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When he was diagnosed with two autoimmune diseases, Joel Hechler knew he’d be in for a battle. He didn’t realize maybe his toughest one would be with his insurance company.“I think they put the dollars ahead of a patient’s health,” Hechler said. “I don’t think they fully understand the impact the medicine will have on my long-term health and well-being."Hechler suffers from Crohn’s disease and ulcerative colitis, diseases that attack the lining of his digestive tract. Autoimmune conditions like his can’t be cured but, with the right medication, the symptoms can be controlled.  Finding the right medicine can be hard for those suffering from autoimmune diseases. Even if there are scores of drugs on the market, some patients might only respond to one. In Joel’s case, his doctor thought he’d have a better chance trying a drug called Remicade.“I received a letter from my insurance company that denied the Remicade on the basis that I have to try a different drug before I can get to Remicade," Hechler said.Hechler's insurance company, Premera Blue Cross, wouldn’t approve the drug his doctor prescribed because they wanted him to try a cheaper one first.It’s part of a program that health insurers nationwide use called step therapy, requiring that patients try less-costly drugs before “stepping up” to more expensive ones — even if doctors believes the cheaper drug won’t work.Dr. Larry Adler is president of Huron Gastro in Ypsilanti, Michigan and says he spends virtually every day battling insurance companies over step therapy drugs.“They have to fail this medicine first before they get the new drug,” Adler said. “That doesn’t make any sense.”Adler says it's common for patients to get sicker while waiting for step therapy to run its course.In Hechler's case, it took six weeks of fighting with his insurer to convince them that the cheaper drug wouldn’t be effective. As he was waiting, he was getting worse.“It got to the point where I had to be admitted to the hospital,” Hechler said. "I was very, very sick.”Step therapies are used by insurers to try to control skyrocketing prescription medicine costs, says Glen Perry, Director of Pharmacy Contracting and Sales for Blue Cross Blue Shield of Michigan.“These drugs can cost up to 0,000 per year. These are not cheap medications,” Perry said.“It seems like you’re telling patients that, in many cases, your insurer knows what’s best for you, rather than your doctor,” Jones said.“We are trying to provide the most cost effective and safe medication use,” Perry said, adding that when a doctor and insurer disagree over a drug, they can usually resolve the case within a few days without putting a patient at serious risk.“A delay of one or two days I don’t think is really going to make that much of a difference for the medical outcome of the patient," he said.But for many patients, like Phyllis Toole, the delay is longer than a few days.Phyllis suffers from rheumatoid arthritis, a condition where her body attacks her joints. When her doctor wanted to put her on Orencia, her insurance company HAP said she needed to first try a less expensive drug, Humira.But Phyllis’ doctor was worried about possible side effects and thought Humira could be risky.After battling for months, Phyllis says the whole thing made her feel more like a number than a patient. With her doctor and insurer in a standoff, she was forced to rely on samples of the drug she got from her doctor. HAP never approved her prescription.“They’re playing doctor, is what it feels like,” Toole said. “They’re saying this is what you can have for the symptoms you have. It may make you sicker, but this is what you can have.”HAP issued the following statement to Scripps station WXYZ in Detroit: 3800

WHY DID HE REFUSE TO ENDORSE SLOW JOE UNTIL IT WAS ALL OVER, AND EVEN THEN WAS VERY LATE? WHY DID HE TRY TO GET HIM NOT TO RUN?— Donald J. Trump (@realDonaldTrump) August 20, 2020 187

What to keep in mind with credit card bill payments (READ)Tips on handling your credit cards amid virus outbreak (READ)Help available for renters, homeowners struggling to pay for housing during pandemic (READ)3 ways credit cards can help you ride out a crisis (READ)SAN DIEGO (KGTV) -- Tens of thousands of people in California are being sued for not paying their credit card bills and other types of loan payments. The lawsuits are what's known as rule 3.740 collection cases."A lot of worrying after that, like oh my god, what am I going to do," said Chris Madden. "Stressed out now and just didn't need it."In February, Madden was served with a lawsuit from a debt collection company.During an interview with 10 News that month Madden said he needed to borrow money a few years ago to keep his car. He turned to a lender that could get him money quickly."I figured it was going to be a high-interest rate, like 22% or something," he said. "I started making the payments on it, and then I found out more about it."Madden admits he didn't do a great job getting all the details when he took the money, saying the interest rate wasn't clear. When he finally did look at the fine print, he saw the interest rate was 135%. Court documents show a ,000 loan turned into ,000 owed."They were threatening to take any assets that I have, garnish my wages," Madden said.Madden said he stopped paying. He's being sued by a debt buyer under what's known as a rule 3.740 collections case.According to the 2020 California Rules of Court, "Collections case" means an action for recovery of money owed in a sum stated to be certain that is not more than ,000, exclusive of interest and attorney fees, arising from a transaction in which property, services, or money was acquired on credit."Team 10 discovered a 157% increase in the number of rule 3.740 collections lawsuits filed in San Diego County court from 2015 to 2019. 1927

What color is your county and state?The Harvard Global Health Institute released an interactive map on Wednesday that shows the risk of contracting the coronavirus based on daily new cases per 100,000 people.Based on Harvard's guidelines, three US states need to implement stay-at-home orders, while an additional 13 should consider them. The map has four colors – green, yellow, orange and red – to demonstrate the risk by county and state. The map shows three states – Arizona, Florida and Mississippi – in the red for where infections are high. Just two states – Hawaii and Vermont—are in the green. While Hawaii requires face coverings in public setting such as retailers despite being one of only two states without community spread, the three states in red have not implemented mandatory face coverings in public. "We've left it to the locals to make decisions about whether they want to use coercive measures or impose any type of criminal penalties. We're not going to do that statewide," Florida Gov. Ron DeSantis said on Tuesday.According to Harvard Global Health Institute, when areas are shaded red, stay-at-home orders become necessary. So far, Arizona, Florida and Mississippi have not reinstituted stay-at-home orders despite being in the red. Arizona and Florida did announce that most bars can no longer serve alcohol on site.“The public needs clear and consistent information about COVID risk levels in different jurisdictions for personal decision-making, and policy-makers need clear and consistent visibility that permits differentiating policy across jurisdictions”, said Danielle Allen, director of the Edmond J. Safra Center for Ethics at Harvard University. “We also collectively need to keep focused on what should be our main target: a path to near zero case incidence.”Thirteen states are in the orange, meaning those states should consider either implementing stay-at-home orders or conduct rigorous tracing programs, Harvard said..“Local leaders need and deserve a unified approach for suppressing COVID-19, with common metrics so that they can begin to anticipate and get ahead of the virus, rather than reacting to uncontrolled community spread”, says Beth Cameron, Vice President for Global Biological Policy and Programs at the Nuclear Threat Initiative and a member of the COVID-Local.org team. “Unless and until there is a whole of government response, with measurable progress communicated similarly and regularly across every state and locality, U.S. leaders will be left to react to the chaos of the virus - rather than being able to more effectively target interventions to suppress it. “COVID RISK LEVEL: GREEN- Less than one case per 100,000 people- On track for containment- Monitor with viral testing and contact tracing programCOVID RISK LEVEL: YELLOW- 1-9 cases per 100,000 people- Community spread- Rigorous test and trace programs advisedCOVID RISK LEVEL: ORANGE- 10-24 cases per 100,000 people- Accelerated spread- Stay-at-home orders and/or rigorous test and trace programs advisedCOVID RISK LEVEL: RED- 25 or more cases per 100,000 people- Tipping point- Stay-at-home orders necessaryClick here to view the map. 3170

With a coronavirus vaccine still months off, companies are rushing to test what may be the next best thing: drugs that deliver antibodies to fight the virus right away, without having to train the immune system to make them.Antibodies are proteins the body makes when an infection occurs; they attach to a virus and help it be eliminated. Vaccines work by tricking the body into thinking there’s an infection so it makes antibodies and remembers how to do that if the real bug turns up.But it can take a month or two after vaccination or infection for the most effective antibodies to form. The experimental drugs shortcut that process by giving concentrated versions of specific ones that worked best against the coronavirus in lab and animal tests.“A vaccine takes time to work, to force the development of antibodies. But when you give an antibody, you get immediate protection,” said University of North Carolina virologist Dr. Myron Cohen. “If we can generate them in large concentrations, in big vats in an antibody factory ... we can kind of bypass the immune system.”These drugs are believed to last for a month or more and could give quick, temporary immunity to people at high risk of infection, such as health workers and housemates of someone with COVID-19. If they proved effective and if a vaccine doesn’t materialize or protect as hoped, the drugs might eventually be considered for wider use, perhaps for teachers or other groups.They’re also being tested as treatments, to help the immune system and prevent severe symptoms or death.“The hope there is to target people who are in the first week of their illness and that we can treat them with the antibody and prevent them from getting sick,” said Dr. Marshall Lyon, an infectious disease specialist helping to test one such drug at Emory University in Atlanta.Having such a tool “would be a really momentous thing in our fight against COVID,” Cohen said.Vaccines are seen as a key to controlling the virus, which has been confirmed to have infected more than 20 million people worldwide and killed more than 738,000. Several companies are racing to develop vaccines, but the results of the large final tests needed to evaluate them are months away.The antibody drugs are “very promising” and, in contrast, could be available “fairly soon,” said Dr. Janet Woodcock, a U.S. Food and Drug Administration official who is leading government efforts to speed COVID-19 therapies. Key studies are underway and some answers should come by early fall.One company, Eli Lilly, has already started manufacturing its antibody drug, betting that studies now underway will give positive results.“Our goal is to get something out as soon as possible” and to have hundreds of thousands of doses ready by fall, said Lilly’s chief scientific officer, Dr. Daniel Skovronsky.Another company that developed an antibody drug cocktail against Ebola — Regeneron Pharmaceuticals Inc. — now is testing one for coronavirus.“The success with our Ebola program gives us some confidence that we can potentially do this again,” said Christos Kyratsous, a Regeneron microbiologist who helped lead that work.Regeneron’s drug uses two antibodies to enhance chances the drug will work even if the virus evolves to evade action by one.Lilly is testing two different, single-antibody drugs — one with the Canadian company AbCellera and another with a Chinese company, Junshi Biosciences. In July, Junshi said no safety concerns emerged in 40 healthy people who tried it and that larger studies were getting underway.Others working on antibody drugs include Amgen and Adaptive Biotechnologies. The Singapore biotech company Tychan Pte Ltd. also is testing an antibody drug and has similar products in development for Zika virus and yellow fever.“I’m cautiously optimistic” about the drugs, said the nation’s top infectious diseases expert, Dr. Anthony Fauci. “I’m heartened by the experience that we had with Ebola,” where the drugs proved effective.What could go wrong?— The antibodies may not reach all of the places in the body where they need to act, such as deep in the lungs. All the antibody drugs are given through an IV and must make their way through the bloodstream to wherever they’re needed.— The virus might mutate to avoid the antibody — the reason Regeneron is testing a two-antibody combo that binds to the virus in different places to help prevent its escape.Skovronsky said Lilly stuck with one antibody because manufacturing capacity would essentially be cut in half to make two, and “you will have less doses available.” If a single antibody works, “we can treat twice as many people,” he said.— The antibodies might not last long enough. If they fade within a month, it’s still OK for treatment since COVID-19 illness usually resolves in that time. But for prevention, it may not be practical to give infusions more often than every month or two.A San Francisco company, Vir Biotechnology Inc., says it has engineered antibodies to last longer than they usually do to avoid this problem. GlaxoSmithKline has invested 0 million in Vir to test them.Giving a higher dose also may help. If half of antibodies disappear after a month, “if you give twice as much, you will have two months’ protection,” Lilly’s Skovronsky said.— The big fear: Antibodies may do the opposite of what’s hoped and actually enhance the virus’s ability to get into cells or stimulate the immune system in a way that makes people sicker. It’s a theoretical concern that hasn’t been seen in testing so far, but large, definitive experiments are needed to prove safety.“As best as we can tell, the antibodies are helpful,” Lyon said.___Marilynn Marchione can be followed on Twitter: @MMarchioneAP___The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content. 5919