Pretty sure you’ll want to do this tonight.
Cannabidiol is a trend taking the health-and-wellness world by storm. But contrary to many media reports, those who sell it still run the risk of prosecution.
Cannabidiol is a trend taking the health-and-wellness world by storm. But contrary to many media reports, those who sell it still run the risk of prosecution.
The low-carb, high-fat diet known as keto has recently received a lot of focus after several celebrities, such as Kourtney Kardashian and Halle Berry, have shared the secret to their weight loss.
While the diet boasts tons of benefits (improved mental focus, decreased appetite, and rapid weight loss, to name a few), actually reaching and sustaining nutritional ketosis can be challenging as a keto rookie.
The Pros and Cons of Going Keto
Temptation, social pressure, physical fatigue, and mental grogginess (“keto fog") can cause those unaware of what is ahead within the first few weeks to abruptly quit and go back to their former foods.
Here are a few ways to stay on track and kick the common "keto flu" during those inaugural weeks when the body is completely changing its primary energy source from carbs to fats.
Your best friend invites you over to celebrate her birthday, but you’re only one week into keto – clearly still in your adaptation phase. Don’t panic. Having a dish that anyone can enjoy without realizing it’s low carb will help you show up sweat- and cheat-free.
Solution: Smoked jalapeño poppers topped with bacon, savory cheesecake, crustless quiche.
Solution: Bring the usual party fare, such as chips and dip, but swap the chips for Parmesan Whisps, Moon Cheese, or sliced bell pepper or cucumbers.
You worked late, and now you are hangry. You realize it’s been at least a week since you’ve smelled the beyond-expired heavy whipping cream in your fridge.
Solution: If meal prep isn’t your thing, try it once more with some easy ham-and-egg cups; a sausage, arugula, and Parmesan casserole; or baked ziti. If meal prep seriously isn’t for you, keep a lunchmeat or pepperoni, shredded cheese, and tomato sauce on hand – the cheese can be frozen if bought in bulk and can transform into a skillet pizza or crustless calzone in minutes.
Solution: Find a fast-food chain you enjoy on your drive home, and look up the nutrition info while waiting in line. A cheeseburger sans bun and ketchup can be found almost anywhere and frees up your calories for extra cheese or bacon.
After a long week of navigating the explanations of "having a weird diet" to those who are offended you’re not eating the office doughnuts, you’re craving a little something.
Solution: Think about why you wanted a change, and decide if the temptation is worth it. Sometimes it may be. Before pictures of yourself are a great motivator.
Solution: Preportion your treat of choice, such as low-carb ice cream, so you aren’t tempted to eat it all straight from the box. Berries in heavy unsweetened whipped cream, low-carb bread with butter, or a rich cheese with olives are great low-carb, high-fat options that won’t cause remorse. There are now low-carb hacks to make nearly anything with enough searching.
With a little advance planning for social situations, on-the-go foods, and ways to satisfy cravings without cheating, you can then focus on drinking your damn water and enjoying keto – the transition takes time, but it’s worth it!
It’s not an exaggeration that working out really helps to clear your mind, and that’s exactly what Emmy Rossum is doing to gear up for filming another season of Shameless. The 31-year-old actress shared how she’s preparing for season nine of the popular show, and it all starts with “getting in the proper headspace" six weeks before filming starts.
Emmy worked out with acclaimed trainer Michael Olajide Jr. at Aerospace High Performance Center in LA on April 4. Michael, who’s been described as a "lunatic in the best way" by a POPSUGAR editor who’s trained with him before, helps Victoria’s Secret angels prep for the runway, so you know his workouts are no joke. On Emmy’s Instagram and in her Stories, she shared a series of high-intensity workouts that "hurt so good," including boxing, jump roping, rope pulling, glute bridges with heel sliders, and ab bicycle variations. Just watching these has our legs feeling wobbly, and we’re mentally taking notes for our next trip to the gym.
Michael gave her a well-deserved congrats for crushing her entire workout and said, "Cheers to incredible human beings like this young lady!" Keep reading to get a glimpse at Emmy’s inspiring sweat session – it just might motivate you to get moving, too.
If You Want Strong, Lean Muscles Like Jessica Biel’s, This Is the Workout For You
Bonus if you buy them in bulk and save plastic.
Dealing with your compliant doctor or healthcare professional (HCP) might not seem like a problem to people with diabetes, but it can be a really big problem. The problem begins when the compliant healthcare provider wants to do everything by the textbook. S/he reams off a list as long as your arm of things you […]
This piece is co-authored by Rachel Sachs, associate professor of law at Washington University Law School. It’s cross-posted at the Health Affairs Blog. Although drug formularies are ubiquitous in Medicare and the private insurance market, they’re absent in Medicaid. By law, state Medicaid programs that offer prescription drug coverage (as they all do) must cover all […]
This piece is co-authored by Rachel Sachs, associate professor of law at Washington University Law School. It’s cross-posted at the Health Affairs Blog.
Although drug formularies are ubiquitous in Medicare and the private insurance market, they’re absent in Medicaid. By law, state Medicaid programs that offer prescription drug coverage (as they all do) must cover all drugs approved by the U.S. Food and Drug Administration, however expensive they are and however slim their clinical benefits may be.
Massachusetts would like to change all that. In a recent waiver proposal, Massachusetts asked the Centers for Medicare and Medicaid Services (CMS) to allow it to adopt a closed formulary in Medicaid. That would allow Massachusetts to exclude certain brand-name drugs from Medicaid, increasing its leverage in price negotiations beyond what it can achieve through existing utilization management techniques like prior authorization.
Among Medicaid advocates, the proposal is controversial. Some fear that state budgets would be balanced on the backs of Medicaid beneficiaries, who could be denied access to expensive therapies. But Massachusetts thinks there’s room to drive down drug spending without threatening access to needed medications. In any event, the state has to do something. Drug spending in Massachusetts has increased, on average, 13 percent annually since 2010, threatening to “crowd out important spending on health care and other critical programs.”
By all rights, CMS should welcome Massachusetts’s proposal. Closed drug formularies are tried-and-true, market-based approaches to fostering competition over drug prices, and the Trump administration’s Council on Economic Advisers recently released a report saying that “government policy should induce price competition” in Medicaid. If Secretary of Health and Human Services (HHS) Alex Azar means it when he says that “drug prices are too high,” letting Massachusetts try out a formulary makes a ton of sense.
But The Waiver Is In Trouble
Recent press accounts, however, report that Azar is likely to reject the Massachusetts waiver. Details are sketchy, but the agency is apparently concerned that the pharmaceutical industry would sue CMS if it approved the state’s request for a closed formulary.
As law professors, this explanation mystifies us. Yes, PhRMA might sue CMS if it approves the waiver. This is America; you can sue anyone for anything. The question is whether PhRMA could win.
We don’t see how. CMS’s legal authority to grant the waiver is secure. Under section 1115 of the Social Security Act, CMS can “waive compliance with any of the requirements” of section 1902 of the Medicaid statute. One of the requirements of section 1902 is that state Medicaid programs must cover all medically necessary drugs. CMS is therefore free to relieve states of that obligation through an 1115 waiver.
To be more precise: Section 1927 of the Medicaid statutesays that, “[i]n order for payment to be available” from the federal government for a drug, a state has to agree to cover the drug whenever it’s medically necessary. In exchange, manufacturers must sell the drug to the state’s Medicaid program at a rebated price. But states have to adhere to section 1927 only because, under section 1902(a)(54), they must “comply with the applicable requirements of section 1927.” And section 1115 allows CMS to waive compliance with any provision of section 1902, including the part that incorporates section 1927.
Once a state’s waiver is approved, the “costs of such [waiver] which would not otherwise be included as expenditures … shall, to the extent and for the period prescribed by the Secretary, be regarded as expenditures under the State plan,” and thus eligible for matching payments from the federal government. In other words, CMS can grant waivers allowing states to receive federal Medicaid dollars for a drug that isn’t purchased in conformity with section 1927.
There are some conditions on the approval of 1115 waivers. Any waiver must be “likely to assist in promoting [Medicaid’s] objectives” and must be a genuine experiment. But both conditions appear satisfied here: Making Medicaid a smarter purchaser of drugs likely advances the program’s purposes, and Massachusetts has said it will evaluate the effects that its formulary has on price and access. In any event, CMS is in no position to be finicky about the limits of 1115 waivers—when it comes to the approval of state waivers for work requirements, it’s already pushing the legal envelope. If it’s not worried about the lawsuits over work requirements, why worry about similar lawsuits from PhRMA?
What About The Rebates?
The industry’s legal objection to the Massachusetts waiver may run deeper. There’s been some suggestion that Massachusetts can’t secure a selective waiver of section 1927 of the Medicaid statute. On this argument, maybe section 1927 is an all-or-nothing deal: In exchange for guaranteed access to state Medicaid markets, drug manufacturers promise to offer substantial rebates. If access is restricted, those rebates evaporate too.
We haven’t seen a fully developed version of this argument and we have no idea if CMS is taking it seriously. But the Medicaid statute doesn’t support it. Section 1927 may have been the product of a negotiated legislative compromise—a “‘grand bargain’ struck 28 years ago,” as The New York Timesput it—but nothing in that section purports to limit CMS’s waiver authority. That’s a telling omission. Other parts of the Medicaid statute (section 1916(f), for example) do place constraints on waivers, suggesting that Congress knows how to constrain waiver authority when it wants to.
Indeed, CMS selectively waived section 1927 just a few weeks ago when the agency granted Arkansas’s request to waive “Section 1902(a)(54) insofar as it incorporates Section 1927(d)(5).” A Massachusetts waiver would look almost identical: It would waive section 1902(a)(54) to the extent that it incorporates section 1927(d), which is the part of section 1927 that curtails states’ authority to exclude drugs from coverage. Left intact would be sections 1927(a), (b), and (c), which require drug manufacturers to offer rebates. We could be missing something, but we don’t see any legal objection to that approach.
Even more misguided is the suggestion that federal law might somehow preempt Massachusetts’ closed formulary. State laws are subject to preemption where Congress says they’re preempted (express preemption) or where a state law conflicts with the purposes of a federal statutory regime (conflict preemption). The pharmaceutical industry might look to support a preemption theory by invoking Biotechnology Industry Association v. District of Columbia, a 2007 Federal Circuit decision invalidating a Washington, D.C. law that prohibited drug manufacturers from charging “an excessive price.” In the court’s view, Washington, D.C.’s effort to regulate prices conflicted with the federal patent system’s policy of offering lucrative financial rewards for inventors.
The court’s decision is questionable, to say the least. Right or wrong, however, the decision speaks to a state effort to impose direct price controls on drugs. It doesn’t speak to the question of whether a closed drug formulary is unlawful. And it certainly doesn’t speak to the question of whether a formulary adopted with the explicit consent of the federal government is unlawful. Here, Massachusetts wouldn’t be adopting a formulary in the teeth of a federal statute. It would be adopting a formulary pursuant to a federal statute—in particular, pursuant to the terms of a Medicaid waiver contemplated by the Medicaid statute.
So What’s Going On Here?
To our eyes, the legal objections appear to be pretext. Why, then, is CMS apparently so reluctant to grant Massachusetts’ waiver? We can envision a number of possible reasons, some benign and others less so. It could be, of course, that the reporting overstates the case against the waiver. Two weeks ago, Secretary Azar said that HHS would unveil “a whole slate of” proposals on the topic in “about a month.” Maybe Secretary Azar will use the opportunity to endorse Massachusetts’ waiver.
Perhaps more plausible is the idea that CMS wants congressional buy-in before taking a step—approving closed formularies—that would undermine the legislative bargain struck between rebates and coverage. The Trump administration’s budget proposal, for example, calls for “new statutory demonstration authority to allow up to five states more flexibility in negotiating prices with manufacturers.” Maybe that reflects a genuine desire to act through legislation instead of through a waiver. Then again, CMS knows that Congress has been unable to take real action on drug prices. Waiting for Congress is tantamount to doing nothing.
There is another possibility. CMS reportedly fears that other states may request similar waivers if Massachusetts’ is approved. (Indeed, Arizona has already made such a request.) But if other states come to think that closed formularies are a good idea, why shouldn’t they follow Massachusetts’s lead? That’s how federalism is supposed to work: When a state lights on a good idea, the idea proliferates. It’s sensible for CMS to worry about copycat states when a state waiver might lead to a big increase in federal Medicaid spending, but closed drug formularies should reduce federal spending. The more states jump on board, the better.
In any event, CMS’s reticence here is in sharp contrast to its eagerness to promote the spread of work requirements. CMS has already approved work requirements for three states, and applications are pending from at least eight other states. We do not see a principled argument for distinguishing between the two policies on this basis.
If none of these explanations hold water, a more alarming possibility comes into focus. The Trump administration may have succumbed to lobbying from the pharmaceutical industry. We hope that’s not the case. It would be unlawful for CMS to deny an otherwise-legal waiver just because it threatens industry’s bottom line.
Whatever is going on here, however, it does not bear the hallmarks of good policymaking. CMS should also keep in mind that it faces litigation risk no matter what it does. PhRMA might sue if the waiver is approved, but Massachusetts might sue if it’s denied.
Secretary Azar has only been in office a few months, and he is still working to develop the agency’s policies on drug pricing. His tenure has already marked a significant improvement over Tom Price’s in a number of ways, and we are optimistic that he will prove us wrong about what’s going on at CMS. If he does not, however, we anticipate further legal battles for the administration.
@nicholas_bagley and @RESachs
It’s kind of insane how many different types of fitness are readily available to anyone living in a major city. As a New Yorker myself, I’ve always known how fortunate I am to have an Equinox in every neighborhood and the cream of the crop of hot yoga options at every turn, which is exactly why I was on the antsy side planning a trip to Florence, Italy, earlier this month. Things to look forward to: endless amounts of pasta, gelato, fresh breads (albeit unsalted), and wine. What I wasn’t exactly anticipating: the inevitable weight gain that’s comes hand in hand with gluttonous travel.
Cue this full-body, no-equipment workout.
My HomeAway apartment had loads of space for activities, including this five-move burner that ramped my heart rate up real quick. And since the whole thing takes less than 20 minutes, I was able to get in my fitness, change clothes, and get to touristing (on the days I didn’t pair it with a run around the city). Check out my go-to essential no-equipment workout ahead.
I Did 20 Push-Ups Every Day For 2 Weeks and Here’s What I Learned
Do: Do each move for one minute before moving onto the next. On moves that require you to repeat on the opposite side, swap after 30 seconds. At the end of the round, rest one minute before repeating the circuit. Do the entire circuit three times total.
Lower into a crouching squat with your hands on the floor.
Do a squat thrust by jumping your feet back into a plank position.
Do one basic push-up, bending the elbows and then straightening back to plank.
Jump the feet forward to the hands and come into a squat. Do an explosive jump straight up, getting as much height as you can. This counts as one rep. Continue for 60 seconds.
Alternating Forward Lunge
Start with your feet together. Step forward into a lunge (knee shouldn’t extend past your toes) and lower slowly for five seconds.
Push through front heel to return to stand. This counts as one rep. Continue for 30 seconds; repeat on opposite side.
Lie on your back and open your legs into a diamond shape (aka butterfly legs) with the soles of your feet pressed together and knees out wide.
Extend the arms overhead. Inhale to curl the torso up and tap the floor in front of your feet to stretch your glutes a bit.
Slowly lower back to the starting position. This counts as one rep. Repeat for 60 seconds.
Side Plank With Leg Lift
Place your left elbow on the ground. Extend both legs out so that your body is in one straight line, balancing on the outside edge of your left foot.
Flex both feet and reach your right hand to the ceiling or place on your right hip.
Keeping your spine lengthened and your abs engaged, lift your right leg up just higher than your top hip.
Then slowly lower it back to your bottom leg. This counts as one rep. Continue for 30 seconds on this side; repeat on opposite side.
Sit on the ground with your feet flat on the floor, hands on the ground next to your butt with fingertips facing toward your heels.
Straighten your arms, keeping a little bend in your elbows to keep tension on your triceps and off your elbow joints.
Slowly bend your elbows to lower your body toward the floor until your elbows are at about a 90-degree angle.
Once you reach the bottom of the movement, press down into the floor to straighten your elbows, returning to the starting position for one rep. Repeat for 60 seconds.
Here’s everything you need to know plus seven easy electrolyte-rich snacks.
St. John’s wort is a herbal remedy that appears to be effective for the treatment of depression. But how does it compare to antidepressants?