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      Some States Say They Can’t Afford Ozempic and Other Weight Loss Drugs

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      Public employees in West Virginia who took the drugs lost weight and were healthier, and some are despondent that the state is canceling a program to help pay for them.Joanna Bailey, a family physician and obesity specialist, doesn’t want to tell her patients that they can’t take Wegovy, but she has gotten used to it.Around a quarter of the people she sees in her small clinic in Wyoming County would benefit from the weight-loss medications known as GLP-1s, which also include Ozempic, Zepbound and Mounjaro, she says. The drugs have helped some of them lose 15 to 20 percent of their weight. But most people in the area she serves don’t have insurance that covers the cost, and virtually no one can afford sticker prices of $1,000 to $1,400 a month.“Even my richest patients can’t afford it,” Dr. Bailey said. She then mentioned something that many doctors in West Virginia — among the poorest states in the country, with the highest prevalence of obesity, at 41 percent — say: “We’ve separated between the haves and the have-nots.”Such disparities sharpened in March when West Virginia’s Public Employees Insurance Agency, which pays most of the cost of prescription drugs for more than 75,000 teachers, municipal workers and other public employees and their families, canceled a pilot program to cover weight-loss drugs.Some private insurers help pay for medications to treat obesity, but most Medicaid programs do so only to manage diabetes, and Medicare covers Wegovy and Zepbound only when they are prescribed for heart problems.Over the past year, states have been trying, amid rising demand, to determine how far to extend coverage for public employees. Connecticut is on track to spend more than $35 million this year through a limited weight-loss coverage initiative. In January, North Carolina announced that it would stop paying for weight-loss medications after forking out $100 million for them in 2023 — 10 percent of its spending on prescription drugs.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Abortion Pills May Become Controlled Substances in Louisiana

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      A bill that is expected to pass would impose prison time and thousands of dollars in fines on people possessing the pills without a prescription.Louisiana could become the first state to classify abortion pills as dangerous controlled substances, making possession of the pills without a prescription a crime subject to jail time and fines.A bill that would designate the abortion pills mifepristone and misoprostol as Schedule IV drugs — a category of medicines with the potential for abuse or dependence — passed the state’s Republican-controlled House of Representatives on Tuesday by a vote of 63 to 29. Should the Senate follow suit, Gov. Jeff Landry, a Republican and a vocal opponent of abortion, is likely to sign the legislation into law.The measure — which would put abortion pills in the same category as Xanax, Ambien and Valium — contradicts the way the federal government classifies mifepristone and misoprostol. The federal Food and Drug Administration does not consider abortion pills to be drugs with the potential for dependence or abuse, and decades of medical studies have found both to be overwhelmingly safe.Under the legislation, possession of mifepristone or misoprostol without a prescription in Louisiana could be punishable with thousands of dollars in fines and up to five years in jail. Pregnant women would be exempt from those penalties; most abortion bans and restrictions do not punish pregnant women because most voters oppose doing so.“These drugs are increasingly being shipped from outside our state and country to women and girls in our state,” Attorney General Liz Murrill, a Republican, said in a statement on social media. “This legislation does NOT prohibit these drugs from being prescribed and dispensed in Louisiana for legal and legitimate reasons.”Louisiana already bans most abortions, except when women’s lives or health are in danger or fetuses have some fatal conditions. As a result, abortion rights advocates and legal scholars said that in practice, the measure might not prevent many abortions among Louisiana women. Since the state imposed its strict abortion ban after the Supreme Court overturned Roe v. Wade, many patients have traveled to states where abortion is legal or have obtained pills under shield laws from doctors or nurses in other states who prescribe and mail the medications to Louisiana. Such circumstances would not be affected by the new bill, experts say.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      The Disease Detectives Trying to Keep the World Safe From Bird Flu

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      As Dr. Sreyleak Luch drove to work the morning of Feb. 8, through busy sunbaked streets in Cambodia’s Mekong river delta, she played the overnight voice messages from her team. The condition of a 9-year-old boy she had been caring for had deteriorated sharply, and he had been intubated, one doctor reported. What, she wondered, could make the child so sick, so fast?“And then I just thought: H5N1,” she recalled. “It could be bird flu.”When she arrived at the airy yellow children’s ward at the provincial hospital in Kratie, she immediately asked the child’s father if the family had had contact with any sick or dead poultry. He admitted that their rooster had been found dead a few days before and that the family had eaten it.Dr. Luch told her colleagues her theory. Their responses ranged from dubious to incredulous: A human case of avian influenza had never been reported in their part of eastern Cambodia. They warned her that if she set off the bird flu warning system, many senior government officials might get involved. She risked looking foolish, or worse.Anxious but increasingly certain, Dr. Luch phoned the local public health department, located just across the street. Within minutes, a team arrived to collect a sample from the child, Virun Roeurn, for testing in a lab.By then, Virun’s distraught parents had lost faith in the hospital. They demanded that he be sent by ambulance to the capital, Phnom Penh. His flu swab sample traveled with him.Virun died on the journey. At 8 p.m., Cambodia’s National Public Health Laboratory confirmed Dr. Luch’s suspicion: He had died of highly pathogenic avian influenza.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Hilary Cass Says U.S. Doctors Are ‘Out of Date’ on Youth Gender Medicine

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      Dr. Hilary Cass published a landmark report that led to restrictions on youth gender care in Britain. U.S. health groups said it did not change their support of the care.After 30 years as one of England’s top pediatricians, Dr. Hilary Cass was hoping to begin her retirement by learning to play the saxophone.Instead, she took on a project that would throw her into an international fire: reviewing England’s treatment guidelines for the rapidly rising number of children with gender distress, known as dysphoria.At the time, in 2020, England’s sole youth gender clinic was in disarray. The waiting list had swelled, leaving many young patients waiting years for an appointment. Staff members who said they felt pressure to approve children for puberty-blocking drugs had filed whistle-blower complaints that had spilled into public view. And a former patient had sued the clinic, claiming that she had transitioned as a teenager “after a series of superficial conversations with social workers.”The National Health Service asked Dr. Cass, who had never treated children with gender dysphoria but had served as the president of the Royal College of Pediatrics and Child Health, to independently evaluate how the agency should proceed.Over the next four years, Dr. Cass commissioned systematic reviews of scientific studies on youth gender treatments and international guidelines of care. She also met with young patients and their families, transgender adults, people who had detransitioned, advocacy groups and clinicians.Her final report, published last month, concluded that the evidence supporting the use of puberty-blocking drugs and other hormonal medications in adolescents was “remarkably weak.” On her recommendation, the N.H.S. will no longer prescribe puberty blockers outside of clinical trials. Dr. Cass also recommended that testosterone and estrogen, which allow young people to develop the physical characteristics of the opposite sex, be prescribed with “extreme caution.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Share Your Story About the Organ Transplant System

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      We want to hear from doctors, nurses, technicians, patients and others with experience in the system. Tell us your experiences below.The New York Times is interested in the organ transplant system.Do you have a tip about irregularities in the system? If so, we need your help.If you are a doctor, nurse, technician or anybody else working on organ transplants, we’d love to hear from you. We are also eager to talk to from medical residents working in those transplant programs. And of course, we also want to hear from patients and their families.Share your story about the organ transplant systemWe will not publish any part of your submission without contacting you first. We may use your contact information to follow up with you. More

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      The History Behind Arizona’s 160-Year-Old Abortion Ban

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      The state’s Supreme Court ruled that the 1864 law is enforceable today. Here is what led to its enactment.The 160-year-old Arizona abortion ban that was upheld on Tuesday by the state’s highest court was among a wave of anti-abortion laws propelled by some historical twists and turns that might seem surprising.For decades after the United States became a nation, abortion was legal until fetal movement could be felt, usually well into the second trimester. Movement, known as quickening, was the threshold because, in a time before pregnancy tests or ultrasounds, it was the clearest sign that a woman was pregnant.Before that point, “women could try to obtain an abortion without having to fear that it was illegal,” said Johanna Schoen, a professor of history at Rutgers University. After quickening, abortion providers could be charged with a misdemeanor.“I don’t think it was particularly stigmatized,” Dr. Schoen said. “I think what was stigmatized was maybe this idea that you were having sex outside of marriage, but of course, married women also ended their pregnancies.”Women would terminate pregnancies in several different ways, such as ingesting herbs or medicinal potions that were thought to induce a miscarriage, Dr. Schoen said. The herbs commonly used included pennyroyal and tansy. Another method involved inserting an object in the cervix to try to interrupt a pregnancy or terminate it by causing an infection, Dr. Schoen said.Since tools to determine early pregnancy did not yet exist, many women could honestly say that they were not sure if they were pregnant and were simply taking herbs to restore their menstrual period.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Biden, Trump and Dr. Bob: the Human Realities of Aging on the Job

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      He had become the local expert on what he called the “unwanted side effects of old age,” so Dr. Bob Ross, 75, rubbed arthritis cream onto his hands and walked into an exam room to see his seventh elderly patient of the day. He had been a doctor in the remote town of Ortonville, Minn., for nearly five decades, caring for most of its 2,000 residents as he aged alongside them. He delivered their children, performed their high school physicals, tended to their workplace injuries and now specialized in treating the wide-ranging symptoms of what it meant to grow old in America.“What’s hurting you most today?” he asked Nancy Scoblic, 79.“Let me take out my list,” she said. “Sore knees. Bad lungs. I’ve got a spot on my leg and pain in my shoulder. Basically, if it doesn’t hurt now, it’ll probably hurt later.”She’d known him for most of her life, first as Bobby, whom her family sometimes babysat, then as Bob in high school, and now as Dr. Bob — the physician who had cared for her grandparents and also her grandchildren, and who almost everyone in Ortonville entrusted with their most vulnerable moments. It was behind the closed door of Dr. Bob’s exam room where hundreds of people filled out their advance directives, took cognitive evaluations and tested out their new walkers and hearing aids. It was Dr. Bob who delivered bad news with a farmer’s directness and then sat with families around a hospice bed for hours when the only thing left to do was to pray.Most of his patients were white, geriatric and still largely self-sufficient — members of the same demographic as the country’s two leading presidential candidates in the 2024 election, 81-year-old Joe Biden and 77-year-old Donald Trump. The conversations at the heart of an election cycle were the same ones unfolding inside Bob’s office: What were the best ways to slow the inevitable decline of the human body? How did aging impact cognition? When was it possible to defy age, and when was it necessary to make accommodations in terms of decision-making or professional routines. These were the questions he asked his patients each day, and also himself.He took Nancy’s hand and helped her onto the exam table, checking for circulatory problems as he felt her lymph nodes and her carotid artery for signs of swelling. He pressed his hands against her abdomen to seek out masses in the liver or enlargement of the spleen. It was the same geriatric exam he conducted at least 25 times each week, as Ortonville’s soybean farmers aged into retirement and America’s baby boomers arrived in his office showing more evidence of cancer, more bruises from falls, more diabetes, more strokes and more signs of memory loss and possible dementia.Bob helps Nancy Scoblic with her coat after an appointment. We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Insurance Companies and the Prior Authorization Maze

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      More from our inbox:Elect the U.S. Attorney GeneralFriendship MemoriesA Leadership GapInsurance companies have weaponized a seemingly benign process to protect their profits, and it’s putting patients at risk.To the Editor:Re “‘What’s My Life Worth?’ The Big Business of Denying Medical Care,” by Alexander Stockton (Opinion video, March 14), about prior authorization:Mr. Stockton’s video captures a current snapshot of an important truth about medical insurance in our country and in doing so does a service to all citizens by making them aware of this threat to themselves and their families.The immediate truth is that medical insurance companies are inadequately regulated, monitored and punished for their greed. In their current iteration they are bastions of greed, power and money. They need to be reined in.But there are other truths as well. Some physicians, just like some pharmaceutical companies, are unable to contain their greed and allow avarice to cloud their judgment, compromise their ethics and in some cases cross the line to Medicare fraud or other illegal activity.Medical care in our country is very big business involving billions of dollars. Without proper controls, regulation and monitoring, malfeasance follows. The challenge in such a complex and multifaceted context is how to implement such controls and monitoring without making things worse.Ross A. AbramsJerusalemThe writer, a retired radiation oncologist, is professor emeritus at Rush University Medical Center in Chicago.To the Editor:The Times’s video exploits tragic outcomes and does not mention basic important facts about the limited yet key role of prior authorization in ensuring that patients receive evidence-based, affordable care.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More