'Study Backs NP, PA Prescriptions for Abortion Drugs'

 

• Twenty-six states have laws restricting advance practice clinicians such as NPs and PAs from prescribing medication abortion.
• In this retrospective study, the estimated effectiveness of medication abortion was 92.9% with advance practice clinicians and 90.1% with physicians, meeting criteria for noninferiority.
• Emergency department visits and adverse events after medication abortion provisions were rare and did not differ by clinician type.

Medication abortion was just as safe and effective when provided by nurse practitioners (NPs) or physician assistants/associates (PAs) as compared to physicians, a retrospective cohort study suggested.

The estimated effectiveness of mifepristone (Mifeprex) and misoprostol was 92.9% for the advance practice clinicians, which met noninferiority criteria compared with the physicians in the study (90.1%), reported researchers led by Sarah Averbach, MD, MAS, of the University of California San Diego.

Abortion completion rates following prescriptions from NPs and PAs, which made up the bulk of the advance practice clinicians, were 92.8% and 93.2%, respectively. Emergency department visits (0.2%) and adverse events (0.1%) were rare and didn't differ by clinician type, according to the research letter in JAMA Network Open.

"Our estimates of abortion completeness when provided by APCs [advance practice clinicians] are similar to published estimates provided with ultrasonography dating and follow-up to 70 days by a variety of clinicians (93.3%), and to 77 days when provided by physicians (88.4%)," the authors noted.

"These data affirm the safety and effectiveness of [medication abortions] provided by APCs," Averbach and team concluded.

In 2016, the FDA changed the risk evaluation and mitigation strategy (REMS) program for mifepristone to allow advance practice clinicians -- like NPs, PAs, and certified nurse midwives -- to prescribe abortion drugs.

But "in the absence of sufficient data, 26 states have physician-only laws restricting APCs from providing medication abortion," according to the study authors.

Most of the literature thus far has focused on the effectiveness and safety of advance practice clinicians providing procedural abortions, they noted, so Averbach and team set out to compare medication abortion effectiveness by advance practice clinicians and physicians.

They included all medication abortions for pregnancies under 77 days' gestation provided at Planned Parenthood of the Pacific Southwest across three counties in California from December 2021 to December 2025.

Of the 59,150 medication abortions analyzed, 32,008 were provided by NPs, 23,012 by PAs, 2,553 by certified nurse midwives, and 618 by physicians; 59 medication abortions were missing data on practitioner type and were excluded from the final sample.

Mean patient age was 27 years, 62% paid with Medicaid, 22% paid with private insurance, and 16% self-paid. Four percent of patients traveled from out of state. About two-thirds of the abortions were for pregnancies at 49 days' gestation or less.

Pregnancy was confirmed via ultrasound for all patients before mifepristone and misoprostol were dispensed. A week or two later, patients were seen again for transvaginal ultrasonography to see if they were still pregnant or retained products of conception, and were offered an additional dose of misoprostol or aspiration if needed.

In an adjusted model, the type of provider was not significantly associated with complete abortion. Estimated effectiveness was 92.9% for NPs, 93.1% for PAs, 91.9% for certified nurse midwives, and 91% for physicians.

There were 41 minor adverse events, of which 26 were hemorrhages and 15 were infections. All four severe adverse events were blood transfusions.

Of patients who visited the emergency department, 53 were for bleeding, 25 for pain, 39 for incomplete abortion or ongoing pregnancy, four for fainting or dizziness, four for allergic reaction, two for infection, one for hematometra, and two were unspecified.

As for limitations, the authors noted that group sizes were unbalanced and some patients were lost to follow-up.

Disclosures

This study was supported by the Society for Family Planning Research Fund.

Averbach had no disclosures.

Co-authors reported receiving fees from Bayer, royalties from UpToDate, and being the chief medical and transformation officer at Planned Parenthood of the Pacific Southwest.

Primary Source

JAMA Network Open

Source Reference: Averbach S, et al "Medication abortion provision by advance practice clinicians and abortion completeness" JAMA Netw Open 2026; DOI: 10.1001/jamanetworkopen.2026.23855.

https://www.medpagetoday.com/obgyn/abortion/122256

The Upside-Down World of the GLP-1 Bridge

 I spent 10 minutes in complete silence in my patient's room today, my eyes scanning lines of text in the electronic medical record. I wasn't looking for a life-threatening lab value or an undiscovered malignancy. I was hunting for an old diagnostic code for obstructive sleep apnea. When I finally found the assessment section of a sleep study from 2019, I celebrated. She had mild obstructive sleep apnea (OSA).

My patient has class 3 obesity, prediabetes, hypertension, and mild (thankfully) OSA. With the recent trial launch of the federal Medicare GLP-1 Bridge program, American medicine has officially stepped into a contentious, bureaucratic "upside down" where being relatively healthier makes it easier to get treated, and being sicker can mean you're left behind. A subtle change from mild to moderate OSA would completely ruin her chances at receiving an affordable GLP-1 through the bridge program.

For months, my colleagues and I anxiously awaited this program. On paper, it promised a paradigm shift: a short-term demonstration pathway running outside of the standard Part D framework to make comprehensive obesity care financially practical with a flat $50 monthly copay. For millions of older Americans, this felt like a monumental victory against the archaic statutory rules dating back to 2006 that have long precluded Medicare from covering weight-loss medications. We envisioned a world where we would no longer have to scrape and claw through multiple levels of insurance appeals to get our patients the preventive medications they deserve.

It seemed too good to be true. Turns out, it was.

We knew this demonstration program wouldn't be perfect, and the logistical details were clearly outlined prior to launch. However, the dividing line between those who qualify for more affordable GLP-1s and those who do not became much more stark once the rules hit the clinic floor.

While the Bridge program is an undeniable blessing for a select segment of the population, it has devolved into an agonizing exercise in administrative gymnastics for the rest of our patients. The fatal flaw lies in the program's exclusionary criteria. To qualify for the $50-a-month weight-loss drug bridge, CMS explicitly mandates that a patient must not have type 2 diabetes, moderate-to-severe sleep apnea, or metabolic dysfunction-associated steatohepatitis (MASH). The justification given is that these conditions are already technically "covered" indications under standard Part D plans.

The structural irony here is palpable. For years, primary care physicians have spent countless hours begging insurance companies, writing endless prior authorizations, and filing exhaustive appeals to secure GLP-1 coverage for our sickest patients. Diabetes, severe sleep apnea, and advanced fatty liver disease were the principal diagnoses that gave clinicians the highest clinical leverage to fight for coverage.

Now, the incentives have been completely inverted. Instead of compiling evidence of a patient's worsening chronic illnesses to justify treatment, I am actively forced to scour the medical chart to prove they do not have these severe conditions. The Bridge program rules dictate that if a patient has a BMI of 35 but their sleep apnea crosses the threshold from mild to moderate, they are immediately disqualified from the cheaper $50 option. They are promptly rejected by the program's centralized processor and redirected back to standard Medicare Part D plans, the exact same fragmented system that charges hundreds of dollars per month out-of-pocket and has spent years denying these very drugs for long-term weight management.

We are trapped in a systemic paradox where I have to look a patient in the eye and essentially say, "I'm sorry, you are simply too sick to get the medication you deserve at a price you also deserve to pay."

The coverage process is so profoundly warped that several of my own patients have openly resorted to asking me to omit or delete their documented diagnoses from the medical record with hopes to get the medications for affordable prices. I of course decline, but I completely understand their sentiment. Desperate patients shouldn't be put in a position where they feel forced to ask their physicians to manipulate their clinical history just to afford a standard, FDA-approved therapeutic.

Don't mistake my frustration for cynicism. I am not here to argue that the Bridge program is inherently evil. I am thrilled for my patients with uncomplicated obesity who can finally access these life-changing therapies without facing thousands of dollars in out-of-pocket costs that don't even count toward their annual deductibles. But my patience is rapidly thinning as we face the daily backlash from frustrated, highly complex patients who continue to pay absurd prices despite having much more compelling diagnoses to get these medications. The very individuals backed by the most robust, long-term clinical trial outcomes data -- those navigating the dangerous intersection of severe obesity and advanced metabolic disease or obstructive sleep apnea -- are being left in the wake.

We cannot build a sustainable model for chronic disease management on a foundation of administrative contradictions. I look forward to a day when medical necessity, backed by sound clinical judgment, dictates care rather than a maze of arbitrary regulatory workarounds. Until CMS establishes uniform, equitable coverage for everyone who clinically qualifies for these medications, we will continue to spend hours scouring patient charts and appealing insurance decisions to help to cover these life-saving medications.

John Logan, MD, is an assistant clinical professor with the University of Kansas Health System.

https://www.medpagetoday.com/opinion/second-opinions/122244

US attack on tunnel disrupts phone, internet services in southern Iran

 

A US attack on the Mirzaei tunnel on Saturday severely disrupted telecommunications infrastructure in Hormozgan province, causing widespread phone and internet outages in northern Bandar Abbas, the province’s communications department said.

https://www.iranintl.com/en/liveblog/202607186178

'Iran says it is pursuing diplomacy while maintaining military readiness'

 

Iran is continuing to pursue diplomacy while its armed forces remain fully prepared to confront any aggression, Foreign Ministry spokesman Esmaeil Baghaei said in remarks published Saturday by the state-run Iran newspaper.

Baghaei said implementation of the MoU with the US had been suspended after Washington violated its commitments and launched military attacks. He said the deal was based on “commitment for commitment” and that Tehran no longer considered itself bound to implement it.

https://www.iranintl.com/en/liveblog/202607186178

Two US forces killed, one missing in Jordan after Iranian attacks

 

Two US service members were killed in action in Jordan on July 17 as US and partner forces defended against Iranian ballistic missile and drone attacks, US Central Command said in a post on X on Saturday.

CENTCOM said one service member remained missing in action. Four others were medically evacuated to Jordanian hospitals and later discharged, while personnel treated for minor injuries had returned to duty.

https://www.iranintl.com/en/liveblog/202607186178

World Cup helped drive strongest consumer spending growth in four years during June: B of A

 The World Cup is helping to boost consumer spending around the U.S. in June, with host cities seeing notable gains, according to new data from Bank of America.

The Bank of America Institute found that consumer spending using credit and debit cards rose 6.3% from a year ago in June – which was the strongest growth in over four years – based on internal card data from the bank. That growth was largely driven by discretionary spending amid the decline in gas prices, as total card spending was up 5.6% when excluding gasoline.

The firm's analysis noted that the start of the FIFA World Cup 2026 on June 11 helped lift consumer spending for the month compared to the preceding period.

"The World Cup scored big for consumer spending in June," Joe Wadford, an economist at the Bank of America Institute, told FOX Business. "Bank of America card spending showed healthy improvement toward the end of the month, due in part to a lift from the World Cup."

England fans celebrate a goal during the match with DR Congo at an Atlanta bar. (James Manning/PA Images via Getty Images)

In looking at card spending since the tournament began, the Bank of America Institute data shows higher consumer spending, particularly at restaurants and bars, which may be attributed to the World Cup. Some of the gains are likely due to online promotions near the end of June, but occurred in July last year, and thus boosted the year-over-year comparison, the firm noted.

The analysis compared brick-and-mortar spending in World Cup host cities based on zip codes with spending in other parts of the U.S., finding that some of the surge has been concentrated in communities where games are being played. Restaurants saw consumer spending rise by two percentage points in host cities, while it was flat in all other cities in that period.

"World Cup host cities saw a significant increase in brick and mortar spending, especially compared to the rest of the U.S.," Wadford said.

Fans at a New York bar react to a goal in the match between France and Morocco. (Michael M. Santiago/Getty Images)

Retail data that excluded restaurants also showed a gain for stores in host cities after the World Cup began, whereas non-restaurant retailers everywhere else saw slower spending growth once the tournament began.

"From packed stadiums to busy restaurants, the World Cup created a tailwind for the economy. But two of the main beneficiaries of the World Cup were local retailers and restaurants," Wadford said.

"To me, this is a particularly positive story, as it suggests that a major portion of World Cup-generated spending stayed in the community."

Scotland fans in the famed Tartan Army at a bar in Miami. (Ryan McDougall/PA Images via Getty Images)

The Bank of America Institute analysis also looked at the same internal card data by income level, finding that lower-income households in particular increased spending at local brick-and-mortar businesses in host cities, while higher-income households eased their spending slightly.

Additionally, all income groups boosted their spending at brick-and-mortar restaurants when comparing the pre-World Cup period to the timeframe after it began.

"Positively, lower-income households provided the biggest boost to World Cup spending. Some of this is due to the fact that younger households skew lower income, and they were likely the main ones going out to celebrate this generational event," Wadford explained.

"But some of the boost is due to this broader story of an improving economy for lower-income households. For example, we're seeing a stronger labor market and higher wage growth, which in turn is helping to boost spending for lower-income families," he added.

https://www.foxbusiness.com/economy/world-cup-helped-drive-strongest-consumer-spending-growth-four-years-during-june-bank-america-says

GCC: Iran's strikes on neighbors 'war crimes'

 Gulf Cooperation Council (GCC) Secretary General Jasem Mohamed Albudaiwi condemned on Saturday Iran's latest strikes targeting Bahrain, Jordan, and Kuwait.

In a statement, he labeled the actions as "war crimes," stressing that Tehran should be held accountable and prosecuted, "given the deliberate targeting of infrastructure and civilian facilities in flagrant violation of all international norms and conventions."

Albudaiwi said that the Council stands with the affected Arab countries, wishing those wounded in Kuwait a speedy recovery.

https://breakingthenews.net/Article/GCC:-Iran's-strikes-on-neighbors-'war-crimes'/66724807