AGP Executive Report

Diabetes Care: The FDA approved Onswik (insulin efsitora alfa-gobe), a once-weekly basal insulin for adults with type 2 diabetes, offering an alternative to daily injections and expanding global access after approvals in Europe, Mexico, and Japan. Puerto Rico Health & Environment: Steri-Tech in Salinas agreed to a proposed $700,000 civil penalty and stricter controls to cut ethylene oxide emissions by at least 99.99% from sterilization vents, after alleged Clean Air Act violations. Local Health Policy: A new Puerto Rico measure seeks to expand public guidance on rainwater harvesting, while separate coverage highlights Puerto Rico’s rapid aging trend as health needs rise. Public Health Watch: Florida reported a dengue death amid a worst-in-decades outbreak, with cases climbing statewide and mosquito alerts issued in multiple areas. Healthcare Workforce: The American Hospital Association urged DHS to reconsider a proposed new $103,265 H-1B petition fee, warning it could worsen staffing shortages and reduce access to care.

Puerto Rico Air Quality & Health: Steri-Tech Inc. agreed to a $700,000 civil penalty and tighter controls on ethylene oxide emissions at its Puerto Rico sterilization facility in Salinas, with the plan requiring at least a 99.99% reduction from each sterilization-chamber vent while the settlement moves through public comment and court approval. Aging & Care Needs: Puerto Rico’s population is aging fast, with an aging index rising 41%, a trend that can strain healthcare capacity and long-term services. Drug Pricing & Consumer Relief: Puerto Rico is joining the U.S. “most-favored-nation” Medicaid drug-pricing program, as questions grow about secrecy and transparency—while multiple states’ attorneys general push consumers to claim compensation from generic drug price-inflation settlements. Healthcare Workforce Policy: The American Hospital Association urged DHS to rethink a proposed new $103,265 H-1B petition fee, warning it could worsen healthcare staffing shortages, especially in rural and underserved areas. Local Health Tech/Industry: Vicapsys Life Sciences says it completed a reverse merger tied to Puerto Rico distribution and is moving to acquire NitroMist (nitroglycerin) lingual aerosol, aiming to build a vertically integrated pharmaceutical manufacturing and distribution platform.

Pharma & Manufacturing: Vicapsys Life Sciences says it completed its reverse merger with Stateline Distributors of Puerto Rico and signed a definitive deal to acquire the FDA-approved NitroMist (nitroglycerin) lingual aerosol, while also discussing a potential Puerto Rico API facility with cleanroom and distribution space. Public Health & Access: MISTR announced a plan to fund 1 million HIV tests and 1 million Hepatitis C tests nationwide by end of 2027, connecting results directly to prevention and care. Medicaid Drug Costs: The White House says all 50 states, Puerto Rico, and DC have applied to join the GENEROUS Medicaid drug-pricing model, aiming to cut costs by tying net prices to selected foreign prices. Local Health Resilience: A new Puerto Rico House bill would expand public guidance on safe residential rainwater harvesting as drought and service interruptions continue. Aging & Care Needs: Puerto Rico’s Aging Index rose 41% from 2020 to 2025, signaling growing pressure on health services for older adults. Air Quality & Medical Sterilization: EPA and DOJ move toward a proposed $700,000 fine and stricter ethylene oxide controls for Steri-Tech’s Salinas sterilization facility. Food Safety: Recalled frozen berries linked to a multistate E. coli outbreak were distributed in Puerto Rico, urging residents not to eat affected lots.

Medicaid Drug Pricing Push: CMS says all 50 states plus Puerto Rico have applied for the GENEROUS Model, a five-year most-favored-nation drug pricing plan that could cut Medicaid prescription costs by tying prices to those paid abroad. Generic Drug Payouts: Multiple state AGs, including Puerto Rico, are urging consumers to file claims after settlements over alleged generic drug price-fixing; eligibility generally covers purchases made between May 2009 and December 2019, with claims due in 2027. Aging & Health Planning: Puerto Rico’s aging index rose 41% from 2020 to 2025, signaling faster growth in the 65+ population and mounting pressure on labor, health services, and long-term care. HIV/Hep C Testing Expansion: MISTR announced a commitment to fund free HIV and Hepatitis C testing for one million people each by end of 2027, with testing linked directly to prevention and treatment. Rural Hospital Funding Gap: Nearly $25M reached 132 rural hospitals, but 36 likely eligible hospitals were left out, raising questions about access to critical care support. Workforce & Care Access: A new $1M donation supports nursing and health science programs at Polk State College’s campus, highlighting ongoing investment in clinical training.

Medicaid Drug Pricing: CMS says all 50 states, D.C., and Puerto Rico have applied for the GENEROUS most-favored-nation model, with 40 already signed and the rest due by Sept. 30—aimed at lowering brand drug costs for Medicaid. Pandemic Update: The 13th COVID-19 wave is cresting heading into winter, with Puerto Rico among places showing elevated active infection rates. Dengue Alert: Florida confirmed its first dengue death in a major outbreak; Puerto Rico and other U.S. territories are also seeing hundreds of cases, underscoring mosquito-borne risk closer to home. Rural Hospital Funding: Nearly $25M went to 132 rural hospitals, but 36 likely eligible facilities were left out without clear public explanation—raising concerns for local emergency and inpatient care access. Health Equity & Care Access: Banfield Foundation released its 2025 impact report with $3.4M in grants to expand preventive veterinary care in under-resourced communities and territories. Human Rights & Health: Human Rights Watch detailed hardships for people deported to gang-ravaged Haiti, including days without food or bathing while held in U.S. detention.

Pandemic Update: The U.S. 13th COVID-19 wave is cresting nationally, but Puerto Rico is still flagged with about 1 in 23 people actively infectious, as outbreaks expand across dozens of states and territories. Heart Health: A new American Heart Association statement says cardiovascular disease is the leading killer of Hispanic adults, with risk and outcomes varying by heritage and birthplace—highlighting gaps in blood pressure control, obesity, and diabetes. Public Health & Speech: A federal appeals court struck down Puerto Rico’s emergency law that criminalized certain “fake news,” reinforcing that misinformation can’t be handled by suppressing speech. Cancer Prevention: The Prevent Cancer Foundation’s 2026 gala raised over $2M for early detection and prevention work in Puerto Rico. Drug Pricing: Puerto Rico will move into the U.S. Most Favored Nation Medicaid drug-pricing model, though critics question savings because deal terms remain confidential. Dengue Watch: Florida confirmed a dengue death amid rising cases; Puerto Rico is also reporting hundreds, underscoring mosquito-control and bite prevention. Local Care Concerns: A letter raises questions about whether GMH’s electrical system is still being fixed, spotlighting patient-safety risks in hospital infrastructure.

Medicaid Drug Pricing (Puerto Rico): Puerto Rico is now set to get Most Favored Nation prescription drug prices under the GENEROUS Medicaid model, with CMS saying the program could save $64.3B over 10 years—while critics warn the underlying deals remain too secret to verify patient savings. Public Health & Access: The Connecticut–Puerto Rico Trade Commission says it’s using trade ties to support island priorities, including healthcare and energy, after stepping up around Puerto Rico’s water crisis. Dengue Alert (Florida): Florida confirmed a dengue death in Hillsborough County amid one of its worst outbreaks in decades, raising concern for older adults and people with chronic conditions as cases remain locally acquired. Climate & Health Risk: PAHO warns El Niño is strengthening and could drive health impacts across the Americas, including food insecurity and vector- and water-borne disease pressures. Workforce & Training: Lincoln Tech’s Grand Prairie campus was named an ACCSC “School of Excellence,” highlighting training pipelines for healthcare-adjacent trades like HVAC and welding. Community Health Context: A report on rural behavioral health in Kansas flags a transportation gap that can delay care for people in mental health crises.

Medicaid Drug Costs (Puerto Rico included): CMS says all 50 states, DC, and Puerto Rico have applied to join the GENEROUS model, using most-favored-nation pricing and manufacturer rebates to lower Medicaid prescription costs, with projected $64.3B in savings over 10 years. Local Health & Safety (Dengue): Florida confirmed a dengue-related death tied to its Hillsborough County surge, where locally acquired cases have spiked to more than 130 this year. Public Health & Climate: PAHO warns El Niño is strengthening and could raise health risks across the Americas, including food insecurity and vector- and water-borne disease pressures. Access & Infrastructure (Puerto Rico water): A Puerto Rico water crisis tied to drought and aging systems is driving rationing and service disruptions, with advocates pointing to long-standing accountability and transparency gaps. Cancer Care & Costs (Fundraising): Former UW basketball star Josh Davis was diagnosed with incurable mantle cell non-Hodgkin’s lymphoma and his family launched a fundraiser to help cover medical bills. Oncology Update (EU approval path): EMA CHMP issued a positive opinion for relacorilant (Lifyorli) plus nab-paclitaxel for platinum-resistant ovarian cancer, moving to an EC decision in Q4 2026.

Medicaid Drug Costs (Puerto Rico included): President Trump announced that all 50 states, Washington, D.C., and Puerto Rico will move into his “most-favored-nation” prescription pricing plan for Medicaid under the GENEROUS model, using manufacturer rebates to cap Medicaid drug prices at levels paid in other developed countries—projected to drive about $65B in Medicaid savings over the next decade. Dengue Alert (Florida, health risk): Florida confirmed a death tied to locally acquired dengue in Hillsborough County, where cases have surged to 130+ this year—described as “wildly unusual” for the area—amid warm, rainy conditions that boost mosquito spread. Local Water & Health Access (Puerto Rico): A new report highlights how drought and aging infrastructure are driving water rationing and service disruptions across Puerto Rico, raising concerns about accountability and residents’ ability to demand fixes before the next crisis. Puerto Rico Labor & Health Context: Puerto Rico’s unemployment rate rose to 6.1% in August, with 76,000 estimated unemployed—an economic pressure point that can affect access to care. Cancer Treatment Update (EU): EMA’s CHMP issued a positive opinion for relacorilant (Lifyorli) plus nab-paclitaxel for platinum-resistant ovarian cancer, moving the therapy closer to potential approval.

Medicaid Drug Costs: President Trump says all 50 states, D.C., and Puerto Rico will join his “most-favored-nation” Medicaid pricing plan (GENEROUS), using manufacturer rebates to cap net drug prices and aiming for major savings for state budgets. Local Health Infrastructure: A Puerto Rico water crisis tied to drought and aging systems is exposing long-running gaps in accountability and service reliability, with residents facing rationing and disruptions. Dengue Alert (US): Florida confirmed a locally acquired dengue death in Hillsborough County amid an unusually large outbreak, underscoring mosquito risk as conditions favor spread. Cancer Treatment Update (EU): EMA’s CHMP issued a positive opinion for relacorilant (Lifyorli) plus nab-paclitaxel for platinum-resistant ovarian cancer, moving toward an EC decision. Workforce Watch (PR): Puerto Rico’s unemployment rate rose to 6.1% in August, while employment and labor force participation increased year over year.

Medicaid Drug Costs (Puerto Rico included): President Trump says all 50 states, D.C., and Puerto Rico will join the GENEROUS “most-favored-nation” Medicaid drug pricing model, using manufacturer rebates to cap net prices at levels paid in other developed countries—aimed at saving billions for Medicaid and reinvesting in care. Local Health & Infrastructure: A Puerto Rico water crisis tied to drought and aging systems is exposing long-running gaps in accountability and how residents can demand fixes before the next disruption. Labor Watch: Puerto Rico’s seasonally adjusted unemployment rate rose to 6.1% in August, with employment and labor force participation also increasing year over year. Cancer Update: The EU’s CHMP issued a positive opinion for relacorilant (Lifyorli) plus nab-paclitaxel for platinum-resistant ovarian cancer, moving the therapy closer to potential approval. Suicide Prevention: Fort Buchanan hosted “A Moment for Life,” a suicide prevention event focused on connecting people to mental health resources through physical, spiritual, and awareness activities.

Medicaid Drug Pricing (Puerto Rico included): President Trump says his “most-favored-nation” Medicaid drug deals now cover all 50 states, Washington, D.C., and Puerto Rico, using manufacturer rebates so Medicaid pays no more than prices in comparable developed countries—promising about $65B in savings over the next decade, though critics want more details on which drugs are included and how access could be affected. Suicide Prevention in Puerto Rico: At Fort Buchanan, a “A Moment for Life” event brought together service members and community partners for “Connect, Reflect and Restore,” offering suicide-prevention resources and support for physical, mental, and spiritual well-being. Dengue Alert (regional health risk): Florida reported a dengue death amid one of its worst outbreaks in decades, with more than 130 locally acquired cases in Hillsborough County so far this year—highlighting mosquito-spread risks that have also affected Puerto Rico historically. GLP-1 and Alcohol Use Disorder: New research is exploring whether GLP-1 medications (like semaglutide) could reduce alcohol cravings and drinking for people with alcohol use disorder, with early trial results showing large drops in alcohol consumption. Community Health & Access (global): Direct Relief reported delivering millions of medication doses and supplies to U.S. territories and countries, including support for flood-affected families in Nepal with an emphasis on continuity of care.

Medicaid Drug Pricing: A Reuters report says the Trump administration plans to expand its Medicaid “most-favored-nation” drug pricing model to cover all 50 states, D.C., and Puerto Rico—aiming to narrow the U.S. drug price gap. HIV Prevention Access: A new piece highlights how persistent stigma still blocks people from using modern HIV prevention like PrEP, even as prevention options have improved dramatically. HIV Community Impact: AIDS Healthcare Foundation is set to mark 40 years of HIV/AIDS impact with a free World AIDS Day concert in Inglewood on Nov. 30, underscoring ongoing prevention and care needs. Public Health Risk Alert: North Carolina’s teen death from a brain-eating amoeba (Naegleria fowleri) is linked to exposure at an artificial water feature, with officials stressing early symptoms can look like common illness before rapidly worsening. Local Health & Economy: Puerto Rico’s retail sales rose 1.2% in fiscal year 2026, but analysts warn it may reflect inflation rather than higher unit sales; medical care prices rose too. Workforce & Health: Puerto Rico’s Warmkraft plans a Mayagüez facility focused on chemical treatment to repel disease-carrying insects like dengue and Zika, with potential spillover into hospitality and health care uses.

Medicaid Funding Warning (Puerto Rico): Puerto Rico’s government and health sectors warn the island could face a Medicaid financing deficit of billions starting in 2027 if Congress doesn’t extend or permanently fix the current agreement—potentially dropping the federal match from about 76% to 55%, threatening care for nearly 1.3 million residents on Medicaid and the Vital Plan. Food Safety Recalls (Walmart): Walmart shoppers are urged to check labels after recalls tied to possible E. coli contamination in frozen berries and a choking-hazard candy issue, with Puerto Rico listed among affected areas. Public Health Risk (Water Exposure): A North Carolina teen who died from a rare brain-eating amoeba (Naegleria fowleri) was likely infected from an artificial water feature at a Durham community mental health center; officials say the water feature was drained and closed. HIV Services Milestone: AIDS Healthcare Foundation will mark 40 years of HIV/AIDS impact with a free World AIDS Day concert on Nov. 30 in Inglewood, highlighting ongoing need for prevention and support. Community Health & Access: The National Association of Free & Charitable Clinics marks 25 years supporting healthcare access, underscoring the role of safety-net clinics.

Medicaid Funding Crisis: Puerto Rico Hospital Association warns 700,000 to 1 million people could lose Plan Vital coverage if Congress doesn’t extend Medicaid funding before Oct. 1, 2027—federal support could drop from about $4B to under $500M, shrinking the match rate from 76% to 55%, threatening access to doctors, meds, and hospitals. Public Health Alert: A North Carolina teen’s death from the brain-eating amoeba Naegleria fowleri was linked to a water feature at a Durham mental health center; the feature was closed after testing positive, spotlighting water safety at community sites. Food Safety Recall: FDA recalled specific So Delicious Dairy Free Salted Caramel Cluster non-dairy ice cream pints after reports of “small stones and other hard objects”; Walmart confirmed sales in Puerto Rico, so consumers should check lot codes and best-by dates. Community Health Access: Enterprise reopened its Hatillo rental facility after Hurricane Maria, expanding local transportation options that can support healthcare access for residents and providers. Health Equity & Coverage: Hospital Association and multisector voices are pushing for a permanent Medicaid solution, arguing temporary extensions make long-term health planning nearly impossible.

Water Safety Alert: A North Carolina teen’s fatal Naegleria fowleri “brain-eating amoeba” case is linked to a man-made water feature at the El Futuro mental health center in Durham; the feature remains closed while investigators review how exposure may have happened. Food Recall: The FDA is tracking a high-risk recall tied to an E. coli and Salmonella sprout outbreak, with a seed supplier now agreeing to recall the alfalfa seed lot used by Everything Sprouts (sold in Puerto Rico and shipped internationally). Heart Health Focus: A new American Heart Association statement says cardiovascular disease now kills more Hispanic adults than cancer, with heart failure and first stroke occurring years earlier—especially tied to obesity, diabetes, and high blood pressure that are often less controlled. Vascular Care Access: The SVS Foundation awarded $80,000 total in grants to expand peripheral artery disease screening and limb-preserving care in underserved communities. Local Health Tech: Apple says hypertension notifications on Apple Watch Series 12 and Ultra 4 may be unavailable in 33 regions due to regulatory clearances still in process. School Nutrition Costs: The School Nutrition Association urges federal help, asking USDA to use Section 32 funds for emergency per-meal reimbursements as food, labor, and equipment costs strain school meal programs.