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Bottle deposit scheme would cut marine pollution: Green Alliance
 Plastic marine litter could be cut significantly if the government adopted a bottle deposit scheme as part of five key actions to tackle pollution of the oceans, a green thinktank has said.

The single most effective action to reduce plastic pollution in the seas would be a container return scheme along the lines of those run in large parts of Europe, north America and Australia, according to a new analysis by Green Alliance. In such schemes, a small tax is added to recyclable and reusable containers at the point of sale, which consumers can reclaim by returning them.

The thinktank says its own research – using data from Australian analysis – shows 33% of plastic marine pollution comes from littering of drinks bottles.

They say a deposit scheme would capture about 95% of littered plastic bottles – reducing marine litter by almost a third.

Green Alliance said announcements by the new environment secretary Michael Gove promising to tackle marine litter, and his announcement that the government is to legislate to ban microbeads in cosmetic products, were a step forward.

But it said the government could go further by adopting its five key measures.

As well as a deposit scheme, they are calling for the government to:

Enforce Operation Clean Sweep – a voluntary industry initiative to reduce pollution from plastic pellets known as nurdles – responsible for 9% of marine plastic pollution.Enforce existing maritime dumping bans.

Upgrade wastewater treatment plants with sand filters to catch microplastic fibres from synthetic clothes when they are washed.

Expand the ban on microbeads to all products – not just cosmetic rinse-off face washes and other wash-off products.

The Guardian revealed new figures last month which show a million plastic bottles are bought every minute across the globe and that production will increase 20% by 2021. Fewer than half of the bottles bought in 2016 were collected for recycling and just 7% of those collected were turned into new bottles. Instead most plastic bottles ended up in landfill or in the ocean.

Dustin Benton, acting policy director of Green Alliance, said: “It is depressing to visit a beach that is covered in plastic and downright scary to learn that the seafood you are eating might be contaminated by plastic pollution.

“The popularity of the microbeads ban and plastic bag charge shows the public is up for tackling these problems.

“The government should listen, introduce a bottle deposit scheme and enforce rules on sources of industrial waste.”

They compared the leakage into the marine environment of nurdles, used as raw material in industrial processes, as a clear case of industrial pollution.

“We don’t stand for that anywhere else. We should not stand for it with plastic,” said Benton.

Between 5m and 13m tonnes of plastic leaks into the world’s oceans each year to be ingested by sea birds, fish and other organisms, and by 2050 the ocean will contain more plastic by weight than fish, according to research by the Ellen MacArthur Foundation.

Experts estimate plastic is ingested by 31 species of marine mammal and more than 100 species of sea birds.

In an interview with Sky, Gove indicated he supported a bottle deposit scheme. He told the broadcaster it was a “great idea”, but said it was important to make sure it would work properly before guaranteeing its implementation.

Output: The introduction of a bottle deposit scheme would be the most effective way of reducing plastic litter in oceans, according to UK environmental thinktank Green Alliance. The group says that 33% of marine pollution comes from drinks bottles and that a deposit scheme similar to those in Australia, Europe and north America would capture 95% of such items. The group is also calling for enforcement of a voluntary industry initiative to reduce pollution from plastic “nurdles” or pellets, as well as the upgrading of wastewater plants to capture microplastic fibres and the expansion of the ban on microbeads.


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Sinclair Pharma 12.6% CAGR predicted for global dermal filler market to 2023
 Global Dermal Fillers Market Overview

The Dermal Fillers Market Size was estimated at USD 5.1 Billion in 2022 and is projected to grow from USD 5.50 Billion in 2023 to USD 10.11 Billion by 2032, exhibiting a compound annual growth rate (CAGR) of 7.90% during the forecast period (2023 - 2032). Increased interest in plastic surgery and the growing need for minimally invasive techniques are key market drivers contributing to market growth and revenue.

Source: Secondary Research, Primary Research, MRFR Database, and Analyst Review

Dermal Fillers Market Trends

The growing interest in plastic surgery is driving the market growth

The rising interest in plastic surgery drives Market CAGR for dermal fillers. The increasing number of face surgeries performed by both men and women is expected to impact the market's development over the evaluation period significantly. Recently, individuals have searched for less invasive and less painful treatments to achieve a more youthful and healthier appearance. Because invasive cosmetic operations can have a variety of hazards and also demand the patient take more time to recuperate from the surgery. American Society of Plastic Surgeons reported that roughly $13.2 Mn aesthetic operations were performed in the US, with collagen fillers accounting for $3.4 Mn of those treatments in 2020. Such compelling figures demonstrate the considerable growth in demand for cosmetic operations.

Additionally, the market saw substantial potential due to the increasing demand for less invasive procedures. Businesses are releasing a variety of novel items to fulfill rising demand, which is expected to increase the rate of growth in the future years. One of the major advancements in the worldwide industry is that practically every demographic has expressed a curiosity for these non-intrusive or minimally invasive treatments. This is especially true for men, who increasingly use cosmetic operations to improve their appearance. A rising number of men are discovering that aging and gravity may harm how they look at their facial characteristics. As a result, males are turning to face filler treatments for their efficiency in wrinkle reduction.

Furthermore, technical advancements in medical cosmetic supplies drive market expansion. A rise in unhealthy habits has resulted in early aging, leaving people self-conscious about their looks and increasing the demand for dermal filler treatments. Moreover, cosmetic procedures are employed in various uses, such as lip enlargement, cheek volume reconstruction, and face revitalization, which increases the requirement for dermal filler goods.

The coronavirus epidemic is expected to have a detrimental influence on the worldwide market. The market is anticipated to decline by 40% in 2020 compared to 2019. Several cosmetic establishments and clinics were closed during the worldwide shutdown. The increasing prevalence of coronavirus limits the number of cosmetic procedures, which negatively influences the growth of the dermal fillers industry. The economy rebounded following the pandemic in 2021, as the globe gradually relaxed the COVID-19 rules due to a decrease in the overall number of confirmed cases. Major firms such as AbbVie Inc. and Revance Therapeutics saw an increase in their aesthetics offering as consumer interest in injectable therapies increased internationally.

For instance, the International Society of Aesthetic Plastic Surgery estimated 4,315,859 hyaluronic acid filler treatments were performed worldwide in 2019. This represents a 15.7% rise over the comparable period of 2018. A rise in aesthetic operations is also predicted to contribute to market growth. Therefore, it is anticipated that demand for Dermal Fillers will increase throughout the projection period due to the rising interest in plastic surgery. Thus, driving the Dermal Fillers market revenue.

Dermal Fillers Market Segment Insights

Dermal Fillers Type Insights

The market segments of dermal fillers, based on type, includes hyaluronic acid, polymers & particles, calcium hydroxylapatite, and collagen. The hyaluronic acid category dominated the market, accounting for 35% of market revenue (USD 1.8 Billion) in 2022. The growing market for hyaluronic acid and products based on it is mostly due to its safety and durability. In addition, significant firms providing hyaluronic acid treatments in rapidly expanding regions will boost the overall market growth.

Dermal Fillers Application Insights

The dermal fillers market segmentation, based on application, includes facial line correction treatment, face-lift, and lip treatments. The lip treatments category generated the most income of about 47% (USD 2.4 billion) in 2022. An increasing desire for aesthetic attractiveness and increased beauty sensitivity within women, led by the growth of less invasive treatments, are expected to propel the sectors throughout the projected timeframe.

Figure 1: Dermal Fillers Market, by Application, 2022 & 2032 (USD Billion)

Source: Secondary Research, Primary Research, MRFR Database, and Analyst Review

Dermal Fillers Brand Insights

The market segmentation of dermal fillers, based on brand, includes juvederm, radiesse, and restylane. The juvederm dominated the market, accounting for 45% of market revenue (USD 2.2 Billion) in 2022. The Restylane category is expected to grow quickly during the projected timeframe.

Dermal Fillers Regional Insights

By region, the research provides market insights into North America, Europe, Asia-Pacific, and the Rest of the World. The North American Dermal Fillers market will dominate, owing to increased demand for cosmetic solutions and the growing use of non-invasive or partially invasive procedures in this region. In addition, expanding clinical studies into developing novel skin-friendly beauty items will boost the market growth during the projected timeframe.

Further, the major countries studied in the market report are the US, Canada, German, France, the UK, Italy, Spain, China, Japan, India, Australia, South Korea, and Brazil.

Figure 2: Dermal Fillers Market Share by Region 2022 (USD Billion)

Source: Secondary Research, Primary Research, MRFR Database, and Analyst Review

Europe region’s Dermal Fillers market accounts for the second-largest market share due to the increased requirement for minimally invasive procedures to enhance facial beauty, along with the approval of products and accessibility throughout the area will boost market share. Further, the German market of Dermal Fillers dominates the market share, and the UK market of Dermal Fillers is anticipated to grow rapidly in the European region during the projected timeframe.

The Asia-Pacific Dermal Fillers Market is anticipated to grow significantly during the projected timeframe because of the increased need for aesthetically pleasing facial items and non-invasive cosmetic treatments, boosting market demand in the APAC region. Moreover, China’s market of Dermal Fillers holds the largest market share, and the Indian market of Dermal Fillers is anticipated to expand rapidly in the Asia-Pacific region.

Dermal Fillers Key Market Players & Competitive Insights

Leading market players invested heavily in research and development (R&D) to scale up their manufacturing units and product lines, which will help the market of Dermal Fillers to grow and expand worldwide. Market participants are also undertaking various organic or inorganic strategic approaches to strengthen and expand their footprint, with important market developments including new product portfolios, contractual deals, mergers and acquisitions, capital expenditure, higher investments, and strategic alliances with other organizations. Businesses are also coming up with marketing strategies such as digital marketing, social media influencing, and content marketing to increase their scope of profit earnings. The Dermal Fillers industry must offer cost-effective and sustainable options to survive in a dynamic market.

Manufacturing locally to minimize operational expenses is a key business strategy manufacturers use in the Dermal Fillers industry to benefit customers and capture untapped market share and revenue. The Dermal Fillers industry has recently offered significant advantages to the medicine and service industry. Major players in the Dermal Fillers market, including Galderma Laboratories, LP (Switzerland), Allergan (Ireland), Merz Pharma (Germany), Dr. Korman Laboratories (Israel), Sinclair Pharma (UK), Teoxane Laboratories (Switzerland), Suneva Medical (US), SciVision Biotech Inc. (Taiwan), Medytox (South Korea), are attempting to expand market share and demand by investing in research and development (R&D) operations to produce sustainable and affordable solutions.

Sinclair Pharma is a multinational aesthetics firm headquartered in London, a subsidiary of Huadong Medicine Ltd. The firm provides a range of complementary cosmetic pharmaceutical medicines emphasizing collagen stimulation for excellent quality, long-lasting, and minimally intrusive treatments. Sinclair Pharma reported in April 2022 that Perfectha Lidocaine was granted the European CE mark for its use in wrinkle reduction, face contouring, and density regeneration. This CE accreditation allows Perfectha Lidocaine to launch in the UK and with all significant European markets.

Allergan Aesthetics, an AbbVie subsidiary, creates, produces, and sells top companies and goods such as face injections, figure contouring, and cosmetic surgery. Allergan's collection includes the most complete, rooted-in-science aesthetic solutions in the market. Allergan Aesthetics, an AbbVie subsidiary, partnered with Luminera, a privately owned aesthetics firm with a product line and pipeline of superficial filler products, in October 2020. According to the terms of the agreement, Allergan Aesthetics acquired Luminera's entire dermal filler portfolio and its research and development pipeline, significantly boosting its top dermal filler offering with its Juvederm filler assortment.

Key Companies in the market of Dermal Fillers include

Galderma Laboratories LP (Switzerland)

Allergan (Ireland)

Merz Pharma (Germany)

Dr. Korman Laboratories (Israel)

Sinclair Pharma (UK)

Teoxane Laboratories (Switzerland)

Suneva Medical (US)

SciVision Biotech Inc (Taiwan)

Medytox (South Korea)

Dermal Fillers Industry Developments

April 2022:Sinclair Pharma reported in April 2022 that Perfectha Lidocaine was granted the European CE mark for its use in wrinkle reduction, face contouring, and density regeneration. This CE accreditation allows Perfectha Lidocaine to launch in the UK and with all significant European markets.

February 2021:Allergan Aesthetica, along with CollPlant, established a research and worldwide commercial partnership in February 2021 to utilize their plant-based recombinant human collagen (rhCollagen) in conjunction with Allergan's unique technologies to create and commercialize dermal and connective tissue fillers.

October 2020:Allergan Aesthetics, an AbbVie subsidiary, established a partnership with Luminera, a privately owned aesthetics firm having a product line and pipeline of superficial filler products, in October 2020. According to the terms of the agreement, Allergan Aesthetics acquired Luminera's entire dermal filler portfolio and its research and development pipeline, significantly boosting its top dermal filler offering with its Juvederm filler assortment.

Dermal Fillers Market Segmentation

Dermal Fillers Type Outlook

Hyaluronic acid

Polymers & particles

Calcium hydroxylapatite

Collagen

Dermal Fillers Application Outlook

Facial Line Correction Treatment

Face-Lift

Lip Treatments

Dermal Fillers Brand Outlook

Juvederm

Radiesse

Restylane

Dermal Fillers Regional Outlook

North America

US

Canada

Europe

Germany

France

UK

Italy

Spain

Rest of Europe

Output: Sinclair Pharma is named among key players in the global dermal fillers market, which is predicted to see a CAGR of 12.6% growing from $4,450m in 2016.to $10,008.4m by 2023, according to  Market Research Future. The market's growth is attracting a host of new companies. While the number of males undergoing facial injectable surgery is growing rapidly, women account for ~91% of the surgeries. Americas, driven by North and Latin America, remains the top market, followed by Europe, dominated by France although the UK is the fastest growing market. AsiaPac is expected to see a CAGR of 13.1% whilst growth in MEA is likely to be limited.


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Cyber cover accelerates growth of captive insurance
 The captive insurance market continues to remain “resilient, effective, efficient and profitable,” with rising premiums and lower combined ratios compared with the traditional insurance market as it further expands to cover evolving risks such as cyber liability, according to a new report by A.M. Best Co. Inc.

Best’s captive insurance composite ended 2016 with pretax profits up 15.8% over 2015 to $1.6 billion, including more than $803 million in underwriting profit, according to the report released by the Oldwick, New Jersey-based rating agency on Wednesday.

“Although captives are not intended to be profitmaking entities, their earnings are viewed as insurance expense savings that stakeholders would otherwise pass on to traditional commercial insurers,” the report stated.

In 2016, premiums increased modestly by 3.2%, reversing the slight declines of recent years, largely due to growth in medical professional liability and commercial multi-peril, according to the report.

Despite some catastrophe-related events in 2016, the captive insurance composite’s results outpaced the operating and underwriting results of the commercial casualty composite, with net premiums written, pre-tax operating income and policyholder surplus reaching all-time highs, according to the report. The captive insurance composite’s combined ratio improved from 86.9% in 2015 to 82.9% in 2016, while its five-year average combined ratio of 88.2% compares favorably with the commercial casualty composite’s 100.1% average over the same period.

“Although their mission is to break even, the CIC has had an excellent track record on profitability thus far and A.M. Best believes that, barring any unforeseen issues, results for the captive group should remain favorable in 2017,” the report said. “Some margin compression is inevitable owing to the prevailing low interest rate environment. However, captive insurers are not typically focused on high rates of return, but on loss control and capital preservation.”

Captives ensure availability and price stability and provide stakeholders with solutions and flexibility when emerging market issues such as cyber liability dictate enhanced coverage, according to the report. Direct premiums written by captives on cyber coverage rose 63.7% to $8.8 million in 2016, with paid losses of $1 million last year.

Meanwhile, the regulatory environment continues to evolve, with the New York State Department of Financial Services implementing both new and revised cybersecurity regulations, according to the report.

The governor of Vermont signed legislation this year to add agency captives — a reinsurance company owned by an insurance agency or brokerage — to the list of captives already allowed in that state.

“A.M. Best believes the inclusion of agency captives highlights the push by the insurance industry in recent years to get closer to their insureds,” the report said. “Many agents have long-standing relationships, with profitable books of business. Agency captives will allow them to continue to control that relationship by working with an unrelated primary carrier while sharing in the risk by participating in the fortunes of the business written.”

Some domiciles have enacted legislation that allows for dormancy status, giving the captive sponsor the ability to declare a captive dormant to save time and the costs of maintaining the captive, according to the report.

Recently, self-procurement taxes — taxes on premiums paid to non-admitted insurers — have played a major role in domicile selection, as one general interpretation of the Non-admitted and Reinsurance Reform Act — part of the Dodd-Frank Wall Street Reform and Consumer Protection Act — is that the entire tax is owed to the home state rather than being split among the states in which the risk is covered, the report noted.

“Accordingly, this interpretation provides an even greater incentive to have a captive domiciled in the home state, to avoid the entire self-procurement tax,” the report said. “With tax reform and a Dodd-Frank repeal being possibilities under the new administration, changes may very well be on the horizon. However, the House of Representatives’ proposed Financial CHOICE Act suggests no changes to the NRRA so for now self-procurement taxes will continue to play an important role in captive domicile selection.”

The number of captives in key North American domiciles grew by 4.4% in 2016, while both new formations and closings declined, according to a recent report from Strategic Risk Solutions cited by Best.

“Of particular note is the growth in North Carolina, which began licensing captives at the end of 2013,” the Best report said. “The state has been aggressive in implementing laws favorable to captives and is now the sixth largest domicile by number of total captives. States continue to enact captive-friendly bills in the hopes of their domicile being selected to help increase much needed revenue.”

Output: Captive insurance – coverage provided by the insured's creation of a special purpose company – is growing at a faster pace than the traditional market on the back of demand for protection from emerging risks such as cyber attacks, a report by New Jersey-based ratings agency AM Best has said. Its captive composite gauge showed the market grew 15.8% last year to $1.6bn, outpacing the operating and underwriting results of the commercial casualty composite sector. The market remains “resilient, effective, efficient and profitable”, the report said. Premiums increased 3.2% due in part to growth in medical professional liability and commercial multi-peril, according to the report.


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Enbala Power Networks receives $5.5m investment from Zoma Capital
 Enbala Power Networks, a Vancouver, CA-based provider of virtual power plant (VPP) and distributed energy resource management software (DERMS), received an approx. $5.5m investment from Zoma Capital.

Zoma’s investment marks the second close of Series B financing, bringing the Series B total to $17.5m. Enbala had announced a $12M Series B venture capital financing earlier in 2017 from ABB Technology Ventures, Chrysalix Venture Capital, GE Ventures, National Grid, and Obvious Ventures.

Zoma Capital is the investment arm for the family office of Ben and Lucy Ana Walton, based in Denver. Zoma Capital invests in a broad range of market-based sustainable solutions addressing environmental and social problems, with an emphasis on energy, water and community development and with a geographic focus on Colorado and Chile.

Led by President and CEO Arthur “Bud” Vos, Enbala provides a real-time energy-balancing platform which captures and aggregates available customer loads, energy storage and renewable energy sources to form a network of continuously controlled energy resources. The platform dynamically optimizes and dispatches these resources to respond to the real-time needs of the power system – all without impacting customer operations.

FinSMEs

03/08/2017

Output: Enbala Power Networks, a Canadian provider of virtual power plant and distributed energy management software, has received an investment of approximately $5.5m from Zoma Capital, which has stakes in a range of sustainable technologies. Enbala provides a real-time energy-balancing platform that captures and aggregates available customer loads and stores energy to form a network of continuously controlled energy resources. The platform optimises and dispatches these resources in response to the real-time needs of the power system.


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Hawaii approves its largest battery-connected solar farm
 HONOLULU (AP) - The Hawaii Public Utilities Commission has approved a contract to build the largest solar farm connected to a battery system in the state.

State regulators last Friday approved the contract between Kauai Island Utility Cooperative and AES Distributed Energy Inc. to build the 28-megawatt solar photovoltaic plant with a 20-megawatt, five-hour energy storage system.

When construction is complete, the facility will be the largest solar-plus-utility-scale-battery system in Hawaii and have the capacity to power roughly 8,500 homes. The utility cooperative expects it to be finished by late 2018, the Honolulu Star-Advertiser reported (https://bit.ly/2f7S0hS ).

Approval of the facility will boost the cooperative’s renewable energy generation so it makes up more than than 50 percent of the utility cooperative’s energy portfolio, said David Bissell, the president and CEO. The cooperative is working to reach that goal in the next 18 month, he said.

AES is set to build, operate and maintain the facility over the course of its 25-year contract with Kauai Island Utility Cooperative.

Kauai Island Utility Cooperative said in its application that it will save members more than $97 million over the life of the project.

The facility will dispatch stored energy to help Kauai Island Utility Cooperative’s system ramp up to meet the power needs during afternoon and evening peak electricity demand periods and reduce the need for nighttime generation that traditionally relies on oil-fired plants.

Output: The Hawaii Public Utilities Commission has agreed to permit the construction of the largest solar farm connected to a battery system in the state. The contract between Kauai Island Utility Cooperative and AES Distributed Energy includes building a 28 MW solar plant with a five-hour energy storage system. When completed the farm will be the largest such facility in Hawaii and will provide power for about 8,500 homes. AES will operate and maintain the facility over the 25-year contract.


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Cities must ban all cars, including electric vehicles: UK adviser
 Cars must be driven out of cities to tackle the UK’s air pollution crisis, not just replaced with electric vehicles, according to the UK government’s top adviser.

Prof Frank Kelly said that while electric vehicles emit no exhaust fumes, they still produce large amounts of tiny pollution particles from brake and tyre dust, for which the government already accepts there is no safe limit.

Toxic air causes 40,000 early deaths a year in the UK, and the environment secretary, Michael Gove, recently announced that the sale of new diesel and petrol cars will be banned from 2040, with only electric vehicles available after that. But faced with rising anger from some motorists, the plan made the use of charges to deter dirty diesel cars from polluted areas a measure of last resort only.

Kelly’s intervention heightens the government’s dilemma between protecting public health and avoiding politically difficult charges or bans on urban motorists. “The government’s plan does not go nearly far enough,” said Kelly, professor of environmental health at King’s College London and chair of the Committee on the Medical Effects of Air Pollutants, official expert advisers to the government. “Our cities need fewer cars, not just cleaner cars.”

Ministers were forced to produce an air pollution plan after being sued twice in the courts over illegal levels, but it was criticised as “woefully inadequate” and “lacking urgency” by city leaders and “inexcusable” by leading doctors. The government’s own research showed the fastest and most cost-effective measure to cut the nitrogen dioxide (NO2) pollution largely caused by diesel engines is to charge dirty cars to enter urban areas.

Electric vehicles emit no NO2 but do produce small particle pollution from the wear on brake discs and tyres and by throwing up dust from roads. A recent European commission research paper found that about half of all particulate matter comes from these sources.

“While governments don’t currently pay much attention to particulate matter, it is in fact highly polluting, with strong links to cardiopulmonary toxicity,” said Kelly in an article in the Guardian.

The Royal College of Physicians estimates that 29,000 people die early each year from particle pollution, more than the 23,500 premature deaths attributed to NO2. The combined total is 40,000 because some people are harmed by both pollutants. NO2 levels are illegally high in most urban areas, allowing legal action to be taken, but small particle levels are not.

The legal limit in England and Wales for particulate matter is two and a half times the World Health Organisation’s (WHO) guideline set in 2005 and which has already been adopted in Scotland. London’s air is above the WHO limit but below that in England and Wales, said Kelly: “So it’s legal but unhealthy.” In any case, both the UK government and the WHO agree there is no safe level of small particle pollution.

Kelly said enabling people and goods to move easily and cheaply around cities such as London is crucial, especially as their populations are growing fast, and backed better public transport as the solution: “The safe and efficient movement of people around the capital can only be achieved through a clean and expanded mass transit system – served by buses, overground train and the underground system – and by as much active transport in the form of walking and cycling as is feasibly possible.”

“Encouragingly, attitudes toward car ownership do appear to be changing, with younger Londoners increasingly replacing little-used vehicles with car club membership and ride-sharing apps,” he said.

Oliver Hayes, Friends of the Earth air pollution campaigner, said: “Electric cars are critical in the fight against climate change and deadly air pollution, but they’re not a panacea. We must now build the infrastructure that reassures ordinary people that cycling and walking is safe, and invest in public transport that is consistently clean, cheap and reliable.”

A government spokeswoman said: “Reducing roadside pollution is a priority for this government – which is why we have committed £3bn to help towns and cities take action against harmful [NO2] emissions caused by dirty diesels. Next year the government will publish a comprehensive Clean Air Strategy which will address other sources of air pollution.”

Kelly said the traffic pollution problems facing the UK affect cities around the world, which are also increasing rapidly in size. “By 2050, nearly two-thirds of the world’s population will live in urban areas. How we manage and plan for growing urbanisation will be key to so many global aspirations from improving air quality and human health, maintaining economic success and combatting climate change.”

Output: Cars must be removed from cities, rather than replaced by electric vehicles, according to the UK government’s leading adviser on air pollution. Professor Frank Kelly commented that while electric vehicles do not produce exhaust fumes, they are still responsible for tiny pollution particles produced by brake and tyre dust for which there are no safe levels. Recent research from the European Commission discovered that nearly 50% of all particulate matter comes from these sources. An estimated 29,000 people die prematurely in the UK each year from particle pollution, more than the 23,500 who die from NO2 pollution.


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Enel reaches agreements for portfolio of solar plants
 Through its subsidiary Enel Green Power España (EGPE), Enel Group has secured a deal to develop a 339MW portfolio of solarpower plants in Spain.

The deal was awarded following the closing of a tender that aimed to collect 3,000MW of energy from renewable sources. This tender was part of the Spainish Government's plan to help the country achieve its target of consuming 20% of its energy from renewables by 2020.

Enel Group is set to invest around €270m to develop the new solar facilities, which will be situated in Murcia and Bajadoz regions.

The proposed solar capacity will complement the 540MW of windpower capacity that EGPE was awarded in May this year.

"Enel Group is set to invest around €270m to develop the new solar facilities."

Enel Group Global Renewable Energies head Antonio Cammisecra said: “This new milestone confirms our commitment to green energy in Spain, a country that continues to offer growth opportunities for our renewable projects.

“Together with the wind capacity awarded in May, this 339MW of solar capacity will support our renewable footprint in Spain, while also contributing to the country’s push to achieve its green energy goal.”

Scheduled to be operational by 2019, the proposed plants will sell their output in the Spanish pool market.

The Spanish Government will also provide incentives, by means of yearly capacity payments, to guarantee a steady return over the 25 years of the facilities’ lifetime.

Image: Solarpower generation. Photo: courtesy of minoru karamatsu/Flickr.

Output: Enel Green Power España has secured the rights to develop a 339 MW suite of solar power plants across Spain. The agreement was part of the Spanish government's plan to use renewables for 20% of its energy consumption by 2020. The investment will cost roughly €270m ($317m). The company also announced through its subsidiary that they have reached an agreement to develop a 90 MW photovoltaic project in Ribera do Piauí, in North-eastern Brazil.


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Enel reaches agreements for portfolio of solar plants
 The government of the Brazilian state of Piauí has announced Enel Green Power Brasil Participações Ltda., the Brazilian unit of Italian energy company Enel, was granted environmental authorization for a 290 MW PV project it is planning to build in Ribera do Piauí, in the microregion of Alto Médio Canindé, northeastern Brazil.

The local environment department Secretaria Estadual de Meio Ambiente do Piauí (SEMAR) has also granted approval for the construction of a 500 KV transmission line to connect the facility to the country’s electricity network.

According to SEMAR, the PV plant consists of seven sub-units, which are owned by four special purpose vehicles: Enel Green Power Nova Olinda B Solar S.A; Enel Green Power Nova Olinda C Solar S.A; Enel Green Power Nova Olinda Sul Solar S.A and Enel Green Power Nova Olinda Norte Solar S.A.

The $300 million project was selected by the Brazilian energy agency EPE in the second auction for wind and solar power projects (Leilão de Reserva), which was held in August 2015. Enel previously announced that construction of the plant had started in June.

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Two of Enel’s solar projects in Brazil achieved grid connection in early June. Both located in the town of Lapa, the Bom Jesus da Lapa (80 MW) and Lapa (78 MW) projects will supply energy to the country’s grid under a 20-year PPA.

According to Enel, its local susbidiaries Enel Green Power Brasil and Enel Brasil have an installed renewable energy generation capacity of 1,306 MW in Brazil. Of this capacity, 401 MW comes from wind power plants, while solar has a share of less than 200 MW. Hydropower plants still accounts for the majority of this capacity with over 893 MW. Enel also has currently 442 MW of further wind projects and over 600 MW of PV installations under development in Brazil.

Output: Enel Green Power España has secured the rights to develop a 339 MW suite of solar power plants across Spain. The agreement was part of the Spanish government's plan to use renewables for 20% of its energy consumption by 2020. The investment will cost roughly €270m ($317m). The company also announced through its subsidiary that they have reached an agreement to develop a 90 MW photovoltaic project in Ribera do Piauí, in North-eastern Brazil.


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German government and car makers agree to 'save diesel'
 German ministers and carmakers meet to 'save diesel'

BERLIN (Reuters) — German politicians and car bosses agreed on Wednesday to overhaul engine software on 5.3 MM diesel cars to cut pollution and try to repair the industry's battered reputation.

However, environmentalists said the plan - almost two years after Volkswagen admitted to cheating US diesel emissions tests—was too little, too late, and vowed to press ahead with legal action aimed at banning polluting vehicles.

Chancellor Angela Merkel's government has come under mounting pressure for not doing enough to crack down on vehicle pollution and for being too close to powerful carmakers.

The issue has become a central campaign topic ahead of next month's national election, prompting the government to summon car bosses to try to avert moves in some cities to force bans on diesel vehicles.

Justice Minister Heiko Maas said the agreement was only a first step, warning that bans on diesel vehicles could not be ruled out and urging car makers to focus more on consumers.

"The legal requirements for clean air remain in effect," he told Thursday editions of Germany's daily newspaper Bild.

Ministers have been wary of angering the owners of 15 MM diesel vehicles and damaging an industry that is the country's biggest exporter and provides about 800,000 jobs.

Politicians stopped short of demanding costly mechanical modifications to engine and exhaust systems and said they had agreed for now on software updates for 5.3 MM cars.

"We expect a new culture of responsibility from carmakers," Environment Minister Barbara Hendricks, from the centre-left Social Democrats, told a news conference, also adding the software updates were just a first step in cutting emissions.

"There is much to make good—to the environment, to people in cities, car owners and not least to the security of the car industry in Germany and its hundreds of thousands of jobs."

Hendricks criticised the VDA automakers lobby for putting out a statement proclaiming a deal two hours before ministers spoke to the media. She added the VDA's comment that the deal was "unique in Europe and the world" lacked humility.

The stakes have increased for German carmakers in recent weeks. Britain and France have announced plans to eventually ban all diesel and petrol vehicles and Tesla has launched its first mass-market electric car.

Meanwhile, top German manufacturers BMW, Daimler, Audi, Porsche and VW are being investigated by European regulators for alleged anti-competitive collusion.

LOST TRUST

The DUH environmental group said the initiative had failed as software updates would only result in a cut of about 2%–3% of emissions of toxic nitrogen oxides (NO x ), adding it would pursue court cases for diesel bans in 16 cities.

"Today's summit is bad news for hundreds of thousands of people who will get sick and 10,600 who will die prematurely due to NOx each year," DUH head Juergen Resch said in a statement.

The VDA said the software updates should cut NOx emissions by 25%–30% for those cars affected, reducing pollution at least as much as possible driving bans.

"The car industry knows it has lost a lot of trust. We must and will work on winning back that trust," VDA president Matthias Wissmann said.

Transport Minister Alexander Dobrindt said a refusal by foreign carmakers to participate in the plan was "completely unacceptable."

Carmakers also agreed to fund incentives aimed at encouraging consumers to trade in older diesel cars that cannot be helped with software updates.

The VDA said the software updates would cost VW, Daimler and BMW together at least 500 MM euros ($593 MM), while scrapping incentives would be much more expensive.

Evercore analyst Arndt Ellinghorst said the costs were manageable for the industry, but cautioned: "What the agreement doesn’t do is restore consumer confidence in diesel engines."

German car sales data on Wednesday showed diesel car sales fell 12.7% in July. Now diesel makes up only 40.5% of new car sales in Europe's largest car market, down from 46% at the end last year.

An opinion poll published on Wednesday by Die Welt newspaper showed 73% of Germans want politicians to take a tougher line with the car industry on air pollution.

VW's emissions test cheating—which was exposed by US regulators—led to a string of revelations that showed diesel vehicles from most manufacturers release far more NO x gases on the road than in laboratory tests used to assess their safety.

But cutting back on NOx pollution is causing another headache for carmakers, which were betting on diesel technology to help cut carbon dioxide (CO 2 ) emissions to meet climate change rules. Diesel engines are up to 20% more fuel efficient than petrol equivalents.

Falling sales of diesel cars have led to an increase in CO 2 emissions, Germany's KBA motor authority said on Wednesday. Average emissions per vehicle rose 0.4% in July to 128.4 grams of carbon dioxide per kilometer, it said.

Reporting by Emma Thomasson and Andreas Cremer; Additional reporting by Andrea Shalal and Edward Taylor; Editing by Keith Weir and Robin Pomeroy

Related News

From the Archive

Output: German ministers and car manufacturers have agreed that there will be an overhaul of the engine-management software on 5.3 million diesel vehicles in an attempt to improve emissions and the car industry's damaged reputation. Justice minister Heiko Maas said the agreement was only the first step, however, environmentalists have said it is too little, too late and have said that they will continue with legal action aimed at banning the cars. The government is hoping the measure will be enough to deter cities from banning diesel vehicles.


Instruction: create a high quality summary of the given input

Input:
Apple's Safari update will boost Facebook, Amazon and Google
 “ Data-Driven Thinking” is written by members of the media community and contains fresh ideas on the digital revolution in media.

Today’s column is written by Auren Hoffman, CEO at SafeGraph.

In September, Apple will release new changes to Safari with iOS 11 called “Intelligent Tracking Prevention.” These changes will have large effects on the ad tech industry and create new winners and losers.

In short, the iOS 11 changes will really help the big guys, are neutral to the small guys and significantly hurt the mid-size guys.

A Recap

Today, all Safari browsers essentially block third-party cookies that are dropped by domains other than the domain of the URL to which the user browsed. But the browsers reward first-party cookies with lots of privileges. This has been good for well-known sites, but also for large ad networks that get lots of clicks because a click gets routed through the ad network domain and becomes a first-party cookie.

IOS 11 will change the concept of a “first-party cookie.” The new first-party cookie comes with a ticking clock. In the first 24 hours, the cookie acts exactly like it used to – and can be used for retargeting. So, if you go to jetblue.com and search for a beach vacation, you can be retargeted for that beach vacation for exactly 24 hours. It is just like Jack Bauer racing against the clock before the world explodes.

For the first 30 days, the new first-party cookie lets you login on-site so you don’t have the annoyance of re-entering your password if you go back to the site 15 days later.

If you have not gotten back to the site in 30 days, your first-party cookie expires.

The Losers

Traditional ad networks: Slightly negative impact. Because Safari has not enabled third-party cookies for a long time, many ad networks will not be affected by the iOS change because they were already unable to participate in the Safari economy. They might suffer a bit because this move will likely lower the price of Safari inventory and raise the price of Chrome and Internet Explorer inventory, both of which promote third-party cookies.

Large retargeters and demand-side platforms (DSPs): Very negative impact. This class of third-party ad networks received a lot of clicks, which resulted in first-party cookies for a large percentage of their users. Now the number of first-party cookies they have access to could decline by more than 98% in Safari.

Publishers: Very negative impact. As mentioned, some of the largest high-dollar bidders of Safari inventory, including large retargeters and DSPs, will stop bidding on Safari. The average CPM price for Safari should decline significantly. Publishers, especially higher-end publishers that cater to wealthy iOS users, will be stuck with many low-dollar bidders, less relevant ads and potentially unhappy users who have to see even more annoying ads.

The Winners

Facebook and Amazon: Very positive impact. Not surprisingly, Facebook and Amazon are the big winners in this change. Most of their users come every day or at least every week. And even the mobile users click on links often, which, on Facebook, takes them to a browser. These companies will also be able to buy ad inventory on Safari at lower prices because many of the high-dollar bidders will go away.

Google: An initially negative impact that will be positive in the long term. Google’s long-term gain will have short-term pain. That’s because most of the off-property ads are in the doubleclick.net domain and not google.com. We should expect Google to merge these domains so that everything is under the google.com domain – but that will take time to fully roll out. On the flip side, we should see more ad money flee people using Safari browsers, which means likely a bigger advertiser ecosystem on Android and Chrome.

To recap, the iOS 11 changes really help the big guys, are neutral to the small guys and significantly hurt the mid-size guys.

Follow Auren Hoffman (@auren) and AdExchanger (@adexchanger) on Twitter.

Output: Apple's forthcoming update to its Safari browser, due for release in September, is set to be good news for Facebook and Amazon, but disastrous for large retargeters and publishers. The iOS 11 update will put a 30-day limit on first-party cookie privileges, leading to a potential 98% reduction in access to first-party cookies for demand-side platforms and leaving publishers with more low-dollar bidders. In contrast, Facebook and Amazon will be able to purchase ad inventory on Safari at lower prices, while Google will benefit in the longer term from ad spend fleeing Safari.


Instruction: create a high quality summary of the given input

Input:
XL Catlin appoints former Boston Marks CEO Watts to aviation team
 TORONTO and NEW YORK, Aug. 1, 2017 /PRNewswire/ -- XL Catlin has strengthened its North America Aviation Insurance team with the following key appointments:

Canada:

David Watts , named Vice President, Canadian Aviation Manager, Canada . Mr. Watts joins XL Catlin from Boston Marks London where he has served as Chief Executive Officer.

, named Vice President, Canadian Aviation Manager, . Mr. Watts joins XL Catlin from Boston Marks London where he has served as Chief Executive Officer. Alex Barker , assumes management responsibility of the Aviation team in Calgary reporting to David Watts .

, assumes management responsibility of the Aviation team in reporting to . Stephanie Hope , joined as Aviation Underwriter, Calgary . Ms. Hope joins from Charles Taylor plc where she most recently served as Loss Adjuster.

United States:

Timothy Bartos , appointed Vice President Senior Underwriter, New York . Mr, Bartos most recently served as New York Regional Aviation Manager at AIG.

Commenting on the appointments, Eric Donofrio, Head of North America Aviation said: "We are relentlessly focused on securing the best talent to continue to serve our brokers and clients with innovative products and top level service. Both David and Timothy are experienced underwriters and leaders, an excellent addition to our teams in Canada and the U.S."

Nick Greggains, Country Manager, XL Catlin, Canada added: "Alex's promotion is in recognition of his hard work and leadership and we are delighted to have Stephanie join our growing team of Canada market experts. Our North American Aviation team has exceptional technical knowledge and experience in their relevant fields, and with the addition of David at the helm in Canada we will continue to deliver on our promise and market leading portfolios."

XL Catlin offers a comprehensive suite of Aviation insurance options. We can offer multi lines within aviation for individual clients. Coverage extends to traditional and specialized companies from component manufacturers to airport operators.

About XL Catlin Insurance Operations

XL Catlin insurance companies offer property, casualty, professional, financial lines and specialty insurance products globally. Businesses that are moving the world forward choose XL Catlin as their partner. To learn more, visit xlcatlin.com.

About XL Catlin

XL Catlin is the global brand used by XL Group Ltd's (NYSE:XL) insurance and reinsurance companies which provide property, casualty, professional and specialty products to industrial, commercial and professional firms, insurance companies and other enterprises throughout the world. Clients look to XL Catlin for answers to their most complex risks and to help move their world forward. To learn more, visit xlcatlin.com .

SOURCE XL Catlin

Related Links

http://xlcatlin.com

Output: XL Catlin has appointed David Watts as aviation manager for Canada, as the speciality insurer makes changes to its north American aviation business. Watts, who was the CEO of Boston Marks London, will be joined by Alex Barker, who will have responsibility for the aviation team in Calgary, and Stephanie Hope, who will be aviation underwriter in the Canadian city. The company has also appointed Timothy Bartos as vice-president senior underwriter in New York.


Instruction: create a high quality summary of the given input

Input:
Reining in pharmaceutical costs
 This analysis is part of USC-Brookings Schaeffer Initiative on Health Policy , which is a partnership between the Center for Health Policy at Brookings and the University of Southern California Schaeffer Center for Health Policy & Economics. The Initiative aims to inform the national health care debate with rigorous, evidence-based analysis leading to practical recommendations using the collaborative strengths of USC and Brookings.

Karen Van Nuys Executive Director, Life Sciences Innovation Project - Schaeffer Center for Health Policy & Economics, USC Dana Goldman Leonard D. Schaeffer Director's Chair - Schaeffer Center for Health Policy & Economics Distinguished Professor of Public Policy, Pharmacy, & Economics - Sol Price School of Public Policy and USC School of Pharmacy Nonresident Senior Fellow - Economic Studies, Center for Health Policy I Ian D. Spatz Adjunct Professor - Sol Price School of Public Policy, USC

Most Americans believe that President Trump and the Congress should make lowering the cost of prescription drugs a priority. With strong support among Republicans, Democrats and Independents, policy fixes that can slow the rapid rise of prescription pharmaceutical costs may be among the few areas where bipartisan cooperation is possible. Even so, many of the most prominent policy proposals lack consensus and, if recent experience with health reform is any indication, could result in continued political battles.

It doesn’t have to be that way. Rather, the administration and lawmakers should prioritize four actions that could engender more cooperation and improve health over the long-term:

Encourage competition in the market for generic drugs to keep prices in check Reduce regulatory barriers to value-based pricing to better align the price of drugs to their benefits Review the incentives provided to brand-drug manufacturers to balance rewards to innovation without creating unnecessary barriers to competition. Introduce greater transparency in the pharmaceutical distribution system to ensure that returns are justified across all players

Encourage Competition in Generic Drug Markets

Although generic drugs, which make up 88% of the prescriptions written in the United States, remain the segment of the pharmaceutical market with low prices, recent high-profile examples of large price spikes for non-patented medicines such as Mylan’s Epi-Pen (which contains a generic drug) and Turing’s Daraprim have raised legitimate concerns among patients and payers. While the overall generic market works well, these incidents generally occur when there are few suppliers for an unpatented drug, resulting in weak competitive pressure to keep prices low. Fixes in this area should thus focus on enhancing competition in generic drug markets. (We have argued some of these ideas elsewhere.)

First, the FTC should enforce existing anti-trust measures more aggressively, particularly when it comes to mergers and acquisitions among generic drug manufacturers. Going beyond enforcement of existing laws, bill HR749 was introduced in the House of Representatives earlier this year to enhance competition in generic markets by expediting the FDA review of new generic drugs in markets with few competitors, and by awarding (tradable) priority review vouchers to manufacturers who introduce new drugs in markets with weak competition. FDA Commissioner Scott Gottlieb is reportedly investigating ways to prioritize applications for generic drugs that currently have fewer than three competitors, which the agency claims is a crucial benchmark for pricing.

Commissioner Gottlieb has also floated plans to drive up competition by publishing a list of the 180 brand-name drugs no longer under patent and without any current generic competitors, as well as working to get through the agency’s backlog of 2,640 generic drug applications within a year.

There are additional proactive measures worth exploring, such as a national stockpile of critical watchlist drugs, similar to the US Pediatric Vaccine Stockpile program. Purchasing drugs to supply such a stockpile would encourage manufacturers to stay in otherwise tenuous markets, and the stockpile itself could be drawn down in the event of a supply disruption brought on by manufacturer exit or other cause.

An alternative to the stockpile would be a government purchase commitment for drugs on the watchlist, essentially guaranteeing manufacturers of these drugs a minimum revenue. This could be implemented through non-recourse financing, in which the government guarantees a loan in the amount of what the manufacturer would earn if some previously established quantity of a drug was sold at a minimum price. If the manufacturer sells the product at that price or higher, they repay the loan in full. If a lower price must be charged to sell that quantity, the government forgives the difference. Thus, manufacturers in watchlist markets can be confident they will not suffer large losses, making them more willing to enter and remain in those markets as a result.

Finally, the FDA should explore the option of declaring a de facto drug shortage when the price of critical drugs increases dramatically. While the current drug shortage program at FDA focuses on shortages due to manufacturing issues and other supply chain interruptions, it could be expanded to inaccessibility brought on by dramatic price increases.

Reduce Barriers to Value-Based Pricing

Value-based health care – also known as pay-for-performance – has risen to the top of the health policy agenda as we seek ways to improve quality while controlling spending. Value-based pricing seeks to better align incentives between payers and providers.

Recent experience in Medicare shows promise. Medicare implemented value-based payment for hospitals a few years ago, with reimbursement based in part on how well the hospital performed on three sets of measures: process of care, patient satisfaction, and mortality. Medicare’s separate readmission policy financially penalizes hospitals for excessive readmissions for patients who entered the hospital with heart failure, pneumonia, or a heart attack. And recently, the federal government reaffirmed and strengthened its commitment to value-based payment by promising that 85% of all Medicare fee-for-service payments will be based on quality and value in 2016.

We have not seen similar progress in pharmaceuticals. For decades, manufacturers and insurers in the United States have relied on a price-per-dose model – the pharmaceutical analog to fee-for-service. Like fee-for-service, such a model can distort incentives for payers and patients. For example, in the case of stand-alone prescription drug plans in Medicare, price-per-dose arrangements penalize insurers who encourage patient-benefiting adherence.

Value-based pricing offers a solution. Contracts can take many forms, and different versions have been proposed (and even piloted) elsewhere. Important examples include:

Outcomes-based pricing, wherein the price paid to manufacturers is based in whole or part on patient benefits as measured by clinical or financial measures. Clinical measures may include laboratory values or patient-reported results. Financial measures may include other health care interventions avoided, such as hospitalization. Despite the challenges to implementing such pricing, one-quarter of payers have entered into at least one such arrangement. Indication-based pricing, wherein the price of a drug depends upon which disease it is being used to treat. Novartis’ interleukin-1 inhibitor canakinumab (Ilaris) was originally approved in 2009 to treat a group of very rare autoinflammatory diseases, and costs $16,000 per dose. However, further trials have demonstrated that the drug is also effective in reducing the risk of stroke, heart attack and death in patients with a prior heart attack and inflammatory atherosclerosis, a much broader population. The drug’s per-dose value, however, is likely to differ in its cardiac application from that in the autoinflammatory diseases for which it is already being prescribed, and its pricing should reflect those different values. Under current legislation, the price of a drug cannot depend on its application, meaning that Novartis would have to charge the same price for the drug in all indications for which it is approved. Drug licensing schemes, wherein a drug manufacturer sells a license for a large lump-sum payment that entitles licensees to unfettered supply of the drug for a fixed time period at zero or very low cost (see more detail here). Money-back guarantees, wherein drug companies provide refunds for patients who try a drug but see no clinical benefit. This variation of outcomes-based pricing has the potential to shift the risk of non-performance from the payer and patient to the drug manufacturer. A prime example is Amgen’s recent deal with Harvard Pilgrim Healthcare that provides a refund if patients who are taking their cholesterol-lowering therapy suffer a stroke or heart attack.

Several steps must be taken before value-based pricing arrangements can be implemented broadly. Some may be accomplished through regulation, but others may require legislation. First, a “safe harbor” should be created to exempt value-based arrangements from the regulations that currently discourage their development, such as Medicaid best-price rules, anti-kickback provisions under the Stark rule, and FDA restrictions on manufacturer communications prior to drug approval. Regulators must provide a clear definition of the attributes that constitute a value-based pricing arrangement to ensure that the safe harbor will protect legitimate agreements and not reward arrangements that are designed to merely avoid regulation.

Given its size and role in piloting payment reforms, Medicare should be an important player in advancing value-based pricing. The silos between the Medicare Part A, B, and D programs create barriers to innovative pricing for expensive outpatient drugs whose value derives from reducing hospitalizations or other inpatient expenditures. Medicare Advantage plans, which integrate coverage for drug, inpatient and outpatient expenditures, may be better testing grounds.

But ultimately, the private sector may prove more promising here, as evidenced by the previously mentioned deal between Amgen and Harvard Pilgrim, the partnership established last year between Eli Lilly and Anthem, and similar arrangements between Novartis and other insurers. We look forward to learning how these private sector experiments play out, as well as seeing them proliferate as that evidence develops.

Review Incentives for Innovation

While pricing in generic drug markets has raised concerns, it is branded drugs that are the primary drivers of drug spending. But unlike in the generic market, manufacturers’ pricing power based on protection from competition is intentional – having been enshrined in Article I of the Constitution as part of the patent clause – and extended by Congress into other areas through the Orphan Drug Act and FDA-enforced market and data exclusivity. Policies that lower prices of brand drugs send important signals to companies that would invest in R&D. This could negatively impact future health, which is generally not a consideration in generic markets.

In fact, high prices for innovative drugs are one element in a complex innovation ecosystem that seeks to balance the interests of current patients who need access to today’s new (and expensive) drugs, and those of future patients for whom today’s new drugs will be low-priced generics, but who will need entirely new innovative drugs. For this reason, we believe that interventions in branded drug markets deserve especially careful deliberation and study. Because the financial and health stakes are so large, it is little surprise that intense lobbying has limited – and will likely continue to limit – action. The 1984 Drug Price Competition and Patent Term Restoration Act, popularly known as Hatch-Waxman, presents a model for making progress on these difficult issues.

That law, which created our modern generics industry, represented a carefully thought-through pathway that rebalanced the trade-off between savings today and innovation tomorrow, and has been accepted by both industry and consumers. In that agreement, patients gained access to affordable generics while industry gained new incentives for research and development. It is time for renewed attention to this balance.

In the three plus decades since Hatch-Waxman, we have learned much about where drug discovery incentives may be inadequate as well as excessive. For example, it is now well-established that drug discovery for rare diseases is very responsive, perhaps overly so, to market opportunities offered by the FDA.[1] We believe that it is time to re-kindle the spirit of Hatch Waxman, and better align reimbursement with health outcomes to reward truly innovative products and to ensure that — in the long-run — all Americans have access to these discoveries through a robust generic market. We recommend that the administration convene a blue-ribbon committee of scientific and economic experts to study the evidence and develop recommendations regarding branded drug pricing, giving particular focus to the interaction of the patent system and the market exclusivity provided under FDA law. Several approaches have already been suggested in the media and elsewhere, and the committee should weigh them and other ideas together to develop a carefully considered set of recommendations.

The patent system has been at the core of providing drug companies with the limited protection from competition that they need. Yet patents have come under criticism lately in studies that find mixed evidence that they increase innovation (see here, here, here, and here), raising the question: might alternative systems for protecting returns, including stronger or longer grants of market or data exclusivity, be more straightforward and effective? For instance, exclusivity rewards continued innovation with existing drugs, while patents only encourage innovation on drugs whose patents haven’t expired. And the current patent system may inhibit the development of drug compounds that have lost their patent protection, or drugs with very long development times.

Thus, market exclusivity might reinvigorate an entire chapter of now-dormant-yet-promising research. This was the reasoning behind the 1983 Orphan Drug Act, which gave manufacturers incentives, including seven years of market exclusivity and a combination of Federal grants and tax credits to support clinical trials, to develop highly specialized drugs for rare diseases. However, the model has raised questions about its tendency to produce very expensive drugs, from Ceredase, an early iteration of treatments for the rare metabolic disease Gaucher, to Exondys 51, which the FDA approved in 2016 to treat Duchenne muscular dystrophy. Both drugs cost approximately $300,000 per year.

Introduce Sunshine into the Drug Distribution System

Another key consideration when it comes to brand-name drug pricing is the pharmaceutical supply chain. One recent study suggests that, for every $100 spent on retail drugs in this country, about $41 goes to parties in the distribution chain: insurers, wholesalers, pharmacies, and benefit managers. But the drug pricing system is complex and opaque—brand-name drug prices differ among care settings and among coverage options, and different purchasers pay different amounts for drugs based largely on their ability to influence the selection of drugs from among competing brands within a drug class. The discounts negotiated are important to those paying for drugs but are confidential and it is unclear the degree to which they are passed through to consumers, who care most about their premiums and out-of-pocket costs—often a fixed copayment or coinsurance for those with drug coverage.

This complex and non-transparent system allows competition to regulate prices but can lead to market distortions. For instance, the system could potentially reward growing differences between gross (list) prices and net prices—those that reflect negotiated rebates and discounts. This may drive the selection and use of drugs with larger net vs. gross differences by increasing margins for middlemen such as wholesalers, pharmacists, and pharmacy benefit managers. While each plays a crucial role in the drug distribution chain, each will also act to maximize profits even where the health system as a whole may not benefit.

Payers need to review this issue to ensure that their purchasing practices and supply chain agreements are delivering the most value for consumers. Greater simplicity and transparency may be tools to help get there, but further regulation may be needed to eliminate distortions that are beyond the reach of individual payers to address.

Conclusion

When it comes to pharmaceutical spending, there is a fundamental tension between short-run policy solutions and the long-term interests of the public. We have ample evidence that blunt policy solutions could seriously harm innovation, just as we are making progress against some of the most pernicious diseases like cancer and Alzheimer’s. But more Americans are struggling to afford the innovative medicines that could bring them healthier, more productive, longer lives. The goal of any intervention is to ensure an innovation ecosystem that simultaneously balances the interests of current patients who need access to today’s new (and expensive) drugs, and those of future patients for whom today’s new drugs will be low-priced generics, but who will need entirely new innovative drugs of their own.

Ian Spatz is a senior advisor to Manatt Health, an interdisciplinary health care consulting practice, and a board member with the Patient Assistance Network Foundation. Karen Van Nuys and Dana Goldman both consult for Precision Health Economics, a health care consultancy that provides services to health insurance, pharmaceutical, biologic and health care technology companies, and holds equity in its parent company, Precision Medicine Group. With the exception of these affiliations, the authors did not receive financial support from any firm or person for this article or from any firm or person with a financial or political interest in this article. They are currently not an officer, director, or board member of any organization with an interest in this article.

[1]The House-passed bill to reauthorize PDUFA (FDARA) contains provisions aimed at correcting some of the Act’s previous weaknesses.

Output: Most Americans believe that President Trump and the Congress should make lowering the cost of prescription drugs a priority. With strong support among Republicans, Democrats and Independents, policy fixes that can slow the rapid rise of prescription pharmaceutical costs may be among the few areas where bipartisan cooperation is possible.


Instruction: create a high quality summary of the given input

Input:
Q&A with Ubl: Accelerate competition to slow drug price increases
 Stephen Ubl wants to accelerate competition in the drug industry. That, he said, is one way to slow the pace of price increases for pharmaceuticals, not to mention keep such rogue actors as Martin Shkreli and Turing Pharmaceuticals in check. Ubl, who took over as CEO of the Pharmaceutical Research and Manufacturers of America in late 2015, would also like to see the federal government make it easier for drugmakers to venture into the value-based payment world. Ubl recently stopped by Modern Healthcare's Chicago offices to meet with the editorial team. The following is an edited transcript.

Modern Healthcare: The industry's competitive landscape has been something that Dr. Scott Gottlieb has focused on since becoming commissioner of the Food and Drug Administration. What's your take on potentially introducing more generics into the field?

Stephen Ubl: Much of the negative press attention focused on the industry over the last year or two has been focused on these types of examples, whether it's Martin Shkreli and Turing or Valeant and the common denominator is they are old drugs, they are off patent, where there is a lack of effective competition.

We have been quite supportive of steps that the FDA could take, including clearing the backlog at the agency. I came out of the medical device industry before joining PhRMA. There is a bit of an analogous situation, in that the device industry is denominated by midsize and smaller firms and a lot of generic manufacturers, keeping in mind that they are not inventing the product. Where they fall down generally is in manufacturing the product. And we think the FDA could take a more forward-leaning posture in engaging with those manufacturers to help them resolve manufacturing issues.

If you look at the incentive structures that Congress has enacted in the past in our space, whether it is for orphan drugs or pediatric drugs, we know how to create incentives for market entry. And we think those hold promise as well in the generic space, so whether there are tax incentives or manufacturing incentives or other incentives that could encourage other manufacturers into the market, we think that's the best way to address these regulatory arbitrage situations.

MH: Are there specific ones that come to mind?

Ubl: The backlog is the most straightforward one. You want to create a system where an entrepreneur or a competitor can eat Martin Shkreli's lunch, but it is hard to do that if it takes four to five months to get a competitor product on the market. Beyond that, I think, structurally, greater incentives. There is also a relationship, as well, to the user-fee agreements. Making better use of real-world evidence we think holds great promise in terms of shortening development cycles and bringing products to market more expeditiously.

MH: Competition is seemingly what's being focused on, but it's not the only answer, and it is not 100% successful either. Even with some drugs in the marketplace that have four or more competitors on the generic side, does it necessarily mean that prices are going to come down?

Ubl: Several months after I joined PhRMA, we issued a 10-page policy document that looks at all the areas of the ecosystem—the FDA and the reimbursement arena and so forth—to try and address affordability. We have to acknowledge that patients are paying more for their healthcare and they are paying more for their drugs. But it is a systems question at many levels. Drug spend is actually moderating pretty significantly. Looking at Express Scripts data for 2016, drug spending is up about 3.5% and net prices are up about 2.8%. What's not moderating is patient out-of-pocket spending for medicines. It has gone up to nearly 50% since 2013. All of this against a backdrop of increasing rebates and discounts that our members are negotiating with PBMs and plans. Rebates and discounts have nearly doubled over the same time period to over $100 billion. The question for us is, how do we create incentives for patients to benefit at the point of sale and more directly benefit from these negotiations between our members and other stakeholders?

One of the other areas I have tried to prioritize is value-based approaches and contracting. There have been a handful of these arrangements and there are public policy barriers and operational barriers. On the policy side, Medicaid best-price reporting rules. You are going to have differential reimbursement based on how the product performs for a particular patient, which means the reimbursement could theoretically be zero. You don't want that reimbursement rate necessarily to reset your Medicaid best price. There has to be some exceptions built in to these arrangements that factor that in.

If you look at the Office of Inspector General guidance, it's nearly 20 years old and was built in a fee-for-service world. So, for example, if our members want to offer a novel discount, say package several oncology agents together and offer a bundled rate, that is currently against the law, or if they want to provide transportation services or adherence programs. The OIG historically has viewed those as inducements to use the product. As you move to capitated models where our members are taking greater risk, we don't think that makes a lot of sense.

MH: On a broader level, should there be more transparency on what the list prices are, what discounts are being negotiated, and how that translates ultimately to the final price?

Ubl: We have advocated for transparency that patients can really use. We have done our own research, other people have as well and, in general, patients want to know if their physician is in their network. Is the hospital in the network? What is my out-of-pocket cost going to be? Is the drug I need covered? Is it on the formulary that I can access?

There is obviously room for more transparency in the system. There is a point at which research shows that the complete transparency leads to other distortions of the marketplace that are not helpful. It is a convoluted system and we have been quite outspoken in the need to evolve the pricing model away from a system where three pharmacy benefit managers control 80% of the market. Plans are suing PBMs, state attorneys general are looking at these dynamics. A lot of the fees that PBMs charge are tied to list price. So there is clearly room for change and we think we should be moving away from those types of a rebate discount arms race, if you will, to a better more informed value-based discussion.

MH: Looking at reauthorization of the Prescription Drug User Fee Act, do you foresee that as a potentially positive outcome and continuing the research surrounding some of these drugs, especially with how it is structured around specific tiers of scaling? Do you think they are appropriate as they are?

Ubl: We are really excited about PDUFA, and the potential transformative effect it could have, particularly, building on the 21st Century Cures Act and other initiatives that the commissioner is undertaking. Taken together, all of those things hold terrific promise. In terms of overall drug costs, as long as it takes $2.5 billion in 10 years to get a product to market, it is going to be challenging. So, looking at ways to modernize and reduce those development cycles is really important.

MH: If the user fees go up, as proposed, could that squeeze out some of the smaller companies that wouldn't be able to accommodate such fee hikes?

Ubl: I've not heard that concern.

MH: If the review process is streamlined, how do you balance that with the concerns on safety, quality and efficacy?

Ubl: There are improvements that can made without sacrificing the FDA's gold standard around safety and effectiveness. And we have already seen that, for example, in the cancer space, whether it is novel clinical trial designs or better use of real-world evidence. It is going to be increasingly possible to measure a product's performance after approval and set up this virtuous dynamic where we are capturing information real-time and adjusting parameters accordingly.

It's not in the industry's best interest, either, to have a bar set in a way that the product doesn't perform in the marketplace. We have a mutual interest in ensuring that the regulatory process remains robust, and yet, again, we have emerging machine learning and other disciplines that are evolving and giving regulators more confidence because they really will be able to capture real-time information in the marketplace in a non-controlled, non-clinical trial setting.

MH: How much advocacy has PhRMA been doing on the 340B drug discount program?

Ubl: We have been quite public in our views of the 340B program and reforms that we would like to see in terms of the outpatient proposal the administration made. We don't think (the CMS' proposed payment cuts) goes far enough. We would like to see the program fundamentally reformed to restrain its growth and to ensure that patients benefit more directly from the discounts.

The 340B program has grown exponentially. It was a program that was initially intended for about 100 hospitals that now 2,500 hospitals can use to access discounts in the neighborhood of 30% to 50%. We don't question the underpinning of the need for this program. But, again, it would be nice to see the benefit flow to the patient more directly.

Output: Stephen Ubl wants to accelerate competition in the drug industry. That, he said, is one way to slow the pace of price increases for pharmaceuticals, not to mention keep such rogue actors as Martin Shkreli and Turing Pharmaceuticals in check.


Instruction: create a high quality summary of the given input

Input:
Under Trump, Hospitals Face Same Penalties Embraced By Obama
 About Capitol Desk Capitol Desk delivers the latest in health care policy and politics from Sacramento and around the state. Have an idea? Let us know.

Amid all the turbulence over the future of the Affordable Care Act, one facet continues unchanged: President Donald Trump’s administration is penalizing more than half the nation’s hospitals for having too many patients return within a month.

Medicare is punishing 2,573 hospitals, just two dozen short of what it did last year under former President Barack Obama, according to federal records released Wednesday. Starting in October, the federal government will cut those hospitals’ payments by as much as 3 percent for a year.

Medicare docked all but 174 of those hospitals last year as well. The $564 million the government projects to save also is roughly the same as it was last year under Obama.

In California, Medicare penalized 221 hospitals, or 74 percent of those it evaluated. All but 13 had been penalized last year as well. Medicare penalties reached into 42 counties, including 60 hospitals in Los Angeles County. Ten or more hospitals were penalized in Alameda, Orange, Riverside, San Bernardino and San Diego counties. The average California hospital penalty was 0.56 percent, below the national average.

High rates of readmissions have been a safety concern for decades, with one in five Medicare patients historically ending up back in the hospital within 30 days. In 2011, 3.3 million adults returned to the hospital, running up medical costs estimated at $41 billion, according to the federal Agency for Healthcare Research and Quality.

Get The Data MEDICARE HOSPITAL PENALTIES YEARS 1 To 6 Medicare is penalizing hospitals that see patients return to the hospital too soon after being discharged. Medicare reduces what it pays each hospital per patient, per stay. Medicare Readmission Penalties By Hospital (.csv)

Medicare Readmissions By State (.csv) Questions about republishing our content? Click here.

The penalties, which begin their sixth year in October, have coincided with a nationwide decrease in hospital repeat patients. Between 2007 and 2015, the frequency of readmissions for conditions targeted by Medicare dropped from 21.5 percent to 17.8 percent, with the majority of the decrease occurring shortly after the health law passed in 2010, according to a study last year in the New England Journal of Medicine conducted by Obama administration health policy experts.

Some hospitals began giving impoverished patients free medications that they prescribe for their recovery, while others sent nurses to check up on patients seen as most likely to relapse in their homes. Readmissions dropped more quickly at hospitals potentially subject to the penalty than at other hospitals, another study found.

“The sum of the evidence really suggests that this program is helping people,” said Dr. Susannah Bernheim, the director of quality measurement at the Yale/Yale-New Haven Hospital Center for Outcomes Research and Evaluation, which measures readmission rates for Medicare.

But the pace of these reductions has been leveling off in the past few years, indicating that the penalties’ ability to induce improvements may be waning.

“Presumably, hospitals made substantial changes during the implementation period but could not sustain such a high rate of reductions in the long term,” the New England Journal article said.

An analysis by Bernheim’s group found no decrease in the overall rate of readmissions between 2012 and 2015, although small drops in the medical conditions targeted by the penalties continued.

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“We have indeed reached the limits of what changes in how we deliver care will allow us to do,” said Nancy Foster, vice president for quality at the American Hospital Association. “We can’t prevent every readmission. It could be that there is further room for improvement, but we just don’t know what the technique is to make that happen.”

The Hospital Readmissions Reduction Program was created through a section of the ACA designed to use the purchasing power of Medicare to reward hospitals for higher quality. Those penalties, along with other ones aimed at improving hospital care, have been spared the partisan rancor over the law, and they would have continued under the GOP repeal proposals that stalled in Congress. But they have also been largely ignored.

Dr. Ashish K. Jha, a professor at the Harvard T.H. Chan School of Public Health, said the fight over abolishing the Affordable Care Act has drowned out talk about how to make the health care system more effective. “We’ve spent the last six months fighting about how we’re going to pay for health insurance, which is one part of the ACA,” he said. “There’s been almost no discussion of the underlying health care delivery system changes that the ACA ushered in, and that is more important in the long run to be discussing because that’s what’s going to determine the underlying costs and outcomes of the health system.”

The readmission penalties are intended to neutralize an unintended incentive in the way Medicare pays hospitals that had profited from return patients. Medicare pays hospitals a lump sum for a patient’s stay based on the nature of the admission and other factors. Since hospitals generally are not paid extra if patients remain longer, they seek to discharge patients as soon as is medically feasible. If the patient ends up back in the hospital, it becomes a financial benefit as the hospital is paid for that second stay, filling a bed that would not have generated income if the patient had remained there continuously.

Use Our Content This story can be republished for free ( details ).

Because of the way the readmission penalty program was designed, it is not surprising that the new results are so similar to last year’s. As before, Medicare determined the penalties based on readmissions of the same six types of patients: those admitted for heart attacks, heart failure, pneumonia, chronic lung disease, hip or knee replacements or coronary artery bypass graft surgery. Hospitals were judged on patients discharged between July 2013 and June 2016. Because the government looks at a three-year period, two of those years were also examined in determining last year’s penalties.

This year, the average penalty will be 0.73 percent of each payment Medicare makes for a patient between Oct. 1 and Sept. 30, 2018, according to a Kaiser Health News analysis. That too was practically the same as last year. Forty-eight hospitals received the maximum punishment of a 3 percent reduction. Medicare did not release hospital-specific estimates for how much lost money these penalties would translate to.

More than 1,500 hospitals were exempted from penalties this year as required by law. Those include hospitals treating veterans, children and psychiatric patients. Critical access hospitals, which Medicare also pays differently because they are the only hospitals in their areas, were excluded. So were Maryland hospitals because Congress has given that state extra leeway in how it distributes Medicare money.

Of the 3,241 hospitals whose readmissions were evaluated, Medicare penalized four out of five, KHN’s analysis found. That is because the program’s methods are not very forgiving: A hospital can be penalized even if it has higher than expected readmission rates for only one of the six conditions that are targeted. Every non-excluded hospital in Delaware and West Virginia will have their reimbursements reduced. Ninety percent or more will be punished in Arizona, Connecticut, Florida, Kentucky, Massachusetts, Minnesota, New Jersey, New York and Virginia. Sixty percent or fewer will be penalized in Colorado, Kansas, Idaho, Montana, Oregon, South Dakota and Utah.

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Since the readmission program’s structure is set by law, the administration cannot make major changes unilaterally, even if it wanted to.

Congress last year instructed Medicare to make one future alteration in response to complaints from safety-net hospitals and major academic medical centers.

They have objected that their patients tended to be lower income than other hospitals and were more likely to return to the hospital, sometimes because they didn’t have a primary care doctor and other times because they could not afford the right medication or diet. Those hospitals argued that this was a disadvantage for them since Medicare bases its readmission targets on industry-wide trends and that it hurt them financially, depriving them of resources they could use to help those same patients.

Bernheim noted that despite those complaints, safety-net hospitals have shown some of the greatest drops in readmission rates. In October 2018, Medicare will begin basing the penalties on how hospitals compared to their peer groups with similar numbers of poor patients. Akin Demehin, director of policy at the hospital association, said, “We expect the adjustment will provide some relief for safety-net hospitals.”

Medicare is planning to release two other rounds of recurring quality incentives for hospitals later this year. One gives out bonuses and penalties based on a mix of measures, with Medicare redistributing $1.9 billion based on how hospitals perform and improve. The other, the Hospital-Acquired Condition Reduction Program, cuts payments to roughly 750 hospitals with the highest rates of infections and other patient injuries by 1 percent.

Update: This story was updated on Aug. 3 to add a quote from Dr. Ashish Jha.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Output: Amid all the turbulence over the future of the Affordable Care Act, one facet continues unchanged: President Donald Trump’s administration is penalizing more than half the nation’s hospitals for having too many patients return within a month.


Instruction: create a high quality summary of the given input

Input:
Let’s Stop the Bickering and Fix the Health Care System
 If either of us were building the American health care system from scratch, we’d probably end up in different places.

We have contrasting ideas — one of us is a Democrat, the other a Republican — about what ails the system and how to reshape it. But this is not the time for more partisan fighting. It’s time to build a better system, even if incrementally, because that’s what the American people deserve. It’s time to put aside blame and stabilize a health care marketplace where premiums are expected to rise by more than 15 percent in most states and millions of people are worried about obtaining or affording coverage.

This week the 43-member House Problem Solvers Caucus — which we lead and which is almost evenly split between Democrats and Republicans — released a carefully drafted compromise to shore up the struggling insurance exchanges.

Ultimately, everyone had to give a little and endorse provisions that purists in both our parties may not like. This is how American democracy is supposed to work, even if it has not for quite some time.

Output: If either of us were building the American health care system from scratch, we’d probably end up in different places. We have contrasting ideas — one of us is a Democrat, the other a Republican — about what ails the system and how to reshape it. But this is not the time for more partisan fighting.


Instruction: create a high quality summary of the given input

Input:
New bipartisan Obamacare push faces steep climb
 “Lamar Alexander and Patty Murray shepherded a bill through — [the update to] No Child Left Behind — that made the school-choice people happy and made the teachers unions happy, so stranger things have happened,” said Sen. Roger Wicker (R-Miss.).

Alexander and Murray want a bill to stabilize the Obamacare insurance markets in time for next year’s plans. Lawmakers who are warm to the idea agree the contours would combine expanded state flexibility for Republicans with market stability — such as funding critical Obamacare cost-sharing subsidies — for Democrats.

Republicans will seek a more flexible 1332 waiver — an existing Obamacare provision that allows states to make changes to the law’s requirements, according to GOP sources. Democrats say funding the approximately $7 billion annual payment to insurance companies to help cover low-income people is the minimum requirement for a deal. The Trump administration has said it is ready to pull the monthly payments at any time in response to the failed repeal effort, a move that could immediately drive companies off the exchanges and further undermine the Obamacare markets.

Alexander says he’s ready to fund the program, but adds “it also should include greater flexibility for states in approving health insurance policies. Any solution that Congress passes for a 2018 stabilization package would need to be small, bipartisan and balanced.”

But first, Alexander needs to win over skeptics in his own party, which is coming off an exhausting and ultimately fruitless effort to repeal and replace Obamacare. Other Republicans have likened the cost-sharing program to a “bailout” for insurance companies.

Several conservative senators, as well as President Donald Trump, haven’t given up on repealing the law outright. Sens. Ted Cruz (R-Texas) and Paul have balked at any proposal that aims to fix Obamacare rather than roll it back.

“I think it would be a serious mistake to bail out the insurance companies instead of honoring our promise to repeal Obamacare,” Cruz said.

Senate GOP leaders have made clear that they’ve tried everything on Obamacare and are ready to move on. But they’ve left the door open to any Obamacare bill that has the votes. Alexander and Senate Majority Leader Mitch McConnell are close friends, and it is unlikely the chairman would move forward with a bipartisan bill if his leader was opposed.

“Show me 51 or show me 60, I guess, and I’m happy to talk,” said Senate Majority Whip John Cornyn (R-Texas).

Alexander and Murray — who have made deals on the No Child Left Behind update, the 21st Century Cures Act and an updated Medicare payment policy, among other things — have their work cut out for them. The HELP Committee is a diverse mix of Republicans and Democrats representing a cross-section of ideological spectrums. On the Republican side, HELP has conservatives Tim Scott of South Carolina and Pat Roberts of Kansas, the libertarian Paul and moderates Murkowski and Collins. On the other side of the dais are the Senate’s most liberal Democrats — Warren and Sanders — and more moderate lawmakers, such as Bob Casey (D-Pa.) and Tim Kaine (D-Va.).

Should Alexander and Murray get a bill through committee, it would have a strong shot at passage in the full Senate. The group will need to find common ground quickly — Alexander has set a mid-September deadline to strike a deal propping up the Obamacare markets, in hopes of speeding a bill through Congress by the end of a month. That leaves just a few weeks for the committee to hold hearings, negotiate a stabilization package and then win broader Senate support on an issue that Republicans and Democrats have fought over for nearly a decade. Staff is expected to work on the plans while members are in their home states in August.

Democrats and Republicans have starkly different visions for the future of the health care system, and there’s little appetite on either side to give in. That means crafting a narrow bill that props up Obamacare in the short term without shaping the longer-term debate.

“If you start piling on everybody’s pet priorities, it’s a dangerous path to go down,” said Sen. Brian Schatz (D-Hawaii), an advocate for single-payer health care. “Just because Chairman Alexander and I don’t agree on the Affordable Care Act doesn’t mean that either of us think that lighting the individual market on fire is a good idea.”

Still, it remains unclear what qualifies as neutral ground. Both sides have floated funding stabilization efforts, either through a federal reinsurance system or by sending more money to the states. And Kaine said he’s intrigued by a proposal from Sens. Bill Cassidy (R-La.) and Collins to automatically enroll individuals in basic health plans.

But Republicans remain loath to pour more money into Obamacare without a clear path toward rolling back some of its regulations — a suggestion that still makes Democrats nervous.

“The notion of flexibility to the states, I think that’s good,” Kaine said. “But sometimes flexibility to the states leads to a race to the bottom line. Sometimes flexibility to the states is actually perceived by the states as the feds just pushing off hard decisions on them.”

Democrats are already pushing back on Alexander’s suggestion that a compromise bill fund cost-sharing subsidies for only a year.

“Solving the CSR problem for a year doesn’t keep the insurance companies in,” said Sen. Chris Murphy (D-Conn.), one of the Senate’s strongest Obamacare defenders. “If we’re going through the trouble of bringing Republicans and Democrats together to forge a compromise, let’s do it for more than one year.”

For now, though, some rank-and-file lawmakers are just excited hearings have been planned.

“I love it,” Murkowski said of the hearings. “Smart people making good things happen.”

Collins, who with Murkowski played a pivotal role in sinking the GOP’s repeal bills, was equally enthusiastic: “Lamar Alexander is a master at getting bills through.”

Output: There’s never been a major bipartisan Obamacare bill, and the path to passing one now — after the death of Senate Republicans' repeal effort — is steep. Lamar Alexander (R-Tenn.), chairman of the Senate Committee on Health, Education, Labor and Pensions, and ranking Democrat Patty Murray of Washington are up against both time and history in their race to stabilize the shaky Obamacare markets and solidify their status as the chamber’s top deal-makers.