A bipartisan group of lawmakers has reintroduced the PASTEUR Act in Congress, which stands for Pioneering Antimicrobial Subscriptions to End Upsurging Resistance.
The legislation would encourage investment in the development of drugs to address what some have called "the antimicrobial resistance crisis." It also aims to improve the appropriate use and availability of antibiotics.
David Hyun, antibiotic resistance project director for The Pew Charitable Trusts, said antibiotic resistance is due to not having enough new antibiotics coming to the market in the last couple of decades. He added the antibiotic pipeline has been pretty dry, compared with where things were about three or four decades ago.
"This is a problem because our antibiotic arsenal has not been able to keep pace with the emergence of antibiotic resistance that we're seeing in patients," Hyun explained.
Hyun emphasized the PASTEUR Act is creating an economic incentive for the drug-development pipeline, to incentivize and make sure new antibiotics are being researched and developed and filling unmet needs and space of antibiotic resistance.
Cornelius Clancy, professor of medicine at the University of Pittsburgh, said a key component of the bill is to establish a subscription-style model for antibiotics. He pointed out the Department of Health and Human Services will pay for access to a given new drug which is active against antibiotic-resistant pathogens, and provide drugs to health care systems. Reimbursement to companies developing drugs will not be on a per-use basis for the use of the drug.
"So this model attempts to come up with a new way of reimbursing for antibiotics where people will purchase -- or systems will purchase -- access to the drugs," Clancy noted. "And then they can use them as often or as little as they like, and companies are not dependent upon dose-by-dose reimbursement."
Clancy stressed it takes 10 to 20 years to develop a new antibiotic for the pipeline. He added some new antibiotics introduced and reaching clinics over the past 20 years have almost without exception, failed economically. Therefore, companies have either left or chosen not to get into the antibiotic drug development space.
"And the reason that's important is we are seeing more and more resistant infections that we need new antibiotics for," Clancy cautioned. "That trend is only going to increase in the future."
Clancy added without some sort of effort to spur antibiotic development and to improve the economic prospects, for companies attempting to develop antibiotics then the U.S. runs into the risk in the future of not having enough antibiotics to fight infection-causing bacteria.
Support for this reporting was provided by The Pew Charitable Trusts.
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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.
Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.
Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.
"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."
Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.
Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.
"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."
Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.
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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.
Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.
"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained
Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.
Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.
"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.
Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.
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New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.
The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.
"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.
Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.
Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."
"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.
Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.
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