Aye-n’t going to happen. Last week I covered how Florida had their importation plan approved by the Food and Drug Administration. It all seems so unlikely to happen or, if it does, it has a lot to go through before it happens. And already the Canadians are saying no thank you.

International Math. The Commonwealth Fund has a look at the drugs selected for 2026 Medicare negotiation and what the prices are internationally. Excellent resource to flip through.

ADHD Surge. NYT reporting that post-pandemic, the use of ADHD medicines is rising. Partly social media, partly loss of stigma, partly newly diagnosed/stress post-pandemic. I imagine it is all of the above but something we’ll need to wrap into health policy moving forward. Mental health today is so different than mental health 20 years ago.

Hanging on. The Washington Post has a nice article on the lack of progress in changing prior authorization in Medicare. A proposed rule was issued that would automate prior authorization electronically and expedite prior authorization requests. So far, radio silence. A surprisingly niche topic for a newspaper.

ER that might not do. Little story, I was on a vacation in rural Montana and fell and broke my nose. I spoke with a park ranger and his advice? If you can breathe, wait until you get home to seek care. No doctors (much less a hospital) for hours. Now I was fine, but it did make me think about things that could be way more serious and what happens then. NPR has a nice roundup about the rural emergency hospital program.

The program provides additional funding if a rural hospital operates only an emergency room; inpatient services are not permitted. That’s the part of the story that made me pause. I am sure there are lots of reasons to curb inpatient services in rural areas; I mean they likely are underutilized and you can’t predict demand. But… a few beds would seem to make sense. You would want lower utilization cases to be treated close to home instead of hours away. The article does a nice job of looking at both sides.

Click Bait. Kaiser News has a story about how some beneficiaries feel trapped by Medicare Advantage because they hear about the perks, sign up and then discover that when they need care for a more serious issue, there are hurdles. When they go to switch coverage, the transition to fee-for-service or Medigap can be expensive and or difficult in the case of Medigap (pre-existing conditions.)

The article didn’t propose solutions but a few thoughts came to mind. Why is there still a pre-existing condition clause in Medigap? That seems like a good starting point. I’d also want to make sure that patients enrolling in Medicare Advantage to have an understanding that it can be difficult to switch out because of pre-existing conditions.

It could be possible to reframe the transition to other coverage. Yes, Medicare Advantage can be terrific for some beneficiaries. It is less expensive but there is a need to recognize that and save knowing that options in the future might be more costly. Potentially it would at least serve as less of a premium shock.

Blood work. The accuracy of Alzheimer’s blood tests and how they will need to be more accurate in the future.