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A key aspect of the Democrat-passed law to lower drug prices is significantly more expensive to the government than expected, according to nonpartisan budget experts in Congress. The redesign of the Medicare Part D drug benefit will cost $10 billion to $20 billion more next year than the Congressional Budget Office initially projected. That office estimates that a separate recently announced program to pay insurers to lower drug premiums will cost $5 billion. (Wilkerson, 10/3)

The state of Texas is accusing major pharmacy benefit managers and drug companies of colluding to raise the cost of insulin. Texas alleged drug manufacturers Eli Lilly, Novo Nordisk and Sanofi raise the price of insulin and then pay an undisclosed amount back to PBMs Optum Rx, Express Scripts and CVS Caremark through a quid pro quo agreement. PBMs then give preferred status on its standard formularies to drugs with the highest list prices, the state said. (Tong, 10/3)

On hospital costs —

The Biden administration could stand to take a firmer hand on hospital price transparency, especially when it is unclear whether the price data being published are even accurate, the Government Accountability Office (GAO) wrote in a Wednesday report. On instruction from Congress, the GAO conducted a review of the requirements, the CMS’ enforcement and whether the agency’s policy was successfully serving patients, payers and researchers. (Muoio, 10/3)

California health workers this month will finally get a long-promised minimum wage increase. It’ll kick in this month, according to a letter state health officials sent to the Legislature Oct. 1, describing a process that should trigger the pay boost. “The health care minimum wage increases shall be effective 15 days after the date of this notification, on October 16, 2024, unless a later effective date is specified,” Michelle Baass, the director of the California Department of Health Care Services wrote in the letter. (Ibarra, 10/3)

In news about Obamacare —

The 2024 elections hold the possibility of dramatic changes for the health insurance sector as the presidential contest between Vice President Kamala Harris and former President Donald Trump reveals very different visions for the future. Yet the Democrat Harris and the Republican Trump may not act as expected when they confront key issues from the White House. And the outcome of the congressional elections that determine control of the House and Senate will pose different obstacles and opportunities to whoever is the new president. (McAuliff, 10/3)

As Donald Trump calls for overhauling the Affordable Care Act with a new health care system, a Republican senator running for an influential leadership position says the party should combine that pursuit with a major tax bill in the new year. Sen. Tom Cotton, R-Ark., told NBC News after the vice presidential debate in New York on Tuesday night that if voters elect Trump and a GOP-controlled Congress, Republicans will be able to “make health care more affordable, more tailored and more personalized than the one-size-fits-all option,” referring to the ACA, or Obamacare. (Haake and Kapur, 10/2)

On Medicare Advantage —

UnitedHealthcare has filed a lawsuit against the Centers for Medicare and Medicaid Services, alleging the government agency lowered its Medicare Advantage star ratings based on one test phone call that lasted less than 10 minutes. The insurer is the latest to sue CMS over star ratings. (DeSilva, 10/3)

Next year’s Medicare Advantage market will be two things at once: remarkably stable broadly, but rife with changes under the surface. Health insurance companies will still offer older adults a lot of plan choices with low, or completely free, premiums. That’s why the federal government expects enrollment in the $500 billion Medicare Advantage program to grow once again in 2025 — a stark contrast from insurers’ cries that modest payment reforms would damage them and seniors’ options. (Bannow and Herman, 10/4)

A small group of House Republicans will spend the run-up to Election Day pushing an unexpected message: support for abortion rights. With control of the House on the line, Republican lawmakers running in districts that Joe Biden won in the 2020 presidential race have moderated their message on abortion — including, in some cases, using the term “pro-choice.” (Alfaro, 10/3)

Former President Trump said in an interview that he told Melania Trump that she’s “got to write what you believe” regarding her apparent pro-choice stance on abortion in her memoir that’s set to release next week. “We spoke about it. And I said, you have to write what you believe. I’m not going to tell what you to do. You have to write what you believe,” Trump told Fox News Channel’s Bill Melugin in an interview that aired Thursday. (Ventura, 10/3)

Abortion-rights ballot measure supporters across the country have raised nearly eight times as much as groups campaigning against the amendments on the November ballots. But that advantage may not translate into a huge benefit down the stretch in Florida, the most expensive of the nine statewide campaigns to enshrine abortion rights into state constitutions. (Mulvihill, 10/4)

Also —

In a year in which support for abortion rights could determine control of statehouses, Congress, and the presidency, Prop 1 seemed like a shoo-in, especially in the blue state of New York. Yet with a little over a month before the election, the effort to pass the New York ERA has been stumbling. An opposition campaign, calling itself the Coalition to Protect Kids, has fixated on the amendment’s protections for trans people, exaggerating its impact on women’s sports and pushing misleading claims about its effects on parental rights. (Pauly, 10/4)

Severe flooding in western North Carolina as a result of Hurricane Helene has stirred up colonies of yellow jackets, raising the risk of stings. The rain and floodwater most likely destroyed the insects’ underground nests, in addition to toppling trees or stumps that held nests, said Chris Hayes, an extension associate in urban entomology at North Carolina State University. ... North Carolina health officials said they have bought large amounts of Benadryl and EpiPens to address the problem. (Bendix and Edwards, 10/4)

An estimated tens of thousands of people in and around Asheville, N.C., are still without running water, six days after the tropical storm Helene. The faucets ran dry in Alana Ramo’s home last Friday after the storm swept through. She resorted to creek water and rainwater. “We [were] going around the house labeling buckets as ‘flush only’ or ‘tap water not filtered’ and then ‘filtered water’ or ‘drinkable,’” Ramo says. (Huang, 10/3)

Language and other barriers are hobbling the flow of assistance to hard-hit communities where affordable housing drew growing numbers of Hispanic migrants. (Sandoval, 10/3)

The search for victims of Hurricane Helene dragged into its second week on Friday, as exhausted rescue crews and volunteers continued to work long days — navigating past washed out roads, downed power lines and mudslides — to reach the isolated and the missing. With at least 215 killed, Helene is already the deadliest hurricane to hit the mainland U.S. since Katrina in 2005, and dozens or possibly hundreds of people are still unaccounted for. Roughly half the victims were in North Carolina, while dozens more were killed in South Carolina and Georgia. (Amy, 10/4)

Also —

Hospital leaders raced to shore up stocks of IV fluids after Hurricane Helene severely damaged a plant in North Carolina that produces much of the country’s supply, laying bare the precarious system for manufacturing and distributing critical medicines. Flooding from the storm damaged the plant in the Blue Ridge Mountains town of Marion that produces 60 percent of the country’s IV supply, forcing its parent company, Baxter International Inc., to shut it. (Lazar, 10/3)

The North Cove facility is the largest manufacturer of intravenous and peritoneal dialysis solutions in the U.S. Here are the medications and their NDCs. (Twenter, 10/3)

The effectiveness of this year's influenza vaccine was lower in South America than last season, the Centers for Disease Control and Prevention reported Thursday, which might be a clue to how much protection the shots could offer people in the U.S. this winter. Vaccine effectiveness was 34.5% against hospitalization, according to interim estimates from a new article published by the CDC's Morbidity and Mortality Weekly Report, among high-risk groups like young children, people with preexisting conditions and older adults. That means, vaccinated people in those groups were 34.5% less likely than unvaccinated people to get sick enough to go to the hospital. (Tin, 10/3)

This year's flu vaccine significantly reduced the risk of hospitalization in the Southern Hemisphere but wasn't as effective as the vaccine used in the prior season, according to an early study from the Centers for Disease Control and Prevention published Thursday. Countries in the Southern Hemisphere experience their flu season before countries in the Northern Hemisphere. (Benadjaoud and Kekatos, 10/3)

In covid news —

Six U.S. companies will spend at least $350 million to manufacture medical gowns to store in the Strategic National Stockpile, years after doctors and nurses working in hospitals found themselves without the equipment while COVID-19 raged. The purchase of the gowns is one of the final steps toward shoring up the personal protective equipment in the stockpile after it was depleted just weeks into the COVID pandemic. Equipment had not been regularly restocked in the years before the crisis began. (Seitz, 10/3)

The co-owner of a Chicago COVID-19 testing laboratory has pleaded guilty to a $14 million fraud scheme in which his company provided fake negative results to people who had been tested and billed the federal government for the tests. Zishan Alvi, 45, of Inverness, pleaded guilty on Monday to one count of wire fraud, and faces up to 20 years in prison when he is sentenced in February. Alvi was indicted in March 2023, more than a year after the FBI raided the headquarters of his company, LabElite, in the Norwood Park neighborhood. (Feurer, 10/1)

�������ýҕ�l Health News: Here’s Why Getting A Covid Shot During Pregnancy Is Important
Nearly 90% of babies who had to be hospitalized with covid-19 had mothers who didn’t get the vaccine while they were pregnant, according to new data released by the Centers for Disease Control and Prevention. The findings appear in the agency’s Morbidity and Mortality Weekly Report. Babies too young to be vaccinated had the highest covid hospitalization rate of any age group except people over 75. (Fortiér, 10/4)

�������ýҕ�l Health News: Trump Leads, And His Party Follows, On Vaccine Skepticism
More than four years ago, former President Donald Trump’s administration accelerated the development and rollout of the covid-19 vaccine. The project, dubbed Operation Warp Speed, likely saved millions of lives. But a substantial number of Republican voters now identify as vaccine skeptics — and Trump rarely mentions what’s considered one of the great public health accomplishments in recent memory. “The Republicans don’t want to claim it,” Trump told an interviewer in late September. (Tahir, 10/4)

California health officials said Thursday they have confirmed two cases of H5N1 avian flu in people who had contact with infected dairy cattle in the Central Valley. They mark the first human cases of bird flu in the state and bring the total in the country to 16 since the current outbreak began in 2022. Other human cases have been found in Colorado, Michigan, Texas and Missouri. ... The two California cases are not related to each other, which means officials think transmission is not happening between people, but rather from animal to human. (Ho, 10/3)

Researchers have been working on mRNA flu vaccines since before the Covid-19 pandemic, but we may get one for bird flu first. (Baraniuk, 10/3)

Bird flu appears to have devastated big cats living at two zoos in South Vietnam. At least 47 tigers, three lions, and a panther at these zoos are thought to have died from the bird flu throughout August and September. Officials believe that the cats may have contracted the infection through contaminated chicken meat. (Cara, 10/3)

On the spread of EEE —

The risk level of contracting Eastern equine encephalitis, or EEE, in several towns in three Massachusetts counties has lowered, the Massachusetts Department of Public Health announced. "Communities previously at high or critical risk are now at moderate risk,” the department said in a statement on Wednesday. (Mancini, 10/2)

A fifth human case of Eastern equine encephalitis has been confirmed in New Hampshire. The Department of Health and Human Services reported that an adult in Danville tested positive for the virus in early August and later died. (Ketschke, 10/4)

With cases of Eastern Equine Encephalitis on the rise in the Northeast, U.S. Senate Majority Leader Chuck Schumer is calling for increased coordination between local and federal agencies. Following the first human EEE death in New York in more than a decade last month, the powerful Democrat appeared in Glens Falls to announce a two-pronged approach to controlling the mosquito-borne illness. Schumer called on the Centers for Disease Control and Prevention to work with the U.S. Environmental Protection Agency and local health officials to survey and track mosquitoes. (Shellow-Lavine, 10/3)

In response to outbreaks of West Nile virus and EEE, cities spray chemicals to kill mosquitoes. Is there a better way? (Kruzman, 10/1)

The World Health Organization authorized Abbott Laboratories' mpox diagnostic test for emergency use on Thursday, the first such approval in the agency's effort to bolster testing capabilities in countries facing outbreaks of the disease. The real-time PCR test, Alinity m MPXV assay, enables detection of mpox virus DNA from human skin lesion swabs, the WHO said, adding that it was designed for use by trained clinical laboratory personnel. (10/3)

Ghana's health service has reported the country's first case of mpox this year, without disclosing which variant had been recorded, according to a statement. A health official told Reuters that testing was underway to determine whether it was the clade Ib form of the mpox virus that has triggered global concern, as it appears to be spreading quickly and little is known about the strain. (10/3)

As cases of mpox steadily increase across the African continent, some 68% of them don’t have an epidemiological link — meaning they’re popping up among people that health workers aren’t monitoring and who aren’t known to have been in contact with previously identified cases. “This is a major concern,” said Africa Centres for Disease Control and Prevention Director General Dr. Jean Kaseya during a press briefing, noting that there are concerning gaps in the continental response in areas of surveillance, contact tracing, and data collection. (Jerving, 10/2)

California drugmaker trying to help stop Marburg disease —

California-based Gilead Sciences said on Thursday it would donate about 5,000 vials of its antiviral drug remdesivir to the Rwanda Medical Supply for emergency use in response to the Marburg virus outbreak. The drug is being supplied in conjunction with Rwanda's health ministry and the Africa Centers for Disease Control, Gilead said. (10/3)

Schools, community organizations and hospitality groups now have access to free bulk naloxone, an opioid overdose reversal drug, thanks to recent state legislation and federal funding. In the first two months since the new law went into effect, the Mississippi Department of Health has distributed 3,470 boxes of bulk naloxone. That’s more than it distributed in the prior 10 months combined. (Royals, 10/2)

Under the federal Emergency Medical Treatment & Labor Act (EMTALA), hospitals that have emergency departments and participate in Medicare — about 98% of hospitals in the United States — must provide emergency care to all patients, regardless of their ability to pay. Florida and Texas, however, recently have required hospitals to ask patients about their immigration status. Supporters say the new policies will illuminate the costs of caring for people living in the country illegally, but critics say they are designed to dissuade immigrants from seeking care. (Chatlani, 10/3)

Small businesses in Oklahoma can enroll in a new health care option being offered by the State Chamber of Oklahoma. ChamberCare is now accepting applications from small businesses headquartered in Oklahoma. This option is available to employers who are members of the State Chamber or participating local chambers and employ between two and 50 people. ChamberCare will be part of the Aetna network to provide medical coverage, but no dental or vision. (Murphy, 10/1)

In a sign of the times, Capitol Weekly’s annual health care conference on Thursday focused broadly on expenses and efficiency, befitting for an American health care system that has become one of the most expensive in the world. Keynoting the event was Assemblyman Jim Wood (D-Healdsburg), the former longtime chairman of the Assembly Health Committee, who noted that there are some estimates that 20 to 30 percent of health care spending is wasted. (Joseph, 10/3)

Texas Attorney General Ken Paxton (R) sued the social platform TikTok for allegedly operating in a way that “puts the online safety and privacy of Texas children at risk” and violates a bill that aims to protect children from harmful practices related to the use of digital services, according to a Tuesday press release. According to the filing, Paxton seeks civil penalties of up to $10,000 per violation and an injunction to prevent other violations. (Ventura, 10/3)

Schizophrenia is a poorly understood illness, but scientists now have greater insight into one of the disorder’s hallmarks, auditory hallucinations, thanks to new research published Thursday. People with schizophrenia often “hear” voices and sounds even when there are none — up to 80% of people with the mental illness have auditory hallucinations. Scientists have theorized that this happens when a person with schizophrenia struggles to recognize inner speech as self-generated. But nobody had been able to fully explain the mechanisms behind this phenomenon until now. (Broderick, 10/3)

Oregon hospitals are again suing the state over its failure to provide mental health services — just as lawmakers prepare to write a new budget. Legacy Health System, PeaceHealth and Providence Health & Services brought a similar lawsuit in September 2022. St. Charles Health System later joined it. A federal judge struck it down, only to have it revived on appeal. Now, four months after that appeals decision, hospitals have filed beefed-up arguments intended to sidestep the state’s earlier objections. The suit seeks to compel the Oregon Health Authority to provide better treatment for civilly committed patients whom a judge has determined are a danger to themselves or others because they are experiencing mental illness. (Budnick, 10/3)

Some 2,400 Kaiser mental health workers in Southern California say they’re prepared to go on strike if the health care provider can't meet demands aimed at reducing employee turnover and improving patient care. More than 80% of caregivers — including psychologists, social workers and marriage and family therapists — signed the strike authorization petition. (Garrova, 10/3)

In midcoast Maine, a pediatrician sees teenagers so dependent on cannabis that they consume it practically all day, every day — “a remarkably scary amount,” she said. From Washington State to West Virginia, psychiatrists treat rising numbers of people whose use of the drug has brought on delusions, paranoia and other symptoms of psychosis. (Twohey, Ivory and Kessler, 10/4)

In related news on the gun violence epidemic —

Massachusetts Gov. Maura Healey immediately implemented new gun legislation on Wednesday that not only cracks down on unserialized "ghost guns," and attachments like bump stocks and trigger cranks, but also requires applicants to demonstrate basic safety principles and complete live-fire training before being granted a gun license. State lawmakers approved the gun reform law in July, which was expected to go into effect later this month, and comes as the deep-blue state already has some of the toughest gun laws in the nation. (Wehner, 10/3)

In the second episode of our three-part series, we look at Harborview Medical Center’s initiative to treat the long-term impacts of gunshot wounds. (10/2)

Interviews with family members and a review of private texts and public documents open a window on a 14-year-old’s path to alleged gunman at Apalachee High School. (Blaskey, Cox, Natanson, Meckler and Boburg, 10/3)

In mid-July, as listeria infection cases multiplied across the United States, Maryland health officials who track foodborne illnesses grew increasingly alarmed. The outbreak was spreading at a much more rapid rate than normal for listeria. Two people — in Illinois and New Jersey — had already died and more than two dozen had fallen ill in the previous seven weeks. The health officials feared many more would succumb. (Roubein and Heim, 9/30)

Compassion in the deep-red state only extends so far for a young woman marking her 20th month of sobriety and trying to make a life for her two daughters. (Paquette, 10/1)

Astronauts embarking on long-haul journeys in deep space can’t pack all the calories they will need in the form of freeze-dried food. They also can’t grow everything they’ll need, as onboard garden technology isn’t mature enough to keep them flush with fresh produce. Given those nutritional constraints, a group of engineers thinks future space travelers should pivot their diets. In a study published Thursday in The International Journal of Astrobiology, scientists suggest that astronauts could look to asteroids for all-you-can-eat meals. (Scoles,10/3)

A year ago last week, Jeanne Marrazzo stepped into a very big pair of shoes. Marrazzo became the first new director of the National Institute of Allergy and Infectious Diseases in decades, taking over a job held for 38 years by Anthony Fauci, whose long-term status as a science god in Washington gave way to Covid-19 fall guy in some quarters during and after the pandemic. The months since have been a whirlwind for Marrazzo, a veteran researcher in the field of sexually transmitted infections — especially their effect on women. (Branswell, 10/1)

An impoverished family in Africa is unable to afford a 50-cent course of antibiotics to save the life of a child with a simple bacterial infection. Is such a tragedy best described as a case of antimicrobial resistance, the slow-motion health emergency caused by the misuse of lifesaving antibiotics? For more than a decade, antimicrobial resistance has been framed as a problem of excess. The willy-nilly consumption of antibiotics, scientists said, have rendered the drugs less effective, leading to the unnecessary death of millions, many of them poor. (Jacobs, 9/26)

It’s been four months since Sifa Kunguja recovered from mpox, but as a sex worker, she said, she’s still struggling to regain clients, with fear and stigma driving away people who’ve heard she had the virus. “It’s risky work,” Kunguja, 40, said from her small home in eastern Congo. “But if I don’t work, I won’t have money for my children.” Sex workers are among those hardest-hit by the mpox outbreak in Kamituga, where some 40,000 of them are estimated to reside — many single mothers driven by poverty to this mineral-rich commercial hub where gold miners comprise the majority of the clientele. Doctors estimate 80% of cases here have been contracted sexually, though the virus also spreads through other kinds of skin-to-skin contact. (Mednick, 10/2)

Scurvy now primarily affects populations with limited access to nutritious food, such as people experiencing food insecurity, smokers, those with certain eating disorders, and individuals with malabsorption disorders or severe dietary restrictions. Why aren’t doctors and public health experts talking about this? Did we forget about scurvy once we found the cure? Or does the health care business model neglect problems that cost little to treat? (Ramona Wallace, 10/2)

Melania Trump’s revelation on Thursday that she has been a passionate believer in abortion rights throughout her “entire adult life” has been met with no small amount of cynicism. (Karen Tumulty, 10/3)

Today, the fastest-growing care setting isn’t the hospital or home — it’s the mobile phone. Google now receives more than 1 billion health-related searches every day, and patient messages for medical advice have increased sixfold in the past decade. The explosion in patient messaging is a clear sign that patients want more access to information about their health, despite the long wait times and often unclear responses. (Muthu Alagappan, Rishi Khakhkhar, and Ben Kornitzer, 10/4)

Since 2020, the US has seen an explosion in laws targeting transgender youth. Hundreds of bills have sought to restrict which sport teams they can join, which bathrooms they can use and what medical care they can receive — legislation that opponents say creates a climate of fear and intimidation so severe it could lead some trans youth to suicide. (Lisa Jarvis, 10/4)

Betty Ford was determined not to keep her breast cancer a secret from the American public when she was diagnosed 50 years ago during her time as first lady. As she later remarked, “One day I appeared to be fine, and the next day I was in the hospital for a mastectomy. It made me realize how many women in the country could be in the same situation.” (Barron H. Lerner, 10/3)