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Wednesday, April 22, 2026

Medicare obesity drug pilot extended after insurer pushback

The Trump administration has extended the duration of a pilot programme to provide access to obesity drugs through Medicare, as too few insurance companies have agreed to sign up.

The pilot has been extended by a year, with the federal government footing the bill for the medicines while discussions with the insurers about signing up for a longer-term programme, originally due to begin at the start of next year.

The Medicare GLP-1 Bridge pilot is due to start in July and lay the groundwork for coverage of drugs like Novo Nordisk's Wegovy (semaglutide) and Lilly's Zepbound (tirzepatide) and Foundayo (orforglipron) under Medicare Part D, an outpatient prescription drug benefit provided to more than 50 million older adults in the US.

Some insurers, including UnitedHealth and CVS Health, have said there are challenges with the proposal for the programme which need to be addressed before they can join in.

On UnitedHealth's first-quarter results call, the company pointed to "notable challenges and outstanding questions" with the structure of the Center for Medicare & Medicaid Services' (CMS) BALANCE model for the scheme. That is designed to bypass the historical prohibition 

on coverage of weight-loss drugs under Medicare while data is collected on their ability to reduce healthcare costs and improve health outcomes.

UnitedHealth has nevertheless agreed to participate, according to a Bloomberg report, but others like CVS Health have declined. The deadline for insurers to opt in to the programme passed at the start of this week, and needed an 80% sign-up rate to proceed.

The pilot, meanwhile, had been due to run until the end of this year, with a full rollout following on 1st January 2027, but will instead continue with government funding until the end of that year, according to a CMS update.

A report in the Wall Street Journal, citing a CMS spokesperson, indicated that the extension to the pilot will be used to "allow data collection that will support a more effective potential implementation" of the BALANCE Medicare programme. That will include "data on GLP-1 utilisation to share with Part D plan sponsors ahead of potential implementation of BALANCE."

The extension to the pilot looks likely to be good news for Novo Nordisk and Lilly, as they are now looking at additional months of government-bankrolled coverage of their weight-loss therapies, which at the moment are mostly paid for out of pocket by cash purchasers.

That also means that, for now, the delay to the full programme should not impact deals agreed between the federal government and Novo Nordisk and Eli Lilly last year, which saw them slash prices in return for coverage of the drugs through Medicare and Medicaid.

https://pharmaphorum.com/news/medicare-obesity-drug-pilot-extended-after-insurer-pushback

UK reports another incident in Strait of Hormuz

 The United Kingdom Maritime Trade Operations (UKMTO) shared in a notice on Wednesday that it received another report of an attack in the Strait of Hormuz.

"A master of an outbound cargo ship reports having been fired upon and is now stopped in the water. Crew are safe and accounted for. There is no reported damage to the vessel," UKMTO detailed, adding that the incident occurred eight nautical miles west of Iran.

The organization urged all the vessels going through the Strait to report "any suspicious activity."

https://breakingthenews.net/Article/UK-reports-another-incident-in-Strait-of-Hormuz/66121468

OpenAI showcases cyber tool to defense agencies

 OpenAI has been showcasing its latest cybersecurity tool to federal agencies and state governments since its reveal last week, Axios reported on Wednesday, citing people familiar with the matter.

The tech darling held an event to demo the capabilities of its new GPT-5.4-Cyber model to around 50 cyber defense practitioners. The source revealed that the commercial and government customers are going through the same vetting process to join its Trusted Access for Cyber program.

Attendees were said to include experts working for Five Eyes, an intelligence alliance consisting of Australia, Canada, New Zealand, the United Kingdom, and the United States.

https://breakingthenews.net/Article/OpenAI-showcases-cyber-tool-to-defense-agencies/66121895

Ukraine to restart Druzhba oil flow on Wednesday

 Ukraine is ready to resume Russian crude oil transit via the Druzhba pipeline to Hungary and Slovakia, Hungarian oil company MOL said on Wednesday, based on information from Ukrainian operator JSC Ukrtransnafta. Yesterday, Ukrainian President Volodymyr Zelensky announced that repairs on the pipeline were complete.

Druzhba will restart operations "within a few hours," AFP reported, citing an unnamed Ukrainian official. Deliveries via the pipeline through Ukraine were suspended in January, following a Russian attack.

https://breakingthenews.net/Article/Ukraine-to-restart-Druzhba-oil-flow-on-Wednesday/66121476

Germany's troops to reach 460,000 by mid-2030s

 The German Defense Ministry announced on Wednesday a plan to raise the number of the country's active-duty soldiers from approximately 186,000 to 260,000 and the number of reservists from 70,000 to 200,000 by the middle of the 2030s.

According to the department's revised strategy, commissioned by Defense Minister Boris Pistorius, the process will unravel in three phases. The first one, starting now and ending in 2029, will focus on enhancing the manpower in defense and operational services. The second one, planned to end in 2035, will concentrate on land, air, naval, and other divisions. Finally, from 2039, the focus will be on technology.

The ministry noted that the goal of the first two phases is for the German military to reach "the established target of 460,000 combat-ready soldiers, comprised of 260,000 active-duty soldiers and 200,000 reservists."

https://breakingthenews.net/Article/Germany's-troops-to-reach-460000-by-mid-2030s/66121404

Iran opens fire on container ship in Strait of Hormuz

 Iran’s paramilitary Revolutionary Guard opened fire Wednesday on a container ship in the Strait of Hormuz, damaging the ship and further raising the stakes as planned cease-fire talks in Pakistan failed to materialize.

The British military’s United Kingdom Maritime Trade Operations center said the attack happened around 7:55 a.m. in the strait and targeted a container ship.

The UKMTO said a Guard gunboat did not hail the ship before firing.

A hazy view of several cargo ships in the distance on a blue ocean, seen from a rocky hillside.
Tankers and bulk carriers anchored in the Strait of Hormuz on April 18, 2026.AP
Vessel tracker showing traffic in the Strait of Hormuz.
Iran’s latest attack on a container ship in the Strait happened around 7:55 a.m.MarineTraffic

It said no one was hurt and there was no environmental impact from the attack.

Iran did not immediately acknowledge the assault.

It comes after the US seized an Iranian container ship after shooting it this past weekend and boarded an oil tanker associated with Iran’s oil trade in the Indian Ocean.

https://nypost.com/2026/04/22/world-news/iran-opens-fire-on-container-ship-in-strait-of-hormuz/

Tuesday, April 21, 2026

New Drugs Are Primary Care Game Changers, but Pricey

 New drugs approved in 2025 are poised to significantly improve the management of motion sickness, acute pain, urinary tract infections (UTIs), and chronic spontaneous urticaria.

Gerald W. Smetana, MD, a professor emeritus of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, talked about new treatments in a presentation at the American College of Physicians Internal Medicine (ACP-IM) Meeting 2026 in San Francisco.

“This is the first time in my 15-year history of giving this new drugs talk that I’ve given all four drugs a thumbs-up, with the potential to change practice,” Smetana said during his presentation.

Making Headway Against Motion Sickness

Motion sickness is a common problem with limited solutions, Smetana said. In December 2025, the FDA approved tradipitant, a novel neurokinin-1 antagonist that is the first new medication approved to treat vomiting induced by motion in more than 40 years. It works by blocking discordant messages from sensory and vestibular centers that promote reflex nausea.

The approval was based on data from two phase 3 trials conducted on boats, in which the drug significantly reduced vomiting in participants with a history of motion sickness compared to placebo. In one study of 365 adults, about 18% and 20% of those who took 170 mg and 85 mg, respectively, of the drug daily experienced vomiting compared to approximately 44% of those who took placebo.

Whether those without a history of the condition would benefit from proactive treatment remains unclear, Smetana said. Tradipitant is expected to be available this spring.

While the final price has not yet been disclosed, estimated costs of more than $500 per eight-tablet bottle may be prohibitive and place it as a second-line treatment requiring prior authorization, Smetana said.

William Callahan, DO, a family medicine physician at Jefferson Health in Jenkintown, Pennsylvania, noted that the drug is not approved for the prevention of nausea.

Research is needed to compare the drug to the current standard, scopolamine transdermal treatment, and to understand how tradipitant treats nausea alone, Callahan told Medscape Medical News.

“The clear benefit of tradipitant is its safety profile, with no reported anticholinergic side effects,” Callahan said.

Non-Opioid Tackles Acute Pain

Suzetrigine targets the peripheral sensory nerves and dorsal root ganglia, reducing incoming pain signals, Smetana said. The drug represents the first new class of non-opioid pain medication in decades.

The approval of the drug for acute postoperative pain was supported by data from two phase 3 studies that involved adults undergoing bunionectomy or abdominoplasty.

Patients randomly assigned to a 48-hour course of suzetrigine showed a significantly shorter time to a reduction in their pain score than patients assigned to receive placebo.

However, efficacy and safety for subacute and chronic pain are unknown, and data for use beyond 14 days are lacking.

Notably, the studies used hydrocodone bitartrate/acetaminophen for comparison, and suzetrigine performed similarly, Callahan said.

“This is huge: a non-opiate providing opiate-level pain control,” he said.

Gepotidacin: Greater Infection Coverage

Epidemiologic data show that approximately one third of women in the US experience at least one UTI that requires antibiotics, Smetana said.

Not all patients respond to first-line therapies, which include nitrofurantoin monohydrate, trimethoprim-sulfa, and cefpodoxime, Smetana said. The new drug gepotidacin works by blocking the activity of two bacterial topoisomerases and was approved to treat uncomplicated UTI by the FDA in March 2025.

In studies that supported approval, gepotidacin was noninferior to nitrofurantoin. Cure rates in cases of resistant Escherichia coli were also higher for patients treated with the new drug than for those treated with nitrofurantoin. Clinicians may consider using the new drug in cases of known or suspected resistant bugs, Smetana said during his presentation.

The main barrier to expanding use of gepotidacin may be the high cost of nearly $2000 for a 5-day course, Callahan said. And manufacturer cost assistance is only available to those with commercial insurance. With those considerations, the drug will likely be reserved for patients with documented resistance patterns or allergies that require this medication, he said.

Top Dollar for Clearer Skin

Remibrutinib, a selective tyrosine kinase inhibitor given orally, offers an option to help clinicians manage refractory chronic spontaneous urticaria in primary care, Smetana said. The drug was approved in September 2025. The condition, characterized by recurring hives or wheals for at least 6 weeks, is distinct from the physical urticaria caused by heat or skin pressure, he said.

In two studies, patients treated with remibrutinib showed significant improvement in urticaria activity from baseline to 24 weeks with twice-daily dosing at 25 mg, showing sustained improvements for up to 1 year.

No new safety concerns appeared, but given a theoretic potential for effects on the risk for infection, more postmarketing safety data are needed beyond 52 weeks, Smetana said.

The drug may be preferable to patients who would choose oral treatment over injectable biologics despite the higher estimated 30-day cost of $4521 for remibrutinib vs $1472 for omalizumab and $3992 for dupilumab, he said.

Callahan said chronic spontaneous urticaria can be difficult to treat, with significant trial and error needed to identify the best option for a patient, he said.

“Many primary care practices are not set up to administer injectable biologic treatments, which makes this medication important,” he said. “Further studies will be needed to compare remibrutinib to the current standards of care, specifically biologics, which would likely determine where it falls along the pathway of treatment.”

Smetana and Callahan reported having no relevant financial conflicts.

https://www.medscape.com/viewarticle/new-drugs-are-primary-care-game-changers-pricey-2026a1000cg6