Axios Vitals

An Ohio district court judge's procedural ruling in the national opioids lawsuit Wednesday has big implications — because it could open up opioid makers, drug distributors and others to face serious charges in court.

• The plaintiffs — various cities, counties and states — are suing the health care companies for their role in the opioid epidemic.

Why it matters: Yesterday's ruling, in which the judge denied health care companies' motion to dismiss the lawsuit, may increase the amount of money at stake, which would go toward the fallout from the epidemic.

• "It is accurate to describe the opioid epidemic as a man-made plague, 20 years in the making. The pain, death, and heartache it has wrought cannot be overstated," Judge Dan Polster said in the ruling.

While the judge sustained nearly all of the legal theories on which the plaintiffs are suing the opioid companies, 2 are particularly important, according to Joe Rice, one of the plaintiff's lead attorneys.

• The plaintiffs are suing under the Racketeer Influenced and Corrupt Organizations Act. If the plaintiffs win on this charge, the companies would have to pay for the damage caused.
• The plaintiffs are also allowed to proceed on a "public nuisance" claim. If the defendants are found liable, Rice says, they would have to cure or abate the nuisance — putting them on the hook for even more money.
• Purdue Pharma, one of the defendants and the one named on yesterday's ruling, declined to comment.

We don't know yet whether this case will go to trial or whether the parties will eventually settle. But the seriousness of the charges will inevitably affect that calculation.

• "I think this makes the case much easier to try," Rice says.

Movement on a giant court case wasn't the end of yesterday's opioid updates.

The industry received slightly better news regarding the opioid lawsuits that are pending in New York over the state's new opioid tax.

• A district court judge issued an injunction that stops the collection of the tax while the legal process plays out, and rejected the state's motion to dismiss all 3 cases arguing that the law is unconstitutional.

HHS released guidance yesterday recommending when naloxone — which reverses opioid overdoses — should be prescribed to patients at risk for opioid complications.

• These include patients on high doses of opioids, who take other medications that enhance opioid complications, and who have underlying health conditions.

An Energy and Commerce Committee report "revealed systemic failures by both distributors and the DEA that contributed to — and failed to abate — the opioid crisis in West Virginia," chairman Greg Walden said.

• The report concludes that “blame for the opioid epidemic is widespread and goes far beyond the bounds of this investigation. Pharmaceutical manufacturers, pharmacists, physicians, drug traffickers, and others have contributed to this problem as well."

Nearly 30 drugmakers have taken steps to raise the price of their drugs in January, Reuters reports.

• The industry had said it was halting price increases under pressure from the Trump administration.

For example: Novartis plans to raise prices on more than 100 indications of over 30 different drugs. These include a multiple sclerosis drug, an arthritis treatment and a leukemia treatment.

• A spokesman said that the company will be raising list prices on 14% of the drugs it sells in the U.S., with an average list price increase of 4.7%. But rebates and discounts will result in a 5% net price decrease across the company's U.S. portfolio.

Our thought bubble: This isn't surprising. At this point, no one should think that drug companies are going to voluntarily stop raising list prices.

The Affordable Care Act's open enrollment period for 2019 is over, and almost 8.5 million people signed up for health insurance in the 39 states using the federal HealthCare.gov website, CMS announced yesterday.

• This is down about 4% from last year's open enrollment.
• Expensive premiums, low unemployment, people shifting into Medicaid and some Trump administration moves all contributed to the lower enrollment figure, my colleague Bob Herman notes.

One reason that signups may be relatively stable despite the Trump administration's changes is that most of the people who were already signed up want health insurance, and receive the federal assistance they need to pay for it.

• "This market appears to have reached its equilibrium two years ago, and none of the massive market shocks we’ve seen have seemed to have moved it," Avalere's Chris Sloan says. "We have just found the number of people who want coverage through a marketplace."
• Plus, since the individual mandate won't be in effect in 2019, the enrollment figures indicate that the individual mandate "was not driving enrollment in the market nearly to the extent it was intended to," Sloan adds.

Americans are not getting taller, but they are gaining more weight, according to new CDC data.

The bottom line: Obesity is more complicated than eating habits or exercise, Bob notes. But research has shown that gaining weight over time makes people more susceptible to other health risks like diabetes or heart disease.