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      Gilead Agrees to Allow Generic Version of Groundbreaking H.I.V. Shot in Poor Countries

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      Many middle-income countries are left out of the deal, widening a gulf in access to critical medicines.The drugmaker Gilead Sciences on Wednesday announced a plan to allow six generic pharmaceutical companies in Asia and North Africa to make and sell at a lower price its groundbreaking drug lenacapavir, a twice-yearly injection that provides near-total protection from infection with H.I.V.Those companies will be permitted to sell the drug in 120 countries, including all the countries with the highest rates of H.I.V., which are in sub-Saharan Africa. Gilead will not charge the generic drugmakers for the licenses.Gilead says the deal, made just weeks after clinical trial results showed how well the drug works, will provide rapid and broad access to a medication that has the potential to end the decades-long H.I.V. pandemic.But the deal leaves out most middle- and high-income countries — including Brazil, Colombia, Mexico, China and Russia — that together account for about 20 percent of new H.I.V. infections. Gilead will sell its version of the drug in those countries at higher prices. The omission reflects a widening gulf in health care access that is increasingly isolating the people in the middle.Gilead charges $42,250 per patient per year for lenacapavir in the United States, where it is approved as a treatment for H.I.V. The company has said nothing about what lenacapavir will cost when used to prevent H.I.V. infections, a process called pre-exposure prophylaxis, or PrEP.The generics makers — four companies in India, one in Pakistan and one in Egypt — are expected to sell it for much less. Researchers at Liverpool University found the drug could profitably be produced for as little as $40 per patient per year, if it were being purchased in large volumes.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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      Is It Better to Buy or Lease a Car? It Depends.

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      The lowest overall cost is to buy a car and keep it for a long time. But leasing usually has lower monthly costs. And leasing an E.V. may come with a tax break.Most people have two options when they want a new car: buy it with a traditional loan or lease it.Either can make sense, depending on your personal situation.If you’re looking for the lowest overall cost over the longer term, buying a car with a loan, and then driving it for a while debt free after you finish making payments, is usually the best option.But if low monthly payments and a smaller down payment are a priority, a lease may be worth considering. And if you’re willing to try an electric vehicle or a plug-in hybrid, tax breaks available for leased models may make deals more affordable. Almost half of new E.V.s were acquired with leases in the second quarter of this year, up from around a fourth a year earlier, according to data from Experian.The Federal Reserve’s decision on Wednesday to cut its benchmark rate by half a point indirectly affects rates on car loans, which are also influenced by factors like the borrower’s credit score and the level of loan delinquencies. The average interest rate for a new-car loan in August was 7.1 percent, and 11.3 percent for a used-car loan, according to the automotive site Edmunds. “It will take a number of additional rate cuts before the cumulative effect becomes material for car buyers,” said Greg McBride, chief financial analyst at Bankrate.Paying cash for your car is, of course, interest free. But while car prices have eased somewhat, they remain high. The average transaction price in July was around $48,000 for a new car, and about $25,000 for a used car, according to Kelly Blue Book, part of Cox Automotive. Most people who buy a new automobile and many who buy one used get some kind of financing.With a traditional loan, you make a down payment and then pay off the debt with fixed monthly payments over time. (The average new-car loan term is about six years.) When the loan is repaid, you can keep the car and drive it payment free or trade it in and get credit for its value toward your next car purchase.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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      In His Last Months as President, Biden Is Both Liberated and Resigned

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      President Biden spent decades seeking the highest office, only to drop his bid for re-election under pressure. These final months before the November election are bittersweet, his allies say.President Biden began the final stretch of his political career this week freed from the rigors of running for re-election, appearing by turns nostalgic, liberated and — in some cases — resigned to finding himself once again in a supporting role.After a two-week summer vacation, Mr. Biden has been campaigning for Vice President Kamala Harris, now at the top of the Democratic ticket, and traveling the country to promote his administration’s accomplishments.But for a man who has spent decades seeking the highest office, only to drop his bid for re-election under pressure from his own party, these final months before the November election are bittersweet, his allies say.“For my whole career I’ve either been too young or too old, never in between,” Mr. Biden told a crowd of union workers on Friday in Ann Arbor, Mich. The president, who was not yet 30 when he first won a Senate seat in 1972, cracked that he went on to serve for “374 years.”Earlier in the week, Mr. Biden appeared unbothered about alienating conservatives when he attacked Senator Ron Johnson of Wisconsin — in the Republican’s home state — for not voting for the Inflation Reduction Act, the president’s signature legislation.And on Monday in Pittsburgh, during an event with Ms. Harris, Mr. Biden did not seem particularly keen to cede the spotlight. He spoke eight minutes longer than the vice president, even as he said he would be “on the sidelines” going forward.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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      Has the Spread of Tipping Reached Its Limit? Don’t Count on It.

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      Americans are being asked to tip more often and in more places than ever before: at fast food counters and corner stores, at auto garages and carwashes, even at self-checkout kiosks. That has rankled many customers and divided both employers and tipped workers.It may soon get worse. Both major-party presidential candidates have embraced proposals to eliminate income taxes on tips, a move that would, in effect, subsidize tipping and prompt more businesses to rely on it.Economists across the political spectrum have panned the tax idea, arguing that it is unfair — favoring one set of low-wage workers over others — and could have unintended consequences. Even some tipped workers and groups that represent them are skeptical, worrying that over the long term the policy could result in lower pay.But the debate alone underscores how service-sector workers have emerged from the pandemic as an economically and politically potent force. The spread of tipping in recent years was, in part, a result of the intense demand for workers, and the leverage it gave them. The presidential candidates’ dueling proposals signal that they see the nation’s roughly four million tipped workers as a constituency worth wooing.“I do think it’s a reflection of this change in which people are finally hearing and recognizing that these workers matter,” said Saru Jayaraman, president of One Fair Wage, an advocacy organization. “Tipped workers had never seen their needs named in any way by any presidential candidate, ever.”Ms. Jayaraman isn’t a fan of the tax exemption idea, though she is optimistic that the attention being paid to the issue could lead to policies she considers more important. One is the elimination of the subminimum wage, which allows businesses in some states to pay workers as little as $2.13 an hour as long as they receive enough in tips to bring them up to the full minimum wage.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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      A Bargain at the Opera: Philadelphia Offers All Seats for as Low as $11

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      Seeking new audiences, Opera Philadelphia is putting in place a pay-what-you-can model, one of the first of its kind by a major opera company.In Philadelphia, a night at the opera may now be cheaper than going to the movies.Opera Philadelphia, a company with a reputation for innovation and ambition, announced on Tuesday that it was putting in place a pay-what-you-can model for the 2024-25 season, with all tickets for all performances starting at $11. The initiative, which the company calls Pick Your Price, is aimed at attracting new audiences.“People want to go to the opera, but it’s expensive,” said Anthony Roth Costanzo, the celebrated American countertenor who became the company’s general director and president in June. “Our goal is to bring opera to more people and bring more people to the opera.”It immediately proved popular. On Tuesday, the day the initiative was announced, Opera Philadelphia said it sold more than 2,200 tickets for the coming season, compared with about 20 the day before. The tickets were originally priced at $26 to $300.High ticket prices have long been a barrier to audiences, and especially to newcomers. In recent years a number of performing arts groups, including Lincoln Center, the Chicago Sinfonietta and Ars Nova, the Off Broadway incubator, have experimented with pay-what-you-can approaches. Other opera companies have experimented with discounts, including rush tickets and deals offered to young people. But Opera Philadelphia’s approach was one of the boldest yet.Its website explains that all tickets start at $11 but that people will be given the option of choosing to pay much more, including the standard price.Like many nonprofit performing arts organizations, Opera Philadelphia gets much more of its revenue from philanthropy than through ticket sales. Radically lowering the prices could encourage more donations, which will no longer risk being seen as subsidizing an expensive art form that is out of reach for many people. And Costanzo said that the new model would allow the company to concentrate more on staging interesting works, and less on worrying about ticket sales.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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      Congress Presses Health Insurance Regulators on ‘Troubling’ Billing Tactics

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      Lawmakers are zeroing in on MultiPlan, a firm that has helped insurers cut payments while sometimes leaving patients with large bills.Lawmakers on Tuesday called on health insurance regulators to detail their efforts against “troubling practices” that have raised costs for patients and employers.In a letter to a top Labor Department official, two congressmen cited a New York Times investigation of MultiPlan, a data firm that works with insurance companies to recommend payments for medical care.The firm and the insurers can collect higher fees when payments to medical providers are lower, but patients can be stuck with large bills, the investigation found. At the same time, employers can be charged high fees — in some cases paying insurers and MultiPlan more for processing a claim than the doctor gets for treating the patient.The lawmakers, Representatives Bobby Scott of Virginia and Mark DeSaulnier of California, both Democrats in leadership positions on a House committee overseeing employer-based insurance, highlighted MultiPlan as an example of “opaque fee structures and alleged self-dealing” that drive up health care costs. In their letter, they pressed the department for details on its efforts to enforce rules meant to promote transparency and expose conflicts of interest.MultiPlan’s business model focuses on the most common way Americans get health coverage: through an employer that “self-funds,” meaning it pays medical claims with its own money and uses an insurance company to process claims. Insurers such as Aetna, Cigna and UnitedHealthcare have pitched MultiPlan’s services as a way to save money when an employee sees a provider out of network.In many cases, MultiPlan uses an algorithm-based tool to generate a recommended payment. Employers typically pay insurers and MultiPlan a percentage of what they call the “savings” — the difference between the recommendation and the original bill.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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      New Real Estate Rules Sow Confusion, at Least in Short Term

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      Changes in how real estate commissions are advertised and paid went into effect this weekend. Buyers and even some agents aren’t sure what they mean.An hour before the open house on Saturday afternoon, a real estate agent paced across the dark bamboo floors, straightening the throw blanket, fluffing the pillows and lighting a scented candle.The last-minute sprucing at the $1.2 million condo in Jersey City, N.J., was exactly what agents have done at open houses for decades before this weekend.The difference now is the information they are required to disclose and where they can disclose it when it comes to real estate commissions — a charge that had hovered between 5 to 6 percent of the sales price, and until now was typically paid by the seller and split between the seller’s agent and the buyer’s agent.The changes that went into effect this weekend decouple the two commissions: Sellers are no longer expected to pay buyers’ commissions, though they can still choose to do so, and the proposed commission split can no longer be advertised on the online database commonly used to sell homes, the M.L.S.The new rules went into effect across the United States as part of a $418 million settlement agreement with the National Association of Realtors, a powerful real estate trade group that was successfully sued by a group of homeowners in Missouri who argued that the longtime practice requiring them to pay agents’ commissions led to inflated fees. Brokerages have spent months trying to educate agents and consumers on the looming changes.But when they were implemented nationwide this Saturday, buyers remained befuddled.Sarthak Jain, left, and his wife, Aditi Maheshwari, touring a duplex in Jersey City alongside their Realtor.Andres Kudacki for The New York TimesWe 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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      Harris y Trump presentan un claro contraste sobre la economía

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      Ambos candidatos abogan por ampliar el poder del gobierno para dirigir los resultados económicos, pero en ámbitos muy diferentes.[Estamos en WhatsApp. Empieza a seguirnos ahora]La vicepresidenta Kamala Harris y el expresidente Donald Trump volaron a Carolina del Norte esta semana para pronunciar lo que se anunciaron como importantes discursos sobre la economía. Ninguno de los dos expuso un plan detallado de políticas: ni Harris, que se centró durante media hora en la vivienda, los comestibles y los medicamentos con receta, ni Trump, que durante 80 minutos desperdigó varias propuestas entre reflexiones en voz alta sobre inmigrantes peligrosos.Pero ambos candidatos, cada uno a su manera, enviaron a los votantes mensajes claros e importantes sobre sus visiones económicas. Cada uno de ellos defendió la visión de un gobierno federal poderoso, uno que utilice su poder para intervenir en los mercados en busca de una economía más fuerte y próspera.Solo discreparon, casi por completo, sobre cuándo y cómo debe utilizarse ese poder.El viernes en Raleigh, Harris empezó a imprimir su propio sello a la economía progresista que ha dominado la política demócrata en la última década. Este pensamiento económico abraza la idea de que el gobierno federal debe actuar con agresividad para fomentar la competencia y corregir las distorsiones en los mercados privados.El planteamiento busca grandes subidas de impuestos a las empresas y a quienes obtienen ingresos altos, para financiar la ayuda a los trabajadores de ingresos bajos y de clase media que luchan por crear riqueza para sí mismos y para sus hijos. Al mismo tiempo, ofrece grandes exenciones fiscales a las empresas que se dedican a lo que Harris y otros progresistas consideran un gran beneficio económico, como la fabricación de tecnologías necesarias para luchar contra el calentamiento global o la construcción de viviendas asequibles.Esta filosofía anima la agenda política que Harris presentó el viernes. Se comprometió a entregar hasta 25.000 dólares en ayudas al pago inicial a cada comprador de primera vivienda durante cuatro años, al tiempo que destinaría 40.000 millones de dólares a empresas constructoras de primeras viviendas. Harris afirmó que reinstauraría de forma permanente el crédito tributario por hijos ampliado que el presidente Biden estableció temporalmente con su ley de estímulo de 2021, al tiempo que ofrecería aún más ayuda a los padres de recién nacidos.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