Ore. Clinicians Move to Organize with Teachers Union

 Physicians, physician assistants, and nurse practitioners from Oregon-based Legacy Health announced

opens in a new tab or window that they intend to unionize, following in the footsteps of other doctors from Legacy hospitals over the past year.

Roughly 150 primary care providers plan to unionize with the Pacific Northwest Hospital Medicine Association (PNWHMA), a hospitalist-specific labor union affiliated with the American Federation of Teachers.

The group submitted union authorization cards to the National Labor Relations Board (NLRB) on May 8, and the agency will hold a hearing to set an election date in the coming weeks, according to a press releaseopens in a new tab or window.

The announcement comes amid a potential merger between Legacy Health and Oregon Health & Science University (OHSU), another large health system in the Portland area, according to the press release. Earlier this year, more than 600 NPs and PAs at OHSUopens in a new tab or window announced their own intention to unionize.

Angela Marshall Olson, DO, of Legacy Health at Raleigh Hills Primary Care in Beaverton, Oregon, who is one of the physicians leading the efforts, told MedPage Today that she and her colleagues are organizing to help protect providers' work-life balance while continuing to ensure high-quality patient care.

"It is very difficult to access primary care," she said. "As front-line workers, we can provide the best feedback to our administrative teams on all of these care solutions. Because sometimes ... it takes somebody who actually does the job to help provide the best problem-solving solutions."

These clinicians will join nearly 200 hospitalists from six Legacy hospitals who voted to unionize with PNWHMA last year, as well as 17 physicians from Legacy Women's Clinic who voted to unionize earlier this year, according to press release

Marshall Olson noted that the doctors and advanced practice providers (APPs) decided to unionize together because they do the same types of work and they share the same challenges.

Chris Stamatakos, PA, of Salmon Creek Primary Care, who also is involved in the unionization efforts, echoed those comments in the press release.

"I'm participating in the Pacific Northwest Hospital Medicine Association because a provider's need for representation has never been greater," Stamatakos said. "Provider satisfaction should be a central tenet to helping achieve organizational goals, despite the many challenges in healthcare today."

Legacy Health said in a statement that it "respects the rights of our employees to choose whether or not to be represented by a union."

"We appreciate the continued hard work and dedication of our primary care providers, who play a vital role in delivering high-quality care to our patients and communities," the statement said. "We are committed to establishing a productive dialogue with the union representatives who will be working with Legacy on behalf of these providers."

Legacy Health is a non-profit health system that operates six hospitals and more than 70 primary care, specialty, and urgent care clinics in the Portland and Vancouver metro areas. The organization claims to employ more than 3,000 healthcare providers. Neither Legacy Health nor OHSU commented on the status of the potential merger between the two health systems.

Marshall Olson noted that the decision to unionize should be viewed in light of recent organizing efforts among doctors across the U.S.opens in a new tab or window

"There's been a hesitancy for physicians to unionize in since the 70s," she said. "Recently, we've seen kind of an uptick in interest in unionization. I think it's a direct response to what is happening in healthcare, which is a more corporate approach."

While the potential merger between Legacy Health and OHSU has had some effect on interest in creating the union, Marshall Olson said efforts began before any providers were aware of a potential merger. She added that the challenges posed by the COVID-19 pandemic also played a key role in spurring action.

"It's a very critical time in primary care right now, because people are so burned out at this point," Marshall Olson said. "What we're looking to do is combine our voices to help with a strategy for provider retention and provider happiness in order to help avoid further shortages for primary care."

https://www.medpagetoday.com/special-reports/features/110122

UK weight-loss drug price rivalry intensifies with Pharmacy2U mark-down

 Britain's Pharmacy2U said on Wednesday it had cut the prices of weight-loss medication Wegovy and Mounjaro, becoming the latest in a slew of online pharmacies and slimming clinics to do so as initial supply shortages of the drugs ease in the country.

WHY IT’S IMPORTANT

The British market could provide a glimpse into how the fight for patients among private suppliers could develop as drugmakers Novo Nordisk and Eli Lilly ramp up production.

Growing competition between retailers has raised fears that some patients who buy the drugs themselves, amid limited capacity of the National Health Service, will miss out on long-term aftercare if they keep switching providers.

CONTEXT

British drug retail companies that have previously marked down weight-loss drugs include Simple Online Pharmacy, Mayfair Weight Loss Clinic and London Slimming Clinic. They have sacrificed some of their retail margin to win patients as manufacturers have not cut their prices.

BY THE NUMBERS

Pharmacy2U, which serves over 1.4 million UK patients via online prescription services, cut the price of a one-month supply of the Wegovy starter kit to 129 pounds ($162.90) from 169 pounds previously. It cut the price of the Mounjaro starter kit to 139 pounds from 179 pounds.

Pharmacy2U said the offer was limited until May 31 but it "is constantly reviewing the prices of its weight loss services and will be able to confirm pricing again in June".

https://finance.yahoo.com/news/uk-weight-loss-drug-price-144915039.html

'Walgreens launches own brand of opioid overdose reversal drug'

 U.S. pharmacy chain operator Walgreens Boots Alliance said on Wednesday it has launched its own brand of popular overdose reversal drug, naloxone, which would be available over-the-counter (OTC).

The launch comes weeks after Walgreens' brand was approved by the U.S. Food and Drug Administration in April.

WHY IT'S IMPORTANT

Opioid abuse has plagued the United States for more than two decades and killed more than half a million Americans, with fentanyl and synthetic versions being a major culprit in recent years, according to government data.

Naloxone rapidly reverses or blocks the effects of opioids, restoring normal respiration, especially when given within minutes of the first signs of an overdose.

It is seen as a key tool to help in surviving an opioid overdose.

CONTEXT

The U.S. FDA approved an OTC version of Emergent Biosolutions' Narcan last year, aimed at making it easier to access without a prescription.

The health regulator had approved the first generic version of the medication in 2021, sold by Israeli drugmaker Teva Pharmaceuticals.

Other drugmakers also sell various versions of the product, and privately held Harm Reduction Therapeutics' naloxone-based nasal spray, RiVive, is also approved for prescription-free sale.

BY THE NUMBERS

Walgreens said its naloxone-based drug, sold as Naloxone HCl Nasal Spray, is currently available online and will be available in all of its stores by the end of the month.

Walgreens' spray would be sold at a retail price of $34.99 per pack, with each pack containing two single doses of 4 milligrams each.

The OTC version of Emergent BioSolutions' Narcan is sold at around $50 per carton.

https://finance.yahoo.com/news/walgreens-launches-own-brand-opioid-134744769.html

'US imposes sanctions on Nicaragua over repression, migrant smuggling'

 The United States on Wednesday imposed visa restrictions on more than 250 members of the Nicaraguan government and levied sanctions on three Nicaraguan entities in retaliation for "repressive actions" and a failure to stem migrant smuggling through the Central American country.

Senior administration officials told reporters that the officials subject to visa restrictions included police and paramilitary officials, prosecutors, judges and public higher education officials.

At the same time, the Departments of State, Homeland Security, and the Treasury issued a joint alert to notify airlines and travel agents about the ways smuggling and human trafficking networks are exploiting legitimate transportation services to facilitate illegal migration to the United States through Nicaragua.

"Actions by the Nicaraguan government are of grave concern. President Daniel Ortega and Vice President Rosario Murillo have put in place permissive-by-design migration policies," the Department of Homeland Security said in a statement.

The Nicaraguan government did not immediately respond to a request for comment.

Increasingly migrants have been flying into Nicaragua and then heading north overland to the U.S.-Mexico border as some smugglers have promoted the route through social networks.

Many migrants in recent years have started their journeys in Brazil or other South American countries, but flying into Nicaragua avoids the often perilous journey through the jungle region known as the Darien Gap on the Colombia-Panama border.

The administration of President Joe Biden, a Democrat, has struggled with record numbers of migrant crossings at the U.S.-Mexico border and, as he runs for reelection in November, voters have increasingly said that immigration is a top concern.

Senior Biden administration officials told reporters on a Wednesday conference call that sanctions would be levied against a Russian training center operating in Managua since October 2017 that enabled anti-democratic behavior and repression.

A press release from the Treasury Department said Nicaragua was one of Russia's "main partners" in Central America and the training center provided specialized courts to the Nicaraguan National Police (NNP), which the statement called "a repressive state apparatus, carrying out extrajudicial killings, using live ammunition against peaceful protests, and even participating in death squads."

In addition, the Treasury Department imposed sanctions on two gold companies it said were "government affiliated."

Gold is Nicaragua's top commodity export, the Treasury announcement said, and "this action aims to degrade the ability of the Ortega-Murillo regime to manipulate the sector and profit." Reuters was not immediately able to reach the companies for comment.

Migrant apprehensions on the border halved from December to March, according to U.S. government data, in part because of increased enforcement by Mexican authorities, U.S. Homeland Security Secretary Alejandro Mayorkas has said.

https://www.yahoo.com/news/us-imposes-visa-restrictions-other-151606098.html

Lilly Strikes Deal To Combat Counterfeit Diabetes And Weight Loss Drugs

 

• As part of the deal, Totality Medispa will pay Lilly a monetary payment and cease using Lilly's branding to promote its products.
• In April, U.S. District Judge ruled that Eli Lilly cannot rely on state law to stop a compounding pharmacy from marketing tirzepatide drugs.

https://www.benzinga.com/general/biotech/24/05/38845991/eli-lilly-strikes-deal-to-combat-counterfeit-diabetes-and-weight-loss-drugs-mounjaro-and-zepbound

Student-loan forgiveness deadline extended

 Borrowers now have until June 30 to consolidate their loans

The Biden administration is giving borrowers more time to take a key step that will make them eligible for a student-loan forgiveness program.

Borrowers with federal student loans that aren't owned by the Department of Education now have until June 30 to consolidate into the Direct Loan program in order to qualify for a debt-relief program focused on borrowers who have been in repayment for at least 20 years. Previously, the deadline to consolidate was April 30.

So far, the administration has approved $49.2 billion in cancellation for 996,000 borrowers under this initiative, known as the income-driven repayment account adjustment program. The announcement comes as advocates and attorneys working with borrowers had expressed concerns about borrowers missing out on relief due to the deadline.

The federal student-loan program allows borrowers to have their debts canceled after at least 20 years of payments through a program known as income-driven repayment. Still, for years, borrowers struggled to access this relief. In April 2022, the Department of Education found that was partly because servicers had pushed borrowers towards payment programs that made them ineligible for forgiveness.

In response, the agency began reviewing borrowers' accounts looking for months that should have counted towards forgiveness. Department of Education officials said Wednesday that the review will be completed in September.

However, a quirk in the federal student-loan system has meant that some borrowers need to take action to qualify for the account adjustment. Before 2010, the bulk of federal student loans were made by outside lenders and guaranteed by the federal government. These are known as Federal Family Education Loans or FFEL loans. During the financial crisis, the government purchased some of the FFEL portfolio to help capitalize lenders.

In 2010, the government ended the guaranteed program. In the years since, all federal student loans have been made directly by the Department of Education to borrowers under what's known as the Direct Loan program.

As a result, there are multiple types of federal student loans with different implications for borrowers. The government has less control over commercially held FFEL loans, or FFEL loans still held by outside entities, which is why borrowers have to consolidate them into government-owned loans to receive certain benefits, like the account adjustment.

Borrowers with Direct Loans and those with Department-owned FFEL loans have had or will have their accounts adjusted automatically through the program. Borrowers with these loans who have repayment for at least 20 years, or 25 years, for those with loans from graduate school, will have or have had their debt canceled through the adjustment. Other borrowers will see their payment counts updated so they're closer to forgiveness.

But borrowers with commercially-held FFEL loans and borrowers with Perkins loans need to consolidate into the Direct Loan program in order to be eligible for the account adjustment.

The account adjustment also provides benefits for borrowers looking to qualify for relief under Public Service Loan Forgiveness. That program allows borrowers who have worked for the government or certain nonprofits for at least 10 years to have their remaining balance canceled. Certain months that previously didn't count towards the 120 needed for relief under PSLF - like months spent in forbearance - count under the adjustment as long as the borrower was working at a qualifying job during that month.

Typically, payments made on FFEL loans, even if they're owned by the Department, don't count towards the 120 needed for PSLF. But if borrowers consolidate into the Direct Loan program before June 30, payments made on these loans will be credited towards relief under PSLF.

Should I consolidate?

To figure out if you need to consolidate to be eligible for the relief programs, log on to studentaid.gov, find your dashboard and navigate to the "Loan Breakdown" section. There you will find a list of your loans. Any loans that begin with the word "Direct" don't need to be consolidated to qualify for the payment count adjustment or PSLF.

Any loans that start with the word "Perkins" need to be consolidated to qualify.

Loans that start with "FFEL" and have a servicer other than "Dept. of Ed" or "Default Management Collection System," need to be consolidated to qualify for the IDR account adjustment.

Any loan that starts with "FFEL" needs to be consolidated in order for payments to count towards PSLF.

How do I consolidate?

To consolidate your loans, log on to studentaid.gov and fill out a consolidation application here. There is no fee to consolidate.

Part of targeted forgiveness effort

The account adjustments are part of a broader effort by the Biden administration over the past few years to make it easier for borrowers who are already eligible for debt cancellation under the law to access that relief. For years, borrowers eligible to have their debt wiped out under Public Service Loan Forgiveness, income-driven repayment, a program for borrowers who are severely disabled and borrowers who have been scammed by their schools have been stymied from accessing debt cancellation due to paperwork challenges.

Through these initiatives, officials have approved more than $155 billion in cancellations for roughly 4 million borrowers.

The White House is also taking a second stab at mass student-debt relief after the Supreme Court struck down its plan last year to cancel up to $20,000 in loans for a wide swath of borrowers. If implemented, the new plan would wipe out some debt for at least 25 million more borrowers. Still, officials could face an uphill battle in implementing the plan before the November election.

https://www.morningstar.com/news/marketwatch/20240515281/student-loan-forgiveness-deadline-extended-heres-how-to-take-advantage

'How fast is bird flu spreading in US cows? ‘We have no idea’': Public health spox

Avian flu is spreading rapidly among cattle, but public health and infectious disease experts are concerned the United States is too limited in its testing, leaving an incomplete picture of the virus’s spread.  

The threat to the general public is currently low, health officials say, and the country’s milk supply is safe. Just one person has been infected.

“It’s critical that we are well-positioned to test, treat, prevent this virus from spreading. I think that’s clear in everything we’re saying,” Health and Human Services Secretary Xavier Becerra told reporters recently. 

But the outbreak is widespread; officials have found the virus in 42 herds across nine states. Dairy farm workers are at risk every time they are exposed to potentially infected cattle, and viral mutations could cause an outbreak, experts warn.  

Cases are potentially being missed, either in people, cattle or both. In past avian flu outbreaks in other parts of the world, the virus typically kills about half the people it infects.  

But even if this strain doesn’t pose a significant risk to the public, many experts see the response as the biggest test of pandemic preparedness since COVID-19.

“There are opportunities that have been missed that we could have absolutely applied from the COVID experience. I think there’s still time. We’re not in trouble yet,” said Erin Sorrell, a senior scholar at the Johns Hopkins Center for Health Security.

Bird flu was first detected in dairy cows in March, though data from viral samples showed it had been circulating in cattle for at least four months prior. That’s concerning to some experts, who said there could have been widespread human exposure and asymptomatic spread among dairy workers.

The Centers for Disease Control and Prevention (CDC) is monitoring at least 260 people for symptoms and has tested at least 30 for novel influenza A, the broad category of flu that includes H5N1. Only one positive case has been identified, a farmworker in Texas who has since recovered.  

Farmers have been reluctant to allow federal health officials onto their land to test potentially infected cattle amid uncertainty about how their businesses would be impacted.  

Farmworkers have also been reluctant to participate in screening, and experts said it’s likely due to a mix of fears over job loss, immigration status, language barriers and general distrust in public health systems. 

“They are socioeconomically vulnerable. … In some circumstances, it kind of requires the buy-in of the employer to engage in surveillance of these workers. And that hasn’t happened in a substantial way to date,” said Jessica Leibler, an environmental epidemiologist at Boston University’s school of public health. 

Exposure does not necessarily mean infection, but the more workers who are exposed to potentially infected cattle, the greater the risk. Each new infection in mammals provides the opportunity for the virus to mutate. 

“Without testing, without surveillance, we have no idea [of the spread],” Sorrell said.  “We are not able to essentially move forward with an improved approach to protecting agricultural workers from occupational exposures if we don’t understand how they were exposed, and the potential risk of additional people being exposed and infected.” 

A federal order from the end of April requires mandatory testing of dairy cattle herds, but only if they are crossing state lines. CDC workers can’t conduct investigations without an invite from state or private landowners, and the agency doesn’t have the ability to require states to test within their own borders. Becerra said the CDC is engaged in ongoing discussions with multiple states about setting up field investigation.

Stacey Schultz-Cherry, an expert in animal influenza at St. Jude Children’s Research Hospital, said those limitations are a hindrance but officials should be able to find workarounds, such as wastewater testing. 

“There are ways to do surveillance and testing on samples that can’t or maybe don’t have to be traced back to a particular area or particular farm, because people are going to be very sensitive about it,” she said. 

Federal officials have been working with state veterinary and agricultural officials to do outreach to dairy farmers and producers and emphasize the need to cooperate with federal health investigations.

“It is important for the public health officials at the state level, or the state veterinarians, or state ag officials, for us, to essentially communicate that it’s in the long-term best interest of the industry and all of us to make sure that we have as much information as possible,” Agriculture Secretary Tom Vilsack told reporters in a recent briefing.

“Producers obviously look at this circumstance and they see this as an animal health issue …  so they may not fully appreciate and understand the approach that public health officials need to take in the circumstance,” Vilsack said.

The agency is also for the first time offering financial incentives for farms impacted by avian flu, including reimbursement for lost milk supply from infected cows.   

William Schaffner, an infectious disease specialist and professor at the Vanderbilt University school of medicine, said dairy industry producers and workers don’t have the same relationship with public health as the poultry and egg industry does.

“This is new for them; they’re more edgy and concerned,” Schaffner said. “All these diplomatic overtures and discussions are going on and are being led at the local level, because that’s where personnel are more comfortable. COVID developed a political veneer, and that impeded public health. That legacy still exists, and that may influence some of the caution in the dairy industry.” 

https://thehill.com/policy/healthcare/4657340-bird-flu-cows-spread-no-idea/