HealthHombre DailyMedia

The Top 15 Specialty Pharmacies of 2025: PBM-Affiliated Pharmacies Dominate While Health Systems and Independents Gain Ground (rerun)

Thu, 11 Jun 2026 06:30:00 -0400

This week, we’re rerunning some popular posts while we prepare for tomorrow’s live video webinar: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Click here to see the original post from April 2026.

By Adam J. Fein, Ph.D.

Drug Channels Institute’s (DCI’s) latest analysis reveals that PBM-affiliated specialty pharmacies continue to dominate the dispensing of specialty drugs.

For 2025, DCI has identified more than 1,900 dispensing locations with specialty pharmacy accreditation from one or both of the two major independent accreditation organizations. The overall number of accredited locations grew by only 3% in 2025, but is more than five times larger than the 2015 figure.

However, market share for the dispensing of specialty drugs remains highly concentrated. For 2025, the three largest specialty pharmacies accounted for two-thirds of total prescription revenues from pharmacy-dispensed specialty drugs. These businesses are all owned by vertically integrated organizations that also own a PBM.

Below, we share DCI’s latest analysis of the top 15 specialty pharmacies, including updated market shares and revenue estimates, highlighting how vertical integration and channel control continue to reshape specialty dispensing. Despite growth in accredited locations, economic power remains concentrated among a small group of PBM-affiliated entities.
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Mapping the Vertical Integration of Insurers, PBMs, GPOs, Specialty Pharmacies, and Healthcare Services: DCI’s 2026 Update (rerun)

Wed, 10 Jun 2026 06:30:00 -0400

This week, we’re rerunning some popular posts while we prepare for Friday’s live video webinar: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Click here to see the original post from April 2026.

By Adam J. Fein, Ph.D.

It's time for Drug Channels Institute’s (DCI) annual update of vertical integration among insurers, PBMs, specialty pharmacies, and healthcare services within U.S. drug channels. As you can see below, we have updated and revised our infamous illustration of the major vertical business relationships within the largest companies.

These organizations continue to exert greater control over patient access, sites of care/dispensing, and pricing, although some have started to unwind their vertical integration strategies. Scrutiny of these companies’ actions continues to grow.

For all the details behind these companies’ operations, check out DCI’s new 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.
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The Top Pharmacy Benefit Managers of 2025: Market Share and Key Industry Developments (rerun)

Tue, 09 Jun 2026 06:30:00 -0400

By Adam J. Fein, Ph.D.

Three is still the magic number for pharmacy benefit managers (PBMs).

For 2025, 80% of all equivalent prescription claims were processed by three companies: the CVS Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group. Express Scripts continued to pull ahead of its peers, while CVS Caremark’s claim volume declined for the second year.

Independent PBMs continued to gain business from these larger PBMs, showing fragmentation at the margins. Many smaller PBMs still rely on their larger competitors for claims processing, network management, and rebate negotiation. So even if a plan sponsor chooses an alternative PBM, the Big Three can still win with behind-the scenes economics.

Below, we draw on DCI's new 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers to break down the latest market share data for the largest companies.

The Big Three PBMs’ dominance persists, but they face growing regulatory and competitive constraints. The largest PBMs are restructuring their businesses in response to client demands, legislative changes, and legal pressures. The emerging Net Pricing Drug Channel will accelerate these shifts, forcing changes in how PBMs generate profits, structure contracts, and justify their role in the drug channel.
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The Top 15 U.S. Pharmacies of 2025: Market Shares and Revenues at the Biggest Chains, PBMs, and Specialty Pharmacies (rerun)

Mon, 08 Jun 2026 06:30:00 -0400

By Adam J. Fein, Ph.D.

Next week, the Drug Channels Institute (DCI) will release our 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. This 17th edition provides our most comprehensive and up-to-date examination of the U.S. drug pricing, reimbursement, and dispensing system.

For 2025, DCI estimates that total prescription dispensing revenues at retail, mail, long-term care, and specialty pharmacies reached $751 billion in 2025, up 10% from the 2024 figure.

GLP-1 agonist drugs have become the dominant driver of revenue growth. Over the past five years, increases in dispensing revenues from GLP-1 products accounted for about 60% of retail pharmacies’ total revenue growth.

The table below—one of 270 in our new report—racks up DCI's first look at the 15 largest organizations that competed for a share of those dollars. For a sneak peek at the complete report, click here to download our free 32-page report overview (including key industry trends, What's New in this edition, the Table of Contents, and a List of Exhibits).
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Pharmacy Copay Misuse: The Multi-Billion Dollar Issue Hiding In Plain Sight

Fri, 05 Jun 2026 06:00:00 -0400

Today’s guest post comes from Stephen Hom, Co-Founder, EVP & Chief Operating Officer of RIS Rx.

Drawing on RIS Rx’s proprietary data and case studies, Stephen highlights patterns that can undermine patient support program effectiveness. He argues that a more data-driven approach can help manufacturers identify hidden risks, improve program performance, and ensure that affordability resources reach the patients they are intended to support.

Request a complimentary analysis from RIS Rx.

Read on for Stephen’s insights.
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The 340B Contract Pharmacy Market in 2026: A Maturing Industry Dominated by Big Chains and PBMs

Tue, 02 Jun 2026 06:30:00 -0400

By Adam J. Fein, Ph.D. and Greis Kapexhiu

It’s time for Drug Channels Institute’s latest exclusive analysis of the 340B contract pharmacy market, which continues to boom along with the overall program’s expansion.

However, our 2026 analysis finds that the contract pharmacy market is now entering a more mature phase characterized by consolidation, slower growth, and increasing dominance by the industry’s largest participants.

Below, we characterize the state of the marketplace:

Nearly two-thirds of the entire U.S. pharmacy industry participates as contract pharmacies for the 340B hospitals and federal grantees.

The number of 340B pharmacy locations declined for the third year, due largely to the retail pharmacy shakeout and manufacturers’ 340B policies.

Meanwhile, the total number of unique contract pharmacy/covered entity relationships continues to expand. Five multi-billion-dollar, for-profit, publicly traded pharmacy chains and pharmacy benefit managers (PBMs)—Cigna, CVS Health, UnitedHealth Group, Walgreens, and Walmart—now account for a record 77% of all relationships.

The 340B program was originally designed as a narrow policy solution to address an unintended consequence of Medicaid’s best-price provision while supporting core safety-net providers. The 2026 market data illustrate just how dramatically the program’s current operations and economic incentives have diverged from that original intent.

Read on for our latest analysis of this ever-expanding profit pool for pharmacies and PBMs. For a deep dive on what the 340B program’s growth means for drug channel participants, join Adam J. Fein, Ph.D., and Tyler Novotny on June 12 for a new live video webinar: 340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.
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Drugs, Discounts and Data: Crafting Sustainability in an Imperfect System

Fri, 29 May 2026 06:00:00 -0400

Today’s guest post comes from Angie Franks, Chief Executive Officer at Kalderos.

As Angie explains, the industry still lacks the transparency needed to effectively manage where discounts occur and how funds move across stakeholders. She argues that improving visibility and coordination across the ecosystem is essential to building a more sustainable and accountable model for both innovation and patient support.

To learn more, register for Kalderos’ free webinar on June 23, 2026:
GTN Oversight: A New Standard of Transparency Is Here.

Read on for Angie’s insights.
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Drug Channels News Roundup, May 2026: My $0.02 on Optum Rx’s Transparency, Must-Read 340B History, PBM Unbundling Update, PA Delays, and Vegas Fun

Wed, 27 May 2026 06:00:00 -0400

By Adam J. Fein, Ph.D.

Summer unofficially kicked off last weekend. So fire up the grill and enjoy these noteworthy delicacies, seared to perfection on the Drug Channels barbeque:

Why Optum Rx Is Accelerating Its Transparency Strategy

The Most Important 340B Paper You’ll Ever Read

Blue Shield of California’s PBM Unbundling Plan Meets Reality

Prior Authorization: Administrative Complexity = Delayed Care

Plus: The Drug Channels Institute team takes on Las Vegas—with stickers!

P.S. Join my 70,000+ LinkedIn followers for links to interesting industry news, along with unfiltered commentary from the DCI community.

340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Don't miss DCI’s upcoming webinar on Friday, June 12, 2026, from 12:00 p.m. to 1:30 p.m. ET. Adam J. Fein and Tyler Novotny will unpack the good, the bad, and the ugly of the 340B program—and what it means for you. Click here to learn more and sign up.

PBM Shakeout: How Vertical Integration Is Reshaping What’s Next (VIDEO)

Wed, 20 May 2026 06:30:00 -0400

Here at Drug Channels, we’ve been closely tracking the evolution of the pharmacy benefit management (PBM) industry for many years.

The short video below—excerpted from DCI’s recent PBM Industry Update 2026: Trends, Challenges, and What’s Ahead video webinar—reviews the shifting market positions of the largest PBMs and explains why vertical integration continues to reshape the industry’s competitive dynamics.

I also discuss the proliferation of smaller PBMs, many of which still depend on the largest PBMs for claims processing, pharmacy networks, rebate negotiation, and other core services. However, the market is entering what we believe will be a significant shakeout phase.

The growing administrative complexity of state and federal regulation will disproportionately burden smaller PBMs that lack the scale, capital, and integrated infrastructure of the largest organizations. Over the next five years, we expect many smaller PBMs to disappear through acquisition, consolidation, or business failure.

Meanwhile, vertical integration will continue to create strategic and financial advantages for the largest healthcare organizations—along with new opportunities to shift profits, manage risk, and coordinate services across multiple parts of the healthcare system.

What do you think?

Can’t see the video? Click here to watch the PBM clip.

ADDITIONAL BACKGROUND AND ANALYSIS

For more on the PBM industry, see these articles and reports:

Watch the full webinar replay and download the complete slide deck.

The Top Pharmacy Benefit Managers of 2025: Market Share and Key Industry Developments

Mapping the Vertical Integration of Insurers, PBMs, GPOs, Specialty Pharmacies, and Healthcare Services: DCI’s 2026 Update

The 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers

Cathy Kelly at The Pink Sheet also wrote an article about the webinar: PBM Regulation May Bolster Big Three Market Position Versus Smaller Competitors.

340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Don't miss DCI’s next live video webinar on Friday, June 12, 2026, from 12:00 p.m. to 1:30 p.m. ET. Adam J. Fein and Tyler Novotny will unpack the good, the bad, and the ugly of the 340B program—and what it means for you. Click here to learn more and sign up.

Protecting Gross-to-Net Performance Through Single-Channel Ecosystems

Fri, 15 May 2026 01:00:00 -0400

Today’s guest post comes from Peter Darch, SVP of Strategy and Operations at PHIL Inc.

Peter explains that growing pressure on drug pricing is exposing structural inefficiencies in gross-to-net (GTN) across traditional distribution channels. He argues that single-channel ecosystems can better coordinate affordability, coverage, and dispensing, improving both patient outcomes and brand performance.

Click here to learn more about PHIL’s technology solution for brands.

Read on for Peter’s insights.
Read more »

Drug Channels News Roundup, Mid-May 2026: Flawed Launch Price Math, Rising Pharmacy Closures, Hospital Pay Realities, 340B Hospitals vs. Grantees, and a Luxury Take on Specialty Pharmacy

Wed, 13 May 2026 06:30:00 -0400

By Bryce Platt, PharmD

The onslaught of pharmacy-related news doesn’t end. It may even be increasing in volume due to AI.

But don’t worry—I’ve gathered some high-impact information over the last month from my LinkedIn posts that you can quickly read between your sets at the gym.

I recommend reading BETWEEN your sets, but some may be brave enough to read during the set itself.

In this issue:

Why Drug Launch Price Analyses May Be Misleading

Pharmacy Closures Are Accelerating—New Data Reveal Where and Why

How Hospitals Really Get Paid for Uncompensated Care (It’s More Complicated Than You Think)

340B Hospitals vs. Federal Grantees: The Overlooked Differences That Matter

Extra: What If Specialty Pharmacy Worked Like a Luxury Hotel? A Surprising Reimagining

P.S. Join my more than 33,000 LinkedIn followers for valuable daily posts at 9 a.m. ET.

340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.

Don't miss DCI’s upcoming webinar on Friday, June 12, 2026, from 12:00 p.m. to 1:30 p.m. ET. Adam J. Fein and tyler Novotny will unpack the good, the bad, and the ugly of the 340B program—and what it means for you. Click here to learn more and sign up.

340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders (NEW Live Video Webinar)

Tue, 12 May 2026 06:30:00 -0400

Join Dr. Adam J. Fein, president of Drug Channels Institute (DCI) and the editor of Drug Channels, for his latest exclusive video webinar:

340B in 2026: Market Shifts, Policy Battles,
and What They Mean for Stakeholders

This event will be broadcast live on:
Friday, June 12, 2026
12:00 p.m. to 1:30 p.m. ET

Dr. Fein will be joined by Tyler Novotny, MBA, the SVP at DCI.

The webinar will be broadcast live from the Drug Channels studio in beautiful downtown Philadelphia. It is part of The Drug Channels 2026 Video Webinar Series.

WHAT YOU WILL LEARN

Join industry expert Adam J. Fein, Ph.D., and his colleague Tyler Novotny, MBA, for an exclusive deep dive into the 340B Drug Pricing Program—one of the most complex and controversial segments of the U.S. pharmaceutical market.

In this all-new webinar, Adam and Tyler will deliver a fact-based, data-driven analysis of the 340B program’s structure, economics, and rapid evolution. He’ll unpack the key controversies reshaping the program, explain what’s really happening behind the headlines, and provide a clear, actionable outlook for stakeholders across the drug channel.

Whether you’re in pharma, provider organizations, pharmacy, or policy, you’ll gain the insights needed to understand where 340B is headed—and what it means for your business.

Key topics include:

The structure and economics of the 340B program

Growth trends among covered entities and their partners

340B’s expanding role in pharmacy—and its impact on PBMs and retail

DCI’s latest data on the contract pharmacy marketplace and the leading participants

The role of third-party administrators and vendors in the 340B ecosystem

What’s behind the growing controversy over the definition of an eligible patient

Why diversion and duplicate discounts have become flashpoints

The implications of the Net Pricing Drug Channel for 340B pricing dynamics

How 340B funds are generated and distributed across participating entities

How employers and plan sponsors could reshape the program’s future

Manufacturers’ evolving distribution strategies for 340B contract pharmacies

Recent legal developments affecting manufacturer policies and contract pharmacy arrangements

The expanding influence of state legislation

The impact of the Inflation Reduction Act on program operations and oversight

The HRSA vs. CMS oversight crisis

The outlook for a potential 340B rebate model

What’s ahead for state and federal policy

Emerging risks, challenges, and threats to watch

Plus: fresh insights and expert perspective you won’t find anywhere else.

As always, they will clearly distinguish their opinions and interpretations from the objective facts and data.

This 90-minute video webinar will feature a dedicated Q&A session, where attendees can unmute and engage directly with Tyler and Adam.

Register now to stay informed and get ahead of the curve on 340B!

PRICING OPTIONS

Take advantage of this exclusive educational opportunity for just $420 per viewing device. Once you register, you'll receive a unique Zoom access link within 24 hours—making it easy to add the event to your calendar and ensure you don’t miss out.

Special Discounts For Teams!

We understand that many professionals are working remotely, so we’re offering substantial savings for multiple registrations from the same organization. What's more, an unlimited number of attendees can watch together at a single physical location with one registered device.

Important Reminder: Each device at a single physical location must have its own registration. The webinar may not be recorded, streamed, broadcast, or shared across different locations, devices, or sites.

Click here to register. All discounts will be automatically computed based on the number of registrations you enter in your cart. (You can reset the cart by entering 0 in the quantity field.)

340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders

Questions about corporate pricing? Please contact Marie Caldwell (mcaldwell@hmpglobal.com).

Purchasing access for multiple sites? We'll contact you for your participant list. Or, download this spreadsheet and email your registrants’ information to dcisupport@hmpglobal.com.

Payment can be made with all major credit cards (Visa, MasterCard, American Express, and Discover). Prefer check or ACH? Click here to request an invoice.

IMPORTANT THINGS TO KNOW

Watch and listen via any modern browser via computer, tablet, or mobile. (No telephone access.)

Each registrant will receive an email with a link to watch the event. This link is unique to the registrant and can only be accessed once.

Every registrant will also receive a link to download Dr. Fein's slides.

This event is part of The Drug Channels 2026 Video Webinar Series. If you already purchased access to the 2026 Drug Channels Video Webinar Series, then you already should have received an email from Zoom with a link to access the June 12, 2026, event.

Organizations that purchased corporate access for The Drug Channels 2026 Video Webinar Series will receive a custom, branded signup link so employees can easily register. We will automatically refund payments from anyone at a company with corporate access who purchases a single registration using their corporate email account.

Each registration for a DCI webinar is valid for a single device at a single physical location. Each device at a physical location requires its own registration. Attendees are not permitted to record, stream, share, or project a DCI webinar to other sites or locations. Purchasers who violate this limitation by recording, streaming, sharing, or projecting a DCI webinar to other sites, devices, or locations will be liable for the full cost of all locations that viewed the webinar. DCI reserves the right to prohibit purchasers who violate our terms from attending future DCI webinars.

Unfortunately, we are unable to offer refunds.

The Hidden Costs of Over-Customizing Your Hub Technology Stack

Fri, 08 May 2026 06:30:00 -0400

Today’s guest post comes from George Moore, Chief Product and Technology Officer at CareMetx.

George argues that customer relationship management (CRM) program customization delivers short-term workflow gains at the expense of long-term scalability, integration simplicity, and upgradeability. He highlights three common pitfalls and offers an approach on how to avoid them.

To learn more, download CareMetx’s Guide to Building an Agile, Scalable Hub Architecture.

Read on for George’s insights.
Read more »

Specialty Pharmacy Accreditation: DCI’s Exclusive Analysis Reveals a Market at an Inflection Point

Tue, 05 May 2026 06:30:00 -0400

The Drug Channels Institute (DCI) team attended Asembia’s AXS26 Summit last week. Once again, the specialty pharmacy market delivered a classic paradox: a sprawling, fragmented landscape of participants paired with highly concentrated economics controlled by a handful of PBM-affiliated giants.

Below, we share our proprietary analyses of the specialty market’s participants. DCI identified more than 1,900 pharmacy locations that have achieved specialty pharmacy accreditation from one of the two major independent accreditation organizations.

Despite growing revenues from specialty drugs, overall growth in accredited pharmacies has plateaued. However, pharmacy locations owned by healthcare providers—hospitals, health systems, physician practices, and other healthcare providers—continue to expand and now account for nearly 40% of all accredited specialty pharmacy locations.

Read on for a bit of our arithmomania. Because in specialty pharmacy, what gets counted reveals who really counts.
Read more »

Where Gross-to-net Pressure Actually Lives After Launch

Fri, 01 May 2026 00:00:00 -0400

Today’s guest post comes from Cindy Baksh, Chief Product Officer at ConnectiveRx.

Cindy explains that many gross-to-net (GTN) exposures now occur at the claim level, where evolving payer tactics, pharmacy economics, and copay complexity create unpredictable leakage. She argues that manufacturers must augment downstream review with real-time visibility and intervention to protect both revenue and patient access.

To learn more, register for ConnectiveRx’s free webinar on June 17: Gross-To-Net FOMO: What GTN Dangers Are You Missing Post-Launch?

Read on for Cindy’s insights.
Read more »

Drug Channels News Roundup, April 2026: PBM Specialty Pharmacy Steering, MLR Profit Shifting, Hospitals’ Fake Prices, and a Peek Behind the Scenes at DCI

Tue, 28 Apr 2026 00:00:00 -0400

Spring has officially arrived at Drug Channels' worldwide headquarters in beautiful downtown Philadelphia. (Photo proof at right.) So, dive into this month’s curated crop of noteworthy news:

The patient experience at PBM-affiliated specialty pharmacies

New evidence of profit shifting in vertically integrated Part D businesses

The growing gap between non-profit hospitals’ public mission and financial reality

Plus: Behind-the-scenes at DCI

P.S. Join my nearly 70,000 LinkedIn followers for links to neat stuff, along with unfiltered commentary from the DCI community.
Read more »

Beyond Formulary Access: Building a Scalable Pharmaceutical Manufacturer Commercial Platform for Direct-to-Consumer and Employer Channels

Fri, 24 Apr 2026 07:00:00 -0400

Today’s guest post comes from Laura Jensen, Chief Commercial Officer and President, Pharma Direct at GoodRx.

Laura suggests that manufacturers must move beyond payer-centric models toward integrated, direct-to-consumer and employer channel strategies that connect pricing, demand, and fulfillment. She argues that this approach will help manufacturers convert patient intent into therapy initiation while expanding access at scale.

To learn more about GoodRx’s pharma solutions, visit GoodRx Pharma Direct.

Read on for Laura’s insights.
Read more »

Minnesota’s 340B Hospitals Make One Billion More From 340B Than They Spend on Uncompensated Care

Thu, 23 Apr 2026 07:00:00 -0400

By Bryce Platt, PharmD

Minnesota’s new 340B data reveal a growing disconnect between the program’s size and the value Minnesotans receive in return.

In 2024, nonprofit hospitals generated more than $1.3 billion in 340B net profits—nearly a billion dollars more than they provided in uncompensated care. At the same time, these same institutions already benefit from substantial tax exemptions tied to their not-for-profit status and charitable mission.

The gap between 340B profits and charity care isn’t a rounding error or a one-off anomaly. The 340B Drug Pricing Program has evolved into a significant profit center for hospital systems. This is another layer on top of existing public subsidies, not a substitute for them.

As you’ll see below, our analysis describes a 340B program that generates financial gains far in excess of any contribution back to the people of the state. There is also no clear accountability for how those dollars are used.
Read more »

Listen to the Latest ‘KFF Health News Minute’

Tue, 21 Apr 2026 10:00:00 -0400

April 16

Katheryn Houghton reads the week’s news: Many Americans say it’s hard to pay for the dentist, but putting off care also has its costs. Plus, for some patients, Medicare will start covering GLP-1 drugs for weight loss this year.

April 9

Zach Dyer reads the week’s news: Rising health costs have some middle-aged adults skipping the doctor until Medicare will pick up the tab. Plus, there’s little evidence that immigrants without legal status are using Medicaid, despite White House claims.

April 2

Arielle Zionts reads the week’s news: Scientists say staff losses at the National Institutes of Health could lead to fewer medical breakthroughs. Plus, doctors worry they’ll see more kids with potentially deadly complications from measles, as cases surge.

March 26

Jackie Fortiér reads the week’s news: Consumers know which party they blame after Congress failed to extend enhanced Obamacare subsidies. Plus, updated standards say seniors should aim for even lower blood pressure readings.

March 19

Sam Whitehead reads the week’s news: Amid federal spending cuts and suspicion of fluoride, tooth problems are sending more kids to the ER. Plus, patients look to health savings accounts to deal with rising medical costs.

March 12

Katheryn Houghton reads the week’s news: Looming Medicaid cuts could mean states stop covering dental care for adults, and a growing number of U.S. nurses are moving to Canada.

March 5

Zach Dyer reads the week’s news: The Trump administration is calling for sharp restrictions on direct-to-consumer drug ads, and for some people facing skyrocketing health insurance costs, becoming eligible for Medicare because of a new diagnosis is a terrible irony.

Feb. 26

Sam Whitehead reads the week’s news: Some places are bringing back house calls to try to fight maternal and infant mortality, and almost all Americans benefit from health care subsidies in different forms.

Feb. 19

Arielle Zionts reads the week’s news: Some health systems are using AI tools to help patients get primary care, and the Trump administration’s new data-sharing rules make going to the hospital more dangerous for people without legal status.

Feb. 12

Jackie Fortiér reads the week’s news: Moves by the Trump administration have slowed cancer research, and more of America’s doctors are working into their golden years.

Feb. 5

Katheryn Houghton reads the week’s news: American farmers are being hit hard by the end of extra Obamacare subsidies, and hospitals are starting their own Medicare Advantage plans.

Jan. 29

Zach Dyer reads this week’s news: An expensive new gene therapy that can potentially cure people with sickle cell disease will be covered by Medicaid, but only when it works for patients. Plus, community health centers are preparing to help care for millions more uninsured people.

Jan. 22

Arielle Zionts reads the week’s news: Some states are cutting public funding for a type of autism therapy, and older adults are more likely than younger ones to stop taking GLP-1 drugs such as Ozempic.

Jan. 15

Jackie Fortiér reads the week’s news: Parents are confused by an overhaul of U.S. childhood immunization guidelines, and while people 65 and older make up the fastest-growing homeless population in the country, traditional homeless shelters often can’t accommodate them.

Jan. 8

Zach Dyer reads the week’s news: Instead of extending extra Affordable Care Act subsidies that would keep monthly premiums more affordable, some Republicans are pushing health savings accounts. Plus, people seeking cheaper health insurance options outside the ACA marketplaces may find some, but they come with downsides.

Jan. 1

Katheryn Houghton reads the week’s news: AI voices can help patients who have had their voice boxes removed sound like themselves again, and many state-run psychiatric hospitals don’t have enough beds to treat patients unless they’ve been charged with a crime.

The KFF Health News Minute is available every Thursday on CBS News Radio.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

The Top 15 Specialty Pharmacies of 2025: PBM-Affiliated Pharmacies Dominate While Health Systems and Independents Gain Ground

Tue, 21 Apr 2026 07:00:00 -0400

By Adam J. Fein, Ph.D.

Real Estate Investors Profit From Long-Term Care While Residents Languish

Tue, 21 Apr 2026 05:00:00 -0400

By the time she was hospitalized in 2020, Pearlene Darby, a retired teacher, had suffered open sores on both legs, both hips, and both heels, as well as a five-inch-long gash on her tailbone. She died two weeks later at age 81 from infections and bedsores, according to her death certificate. Her daughter sued the nursing home, alleging it had left Darby sitting in her own feces and urine time and again.

The lawsuit, settled on confidential terms last year, blamed not only the managers of City Creek Post-Acute and Assisted Living but also the building’s owner, a real estate investment trust, or REIT.

In the year Darby died, City Creek paid CareTrust REIT more than $1 million in rent, while the Sacramento, California, nursing home ran a deficit, court records show.

Federal tax rules ban REITs from running health care facilities, but CareTrust was not an absentee landlord either, according to internal records filed in the case. It chose the nursing home’s management company and required through the lease that the home keep at least 80% of beds occupied. CareTrust granularly tracked how well the home kept to its financial plan, down to the money spent monthly on nurses and food, the records said. And the documents showed that the real estate company kept tabs on government safety inspection findings and Medicare quality ratings.

Both CareTrust and the nursing home operator denied liability for Darby’s death. CareTrust officials said in court papers that it is not involved in day-to-day nursing home decisions or patient care, and that it monitors facilities to ensure nothing jeopardizes rent payments. In a written statement, CareTrust Corporate Counsel Joseph Layne told KFF Health News: “We are the property owners, not the operators.”

Landlords With Influence

Over the past decade, real estate investment trusts have bought thousands of buildings that house nursing homes, hospitals, assisted living facilities, and medical offices. A KFF Health News examination of court filings and corporate records shows that these landlords have more influence than the health care facilities publicly acknowledge.

The documents reveal REITs often select the management who oversee the operations and leave them in place even when they are aware of threadbare staffing, floundering governance, repeated safety violations, or other problems that hamper quality of care. A California jury in March awarded $92 million in punitive damages against a former REIT over the death of a 100-year-old resident with dementia who froze to death outside her assisted living facility.

“The REITs are in charge,” said Laraclay Parker, one of the lawyers who represent Darby’s daughter.

Absence of Oversight

Despite their ubiquity, REITs remain invisible to state and federal health regulators. Hospitals and nursing homes are not required to disclose rent payments or landlord identities in the annual reports they submit to Medicare.

Under President Donald Trump, the Centers for Medicare & Medicaid Services indefinitely suspended a Biden-era requirement that nursing homes disclose REIT involvement. Catherine Howden, a CMS spokesperson, said in a statement that the agency does not regulate facilities based on their tax status or corporate form and instead focuses on the quality of the care they provide.

REITs now own a fifth of the nation’s senior housing, which includes assisted living, memory care, and independent living, according to an industry analysis. REITs also hold investments in 1 in 6 nursing homes. Publicly traded REITs that focus on health care are now worth nearly a quarter of a trillion dollars, according to Nareit, an industry association.

While one research study found REIT investments were associated with higher spending on nursing wages, another concluded that after being bought by REITs, nursing homes frequently replaced registered nurses with less skilled nurses and aides. A third analysis concluded that health inspection results were worse after REIT investment.

Researchers also found that investor-owned hospital chains that sold buildings to REITs were more likely to close or go bankrupt, as happened in 2024 with Steward Health Care. Often, private equity investors kept the sale proceeds as profits while the hospitals were burdened with new rent costs. “There were no improvements in clinical outcomes,” said Thomas Tsai, an associate professor at the Harvard T.H. Chan School of Public Health.

REITs are required to distribute most of their income and don’t have to pay the 21% federal corporate income tax on it. There is a catch: A REIT that “directly or indirectly operates or manages” a health care facility loses the tax break for five years. Typically, a REIT leases the property to another company that runs the nursing home or assisted living facility and maintains its tax break. Nareit said health care REITs distributed more than $7 billion in dividends in 2024.

Michael Stroyeck, head of health care analysis at Green Street, a real estate research company, said “there’s definitely a symbiotic relationship” between REITs and facility managers because they have the same goals. He said he has seen REITs replace operators that are having difficulties or go bankrupt.

John Kane, a senior vice president at the American Health Care Association and the National Center for Assisted Living, an industry group that represents nursing homes, said in a statement: “Given government funding often falls short, REITs have been valuable partners in helping to invest in long term care without influencing daily operations.”

Low Staffing at a Chain

Strawberry Fields REIT, which like CareTrust trades on the New York Stock Exchange, owns or controls the buildings of 131 nursing home facilities. The nursing home operations inside 66 of those facilities are owned by Moishe Gubin, Strawberry Fields’ chief executive, and Michael Blisko, one of its directors, according to Strawberry Fields’ annual report for last year.

Gubin and Blisko also jointly own Infinity Healthcare Management, which manages their nursing homes; Blisko is Infinity’s CEO. On average, Infinity-affiliated nursing homes provided an hour and a quarter less nursing care per resident per day than the national average of four hours, a KFF Health News analysis of federal records found.

Infinity and several of its nursing homes have recently settled 30 death and injury lawsuits in Cook County, Illinois, totaling more than $4 million, said Margaret Battersby Black, a Chicago lawyer. A jury last year awarded $12 million in a lawsuit brought against Infinity and one of its Chicago nursing homes over the 2023 death of Shirley Adams. A retired candy factory worker, Adams died after developing infected bedsores at Lakeview Rehabilitation and Nursing Center, according to the lawsuit.

“She had wounds that no one could explain,” one of her adult children, Leslie Adams, testified at trial. Medicare gives Lakeview its lowest quality rating, one star out of five.

Paul Connery, a lawyer for Adams’ family, said they are still trying to collect on the judgment against the nursing home and management company, which now totals $17 million with interest and attorney fees.

“If I get caught speeding and I went to court, they issue me a ticket and I’ve got a fine to pay,” Adams said in an interview. “How are they able to still continue to move on with business like nothing has happened?”

In a phone interview and an email, Gubin said Strawberry Fields, Infinity, and the nursing homes are all legally distinct and that he has not played an active role in Infinity in more than a decade. He said nursing homes get sued all the time but that the verdict against Lakeview is so large that it will force the home to declare bankruptcy or shut down.

“The whole thing is unfortunate,” Gubin said by phone. “For 15 years they were a perfectly good guardian” and “a well-run building,” he said. “You wouldn’t think it was fair to be judged on your worst day.”

Blisko and an Infinity lawyer did not respond to requests for comment.

Strawberry Fields, which owns 10 assisted living facilities and two long-term care hospitals in addition to the nursing homes, earned net income last year of $33 million from $155 million in rent, a 21% profit margin, securities filings show. Gubin said those weren’t excessive returns.

A $110 Million Verdict

Traditionally, REIT leases make the operating companies responsible for paying property taxes, insurance premiums, and maintenance costs. In 2008, Congress gave health care REITs a new option to make money: On top of collecting rents, they could set up subsidiaries and take profits directly from health care businesses. They still must have independent management overseeing care decisions. Many REITs have embraced the role even though the subsidiaries must pay corporate taxes and risk losing money if the businesses do poorly.

Colony Capital was a REIT that through layers of shell corporations owned both the building and the operation of Greenhaven Estates, a Sacramento assisted living and memory care facility. In 2018 Greenhaven paid Colony $1.4 million in rent, nearly a third of its $4.5 million in revenue that year, according to financial records filed in court.

Greenhaven also was on the verge of losing its license, according to a revocation notice filed in November 2018 by the California Department of Social Services. Greenhaven had racked up years of health violations, including from letting untrained workers administer medications, lacking enough employees to care for people with dementia, and neglecting a resident who smeared feces over his body, bed, floor, and bathroom, the notice said.

In February 2019, a few weeks after celebrating her 100th birthday, Mildred Hernandez, a resident with Alzheimer’s, wandered out of Greenhaven in the middle of the night. Her assisted living wing had no exit door alarms even though it housed several residents with dementia, court records showed. Berta Lepe, one of Greenhaven’s caregivers, found Hernandez under a bush, wearing only a shirt and underwear. The temperature was in the 30s.

“She was talking, but I couldn’t understand what she was saying,” Lepe testified at trial over a lawsuit from Hernandez’s family. Hernandez died of hypothermia a few hours later, according to her death certificate.

Frontier Management, the company that Colony had hired to manage Greenhaven, denied liability and settled the lawsuit on undisclosed terms.

Since the lawsuit, Colony has changed its name to DigitalBridge, which no longer owns Greenhaven and gave up its REIT status. At trial earlier this year, DigitalBridge said resident care was the responsibility of Frontier and that Colony “encouraged” Frontier to address problems. Richard Welch, a former Colony executive, testified that replacing management is disruptive. “I viewed it as a last resort,” he said.

In March, a jury awarded Hernandez’s family $110 million: $10 million in compensatory damages, $92 million in punitive damages against DigitalBridge, and $8 million in punitive damages against Formation Capital, an asset management company.

“REIT money is very detached from knowing about or caring about patient or resident outcomes, because it’s not in their business model,” Ed Dudensing, a lawyer for the family, said in an interview. “Their allegiance is to their investors.”

DigitalBridge has asked the judge to delay finalizing the judgment while its legal challenges to the lawsuit and the verdict are evaluated. A DigitalBridge attorney and a corporate spokesperson did not respond to requests for comment, a Formation attorney declined comment, and a Frontier attorney and a spokesperson did not respond to a request for comment.

‘Wet From Head to Toe’

When CareTrust bought City Creek Post-Acute and Assisted Living in 2019, the Sacramento nursing home where Pearlene Darby lived had a one-star Medicare rating and was losing money. CareTrust leased the building to a management company called Kalesta Healthcare Group based on the business plan Kalesta submitted.

While CareTrust was not the operator, it held periodic phone calls with Kalesta, which provided “a full update of what’s happening at the facility,” including changes in leadership, financial progress, and health inspection survey results, according to deposition testimony by Ryan Williams, a Kalesta co-founder.

According to a state inspection report, in 2020, the year Darby died, City Creek left a resident in soiled linens “wet from head to toe lying in bed” for more than eight hours. During a different visit, a health inspector cited the home after watching a nurse put a dirty diaper back onto a resident after caring for a wound. “It was just a small stool and it is far from where the wound is,” the nurse told the inspector, according to the report.

James Callister, CareTrust’s chief investment officer, said in his deposition that CareTrust officials “review results of regulatory surveys provided to us by the tenant. We review the five-star rating.” He said, “We evaluate results of care, but we do not evaluate types of care given or how or when, no.”

Darby had been living in City Creek since 2011 after a stroke left her in a wheelchair. She needed help getting in and out of bed. From September through November 2020, Darby lost 30 pounds, her family’s lawsuit alleged. During those months, employees dropped her three times as one worker rather than the required two operated the mechanical lift, the lawsuit said.

The suit alleged City Creek failed to reposition her every two hours in bed or her wheelchair, which is the clinical standard for people at risk of bedsores, and to promptly order devices to protect her skin.

In November, the nursing home sent Darby to the hospital. A blood test found bacteria had entered her bloodstream from her feces’ touching open skin wounds, according to the lawsuit. The hospital diagnosed her with sepsis. A surgeon said she needed an operation to redirect fecal waste from her intestines but concluded she wasn’t medically stable enough for surgery, the suit said.

Darby began receiving comfort care measures and was sent back to City Creek. She died two weeks later. In court filings, CareTrust and Kalesta denied the allegations.

In a phone interview, Williams, the Kalesta co-founder, said Darby’s death occurred during the most challenging point of the covid pandemic, when California rules required any nurses testing positive for the virus to be sent home and nurses were quitting out of fear for their health. “It was the most herculean of professional efforts to secure enough staff,” he said.

While expressing sympathy for Darby and her family, he said it was “unconscionable” that personal injury lawyers sued nursing homes over care failures during “the worst of times.”

In court, CareTrust petitioned Judge Richard Miadich to dismiss it from the lawsuit before trial. “This case does not concern a property condition,” CareTrust’s lawyers wrote. “CareTrust is simply a landlord.” But the judge ruled last year a jury should decide whether CareTrust “exercised actual control over City Creek.”

The case was settled out of court a few months later. All parties declined to reveal the settlement terms.

A 67% Profit

As recently as November 2023 — four years after its acquisition — City Creek earned one star from Medicare. It was cited for failing to have the minimum nursing home staffing required by California law during five of 24 randomly selected days in 2022, according to an inspection report. Williams said in the interview that Kalesta had increased spending on nursing over the course of its ownership, including boosting wages, but that it takes a year or two to turn around a troubled nursing home. He said the home’s star rating in 2023 was dragged down by its poor inspection history from before Kalesta took over.

City Creek’s rating has climbed in the past two years, and it now has the top overall rating of five, according to Medicare. Medicare rates City Creek’s current staffing levels as average. That’s better than most nursing homes in more than 200 buildings CareTrust bought before 2025, according to a KFF Health News analysis of federal data. On average, CareTrust nursing homes provided a half hour less nursing care per resident per day than the national average of four hours.

In its statement to KFF Health News, CareTrust’s counsel Layne said the REIT worked to “identify quality operators as tenants,” and that the homes the REIT rents out have more nurses and aides than the minimum required for nursing homes by their state governments. “The operators are licensed by state regulators and retain sole responsibility for operations,” the statement said.

CareTrust, which now owns more than 500 senior housing and nursing home buildings, reported net income last year of $320 million from $476 million in rents and other revenue — a 67% profit margin. By comparison, HCA Healthcare, one of the nation’s largest for-profit hospital and health care chains, reported a 10% profit margin for last year.

Lesley Ann Clement, one of Darby’s lawyers, said cases like hers show the nursing home industry is wrong to complain it lacks financial resources for more staffing.

“There’s plenty of money,” Clement said. “They’re just not spending it on patient care.”

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Listen: Cheap Health Insurance Isn’t Always Cheap

Tue, 21 Apr 2026 05:00:00 -0400

High-deductible plans can look like a deal, until the bills start rolling in. On this episode of the NPR podcast Life Kit, reporter Jackie Fortiér breaks down what to expect and how to prepare.

A lot of people choose their health insurance the way they shop for a flight — sort by the lowest price and click “buy.” But what looks like a bargain upfront can come with costly consequences later.

After some federal financial aid expired, many Americans found that high-deductible health plans were the only option they could afford.

In a new episode of NPR’s Life Kit podcast, KFF Health News reporter Jackie Fortiér and podcast host Marielle Segarra discuss what these plans are, and why they can feel so confusing. Imagine paying $100 out-of-pocket for a routine doctor visit that used to cost you $20. Imagine shouldering thousands of dollars in bills before your insurance pays a cent.

Still, for some people — especially those who rarely need medical care — high-deductible plans work. Listen to the episode to explore how timing your care and taking advantage of free preventive services can help you make the most of your coverage.

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Democrats Demand Trump Administration Halt Plan To Collect Federal Workers’ Health Data

Tue, 21 Apr 2026 05:00:00 -0400

Democratic lawmakers are demanding that the Trump administration halt plans to collect sensitive medical records for millions of federal workers and retirees, as well as their family members.

The Office of Personnel Management has asked 65 insurance companies to provide monthly reports with detailed medical and pharmaceutical claims data of more than 8 million people enrolled in federal health plans, KFF Health News reported earlier this month. The request, which could dramatically expand the personally identifiable medical information OPM can access, alarmed health ethicists, insurance company executives, and privacy advocates.

Now, OPM Director Scott Kupor has two letters on his desk — one from 16 U.S. senators and another led by Rep. Robert Garcia, the top Democrat on the House Oversight Committee — asking him to drop the agency’s proposal.

“The collection of broad, personally identifiable data regarding medical care and treatment raises concerns that OPM could target certain federal employees seeking vital health care services that the Administration disagrees with on political grounds,” the Democratic House members wrote to Kupor April 17, citing KFF Health News.

The letters from congressional Democrats alone are unlikely to reverse OPM’s plans. Republicans — who control Congress and, ultimately, any oversight activities — have not weighed in on OPM’s notice.

OPM did not immediately respond to a request for comment on the letters. The agency, which said in its notice that it will use the data for oversight and to manage the federal health plans, has not publicly addressed written concerns about its proposal.

The notice, posted and sent to insurers in December, states that insurers are legally permitted to disclose “protected health information” to OPM and does not provide instructions to redact identifying information, such as names or diagnoses, from the claims.

That data could be used to implement cost-saving measures, health policy experts told KFF Health News earlier this month. But it would also give the Trump administration — which has laid off or fired tens of thousands of federal workers — access to a vast trove of personal information.

In the letters, Democratic lawmakers lay out a number of concerns about potential consequences of OPM’s obtaining detailed medical claims for millions of federal workers.

The letter from Senate Democrats — led by Adam Schiff of California and Mark Warner of Virginia — argues that OPM is not equipped to safeguard such sensitive data and that the administration could share the records across government agencies, as it has done with personal information on millions of Medicaid enrollees.

They also assert that the agency does not have a legal right to the data and that insurers’ sharing the information with OPM would “violate the core principles of the Health Insurance Portability and Accountability Act.” HIPAA requires certain organizations that maintain identifiable health information — such as hospitals and insurers — to protect it from being disclosed without patient consent. The proposal, the senators warn, threatens patients’ relationships with their clinicians, especially “sensitive disclosures regarding mental health, chronic illness, or other deeply personal conditions.”

“For these reasons, we strongly urge you to cease any further consideration of this proposal,” states the letter, which was sent to Kupor on April 19.

The American Federation of Government Employees, the largest union for federal employees, responded with alarm to KFF Health News’ reporting. The union noted in a statement from its national president, Everett Kelley, that OPM’s proposal “comes in the context of coordinated attacks on federal employees and repeated stretching of the legal boundaries for sharing sensitive personal data across government agencies.

“The question of what this administration intends to do with eight million Americans’ most private health information is not academic,” the AFGE statement read. “It is urgent.”

In an emailed statement, Kelley applauded the congressional letters.

“We are pleased that Democratic lawmakers on the Hill are just as outraged as we are over this administration’s blatant attempt to breach the privacy of millions of Americans across the country,” Kelley wrote. “We share their concerns regarding potential misuse of the information to continue illegally targeting workers and their demand for OPM to withdraw this proposal.”

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The Omnichannel Gap: Building the CRM of the Future for Patient Services

Mon, 20 Apr 2026 07:00:00 -0400

Today’s guest post comes from Karishma Desai, Associate Director of Data Strategy at Claritas Rx.

Karishma explains how the complexities of specialty therapies require a customer relationship management (CRM) system that unifies consent management. She goes on to explain that by embedding AI into the patient journey, automating workflows at scale, and enhancing collaboration among stakeholders, organizations can reduce delays, improve adherence, and deliver better patient outcomes.

To learn more, download Claritas Rx’s white paper: The Omnichannel Gap: Building the CRM of the Future for Patient Services.

Read on for Karishma's insights.
Read more »

In Connecticut, Doctors Now Sue Patients Most Over Medical Bills, Surpassing Hospitals

Mon, 20 Apr 2026 05:00:00 -0400

BRISTOL, Conn. — Many hospital systems in Connecticut have stopped suing their patients over unpaid bills, stung by criticism about the harm caused by aggressive collection tactics.

But physicians, dentists, ambulance companies, and other health care providers are still taking their patients to court, a Connecticut Mirror-KFF Health News investigation of state legal records shows.

Lawsuits by doctors and other nonhospital providers now dominate health care collections in Connecticut, the records show, accounting for more than 80% of cases filed against patients and their families in 2024.

That’s a major reversal from just five years earlier, when hospital system lawsuits made up three-quarters of health-related collection cases in the state’s courts.

The shift is moving medical debt collections into a less regulated realm. Most hospitals, because they are tax-exempt nonprofits, must make financial aid available to low-income patients and follow federal regulations that limit aggressive collection activities. Other medical providers, such as private medical groups, are generally exempt from these rules.

The lawsuits are typically over bills of less than $3,000, but the impact on patients can be devastating. Lawsuits are among the most ruinous byproducts of a health care debt problem that burdens an estimated 100 million people in the U.S.

Lawsuits can lead to garnished wages, liens on homes, and hundreds of dollars of added debt from interest and court fees. They also pile additional financial strains on struggling families, prevent patients from getting needed care, and sap trust in medical providers.

“It’s really messed up,” said Allie Cass-Wilson, a nurse in Bristol, Connecticut, who was sued over a $1,972 debt by an OB-GYN practice where she’d been a patient years earlier. “How can they do that to people?” She did not contest the lawsuit, court records show.

Cass-Wilson, who is 36 and lives in a small apartment just off an expressway on-ramp, said she learned of the outstanding debt only when she was sued. When she tried making an appointment, she said, she was told her doctor wouldn’t see her. “They said I was blacklisted,” Cass-Wilson said. “I was so confused. I couldn’t believe that my medical provider let my care be interrupted like this.”

Cass-Wilson ultimately sought medical care elsewhere.

Radiologists, Dentists, Ambulances

Overall, CT Mirror and KFF Health News identified more than 16,000 health care-related debt cases in Connecticut courts from 2019 to 2024. The database was assembled from online court records with the help of January Advisors, a data science consulting firm that helped extract and sort the data.

Over the six-year period, most of Connecticut’s more than 25,000 licensed physicians and dentists did not pursue patients in court for outstanding balances.

But records show that more than 400 medical providers, including several hospital systems, sued their patients. Among those filing lawsuits were radiologists, anesthesiologists, eye doctors, podiatrists, allergists, and pediatricians.

Dentists, periodontists, and other dental providers filed more than 1,000 lawsuits against patients. And ambulance companies sued more than 140 people.

Med-Aid, a company based outside New Haven, Connecticut, that provides orthopedic braces and other medical supplies to patients, sued more than 400 people, the court records show. The company’s president, Frank Dilieto, did not respond to repeated interview requests.

Cass-Wilson was sued by Briar Rose Network in Bristol, Connecticut, a member of a large network of OB-GYN practices across Connecticut called Physicians for Women’s Health. The network’s members sued close to 100 patients in 2024, records show.

Paula Greenberg, CEO of Women’s Health Connecticut, a private equity-backed company affiliated with Physicians for Women’s Health that manages business operations for the network, said the lawsuits represent a small fraction of the more than 300,000 patients the network sees every year.

“This is an organization committed to patients,” Greenberg said. She noted that the group offers options to help patients pay, including installment plans and financial aid.

Geoffrey Manton, president of Naugatuck Valley Radiological Associates, said his practice also will work with people who say they can’t pay. But, he said, patients sometimes stop responding to their bills.

“Hiding from your problems isn’t going to solve them,” Manton said. “If we didn’t take any action, there could be that person that is in that late-model Mercedes that just chooses not to pay any bills.” The group sued more than 125 patients from 2019 to 2024, according to the court records.

Many medical providers say that aggressive collections stem from the growing prevalence of high-deductible health plans that leave patients with thousands of dollars of bills before their coverage kicks in.

Greenberg and Manton said each of their physician groups must collect. “This is a business,” Greenberg said. “We have to look at our operating costs.”

Critics of medical collection lawsuits note that the patients are typically sued over relatively small debts that are likely to have little impact on multimillion-dollar medical practices.

The average patient debt that members of Physicians for Women’s Health sued over in 2024 was less than $1,100, court records show. The physician group’s annual revenues are typically in the tens of millions of dollars, according to Greenberg.

Even relatively small debts — which often include interest — can place substantial burdens on families struggling to keep up with their bills, especially while dealing with a serious illness, patient advocates say.

“We don’t have a realistic choice in using health care,” said Lisa Freeman, who heads the Connecticut Center for Patient Safety and has advocated for patients struggling with medical bills. “To then get sued for it, when people have less and less funds available for anything extra, that’s very disheartening.”

A Stroke, Then a Lawsuit

Matthew Millman, 54, lost his job as an IT support worker after having a stroke. Then Meriden Imaging Center sued him over an $1,891 bill.

Millman and his wife said they tried to explain their financial situation to the center, which is affiliated with Midstate Radiology Associates, a large physician group that operates imaging centers and doctors’ offices across Connecticut.

“It was very frustrating,” said Millman, who lives in an aging apartment owned by his wife’s family in New Britain. Millman, his wife, and their teenage daughter are barely getting by on his two part-time jobs — one bagging groceries, the other helping homebound seniors. Together, the jobs pay about $1,500 a month, he said.

The imaging center, after winning the collection case against Millman, tried to garnish his wages, though that was unsuccessful because Millman had lost his IT job.

“It’s all about money,” Millman said, shaking his head. “If you are trained in helping somebody with their health, it shouldn’t be about the money first. It should be about their health.”

Court records show that Midstate Radiology, Meriden Imaging Center and affiliates filed more than 1,000 collection lawsuits against patients from 2019 to 2024, making them the most litigious nonhospital providers in the state. As is common in medical debt lawsuits, the plaintiffs prevailed in most cases, records show.

Midstate president Gary Dee, a radiologist, didn’t respond to emails and messages left at his West Hartford office.

Across town from Millman’s apartment in New Britain, Joseph Lentz lives in a cramped apartment with his wife and daughter. He used to oversee operations at a Boy Scout camp but is now unemployed. Lentz lost his job during the pandemic. The family home went into foreclosure, he said.

In 2023, Orthopedic Associates of Hartford sued Lentz over a $3,644 bill the practice said he owed after having shoulder surgery in 2018.

“I’d pay it if I could, I guess,” said Lentz, 59. “But I don’t even know where next month’s rent is coming from. I’m trying to climb out as best I can. I guess this is just one more thing to shovel in.”

The orthopedic group filed more than 580 lawsuits against patients from 2019 to 2024, prevailing in most, records show.

The medical group declined interview requests. But chief executive David Mudano said in a statement: "As an independent physician practice, we strive to balance compassion for patients with the financial responsibility required to sustain our practice.”

Old Debts and Disputed Claims

Lentz, who did not contest the lawsuit, said he has no reason to doubt he owes the debt. But in many cases reviewed by CT Mirror and KFF Health News and in interviews, patients being sued questioned the accuracy of their medical bills, citing care they thought health insurance should have covered or, in some cases, bills for services they never received.

This reflects broader problems with aggressive collection tactics like lawsuits when disputes over the accuracy of medical bills and delayed or denied insurance claims are so widespread in American health care.

A 2022 report by the federal Consumer Financial Protection Bureau found that nearly half of the medical debt complaints fielded by the agency involved bills that consumers said were erroneous in some way or that consumers said they’d already paid.

“We know people are billed incorrectly,” said Lester Bird, who studies debt collection lawsuits at the nonprofit Pew Charitable Trusts. Bird noted that courts are ill equipped to sort through disputed medical charges or insurance claims, especially when there is little documentation in most debt collection lawsuits.

“It’s complicated before it gets to the courts,” Bird said, “and it’s very complicated when it gets into the courts.”

This can create headaches for physicians and other providers. But billing problems ultimately affect patients and their families most, said Connecticut state Sen. Saud Anwar, a Democrat who is also a physician. “Patients are left to deal with it.”

Andrew Skolnick, an attorney in Milford, outside New Haven, was sued in 2023 by an imaging center where his wife had received services in 2020.

Skolnick said that when the couple, who were covered through his job-based insurance, originally received the bill from Diagnostic Imaging of Milford, he tried to tell the imaging center it had submitted the claim to the wrong insurance plan, but he said they wouldn’t speak with him.

The center later filed the lawsuit, alleging he owed more than $2,000, plus almost $300 in interest.

Despite interview requests, officials at Diagnostic Imaging of Milford did not comment for this article.

Unlike most patients who are sued, Skolnick had the resources and expertise to contest the suit. He said he offered to pay what would have been his responsibility under the plan if the imaging center had filed his claim correctly. He ultimately settled for $1,700, court records show.

“It wasn’t a tremendous amount, but I knew that they had made a mistake,” Skolnick said. “The system is not working.”

More Protections?

Anwar, the state lawmaker and physician, expressed concern that lawsuits undermine patients’ faith in their doctors.

“It’s a sacred relationship,” he said. “If your physician, who is taking care of you, is suing you for money, that’s a problem.

Many hospitals, facing bad publicity from suing patients, have stopped taking patients to court over unpaid bills. Hospital collection lawsuits identified by CT Mirror and KFF Health News in Connecticut court records plunged from more than 4,900 in 2019 to fewer than 300 in 2024.

Also, in recent years, several states, including Connecticut, have expanded protections for patients with bills they can’t pay.

Connecticut now bars medical debt from consumer credit reports, and legislators are pushing to get hospitals to provide more financial aid to patients. Other states have restricted the use of wage garnishment and property liens to collect medical debt.

But state efforts to rein in aggressive medical debt collections have mostly focused on hospitals. That may need to change, said Connecticut state Sen. Matt Lesser, a Democrat who co-chairs the legislature’s Human Services Committee.

He is a key backer of a bill introduced this year that would bar hospitals from billing patients who receive public benefits like food assistance or who make less than twice the federal poverty level, about $32,000 for an individual.

The restriction would not apply to bills from physicians and other nonhospital providers, however. “We may have to go bigger if that’s where the heart of the matter is,” Lesser said.

Connecticut Gov. Ned Lamont, a Democrat who spearheaded an initiative to cancel medical debt for more than 150,000 state residents, also expressed concern about physicians suing the people in their care.

“Everyone should do the right thing by patients,” he said.

This article was produced in partnership with The Connecticut Mirror, a statewide nonprofit newsroom that covers public policy and politics.

How We Did It: Analyzing Connecticut Health Care Debt Collection Lawsuits

How often do health care providers sue patients over unpaid bills?

In most states, that’s nearly impossible to answer because courts don’t typically identify which debt collection lawsuits involve a medical debt versus other kinds of debt, such as rent, credit cards, or cellphone bills.

But Connecticut is different. Debt collection cases filed in small-claims court for unpaid medical or dental bills must be classified as health care debt. We worked with the data science consulting firm January Advisors to pull these cases from the Connecticut court database and analyze them. (January Advisors has worked with nonprofits and researchers across the country to collect debt collection data from state courts. The firm did not have any editorial input in our project.)

We started with health care collection cases filed in small-claims court from 2019 to 2024. But this covered only cases involving debts smaller than $5,000. We also wanted to know about cases in which providers sued for bills exceeding $5,000. Connecticut courts don’t assign a “medical” category for large-claim cases. So we pulled all large-claim records for any plaintiff — hospital or nonhospital provider — that appeared in medical small-claims cases. We also included cases with plaintiffs that didn’t appear in that dataset but had common medical terminology in their names, like “hospital” or “DDS.”

We then went through each case manually to confirm that the plaintiff was a medical or dental provider. We determined whether the provider was part of a larger hospital or physician group. And we categorized each plaintiff by a provider type (e.g., hospital system, dental, physician group).

In some cases, the data we pulled was incomplete, so we looked up the court records online and manually entered the information into our database. The Connecticut Judicial Department purges case records from its online portal after a certain amount of time. In those cases, we asked the agency to provide summonses and claims so we could manually enter the case information into our database.

We removed cases with out-of-state defendants or out-of-state plaintiffs and any cases in which missing records made it difficult to confirm information about the provider.

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An Arm and a Leg: The Accidental Architect of America’s Drug Patent Problem

Mon, 20 Apr 2026 05:00:00 -0400

Depending on whom you ask, Alfred Engelberg could be a hero or a villain in the story of American pharmaceuticals. The patent lawyer helped write legislation that led to a dramatic increase in the number of generic drugs on the market. He also contributed to a patent system that gives pharmaceutical companies monopolies on their most lucrative drugs, blocking generic competition and keeping prices high along the way.

An Arm and a Leg host Dan Weissmann traces Engelberg’s story back more than 50 years, from a scrappy childhood on the Atlantic City boardwalk to watching President Ronald Reagan sign his bill into law at the White House Rose Garden. Today, Engelberg advocates for policy changes he believes will enable more generic drugs to reach the market faster.

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

Credits

Emily Pisacreta Producer Claire Davenport Producer Adam Raymonda Audio wizard Ellen Weiss Editor Click to open the Transcript Transcript: Why drugs cost so much, 101: Medicine monopolies

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

Dan: Hey there–

We are kicking off a new series here — We’re calling it An Arm and a Leg 101.

We’ve spent years of reporting on two huge questions: Why does health care cost so freaking much? And what can we maybe do about it?

We’ve been chasing answers one story, one question at a time.

Now, we’re pulling together some of what we’ve learned. Digging a little deeper, going a little broader.

Starting with why so many drugs cost so much.

One of the first questions I ever asked — one of our first stories — was: How can insulin be so expensive? Wasn’t it discovered in the early 20th century? Shouldn’t it be a generic drug by now?

You know, cheap?

And part of the answer I got was: Insulin has been transformed since the early 20th century. A lot.

A medical researcher named Jing Luo told me: Today’s insulins are a long way from what we had a hundred years ago.

Jing Luo: They’ve been really modified at a molecular level. It’s cool stuff. It’s super cool stuff. And you know, there are multiple Nobel prizes in physiology and medicine that have made this happen.

Dan: And all that super-cool stuff, those amazing discoveries, got patented.

Meaning: The patent-holders– the pharma companies — got a monopoly on those amazing discoveries.

The pharma companies claimed patents — and monopolies– on a bunch of other things too. Not all of them amazing.

But each new patent can mean another delay for a generic version coming to market.

Jing Luo: Companies can stack dozens of patents on top of each other to try to thwart generic competition because they can say, look, we’ve got three patents on the active ingredient. We’ve got patents on the medical uses of the active ingredient. We’ve got patents on the non-active excipient associated with this ingredient. We’ve got multiple patents on the devices, and so you who are trying to enter this space will sue you for patent infringement on all of them.

Dan: A patent guarantees you at least a 20-year monopoly. Drugs can generally get an extra five.

And these extra patents — secondary patents –can keep you protected LONGER. If you don’t file them at the same time as the original:

To talk about a drug that’s in the news right now. The original patent on the active ingredient in Wegovy and Ozempic actually expired this year.. The extra five years extends it to the early 2030s.

But dozens of extra patents — secondary patents, filed later — mean that here in the U.S., we might not see cheaper generic versions until 2042. Or later.

And as Jing Luo told me: This strategy isn’t a secret. It’s an industry cornerstone.

Jing Luo: When you listen to these like CEOs of pharma companies being interviewed at CNBC, you know, they’d be like, well, what about generic competition for this product? And they’ll just keep saying, no, no, no. We’ve got this really robust patent portfolio. We can withstand any challenge. We’re gonna tie this up in courts forever and don’t worry about it.We’re gonna continue this gravy boat for a long, long time. That’s the way they reinsure investors.

Dan: A robust patent portfolio. ?Or what researchers and advocates call a patent thicket.

They say quality matters less than quantity.

The numbers are wild.

According to one study, the 10 best-selling drugs for 2021 — drugs for cancer, HIV, arthritis — were protected by a combined total of seven hundred and forty-two patents. With hundreds more “pending.”

When these add-on patents get challenged in court, they actually get tossed out more often than primary patents..

But lawsuits cost money. A robust patent portfolio — a patent thicket — means generic companies would need to be ready to file a LOT of them.

So, we wanted to know: How did all this happen? How did these games get started?

It turns out, there is one guy who can tell you the story from the beginning, for better and for worse. Who helped shape it. Made millions of dollars from it. Saw its flaws. And has spent most of the last 30 years trying to fix them. Hie’s a lawyer named Al Engelberg, and he’s 86 years old.

Alfred Engelberg: I tell people all the time, I live in a world, a pharma world where half the people think I’m dead and the other half wish I was.

Dan: Al Engelberg’s story is the story of generic drugs in America. And it’s a wild ride.

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

?Al Engelberg’s parents fled Nazi Germany in the late 1930s.

He was born here, less than a year after they arrived. They had nothing.

And here’s where they made their new life.

Retro news reel: We are flying over a well-known eastern city. That is remarkable because manufacturing is almost non-existent. A city whose principle business is the entertainment of millions. Atlantic city, often called the vacation capital of the nation

Dan: Al likes to say he learned most of what he knows about practicing law on the Atlantic City boardwalk, by the time he was 16.

Alfred Engelberg: We grew up very, very fast there. I started working when I was about nine or 10 and, and there were lots of opportunities on the boardwalk.

Dan: His first “job” was crawling around under the boardwalk, looking for loose change.

Alfred Engelberg: But I went on to work at hotdog stands and at an illegal bingo game for the local mob.

Dan: And in every job, Atlantic City drove home its major lesson: Cheating — hustling — is something you’ve gotta expect.

At this illegal bingo parlor, Al’s job was walking between tables, doling out bingo cards for a dime apiece. The bosses hired college kids to walk behind kids like Al, to keep him honest.

Alfred Engelberg: I mean, these guys are running an illegal game, but they still need to count, and they still inherently don’t trust anybody.

Dan: Which was correct. Al says the college kids had their own hustle: They’d have him set aside a dollar or two before turning in his dimes — split that dollar with him fifty-fifty — and tell the bosses Al’s count was fine.

Alfred Engelberg: And everybody knowing that the counts were wildly inaccurate anyway ‘cause the little old ladies were, were stealing cards. Everybody in the room had their own thing going, you know, from the customers on.

Dan: After Al made it out of Atlantic City, his unique on-the-job education continued. He studied chemical engineering at Drexel, then took a job as a patent examiner while going to law school at night.

And at that job, he learned: The patent system was ripe for hustling.

Partly because most of his colleagues weren’t necessarily giving the job their all.

Like him, most patent examiners were working their way through law school. And they were sneaking time to study on the job.

Alfred Engelberg: We used to be able to cut our notes down so they fit in these file drawers with the patents. And we would be reading your notes and if your boss came by, you would just drop a patent on top of the notes.

Dan: You could say it was Atlantic City all over again. Everybody in the job is sneaking something for themselves — in this case, time.

And Al Engelberg could see that, even if his colleagues gave it their all, they were too green to do their job well.

A patent examiner’s job — deciding whether a proposed invention deserves a monopoly (which at that time was 17 years) — means deciding whether the idea for that invention would be obvious to “a person of ordinary skill in that field.”

Alfred Engelberg: And most of the examiners had never worked in that field and had absolutely no idea. And this is the big leagues. You’re granting somebody a monopoly for 17 years, and it seemed ridiculous on its face.

Dan: Al cut his own path at the patent office. He’d worked his way through engineering school, in manufacturing plants, he saw what people of ordinary skill in that field solve problems every day. So he specialized in examining patents he actually knew something about.

That got him promoted, then it got him recruited by a corporate lawyer.. After the company paid his way through the rest of law school, he jumped to the Justice Department.

He was ambitious– he wanted experience junior lawyers don’t usually get — like trying cases of his own.

After a few years doing just that, he took a job with a small law firm in New York City in 1968.

Alfred Engelberg: I came to New York to private practice at the age of 30 and I was ready to go. I mean, I was ready to, to tear the world apart and I did.

Dan: Patents were still a specialty. Then, in 1973, he gets a call that leads to his first generic drug case.

Generic drugs were not a hot market at the time.

Alfred Engelberg: ?The generic drug industry in 1970s was essentially, a half a dozen, privately owned family businesses, mostly in the metropolitan New York area. And most of the drugs that they were selling were drugs that were approved before 1962.

Dan: Yeah. 1962 is when the FDA made it harder to get a new drug approved — you had to go through long clinical trials to show that your drug was safe and effective.

Even if your drug was a generic version of an existing drug. Those little companies didn’t have the capital to run those trials, so they were stuck selling those old drugs.

Not much of a business. Maybe 20 percent of prescriptions were for generic drugs.

So when Al Engelberg got a call for his first generic drug case, that was the context. And the case itself did not sound promising. For one thing:

Alfred Engelberg: The call wasn’t even from the client. It was from a bank. The client was bankrupt.

Dan: The client was bankrupt. This bankrupt client, Premo Pharmaceuticals, was getting sued for patent infringement. The bank was willing to put up ten thousand dollars for a defense. Nowhere near enough to actually try a case. Oh, and…

Alfred Engelberg: From what they told me, the information they gave me, we didn’t have a very good defense.

Dan: But Al Engelberg saw an opening. He could see that his opponents have weaknesses too.

Alfred Engelberg: The patent owners were in a very strange position. If they won, they got nothing because we were already bankrupt. Two, they were gonna have to spend the legal fees to win.

Dan: Win against a young lawyer named Al Engelberg who already had a rep as a tough opponent. So they could lose.

Alfred Engelberg: And if they lost, they would lose millions and millions of dollars in business because there wouldn’t be a patent. And they’d have competition from generic drugs.

Dan: And meanwhile, Al Engelberg is also sizing up the judge. He knows the guy doesn’t love patents.

So Al shows up to the first conference and he bluffs.

Alfred Engelberg: I said to the judge, oh, your Honor, you know, it’s another one of those patents. They’re all invalid. And I said, we don’t need very much discovery. We’re, we’ll be ready to go to trial in a few months. Just set a trial date.

Dan: The other side walks out beside themselves.

And within a couple of weeks they call Al to say: Hey, how about this? You guys just acknowledge our patent is OK, and we’ll give you the money we would’ve spent litigating. Call it 400,000 bucks?

Alfred Engelberg: I called the client and said, how’s $400,000? He said, are you kidding?

Dan: They didn’t just get out of trouble — they got out of bankruptcy, with $400,000 in their pockets. Because Al Engelberg knew how to size up a situation.

Alfred Engelberg: You don’t learn that in law school. That’s not what they teach.

Dan: Word gets around about that case, and pretty soon everybody in the generic drug world is calling him.

It’s a small world, but by the end of the 1970s, there may be room for it to start getting bigger.

People are starting to notice: Drugs are expensive. Maybe there should be more cheap generics.

Some generic drug companies form an association and start lobbying: Make it easier to get generic drugs to market without having to go through all those trials.

The brand-name drugmakers push back: They say it takes so long to run the trials and get their drugs approved, they don’t get enough time to make money before those patents expire.

In 1983, Democratic Representative Henry Waxman steps in to broker a compromise, with Republican Senator Orrin Hatch.

And Mr. Engelberg goes to Washington. To run strategy for the generic drugmakers.

Alfred Engelberg: In a lot of ways , that’s where my Atlantic City training really helped me at the end of the day

Dan: There were a lot of people, with a lot of interests. A lot of angles. ?He starts commuting from New York to Washington DC a couple times a week — for months and months, more than a year.

And Al Engelberg says: This time, it wasn’t just about winning a case.

Alfred Engelberg: I was in the back of a cab the way I remember, with the senior partner of the law firm. And he says to me, why are you breaking your ass going to Washington two or three times? Why don’t you send an associate? You know, it’s just like, it’s just another case. And I said. I said, are you kidding? I said, you know, how many lawyers ever get to do what I’m doing right now? To be at the table influencing what may be a major law that’s gonna have major consequences is, is like something I never thought my whole life I’d be doing.

Dan: A kid from Atlantic City was exactly the right person to try to balance all the angles, negotiate a compromise. It took more than a year. It almost didn’t happen. But then it did. Congress passed the bill, and President Ronald Reagan got in front of cameras to sign it.

Ronald Reagan: Let me turn my attention to the real reason we’re here this afternoon, signing into law the Drug Price Competition and Patent Term Restoration Act of 1984.

Dan: better known as Hatch-Waxman.

Hatch Waxman had three basic components:

One: Brand drugmakers got a few extra years on their patents.

Two: Generic drugmakers got a pathway to get FDA approval.

And three –The new law laid out rules for a generic drugmaker when they wanted to CHALLENGE an existing patent.

Negotiating that third part was the part where Al Engelberg’s education on the Atlantic City boardwalk, and the U.S. patent office, and the generic drug industry came together: The result would make him millions and millions of dollars — and blow a giant hole into the grand bargain he had worked so hard to bring about.

That’s coming right up.

This episode of An arm and a Leg is produced in partnership with KFF Health News. That’s a nonprofit newsroom covering health issues in America. The folks at KFF Health News are amazing journalists — their work wins all kinds of awards, every year. We are honored to work with them.

So. The brand-name drug makers and the generic drug makers struck a deal. That deal was good for them. Both sides got something big out of it. The public was supposed to get something out of it too.

And, to be fair, we did: Remember, back then, maybe one out of five prescriptions was for a generic drug. Now it’s nine out of ten.

But we pay more than ever for drugs. Mostly for branded, patent-protected drugs. And the biggest, most-important, most profitable drugs get locked behind patent thickets.

How did that happen?

Well, to understand that, it helps to know what Al Engelberg got out of the whole bargain.

Al had been there at the bargaining table, on behalf of the generics.

One day, during those negotiations, he was in the office with Henry Waxman’s lead counsel, a guy named Bill Corr, when Corr got a call from someone on the other side.

Corr starts pointing at the phone, pointing to Al — indicating: This guy is talking about you.

When Corr gets off the phone he says: That guy’s not sure about this deal where bad patents could be challenged. He’s suspicious about where you might take this. Like, are you just gonna set up a bounty-hunting operation, to get patents declared invalid?

And Corr said, Al, would you do that?

Alfred Engelberg: And I said, you know, Bill, until this moment, I’ve never given it any thought, but it’s a hell of a good idea. Maybe I’ll look at it.

Dan: And he did. Starting almost as soon as Hatch-Waxman became law.

Alfred Engelberg: And we sat in the rose garden, September 23rd, 1984, watched Reagan sign the

Journalists Talk Hot Health Topics: Urgent Care Clinics Performing Abortions and Doulas’ Pay

Sat, 18 Apr 2026 05:00:00 -0400

KFF Health News Michigan correspondent Kate Wells discussed urgent care clinics offering abortions on Apple News Today on April 15.

Click here to hear Wells on Apple News Today.

Read Wells’ “Urgent Care Clinics Move To Fill Abortion Care Gaps in Rural Areas.”

KFF Health News Montana correspondent Katheryn Houghton discussed doula Medicaid reimbursements on Montana Public Radio on April 9.

Click here to hear Houghton on Montana Public Radio.

Read Houghton’s “This Northern Cheyenne Doula Was About To Start Getting Paid — Then Medicaid Cuts Hit.”

KFF Health News contributor Michelle Andrews discussed farm bureau health plans on The Yonder Report on April 8.

Click here to hear Andrews on The Yonder Report.

Read Andrews’ “Farm Bureau Health Plans Beat the ACA on Prices With an Age-Old Tactic: Rejecting Sick People.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
USE OUR CONTENT
This story can be republished for free (details).

What the Health? From KFF Health News: A New CDC Nominee, Again

Fri, 17 Apr 2026 14:35:00 -0400

The Host
Mary Agnes Carey KFF Health News @maryagnescarey Mary Agnes Carey is managing editor of KFF Health News. She previously served as the director of news partnerships, overseeing placement of KFF Health News content in publications nationwide. As a senior correspondent, Mary Agnes covered health reform and federal health policy.
President Donald Trump this week nominated a former deputy surgeon general who has expressed support for vaccines to lead the Centers for Disease Control and Prevention. Considered a more traditional fit for the job, Erica Schwartz would be the agency’s fourth leader in roughly a year, should she be confirmed by the Senate.

And Health and Human Services Secretary Robert F. Kennedy Jr. appeared on Capitol Hill this week in the first of several hearings discussing Trump’s budget request for the department. But the topics up for discussion deviated quite a bit from the subject of federal funding, with lawmakers raising issues of Medicaid fraud, measles outbreaks, the hepatitis B vaccine, peptides, unaccompanied minors, and much, much more.

This week’s panelists are Mary Agnes Carey of KFF Health News, Anna Edney of Bloomberg News, Emmarie Huetteman of KFF Health News, and Joanne Kenen of the Johns Hopkins University Bloomberg School of Public Health and Politico Magazine.

Panelists
Anna Edney Bloomberg News @annaedney @annaedney.bsky.social Read Anna's stories. Emmarie Huetteman KFF Health News Joanne Kenen Johns Hopkins University and Politico @JoanneKenen @joannekenen.bsky.social Read Joanne's bio.
Among the takeaways from this week’s episode:

Trump on Thursday named four officials to the CDC’s leadership team. Schwartz, whom he picked as director, is a physician and Navy officer who served as a deputy surgeon general during Trump’s first term. She has voiced support for vaccines and played a key role in the covid-19 pandemic response.

RFK Jr. testified before three committees of the House of Representatives this week on the president’s budget request for HHS. While the hearings touched on a wide variety of topics, notable moments included a slight softening of Kennedy’s stance on the measles vaccine, including the acknowledgment that being immunized is safer than having measles — although he also stood by the decision to remove the recommendation for the newborn dose of the hepatitis B vaccine.

New studies on the use of acetaminophen during pregnancy and the effects of water fluoridation on cognitive function refute Trump administration claims. And a White House meeting that brought together Trump, Kennedy, and other leaders of the Make America Healthy Again movement aimed to soothe concerns among supporters — yet there’s reason to believe the overture won’t completely mend fences between the Trump administration and the MAHA constituency ahead of the midterm elections.

Also this week, KFF Health News’ Julie Rovner interviews Michelle Canero, an immigration attorney, about how the Trump administration’s policies affect the medical workforce.

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

 Mary Agnes Carey: Politico’s “‘A Crisis in the Making’: Nebraska Races To Impose Work Requirements on Medicaid,” by Alice Miranda Ollstein.

Joanne Kenen: The New York Times’ “He Warned About the Dangers of A.I. If Only His Father Had Listened,” by Teddy Rosenbluth.

Anna Edney: Bloomberg’s “Hormone Drugs Make $6.3 Billion Comeback After FDA Nixes Safety Warnings,” by Anna Edney.

Emmarie Huetteman: KFF Health News’ “Your New Therapist: Chatty, Leaky, and Hardly Human,” by Darius Tahir.

Also mentioned in this week’s podcast:

JAMA Pediatrics’ “Acetaminophen Exposure During Pregnancy and the Risk of Autism in Offspring,” by Kira Philipsen Prahm, Pingnan Chen, Line Rode, et al.

Proceedings of the National Academy of Sciences’ “Municipal Water Fluoridation, Adolescent IQ, and Cognition Across the Life Course: Evidence From the Wisconsin Longitudinal Study,” by John Robert Warren, Gina Rumore, Kamil Sicinski, and Michal Engelman.

KFF Health News’ “Pennsylvania Town Faces Fallout From Trump’s Environmental Rule Rollback,” by Stephanie Armour and Maia Rosenfeld.

The New York Times’ “In Private Meeting, Trump Soothes Disenchanted MAHA Leaders,” by Sheryl Gay Stolberg.

Wakely Consulting Group’s “Who Paid, and Who Stayed? Early 2026 Enrollment Trends in the Individual Market,” by Michelle Anderson, Chia Yi Chin, and Michael Cohen.

Credits
Taylor Cook Audio producer Emmarie Huetteman Editor
Click here to find all our podcasts.

And subscribe to “What the Health? From KFF Health News” on Apple Podcasts, Spotify, the NPR app, YouTube, Pocket Casts, or wherever you listen to podcasts.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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This story can be republished for free (details).

The Hidden Pitfalls of Hub Transitions—and How to Navigate Them

Fri, 17 Apr 2026 07:00:00 -0400

Today’s guest post comes from Brok Vandersteen, Vice President of Business Development at AssistRx.

Brok explains how missteps during patient support program transitions—ranging from service disruptions to data misalignment—can undermine access, adherence, and brand trust. He describes best practices organizations can use to ensure a smooth transition while protecting patients, providers, and program outcomes.

To learn more, download AssistRx’s Hub Transition Process Checklist. You can also schedule a meeting with the AssistRx team at the Asembia Summit in Las Vegas.

Read on for Brok’s insights.
Read more »
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Mapping the Vertical Integration of Insurers, PBMs, GPOs, Specialty Pharmacies, and Healthcare Services: DCI’s 2026 Update

Tue, 14 Apr 2026 07:00:00 -0400

It's time for Drug Channels Institute’s (DCI) annual update of vertical integration among insurers, PBMs, specialty pharmacies, and healthcare services within U.S. drug channels. As you can see below, we have updated and revised our infamous illustration of the major vertical business relationships within the largest companies.

These organizations continue to exert greater control over patient access, sites of care/dispensing, and pricing, although some have started to unwind their vertical integration strategies. Scrutiny of these companies’ actions continues to grow.

For all the details behind these companies’ operations, check out DCI’s new 2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.
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Informa Connect’s Life Sciences Pricing & Contracting USA

Mon, 13 Apr 2026 06:30:00 -0400

Informa Connect’s Life Sciences Pricing & Contracting USA
May 18-20, 2026 | Philadelphia, PA

Drug Channels readers save 10% with code 26DRCH10*

Pricing & Contracting USA arrives at an important moment for our industry. As you work to navigate the evolving healthcare landscape, this annual event brings together 70+ expert speakers to lead the critical discussions that will drive comprehensive market strategy, uniting Medicaid, Policy, Pricing, Contracting & Reporting thought leaders.

Event features include:

Wholesaler/Manufacturer Team-to-Team Meet-and-Greets: Direct industry collaboration led by McKesson and Cencora.

Executive Programming: Fireside Chats with External Counsel, Closed Door Executive Strategy Summit and Luncheon.

Interactive Sessions: Speed Networking, AI Lunch and Learn

Strategic Working Groups: Medicaid Working Group Report, 80 Minute Industry Strategy Working Group.

The Hottest Topics: Get ready for coverage on Most Favored Nation (MFN) Pricing Implementation, Medicare Part B Drug Negotiations (2028 Launch), 340B Rebate Model from all stakeholder perspectives, State Medicaid Revenue Transparency Sessions, Cell & Gene Therapy Outcomes-Based Contracting, AI-Powered Pricing Scenario Planning, Direct-to-Consumer Pharma Initiatives, Chargeback Data Accuracy Impact on Rebates, What's new with GTN, GPOs, PBMs, PDABs and SPTR, Government Shutdown Policy Timeline Disruption, and so much more.

Featuring 70+ speakers from: Accord, Alkermes, AstraZeneca, Azurity, Chiesi, CMS, CSL Vifor, Genentech, Gilead, GSK, Keenova Therapeutics, Novartis, OIG, PhRMA, Sandoz, UCB and many more.

Join us where Medicaid, Commercial & Government Teams will collaborate to drive a successful market strategy! View the agenda for Pricing & Contracting USA to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/pricing-contracting-usa for further details and to register.

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates or other offers. Other restrictions may apply.

The content of Sponsored Posts does not necessarily reflect the views of HMP Omnimedia, LLC, Drug Channels Institute, its parent company, or any of its employees. To find out how you can publish an event post on Drug Channels, please contact Paula Fein (paula@DrugChannels.net).
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The Net Pricing Revolution in the Drug Channel: What’s Deflating the Gross-to-Net Bubble (rerun)

Fri, 10 Apr 2026 07:00:00 -0400
This week, I’m rerunning some popular posts while we prepare for today’s live video webinar: PBM Industry Update 2026: Trends, Challenges, and What’s Ahead.

Click here to see the original post from January 2026.

As I highlighted last week, we are entering the Net Pricing Drug Channel (NPDC) era—a market environment in which net prices, not list prices, determine access, economics, and competitive strategy. This shift represents a structural change in how value is created and captured across the U.S. drug channel.

The NPDC will:
Reward simpler pricing models

Penalize rebate-heavy strategies

Expose business models built on gross-to-net arbitrage

Force channel participants to rethink how they add value when money flows more transparently through the system
The short video below, excerpted from my recent Drug Channels Outlook 2026, explains why this shift is accelerating.

It walks through the key forces now deflating the gross-to-net bubble and explains how manufacturers and other channel participants are responding.

Can’t see the video? Click here to watch the NPDC clip.

For a deeper, data-driven look at the trends, market forces, and policy developments shaping the U.S. drug channel in 2026 and beyond, watch the full webinar replay and download the complete slide deck.

ADDITIONAL BACKGROUND AND ANALYSIS

For more context on the emergence of the Net Pricing Drug Channel and the slowdown in the gross-to-net bubble’s growth, see these Drug Channels articles:
U.S. Brand-Name Drug Prices Fell in 2025 as the Net Pricing Drug Channel Emerges

Gross-to-Net Bubble Hits $356B in 2024—But Growth Slows to 10-Year Low

List Price Reductions Will Deflate the Gross-to-Net Bubble–and Threaten Pharmacy and 340B Profits from IRA-Negotiated Drugs

© 2006-2026 HMP Omnimedia, LLC d/b/a Drug Channels Institute, an HMP Global Company. All rights reserved. This Feed is for personal non-commercial use only.

The FTC Blows Up Express Scripts’ PBM Model—and Launches the Net Pricing Drug Channel (rerun)

Thu, 09 Apr 2026 07:00:00 -0400
This week, I’m rerunning some popular posts while we prepare for tomorrow’s live video webinar: PBM Industry Update 2026: Trends, Challenges, and What’s Ahead.

In February, I posted a few follow-up comments reflecting on Mark Cuban's reaction to the settlement.

Click here to see the original post from February 2026.

Earlier today, the Federal Trade Commission (FTC) announced an extraordinary settlement with Express Scripts that fundamentally reshapes its pharmacy benefit management (PBM) business—and by extension, the entire drug channel.

The settlement addresses virtually every warped incentive that we have been covering on Drug Channels for the past 20 years. I summarize them below, but it’s worth reading the full document (links below) to appreciate just how completely the FTC has dismantled the existing PBM business model.

One small caveat: Plan sponsors could provide a loophole for business-as-usual. (See Section XI.)

But as I predicted in the Drug Channels Outlook 2026 webinar, we are entering the Net Pricing Drug Channel (NPDC) era.

William Gibson once said: “The future is already here–it's just not evenly distributed.” That future just arrived for one of the biggest PBMs. Get ready.
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Interview with Biotricity CEO Waqaas Al-Siddiq

Thu, 10 Feb 2022 06:37:56 -0500

Many computer engineers grew up playing video games, but Waqqas al-Siddiq had a more traditional Canadian upbringing, hunting and enjoying the cold, expansive outdoors. Maybe it was the tracking of game that led him into remote monitoring with design roles at IBM and Intel?

Now, as founder and CEO of Biotricity, Waqqas is providing leading edge biometric monitoring for medical and consumer markets with an emphasis on diagnosis and post-diagnostic products for chronic illness and wellness.

The lead product, Bioflux is a single unit mobile cardiac telemetry device with real-time monitoring and data transmission. Additional solutions include Biocare Telemed, and Bioheart a consumer oriented product.

He’s recently read Sapiens –which he doesn’t really recommend, and Guns, Germs, and Steel -which he does.

CNS drug development roundtable with Annovis and Clene

Thu, 20 Jan 2022 06:52:00 -0500

Alzheimer’s, Parkinson’s, ALS, MS –these are all serious or fatal neurodegenerative diseases that lack effective treatments. Thankfully, innovative companies are developing promising, novel therapies in the field.

Maria Maccecchini is founder and CEO of Annovis Bio, which is focused on improving axonal transport. Robert Glanzman is Chief Medical Officer of Clene, whose approach relies on nanotherpauetics. Our discussion centers on the particular challenges in developing CNS drugs, how Maria and Robert have steered their companies throughout the last two challenging years, and what they hoped to achieve during the JP Morgan Healthcare Conference.

The companies’ approaches –one drug increases energy and the other speed– could be synergistic. If that ends up being the case, remember it all started here on the HealthBiz podcast.

The HealthBiz podcast is available on Spotify, Apple Podcasts, Google Podcasts, YouTube and  many more services.

By healthcare business consultant David E. Williams, president of Health Business Group.

Interview with Qualio CEO Robert Fenton

Thu, 06 Jan 2022 09:39:19 -0500

Qualio CEO Robert Fenton

Robert Fenton was born in Ireland, where he studied pharmacy but then quickly figured out the pharmacist life was not for him. In a stint at big pharma he did come to realize the importance of quality and how it’s not so easy to live up to what you’ve promised, even as a large company with ample resources.

When Robert founded Qualio a decade ago, he already had a remote work approach –which he now prefers to describe as “local everywhere.” Obviously the world has come to his side over the past couple years.

The company’s quality management system (or eQMS) offering is based on the 12 pillars of quality. It’s built for pharma, med device, software as a med device and even cannabis companies.

Unlike some of the legacy players, Qualio is used throughout the full life sciences ecosystem including by labs, CROs and packaging companies. And although many of the customers listed on Qualio’s website are on the smaller side, Robert boasts that many of the highest profile IPOs are clients and that some of the big boys who are household names use Qualio, too.

The HealthBiz podcast is available on Spotify, Apple Podcasts, Google Podcasts, YouTube and  many more services.

By healthcare business consultant David E. Williams, president of Health Business Group.

Essen and Verustat partner on remote patient monitoring. Podcast with Sumir Sahgal, MD

Thu, 16 Dec 2021 06:31:21 -0500

Sr. Sumir Sahgal

Dr. Sumir Sahgal started Essen Health in the Bronx more than 20 years ago to help underserved patients get the care they need to prevent and treat illness. The patient-centered approach has helped Essen grow to almost 30 multi-specialty offices in the Bronx, Brooklyn, Queens and Long Island.

Essen has pioneered innovative approaches and leveraged technology to meet patient needs. In this edition of the HealthBiz podcast Dr. Sahgal describes Essen’s partnership with Verustat, a remote patient monitoring company that provides a platform making it easy for patients to monitor blood pressure, blood sugar and other physiological measures and to get medical and technical help when they need it.

The HealthBiz podcast is available on Spotify, Apple Podcasts, Google Podcasts, YouTube and  many more services.

By healthcare business consultant David E. Williams, president of Health Business Group.

Healthcare predictions for 2022

Tue, 30 Nov 2021 07:47:39 -0500

Looking ahead

Pandemics, wars and other large-scale dislocations lead to fundamental changes in the ensuing years and decades. Two years into COVID-19, I’m ready to hazard a few guesses about what lies ahead for healthcare. These 7 changes should start becoming visible in 2022. Some are more COVID-related than others.

Please share your feedback: dwilliams@healthbusinessgroup.com.

Retailers make care more consumer friendly

COVID becomes less political

Cybersecurity threats in healthcare get bigger and scarier

Consumers stake a claim to their own health data

Climate change becomes a major healthcare issue

Clinical trials simultaneously decentralize and centralize

Old age is pushed back

1. Retailers make care more consumer friendly

Hospital-based health systems are trying to be consumer-centric, but few are succeeding. Some with the best-trained and most capable clinicians talk a good game but are hellish to deal with as a consumer: gaining initial access, scheduling, waiting, follow-up, electronic communications, billing, etc. Here I’m writing from personal experience in Boston, including a recent consumer nightmare that was resolved only when the CEOs of my health plan and hospital agreed to intervene.

Retailers are stepping into healthcare and definitely have a more consumer friendly mindset. The real questions are whether they can address the challenges that make healthcare delivery harder than other consumer services and can overcome the conflicts inherent in third-party reimbursement. I’m most bullish on Walgreens with its recent VillageMD and CareCentrix investments, which take the company directly into primary care and care at home. Walmart — despite its healthcare executive turnover and lack of clear top-level commitment to healthcare—comes second because of its laser focus on reducing costs. It’s in their DNA and matters hugely to consumers.

Amazon has massive potential, of course but I’ve yet to be persuaded that their hard-charging approach will play out in care delivery, especially without a physical footprint. And I’ve never bought into the logic of the CVS/Aetna combination nor been impressed with CVS’s IT infrastructure.

If retailers succeed, there’s a chance they –and other enlightened and well-capitalized primary care providers– will take over the primacy now enjoyed by hospital-based Integrated Delivery Networks (IDNs). This could happen rather fast, thanks to Medicare’s Direct Contracting program, which offers primary care providers major influence on referrals and spending, plus access to patient data. If big primary care providers like Walgreens’ Village MD learn how to manage this opportunity well, Medicare Advantage and commercial risk will follow quickly.

Alternative payment model experts such as Archway Health are showing risk-bearing physician groups (not just retailers) how to gain up to 20x in Medicare revenue overnight under Direct Contracting, and how to actively manage specialist and hospital referrals without being dictated to by IDNs.

2. COVID becomes less political

The response to COVID in the US –and parts of Europe and Latin America—has been blunted by political divisions. COVID denial, vaccine ‘hesitancy,’ and anti-mask sentiment are the kinds of barriers I’m talking about. But divisions are already receding.

What’s behind the rosy outlook? Vaccines work well enough that the vaccinated are not so badly threatened by the unvaccinated. And new COVID treatments mean even almost everyone can be kept out of the hospital, assuming real world experience matches clinical trial results.

Paradoxically, vaccine mandates will make COVID less political over time, even if they inflame tensions in the near term. As my father, retired Chief Scientist for the Insurance Institute of Highway Safety recounts, when seat belts were first available, less then 10 percent of people used them. State laws drove usage toward 90 percent, despite the contention that belt use was a matter of personal freedom and misguided beliefs that belts could harm people by trapping them in their cars or causing injuries during a crash.

Seat belts are not political now. Once people started buckling up, they reconciled their views to their actions. The same can happen with vaccines.

This prediction could be completely wrong. Right now, the Omicron variant is turning countries against one another, Merck’s pill is showing weaker results than expected, and there are political leaders actively promoting division and the politicization of everything. But I’m sticking with a more optimistic view.

3. Cybersecurity threats in healthcare get bigger and scarier

Ransomware made the news in 2021 as hospitals were hit by an unprecedented wave of attacks. It was expensive for hospitals and insurance companies, and a hassle for employees. But few patients were directly affected. That has the potential to change dramatically.

The whole information economy –but especially healthcare—is built on a flawed foundation. Microsoft Windows, which powers computers, networks and many medical devices is intrinsically insecure. Devices from MRIs to ventilators are stuffed with hackable microcontrollers that are rarely secured properly.

Cyber dangers are built right into the business models of certain equipment vendors, whose service and warranty agreements forbid customers or third parties from auditing or updating their equipment. These agreements effectively lock in vulnerabilities, such as when vendors apply custom patches to outdated Windows XP based systems and neglect to penetration test them regularly.

The danger is not limited to hospitals and medical devices. Pharmaceutical development and manufacturing are vulnerable to threats ranging from spyware, to ransomware, to malware that ruins batches and even shuts down or destroys production equipment.

Things may get worse before they stabilize or improve. For example, new Internet of Things (IoT) sensor networks will multiply the attack surface if deployed on insecure infrastructure.

Unlike financial services and defense, healthcare as a whole lacks the sophistication, resolve and funding to stop cyberattacks. Large-scale cyberattacks in healthcare are not inevitable, but the industry is among the economy’s most vulnerable and becoming more so.

4. Consumers stake a claim to their own health data

Data tokenization by Datavant and HealthVerity enables mixing and matching of disparate sources at the patient level and the generation of valuable clinical and commercial insights. We are witnessing rapid growth of the real-world data ecosystem and tremendous value creation.

But individual patients –whose data are being leveraged to build these fortunes—are not really in the conversation and are certainly not benefiting financially. At a recent health data conference, I heard CEOs confidently assure the audience that patients were grateful to be able to contribute their data for the betterment of others.

That sounded pretty self-serving to me, and I heard a few whispers to the same effect.

In 2022 I expect patients to start waking up and asserting themselves, even if the impact is limited initially. We won’t see many companies paying patients for their data, but there will be more of an effort to let individuals control how their data are used and to receive something of value in return. A few companies such as Ciitizen (recently acquired by Invitae), Picnic Health, and Seqster give patients control of their medical and health data and some chance to benefit from it in their care journeys. RxRevu’s founder is launching a new venture (I’m on the advisory board) to take the concept even further.

If you’re skeptical that consumers will wake up, look to Europe where GDPR –the European General Data Protection Regulation– has made consumers much more aware of the information being collected about them and how it’s used. GDPR also includes provisions for individuals to request their own information and to have it deleted. Similar concepts are progressing in the US, starting with the California Consumer Privacy Act.

Healthcare data is a little different, but not completely distinct. The 21^st Century Cures Act enables patients to get easy access to their medical data and share it with others. Its full implementation will put patients in the driver’s seat. Now patients just need to learn how to drive and figure out where to go.

5. Climate change becomes a major healthcare issue

I’ve worried about climate change for a long time, though until about five years ago I thought it would affect my grandkids, not me. Weird and wild weather induced by climate change is here now, though, causing disruptions to the rich as well as the poor. Hurricanes, fires, floods and the rapid emergence of new pathogens are already wreaking havoc beyond expectations. It’s going to get a lot worse -even if it’s not always apparent year to year.

Emerging health problems include heat-related illnesses, water-borne and vector-borne diseases, and injuries from extreme weather. Psychiatrists are also seeing patients with a new complaint: climate anxiety. Good luck curing that one!

Near-term imperatives are to build more resilient healthcare infrastructure (like hospitals with backup generators on the roof), restore and improve global health surveillance, and direct research and development dollars to prevent and cure new diseases. Some expect pandemic-induced public health spending to decay once the immediate crisis recedes. I don’t think so. Instead, there will be sustained public and private investment because we’re not going back to the old normal.

6. Clinical trials simultaneously decentralize and centralize

The weird thing about “decentralized” clinical trials (DCTs) is that they actually involve more centralization than traditional trials. DCTs –sometimes called “virtual” trials—have been discussed for years but radically accelerated during the pandemic. DCT enablers including Medable, Science 37 and Curavit have captured investor imagination and raised hundreds of millions.

The notion is that patients in clinical trials for new drugs and devices should not have to travel to a physical site –usually a hospital or clinic—to be examined, observed and measured. Remote monitoring, video calls, and electronic surveys should suffice. It’s not easy to run trials this way, but initial results are promising. Trials enroll patients faster and data integrity is high.

It’s the patients in these trials that are decentralized. Instead of going into one of a few or several sites, each patient becomes a site. But the trial sponsor has the opportunity to centralize functions –such as recruiting, drug supply, and payments– rather than spreading resources to multiple physical sites. That’s a positive for everyone –except the traditional sites that lose out on the work.

Sponsors are committed to increasing diversity in trials so participants more closely match the racial, ethnic, language, age, gender and geographic profiles of those affected by the condition being addressed. DCTs are a promising way to achieve diversity. Science 37 is emphasizing this advantage; Diversity & Inclusion is one of its five main offerings.

Expect to see more DCTs, especially as sponsors compete for the attention of the limited number of patients who are candidates for trials. Patients with certain (i.e., lucrative-to-pharma) diseases often have a choice of trials and enroll based on convenience. Not surprisingly, consumer-oriented providers are turning their attention to trials. CVS Health is introducing clinical trials services and 2020 On-site shifted its mobile vision clinics from exams for employers to exams for clinical trial sponsors.

To really increase recruitment, we could allow sponsors to pay subjects to participate in trials and stop worrying so much about offering “unfair inducements.” I’m not predicting that change for 2022, however.

7. Old age is pushed back

We still label people as “seniors” when they turn 65, just like we did 50 years ago when life expectancy was almost 10 years lower. Today’s typical 75-year-old is more like the 65-year-old of yore in terms of health and productive years ahead. But COVID strikes older people hard, and those as young as 50(!) were put in the “old” column for pandemic safety purposes. Therefore, if I’d made this prediction in early 2020 I would have been dead wrong. But with higher vaccination rates and better treatments, older people will breathe easier, get back to work and stay there.

Why? They are needed in the workforce to address shortages caused by the Great Resignation and reduced immigration –especially in healthcare– and with the shift from defined benefits to 401(k) accounts they don’t have enough saved for retirement.

Another thing I’ve noticed is that young adults don’t shun seniors the way my generation did, so the workplace should become less hostile for the aging.

That’s a happy note to end on.

Health Care First Steps for President Biden and the Democratically Controlled Congress

Wed, 20 Jan 2021 12:27:53 -0500
After four years of the Trump administration's undermining of The Affordable Care Act/Obamacare, what can we expect over the next few months from the new administration?On the regulatory side, not as much as you might expect.During the campaign Biden talked about building on the law's success in covering the people it has covered––primarily through the Medicaid expansion and for lower income

President-elect Biden wants to make health care better, but it won’t come easy

Wed, 11 Nov 2020 16:08:00 -0500

When ACP released its Visionfor a Better US Health Care System in January, we could not have anticipated that a global pandemic would soon reach our country, and 10 months later, be responsible for deaths of more than 240,000 Americans, many millions more being sickened, and hospital beds again in short supply because of another dangerous surge in cases.

But it turns out that ACP’s vision was prescient in identifying fundamental deficiencies in US health that have worsened the toll from COVID-19. Losing your insurance because you lost your job. Living in a state that has not expanded Medicaid. Being faced with high deductibles and excessive prices even if insured. Discrimination and racism that contributes to poor health. Living in communities that are underserved, neglected, and poor. A failure by the US to invest and support public health and primary care. These are all risk factors for getting sick and dying from COVID-19, just like being old and having chronic conditions like diabetes and heart disease.

You might even say that the United States itself has multiple chronic diseases of its health care system, making it far more vulnerable to COVID-19 than many other countries.

While many issues influenced how Americans cast their votes on November 3, the performance of President Trump and his administration on COVID-19 certainly was one of them. By electing Joseph R. Biden as the next president, and Kamala D. Harris as the next Vice President, voters elected the candidates who promised a major shift in how the US government addresses health care. Voters may have hedged their bet, though, by maintaining GOP control of the Senate, depending on the outcome of two special elections in Georgia. Democrats have to win both Senate seats up for grab in Georgia on January 5 to slit the Senate 50-50, with Vice President Harris being available to cast tie-breaking votes. Should the Republican candidate win either or both, Senator Mitch McConnell (R-KY) will remain the Senate’s Majority Leader and be able to impede much of a Biden administration’s legislative agenda. The filibuster will still require 60 Senate votes on most legislation. The House of Representatives will remain under Democratic control, but with a smaller majority.

The Biden transition website, Build Back Better, lists COVID-19, racial equity, and climate change, and economic recovery, as the top 4 initial priorities for the new administration. Getting Congress to enact legislation to advance policies in these and other areas will be difficult. Still, there is a lot a Biden administration can do to make health care better, even without Congress:

COVID-19: President-elect Biden already is charting a different course on COVID-19 than President Trump, announcing a COVID-19 Task Force composed of physicians and other health experts, co-chaired by former Surgeon General and ACP member Vivek Murthy. He is expected to seek a national mandate to wear masks, using the administration’s regulatory authorities to require it in federal facilities and contractors and in public transportation, while seeking support from the states’ governors for a broader mandate. He pledges to have science and scientists lead the public health response, rejoin the World Health Organization as recommendedby ACP, address lack of supply of personal protective equipment, and expand testing and tracing.

Coverage and cost: A Biden administration can use its executive authority to expand coverage under the ACA, in ways recommended by ACP in its New Vision papers and other policy statements. It can begin to reverse Trump administration rules that allow sale of plans that do not cover the 10 categories of essential benefits required of other ACA-compliant plans. It can increase funding and support for ACA outreach and enrollment and stop states from imposing work requirements as a condition for Medicaid coverage.

President-elect Biden’s more ambitious plans to move the country closer to universal coverage will face an uphill battle. Congress would need to enact legislation to expand Medicare to persons aged 50 through 64, create a public option available to everyone, automatically enroll people in non-Medicaid expansion states in the public option, and lift the income caps on federal subsidies to buy health insurance coverage. Of these, lifting the income caps might be more likely to command bipartisan support, because it would extend subsidies to people with incomes over 400% of the Federal Poverty Level, many of whom have been priced out of coverage. A Biden administration will seek to rein in prescription drug prices, but Congress is unlikely to allow the federal government to negotiate Medicare Rx prices, or eliminate the tax deductibility for direct-to-consumer advertising.

Immigration: As President Trump has shown, presidents have a lot of power to shape immigration policy, without needing to go through Congress, and the courts generally defer to the executive branch. The Biden administration will begin reversing immigration policies that have an adverse impact on health, one of ACP’s top priorities. President-elect Biden has promised that on the first day of his administration, he will terminate the Trump administration’s ban on travel from 7 majority-Muslim countries, restore the DACA program to protect “Dreamers” from deportation, end the practice of separating children from their parents at the border, and appoint a federal task force to re-unite immigrant children who were separated—all actions strongly supported by ACP.

The new administration can take action to address the backlogin visas for international medical graduates (IMGs) seeking permanent residency status, and to ensure the effective and efficient processing of visas for IMGs seeking to enter the United States. It can also begin the process of reversing the public charge rule, which denies residency to legal immigrants if they are likely to use public programs like Medicaid, which ACP has said is a major barrierto legal immigrants getting the health care they need.

Women and LGBQT health: The Biden administration is expected to begin to reverse restrictions on federal funding for Planned Parenthood and on physicians who counsel women on abortion or provide abortion services themselves—as called for by ACP. It may seek to expand the ACA’s essential benefit requirements to ensure coverage for the full range of women’s health, and roll back so-called employer conscience exemptions that allow them to exclude contraception from coverage, although a Supreme Court decision may stand in their way. President-elect Biden pledged to codify Roe v. Wade into federal law, as a hedge against future Supreme Court decisions to overturn or curtail the constitutional right to abortion; this though would require that such legislation pass both the House and Senate, which is very unlikely. Similarly, the Senate would likely reject his call for Congress to end the Hyde rule, with prohibits federal funding for abortion. As ACP and other organizations representing frontline physicians have advocated, the new administration is expected to reverse federal regulations and executive actions that weakenprotections for LGBQT persons

Climate change: As called for by ACP, President-elect Biden has promised to rejoin the Paris Accord on the first day of his administration, which would recommit the United States to specified targets for reducing carbon emissions. He can begin the process of reversing Trump administration regulations that eased restrictions on carbon emissions and opened up more federal lands to drilling for oil. His more ambitious plans to promote green technologies and achieve a carbon-free power sector by 2035 likely will be stymied by the Senate, although the new administration can be aggressive in using its executive authority to achieve as much of this agenda as it can.

Racism and health: There are many things a Biden administration can do to address racism, discrimination, and related health disparities, only some of which require legislation from Congress. It can reverse a Trump administration Executive Order that prohibits implicit bias training for federal employees and contractors as called for by ACP and AAMC, redirect federal funding and priorities to addressing social drivers of health, prioritize persons that are at the greatest risk of COVID-19 because of where they live and their race or ethnicity, have the Department of Justice address inequities in sentencing and legal representation particularly for capital offenses, and seek bipartisan solutions to system racism in law enforcement, although much of the latter likely will require legislation at the state and federal levels. As important as specific policies are, President Biden and Vice President Harris can speak to the need for the United States to extend justice, fairness, diversity, equity, and inclusion to all and support Black Lives Matter, rather than seeking to undermine such goals. ACP welcomes the opportunity to advocate for policies to address the impact of racism and discrimination on health care.

There are initiatives from the Trump administration that ACP will urge the Biden administration to continue, or even expand, including implementing higher Medicare payments for office visits, putting patients over paperwork, easing documentation and reporting requirements, and expanding coverage and payment for telehealth visits and phone calls.

In Envisioning a Better U.S. Health Care System for All: A Call to Action by the American College of Physicians, we wrotethat “U.S. health care costs too much; leaves too many behind without affordable coverage; creates incentives that are misaligned with patients' interests; undervalues primary care and public health; spends too much on administration at the expense of patient care; fails to invest and support public health approaches to reduce preventable injuries, deaths, diseases, and suffering; and fosters barriers to care for and discrimination against vulnerable individuals.” [Disclosure, I was the lead author for this Call to Action]. COVID-19 has shown us how true this is. President-elect Biden now has the opportunity to advance polices to make health care better, and ACP stands ready to assist him, no matter how difficult it may seem.

Trump Calls for Making Permanent Cuts to Social Security Payroll Taxes

Mon, 31 Aug 2020 11:16:26 -0400
President Trump said over the weekend, "If I'm victorious on November 3rd, I plan to forgive these [payroll taxes for Social Security] and make permanent cuts to the payroll tax." Currently, employers and employees split the 12.4% payroll tax on the first $137,700 of 2020 earnings and also split the 2.9% Medicare tax on all earnings. The self-employed pay the entire tax.Trump not only wants to

Why Are Trump and the Republicans So Afraid of Competition When It Comes to Drug Prices?

Mon, 24 Aug 2020 16:54:45 -0400
President Trump recently signed two executive orders directly related to prescription drug prices in the U.S.One order would allow the "reimportation" of prescription drugs from Canada. This longstanding idea would allow U.S. pharmacies and drug wholesalers the ability to pay generally much lower prices for their prescription drugs by getting them from Canadian suppliers who benefit from