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Yahoo
12-06-2025
- Health
- Yahoo
RFK Jr.'s latest big move could leave you paying more for vaccines
Health Secretary Robert F. Kennedy Jr. sent shockwaves through the scientific community this week when he fired all 17 members of the federal government's key vaccine advisory board, raising concerns that he might try to replace them with immunization skeptics. Those fears were confirmed for many on Wednesday when Kennedy unveiled eight new members who included some of the most prominent critics of the COVID-19 vaccines. The swap could have wide-reaching public health consequences. But one of the most straightforward impacts may be on consumers' wallets. That's because recommendations by the board — known as the Advisory Committee for Immunization Practices, or ACIP — determine which vaccines most insurance plans are required to cover at zero cost, such as inoculation against measles or your annual flu shot. If the new members decide to reverse the panel's old guidance, patients could find themselves paying out of pocket for vaccines that were once available for free. 'For the average person who has never heard of ACIP before, this could affect their access to vaccines,' said Jennifer Kates, a senior vice president at the healthcare think tank KFF. Created in 1964, ACIP is the official outside panel of medical experts responsible for advising the Centers for Disease Control and Prevention (CDC) on what to include on its lists of routine shots for both children and adults. While its recommendations aren't binding, federal officials have typically adopted them. As a result, the board's decisions carry enormous weight, affecting patients and parents, as well as the vaccines schools require for students. Over the years, the panel has played a growing role in determining insurance coverage as well. By law, shots recommended by ACIP must be covered by the free Vaccines for Children program, the Children's Health Insurance Program, Medicaid, and Medicare Part D. The Affordable Care Act also requires private insurers to pay for vaccines with no cost sharing if they have the panel's seal of approval. (Past administrations have said the rule only applies if the CDC also adopts the board's recommendation.) In a Wall Street Journal op-ed this week, Kennedy said his decision to replace the board was meant to fight a 'crisis of public trust' in vaccines by ridding the committee of what he described as 'persistent conflicts of interest.' (Kennedy's critics have argued that his allegations against ACIP's former members are unfounded.) His new picks for the panel include several figures who rose to national fame by casting doubt on the safety of COVID-19 vaccines. Among them is Dr. Robert Malone, an accomplished scientist who did pioneering work on mRNA technology but later attacked its use in shots during the pandemic and who was at one point banned from Twitter for spreading COVID misinformation. He'll be joined by Retsef Levi, an MIT business school professor who gained attention in 2023 for claiming there was 'indisputable evidence' that 'MRNA vaccines cause serious harm including death,' and Dr. Martin Kulldorff, who advocated letting COVID spread among younger Americans to achieve 'herd immunity' and was later let go from Harvard Medical after refusing to be vaccinated. In his announcement, Kennedy said that each new member of ACIP was 'committed to demanding definitive safety and efficacy data before making any new vaccine recommendations' — suggesting they'll be less likely to add new shots to the government's immunization schedules. But he added that the board will also 'review safety and efficacy data for the current schedule as well,' raising the possibility that it will scrap some of its old recommendations. Even before this week's shake-up, the government had already begun changing its recommendations on COVID shots. In May, the CDC dropped its recommendation that healthy pregnant women receive the vaccine and revised its guidance for young children, saying they should only receive it after consultation with a doctor. Private insurers could still choose to cover vaccines even if the federal government stops recommending them. Whether they will is less certain. 'That's territory we haven't really had to traverse before,' said KFF's Kates. Sarah Moselle, a vaccine market expert at the health industry consulting firm Avalere, said there may be some 'fragmentation' in how carriers approach the issue. Some may drop coverage entirely or begin requiring co-pays. But many 'do anticipate that they would continue to cover some vaccines,' even if they aren't required to, since it would 'add value' for their customers, she said. In theory, insurers could also have an incentive to maintain vaccine coverage since it could keep their patients healthier and reduce the costs of their care, though it's unclear exactly how those savings would stack up against the added expense of paying for shots. For many vaccines, the out-of-pocket cost might be relatively cheap for patients. But others could turn out to be steep. Take Gardasil, the HPV vaccine that has been the focus of growing safety concerns among patients despite studies suggesting they're unfounded. Some experts told Yahoo Finance they thought the shot could be a target for more scrutiny under Kennedy's new ACIP. Currently, the shot is covered by insurance because it's recommended for pre-teens through young adults. The CDC lists its full price at over $300 a dose. Even modest costs can dissuade patients from getting vaccinated, according to Loren Adler, associate director at the Brookings Institution's Center on Health Policy. 'We know that folks having to pay $10 for a vaccine limits the uptake somewhat,' he said. As a result, just a small increase in what patients have to pay out of pocket could have ripple effects on public health. One issue to keep an eye on, according to Moselle, is whether state governments step in to require more extensive insurance coverage of vaccines if the federal government walks back some of its recommendations. If they do, vaccine access could start to vary more by where patients happen to live. Jordan Weissmann is a senior reporter at Yahoo Finance. Click here for in-depth analysis of the latest health industry news and events impacting stock prices
Yahoo
12-06-2025
- Health
- Yahoo
RFK Jr.'s latest big move could leave you paying more for vaccines
Health Secretary Robert F. Kennedy Jr. sent shockwaves through the scientific community this week when he fired all 17 members of the federal government's key vaccine advisory board, raising concerns that he might try to replace them with immunization skeptics. Those fears were confirmed for many on Wednesday when Kennedy unveiled eight new members who included some of the most prominent critics of the COVID-19 vaccines. The swap could have wide-reaching public health consequences. But one of the most straightforward impacts may be on consumers' wallets. That's because recommendations by the board — known as the Advisory Committee for Immunization Practices, or ACIP — determine which vaccines most insurance plans are required to cover at zero cost, such as inoculation against measles or your annual flu shot. If the new members decide to reverse the panel's old guidance, patients could find themselves paying out of pocket for vaccines that were once available for free. 'For the average person who has never heard of ACIP before, this could affect their access to vaccines,' said Jennifer Kates, a senior vice president at the healthcare think tank KFF. Created in 1964, ACIP is the official outside panel of medical experts responsible for advising the Centers for Disease Control and Prevention (CDC) on what to include on its lists of routine shots for both children and adults. While its recommendations aren't binding, federal officials have typically adopted them. As a result, the board's decisions carry enormous weight, affecting patients and parents, as well as the vaccines schools require for students. Over the years, the panel has played a growing role in determining insurance coverage as well. By law, shots recommended by ACIP must be covered by the free Vaccines for Children program, the Children's Health Insurance Program, Medicaid, and Medicare Part D. The Affordable Care Act also requires private insurers to pay for vaccines with no cost sharing if they have the panel's seal of approval. (Past administrations have said the rule only applies if the CDC also adopts the board's recommendation.) In a Wall Street Journal op-ed this week, Kennedy said his decision to replace the board was meant to fight a 'crisis of public trust' in vaccines by ridding the committee of what he described as 'persistent conflicts of interest.' (Kennedy's critics have argued that his allegations against ACIP's former members are unfounded.) His new picks for the panel include several figures who rose to national fame by casting doubt on the safety of COVID-19 vaccines. Among them is Dr. Robert Malone, an accomplished scientist who did pioneering work on mRNA technology but later attacked its use in shots during the pandemic and who was at one point banned from Twitter for spreading COVID misinformation. He'll be joined by Retsef Levi, an MIT business school professor who gained attention in 2023 for claiming there was 'indisputable evidence' that 'MRNA vaccines cause serious harm including death,' and Dr. Martin Kulldorff, who advocated letting COVID spread among younger Americans to achieve 'herd immunity' and was later let go from Harvard Medical after refusing to be vaccinated. In his announcement, Kennedy said that each new member of ACIP was 'committed to demanding definitive safety and efficacy data before making any new vaccine recommendations' — suggesting they'll be less likely to add new shots to the government's immunization schedules. But he added that the board will also 'review safety and efficacy data for the current schedule as well,' raising the possibility that it will scrap some of its old recommendations. Even before this week's shake-up, the government had already begun changing its recommendations on COVID shots. In May, the CDC dropped its recommendation that healthy pregnant women receive the vaccine and revised its guidance for young children, saying they should only receive it after consultation with a doctor. Private insurers could still choose to cover vaccines even if the federal government stops recommending them. Whether they will is less certain. 'That's territory we haven't really had to traverse before,' said KFF's Kates. Sarah Moselle, a vaccine market expert at the health industry consulting firm Avalere, said there may be some 'fragmentation' in how carriers approach the issue. Some may drop coverage entirely or begin requiring co-pays. But many 'do anticipate that they would continue to cover some vaccines,' even if they aren't required to, since it would 'add value' for their customers, she said. In theory, insurers could also have an incentive to maintain vaccine coverage since it could keep their patients healthier and reduce the costs of their care, though it's unclear exactly how those savings would stack up against the added expense of paying for shots. For many vaccines, the out-of-pocket cost might be relatively cheap for patients. But others could turn out to be steep. Take Gardasil, the HPV vaccine that has been the focus of growing safety concerns among patients despite studies suggesting they're unfounded. Some experts told Yahoo Finance they thought the shot could be a target for more scrutiny under Kennedy's new ACIP. Currently, the shot is covered by insurance because it's recommended for pre-teens through young adults. The CDC lists its full price at over $300 a dose. Even modest costs can dissuade patients from getting vaccinated, according to Loren Adler, associate director at the Brookings Institution's Center on Health Policy. 'We know that folks having to pay $10 for a vaccine limits the uptake somewhat,' he said. As a result, just a small increase in what patients have to pay out of pocket could have ripple effects on public health. One issue to keep an eye on, according to Moselle, is whether state governments step in to require more extensive insurance coverage of vaccines if the federal government walks back some of its recommendations. If they do, vaccine access could start to vary more by where patients happen to live. Jordan Weissmann is a senior reporter at Yahoo Finance. Click here for in-depth analysis of the latest health industry news and events impacting stock prices
Yahoo
12-06-2025
- Health
- Yahoo
RFK Jr.'s latest big move could leave you paying more for vaccines
Health Secretary Robert F. Kennedy Jr. sent shockwaves through the scientific community this week when he fired all 17 members of the federal government's key vaccine advisory board, raising concerns that he might try to replace them with immunization skeptics. Those fears were confirmed for many on Wednesday when Kennedy unveiled eight new members who included some of the most prominent critics of the COVID-19 vaccines. The swap could have wide-reaching public health consequences. But one of the most straightforward impacts may be on consumers' wallets. That's because recommendations by the board — known as the Advisory Committee for Immunization Practices, or ACIP — determine which vaccines most insurance plans are required to cover at zero cost, such as inoculation against measles or your annual flu shot. If the new members decide to reverse the panel's old guidance, patients could find themselves paying out of pocket for vaccines that were once available for free. 'For the average person who has never heard of ACIP before, this could affect their access to vaccines,' said Jennifer Kates, a senior vice president at the healthcare think tank KFF. Created in 1964, ACIP is the official outside panel of medical experts responsible for advising the Centers for Disease Control and Prevention (CDC) on what to include on its lists of routine shots for both children and adults. While its recommendations aren't binding, federal officials have typically adopted them. As a result, the board's decisions carry enormous weight, affecting patients and parents, as well as the vaccines schools require for students. Over the years, the panel has played a growing role in determining insurance coverage as well. By law, shots recommended by ACIP must be covered by the free Vaccines for Children program, the Children's Health Insurance Program, Medicaid, and Medicare Part D. The Affordable Care Act also requires private insurers to pay for vaccines with no cost sharing if they have the panel's seal of approval. (Past administrations have said the rule only applies if the CDC also adopts the board's recommendation.) In a Wall Street Journal op-ed this week, Kennedy said his decision to replace the board was meant to fight a 'crisis of public trust' in vaccines by ridding the committee of what he described as 'persistent conflicts of interest.' (Kennedy's critics have argued that his allegations against ACIP's former members are unfounded.) His new picks for the panel include several figures who rose to national fame by casting doubt on the safety of COVID-19 vaccines. Among them is Dr. Robert Malone, an accomplished scientist who did pioneering work on mRNA technology but later attacked its use in shots during the pandemic and who was at one point banned from Twitter for spreading COVID misinformation. He'll be joined by Retsef Levi, an MIT business school professor who gained attention in 2023 for claiming there was 'indisputable evidence' that 'MRNA vaccines cause serious harm including death,' and Dr. Martin Kulldorff, who advocated letting COVID spread among younger Americans to achieve 'herd immunity' and was later let go from Harvard Medical after refusing to be vaccinated. In his announcement, Kennedy said that each new member of ACIP was 'committed to demanding definitive safety and efficacy data before making any new vaccine recommendations' — suggesting they'll be less likely to add new shots to the government's immunization schedules. But he added that the board will also 'review safety and efficacy data for the current schedule as well,' raising the possibility that it will scrap some of its old recommendations. Even before this week's shake-up, the government had already begun changing its recommendations on COVID shots. In May, the CDC dropped its recommendation that healthy pregnant women receive the vaccine and revised its guidance for young children, saying they should only receive it after consultation with a doctor. Private insurers could still choose to cover vaccines even if the federal government stops recommending them. Whether they will is less certain. 'That's territory we haven't really had to traverse before,' said KFF's Kates. Sarah Moselle, a vaccine market expert at the health industry consulting firm Avalere, said there may be some 'fragmentation' in how carriers approach the issue. Some may drop coverage entirely or begin requiring co-pays. But many 'do anticipate that they would continue to cover some vaccines,' even if they aren't required to, since it would 'add value' for their customers, she said. In theory, insurers could also have an incentive to maintain vaccine coverage since it could keep their patients healthier and reduce the costs of their care, though it's unclear exactly how those savings would stack up against the added expense of paying for shots. For many vaccines, the out-of-pocket cost might be relatively cheap for patients. But others could turn out to be steep. Take Gardasil, the HPV vaccine that has been the focus of growing safety concerns among patients despite studies suggesting they're unfounded. Some experts told Yahoo Finance they thought the shot could be a target for more scrutiny under Kennedy's new ACIP. Currently, the shot is covered by insurance because it's recommended for pre-teens through young adults. The CDC lists its full price at over $300 a dose. Even modest costs can dissuade patients from getting vaccinated, according to Loren Adler, associate director at the Brookings Institution's Center on Health Policy. 'We know that folks having to pay $10 for a vaccine limits the uptake somewhat,' he said. As a result, just a small increase in what patients have to pay out of pocket could have ripple effects on public health. One issue to keep an eye on, according to Moselle, is whether state governments step in to require more extensive insurance coverage of vaccines if the federal government walks back some of its recommendations. If they do, vaccine access could start to vary more by where patients happen to live. Jordan Weissmann is a senior reporter at Yahoo Finance. Click here for in-depth analysis of the latest health industry news and events impacting stock prices
Business Mayor
19-05-2025
- Business
- Business Mayor
Healthy Returns: Trump provides a glimpse of the third round of Medicare drug price negotiations
In a photo illustration, prescription drugs are seen next to a pill bottle on July 23, 2024 in New York City. Spencer Platt | Getty Images News | Getty Images A version of this article first appeared in CNBC's Healthy Returns newsletter, which brings the latest health-care news straight to your inbox. Subscribe here to receive future editions. The Trump administration is already gearing up for another round of Medicare drug price negotiations, but it will look a little different this time around. The U.S. Centers for Medicare and Medicaid Services on Monday issued new draft guidance for that third cycle, as the second round of negotiations is underway. The process was established under the Biden administration's signature Inflation Reduction Act as a way to rein in high health care costs for older Americans. CMS plans to announce a list of 15 drugs eligible for the third round of price talks by February 2026, which will then kick off months of back and forth between the government and manufacturers if they agree to participate. The new negotiated prices for those products will go into effect in 2028. But here are the biggest changes this time around: Medicare Part B drugs – For the first time, the list would include drugs payable under Medicare Part B – which covers medicines administered in a doctor's office or hospital – in addition to prescription drugs covered under Medicare Part D. Previous rounds only targeted Part D medications. – For the first time, the list would include drugs payable under Medicare Part B – which covers medicines administered in a doctor's office or hospital – in addition to prescription drugs covered under Medicare Part D. Previous rounds only targeted Part D medications. Renegotiation process – CMS may choose to renegotiate the prices for certain drugs that already had prices set for the first and second cycles of talks, including those with new approved uses or changes in 'monopoly status.' The agency will announce any medicines selected for the first cycle of renegotiation, with revised prices for those products taking effect in 2028. CMS may choose to renegotiate the prices for certain drugs that already had prices set for the first and second cycles of talks, including those with new approved uses or changes in 'monopoly status.' The agency will announce any medicines selected for the first cycle of renegotiation, with revised prices for those products taking effect in 2028. Transparency – CMS is aiming to boost transparency around the process, seeking public feedback on topics such as how the agency determines an initial price offer for a drug. Read More Care sector fears migration changes are a step back 'This draft guidance is critical to creating a transparent, competitive, and fair prescription drug market that puts American patients first,' Medicare Director Chris Klomp said in a release. But Wall Street analysts are focused on another part of the guidance that could cause issues for Merck , Bristol Myers Squibb and some other pharmaceutical companies. The guidance document suggests that the Trump administration could end a workaround that those companies are using to drag out revenue from top-earning cancer drugs, such as Merck's Keytruda and Bristol Myers Squibb's Opdivo. The plan had been to shift patients to newer injectable – or subcutaneous – versions of their cancer drugs and keep charging Medicare higher prices for them, even after their original intravenous versions are subject to new negotiated prices under the program. Drugmakers have been banking on those subcutaneous versions as a way to dampen the revenue they would lose from Medicare drug price negotiations, along with upcoming patent expirations for the original forms of their drugs. For example, key patents for Keytruda start expiring in 2028. Under the current rules, complex drugs known as biologics are eligible for the negotiation process after 13 years, but the clock restarts for a new version of the drug – like a subcutaneous form – that adds an additional active ingredient. Subcutaneous versions of drugs like Opdivo are combination products that include an additional ingredient, allowing them to be injected quickly instead of being slowly infused like the original intravenous form. But on Monday, CMS said it is 'soliciting comments' on how it 'might consider' grouping these combination drugs with their original versions — if the added ingredient doesn't affect how the drug treats the underlying disease. In other words, the agency is considering whether to count two versions of a drug as a single product in certain cases. That appears to be 'somewhat targeted' at products such as subcutaneous Keytruda and Opdivo, JPMorgan analysts said in a note on Monday. They said the guidance leads to 'at least the potential for inclusion' of those drugs in future negotiations. Still, no changes are final yet, so it may be too soon to predict the impact on drugmakers like Merck and Bristol Myers Squibb. Feel free to send any tips, suggestions, story ideas and data to Annika at Latest in health care: UnitedHealth's surprise leadership shakeup It's not unusual for CEOs who transformed their companies to step back into leadership when things veer off course. This week, UnitedHealth Group Chairman Stephen Hemsley took a page from Bob Iger's playbook at Disney , and took back the CEO position at the company following the abrupt departure of Andrew Witty. The last six months have been challenging for Witty, following the murder of UnitedHealthcare CEO Brian Thompson and disappointing first-quarter earnings. Shares hit a four-year low in recent weeks as it became increasingly clear that United's Medicare Advantage peers had done a better job of pricing for elevated costs in Medicare this year. During Hemsley's 11-year tenure as CEO, UnitedHealth's stock rose more than 300%, as he built the company into a health care juggernaut. Following the massive growth, the company and the industry as a whole have been facing waves of regulatory pressure and public scrutiny of their businesses. For Hemsley, it's a whole new environment to navigate as he tries to right the ship. Feel free to send any tips, suggestions, story ideas and data to Bertha at Latest in health-care tech: OpenAI launches new benchmark tool to evaluate how AI models perform in health scenarios OpenAI on Monday launched a new evaluation tool called HealthBench, a benchmark that will help test how artificial intelligence models perform in realistic health-care scenarios. 'If developed and deployed effectively, large language models have the potential to expand access to health information, support clinicians in delivering high-quality care, and help people advocate for their health and that of their communities,' OpenAI said in a blog post. 'To get there, we need to ensure models are useful and safe.' Read More Taiwan kindergarten druggings spark alarm among island's parents The company said HealthBench was developed alongside 262 doctors from 60 countries. It's based on 5,000 conversations that simulate interactions between individual users or clinicians and AI models. The discussions are split into seven different themes, including global health, emergency situations and handling uncertainty. When a model responds to a prompt, each response is graded against a set of 'physician-written rubric criteria specific to that conversation,' OpenAI said. HealthBench contains 48,562 unique rubric criteria. OpenAI included one example where a user said they found their 70-year-old neighbor unresponsive on the floor. The AI model in that instance told the user to take action right away, and included eight steps they could follow. HealthBench gave this answer a 77% based on its rubric criteria. OpenAI said HealthBench responses were evaluated against responses written by doctors to understand how the model compared to their clinical judgement. The company found that HealthBench 'closely aligns' with physicians' grading. OpenAI said it used HealthBench to evaluate several existing models, including its own o3, GPT-4.1, o1, GPT-4o and GPT-3.5 Turbo models, xAI's Grok 3, Google's Gemini 2.5 Pro, Anthropic's Claude 3.7 Sonnet and Meta's Llama 4 Maverick. The company found that o3 outperformed other models, and it said its models have improved by 28% on HealthBench. OpenAI said the full evaluation suite and underlying data for HealthBench is available in its GitHub repository. 'We hope this supports shared progress toward using AI systems to improve human health,' the company said. Read the full blog post here. Feel free to send any tips, suggestions, story ideas and data to Ashley at
Axios
05-05-2025
- Health
- Axios
Out-of-pocket drug spending hit $98B in 2024: report
Americans spent $98 billion out of pocket on prescription drugs in 2024, marking a cumulative 25% increase over five years, according to an annual report from analytics firm IQVIA. Why it matters: Lowering prescription drug costs remains a priority for both Democrats and Republicans. The Biden administration led Congress in passing a landmark legislative package to negotiate select drug prices for seniors and redesign Medicare Part D. President Trump is continuing the focus, and recently signed an executive order aimed at further cutting drug prices. What they found: Net spending on medicine rose 11.4% in 2024 to $487 billion. Prescription costs on average were flat compared with 2023, but there was greater use of medicines with significant clinical benefits, IQVIA said. More than one-quarter of new prescriptions were not filled in 2024, mostly because they aren't covered by insurers. Payer rejections may be driven by factors like prior authorization requirements or formulary decisions, but nearly half of those rejections are overcome either by the patient switching to a secondary insurer, paying cash, or adding a coupon, per IQVIA. Looking ahead, total net spending on medications in the U.S. will exceed $600 billion by 2029, with obesity and oncology drugs driving growth, IQVIA estimates. Zoom out: Prescription medicine use increased 1.7% last year, the report found. The number of retail and long-term care prescriptions reached 7.1 billion, a nearly 1 billion increase since 2019. But growth in dispensed prescriptions in 2024 was slower than during the previous two years. Stunning stats: Prescription opioid use fell to the lowest level since 1999, and overdose deaths decreased 29% in 2024.
