Happy Monday — it's budget day. Today's newsletter is 991 words or a 3.5-minute read.

1 big thing: Cyberattack losses keep piling up

Illustration: Aïda Amer/Axios

Disruptions from the Change Healthcare cyberattack are costing health providers as much as $1 billion a day and creating enough of a drag to depress first-quarter earnings, analysts and industry officials say.

Why it matters: Even though Change's parent, UnitedHealth Group, has a timeline for restoring the third-party payment systems that roughly half of U.S. health care relies on, it's not as simple as throwing a switch, Tina writes.

  • Hospitals, pharmacies, doctors, medical equipment vendors and others could spend weeks or months sorting out patient eligibility, filing claims and paying additional staff to handle the extra administrative burden.

The big picture: Providers that use Change systems have seen portions — and in some cases nearly all — of their revenue vanish since systems for filing claims or having them paid went offline Feb. 21.

  • "Cash-constrained operators will begin to feel the full brunt of the slowdown in payments for services between late March and early April, assuming it takes about 30 to 45 days to process a claim and receive payment," Compass Point analyst Max Reale estimated.
  • Though the largest health systems can likely weather the storm, Moody's Ratings warned "even large providers with thin margins and weak liquidity are not immune to challenges" if problems linger.

Federal officials over the weekend announced a plan to distribute emergency funds to providers and suppliers facing cash flow problems and called for other payers, particularly UnitedHealth, to do the same.

Between the lines: It's not just a matter of waiting for the money owed to show up.

  • Providers have already incurred massive expenses coming up with workarounds that have been largely manual and paper-based, said Judson Ivy, CEO of revenue cycle management company Ensemble Health Partners.
  • Once the funds start flowing again, it's likely that a significant amount of money due won't actually be paid out because of paperwork errors and lack of prior authorizations.

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Editor's note: This newsletter was updated to reflect that Moody's Investors Service was recently rebranded as Moody's Ratings.

2. Dubious ransomware distinction

Data: FBI Internet Crime Report 2023; Chart: Axios Visuals
Data: FBI Internet Crime Report 2023; Chart: Axios Visuals

Health care organizations last year reported the most ransomware attacks of the 16 industries identified as critical U.S. infrastructure, Tina writes on a new FBI report on internet crime.

By the numbers: The Internet Crime Complaint Center, or IC3, received more than 2,800 complaints identified as ransomware that caused adjusted losses of nearly $60 million in 2023.

  • Of the nearly 1,200 complaints from organizations deemed "critical" infrastructure, 249 came from health care and public health.

Between the lines: Hackers view hospitals, clinics and other health care organizations as lucrative targets because operators tend to pay a ransom to keep critical services running — and because hospital networks contain a trove of valuable patient information.

More here

3. Drug setbacks' unfortunate reminder

Illustration: Aïda Amer/Axios

A pair of setbacks to drugs for Alzheimer's disease and ALS on Friday served as another reminder that widely touted treatments for desperate patients aren't necessarily a sure thing, Axios' Adriel Bettelheim writes.

Why it matters: Drugs are increasingly judged on the probability they'll work instead of real-world clinical results — often with energetic lobbying by patient advocacy groups.

  • That's putting more of a focus on how clinical trials are designed and the steps regulators have to take to validate a drug's effectiveness, even after it hits the market.

Driving the news: Amylyx Pharmaceuticals said its ALS drug Relyvrio failed a post-approval trial of 664 patients by not showing a significant difference over a placebo.

  • The FDA approved Relyvrio in 2022 without the clinical trial evidence the agency typically requires over concerns from agency staff and amid an intense campaign by advocacy groups.
  • The company said it will consult with patients and the FDA about next steps, which may include withdrawing the drug.
  • Even if Amylyx doesn't pull it, doctors could stop prescribing it or significantly restrict its use. That would be devastating for patients with a dreaded neurological condition that has few available treatments.

Meanwhile, Eli Lilly said the FDA said it would delay action on the company's experimental Alzheimer's drug donanemab while it convenes outside advisers to review.

  • A late-stage trial showed donanemab was effective in slowing the disease's progression, but there were lingering questions about whether its usefulness outweighs safety risks after some patients experienced brain swelling and bleeding.
  • The FDA's views on the way Lilly designed its trial could also give clues about how the agency will treat other Alzheimer's drug candidates.

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4. Microplastics linked to cardiovascular risks

Illustration: Aïda Amer/Axios

Scientists are sounding new alarms about the health risks from microplastics after researchers in Italy found buildup of polyethylene and polyvinyl chloride in plaques removed from patients with cardiovascular disease, Maya writes.

Why it matters: Microplastics are everywhere, but the findings showed for the first time how they can get into our arteries and exacerbate atherosclerosis, a leading global cause of death.

What they found: The study in the New England Journal of Medicine found a measurable amount of microplastics in more than half of 257 Italian patients who had surgery for plaque buildup in their carotid arteries.

  • Over almost three years, these individuals had a 4.5 times greater risk of major events, including heart attacks and strokes.

Where it stands: The findings are "a game changer," but don't definitively prove that plastics cause cardiovascular events, said Phil Landrigan, who directs Boston College's Program for Global Public Health and the Common Good.

Reality check: Efforts to ban single-use items like plastic water bottles could face big hurdles. Beyond that, it would take major behavioral changes to change the way we eat or clean.

Read here

5. While you were weekending

Illustration: Annelise Capossela/Axios

🫁 Doctors say insurers have made it harder to get coverage for certain home ventilator patients. (Associated Press)

🚩 As President Biden pushes to reclassify marijuana, some DEA officials remain concerned over medicinal benefits they say are unproven and the potential for abuse. (Wall Street Journal)

🚭 Massachusetts' top court upheld a pioneering law in Brookline that bans tobacco sales to anyone born in this century. (Boston Globe)

💉 The blockbuster anti-obesity drug Wegovy can now be prescribed to reduce the risk of cardiovascular death, heart attacks and stroke in overweight patients, further expanding its market reach. (Axios)

Thanks for reading Axios Vitals, and to senior health care editor Adriel Bettelheim and copy editor Matt Piper. Please ask your friends and colleagues to sign up.