaneous file for the week:

• Calls for a worldwide moratorium on gene-editing human embryos expose the ethical divide over the research, which has been thrust into the spotlight following a Chinese scientist’s shocking and unexpected revelation that he successfully accomplished the feat.

Reuters: Experts Call for Halt to Gene Editing That Results in ‘Designer Babies’

• An entrenched culture of sexism at VA facilities has led female veterans to forgo needed care in order to avoid harassment. “It’s like a construction site,” said Rep. John Carter (R-Texas).

The New York Times: Treated Like a ‘Piece Of Meat’: Female Veterans Endure Harassment at the V.A.

• Court filings detail Johnson & Johnson’s role in the opioid epidemic, including accusations that the company operated like a drug “kingpin … profiting at every stage.’’

Bloomberg: US Opioid Drug Epidemic: J&J Called ‘Kingpin’ by Oklahoma

• The cost of this Oregon child not getting vaccinations? $800,000 in medical bills and 57 days in the hospital. The terrifying ordeal shows how quickly a small cut can spiral into a devastating emergency.

The New York Times: An Unvaccinated Boy Got Tetanus. His Oregon Hospital Stay: 57 Days and $800,000.

• Medical ethicists were given a lot to think about this week: In this case, it’s examining the tough decisions that come from deciding to extract sperm from a deceased loved one. While some support the choice if it’s a spouse, what happens if it’s the parents who are making the call?

Stat: Efforts to Save the Sperm of the Dead Bring Heartache and Tough Questions

• Is there a chilling effect on disease research when social media activists engage in thought-policing? Scientists say yes, and that, ultimately, the patients are the ones getting hurt.

Reuters: Special Report: Online Activists Are Silencing Us, Scientists Say

Doctors say our oversanitized culture does no favors to our immune system. (I have been pounding this drum for years, so I had to include this story.) The next time you drop some food on the floor, apparently the right move is to embrace the three-second rule and eat it. Have a great weekend!

After Nearly Two Years Of Bitter Battle Following Their Failed Merger, Cigna And Anthem Await Judge’s Decision

There’s billions of dollars at stake, with each company having “shot for the moon” in their damages requests. The court proceedings peeled back the curtain on large-scale mergers in the health industry, and aired a lot of dirty laundry along the way. In other health industry news: dental insurance, profit reports and federal tax refunds.

Democrats Seek Information On Short-Term ‘Junk Plans’ That Were Expanded By Trump Administration

“Many consumers are being misled to believe that these plans comply with the patient protections of the Affordable Care Act,” said House Energy and Commerce Committee Chairman Frank Pallone (D-N.J.). The lawmakers want to know how companies market the short-term plans, what percentage of applicants are denied coverage, and what brokers who sell the insurance are paid.

Medicare Buy-In Proposal Is Viewed As More Moderate Cousin Of ‘Medicare For All,’ But Hospitals Say It Will Still Disrupt System

The American Hospital Association and Federation of American Hospitals project that Medicare buy-in legislation–which would allow Americans to buy into the program instead of moving everyone onto Medicare–would cost hospitals $800 billion over a decade. Meanwhile, candidates are rushing to show their support for “Medicare for All,” but what does the public think?

Pentagon, EPA Butt Heads On Standards For Groundwater Pollution As Military Faces Billions In Clean-Up Fees

Up to 10 million people in the country may be drinking water laced with high levels of toxic “forever” chemicals — known as PFAS — including thousands of people who live near military bases. Since the 1970s, the Defense Department has been one of the most frequent users of PFAS, and in 2017, military communities around the country began to report alarming levels of the chemicals in their drinking water. Now the Pentagon is advocating for weaker standards in regulating the clean-up, but the EPA is holding firm. Also, a look at how asbestos is still being used in household products.

Report That Finds Sharp Increase In Commercial Health Care Prices Highlights Geographical Differences In Costs

“That fact that you could be paying 2.5 times more for the same healthcare services in San Jose than in Baltimore suggests there is a lot of variation in prices across the country,” said Bill Johnson, lead author of the report. Meanwhile, Humana launches a bundled-payment model for some Medicare Advantage members.

Insurance Giant UnitedHealthcare Will Require All New Employer-Sponsored Health Plans To Pass Drug Discounts To Consumers

Pharmacy benefit managers typically negotiate rebates from pharmaceutical companies to help offset the high initial prices set for many drugs. But those discounts rarely flow directly to the people filling prescriptions. The rebate system has come under intense scrutiny as of late as lawmakers take aim at high drug prices and pharma companies point the blame elsewhere. Meanwhile, the Senate Finance Committee plans to call executives from five pharmacy benefit managers–the middlemen who operate within the rebate system–to testify in front of Congress next month.

New Health Plans Expose The Insured To More Risk

One health plan from a well-known insurer promises lower premiums but warns that consumers may need to file their own claims and negotiate over charges from hospitals and doctors. Another does away with annual deductibles but requires policyholders to pay extra if they need certain surgeries and procedures.

Both are among the latest efforts in a seemingly endless quest by employers, consumers and insurers for the holy grail: less expensive coverage.

Premiums are 15 to 30 percent lower than conventional offerings, but the plans put a larger burden on consumers to be savvy shoppers. Even with those concerns, the offerings tap into a common underlying frustration.

“Traditional health plans have not been able to stem high cost increases, so people are tearing down the model and trying something different,” said Jeff Levin-Scherz, health management practice leader for benefit consultants Willis Towers Watson.

New types of insurance plans are sprouting up as employers face rising health care costs and individuals who buy their own coverage without an Affordable Care Act subsidy struggle to pay premiums. That has led some people to experiment with new ways to pay their medical expenses, such as short-term policies or alternatives like Christian sharing ministries, which are not insurance at all, but rather cooperatives where members pay one another’s bills.

Now some insurers — such as Blue Cross Blue Shield of North Carolina and a Minnesota startup called Bind Benefits, which is partnering with UnitedHealth Group — are coming up with their own novel offerings.

Insurers say the two new types of plans meet the ACA’s rules, although they interpret those rules in new ways. For example, the new policies avoid the federal law’s rule limiting consumers’ annual in-network limit on out-of-pocket costs: one by having no network and the other by calling additional charges premiums, which don’t count toward the out-of-pocket maximum.

But each plan could leave patients with huge costs in a system where it is extremely difficult for a patient to be a smart shopper — in part, because they have little negotiating power against big hospital systems and partly because illness is often urgent and unpredicted.

If the plans prompt doctors and hospitals to lower prices, “then that is worth taking a closer look,” said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute. “But if it’s simply another flavor of shifting more risk to employees, I don’t think in the long term that’s going to bend the cost curve.”

Balancing Freedom, Control And Responsibility

The North Carolina Blue Cross Blue Shield “My Choice” policies aim to change the way doctors and hospitals are paid by limiting reimbursement for services to 40 percent above what Medicare would pay. The plan has no network of doctors and hospitals.

This approach “puts you in control to see the doctor you want,” the insurer says on its website. The plan is available to individuals who buy their own insurance and small businesses with one to 50 employees, aiming particularly at those who cannot afford ACA plans, said Austin Vevurka, a spokesman for the insurer. The policies are not sold on the ACA’s insurance marketplace, but can be purchased off-exchange from brokers.

With that freedom, however, consumers also have the responsibility to shop around for providers who will accept that amount. Those who don’t shop, or can’t because it’s an emergency, may get “balance-billed” by providers unsatisfied with the flat amount the plan pays.

“There’s an incentive to comparison shop, to find a provider who accepts the benefit,” said Vevurka.

The cost of balance bills could range widely, but could be thousands of dollars in the case of hospital care. Consumer exposure to balance bills is not capped by the ACA for out-of-network care.

“There are a lot of people for whom a plan like this would present financial risk,” said Levin-Scherz.

In theory, though, paying 40 percent above Medicare rates could help drive down costs over time if enough providers accept those payments. That’s because hospitals currently get about double Medicare rates through their negotiations with insurers.

“It’s a bold move,” said Mark Hall, director of the Health Law and Policy Program at Wake Forest University in North Carolina. Still, he said, it’s “not an optimal way” because patients generally don’t want to negotiate with their doctor on prices.

“But it’s an innovative way to put matters into the hands of patients as consumers,” said Hall. “Let them deal directly with providers who insist on charging more than 140 percent of Medicare.”

Blue Cross spokesman Vevurka said My Choice has telephone advisers to help patients find providers and offer tips on how to negotiate a balance bill. He would not disclose enrollment numbers for My Choice, which launched Jan. 1, nor would he say how many providers have indicated they will accept the payments.

Still, the idea — based on what is sometimes called “reference pricing” or “Medicare plus” — is gaining attention.

North Carolina’s state treasurer, for example, hopes to put state workers into such a pricing plan by next year, offering to pay 177 percent of Medicare. The plan has ignited a firestorm from hospitals.

Montana recently got its hospitals to agree to such a plan for state workers, paying 234 percent of Medicare on average.

Partly because of concerns about balance billing, employers aren’t rushing to buy into Medicare-plus pricing just yet, said Jeff Long, a health care actuary at Lockton Companies, a benefit consultancy.

Wider adoption, however, could spell its end.

Hospitals might agree to participate in a few such programs, but “if there’s more take-up on this, I see hospitals possibly starting to fight back,” Long said.

What About The Bind?

Minnesota startup Bind Benefits eliminates annual deductibles in its “on-demand” plans sold to employers who are opting to self-insure their workers’ health costs. Rather than deductibles, patients pay flat-dollar copayments for a core set of medical services, from doctor visits to prescription drugs.

In some ways, it’s simpler: no need to spend through the deductible before coverage kicks in or wonder what 20 percent of the cost of a doctor visit or surgery would be.

But not everything is included.

Patients who discover during the year that they need any of about 30 common procedures outlined in the plan, including several types of back surgery, knee arthroscopy or coronary artery bypass, must “add in” coverage, spread out over time in deductions from their paychecks.

“People are used to that concept, to buy what they need,” said Bind’s CEO, Tony Miller. “When I need more, I buy more.”

According to a company spokeswoman, the add-in costs vary by market, procedure and provider. Less than 7 percent of members should need add-in services in any given year, Bind estimates.

On the lower end, the cost for tonsillectomy and adenoidectomy ranges from $900 to $3,000, while lumbar spine fusion could range from $5,000 to $10,000.

To set those additional premiums, Bind analyzes how much doctors and facilities are paid, along with some quality measures from several sources, including UnitedHealth. The add-in premiums paid by patients then vary depending on whether they choose lower-cost providers or more expensive ones.

The ACA’s out-of-pocket maximums — $7,900 for an individual or $15,800 for a family — don’t include premium costs.

The Cumberland School District in Wisconsin switched from a traditional plan, which it purchased from an insurer for about $1.7 million last year, to Bind. Six months in, Superintendent Barry Rose said, it is working well.

Right off the bat, he said, the district saved about $200,000. More savings could come over the year if workers choose lower-cost alternatives for the “add-in” services.

“They can become better consumers because they can see exactly what they’re paying for care,” Rose said.

Levin-Scherz at Willis Towers said the idea behind Bind is intriguing but raises some issues for employers.

What happens, he asked, if a worker has an add-in surgery, owes several thousand dollars, then changes jobs before paying all the premiums for that add-in coverage? “Will the employee be sent a bill after leaving?” he said.

Hospitals, Health Industry Question Trump Administration’s Legal Authority To Require Price Transparency

The Trump administration is considering requiring hospitals and insurers to reveal the true costs of medical services, which have always been tightly held, confidential secrets by the parties involved. The industry says the administration lacks the authority to mandate such disclosures, while also pointing out that they wouldn’t do much to help consumers.

Republicans See ‘Medicare For All’ Enthusiasm As Democrats’ Waterloo

Although “Medicare for All” has become a rallying cry for many 2020 Democratic hopefuls, Republicans view it another way. GOP lawmakers are eager to use the push to paint their opponents as extremists and socialists. But, really, it’s unclear how the whole debate will play out 21 months from now.

How Much Difference Will Eli Lilly’s Half-Price Insulin Make?

When Erin Gilmer filled her insulin prescription at a Denver-area Walgreens in January, she paid $8.50. U.S. taxpayers paid another $280.51.

“It eats at me to know that taxpayer money is being wasted,” said Gilmer, who has Medicare and was diagnosed with Type 1 diabetes while a sophomore at the University of Colorado in 2002.

The diagnosis meant that for the rest of her life she’d require daily insulin shots to stay alive. But the price of that insulin is skyrocketing.

Between 2009 and 2017 the wholesale price of a single vial of Humalog, the Eli Lilly and Co.-manufactured insulin Gilmer uses, nearly tripled — rising from $92.70 to $274.70, according to data from IBM Watson Health.

Six years ago, Gilmer qualified for Social Security Disability Insurance — and thus, Medicare — because of a range of health issues. At the time, the insulin she needed cost $167.70 per vial, according to IBM Watson Health.

“When it’s taxpayer money paying for medication for someone like me, it makes it a national issue, not just a diabetic issue,” Gilmer said.

Stories about people with Type 1 diabetes dying when they couldn’t afford insulin have made headlines. Patient activists like Gilmer have protested high prices outside Lilly’s headquarters in Indianapolis.

Elizabeth Pfiester, founder of T1International, addresses a crowd outside the Indianapolis headquarters of pharmaceutical giant Eli Lilly and Co. in September.(Bram Sable-Smith/NPR)

Last October in Minnesota, state Attorney General Lori Swanson sued insulin manufacturers, alleging price gouging. Pharmaceutical executives were grilled about high drug prices by the Senate Finance Committee on Feb. 26.

This is the backdrop for Lilly’s announcement last week that it is rolling out a half-priced, generic version of Humalog called “insulin lispro.” The list price: $137.35 per vial.

“Patients, doctors and policymakers are demanding lower list prices for medicines and lower patient costs at the pharmacy counter,” Eli Lilly CEO David Ricks wrote in a blog post about the move. “You might be surprised to hear that we agree – it’s time for change in our system and for consumer prices to come down.”

No Panacea

When Lilly’s Humalog, the first short-acting insulin, came to market in 1996, the list price was about $21 per vial. The price didn’t reach $275 overnight, but yearly price increases added up.

In February 2009, for example, the wholesale price was $92.70, according to IBM Watson Health. It rose to $99.65 in December 2009, then to $107.60 in September 2010, $115.70 in May 2011, and so on.

“There’s no justification for why prices should keep increasing at an average rate of 10 percent every year,” said Inmaculada Hernandez of the University of Pittsburgh School of Pharmacy, who was lead author of a January report in Health Affairs attributing the skyrocketing cost of prescription drugs to accumulated yearly price hikes.

“The public perception that we have in general is that drugs are so expensive because we need to pay for research and development, and that’s true,” Hernandez said. “However, usually research and development is paid for in the first years of life of a drug.”

At $137.35 per vial, Lilly’s generic insulin is priced at about the same level as Humalog was in 2012, 16 years after it came to market.

“We want to recognize that this is not a panacea,” said company spokesman Greg Kueterman. “This is an option that we hope can help people in the current system that we work with.”

It’s worth noting that Humalog is a rapid-acting insulin, but that’s only one of the two types of insulin most people with Type 1 diabetes use every day. The second kind is long-lasting. Lilly makes one called Basaglar. The most popular long-lasting insulin is Lantus, produced by Sanofi. Neither has a lower-cost alternative.

Still, Lilly’s move on Humalog could put pressure on the other two big makers of insulin to act.

Novo Nordisk called Lilly’s lower-priced generic insulin “an important development,” in an emailed statement.

“Bringing affordable insulin to the market requires ideas from all stakeholders,” Novo Nordisk’s Ken Inchausti said in an email, which also listed steps the company has taken, such as a patient assistance program. The statement didn’t say whether Novo Nordisk is considering offering a lower-priced version of its popular insulin Novolog, a rival of Humalog.

A statement from Sanofi, the third major insulin maker, also didn’t say whether the company would offer lower-priced versions of its insulins.

“Sanofi supports any actions that increase access to insulins for patients living with diabetes at an affordable price,” spokewoman Ashleigh Koss said in the email, which also touted the company’s patient assistance program.

A Different Kind Of Generic

One twist in this story is that Lilly’s new insulin is just a repackaged version of Humalog, minus the brand name. It’s called an “authorized generic.”

“Whoever came up with the term ‘authorized generic’?” Dr. Vincent Rajkumar said, laughing. Rajkumar is a hematologist at the Mayo Clinic in Rochester, Minn.

“It’s the same exact drug” as the brand name, he continued.

Typically, Rajkumar said, authorized generics are introduced by brand-name drugmakers to compete with generic versions of their drugs made by rival companies.

But in the case of Humalog and other insulins, there are no generics made by competitors, as there are for, say, the cholesterol medicine Lipitor or even other diabetes drugs, such as metformin.

So when Lilly’s authorized generic comes to market, the company will have both Humalog insulin and the authorized generic version of that medicine on the market.

Rajkumar said it’s a public relations move.

“There’s outrage over the price of insulin that is being discussed in Congress and elsewhere. And so the company basically says, ‘Hey, we will make the identical product available at half price.’ On the surface that sounds great,” Rajkumar said.

“But you look at the problems and you think, ‘OK, how crazy is this that someone is actually going to be buying the brand-name drug?’”

In fact, it’s possible that Lilly could break even or profit off its authorized generic compared to the name-brand Humalog, according to University of Pittsburgh’s Hernandez.

The profit margin would depend on the rebates paid by the company to insurers and pharmacy benefit managers. Rebates are getting a lot of attention these days as one factor that pushes drug prices higher. They’re usually not disclosed and increase as a drug’s price increases, providing an incentive to some companies to raise prices.

“Doing an authorized generic is nothing else than giving insurers two options,” Hernandez said: pay the full list price for a brand-name drug and receive a higher rebate, or pay the lower price for the authorized generic and receive a presumably smaller rebate.

“What we really need to get insulin prices down is to get generics into the market, and we need more than one,” Hernandez said, adding that previous research has shown that prices begin to go down when two or three generics are competing in the marketplace.

Even so, Lillly’s Kueterman said the authorized generic insulin “is going to help hopefully move the system towards a more sustainable model.”

“I can guarantee you the reason that we’re doing this is to help people,” Kueterman said, noting the company’s Diabetes Solution Center has also helped “10,000 people each month pay significantly less for their insulin” since it opened in August.

For Erin Gilmer, the news about an authorized generic insulin from Lilly has left her mildly encouraged.

“It sounds really good, and it will help some people, which is great,” Gilmer said. “It’s Eli Lilly and pharma starting to understand that grassroots activism has to be taken seriously, and we are at a tipping point.”

This story is part of a partnership that includes NPR and Kaiser Health News.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Headline writers across the world (read: yours truly) breathed a sigh of relief this week when the venture formally known as “the health initiative founded by Amazon, Berkshire Hathaway and JPMorgan Chase” finally picked a name. After more than a year of tight-lipped secrecy, they settled on “Haven.” What do you guys think? I’m just thankful it’s short.

On to what you may have missed this week!

FDA Commissioner Scott Gottlieb sent shock waves through Washington and the industry when he announced he’ll be retiring at the end of the month. Gottlieb was a standout in the anti-regulatory, pro-business Trump administration as one of the most activist commissioners in recent years. Over the past two years, he has launched what could be termed a crusade against teen vaping — his most recent action coming just the day before the announcement, when he called out Walgreens and gas stations for selling tobacco products to minors — and cracked down on “miracle cures” and unregulated stem cell clinics and supplements, among other initiatives. Public health advocates are fretting that with him gone, some of the progress they’ve seen will be chipped away.

The departure is also a blow to the administration in that Gottlieb is a highly liked health official who worked well with Congress, winning over even Democratic lawmakers on Capitol Hill. Behind the scenes, he was known as someone who was “accessible,” would field lawmakers’ questions and was actively working on things that would make Congress happy. “I’ve never seen an administration official, Republican or Democrat, that has worked with the Hill so well on a bipartisan basis,” a senior congressional aide told Stat.

That’s not to say he didn’t have his critics. A decision on approving a powerful opioid late last year, in particular, drew fire from many advocates.

Gottlieb said his decision to leave was based on the fact that he missed spending time with his family, and White House officials confirmed that President Donald Trump did not seek the resignation.

Now the big question is: Who is going to replace him?

Stat: With Gottlieb’s Resignation, the Trump Administration Loses Its Backroom Whisperer on Capitol Hill

Politico: ‘Something Very Rare’: FDA’s Gottlieb Aggressively Tackled Difficult Issues

Stat: The Likely, Possible, and Longshot Contenders to Replace Gottlieb at FDA

As expected, legal challenges to the administration’s changes to the family planning rules came not in a trickle but a flood. California Attorney General Xavier Becerra, in his 47th lawsuit against the administration, said the rules restricting abortion referrals were like something out of 1920 and not 2019. Apart from California’s case, 20 states and D.C. announced they will be filing suits. Then came the announcement that Planned Parenthood Federation of America and the American Medical Association will also challenge the restrictions, deeming the changes a “domestic gag rule” and an overreach from the administration.

The New York Times: California Sues Trump Administration to Block Restrictions to Family Planning Program

The Washington Post: Planned Parenthood, American Medical Association Sue Trump Administration Over Abortion ‘Gag Rule’

Facing increasingly intense outrage over insulin prices, Eli Lilly has decided to offer an authorized generic version of its drug for half the cost. Stories of people dying after they rationed newly pricey insulin have been circulating with ever-increasing frequency, and lawmakers have made it their priority to specifically rout out answers about insulin price hikes. In that context, Eli Lilly’s move here seems more damage control than charitable, but it also puts them in good company with drugmakers who have been hotfooting it to avoid whatever worse would come out of Congress if they don’t make some changes.

Stat: Lilly Will Sell a Half-Price Version of Its Insulin. Will It Appease Critics?

Former Colorado Gov. John Hickenlooper officially threw his hat into the narrowing 2020 field this week. Hickenlooper seems to gravitate more toward the moderate wing of the Democratic Party, saying he supports universal health care in principle but refusing to get behind a “Medicare-for-all” plan. His evolution on gun control (as a governor who oversaw a mass shooting in the state where Columbine occurred) is also worth checking out.

The New York Times: John Hickenlooper on the Issues

There has always been a gap swallowing people who make too much for health law subsidies or Medicaid but not enough to comfortably afford insurance through the exchanges. A new county-by-county analysis looks at just how tough it is for the people who fall into the holes created by the ACA. A particularly striking figure? In almost all of Nebraska, a 60-year-old with a $50,000 income would pay from 30 to 50 percent of that income in premiums for the least expensive ACA health plan.

The Washington Post: ACA Premiums Rising Beyond Reach of Older, Middle-Class Consumers

Meanwhile, the Trump administration is interested in bolstering interstate insurance sales despite there being little appetite for it in the past and experts saying it wouldn’t lower premiums. In fact, the practice is already allowed under the health law, and no one does it because insurers think it’s just not worth it.

The Wall Street Journal: Trump Administration Looks to Jump Start Interstate Health-Insurance Sales

A teenager who got vaccinated against his mother’s wishes was the star witness at a hearing this week sparked in part by the measles outbreak. Ethan Lindenberger, a high school senior, hoisted the blame for his mother’s deeply rooted beliefs squarely on Facebook’s shoulders.

The anti-vaccination movement has long flourished on Facebook, partly because of the site’s search results and “suggested groups” feature. On Thursday, the company announced it has developed a policy to try to curb that culture of misinformation on vaccines, saying it will rank pages and groups that spread that kind of information lower and will keep them out of recommendations or predictions in search.

The Washington Post: Ethan Lindenberger: Facebook’s Anti-Vax Problem Intensified in Congressional Testimony

The New York Times: Facebook Announces Plan to Curb Vaccine Misinformation

After 12 long years, scientists finally announced that a second patient appears to have been cured of HIV. While the news was well-welcomed around the world — “This will inspire people that cure is not a dream,” said Dr. Annemarie Wensing, a virologist — there are some practical obstacles to consider. For example, bone marrow transplants (which is how both patients were cured) are extremely risky, especially since there are drugs that exist that can control HIV fairly well.

The New York Times: H.I.V. Is Reported Cured in a Second Patient, a Milestone in the Global AIDS Epidemic

In a scathing ruling that could have wide-reaching ramifications for the insurance industry, a judge blasted UnitedHealth Group for policies that he says were aimed at effectively discriminating against patients with mental health and substance abuse disorders to save money. The decision is part of a larger debate over parity in relation to coverage for mental health services versus other illnesses like diabetes. Insurance companies have been getting around parity requirements with internal rules, but advocates are viewing the judge’s ruling as a warning shot that those loopholes will no longer be tolerated.

The New York Times: Mental Health Treatment Denied to Customers by Giant Insurer’s Policies, Judge Rules

The FDA this week approved a cousin of party drug “Special K” to help people with severe cases of depression, marking a shift away from traditional antidepressant medications. While many said the news would give hope to desperate patients, others are worried about the potential for abuse.

The New York Times: Fast-Acting Depression Drug, Newly Approved, Could Help Millions

Honorable mention for International Women’s Day: A veritable “tsunami wave of women veterans” over the past several years is forcing the VA to step up in terms of meeting female-specific health care needs. Among basic issues are seeing to it that doctors are trained to deal with gynecological matters and ensuring that VA facilities have child care services available when female veterans come in for appointments.

The Wall Street Journal: As More Military Women Seek Health Care, VA Pursues Improvements

In the miscellaneous file for the week:

• Nearly 600,000 children have dropped off of states’ Medicaid and CHIP rolls over a one-year span. While states rush to assure anyone asking that it’s because the economy is improving, public health experts are alarmed at the disturbing trend.

Stateline: Child Enrollment in Public Health Programs Fell by 600K Last Year

• In a “craning your neck at the car wreck” sort of way, this profile on disgraced pharma bro Martin Shkreli is a wild read. Through the help of a contraband smartphone, Shkreli is, from his prison cell, still pulling the strings at his old company, schmoozing up his prison friends “Krispy” and “D-Block,” and planning his big comeback.

The Wall Street Journal: Martin Shkreli Steers His Old Company From Prison — With Contraband Cellphone

• Last year, doctors burst onto the gun-debate scene through the help of a viral tweet that directed them to “stay in their lane.” But a new analysis provides an interesting look at which lawmakers are getting the most money from physician-related PACs. (Hint: It’s overwhelming ones who are against tighter gun regulations.)

The Wall Street Journal: Doctors’ PACs Favored Candidates Opposing Gun Background Checks

• In slightly terrifying news, research that was halted over concerns it could create deadly flu viruses that could be used by terrorists was just given the green light again —without any explanation as to why. *Gulp*

The New York Times: Studies of Deadly Flu Virus, Once Banned, Are Set to Resume

• Everyone is expecting a big settlement in the sweeping opioid case against Purdue Pharma. But what happens if the opioid maker declares bankruptcy first?

Stat: If Purdue Pharma Declares Bankruptcy, What Happens to the Opioid Cases?

• Luke Perry’s early death from a stroke this week has many middle-aged Americans worried.

The New York Times: Here’s How Strokes Happen When You’re As Young As Luke Perry

• Drug companies and doctors are in a dirty war over fetal transplants. It may seem click-baity at first, but the issue is highly revealing of how the health industry works when it comes to something that could make people lots of money.

The New York Times: Drug Companies and Doctors Battle Over the Future of Fecal Transplants

That’s it from me! Have a great weekend!