'Boys will be boys' -- Musk-Navarro spat demonstrates the Trump administration is pretty ... adult

 

By Monica Showalter

DOGE chief Elon Musk and White House trade advisor Peter Navarro got into a public spat yesterday, and the White House had the perfect response.

According to Axios:

White House press secretary Karoline Leavitt, asked for comment on the Musk-Navarro spat at the daily press briefing, replied with a smile: "Boys will be boys, and we will let their public sparring continue."

• Musk, the 53-year-old Tesla CEO, is worth $350 billion and has unprecedented influence over the mechanics of government.
• Navarro, 75, is leading the administration's effort to re-wire the global economy.

Which was exactly the right thing to do.

If they want to fight it out in public, let them fight, because the alternative -- either getting rid of one, or getting rid of the other -- is worse for the administration with all its phenomenal talent.

According to Wikipedia, which has an utterly sucky, biased, disgracefully mendacious bio of Navarro, the back and forth went like this:

On April 5, 2025 Navarro was criticized by Trump advisor Elon Musk, who questioned his educational qualifications from Harvard on X and wrote "He ain’t built shit."[178] In response, Navarro said Musk is not a "car manufacturer". On April 8, Musk responded by calling Navarro "a moron" and "dumber than a sack of bricks", and said he should consult "the fake expert he invented, Ron Vara".

Musk also called Navarro "Retarrdo" which got the New York Post excited:

And we know it's been boiling for several days. On April 7, Elon, without comment, mysteriously put up a classical video from Milton Friedman, demonstrating how a pencil, the most ordinary of objects, was really the product of a global supply chain and free trade, which must have clearly been a dig at Navarro, who is a protectionist:

Elon, for one, is utterly, utterly, invaluable to the administration with his capacity to use algorithms to zero in on waste, fraud and abuse on a scale never before seen in government. (Wait till he gets hold of the voter rolls if it can happen.) His work enforcing simple honesty and transparency in government is likely to lead to the destruction of the entire Democrat party and all its fraudulent activities, the destruction of Trump's enemies. His stellar performance at Twitter (now X), making it profitable when it was impossible to be profitable before -- and the same with Tesla and SpaceX before -- is a gift from heaven to the government that needs to learn to live within its means and he truly is a national hero. He's also been persecuted by the left, first through lawfare during the Biden administration, and now through actual terrorism against Tesla and its buyers, which makes him even more heroic.

Navarro, too, is a naturally sympathetic figure, first having challenged the vaunted Dr. Anthony Fauci at the height of the COVID lockdowns over his false claims against hydroxycholorquine (HCQ) which was an inexpensive and effective means of treating COVID, and second in refusing to turn over documents to sleazy, partisan Rep. Adam Schiff over the events of Jan. 6, and literally going to jail for it, a draconian punishment never before seen that must have tested him. Yet he never bent to them, never waivered in his support for separation of powers, and for President Trump. It's not surprising he's one of the few people in Trump's second administration who carried over from the first. Navarro must be immensely comforting to President Trump to have around, having shown such loyalty.

For Trump, it would be miserable to be rid of either of them. And he doesn't want it.

So, better to let them duke it out even in public, and let insults be insults.

It's better than the sneaky pete swamp games we are used to -- Obama plotting against Kamala Harris and Joe Biden, Hillary Clinton plotting with the DNC to rig the primaries against Bernie Sanders, Biden directing the Justice department to target political opponents, phony stories in the press about Elon fighting with Marco Rubio premised on leaks from anonymous sources.

This administration is nothing if not transparent. They take their fights outside. They can fight all they like, it's better to do it in the open, actually, rather than through the Obama-ish stab in the back, with scurrying around amid anonymous media leaks.

What it tells those of us on the outside is that Trump is sufficiently confident in his own leadership to make his own decisions, no matter what his aides may think. The buck stops at Trump. He makes the decisions, and he owns them. His aides can say what they want to say, he's not policing their speech like a dictator might.

That's a refreshing change in leadership style from Joe Biden, who essentially acted as a puppet for other political players.

While it's unconventional, the corporate same old-same old is no longer the rule of the day, and actually, it doesn't really hurt the Trump administration if Navarro and Musk want to argue in public because Trump is in charge. Trump's the boss, and in bringing the arguments out into the public -- and having the public engage them as well -- helps Trump make better decisions anyway.

The recent pause in tariffs for allies trying to make things right, just announced, is a textbook illustration of this brand of adult leadership in action.

Trump and his team are not like the others.

Color me impressed.

https://www.americanthinker.com/blog/2025/04/boys_will_be_boys_musk_navarro_spat_demonstrates_the_trump_administration_is_pretty_adult.html

House Republicans Block Democratic Bid To Force Vote On Tariffs

 by Jackson Richman via The Epoch Times (emphasis ours),

House Republicans blocked on April 9 an effort by Democrats to force a vote on halting the reciprocal tariffs imposed by President Donald Trump, which are currently paused for three months.

The container ship CMA CGM Osiris arrives at the Port of Oakland, Calif., on April 9, 2025. Justin Sullivan/Getty Images

The maneuver was done through a rule, which the House of Representatives must vote on to advance to votes on measures.

The House Rules Committee advanced the rule 9-3 on April 9, which mainly deals with the unrelated budget resolution to unlock the reconciliation process to pass Trump’s signature legislative agenda. The rule punts the vote on the resolution to September.

The disapproval resolution would block the emergency authority that allowed Trump to enact the tariffs, which were announced on April 2. The reciprocal tariffs took effect at 12:01 a.m. ET on Wednesday.

The resolution was introduced by Reps. Gregory Meeks (D-N.Y.), Rick Larsen (D-Wash.), and Richard Neal (D-Mass.). It has an additional 23 co-sponsors.

“By implementing these tariffs, Trump has now imposed the largest and most regressive tax in modern history, sent the stock market into its worst plunge since COVID, and is risking a global recession,” they said in a statement. “These tariffs are nothing more than a sales tax on American families, driving up prices on everything from groceries to cars.”

Disapproval resolutions force a vote in the House and Senate, where a simple majority is needed for passage as opposed to being subject to the 60-vote filibuster threshold.

The Senate passed a resolution last week to block Trump’s 25 percent and 10 percent tariffs on Canadian goods and energy, respectively. All Democrats and four Republicans voted in favor of it. The House is not expected to take it up, and the president is expected to veto it should it pass Congress. House Republicans blocked a similar disapproval resolution last month through a rule.

Trump announced on Wednesday a 90-day pause on reciprocal tariffs for dozens of countries and retained a baseline 10 percent tariff for all countries, except China.

The president increased tariffs to 125 percent on China, after Beijing announced 85 percent retaliatory tariffs on the United States.

“At some point, hopefully in the near future, China will realize that the days of ripping off the U.S.A., and other Countries, is no longer sustainable or acceptable,” posted Trump on Truth Social, announcing the pause.

The president said he paused most reciprocal tariffs because more than 75 countries have reached out to the administration, requesting trade negotiations.

Congressional Republicans have largely expressed support for Trump’s tariffs.

Rep. August Pfluger (R-Texas) told reporters that the president is “making good on a campaign promise to shake things up, to reorder the world system whether it’s trade or whether it’s alliances or military organizations.”

Rep. Rich McCormick (R-Ga.) told reporters that the tariffs finally put China on notice.

“If China needs our market more than we need their market, because they already put unfair tariffs and regulations and restrictions on us, they’re going to suffer way more from this than we are in a trade war,” he said.

“If the rest of the world’s going to come to the table, why shouldn’t China too?” he added.

Nathan Worcester contributed to this report.

https://www.zerohedge.com/political/house-republicans-block-democratic-bid-force-vote-tariffs

KUDLOW: The art of the Trump trade deal

 Say what you will, and most people were screaming, but the fact is that President Donald Trump's original Liberation Day announcement of punitive reciprocal tariff charges on almost everyone in the world has actually worked.

Pundits told us that former friends and allies would flock to China. They were dead wrong.

Roughly 75 countries – and still counting – have flocked to the U.S. to make a deal with Donald Trump.

Exactly what he predicted would happen. That's the art of the deal for you.

And the next step announced today is a 90-day pause to the reciprocal tariff charges for all those nations who heeded the Trump administration's warnings and chose not to retaliate. They will pay only the 10% baseline tariff during the pause.

This is an absolutely brilliant move by Mr. Trump. A logical next step in his negotiating process.

I'm sure his top economic adviser, market-savvy Treasury Secretary Scott Bessent, advised the President about turmoil in stock and bond markets.

But it's also just going to take a while to make tailored deals with 75 countries. Plenty of staff will be involved, there will be a lot of paperwork, calls back and forth, and so on.

The pause is not, however, a change in Mr. Trump's policy vision to battle unfair trading practices, to fight hard for export market access, and to create a level playing field.  

And, of course, Mr. Trump's vision of reciprocity over time could well mean lower tariff rates and other non-tariff barriers to American exports.

What is changing with the 90-day pause is the management and execution of the policy.

Again, a brilliant move by the President.

All this may well take us toward a world of freer trade. Certainly freer than the broken system we've had to live with in recent decades.

And let's not forget that the Trump tax cuts will be passed by Congress in a few months. 

Those tax cuts will overshadow the tariffs. But, in fact, the tax cuts and the tariffs go hand in hand, as investors and businesses from around the world will be incentivized to come to America.

And one final point: Mr. Trump has completely outfoxed China's Xi Jinping.

Xi took the road of escalation and retaliation. Big mistake.

By slapping 125% tariffs on China, Mr. Trump has basically ended the Chinese model of government subsidies for cheap manufacturing goods at low wages as their principal export policy.

Trump has basically closed the U.S. market to China.

The export-dependent China will now be faced with a catastrophic economic crisis.

And China's ruse to manufacture in Mexico and take advantage of the free-trade USMCA will also be cut off.

Meanwhile, China is surrounded by American allies who are doing business with Mr. Trump to lower their trade barriers. We're talking about Vietnam, South Korea, Taiwan, Malaysia, Japan, India, Australia, and others.

China is surrounded now. China is boxed in.

Not only is their economy in shambles, but their world position is also in shambles.

Think of this again: the world voted with its feet. They came to America, not to China.

Those countries chose freedom over dictatorship.

And that too is part of Mr. Trump's art of the trade deal.

https://www.foxbusiness.com/politics/larry-kudlow-art-trump-trade-deal

Idaho Legislature Clears Way For Ivermectin To Be Sold Over The Counter

 by Jack Phillips via The Epoch Times (emphasis ours),

Idaho is set to become the latest state in the United States to allow anti-parasite drug ivermectin to be sold without a prescription after the state Legislature passed a measure.

Ivermectin pill bottles on a pharmacy shelf, in this file photo. Carl DMaster/The Epoch Times

Senate Bill 1211 was easily approved in the state Legislature on Friday and delivered that same day to Gov. Brad Little’s desk.

The bill, according to its text, “adds to existing law to provide that ivermectin may be sold or purchased without a prescription or consultation with a health care professional,” meaning it can be sold over the counter.

The bill passed 29–9 in the state Senate and 66–1 in the House.

Little has not publicly commented on whether he will sign the bill or not. The Epoch Times contacted the governor’s office for comment Sunday.

Sen. Tammy Nichols, a Republican, presented the bill on the floor on April 3. “We’re not mandating use, we’re not prescribing treatment, and we are not mandating that it be sold,” Nichols told KTVB-7. “What we’re doing with this bill is simple. We’re removing a barrier.”

A co-sponsor of the bill, Senate President Pro Tempore Kelly Anthon, a Republican, said that the drug has a wide range of applications.

“This is a drug that has had really immeasurable impacts on improving the lives of billions and billions of people throughout the world since it was discovered. It’s been called, in many places, a wonder drug,” Anthon told lawmakers in an Idaho Senate committee in on-camera remarks last week. “It’s been able to serve in treating and in many ways curing human diseases—treating parasites, worms in humans. And in most countries, it is legal over the counter.”

With the legislative action, Idaho became one of several states that have either passed or are considering a bill to deregulate the sale of ivermectin.

Earlier this year, Arkansas allowed the over-the-counter sale of ivermectin after the state Legislature passed a measure, which was signed by Republican Gov. Sarah Huckabee Sanders. In 2022, Tennessee Gov. Bill Lee, also a Republican, signed a similar measure.

The drug became popular during the COVID-19 pandemic as some doctors and studies said it was effective in treating the virus, though U.S. health regulators have warned people not to take it for COVID-19. 

The Food and Drug Administration (FDA) has said that the agency has not cleared ivermectin to be used for COVID-19, while advising against people using forms of ivermectin intended for animals.

“The FDA has not determined that ivermectin is safe or effective for these indications,” the agency’s website says.

A study released in June 2021 found that ivermectin, however, was linked to “large reductions” in COVID-19 deaths. Among hospitalized COVID-19 patients, the risk of death was found to be 2.3 percent among those treated with the drug, compared to 7.8 percent for those who weren’t, according to the study.

A March 2022 study found that the drug was associated with decreased mortality as compared with remdesivir usage by analyzing a national federated database of adults aged 18 and older with a confirmed COVID-19 infection from January 2020 to July 2021.

Tom Ozimek contributed to this report.

https://www.zerohedge.com/political/idaho-legislature-clears-way-ivermectin-be-sold-over-counter

Wisconsin Voter ID Win Buoys California GOP Activists

 by Susan Crabtree via RealClear Politics (emphasis ours),

Republicans celebrated a consolation prize in Wisconsin Tuesday night, predicting that the big win for a strong voter ID law in the critical swing state could have reverberations as far away as California.

“Even far lefties want voter ID,” Ric Grenell, Trump’s envoy for special missions who is weighing a run for California governor in 2026, declared in an X.com post. “Next up…California!”

Although the GOP candidate for state Supreme Court lost in the hotly contested Wisconsin election in which Elon Musk played a starring role, Republicans from Musk to President Trump to GOP state legislators around the country touted the voter ID victory. Musk said, with some online blowback, that Tuesday’s silver lining will have more long-term impact than the Democrat’s judicial win.

“This was the most important thing,” Musk posted on X in response to a post that the voter ID measure had prevailed by a wide margin.  

Some 63% of Wisconsin voters Tuesday approved the measure to enshrine the state’s voter ID law in the state constitution. The Badger State already required that voters have a photo ID in order to participate at the polls, but the law is now elevated to a constitutional amendment.

The move makes Wisconsin the latest state to formalize voter ID rules, and it’s one of 36 states that have some form of voter identification requirement, according to the National Conference of State Legislatures.

The win also is emboldening proponents of voter ID laws as far away as solidly blue California. A Gallup poll last fall found that large majorities of Americans back photo ID laws, with some 84% of Americans saying they back having “all voters” provide “photo identification at their voting place in order to vote.”

Grenell, who served as director of national intelligence during the first Trump administration, wasn’t just touting California’s voter ID campaign out of nowhere when suggesting that California would be the next state to back voter ID requirements. Before joining the Trump administration again in January, Grenell was busy as the co-chair of Fix California, a nonprofit devoted to increasing voter registration and imposing stricter voting rules around the state’s mail-in and loose ballot-harvesting laws.

Before the 2022 midterm congressional elections, Grenell said he aimed to register up to 1.4 million potential conservative voters in the state, aiming to replicate the results of Stacey Abram’s Fair Fight organization in Georgia. Late last year, California election analysts, including Rob Pyers of the nonpartisan California Target Book, reported that Republicans had increased their share of registered voters across all 58 counties and in every congressional, state senate, and assembly district.

The latest California secretary of state update in mid-March shows that Republicans have gained 1 million registered voters in California over the last eight years.

(Republican registration has ticked up to 25% of registered voters, pulling ahead of “no party preference,” which now stands at 22%. But they are still far behind the 46% of voters who are registered Democrats.)

One of Grenell’s close political allies and friends is leading the voter ID drive in California. Republican Assemblyman Carl DeMaio, a former conservative talk show host who heads a different nonprofit, Reform California, is now focused on passing a bold 2026 ballot measure that would not only change the California constitution to require voter ID but also mandate citizenship verification to vote across the state.

In early March, DeMaio formed “Californians for Voter ID” and released polling from Public Opinion Strategies showing strong support in California for new laws requiring identification to vote. Some 68% of all Californians back a change requiring an ID when casting a ballot, including 93% of Republicans and 52% of Democrats, according to the poll. The survey also found that a whopping 72% of Californians support verifying citizenship for anyone wishing to register to vote.

Proponents of voter ID laws argue they boost the public’s trust in election outcomes and reduce voter fraud. Critics contend that such rules disproportionately prevent voters of color, low-income, and older voters from vesting ballots because those groups are more likely to lack some form of photo ID.

Right now, citizenship is required to vote under California law, but voter registrations through the state’s online DMV application only require California residents to check a box marked “U.S. citizen” without requiring proof. DeMaio has mocked the process as only requiring “pinky swearing” that residents are citizens.

“Here’s the deal. Neither side should ever be in doubt about the integrity of an election,” DeMaio said during remarks at the California GOP convention in mid-March. “If you have a third of voters of any party upset with the integrity of an election, you have a problem with your democracy, and you must fix it, no matter what side of the aisle you’re on.”

DeMaio then introduced then-Assemblyman Bill Essayli, a Republican representing Riverside, California, who had co-authored several voter ID bills with him over the last few months. Trump this week named Essayli, 39, as U.S. attorney for the Central District of California, an office employing more than 250 lawyers.

In addition to Essayli, DeMaio’s voter ID coalition partners include GOP Rep. Ken Calvert, the longest-serving Republican in the California congressional delegation who narrowly won his election by three percentage points in 2024. Other players are Julie Luckey, mother of tech entrepreneur Palmer Luckey, a big Trump funder, and the Lincoln Club of Orange County, a conservative organization.

Despite the majority support for voter ID laws in California and nationwide, DeMaio is well aware that getting a constitutional amendment passed is no easy feat. The assemblyman pursued an unsuccessful “election integrity” ballot initiative in 2023, which didn’t end up qualifying because it failed to attract enough signatures and financial backing.

This time, DeMaio believes he has the wind at his back, although he’s leaving nothing to chance. He says he’s already enlisting thousands of volunteers across the state to gather the 1 million signatures needed to qualify and has garnered financial commitments from big Trump donors to help make that happen.

DeMaio told supporters on a conference call last week that these “big Trump donors” have committed $16 million to help qualify the initiative but will release the money only if the grassroots donor campaign hits a $3 million target to unlock the funds. The funds will pay for social media ads and text messages to support the campaign, legal work to draft and file the initiative, paid signature gatherers, and the costs of printing and sending petition kits across the state. DeMaio is also planning a statewide bus tour with rallies every month in different areas of the state.

During the late March conference call, DeMaio outlined several key upcoming deadlines for the voter ID campaign, including May 1, the deadline for forming the statewide commitment and raising initial costs for filing the initiative, and Aug 31, the date the initiative language must be filed with the secretary of state. The secretary of state then formally approves the initiative in early October, and once that takes place, the campaign has 180 days to attain 1 million verified signatures by April 2026.

On the same conference call last week, DeMaio warned supporters that Democrats, the media, and even some Republicans are already attacking the campaign as a misuse of time and energy.

“All I had to say to them is it’s a shame your name is going down in the history books as people who are trying to keep our state controlled by the blue supermajority that has ruined it,” DeMaio warned. “We cannot have people try to split us up. We’ve got to unite. We’ve got to demand that elected officials who are Republicans do everything they can do.”

Susan Crabtree is RealClearPolitics' national political correspondent.

https://www.zerohedge.com/political/wisconsin-voter-id-win-buoys-california-gop-activists

Concerns On Lilly-Affiliated Direct-to-Consumer Telehealth Platform for Alzheimer’s Diagnosis

 Some neurologists and a consumer watchdog are raising concerns that a direct-to-consumer telehealth platform affiliated with the drug company Eli Lilly — marketed to individuals concerned about memory loss — could lead to misdiagnoses or unnecessary treatment with anti-amyloids.

Lilly, which makes the once-monthly anti-amyloid infusion donanemab (Kisunla), announced in late March that patients would be able to quickly access a neurologist for diagnosis via its telehealth platform, LillyDirect.

The drugmaker said its aim is to “help people experiencing memory and thinking issues to overcome barriers to diagnosis and care.”

Eric Widera, MD, professor of medicine at the School of Medicine at the University of California, San Francisco, said he had doubts about Lilly’s motivation. “They’re a drug company, and they want to sell their drug,” Widera told Medscape Medical News.

As previously reported by Medscape Medical News, the US Food and Drug Administration approved donanemab for early Alzheimer’s disease in July 2024.

Lilly did not report any sales of donanemab until the fourth quarter, when it announced revenue of $8 million. Given the drug’s reported annual cost of $32,000, this suggests that approximately 250 individuals received the drug. In late March, the European Medicines Agency recommended against approving donanemab.

Widera said the telehealth platform could have some benefits, such as potentially earlier detection of dementia or Alzheimer’s disease or earlier referrals to specialists, but added that it wasn’t clear whether the clinicians providing consultations via the Lilly platform would be neurologists or neurologists trained in dementia diagnosis.

Adriane Fugh-Berman, MD, professor of pharmacology and physiology at Georgetown University School of Medicine, Washington, DC, told Medscape Medical News that telehealth can be useful for follow-up visits or for getting specialist care in remote areas. But it is also becoming “a tool for drug companies to essentially sell their drugs directly to consumers,” said Fugh-Berman, who directs PharmedOut, a Georgetown center that educates healthcare professionals and students about industry marketing practices.

Conflicts of Interest?

Widera and Fugh-Berman both said that the lack of financial details about the arrangement between Lilly and its partner Synapticure, a telehealth and disease management company focused on neurodegenerative diseases, is concerning.

There’s potential for conflicts of interest because Synapticure is being supported by Lilly to potentially offer a recommendation for treatment with donanemab, said Widera.

Researchers from Brown University in Providence, Rhode Island, recently reported in The New England Journal of Medicine that drug company/telehealth partnerships, such as LillyDirect, may violate the federal Anti-Kickback Statute. This law prohibits incentives for referrals or arrangements that could encourage clinicians to provide unnecessary or inappropriate care.

Lilly has reportedly said that it does not receive any compensation from telehealth companies for referrals and does not offer incentives for third parties to prescribe its medications.

A handful of senators, led by Dick Durbin, said Congress wanted answers about the arrangement. They “steer patients toward particular medications and create the potential for inappropriate prescribing that can increase spending for federal health care programs,” the senators wrote to Eli Lilly.

“Synapticure is fully independent of Lilly” and “exercises autonomous clinical judgment,” Eric Anderson, MD, Synapticure’s chief medical officer, told Medscape Medical News. He added that the telehealth company is “not incentivized to prescribe Lilly medications” or to meet any quotas and that the drug maker does not pay its physicians.

With a nationwide shortage of neurologists, Widera wondered how they could be so readily available through Synapticure.

Anderson said that Synapticure’s model is “very attractive” to neurologists. “Being able to be a 50-state specialty provider that is focused on providing access and comprehensive care to people who are hard to reach is a mission and vision that resonates well with neurologists,” said Anderson.

Questions on Diagnostic Accuracy

While Lilly and Synapticure say virtual visits can speed up diagnoses, some question whether those diagnoses will be accurate.

The process of getting in to see a specialist might be easier, “but what is the end result, and is that good for patients” asked Fugh-Berman. “How much of this is really making people who are normally functional into dementia patients?”

Anderson noted that some individuals who use the platform may already have a clear diagnosis of cognitive dysfunction or dementia, while others will have no diagnosis. A care navigator first checks whether the individual’s insurance covers a telehealth visit and asks for any available medical records, imaging, or lab results. If the person has not previously undergone cognitive screening, a trained navigator will administer the Montreal Cognitive Assessment or a similar test.

A Synapticure neurologist or geriatrician experienced in dementia care then reviews the records and tests and determines if the person is eligible for an in-depth evaluation via telehealth, said Anderson.

David Knopman, MD, professor of neurology at the Mayo Clinic, Rochester, Minnesota, said that increasing access to cognitive specialists is laudable. “There’s no question that the access to specialty dementia care is horrible,” Knopman told Medscape Medical News. However, he added, “Getting the right diagnosis is not trivial.”

Knopman said he had concerns about telehealth, especially if it is used for initial diagnosis.

“There’s nothing like a face-to-face, unhurried interview with a patient and informant by a specialist in person,” he said. Knopman said he conducted virtual evaluations during the COVID pandemic and found it “terribly inadequate,” especially for new patients.

“Since you can’t touch the patient or really watch them walk, or do the rest of the neurologic exam, all of the clinical information that would relate to, say, Lewy body disease and the motor disorders that can co-occur with it would be missing,” he said.

In addition, there are other potential pitfalls, said Knopman. He said that at the Mayo Alzheimer’s clinic, roughly half of the individuals evaluated are ultimately not suitable candidates for lecanemab or donanemab, often because they were previously misdiagnosed.

Both Widera and Knopman also wondered how patients who lived in some areas would be able to access PET imaging, an infusion center, or specialty care and follow-up monitoring if they were donanemab candidates.

Anderson said that Synapticure aims to connect patients with all aspects of care, including imaging, infusions, and safety monitoring. If any of these elements are unavailable — perhaps because of the patient’s geographic location — the treatment does not proceed.

Widera and Knopman reported no relevant conflicts.

https://www.medscape.com/viewarticle/concerns-raised-over-lilly-affiliated-direct-consumer-2025a10008gb

Skyrocketing Cost of Obesity Drugs Has State Medicaid Programs Looking for Solutions

 States increasingly struggling to cover the rising cost

opens in a new tab or window of popular GLP-1 receptor agonists like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) are searching for ways to get out from under the budgetary squeeze that took them by surprise.

One solution some policymakers may try is restricting the number of people on Medicaid who can use the pricey drugs -- approved for diabetes and weight management -- for weight-loss purposes.

Pennsylvania's Medicaid coverage of the drugs is expected to cost $1.3 billion in 2025 -- up from a fraction of that several years ago -- and is contributing to projections of a multibillion-dollar budget deficit. The state is thinking about requiring Medicaid patients who want to use GLP-1 drugs for weight loss to meet a certain number on the body-mass index or try diet and exercise programs or less expensive medications first.

"It is a medication that's gotten a lot of hype and a lot of press, and has become very popular in its use, and it is wildly expensive," Val Arkoosh, MD, MPH, Pennsylvania's human services secretary, told a state House hearing in March.

At least 14 states already cover the cost of GLP-1 medications for obesity treatment for patients on Medicaid, the federal healthcare program for people with low incomes. Democrats and Republicans in at least a half-dozen other states floated bills this year to require the same coverage, according to an Associated Press analysis using the bill-tracking softwareopens in a new tab or window Plural.

Some bills have stalled while others remain alive, including a proposal in Arkansas requiring GLP-1 drugs to be covered under Medicaid when prescribed specifically for weight loss. Iowa lawmakers are thinking about ordering a cost-benefit analysis before making the commitment. Already, West Virginiaopens in a new tab or window and North Carolinaopens in a new tab or window ended programs in 2024 that provided coverage for state employees, citing cost concerns.

"It is very expensive," said Jeffrey Beckham, the state budget director in Connecticut, where Medicaid coverage of the drugs for weight loss may be scrapped entirely. "Other states are coming to that conclusion, as well as some private carriers."

Overall Medicaid spending on GLP-1 drugs -- before partial rebates from drug manufacturers -- jumped from $577.3 million in 2019 to $3.9 billion in 2023, according to a November reportopens in a new tab or window from KFF, a nonprofit that researches healthcare issues. The number of prescriptions for the drugs increased by more than 400% during that same time period. The average annual cost per patient for a GLP-1 drug is $12,000, according to a Peterson-KFF trackeropens in a new tab or window.

About half of Americans "strongly" or "somewhat" favor having Medicare and Medicaid cover weight-loss drugs for people who have obesity, a recent AP-NORCopens in a new tab or window poll showed, with about one in five opposed to the idea and about one-quarter with a neutral view.

But Medicare does not cover GLP-1 receptor agonists for weight management, and the Trump administration said Fridayopens in a new tab or window that it wouldn't put into place a proposed rule by the Biden administration to cover the medications under Medicare's Part D prescription drug coverage. Biden's proposal was expensive: It would have included coverage for all state- and federally funded Medicaid programs, costing taxpayers as much as $35 billion over the next decade.

States that do provide coverage have tried to manage costs by putting prescribing limits on the GLP-1 drugs. There's also some evidence that if Medicaid patients lose weight with the drugs, they'll be healthier and less expensive to cover, said Tracy Zvenyach, PhD, of Obesity Action, an advocacy group that urges states to provide coverage.

Zvenyach also stressed how it's unclear whether patients will need to regularly take these drugs for the rest of their lives -- a key cost concern raised by public officials. "Someone may have to be on treatment for over the course of their lifetime," she said. "But we don't know exactly what that regimen would look like."

About 40% of adults in the U.S.opens in a new tab or window have obesity, according to the CDC. Obesity can cause hypertension, type 2 diabetes, and high cholesterol, which lead to greater risks of things like stroke and heart attacks.

Adam Raphael Rom, MD, a physician at Greater Philadelphia Health Action, a network of health centers in the city, said most of his patients who take GLP-1 drugs are covered by Medicaid and some are non-diabetics who use it for weight loss.

One patient told Rom the therapy changed her relationship with food. "I've had patients lose like 20, 40, 60 pounds," he said.

But obesity experts have told the Associated Pressopens in a new tab or window that as many as one in five people may not lose the amount of weight that others have seen come off. And in a recent survey, conducted by KFF, state Medicaid directors said cost and potential side effects are among their concerns.

The debate over coverage coincides with rising Medicaid budgets and the prospect of losing federal funding -- with congressional Republicans considering siphoning as much as $880 billionopens in a new tab or window from Medicaid over the next decade.

Connecticut is facing a $290 million Medicaid account deficit, and Gov. Ned Lamont (D) proposed doing away with a 2023 requirement that Medicaid cover GLP-1 drugs for severe obesity, though the state has never fully abided by the law due to the cost.

Starting June 14, though, state Medicaid patients will be required to have a type 2 diabetes diagnosis to get the drugs covered. Lamont also is pushing for the state to cover two less expensive oral medications approved by the FDA for weight loss, as well as nutrition counseling.

Sarah Makowicki, 42, tried the other medications and said she suffered serious side effects. The graduate student and statehouse intern is working on a bill that would restore the full GLP-1 coverage for her and others.

Sara Lamontagne, a transgender woman with a disability who is on Medicaid, said she regained weight when her coverage for GLP-1 medication was cut off in the past. She said she went from 260 pounds to over 300, heavier than she had ever been.

"So, it's a horrible game to be played, to be going back and forth," said Lamontagne, whose attempts to appeal the state's recent denial of her semaglutide prescription refill have been unsuccessful.

Makowicki said GLP-1 drugs combined with weight-loss surgery helped her change her life: She's had knee-replacement surgery and lost over 200 pounds.

"I am a different person from what I was 5 years ago," Makowicki said. "Not only in my physical space, but also mentally."

https://www.medpagetoday.com/publichealthpolicy/medicaid/115035