Top Stories

  • California’s largest health system, Sutter Health, will pay $575 million to employers, unions and the government to resolve a lawsuit brought by state Attorney General Xavier Becerra, accusing the system of using anti-competitive practices to consolidate power and boost prices. While Sutter has not admitted guilt, it will put a limit on out-of-network costs, add measures to improve transparency and eliminate contract deals that allow insurers to pick and choose which facilities within one system to include in the network, known as all-or-nothing deals. (San Francisco Chronicle)
  • The Centers for Medicare and Medicaid Services finalized a new rule that requires insurers with plans on the Affordable Care Act exchange to send beneficiaries a separate bill for at least one dollar, for the share of their premium that funds abortion service coverage prohibted from public funding. The rule, which takes effect June 27, 2020, has been criticized as creating additional complexities for insurance companies. (Modern Healthcare)
  • The owners of Purdue Pharma LP, the Sackler family, asked bankruptcy Judge Robert Drain to publicly disclose the 580-page document detailing the drugmaker’s factual and legal defenses, in an effort to help clear their name as Purdue has been repeatedly credited as causing the opioid epidemic. The Sacklers say their pledge to contribute $3 billion to the settlement resolving cases against Purdue has been misinterpreted as acknowledgment of guilt, and they are attempting to reframe that narrative. (Bloomberg)

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General

Obamacare Sign-Ups Steady as Debate Persists Over Its Future
Ricardo Alonso-Zaldivar, The Associated Press

More than 8 million people have signed up for coverage next year under former President Barack Obama’s health care law, the government said Friday, a sign of continued demand for the program amid persistent uncertainty over its future.

Democratic presidential aspirants disregard political gift of ACA court ruling
Amy Goldstein and Sean Sullivan, The Washington Post

Less than an hour after an appeals court invalidated part of the Affordable Care Act and pushed off a decision on the rest of it, congressional Democrats began punching, accusing President Trump and his party of imperiling Americans’ insurance and consumer health protections.

Georgia Could Be First State to Test Trump Health Proposals
Sudhin Thanawala, The Associated Press

Georgia could be the first state to test multiple proposals from President Donald Trump that would dramatically change the market for insurance under the health care overhaul passed by his predecessor.

Hospital opposition to state health care reforms foreshadows challenges for Congress
Jessie Hellmann, The Hill

State lawmakers seeking to rein in health care costs are facing formidable pushback from hospitals, foreshadowing the obstacles a Democratic president and Congress would also face if they try to follow through on bold promises for health reform.

Vaping Patients May Be Prone to Relapse, C.D.C. Warns
Denise Grady, The New York Times

New findings indicate the outbreak of severe lung injuries may have peaked, but cases are still surfacing. The agency is urging doctors to monitor people closely after hospitalization.

Texas Law Highlights Dilemma Over Care For Patients With No Hope Of Survival
Charlotte Huff, Kaiser Health News

Critically ill Tinslee Lewis ― a Fort Worth baby embroiled in a dispute between her family and a hospital over whether to continue life-sustaining treatment ― is the most recent public face of the heartbreaking and intractable dilemmas often confronted quietly in intensive care units. But her circumstances are complicated by a rare law that Texas enacted two decades ago, which critics say gives hospitals the upper hand on whether to stop treatment.

A major funder of the anti-vaccine movement has made millions selling natural health products
Neena Satija and Lena H. Sun, The Washington Post

The nation’s oldest anti-vaccine advocacy group often emphasizes that it is supported primarily by small donations and concerned parents, describing its founder as the leader of a “national, grass roots movement.”

U.S. Index Futures Gain Ahead of Holiday Break: Markets Wrap
Robert Brand, Bloomberg

U.S. equity-index futures gained and stocks in Europe edged higher, with volumes subdued as investors count down to the holiday break. Ten-year Treasuries and the dollar were steady.

Payers

For Her Head Cold, Insurer Coughed Up $25,865
Richard Harris, NPR News

Alexa Kasdan had a cold and a sore throat. The 40-year-old public policy consultant from Brooklyn, N.Y., didn’t want her upcoming vacation trip ruined by strep throat. So after it had lingered for more than a week, she decided to get it checked out.

Blues insurer CareFirst to enter Medicaid market with two acquisitions
Shelby Livingston, Modern Healthcare

Baltimore-based insurer CareFirst Blue Cross and Blue Shield is entering the Medicaid managed-care market with acquisitions of two small Medicaid plans in Maryland and Washington, D.C.

Providers

Brooklyn Hospital Center Plans to Sell Land to Finance Overhaul of Campus
Melanie Grayce West, The Wall Street Journal

Facing financial pressure and increasing capital needs, the Brooklyn Hospital Center wants to redevelop its downtown Brooklyn campus and sell large parcels of its site to finance the project.

Many health care workers are refusing flu shots, endangering patients, regulators say
Kay Lazar, Boston Globe

Hundreds of workers who care for some of the state’s frailest residents, including those in nursing homes and dialysis centers, are failing to get their annual flu shot, placing patients with weak immune systems at risk of serious illness or death, health specialists said.

Pharma, Biotech and Devices

Roche enters $1.15 billion licensing deal for Sarepta gene therapy
Silke Koltrowitz, Reuters

Roche (ROG.S) entered into a $1.15 billion licensing agreement with Sarepta Therapeutics (SRPT.O) to obtain the right to launch and commercialize Sarepta’s investigational gene therapy for Duchenne muscular dystrophy (DMD) outside the United States.

Cigna’s Express Scripts and Prime Therapeutics form three-year partnership
Alex Kacik, Modern Healthcare

Cigna Corp.’s Express Scripts and Prime Therapeutics solidified the terms of a three-year collaboration as the pharmacy benefit managers look to leverage the scale of the more than 100 million individuals that their clients cover.

J&J to Buy Remaining Stake in Verb Surgical to Strengthen Digital Surgery Portfolio
Manojna Maddipatla, Reuters

Johnson & Johnson said on Friday it would acquire the remaining stake in Verb Surgical Inc, from Verily, Alphabet Inc’s life sciences division.

Merck Says Ebola Vaccine to Be Available at Lowest Access Price for Poor Nations
Dania Nadeem, Reuters

Merck & Co said on Friday it expects to make licensed doses of its recently approved Ebola vaccine available in the third quarter of 2020 and price the single-dose injection at the lowest possible access price for poor and middle-income countries.

Health IT

Drugmakers Turn to Data Mining to Avoid Expensive, Lengthy Drug Trials
Peter Loftus, The Wall Street Journal

Pfizer, Johnson & Johnson and Amgen try to win drug approvals by analyzing vast data sets of electronic medical records.

Electronic Health Records Creating a ‘New Era’ of Health Care Fraud, Officials Say
Fred Schulte and Erika Fry, Fortune and Kaiser Health News

The federal government funneled billions in subsidies to software vendors and some overstated or deceived the government about what their products could do, according to whistleblowers.

Opinions, Editorials and Perspectives

Stepping Away From the Agonizing Overuse of Step Therapy
Angus Worthing, Morning Consult

For many of the 54 million Americans who live with a rheumatic disease, simple tasks such as walking up a flight of stairs can be painful and challenging endeavors. To manage disease symptoms and help make activities of daily living safer and easier, patients often turn to rheumatologists like me, who can prescribe treatments that provide relief.

Research Reports

Prevalence of Diabetes by Race and Ethnicity in the United States, 2011-2016
Yiling J. Cheng et al., JAMA

In this cross-sectional study that included 7575 adults, the age- and sex-adjusted diabetes prevalence was 12.1% for non-Hispanic white, 20.4% for non-Hispanic black, 22.1% for Hispanic, and 19.1% for non-Hispanic Asian groups. The diabetes prevalence also differed significantly among Hispanic or non-Hispanic Asian subgroups.

Morning Consult