The decision by the Federal Trade Commission to block DNA sequencing behemoth Illumina's $7.1 billion purchase of Grail puts the focus on how much power one company should wield in the burgeoning cancer detection market.

Driving the news: The FTC on Monday rejected the deal, saying the combination of Grail — which makes liquid biopsy tests — with Illumina, the only provider of sequencing for multi-cancer early detection (MCED) tests will "stifle competition and innovation in the U.S. market."

• Illumina has promised to appeal. But the company is facing a fight on both sides of the Atlantic, after the European Commission in December blocked the deal on similar grounds.

Catch up quick: Illumina is a $36 billion company that specializes in DNA sequencing and array-based technologies.

• As Axios' Alison Snyder previously reported, new competition has been entering the field. But Illumina has dominated with an estimated 80% share of the global market.
• Illumina — which founded Grail in 2016 and later spun off the company, keeping a minority share — set its sights on bringing the company back in the fold in 2020. It closed the deal in 2021.
• It has since faced heavy pushback from regulators, as well as a proxy fight from investor Carl Icahn.

The big picture: The FTC action is evidence of the Biden administration antitrust team's increased focus on health care mergers.

• "I think it's a sign they haven't abandoned that more pro-enforcement agenda," said Rebecca Haw Allensworth, an antitrust professor at Vanderbilt Law School, told the Wall Street Journal.

What they're saying: Conor McNamara, an RBC Capital Markets’ health care analyst, said Monday the FTC's move was in line with expectations, saying he believes "the Grail distraction is coming to an end."

• "We read [the ruling] as the FTC is saying, 'Look, if sequencing was a widely available technology that anyone could provide to the test makers, it wouldn't be a big deal but Illumina is really the only game in town," McNamara told Axios. "That's part of why we like the Illumina stock ... there's no real competition."

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Hospitals routinely charge less to patients who pay in cash and some seek to recoup the difference from commercially insured patients in markets where they can exert leverage, according to a study published in Health Affairs, writes Axios' Adriel Bettelheim.

Why it matters: The Johns Hopkins analysis for 70 services as of September 2022 provides another window into the opaque world of hospital pricing and could be a data point for employers in their negotiations with insurers or directly with providers.

• It also showed how 17 months after the implementation of a federal hospital price transparency rule, nearly half of the general acute care hospitals still had not disclosed most of their prices, the authors noted.

What they found: Hospitals routinely calculated cash prices and commercially negotiated rates in increments of a 5% discount from list prices, or "chargemasters."

• Cash prices were likelier to be lower than negotiated rates at nonprofit or government-owned hospitals that see more uninsured patients — and in areas with strong hospital market power.
• Overall, cash prices were lower than or equal to the median negotiated rates for the same procedure in the same hospital 47% of the time — most commonly for consultations, exams and other "evaluation and management" services.

Inflation and higher health spending helped drive monthly premiums for Affordable Care Act coverage up an average of 3.4% between 2022 and 2023, reversing several years of declines, according to a new report from the Urban Institute and the Robert Wood Johnson Foundation, Axios' Arielle Dreher writes.

Why it matters: Some of the increase was also attributed to uncertainty over whether Congress would extend or make permanent premium subsidies, which complicated insurers’ decision-making. Extending subsidies would incentivize healthy people who choose to buy coverage previously deemed unaffordable.

What they found: There were considerable regional variations, with consumers in smaller cities and rural areas bearing a higher burden.

• The average silver plan benchmark premium increased from $438 to $453 in the last year for a 40-year-old nonsmoker.
• Markets with a single insurer had premiums that were $128 more than in markets with five or more insurers.
• States like West Virginia and Wyoming had the highest average benchmark premiums in 2023, at over $800.

Approximately 1 in 6 people experience infertility at some stage in their lives, according to a new report from the World Health Organization, Axios' Oriana González writes.

Why it matters: Despite the large number, access to fertility treatments remains scarce due to "high costs, social stigma and limited availability," said WHO director-general Tedros Adhanom Ghebreyesus.

• This is the first time in a decade that WHO releases a report on the prevalence of infertility, which it defined as "the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse."

Details: WHO examined data from 1990 to 2021, finding that roughly one in six people globally — 17.5% — have been unable to have a child at some point in their lives.

• In the Americas, infertility prevalence was higher, at about 20%.
• The WHO found that infertility prevalence did not vary significantly with different income levels. High-income countries had a lifetime infertility prevalence of 17.8% and low- and middle-income countries had 16.5%.

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