KHN Morning Briefing

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Political Cartoon: 'Scared Stiff'

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Drug prices go up
Not just today, everyday
Let's just blame Shkreli

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Summaries Of The News:


Mylan's Offer Of EpiPen Discounts Meets With Criticism

Critics reacted by pointing out that the company did not lower the list price of the EpiPen, which has risen to $600 for a pack of two from about $100 in 2007. Many experts also said the company's move to provide "savings cards" was more of a public relations move that wouldn't have much overall impact.

The Wall Street Journal: Mylan Reacts To EpiPen Backlash
Mylan NV raced Thursday to counter a firestorm of criticism over its pricing of lifesaving EpiPens, saying it would help more patients cover their out-of-pocket costs. But the drugmaker didn’t lower the list price, and its stranglehold on the market means it is unlikely to face competitive pressure to do so. (Rockoff, 8/25)

The New York Times: Mylan To Offer Some Patients Aid On Cost Of EpiPens
But the moves did not mollify critics of Mylan because the company did not lower the list price of the EpiPen, which has risen to $600 for a pack of two from about $100 in 2007. So the total cost to the health system, a cost borne largely by insurers, the federal government and school districts, will remain the same. (Pollack, 8/25)

The Washington Post: Why Mylan’s ‘Savings Card’ Won’t Make EpiPen Cheaper For All Patients
Although the company said that the savings card would halve the cost of the drug to commercially insured patients who pay full price, outside experts said the overall impact will likely be small and that it did not amount to a solution to the broader problem. Such savings cards are a classic public relations move by the pharmaceutical industry, said Harvard Medical School professor Aaron Kesselheim, and it will only be used by a fraction of the people who need the drug. For example, such savings cards are illegal in government health programs such as Medicaid. (Johnson, 8/25)

NPR: EpiPen Manufacturer Offers A Discount, But Critics Aren't Soothed
The device's manufacturer, Mylan NV, announced Thursday that it will offer coupons worth as much as $300 off a two-pack. The move is a reaction to harsh criticism from consumers and several lawmakers over repeated price increases that have boosted the cost of the medication to more than $600 from less than $100 just a few years ago. ... But coupons may not be enough to tamp down anger over the price hikes. (Kodjak, 8/25)

The Hill: EpiPen Maker Lowers Price After Uproar 
The maker of EpiPens announced Thursday that it is reducing the price of the device following an uproar in Washington over the cost of the treatment for serious allergic reactions. Mylan, the company that makes EpiPen, said it will provide a savings card worth up to $300 for people who had been paying the full price out-of-pocket, effectively reducing the cost by 50 percent. The company is also making it easier to qualify for its patient assistance program, which eliminates out-of-pocket costs for uninsured and underinsured people. (Sullivan, 8/25)

The Star Tribune: EpiPen Manufacturer Says It Will Offer New Discounts On The Product 
Mylan, the embattled drug company whose price hikes of an anti-allergy product sparked calls for a government investigation and a congressional hearing has announced plans to broaden discounts offered to consumers on its EpiPen. The company said Thursday that it will increase the value of a savings coupon offered on an epinephrine auto injector to $300 from $100 and double the eligibility for subsidies that eliminate out-of-pocket costs to uninsured or underinsured patients. (Spencer, 8/25)

Marketplace: Mylan Says Raising EpiPen Price 500% Isn't The Problem
Today the CEO of Mylan responded to the uproar over her company's price increases for EpiPens, the life-saving anti-allergy injectors. A pack of two EpiPens now costs $600, up from $100 in 2007. CEO Heather Bresch said Mylan will offer more financial assistance to help people pay their out-of-pocket costs — the piece that health insurance doesn't cover. But she did not offer to take back any of the price increases. Instead, Mylan blames rising health care premiums and deductibles. But Robert Weissman, president of the watchdog group Public Citizen, says that’s not it at all.  “The problem is that Mylan has jacked up their price,” he said.  (Douban, 8/25)

Very Public EpiPen Pricing Brawl Offers Case Studies In Social Media, P.R. Crisis Management

Parents used social media to challenge Mylan's price hikes while the company's CEO is responding with a message that their anger should be focused on the nation's broken health system. Meanwhile, the topic is getting play on the presidential campaign trail and from congressional lawmakers. Even actress Sarah Jessica Parker has jumped into the fray, announcing that she will end her association with Mylan.

The New York Times: How Parents Harnessed The Power Of Social Media To Challenge EpiPen Prices
[Mellini Kantayya] went online to, a service that collects signatures and then sends them to designated lawmakers, and created the petition “Stop the EpiPen Price Gouging,” which went live on July 11. Then Ms. Kantayya shared the link with her 836 Facebook friends, with a post that began, “Stupid pharmaceutical company!” What happened next is a lesson in the power of social media to help create a groundswell, particularly among a group as committed and motivated as the parents of children with food allergies, who must often buy multiple pens for home, school and day care. In just 45 days, Ms. Kantayya’s petition grew from a few dozen signatures to more than 80,000 people who sent more than 121,000 letters to Congress. (Parker-Pope, 8/25)

CNN Money: EpiPen CEO: Blame The 'Broken' System, Not Me
Heather Bresch, the Mylan CEO under fire for skyrocketing EpiPen costs, believes Americans should redirect their anger toward a "broken" health care system. Mylan (MYL) was forced to respond to the national outrage over a more than 400% increase in price for the lifesaving allergy treatment by pledging on Thursday to make it more affordable. But Bresch argued that a lack of transparency in the complex health care system -- with bigger cuts for everyone along the supply chain -- "incentivizes higher prices" in the industry. She pointed out that copays and deductibles are on the rise, too. (Egan, 8/25)

Bloomberg: Lawmakers Blast Mylan’s Move To Curb EpiPen Costs As PR Fix 
In response to intense criticism over the past few days, Mylan acted Thursday to expand assistance programs that help patients with high out-of-pocket expenses -- but didn’t go as far as cutting the treatment’s list price. Health insurers and U.S. lawmakers, along with Democratic presidential candidate Hillary Clinton, criticized the effort as an attempt to cover a 400 percent price hike that won’t make the drug more affordable. Mylan has been under fire for increasing the price to about $600 for a two-pack from $57 for a single pen in 2007. (Koons and Edney, 8/25)

Stat: 5 Questions About EpiPen Pricing That The Mylan CEO Has Yet To Answer
Amid a chorus of criticism over the rising cost of EpiPens — a furor that has sent her company’s stock down more than 10 percent — Mylan CEO Heather Bresch went on CNBC on Thursday to manage a crisis. But her appearance may have raised more questions than it answered. Mylan is not lowering the price of EpiPen, though it is expanding a program to help patients with the cost. Some of Bresch’s sharpest critics — including members of Congress and Hillary Clinton — have made clear that’s not enough. (Garde, 8/25)

Roll Call: Democrats: EpiPen Cost Curbing Is PR Move, Not a Fix
Some Congressional Democrats are criticizing a pharmaceutical company's effort to curb the rising cost of a drug used to combat severe allergic reactions as a public relations move rather than a solution. ... “This step seems like a PR fix more than a real remedy, masking an exorbitant and callous price hike," Sen. Richard Blumenthal said in a statement. "This baby step should be followed by actual robust action." (Bowman, 8/25)

Roll Call: EpiPen Crisis Hitting Senators Close To Home
The debate over the cost of EpiPens isn't just politics for some lawmakers. It's personal. Democratic Sens. Amy Klobuchar of Minnesota and Mark Warner of Virginia both have adult daughters who rely on the drug injector. Klobuchar's daughter, Abigail, 21, keeps one with her because of a nut allergy. A spokeswoman for Warner said the senator's youngest daughter, Eliza, 22, is so prone to allergic reactions that she actually needs to use EpiPens regularly — and the Warner family keeps them around the house. (Lesniewski, 8/26)

Stat: Sarah Jessica Parker, Angry At EpiPen Price, Drops Mylan Sponsorship
Under fire for aggressively hiking the price of the EpiPen device, Mylan Pharmaceuticals has now lost an influential advocate: Sarah Jessica Parker. The actress said on her verified Instagram account Thursday that she has ended her relationship as a paid spokeswoman for the drug maker “as a direct result” of the price increases. Parker wrote that she is “disappointed, saddened and deeply concerned by Mylan’s actions” and called on the company to “take swift action to lower the cost to be more affordable for whom it is a life-saving necessity.” (Robbins, 8/25)

A Monopoly, FDA Oversight And Other Factors That Contributed To The EpiPen Controversy

Reports put the ongoing fracas over the soaring price tag of this emergency allergy medication into context by detailing a range of factors including why EpiPens are not reusable and legal challenges related to price gouging.

The Washington Post: How Mylan, The Maker Of EpiPen, Became A Virtual Monopoly
EpiPen’s rising price is particularly notable because state and federal legislation have been key to the drug’s rapid growth. Annual prescriptions for EpiPen products have more than doubled in the past decade to 3.6 million, according to IMS Health data. Mylan benefited from factors including failed competitors, patent protections and laws requiring allergy medications in schools. Having a virtual monopoly has facilitated the rapid price hike. Mylan reached $1 billion in sales for the second time last year. (Johnson and Ho, 8/25)

Stat: Senators Want To Know What FDA Is Doing To Make EpiPen Rivals Available
While anger is directed at Mylan Pharmaceuticals over the rising cost of its EpiPen device, some lawmakers wonder whether the US Food and Drug Administration should share some of the blame for the high prices paid by consumers. How so? They want to know if the agency made it possible for Mylan to dominate the market and charge whatever price it wants. (Silverman, 8/25)

USA Today: Why Not Reuse EpiPens With New Epinephrine After They Expire?
The controversy surrounding skyrocketing prices over the EpiPen emergency allergy shots has nothing to do with what's in the devices. That's the 100-year-old chemical epinephrine, which costs just pennies. It's the device that Mylan is charging so much for. So why not replace cartridges of epinephrine that have expired with new ones? (O'Donnell, 8/25)

Detroit Free Press: EpiPen Makers Sued For Selling Pens In Packs Of 2
As the makers of EpiPen battle a firestorm surrounding price increases, a new federal lawsuit seeking class-action status argues that the company is engaging in price gouging by forcing consumers to buy the pens in packs of two. The lawsuit was filed Tuesday in the Eastern District of Michigan on behalf of six EpiPen purchasers, three of them based in Michigan. It says there is little evidence doctors ever recommended the pens be sold in packs of two — and yet by 2011, EpiPen’s maker Mylan did just that. (Bethencourt, 8/25)

Morning Consult: Pfizer’s Involvement In EpiPens Could Complicate Drug Price Debate
Mylan Pharmaceuticals has come under intense fire for massive price hikes of EpiPens over the last week, facing scrutiny from lawmakers and industry groups. It is less well known, however, that while Mylan markets and prices the drug, Pfizer Inc. actually manufactures the drug and has seen increased revenues from EpiPens over the last few years. The financial relationship between the two drug companies is unclear, and Pfizer declined to elaborate. Mylan did not respond to a request for further comment about EpiPens or how the two companies divide revenues. (Owens, 8/26)

In addition, news outlets also offer timelines and background on rising costs of this drug and others that came before it -

USA Today: A Timeline Of Eye-Popping Drug Prices
The firestorm over steep price increases for the EpiPen — which can rescue people having life-threatening allergic reactions  — is just the latest in a long line of controversies over high prescription drug prices. A decade ago, much of the concern over prescription drug prices involved new high-tech cancer drugs, used by only a few thousand patients a year. In recent years, the prices for decades-old generic drugs have soared, as well, as pharmaceutical companies purchase the rights for drugs with no competition. Here's a recap of some of the most eye-popping prices. (Szabo, 8/25)

CNN Money: What Happened To AIDS Drug That Spiked 5,000%
Outrage over the massive EpiPen price hike feels like deja vu. A year ago, America was in shock when a drug called Daraprim that's used by some AIDS and transplant patients skyrocketed overnight from $13.50 to $750 a pill. ... Hillary Clinton tweeted that the 5,000% spike was "outrageous" and amounted to "price gouging." Nothing about the drug itself had changed except this: a new company -- Turing Pharmaceuticals -- had bought the rights to distribute it. The Daily Beast dubbed Turing's CEO "the most hated man in America." (Long, 8/25)

Sen. Manchin Shares Parents', Lawmakers' Concerns About EpiPen Pricing

The West Virginia senator's statement is noteworthy because his daughter, Heather Bresch, is the CEO of Mylan, the company that markets EpiPen, and at the center of this week's price tag controversy.

The Wall Street Journal: Sen. Joe Manchin, Father Of Mylan’s CEO, Airs ‘Concerns’ About Drug Costs
In a statement more remarkable for who said it than for what he said, Sen. Joe Manchin (D., W. Va.) said he shares the concerns of other senators and the public about “skyrocketing prices of prescription drugs.” Sen. Manchin’s daughter is Heather Bresch, chief executive of Mylan NV and the central figure in the current national furor over the skyrocketing cost of Mylan’s auto-injector product called the EpiPen. (Burton, 8/25)

Politico: Manchin Shares 'Concerns' On Drug Prices Amid Daughter's Company Controversy
Sen. Joe Manchin said Thursday that he shares the concerns his colleagues have voiced about how a pharmaceutical company run by his daughter prices a life-saving medicine it produces. The West Virginia Democrat’s daughter is Heather Bresch, the CEO of Mylan, the company that makes the EpiPen, a product that delivers the life-saving drug epinephrine for people with allergies to bee stings or certain foods. Mylan has come under fire in recent days for raising the price of the EpiPen by 548 percent since it acquired the rights to the product in 2007. (Nelson, 8/25)

The Hill: Senator Responds To Criticism Of Daughter's EpiPen Company 
Sen. Joe Manchin (D-W.Va.), whose daughter Heather Bresch is the CEO of the company that makes EpiPens, said Thursday that he shares his colleagues' concerns about the recent price hike in the emergency allergy medication. "I am aware of the questions my colleagues and many parents are asking, and frankly I share their concerns about the skyrocketing prices of prescription drugs," Manchin said in a statement.  (Sullivan, 8/25)

Health Law Issues And Implementation

Obamacare Affordability And Access Become Issues In Competitive Senate Campaigns

Politico reports that some of the steepest premium hikes requested by insurers are in swing states that could determine Senate control. Meanwhile, the Chicago Tribune looks at the Department of Health and Human Services' guidance to consumers on the issue.

Politico: Obamacare Sticker Shock Hits Key Senate Races
As insurers push large premium increases for 2017 Obamacare plans, some of the steepest hikes have been requested by insurers in crucial swing states that could determine control of the Senate. In nine of 11 states with competitive Senate races, at least one insurer seeks to hike rates for Obamacare customers by at least 30 percent next year: Highmark Blue Cross Blue Shield in Pennsylvania wants to jack up average premiums by more than 40 percent. In Wisconsin, three insurers have asked for rate hikes of more than 30 percent. In New Hampshire, two of the five carriers want to sell plans with rate increase above 30 percent. (Pradhan and Demko, 8/26)

Chicago Tribune: Fewer Choices, Higher Prices Concerns As ACA Enrollment Period Looms
The Affordable Care Act enrollment period doesn't begin until November, but the recent departure of several health insurance providers from federal and state marketplaces is raising concerns of fewer choices and higher premiums. But federal officials emphasized that consumers will still have affordable coverage options during a Wednesday conference call. Even if insurance premiums increase by 25 percent, 60 percent of Indiana consumers would be able to purchase coverage for less than $75 per month, according to a report from the U.S. Department of Health and Human Services. (Lazerus, 8/25)

HHS Report Finds Expanding Medicaid Helps Keep Marketplace Premiums Lower

The researchers say that premiums for insurance purchased on the health law's online marketplaces are about 7 percent lower in states that have expanded their Medicaid programs. In other news, Alabama's House passes a bill to help fund Medicaid with a lottery, South Dakota advocates begin preparing to fight again to expand Medicaid and some experts say doctor house calls might help save Medicaid money.

CNBC: Expand Medicaid And Obamacare Will Cost Less, Federal Government Says
States that allow nearly all poor adults to enroll in their Medicaid health coverage programs saw prices on Obamacare private insurance marketplaces about 7 percent lower than states that haven't expanded Medicaid eligibility, the federal government said Thursday. The findings reflect the fact that poorer people tend to be less healthy than people with higher incomes, who make up the lion's share of Obamacare enrollees in expansion states. (Mangan, 8/25)

The New York Times' The Upshot: How Expanding Medicaid Can Lower Insurance Premiums For All
The Obama administration for years has been pleading with states to expand their Medicaid programs and offer health coverage to low-income people. Now it has a further argument in its favor: Expansion of Medicaid could lower insurance prices for everyone else. A new study published by in-house researchers at the Department of Health and Human Services compared places that have expanded their Medicaid programs as part of Obamacare with neighboring places that have not. They found that, in 2015, insurance in the marketplace for middle-income people cost less in the places that had expanded Medicaid. (Sanger-Katz, 8/25)

Morning Consult: HHS Report: Medicaid Expansion States See Lower Exchange Premiums
Under the expanded program, people within 138 percent of the federal poverty level are eligible for Medicaid. In states that did not expand Medicaid, people within 100 percent and 138 percent of the federal poverty level are eligible for subsidized coverage on the federal exchanges. People within that range make up, on average, 40 percent of the marketplace population in non-expansion states, as opposed to 6 percent in states that expanded Medicaid, the report says. Typically, low-income people have poorer health than people with higher incomes, meaning low-income and potentially sicker people make up a greater part of the exchange risk pools in states that have not expanded Medicaid. (McIntire, 8/25)

The Associated Press: Alabama House Narrowly Approves Governor's Proposed Lottery
The Alabama House of Representatives narrowly approved Gov. Robert Bentley's proposed state lottery Thursday night after 10 hours of contentious debate and two vote attempts. ... The Republican governor, seeking to end the Deep South state's historic opposition to gambling as a revenue source, proposed a lottery as a way to provide money to the state's perpetually cash-strapped Medicaid program. (Chandler, 8/26)

Montgomery (Ala.) Advertiser: Alabama Lottery Bill Rises From The Dead
On a second vote, the House approved the amendment 64 to 35, one vote more than it needed to go over the top. ... It goes to the Senate for concurrence or a conference committee. Senate President Pro Tem Del Marsh, R-Anniston, said Friday morning he planned to move for a conference committee or concurrence on Friday. "We are just happy to know will have something for the people of Alabama to vote on," he said. (Lyman, 8/26) Alabama Lottery Bill Passes House On Second Vote
The legislation is Gov. Robert Bentley's plan to boost funding for the General Fund and Medicaid. "We came out with a victory from the House," Bentley said, speaking to reporters after midnight. "Not us, but a victory for the people of this state. "This is about people. The lottery is just part of that process. The lottery is only a way that we can have money to fund the essential services of this state, particularly Medicaid." ... If the legislation can win final approval, it would go to voters as a proposed constitutional amendment. (Cason, 8/26)

Sioux Falls (S.D.) Argus Leader: Health Care Giants Promise Another Push For Medicaid Expansion In 2017
Despite delays from the Legislature in addressing the proposal to expand the federal health insurance program for needy people, health care industry officials said they would push for expansion in 2017. At a meeting in Sioux Falls, representatives from the governor's office, health care organizations from across the state including Avera, Sanford and Rapid City Regional as well as a handful of legislative candidates met to discuss how they'd again make the argument for expansion in the Legislature. (Ferguson, 8/25)

Stateline: House Calls Might Save Medicaid Money For States
Doctors who make house calls may seem like something from America’s Norman Rockwell past. But they never disappeared entirely, and there is new evidence that home visits can play an important role in providing health care to the aged and chronically ill — while saving taxpayers millions. The federal Centers for Medicaid and Medicare Services (CMS) said this month that a demonstration project has shown that delivering comprehensive primary care services at home helped to keep Medicare recipients with multiple chronic illnesses or disabilities out of hospitals, emergency rooms and nursing homes. (Ollove, 8/25)

ACOs Save Medicare $466M Last Year But Quality Improvements Are Mixed

The Centers for Medicare & Medicaid Services announces that a third of the accountable care organizations will receive bonuses, which are awarded in part on performance and quality marks. ACOs care for about 7.7 million Medicare beneficiaries.

CNBC: Obamacare Accountable Care Programs Had $466 Million In Medicare Savings Last Year
Groups of hospitals, doctors and other health providers that agree to coordinate patient care as part of an Obamacare program generated $466 million in savings to the federal Medicare program in 2015, officials said Thursday. The groups, known as accountable care organizations, provide care for a total of about 7.7 million beneficiaries of Medicare, the program that covers primarily senior citizens. (Mangan, 8/25)

Modern Healthcare: Fewer Than A Third Of Medicare ACOs Received Bonuses Last Year 
The mixed results for Medicare accountable care organizations continued last year with fewer than one-third of them qualifying for bonus payments, the CMS said Thursday. The news comes as the administration is preparing providers for the new Medicare reimbursement program known as MACRA, which is set to begin collecting data in January. It shifts away from fee-for-service payments and toward value-based payments, thus promoting the use of programs like ACOs. (Muchmore, 8/25)

Morning Consult: CMS: ACOs Generating Savings, Improving Quality
Medicare accountable care organizations have saved more than $1.29 billion since 2012, the Centers for Medicare and Medicaid Services announced Thursday. All Medicare ACOs, which number more than 400 including both shared savings program participants and pioneer ACOs, saved a total of $466 million in 2015, the agency said. The administration has sought to enroll more providers in ACOs as part of its goal to tie more medical reimbursements to quality, rather than quantity. (McIntire, 8/25)

Coverage And Access

Middle Class Feels Pinch Of Health Care Costs As Out-Of-Pocket Expenses Rise

The Wall Street Journal reports that the burden of health care costs is shifting in greater part to working middle-class families, in large part because of higher deductibles in insurance plans.

The Wall Street Journal: Burden Of Health-Care Costs Moves To The Middle Class
Growth in overall health-care spending is slowing, but middle-class families’ share of the tab is getting larger, squeezing households already feeling stretched financially. Overall, health-care spending across the economy reached 18.2% of gross domestic product as of June, up from 13.3% in 2000, according to Altarum Institute, a health research group. (Sussman, 8/25)

The Wall Street Journal: 5 Things To Know About Health-Care Spending In The U.S.
Despite a slowdown in the growth rate of overall national health expenditures, Americans are seeing more of their paychecks go to health-care costs. The increase is largely thanks to cost-shifting through higher deductibles in plans offered by employers, which cover the majority of workers and their families. The trend has hit middle-income households the hardest. Here are five things to know about trends in U.S. health-care spending. (Sussman, 8/25)

And in other consumer health cost news —

Kaiser Health News: Report For State Insurance Commissioners Offers Options To Improve Drug Access
As prescription drug costs continue to rise, ensuring that consumers have access to the drugs they need is a growing concern. Insurers blame the drug companies for high prices while drug companies blame insurers for restrictive plans. Consumers are stuck in the middle picking up a higher tab. Now a new study highlights strategies for states to help consumers in this tug of war. (Andrews, 8/26)

Campaign 2016

1994 Failed Health Care Push Still Shapes Hillary Clinton's Cautious Approach Today

In other election news, news outlets weigh the role that candidate health debates have played in past campaigns, Donald Trump's transition team includes a pharmaceutical executive and Bernie Sanders supports the Colorado ballot initiative that would set up a universal health care system in the state.

The Washington Post: After Health-Care Missteps, A Chastened Hillary Clinton Emerged
From the ashes of this defeat emerged a chastened Hillary Clinton whose caution has, over the years and as she seeks to become the nation’s first female president, become a hallmark of her identity. The 21 months from the dawn to the demise of the Clinton health plan showed the first lady as the Washington neophyte that she was, overvaluing her own ideas, misreading power relationships, crusading for a complex plan that would have disrupted many Americans’ health care. She has not attempted anything as daring again. (Goldstein, 8/25)

Stat: Candidate Health Has Long Been Seen As Fair Game. Ask Dukakis
There’s at least one politician who can legitimately claim that he knows what Hillary Clinton is going through as a target of wild speculation about her health: Michael S. Dukakis. ... Dukakis told STAT that he believes that accusations about his health hurt him in his race against George H. W. Bush. (Scott, 8/26)

Politico Pro: Pharma Exec Is Key Player On Trump Transition Team
One of Donald Trump’s top transition team members is a pharmaceutical executive described by friends and political foes as disciplined, press adverse and focused on policy — in other words, the complete opposite of the Republican nominee. Gov. Chris Christie tapped his former chief of staff Rich Bagger to help run the Trump transition team, which has already started its work at 1717 Pennsylvania Ave. to develop a policy agenda for a possible administration and build out a staff. (Haberkorn, 8/25)

Morning Consult: Sanders Backs Public Option On Colorado Ballot
Sen. Bernie Sanders backed Colorado’s Amendment 69 Wednesday, lending his support to the ballot initiative while launching Our Revolution, a new organization aimed at continuing the “movement” Sanders says was launched through his campaign for president, capitalizing on his newfound political capital. It will back candidates and ballot initiatives that back Sanders’ left-leaning priorities. (McIntire, 8/25)

Public Health And Education

Another Local Infection Of Zika Reported In Palm Beach County

In other transmission news, Fla. Gov. Rick Scott will go to D.C. to push for funding, Planned Parenthood helps raise awareness about the virus in Miami and the World Health Organization reports there are no confirmed Zika cases related to travel to the Rio Olympics so far.

The Hill: Florida Gov To Take Zika Funding Pitch To Congress
Florida Gov. Rick Scott (R) is headed back to D.C. next month amid an escalating battle with the federal government over its lack of response to the spread of the Zika virus in Florida.Scott said Thursday that he will arrive at the Capitol on Sept. 6, the first day lawmakers return from their seven-week summer break. (Ferris, 8/25)

NPR: Planned Parenthood Joins Campaign To Rid Miami Neighborhoods Of Zika
In Little Haiti, Liberty City, and a number of other neighborhoods in Miami, canvassers are now walking door to door to spread the word about the risks of Zika, one household at a time — hoping to reach 25, 000 people the next six weeks. In some neighborhoods, these workers aren't sponsored by federal or state health agencies, but by Planned Parenthood. (Allen, 8/26)

NBC News: So Far, It Seems No One Caught Zika At The Olympics: WHO
No one appears to have caught Zika at the Olympics, the World Health Organization said Thursday. WHO and other experts predicted the Olympics would not be a big source of Zika spread to the rest of the world. August is winter in Rio de Janeiro, and the Zika-bearing mosquitoes are less active then. Nonetheless, several athletes withdrew from the games, citing Zika worries. In its latest update on Zika, WHO said so far there had been no cases although cases could still be reported. (Fox, 8/25)

U.S. Labs Prepare For Zika Testing Needs That Could Outpace Current Capacity

An analysis identifies a significant gap between resources on hand and the potential need if the Centers for Disease Control and Prevention's worst-case outbreak scenario comes to pass. Meanwhile, new transmission research finds that the virus can linger in vaginal tissue and an infant's bloodstream for much longer than previously thought.

The Wall Street Journal: Zika Virus’s Spread Pushes Testing Labs To Expand Capacity
As summer drew near, the nation’s health officials took stock of whether they could handle a surge in demand for Zika diagnostic tests if disease-carrying mosquitoes began to proliferate. A survey of state and local laboratories found enough capacity to perform 3,500 to 5,000 tests a week for the Zika virus. But that wouldn’t be enough to meet demand under the Centers for Disease Control and Prevention’s worst-case scenario for a domestic Zika outbreak. (Evans, 8/25)

CNN: Zika Can Hide In Vagina, Baby's Bloodstream 
More surprises from the world of Zika research this week: The virus can hide in vaginal tissue and the bloodstream of infected infants much longer than anyone expected, with dangerous consequences. In most people, Zika lives in the blood for about seven days and then resolves. It can last a bit longer in urine and saliva, but even that goes away after a couple of weeks, leaving antibody testing of the blood as the only way to determine whether you've had the virus. (LaMotte, 8/25)

Dallas Morning News: Zika Flourishes In The Vagina, Study Finds
The vagina is a welcoming home for Zika. In a new study published today, researchers at Yale University found that Zika reproduced in the vaginas of pregnant mice four to five days after infection and that the virus spread from the vagina to the fetal brain. ... We already know that Zika can spread through sex. The second documented case of sexually transmitted Zika was in Dallas earlier this year. In that case, the virus was spread through sex between two men. Last month, the first case of a woman spreading Zika to a man through sex was reported. (Yasmin, 8/25)

Nearly 50 Percent Of Teen Boys Have Received The HPV Vaccine

Almost 63 percent of girls have been vaccinated for the human papillomavirus. The Boston Globe looks at why Rhode Island vaccination efforts have been so successul. In other children's health news, a study links violence exposure to higher viral loads for HIV-positive kids.

The Washington Post: Teen Boys’ HPV-Vaccination Rate Hits Almost 50 Percent, CDC Says
The rate of HPV vaccination among teen boys in the United States surged in 2015, suggesting that more parents and physicians are embracing the message that it's as important for boys to be vaccinated against the human papillomavirus as it is for girls. The Centers for Disease Control and Prevention reported Thursday that 49.8 percent of boys ages 13 to 17 had gotten at least one of the recommended three doses as of 2015, up 8 percentage points from 2014. The rate for teen girls rose more slowly: Almost 63 percent had gotten at least one dose, compared to 60 percent in 2014. (McGinley, 8/25)

Boston Globe: How Did R.I. Win Acceptance Of HPV Vaccine? 
New federal data show Rhode Island is having unparalleled success immunizing teenagers with a shot that has been a hard sell elsewhere — the vaccine against HPV, human papillomavirus. Rhode Island health officials sparked a firestorm last year by requiring that students get the HPV vaccine before entering seventh grade. The mandate was in effect for only the last few months of 2015, and applied to children younger than those in the federal study, a survey conducted in 2015 and released Thursday. Still, Rhode Island health officials said they believe the requirement contributed to the surge in adolescent vaccinations — and Massachusetts officials are watching the Ocean State’s experience as they seek to improve their own record. (Freyer, 8/26)

The Washington Post: How Violence Could Be Hurting Kids With HIV
Exposure to gunfire, assaults and other violence may negatively impact the health of children born with HIV, according to a new Harvard University study. Researchers analyzed the medical records of 268 youths ages 8 to 15 and then asked them about their exposure to violence within the previous year. Fifty-three said they had heard gunshots on their block, for example, and 23 said they lived in a neighborhood where there had been a murder. Twenty reported that a neighbor had been hit by a police officer. (Kelly, 8/25)

Responding To The Opioid Epidemic, The Surgeon General Reaches Out To Prescribers

Dr. Vivek Murthy is mailing letters to the 2.3 million physician-prescribers in America, urging them to to do three things: sharpen their prescribing practices, connect people who need it to treatment and help change how our country thinks about addiction. Meanwhile, other news outlets report on how street drugs continue to be a part of the crisis and offer details about how drug use and overdoses are taking a toll in California, Ohio, Texas and Maryland.

Morning Consult: Surgeon General Pens Open Letter On Opioid Crisis
Surgeon General Vivek Murthy is sending a letter to physicians around the U.S. asking for help in addressing the opioid crisis, the first time his office has done so for a public health crisis. The letter will be sent to 2.3 million health care providers this week, and acknowledges that providers have played a role in the increase of available opioids by prescribing more of the addictive drugs with “good intentions.” Providers were encouraged to treat patients’ pain with opioids, but not educated properly on how to do so safely, and were on the receiving end of heavy marketing campaigns for opioids, he says. (McIntire, 8/25)

Stat: Street Drugs, Not Prescriptions, Now Powering Opioid Crisis
The widespread abuse of the potent opioid fentanyl appears to be largely the result of illicit manufacturing of the synthetic drug as opposed to the misuse of legally prescribed versions of the painkiller, according to two US government studies released Thursday. That represents a dramatic change in the way opioids have traditionally been abused, and means public health officials will likely have to adjust their response to the two-decade-long crisis. (Armstrong, 8/25)

NPR: Illegally Made Fentanyl Seems To Be Fueling A Spike In Overdoses
Federal data suggest illegally manufactured fentanyl, a drug that is 50 to 100 times stronger than morphine, is behind an increase in synthetic opioid deaths. A report from the Centers for Disease Control and Prevention says that there was a 426 percent increase in seized drug products that tested positive for fentanyl from 2013 to 2014. And separate data show the number of deaths involving synthetic opioids, a class that includes fentanyl and tramadol but not hydrocodone, rose 79 percent during that same period. (Hobson, 8/25)

Los Angeles Times: 'The Cheapest Buzz You Can Get On Skid Row': Officials Try To Stop Homeless From Smoking Spice After Dozens Sickened
When paramedics arrived at downtown’s skid row last Friday in response to a 911 call, they found dozens of people who looked as if they’d overdosed. Many were on the ground, passed out.  ... “I’m walking down the street — it looks like a war zone,” said Georgia Berkovich, who works at the Midnight Mission, a block from the intersection. Thirty-eight people were transported to the hospital, many suspected of ingesting the synthetic drug “spice.” (Karlamangla, 8/25)

The Columbus Dispatch: Drug Overdose Deaths Pushed To Another Record High In Ohio
Across Ohio, someone died from a drug overdose every two hours and 52 minutes on average all year long in 2015. That's 8 people a day.  Drug overdoses killed a record 3,050 people in Ohio last year, more than one-third of them from fentanyl, a super-potent opiate often mixed with heroin. The annual report on unintentional drug overdose deaths released today by the Ohio Department of Health showed the increasing toll from all drugs was 20.5 percent higher than 2014, a disappointment to state officials who have worked for years on many fronts to curb the drug-related carnage. (Johnson, 8/25)

CBS News: Dozens Of Ohio Overdoses Blamed On Heroin Mixed With Elephant Tranquilizer
A medical examiner in Ohio has issued a public warning about a dangerous drug that hit the streets this summer. Far more powerful than heroin, it has sent dozens to the hospital -- and dozens more to the morgue. ... Carfentanil is so deadly, it is not even prescribed for humans -- it’s typically used to tranquilize large animals like elephants. The drug is 100 times more potent than the similar drug prescribed for humans, fentanyl, and 10,000 times more potent than morphine. But carfentanil abuse is spreading. Authorities say at least 30 people have died from these overdoses in the Akron, Ohio area since the July 4th weekend. (8/25)

Austin Statesman: Medics Treat Dozens In ‘One Of The Largest’ Austin Upticks Of K2 Cases
EMS officials said the uptick of K2-related cases started Wednesday. Dozens of people who used the synthetic drug commonly known as K2 or Spice required medical attention in downtown Austin on Wednesday and Thursday as part of what emergency crews described as one of the largest upticks in adverse reactions to the drug they’ve seen. On Thursday, several ambulances staged at several points across the downtown area — including at the Austin Resource Center for the Homeless at Seventh and Red River streets — to respond as quickly as possible to the number of calls they were receiving, said officials with Austin-Travis County Emergency Medical Services. (Hall, Martinez-Cabrera and Wilson, 8/25)

CNN: Your Drain On Drugs: Meth Seeps Into Baltimore's Streams
You shouldn't put illegal drugs in your body, and you shouldn't let neighborhood bodies of water ingest them, either. A new study suggests that aquatic life in Baltimore is being exposed to drugs, and it's having an impact. And these aren't soft drugs; they include methamphetamine and amphetamine. They're messing with the growth and development of organisms in local streams. (Christensen, 8/25)

Also, some cities continue to explore the concept of "safe spaces" -

Kaiser Health News: In Boston’s ‘Safe Space,’ Surprising Insights Into Drug Highs
Some arrive on their own, worried about what was really in that bag of heroin. Some are carried in, slumped between two friends. Others are lifted off the sidewalk or asphalt of a nearby alley and rolled in a wheelchair to what’s known as SPOT, or the Supportive Place for Observation and Treatment, at the Boston Health Care for the Homeless Program. Nine reclining chairs have been full most days, especially during peak midday hours. It may be the only room in the country where patients can ride out a heroin or other high under medical supervision. (Bebinger, 8/26)

The New York Times: Seattle’s Potential Solution For Heroin Epidemic: Places For Legal Drug Use
A task force established to combat a heroin epidemic in the Seattle metropolitan area has endorsed a strategy of establishing places where addicts would be allowed to take drugs without fear of being arrested. At these sites, called safe consumption facilities, addicts would receive clean needles and syringes and would be permitted to inject heroin, smoke crack cocaine and take other addictive drugs under the supervision of trained authorities. (Bromwich, 8/25)

State Watch

State Highlights: Calif. Lawmakers Take On Rural Health Issues; Texas Task Force Investigates State's High Rate Of Pregnancy Deaths

Outlets report on health news from California, Texas, Florida, Tennessee, Iowa, New York, Montana, Michigan, Virginia and Minnesota.

California Healthline: California Lawmakers Aim To Tackle Rural Health Challenges
Two proposals meant to ease burdens faced by California’s rural patients and their health care providers are breezing through the state legislature as lawmakers finish up for the year. One measure passed Wednesday requires Medi-Cal to cover patients’ transportation to medical appointments. Another bill would allow small rural hospitals to hire doctors directly, which supporters say could reduce health care costs and make it easier to keep physicians in areas where there are few. (Bartolone, 8/25)

ABC News: Task Force Explores Why Texas Had Higher Pregnancy Death Rates In Study
Texas officials are working to understand why more women across the state have been dying either during pregnancy or shortly after. A study published this month has found that maternal mortality rates doubled in Texas between 2011 and 2012 compared to the years before and a new state task force is attempting to understand why the increase occurred. Dr. Daniel Grossman, Professor at Department of Obstetrics, Gynecology and Reproductive Sciences at University of California San Francisco and Investigator at the Texas Policy Evaluation Project, said the findings gave him pause. (Mohney and Mehta, 8/25)

Health News Florida/News Service Of Florida: Court Sides With Tampa General In Malpractice Case 
An appeals court Wednesday upheld a ruling that cleared Tampa General Hospital from potential liability in a medical-malpractice case stemming from the death of a patient during surgery. The case focused heavily on Tampa General's relationship with the University of South Florida, which employed two physicians involved in the surgery. Tampa General is the primary teaching hospital for the university's College of Medicine. The estate of Annie Godwin sued Tampa General, the university and physicians Jaime Sanchez and David Shapiro after Godwin died on the operating table during a 2009 surgery to remove a cancerous tumor, said Wednesday's ruling by a panel of the 2nd District Court of Appeal. (8/25)

Nashville Tennessean: Nashville General, Meharry Roll Out Faith, Education Network To Improve Health
The chiefs of Nashville General Hospital at Meharry and Meharry Medical College want to improve the health of the city's African American community and on Thursday they formally invited about two dozen ministers and community leaders to join a collaboration that will fuse health and education into pulpits and fellowship halls across Nashville. To tackle an unwieldy amount of poor health outcomes and disparities in education, income and access to care Nashville General CEO Joseph Webb and Meharry President Dr. James Hildreth unveiled the Congregational Health and Education Network in a packed room of faith, education and community leaders on the Meharry campus. (Fletcher, 8/25)

Iowa Public Radio: Report: For-Profit Companies Make Fewer Mistakes Managing Medicaid
A federal report released last year shows in 2014, for-profit companies managing part of Iowa’s three billion dollar Medicaid program made far fewer faulty payments than the state-run portion of the program. Governor Branstad says that shows fraud and abuse will go down, now that for-profit companies are in charge of most of Iowa’s Medicaid patients. The report issued last November by the Centers for Medicare and Medicaid services covered 2014 when about 10 percent of Iowa’s Medicaid program was run by for-profit companies. (Russell, 8/25)

Austin Statesman: Austin Parents Complain That Flu Vaccine Form Shames Those Who Opt Out
Some Central Texas parents are complaining about the wording used in a flu vaccine consent form sent home with students this week, saying it tries to shame families who opt out. ... The forms, created by Florida-based Healthy Schools, LLC, were distributed to a number of Central Texas school districts in partnership with the E3 Alliance, a local nonprofit that researches education trends. Filling out and returning the forms was optional, though that was unclear to some families. (Taboada, 8/25)

Kaiser Health News: ‘Mental Health First Aid’ — Chirlane McCray On How N.Y.C. Is Fixing The System
For Chirlane McCray, New York City’s first lady, mental illness is not an abstract concern. It’s deeply personal. Both of her parents suffered depression, something she describes openly; and, in 2013, McCray’s daughter Chiara went public about her own battle with depression and substance abuse. It’s a pressing health problem for many of her constituents, too. In New York City, about one-in-five people are believed to have depression at any given time. Less than 40 percent get treatment. (Luthra, 8/26)

NPR: Orlando Hospitals Say They Won't Bill Victims Of Pulse Nightclub Shooting
Orlando Regional Medical Center has treated 44 victims of the shooting — more than any other hospital. The center's parent company, Orlando Health, says it will not charge victims for their treatment, reports Abe Aboraya of member station WMFE. Instead, the hospital will look at federal and state funds, victims' funds like the One Orlando fund, and private funds raised for victims," Aboraya reports for our Newscast unit. "The hospital will bill insurance if a patient has it, but it will not go after a patient's copays." (Domonoske, 8/25)

Oakland Tribune: Still Too Risky To Go In The Water At Oakley's Big Break Regional Shoreline
East Bay Regional Park District has had warning signs up around the park on the San Joaquin River for a few months now as it continues monitoring the water for a naturally occurring toxin. What is commonly known as blue-green algae is actually a type of bacteria that reproduce quickly when the conditions are right -- hot weather, long hours of daylight, calm water. Add nutrients such as phosphorus and nitrogen to the mix and they form dense concentrations of "blooms" that are typically bright green and can produce toxins that pose serious health risks to people and pets alike. (Coetsee, 8/25)

Detroit Free Press: 2 Hepatitis A Cases Linked To Detroit Basement Backups
The city's top health official is recommending anyone who has come in contact with raw sewage in their homes during the recent heavy rains to contact their doctor after two cases of infection with the hepatitis A virus have been reported to the city's health department. The Detroit Health Department and Michigan Department of Health and Human Services identified the two cases and said both of the individuals had come in contact with sewage following recent basement backups on the city's east side. (Helms, 8/25)

Richmond Times Dispatch: Hepatitis A Patients In Virginia Are Suing Tropical Smoothie Cafe
At least several people with hepatitis A, plus many who have been vaccinated, are in the process of suing Tropical Smoothie Cafe, a food chain that served frozen strawberries from Egypt that caused an outbreak of at least 28 cases of the liver disease in Virginia. Law firms in Seattle, Wash., and Washington, D.C., are in the process of filing multiple lawsuits against Tropical Smoothie Cafe on behalf of customers inflicted with hepatitis A, as well as a class-action lawsuit on behalf of people who got vaccines after consuming frozen strawberries from Tropical Smoothie Cafe. (Shulleeta, 8/25)

Minnesota Public Radio: New Data Show Most Minnesota Moms Breastfeed Newborns 
New federal data show that 90 percent of Minnesota mothers breastfeed their newborns. That's seventh best among all states. The Centers for Disease Control and Prevention said Minnesota ranks fifth for mothers who are still breastfeeding at six months. ...The Minnesota Department of Health's Linda Dech said the state already has strong laws that support breastfeeding mothers. She says her department is now focusing on getting hospitals to do more to facilitate breastfeeding. (Benson, 8/25)

Health Policy Research

Research Roundup: Drug Costs; Doctors' Choices On Care; The 3 Rs; Zika Outbreak

Each week, KHN compiles a selection of recently released health policy studies and briefs.

JAMA: The High Cost Of Prescription Drugs In The United States
Per capita prescription drug spending in the United States exceeds that in all other countries, largely driven by brand-name drug prices .... prescription medications now comprise an estimated 17% of overall personal health care services. The most important factor that allows manufacturers to set high drug prices is market exclusivity .... The availability of generic drugs after this exclusivity period is the main means of reducing prices in the United States, but access to them may be delayed by numerous business and legal strategies. The primary counterweight against excessive pricing during market exclusivity is the negotiating power of the payer, which is currently constrained by several factors .... Another key contributor to drug spending is physician prescribing choices when comparable alternatives are available. (Kesselheim, Avorn and Sarpatwari, 8/23)

JAMA: Association Of Integrated Team-Based Care With Health Care Quality, Utilization, And Cost
[Researchers sought to] evaluate the association of receiving primary care in integrated team-based care (TBC) practices vs traditional practice management (TPM) practices ... [among patients] who received primary care at 113 unique Intermountain Healthcare Medical Group primary care practices .... In this observational study, receipt of primary care in TBC practices compared with TPM practices was associated with significantly higher rates of some quality of care measures, reductions in some measures of acute care utilization, and decreased actual payments to the delivery system from all payers and patients. Compared with TPM, TBC also was associated with improved quality of care for patients with depression and diabetes, but with decreased quality for patients with hypertension. (Reiss-Brennan et al., 8/23)

JAMA Internal Medicine: Physician-Driven Variation in Nonrecommended Services Among Older Adults Diagnosed With Cancer
Interventions to address overuse of health care services may help reduce costs and improve care. Understanding physician-level variation and behavior patterns can inform such interventions. ... [Researchers used] retrospective study of patients 66 years and older diagnosed with cancer between 2004 and 2011, using population-based Surveillance, Epidemiology, and End Results (SEER)-Medicare data to assess physician-level variation in 5 nonrecommended services. ... The total proportion of patients receiving each service varied from 14% for imaging in staging early breast cancer to 41% in early prostate cancer. ... Physicians’ utilization of nonrecommended services that tend to be overused exhibit patterns that suggest consistent behavior more than personalized patient care decisions. (Lipitz-Snyderman et al., 8/15)

The Kaiser Family Foundation: Explaining Health Care Reform: Risk Adjustment, Reinsurance, And Risk Corridors
The Affordable Care Act’s risk adjustment, reinsurance, and risk corridors programs were designed to work together to mitigate the potential effects of adverse selection and risk selection [on insurers]. ... while the programs have similar goals, they are designed to be complementary. Specifically, risk adjustment is designed to mitigate any incentives for plans to attract healthier individuals and compensate those that enroll a disproportionately sick population. Risk corridors were intended to reduce overall financial uncertainty for insurers, though they largely did not fulfill that goal following congressional changes to the program. Reinsurance compensated plans for their high-cost enrollees .... Premium increases are expected to be higher in 2017 in part due to the end of the reinsurance program. (Cox et al., 8/17)

Here is a selection of news coverage of other recent research:

Reuters: Fewer Dementia Patients In Nursing Homes Get Feeding Tubes
Fewer U.S. nursing home patients with dementia are getting feeding tubes as mounting evidence suggests it may not help them live longer or make them more comfortable, new research suggests. Researchers focused on the sickest dementia patients who tend to have difficulty chewing and swallowing as they near the end of life, a point when they may also struggle to speak, recognize loved ones, get out of bed or go to the bathroom independently. The proportion of these advanced dementia patients who got feeding tubes when they couldn’t eat on their own dropped from 12 percent in 2000 to 6 percent in 2014, according to an analysis of data on 71,000 nursing home residents published in JAMA. (Rapaport, 8/16)

NBC News: More Moms Are Breastfeeding Their Babies — But Not For Long Enough, Experts Say
More than 80 percent of U.S. mothers breastfeed their newborns, a new survey finds, but fewer than a third keep doing so for the recommended minimum of one year, a new survey finds. Many studies support breastfeeding for as long as possible, and the American Academy of Pediatrics recommends that babies get nothing but human breast milk until the age of six months — and that they continue to breastfeed for at least a year. (Fox, 8/22)

Stat: Using DNA Tests To Let Women With Breast Cancer Skip Chemo
It’s a dilemma more and more cancer patients will face as genetic testing becomes part of everyday health care: When a DNA test indicates low risk of a tumor spreading, but traditional tests show a high risk, which do you believe? According to a large European study of 6,693 patients published on Wednesday, many women with early breast cancer can safely believe the genetic test. (Begley, 8/24)

CBS News: ADHD In Black And Latino Children Not Diagnosed, Treated As Often As Whites
While a higher percentage of black children show the symptoms of attention-deficit/hyperactivity disorder (ADHD) than white kids, they are less likely to be diagnosed or treated for the disorder, researchers report. The new study showed a similar trend when it came to Latino children: They were as likely as their white peers to exhibit the signs of ADHD, but less likely to be diagnosed or treated for it. (Bernstein, 8/24)

Editorials And Opinions

Debate On EpiPens: Health Care System At The Heart Of The Problem; Hollow Promises

Commentaries on the controversy about the high prices for the drug that helps people with severe allergies.

Los Angeles Times: Mylan Will Help More Patients Pay For Its EpiPen. Here's Why That's Bad News For Healthcare
Mylan, the profiteering, tax-dodging drug company currently taking immense heat for jacking up the price of its Epipen by 500%, announced Thursday that it will help more patients cover their soaring out-of-pocket costs for the allergy drug device. That’s good for some individual patients and families. But at heart it’s a cynical move that actually protects the company’s profits and harms the healthcare system. As I explained last year, that's because such moves are often marketing schemes dressed up to look like altruism. (Michael Hiltzik, 8/25)

Los Angeles Times: Drug Companies Spend Millions To Keep Charging High Prices
Pharmaceutical heavyweight Mylan, the latest poster child for drug-industry greed, finally stuck up for itself Thursday. It argued that “the system,” not avarice, was to blame for the company jacking up the price of EpiPens, a common (and life-saving) allergy remedy, by over 400%. “Look, no one’s more frustrated than me,” Mylan Chief Executive Heather Bresch declared on CNBC. Actually, millions of people — those with chronic medical conditions or other illnesses — are more frustrated than her. (David Lazarus, 8/26)

Los Angeles Times: EpiPen Price Gouging Demonstrates Need For More Competition In Generic Drugs
In the latest in a recent series of controversies over prescription drug prices, Mylan Pharmaceuticals has come under well-deserved fire for jacking up the price of a package of EpiPens — devices that deliver an emergency shot of epinephrine to someone suffering a potentially fatal allergic reaction — 550% since acquiring the right to sell the devices in 2007, from $94 to $608. That may seem modest in comparison to the more than 5,000% increase that Turing Pharmaceuticals quickly imposed on Daraprim, an anti-malarial drug also used by HIV patients, or the more than 3,000% increase that Valeant has extracted for Syprine, a blood-cleaning agent. But given the life-saving nature of EpiPens, their widespread use and Mylan’s effective monopoly, the company’s profiteering is outrageous. (8/26)

The Washington Post: EpiPens Save Lives. If They Cost Too Much, Kids Will Die.
But in 2007, Mylan pharmaceutical company won a near-monopoly on the device. The company used its new power to raise the price of EpiPens by more than 400 percent in recent years. Because it could. Now many families will have to make huge sacrifices to scrounge up more than $500 every year. (They expire.) And some children will have to go back to school without this medication because their families can’t afford it. That is unconscionable. (Chirlane McCray, 8/25)

Chicago Tribune: Beware The Company You Keep: EpiPens And Pharma Bro Martin Shkreli
On Thursday, Mylan said it would boost programs that help patients pay for the EpiPen but would not reduce the price. Stay tuned for Capitol Hill hearings and investigations. Mylan, welcome to Shkreli-Land. Among the defenders of Mylan's pricing is ... you guessed it: Martin Shkreli. We don't begrudge Mylan its profits. And no, we can't say if the price of the EpiPens is too high. That's for the market to decide. What we do know is that when Shkreli spiked the price of his company's drug, Daraprim, competitors emerged to offer similar drugs at lower prices. The same could happen here. That's the way the market works. (8/25)

The Hill: My Life With EpiPens 
EpiPens offer a lifeline for those of us with life-threatening allergies, making the debate on their soaring price all the more pivotal. EpiPen is the brand name for Mylan’s epinephrine auto-injector, a shot that delivers the exact amount of adrenaline my body needs after an allergy attack. That medicine, stored in what looks like an oversized yellow pen, opens my throat up and gives me time to get to a hospital for further treatment. (Ben Kamisar, 8/25)

Viewpoints: Repairing Marketplaces After Aetna Leaves; American Diet; Ky. Medicaid Changes

A selection of opinions on health care from around the country.

The Hill: Aetna's Extortion Boosts Urgency For ObamaCare Public Option 
Here's one figure to focus on when thinking about Aetna's extortion of the federal government for the Justice Department (DOJ) decision to fight its merger with Humana: $1 billion. That's the amount Aetna will owe Humana if the merger falls through. One billion dollars of health insurance premiums collected from businesses and individuals as part of Aetna's drive to become a bigger near-monopoly and maximize profits. The impact on Americans' access to health be damned. (Richard Kirsch, 8/25)

Modern Healthcare: To Cure ACA Exchange Ills, Why Not Merge The Entire Individual Insurance Market?
The hand-wringing over insurer pullouts and premium spikes in the Affordable Care Act exchanges is growing frantic since Aetna announced last week it would exit from the marketplaces in 11 of the 15 states where it currently sells plans. ... Earlier this week, the prominent health economist Henry Aaron of the Brookings Institution offered what he called “simple way” to reduce the risk of more insurers leaping off the exchange ship. “Make the Obamacare exchange one big marketplace for everyone buying individual health insurance coverage,” he wrote in an op-ed piece in the Washington Post. “Nationwide, this would merge the 12 million people who get their insurance through Obamacare with the roughly 9 million who buy their policies outside the exchanges.” It's an approach that insurers almost certainly would fight. But it's something that state leaders around the country might consider because they could do it on their own without waiting for a deadlocked federal government to act. (Harris Meyer, 8/24)

The New York Times: Can We Talk About Your Weight?
Recently, when attending a medical talk about the connection of unhealthy diets to obesity, heart disease and cancer, I was caught by surprise. “When I want to discuss this issue with patients,” the speaker, a physician, said, “I ask permission.” Permission? I said to myself. Since when do doctors with proven strategies for improving health ask for permission? (Dr. Barron H. Lerner, 8/25)

The Hill: Our Nation’s Top Killer? The Iconic American Diet
Dietary risk factors remain the leading cause of death in our country, but neither candidate has talked about food policy. We know about their personal food preferences, but where do the candidates stand on reforming legislation, like the Supplemental Nutrition Assistance Program (SNAP)? We hear about funding and restrictions, but we don’t hear about transforming the system. What foods are in? Which food-like substances are out? What position will the candidates take? Nobody knows. (Dr. Agustina Saenz, 8/25)

Chicago Tribune: 'Bubble' Laws Protect Patients And Protesters Alike
The U.S. Constitution is silent about dogging — the practice of following people down a sidewalk like a pesky canine in an effort to communicate with them against their will. But Chicago-area anti-abortion activists insist that the First Amendment's guarantee of freedom of speech implicitly gives them a right to dog, and they filed suit in federal court Tuesday in an attempt to overturn a limit on protest activity outside city health care facilities. ... In a rare misfire, the American Civil Liberties Union, which is otherwise a strong proponent of abortion rights, is supporting the anti-abortion protesters, saying the 8-foot privacy bubble "substantially burdens leafleting" on any issue at all outside of hospitals or clinics. Nonsense. The Constitution is not offended by a prohibition on the thrusting of leaflets into unwilling hands. (Eric Zorn, 8/25)

Health Affairs Blog: In Kentucky’s New Medicaid Plan Evidence Takes A Back Seat
On June 22, the Governor of Kentucky unveiled a Medicaid reform plan to replace its highly successful Medicaid expansion. The new Kentucky Medicaid plan is not innovative, instead relying on policies that have been shown to be counterproductive, decreasing coverage and access while increasing the health disparities that affect poor and vulnerable populations. (Roy Grant, 8/25)

Louisville (Ky.) Courier-Journal: Is Medicaid Waiver Good For Ky. Kids?
Kentucky Youth Advocates supports Medicaid expansion in Kentucky because children are more likely to have health insurance when their parents have health insurance, and health insurance is a vital component of access to health care. ... The Bevin administration recently submitted its revised 1115 Medicaid Waiver proposal to the federal Centers for Medicare and Medicaid Services (CMS) for approval. We at Kentucky Youth Advocates appreciate that some of our recommendations were incorporated in the final waiver proposal. ... However, we believe that the 1115 Medicaid Waiver creates several barriers for parents to maintain their health insurance and still have outstanding concerns. (Terry Brooks, 8/25)

Los Angeles Times: Court Ruling Could Mean Death With Indignity For Terminally Ill Californians
In the more than two months since California’s End of Life Option Act took effect, an unknown number of terminally ill patients have signed up for a lethal prescription to take control of their final days. We won’t know exactly how many until the state makes its first annual report next year. Anecdotally, however, about 30 people are known to have requested the lethal prescription since June 9, according to Compassion & Choices, an aid-in-dying advocacy group. But this option may be denied other terminally ill people as soon as Friday, when a legal challenge to the new law comes up for a key court hearing. Riverside County Superior Court Judge Daniel Ottolia is expected to decide whether to put the law on hold until the case is resolved. (8/25)

Des Moines Register: National Bill Puts Needed Focus On Outpatient Mental Health Services
Currently, a person will have to wait nearly two months before seeing a provider and get prescribed medications — even if they are having a medication issue or are in crisis. The lack of available outpatient services has led to people seeking emergency mental health treatment. If outpatient services were more readily available to those in need and could be accessed easier and with less of a wait then some, not all, hospitalizations could be avoided. (Nicole, Lepley, 8/25)

San Francisco Chronicle: Reining In Drug Prices Now Up To Voters With Prop. 61
The opposition to Prop. 61, funded mainly by the drug companies’ lobbying group, has contributed $69.6 million to defeat the measure, according to campaign contributions reported to the secretary of state as of Aug. 5. The proposition’s supporters, which include AARP and the California Nurses Association, have raised about $9.5 million. Supporters say they hope highly publicized cases like EpiPen will spur action. In the nine years since Mylan purchased EpiPen, an epinephrine auto-injector developed in the ’70s and used by millions of Americans, the price spiked more than 400 percent, from $57 per shot to more than $600 for a package of two. But patient groups, including San Francisco’s Project Inform and the Bonnie Addario Lung Cancer Foundation in San Carlos, are concerned Prop. 61 would impede access to needed medications. (Victoria Colliver, 8/25)

Health Affairs Blog: Funerals For Friends: How Public Health In Colorado Handles Growing Prescription Drug Misuse
The opioid painkiller epidemic, leading directly to use of cheaper and even more dangerous heroin, is all too real in every state of the union, [Robert Valuck, an epidemiologist, professor at the University of Colorado Denver] warned his evening audience on the opening night of the Colorado Health Symposium 2016. Valuck elicited audible gasps from the crowd when he offered a math lesson in modern opioid prescribing—enough scripts are now written in the United States each year to give every adult a Vicodin every four hours for an entire month. In Colorado’s rural southern counties, where overdose death rates are climbing at an alarming rate, the destruction is all the more visible, said Freddie Jacquez, executive director of the San Luis Valley Area Health Education Center. “We know these people,” Jacquez said. “We’re going to a lot of funerals.” (Michael Booth, 8/25)

JAMA: Decreasing Unintended Pregnancy: Opportunities Created By The Affordable Care Act
The Affordable Care Act (ACA) increased access without cost to highly effective contraceptive methods, despite a legal challenge that was adjudicated by the Supreme Court, and it may help reduce unintended and teenage pregnancies. ... It is important for health care professionals and public health workers to educate women about the availability without cost of these highly effective methods. Clinicians should offer the full range of contraceptive services to patients who wish to delay or prevent pregnancy and work with them to select an effective and appropriate method. Reducing unintended pregnancy has taken on an increased urgency as the Zika virus has been linked to birth defects and is anticipated to spread to the continental United States. (Jared Fox and Wanda Barfield, 8/23)

The New England Journal of Medicine: Uncertainty In The Era Of Precision Medicine
A National Research Council report on “precision medicine” explains that the term “refers to the tailoring of medical treatment to the individual characteristics of each patient.” ... The new tools for tailoring treatment will demand a greater tolerance of uncertainty and greater facility for calculating and interpreting probabilities than we have been used to as physicians and patients. (David J. Hunter, 8/25)