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There’s at least one unassailable fact in the battle over the federal 340B drug discount program: $1.6 billion is a lot of money. That’s how much so-called safety net hospitals will lose from a Trump administration policy, announced last week, to slash reimbursement to providers in the 25-year-old program. (Ross, 11/6)

Doctors who prescribe a large volume of high-cost Part B drugs may be penalized under MACRA’s merit-based incentive system. ...Oncologists, rheumatologists and ophthalmologists — all specialists that administer a lot of high-cost drugs — would be most affected by this move, according to an Avalere report funded by PhRMA. (Karlin-Smith, 11/6)

President Trump blasted the pharmaceutical industry for “getting away with murder” with steep drug prices during the campaign and since, but his administration has done little to force the industry to change its ways. As recently as Oct. 16, the president repeated the “getting away with murder” line and promised to bring prices “way down.” But despite the rhetoric, Trump has not acted on most of the drug pricing promises he made during the election. (Weixel, 11/1)

Cleveland Clinic’s chief executive, Dr. Toby Cosgrove, is retiring from one of the most influential health systems in the country in January. His imminent departure come at a time when hospitals are contending with an array of financial pressures, including rising pharmaceutical costs and government reimbursements that don’t cover costs. (Ross, 11/1)

The pharmacy market is one of the biggest potential new targets for Amazon.com Inc. The online retail giant moved into the roughly $800 billion U.S. grocery market in June by buying Whole Foods Market Inc. Drugs, a $450 billion industry in the U.S., are likewise most often sold from brick-and-mortar stores. Shoppers filling prescriptions frequently pick up toiletries, beauty supplies and dish soap—all retail items Amazon already sells. And the distribution chain for drugs has lots of middlemen whose markups Amazon can seek to undercut. (Langreth and Soper, 11/7)

CVS Health said on Monday that it would begin offering next-day delivery of prescription drugs and same-day service in some big cities next year, reflecting the company’s worries about potential competition from Amazon. CVS Health also said its retail sales declined in the third quarter of this year, a dip that the company said occurred because of the three major hurricanes that forced many stores to close. (Thomas, 11/6)

The 45 states that recently made sweeping allegations of price-fixing against 18 generic pharmaceutical companies are also focusing on how pharmacies and drug wholesalers, like Walgreens Boots Alliance, McKesson, Cardinal Health, and AmerisourceBergen, benefit from higher drug prices. The expanded 235-page complaint that state attorneys general hope to file in federal court in Philadelphia against generic drug makers claims drug wholesalers and distributors that purchase drugs have agreements with generic manufacturers that push the distributors to not restrain drug prices for the benefit of their customers. (Vardi, 11/6)

Combing through the data of its most recent setback in Alzheimer’s disease, Merck (MRK) sees a glimmer of hope that a once-failed drug might come through for patients in the earliest stages of disease. (Garde, 11/2)

The number of so-called pay-to-delay deals declined in fiscal year 2015, the second consecutive year that a drop occurred since the U.S. Supreme Court ruled these controversial agreements can be subject to antitrust scrutiny, according to the latest tally by the Federal Trade Commission. The FTC has kept a watchful eye on these deals, which involve settlements of patent litigation between brand-name and generic drug makers, over concerns that some violate antitrust laws. The agency, which has gone to court several times to argue this point, has in the past claimed these deals cost U.S. consumers an estimated $3.5 billion annually. (Silverman, 11/1)

Hurricane Harvey flooded Houston. Irma blew all around Florida. Then Maria devastated Puerto Rico. In addition to the dozens killed by the storms and millions of lives uprooted, there were an array of effects on companies — much damage, but also many opportunities to get busy cleaning up, making repairs and trying to get life back to normal. The effects are still rippling through corporate earnings, as with Tuesday's reports from companies including Royal Caribbean Cruises Ltd. and Avis Budget Group Inc. (Butters and Saraiva, 11/7)

When Dr. Atul Butte thinks data, the word “big” can’t do it justice. He was honored by President Barack Obama’s administration as an “open science champion of change” in 2013 for his work at Stanford University to sift 400 trillion molecular, clinical, and epidemiological data points to find new medicines and disease-fighting insights — and to speed the process by making the data as public as possible. (Piller, 11/3)

A D.C. Council member is pushing a plan to allow individuals to donate many prescription drugs for use by needy patients. The proposal sponsored by Brandon T. Todd (D-Ward 4) is for a two-year pilot program in which individuals, health-care facilities and pharmaceutical companies would be permitted to donate unused but unexpired prescription drugs that the D.C. Department of Health would store and redistribute based on requests from health-care workers. (Gerber, 11/6)

Several major advertisers are halting their business with Outcome Health following allegations that some employees of the prominent Chicago startup misled clients. Outcome Health streams “point of care” advertising to screens and tablets that it places in doctors’ offices. One of Outcome’s largest customers, Bristol-Myers Squibb Co. , said it has opted not to renew an ad agreement for 2018. Bristol-Myers had been expected to pay Outcome roughly $20 million this year, according to people familiar with the deal. (Vranica and Winkler, 11/5)

A third person has pleaded guilty to conspiracy to make and distribute anabolic steroids and fake drugs to treat infertility, acne and erectile dysfunction. They were marketed online under the brand name “Future Pharma.” United States Postal Inspectors found fake ingredients were shipped from China to Alabama and Florida between 2015 and 2017 and manufactured into drugs labeled as Viagra, Cialis, Accutane and Clomid. (11/6)

Teva Pharmaceutical Industries Ltd. Chief Executive Officer Kare Schultz is finding himself in the hot seat in his first week on the job with rapidly shrinking options to halt the slide in the Israeli company’s securities after its debt was cut to junk overnight. Fitch Ratings cited the “significant operational stress” that the world’s biggest maker of copycat drugs faces at a time when it needs to pay down debt, and pared its rating by two levels to non-investment grade late on Monday. Teva’s debt obligations are almost three times its market value following an ill-timed $40 billion acquisition last year of Allergan Plc’s generics business. (Linsell, Benmeleh and Koons, 11/7)

Two of the largest drug makers – Amgen and Genentech – are both cutting numerous jobs in coming weeks, adding to a growing number of layoffs in the pharmaceutical industry this year. Amgen plans to eliminate about 200 R&D positions, mostly in California, by the end of the year as the company makes “organizational changes” to its R&D apparatus, a spokeswoman confirmed. The cuts are being made at facilities in Thousand Oaks, Ca., and South San Francicso. The move comes eight months after Amgen reassigned about 100 R&D jobs from Thousand Oaks to South San Francisco and Cambridge, Ma. (Silverman, 11/4)

A spat has erupted in Canada over the amount of money that drug makers spend each year on R&D in the country and it comes as the government takes a closer look at coping with high prices. Earlier this week, a government agency called the Patented Medicine Prices Review Board released a report showing that industry R&D investment was 4.4 percent of Canadian sales in 2016. This is a problem for the pharmaceutical industry, which committed 30 years ago to maintain annual R&D spending in Canada at 10 percent or more each year. (Silverman, 11/3)

Crashing out of the European Union without a deal would cause major problems for Britain's health service and risk "chaotic disruption" to medicine supplies, according to a report on Tuesday. The Nuffield Trust, an independent health charity, also warned that Brexit without a deal on future relations with the EU would lead to worsening staff shortages in the National Health Service (NHS). (Hirschler, 11/7)