The Congressional Budget Office shone a glaring spotlight on the state of the U.S. economy with a report that predicts that the federal budget deficit will reach $1 trillion in 2020 on its way to a deficit of more than $1.5 trillion eight years later. Perhaps even more disturbing for makers of drugs and devices is that Medicare spending has resumed its robust growth rate now that the recession is over, and may double to $1.5 trillion in 2028, roughly the same number as the overall budget deficit in 2028.

Health care fraud prevention and enforcement efforts by the U.S. Departments of Justice and Health and Human Services resulted in the recovery last year of $2.6 billion from individuals and entities that tried to defraud the government and Medicare and Medicaid beneficiaries. The fraudulent practices included drug companies paying kickbacks to providers to prescribe their drugs and to pharmacies for promoting them. In announcing the fiscal 2017 numbers, the departments noted there has been a reduction in large monetary settlements over the past several years as many of the big biopharma companies are under corporate integrity agreements with the HHS Office of the Inspector General to establish protections against fraudulent activities.

On the heels of the unveiling of the HEAL Initiative aimed at addressing the U.S. opioid crisis, an NIH working group released several recommendations to guide the initiative's public-private partnerships around ethical challenges. Given that a number of drug companies have been named in federal and state lawsuits for contributing to the crisis, the working group said it would be best if only federal funds were used to support the research efforts in public-private partnerships. If that's not possible, the group advised the NIH to refuse funding from companies involved in the opioid litigation and to return funding if a company is named in future litigation. However, the group determined it would be ethical for the NIH to use money from a settlement to support the research, and any company may contribute assets such as clinical data or a compound, provided no strings are attached.