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1 big thing: Johnson & Johnson's legal bills keep mounting

Illustration: Aïda Amer/Axios

Johnson & Johnson has spent $900 million on litigation in the first half of this year, and that tally is only going to swell, Axios' Bob Herman reports.

The big picture: J&J is fighting thousands of legal battles over the safety of its prescription drugs and medical devices — chipping away at public trust in a health care company that has become a household name, and threatening to strip billions of dollars out of its coffers.

Where it stands: A jury recently said J&J had to pay $8 billion to a man who claimed he got enlarged breasts from taking the company's antipsychotic drug Risperdal.

  • An Oklahoma judge ruled that J&J has to pay $572 million for its role in creating the opioid crisis. Billions more could be on the line for the company in the 2,000 other opioids cases.
  • J&J paid $1 billion earlier this year to settle cases tied to defective metal hip implants.
  • The company is appealing a $4.7 billion verdict tied to claims that its talc powder caused cancer in women.
  • A trial is underway in California over J&J's allegedly faulty pelvic mesh devices.
  • The Federal Trade Commission is investigating whether J&J's contracting practices for Remicade, a treatment for autoimmune and inflammatory diseases, violate federal antitrust laws.

What we're watching: We'll likely know more about J&J's litigation costs when the company reports its third quarter earnings this week.

Yes, but: Investors have not fled J&J, because it is the most profitable health care company in the country, collecting almost $9.4 billion of profit in the first half of this year.

What they're saying: J&J submitted a statement that said its "reputation remains strong," and when it comes to its legal cases, "the facts in these cases are on our side."

2. Two more legal setbacks for Trump

The Trump administration's health care agenda suffered 2 more setbacks in court on Friday, Axios' Sam Baker writes.

A federal judge in New York blocked implementation of the administration's "public charge" rule, which would make it harder for immigrants to gain legal status if they're likely to rely on public programs — including Medicaid or subsidies through the Affordable Care Act.

Medicaid work requirements were also on thin ice, during a contentious hearing before the D.C. Circuit Court of Appeals. 

  • The panel seemed wary, as a lower-court judge has been, of the administration's decision to approve work requirements without giving much weight to the number of people who would lose Medicaid coverage as a result.
  • Listen to the arguments.

The bottom line: Nothing is final on either front. The D.C. Circuit hasn't ruled yet, and when it does, that ruling can be appealed up to the Supreme Court.

  • And the Justice Department is sure to appeal the public-charge ruling, as well.
  • Still, these setbacks are part of a trend, and they are slowing the administration's work while threatening to ultimately derail it altogether.

Go deeper: Trump's shrinking health care legacy

3. Voters don't believe Trump on health care

Illustration: Lazaro Gamio/Axios

The Kaiser Family Foundation's next tracking poll will show that most voters don't believe President Trump's promises of a forthcoming health care plan. KFF President Drew Altman offers a preview in his latest column.

By the numbers: 81% of Republicans are somewhat or very confident Trump will deliver on his health care promises.

  • But 95% of Democrats and 61% of independents say they are not confident Trump will follow through on those promises.
  • In fact, just 37% of those polled were aware that Trump had promised to release a plan to replace the Affordable Care Act.

Between the lines: Trump's argument that he'll protect Medicare — intended as a counterweight to "Medicare for All" — also isn't sticking, the poll found.

  • 49% of seniors trust Democrats to do a better job making sure seniors on Medicare are able to get the health care they need, compared with just 33% who said they trust Republicans.

What's next: For now, this is all theoretical. But if the courts ultimately strike down the Affordable Care Act — as the Trump administration is urging them to do — then Trump will actually need a replacement.

  • Public opinion could shift quickly and sharply in that environment, even among many Republicans.
4. Synthetic opioid crisis still growing

Although opioid prescriptions in the U.S. have fallen, opioid overdose deaths — 47,000 in 2018 — remain at historic levels, Bryce Pardo and Beau Kilmer write for Axios Expert Voices.

  • The continued spread of fentanyl and other illicitly manufactured synthetic opioids suggest the problem could still get worse.

The big picture: Inexpensive and widely available on the internet, fentanyl is attractive to dealers who make counterfeit prescription pills or mix it into heroin. Fentanyl, however, is extremely potent, leading more users to fatally overdose.

What's happening: So far, fentanyl deaths are largely concentrated in parts of Appalachia, the Mid-Atlantic and New England, with western states less exposed.

Between the lines: Fentanyl isn't attracting new drug users. Rather, it's an ingredient suppliers use to cut costs but most consumers seek to avoid.

Go deeper.

5. While you were weekending...
  • Hospitals' attempts to prevent seniors from falling are instead creating an "epidemic of immobility," the Washington Post reports with Kaiser Health News.
  • Mayor Pete Buttigieg is using his health care platform to position himself between the 3 Democratic frontrunners, Politico reports.
  • Meanwhile, Sen. Elizabeth Warren is under increasing pressure from Democrats to say what her health care plan is and how she will pay for it, per WSJ.
  • The Congressional Budget Office announced Friday that House Speaker Nancy Pelosi's aggressive drug pricing proposal would save taxpayers $345 billion over 7 years, Bloomberg writes.
  • A bankruptcy judge on Friday ordered a pause in state litigation against Purdue Pharma and the Sackler family, NYT reports.