Our editor Laura Hughes highlights her five must-read articles for this week.

The agency continues to offer guidance about COVID-19 treatments and testsâand issue warnings to companies that fall out of line.

This week, I’m rerunning some popular posts while I prepare for this Friday’s video webinar: Industry Update and COVID-19 Impact: PBMs & Payers.

I suspect this deal will remain profitable for the participating companies even as COVID-19 alters the US. prescription payer mix. Click here to see the original post and comments from January 2020. National market shares for the largest PBMs in 2019 appears as Exhibit 88 of our 2020 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

P.S. Sorry that today's meme is one day too late for Star Wars day.

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Just before the holidays, Cigna’s Express Scripts business announced a market-changing deal with Prime Therapeutics. Click here to read the press release.

There's been very little written about this transaction, though it has potentially major implications. Below, I share my thoughts on the following topics arising from the deal:

• Implications for manufacturers and pharmacies

• The role of the secretive Ascent Health Services

• What this all means for Walgreens

• Why the Federal Trade Commission won’t challenge the deal

A few weeks ago, I explained why integrated insurer / PBM / specialty pharmacy / provider organizations are poised to restructure U.S. drug channels. The Express Scripts / Prime deal signals that the channel will continue its amazing pace of reinvention.

The scale, scope, and interconnectedness of today’s market participants make the system increasingly resistant to massive disruption from either external players like Amazon or a government takeover. Like it or not, the channel will continue to gain power and extract profit. Read on and see if you agree.
Read more »

That emotion is natural in a situation like this, but there are ways to mitigate it

-- Read more on ScientificAmerican.com

The search for a COVID-19 treatment has ramped up this week, with two new studies detailing the efficacy of Gilead’s antiviral therapy remdesivir in the treatment of patients hospitalised with coronavirus, while researchers in America have been studying famotidine, the active ingredient in Pepcid, as a potential drug to help alleviate symptoms of the virus.

Two antibody cocktails for COVID-19 could be available as early as this autumn

Four individuals were sentenced this week for their respective roles in trafficking the identities and corresponding identity documents of Puerto Rican U.S. citizens.

It is "inconceivable" that immunity will not remain high on the list of health priorities when this pandemic ends and now is the time to create more "convincing experiences" to ensure trial turns into adoption, according to food and drink research and branding experts.

From : Communities>>Regulatory Open Forum
Great! Thanks Anna --------------------------------- Anna Alonzi MD Sr. Regulatory Associate Newtown PA United States ---------------------------------

From : Communities>>Regulatory Open Forum
Annie: Thank you for sharing this news.  I am curious whether the Board considers this a limited exception or a potential new normal option going forward? Scott ------------------------------ Scott Bishop Houston TX United States ------------------------------ ------------------------------------------- Original Message: Sent: 04-May-2020 08:50 From: Annie O'Brien Subject: New: Take the RAC Exams Online this Summer! The RAC board has been working hard to find solutions offering more flexibility [More]

Wednesday’s initial public offering for Cambridge-based Ra Pharmaceuticals marked the ninth biotech startup to go public this year, tying the number in 2013 but still less than either of the two years since. Ra (Nasdaq: RARX), which has 40 employees in one of the former Pfizer buildings in Alewife, ended up with the third-largest IPO size for any Massachusetts-based biotech in 2016, with a total of $92 million raised from the sale of 7 million shares for $13 each. That’s more than the $86 million…

by Charles Ornstein and Lena V. Groeger

Nursing home residents have been among those hardest hit by the new coronavirus. In some states, more than half of the recorded deaths have been long-term care residents. Some of the homes have been cited for putting residents at “immediate jeopardy” of harm or death, our analysis showed.

And many of the affected homes have been previously written up for violating federal standards. That’s true in California, New Jersey and New York.

We’re updating Nursing Home Inspect to include more information about nursing homes across the country, including past problems with infection control practices, and which ones have had cases of COVID-19 among residents or staff.

We introduced this resource in 2012 as a way to search through tens of thousands of nursing home inspection reports to find problems and trends.

You can easily compare the nursing homes in your state based on how many times they have been cited for violating infection control protocols in the past three inspection cycles (roughly three years). We’ve also added data from The Washington Post on homes with COVID-19 cases. Nursing Home Inspect also allows you to sort by the number of health deficiencies cited by regulators; the number of serious deficiencies per home (that is, deficiencies in which patients were put in immediate jeopardy of harm); the amount of fines imposed; and how often the government has suspended payments to the home for new patients, another type of penalty.

Our data is from the U.S. Centers for Medicare and Medicaid Services (CMS), which has its own website called Nursing Home Compare. We’ve taken the information and organized it into an easy-to-use resource for families and residents, as well as researchers and other journalists.

Our site includes:

• State pages: Every state has its own section that allows you to compare all of the homes in a state on a variety of indicators.

• Individual nursing home pages: Every home has a section listing all of the health deficiencies identified within the past three survey cycles (roughly three years). The full text of these deficiency reports, if available, can be accessed via links from this page to CMS. Each home’s page also has ownership status — whether for-profit, government-run or nonprofit — and whether the home has been labeled by the government as a Special Focus Facility, meaning that it has many more problems than other homes. We’ve also labeled Special Focus Facility candidates, which meet the criteria to be a special focus facility but haven’t yet been designated as one. (We only include health deficiencies, not fire and safety violations, in this database.)

• State-by-state maps: The main page of the app shows how states compare in terms of the percentage of homes with at least one serious deficiency, the average fine paid by homes in the state, and the percentage of homes in each state with at least one infection-related deficiency.

• Top 20 Lists: We’ve listed the homes that have paid the most in fines in the nation and those with the highest number of serious deficiencies.

If homes violate federal standards, CMS may impose fines or suspend Medicare/Medicaid payments to the nursing home for new residents until the facility corrects the deficiency.

If problems persist or are not fixed, CMS can end its agreement with the nursing home. Additional details about CMS’ approach to enforcement can be found here.

Nursing Home Inspect continues to allow you to search through nearly 80,000 inspection reports by keywords, such as “choke” or “maggots,” to look for issues you care about. These search results can be sorted by date, city, state or severity of the deficiency.

Nursing homes are inspected on both a regular schedule and when there is a complaint. Inspectors typically work for state agencies paid by Medicare. If they find problems, known as deficiencies, they rank them on a scale of A to L, the most severe. The vast majority are either labeled D or E.

What you won’t find on these pages are self-reported quality measures for each home. Those can be found on Nursing Home Compare. We also don’t list the state sanctions imposed against homes because those are not centrally collected. For information on penalties within a given state, you should consult the state agency that regulates nursing homes. The federal government has a list of contacts available here.

When reading through inspection reports, it is a good idea to keep in mind the caveats we’ve outlined previously.

How We Combined Data Sources

To compile our app, we used different datasets: a listing of all Medicare-certified nursing homes, inspection violations and penalties, and deficiency report narratives.

We merged spreadsheets containing findings from routine inspections and those identified during complaint visits and kept only health violations, not fire safety violations.

We used each home’s unique identification code to match penalties imposed to the dates of their corresponding inspections so we could display that data together for each home. (We also noted some cases in which a penalty date did not have a corresponding inspection in the database.)

You can find the data we used on these sites:

• For a list of nursing homes: https://data.medicare.gov/Nursing-Home-Compare/Provider-Info/4pq5-n9py

• For penalties: https://data.medicare.gov/Nursing-Home-Compare/Penalties/g6vv-u9sr

• For health deficiency information: https://data.medicare.gov/Nursing-Home-Compare/Health-Deficiencies/r5ix-sfxw

• For deficiency report narratives (updated in April 2020): http://downloads.cms.gov/files/Full-Statement-of-Deficiencies-April-2020.zip

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by Joaquin Sapien

New York Attorney General Letitia James is looking into allegations that a Queens adult care facility has failed to protect residents from the deadly coronavirus and misled families about its spread, according to two lawmakers who asked for the inquiry and a relative of a resident who spoke to an investigator with the attorney general’s office.

In a separate action Tuesday, three residents of the Queens Adult Care Center sued the facility in federal court over similar allegations.

Both developments were prompted largely by ProPublica’s recent coverage of the facility, which houses both frail elderly residents and those with mental health issues. On April 2, we reported that workers and residents at the home were becoming ill with the coronavirus as residents wandered in and out of the home without any personal protective equipment. Family members later told ProPublica the management said no residents were sick with the virus at the time.

On April 25, ProPublica published a story and a short film with the PBS series Frontline about the harrowing experience of Natasha Roland, who rescued her father in the middle of the night as he suffered coronavirus symptoms so severe he could barely breathe. Roland, in heart-wrenching detail, described how the management of the Queens Adult Care Center repeatedly assured her that her 82-year-old father, Willie Roland, was safe, even as the virus swept through the facility. She said workers were too scared to care for him, forcing his girlfriend, Annetta King-Simpson, to do so. King-Simpson later fell ill herself. Roland and King-Simpson are now suing the facility in federal court.

In an interview, Assemblywoman Catalina Cruz, whose district covers Corona, Elmhurst and Jackson Heights, said she was troubled by what ProPublica reported. She said she hoped the attorney general can determine whether the Queens Adult Care Center had broken any laws.

“It didn’t sit right with me. I thought something was off here. So I said let’s have the experts look at whether there was a crime or a civil violation,” she said. “Folks who live in this adult home deserve the same dignity as everyone else, and if their rights have been violated, someone needs to pay for that.”

Cruz said she had been suspicious of the facility for several years and had come across a community Facebook page where people posted complaints about treatment of residents at the center. When she saw the ProPublica stories, she said she decided to take action, along with City Council member Daniel Dromm, who had already written to the New York State Department of Health and the office of Gov. Andrew Cuomo about the spread of the coronavirus in the facility on several occasions.

“The plight of those living in adult care centers during this crisis was highlighted in a recent article published by ProPublica, which focused on the perils faced by the residents at the Queens Adult Day Care Center,” the lawmakers wrote in their April 27 letter to the attorney general and the governor’s office. “Failure to inform families about the health of loved ones, to lying and covering up deaths have become regular concerns we have received. We are aware that adult care centers are struggling to keep COVID-19 from affecting their residents and we also know that minorities have been disproportionately affected by the virus. It seems to us that management at this particular center have struggled to implement procedures and policies to protect the lives of its residents.”

Cruz said she received an update from the attorney general’s office on May 5, saying it was looking into the matter but would not provide specific details.

Days after the lawmakers sent the letter, Natasha Roland, 35, said she received a phone call from an investigator with the attorney general’s office. Roland said she recapped what she had previously told ProPublica: She began to worry about her father’s safety when nearby Elmhurst Hospital became a viral hot spot, but the management repeatedly told her there were no coronavirus cases in the facility. She said she only found out the truth weeks later when a worker she was friendly with advised her to come and pick up her father because the virus was raging through the facility and aides were becoming too scared to check on residents. In a subsequent interview, that worker denied telling Roland to pick up her dad.

A spokesperson for the attorney general would not confirm or deny a specific, active investigation into the Queens Adult Care Center, but said James has received hundreds of complaints related to COVID-19 inside nursing homes and adult care facilities across the state and is investigating many of them.

For its part, the Queens Adult Care Center has denied any wrongdoing and repeated its belief that Roland’s allegations are “baseless.”

“Sadly, select elected officials and ProPublica have been intentionally misled with baseless assertions and utter fabrications crafted by the daughter of one of our long-term residents,” said Hank Sheinkopf, a crisis communications spokesperson hired by the facility. “We have strong reason to believe that this individual is seeking to use her father and other select residents as pawns in an attempt to extort the facility. We are considering our legal options.”

He said the facility has “worked tirelessly” to protect its residents and is unaware of a “potential investigation,” but understood that “the AG’s office has contacted many nursing homes, adult care, and assisted living facilities seeking information. We are glad to be a resource to the AG’s office and have nothing to hide.”

Bruce Schoengood’s 61-year-old brother, Bryan, lives in the facility and shared a room with one of the first residents to become infected with COVID-19 and subsequently die of the disease. Bruce told ProPublica he only learned that his brother’s roommate had died by happenstance during a casual conversation with his brother, and that he has complained for more than a month about a lack of communication from the facility. He said he had not yet heard from anyone with the attorney general’s office but would welcome such a conversation.

In the meantime, Bryan Schoengood, Willie Roland and King-Simpson are suing the facility under the Americans with Disabilities Act. In a 59-page complaint, the group has asked a federal judge to appoint a special master to oversee the facility at the home’s expense to ensure that residents there are safe.

The lawsuit argues that residents have experienced a “gross failure to provide the most basic level of care to safeguard their health and safety in the context of a global health pandemic. People with disabilities are exposed to high risks of contracting the virus with no or few preventative measures in place. Residents who fall sick are left to languish in their room without proper access to medical care.”

The lawsuit claims that because the facility has failed to follow state and federal guidelines, “COVID-19 is rampant in the facility among residents and staff alike.”

Alan Fuchsberg is the Manhattan-based personal injury and civil rights attorney representing the three Queens Adult Care Center residents.

In an interview, he said that the facility may not have the resources to properly follow the guidelines, which is why a special master should be assigned to work with a team of outside experts to make sure it can.

“Right now the residents are in a tinderbox,” he said. “And if you drop a match in there, all hell breaks loose. It should be run right. We don’t need dozens of people dying in all our nursing homes and adult care facilities. Some are running better than others and QACC sounds like a place that is not run up to standards.”

He and Bruce Schoengood pointed out that they are not currently suing for damages, but rather to persuade a court to immediately intervene and offer support to the facility’s roughly 350 residents.

Schoengood said the goals of the lawsuit are twofold.

“I think it is both short term and long term,” he said. “Immediate intervention to put proper protocols in place to treat the sick and stop the spread of coronavirus and to communicate with family members. And in the long term I would like to see this facility much better prepared to handle another pandemic or a second wave.”

Responding to the charges in the lawsuit, Sheinkopf again said that “the allegations are baseless and utter fabrications. Queens Adult Care Center (QACC) continues to meet all state issued guidelines.”

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Consumers are turning to dietary supplements in record numbers, but the industry must deliver on the results the products are promising if the industry is to convert them to long term customers, says Steve Mister.

A major health agency fears a humanitarian crisis. Migrant workers are returning home from the hard-hit Dominican Republic. Medical equipment is in short supply. And social distancing is improbable.

For goodness sake, if you're going to hike, wear a mask.

The Ramirezes never thought the coronavirus would get them. They took every precaution, but the virus still found its way into their home. Over the course of days, each member of the 10-person household became infected. Three were hospitalized. And one, the family patriarch, died.

Carson Meyer, daughter of an NBCUniversal executive and sister of jewelry designer Jennifer Meyer, is reaching parents-to-be virtually in the COVID-19 age.

The coronavirus outbreak makes finding jobs more difficult for everyone. College seniors face unique career challenges.

City and county trails reopen this weekend. Almost every day, the rules change in the beaches and parks of Southern California. Here's the latest.

It is an "eerie" day in Seal Beach as businesses struggle to come back and crowds stay away.

Experts caution that even promising early results don’t guarantee that vaccines will be widely available anytime soon.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Unlike other members of this family, the eyes of the Ganges shark are tilted dorsally, instead of laterally or ventrally, indicating that it may swim along the river bed scanning the waters above for prey. Its sharp and slender teeth suggest that it is primarily a fi sh-eater. It is often confused with the bull shark, which is known to attack humans

The Aye-aye is endangered and on the IUCN red list due to hunting and habitat destruction caused largely by humans setting fi res, illegal logging, making charcoal, as well as agriculture and livestock expansion.

At this Idea Exchange, Iranian Ambassador Gholamreza Ansari says Tehran achieved what it wanted to in the Geneva nuclear deal.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.

Apr 24, 2020

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.