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Step therapy requires patients try alternate medication

admin - Latest News - November 20, 2025
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Before insurance plans will approve doctor-recommended medication, they often require patients to try cheaper alternatives in what is known as step therapy. NBC News’s Maggie Vespa reports on a patient with MS who pushed to get coverage for the medication her doctor said she needed. 



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Oct. 15, 2025, 2:00 PM EDTBy Matt BradleyCAESAREA, Israel — Ten years ago this week, two Palestinian attackers boarded a bus in Jerusalem and shot, beat and stabbed Israeli American educator Richard Lakin to death along with two others before police killed one of the militants and injured and arrested the other.The surviving assailant, Bilal Abu Ghanem, was freed in February from his three consecutive life sentences for murder as part of the last Israeli ceasefire and hostage release deal with Hamas.That’s when his son, Micah Avni, had to watch his father’s murderer go free.“It feels like I’ve been betrayed by my country,” Avni, 56, said the day before Hamas exchanged 24 Israeli hostages for about 2,000 Palestinian detainees and prisoners, including 250 serving life sentences for serious crimes including terrorism. Bilal Abu Ghanem, in 2016.Ahman Gharabli / AFP via Getty Images fileAvni’s anguish and anger have now merged with a larger collective, shared by many Israelis whose loved ones were killed or maimed in terror attacks and who must now watch the perpetrators walk free as part of the latest ceasefire negotiated by the Trump administration.Their torment hasn’t just punctured the euphoria surrounding last week’s agreement — it very nearly halted the deal and could still frustrate its full implementation.Two far-right political parties in Israel’s government cited the release of 250 convicts as their reason for voting against President Donald Trump’s ceasefire and hostage release plan.“Alongside this joy, it is absolutely forbidden to ignore the question of the price: the release of thousands of terrorists,” said Itamar Ben-Gvir, the far-right minister of national security and leader of the Otzma Yehudit party, in a statement explaining his party’s opposition. “These are terrorists whose past experience proves that they will return to terrorism and their art of working to murder Jews.”While Ben-Gvir and others refer to thousands of “terrorists” released, 250 of those released were convicted of serious crimes.Most of the rest of the more than 1,700 people let go, among them doctors, nurses and journalists, had been held without charge. These detainees were not involved in the Oct. 7, 2023, attacks and were held under a controversial practice called administrative detention, which allows Israel to detain people for an indefinite period of time without ever charging them. More than 20 minors were on the list.For Palestinians in Gaza and the occupied West Bank, the releases were cause for celebrations. Prisoners and detainees who returned to Gaza rode on the tops of buses through crowds of well-wishers.Families wait outside the Ramallah Cultural Palace for the Palestinian prisoners to be released on Monday.Daniele Hamamdjian / NBC NewsIn the West Bank, families waited for the released prisoners outside the Ramallah Cultural Palace in the Palestinians’ provisional capital. Some women and young girls arrived in traditional Palestinian dresses. Many refused to speak to the gathered press: Israel’s military, they said, had called them and warned them not speak to the media.The prisoners’ families said they had seen others being re-arrested in the past and didn’t want to gamble on the convicts’ hard-won freedom.“For Israel, any Palestinian is a terrorist,” said the uncle of one of the released Palestinians, who refused to give his name, “even if they didn’t do anything.”Palestinian relatives mourn at Al-Shifa Hospital in Gaza City.Khames Alrefi / Anadolu via Getty ImagesIn addition, there is the collective pain of nearly 2 million in Gaza who have endured Israel’s two-year war against Hamas. There is little hope among Palestinians that anybody will be held responsible for the tens of thousands of innocent civilians killed by Israeli fire, along with those maimed in attacks.Israel has accused Hamas of operating in civilian areas, thus necessitating attacks that endanger noncombatants. In November, the International Criminal Court issued arrest warrants for Israeli Prime Minister Benjamin Netanyahu and former Defense Minister Yoav Gallant, as well as Hamas military chief Mohammed Deif, whom Israel said it had killed, over alleged crimes against humanity and war crimes.Israel has forcefully rejected the allegations, and Netanyahu’s office branded the decision “antisemitic,” rejecting them as “absurd and false” and condemning the ICC as a “biased and discriminatory political body.”Tinged with sadnessPrime Minister Benjamin Netanyahu acknowledged many Israelis’ public pain in comments on Sunday night.“Tomorrow, our sons will return to their borders,” he said. “This is a historic event that is tinged with sadness over the release of murderers — and joy over the return of kidnapped people.”Under President Donald Trump’s 20-point plan for ending the fighting, Hamas fighters who lay down their weapons would be spared any punishment — a condition that has also raised grave reservations among many Israelis, including Netanyahu, who had hoped to see Hamas destroyed.Rachel Goldberg-Polin, an American Israeli whose son, Hersh, was kidnapped on Oct. 7 and then killed by Hamas last year, said she’s rejected the feelings of anger that come with grief.Jon Polin and Rachel Goldberg-Polin, parents of Hersh, in Jerusalem in October 2024.Dmitry Solovyov / NBC News“Nothing can bring Hersh back,” she said in an interview last week. “I tend to look at this in a very zoomed-out way. I don’t have this fiery venomous anger that I think wouldn’t serve me in any purpose.”Avni, who opposed this week’s deal, said he worries that the released convicts will simply return to the battlefield or engage in terrorism against Israelis.“Obviously, every single Jewish person wants to get the hostages back,” he said. “It doesn’t mean that strategically trading thousands of terrorists for 20 lives makes sense.”Avni has advocated executing terrorists as a way to remove prisoner exchanges from the negotiating table. Israeli law allows for capital punishment, but only for treason and “crimes against humanity.” The death sentence has been used only twice in Israeli history.In the hours after his father’s murder, Avni admits that he considered taking matters into his own hands. Both Lakin and Abu Ghanem were taken to the same ward in the same Jerusalem hospital after the attack.The scene of the Jerusalem bus attack on Oct. 13, 2015, that resulted in Richard Lakin’s death.Kobi Gideon / Getty Images fileZaka volunteers and security forces inspect the scene after the bus attack that left Lakin and two other civilians dead.Gali Tibbon / AFP via Getty Images fileThe two men were treated only yards apart. Lakin died, but his killer survived.“I think I would have jumped on him and done something but he had police standing there,” Avni said. “I remember thinking to myself, you know, you’ll go to jail for life, and you’ve got responsibilities.”Recounting the cruel irony of his father’s killing still brings tears to Avni’s eyes. His father had been a peace-loving school principal who advocated for racially integrated education, had marched with Martin Luther King Jr. and participated in the anti-segregation “Freedom Riders” movement during the 1960s.The family moved to Israel when Avni was 15 years old.“He was a big believer in coexistence. I wish everybody could be like that, but they’re not,” Avni said of his father. “It was an innocent world view.”Richard Lakin, his grandchild, and his son, Micah Avni.Family handoutMatt Bradley reported from Caesarea, and Daniele Hamamdjian from Ramallah in the occupied West Bank. Matt BradleyMatt Bradley is an international correspondent for NBC News based in Israel.Daniele Hamamdjian contributed.
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Nov. 25, 2025, 6:39 PM ESTBy Angela YangWarning: This article includes descriptions of self-harm.After a family sued OpenAI saying their teenager used ChatGPT as his “suicide coach,” the company responded on Tuesday saying it is not liable for his death, arguing that the boy misused the chatbot.The legal response, filed in California Superior Court in San Francisco, is OpenAI’s first answer to a lawsuit that sparked widespread concern over the potential mental health harms that chatbots can pose. In August, the parents of 16-year-old Adam Raine sued OpenAI and its CEO Sam Altman, accusing the company behind ChatGPT of wrongful death, design defects and failure to warn of risks associated with the chatbot.Chat logs in the lawsuit showed that GPT-4o — a version of ChatGPT known for being especially affirming and sycophantic — actively discouraged him from seeking mental health help, offered to help him write a suicide note and even advised him on his noose setup.“To the extent that any ‘cause’ can be attributed to this tragic event,” OpenAI argued in its court filing, “Plaintiffs’ alleged injuries and harm were caused or contributed to, directly and proximately, in whole or in part, by Adam Raine’s misuse, unauthorized use, unintended use, unforeseeable use, and/or improper use of ChatGPT.”Family sues OpenAI over son’s suicide03:41The company cited several rules within its terms of use that Raine appeared to have violated: Users under 18 years old are prohibited from using ChatGPT without consent from a parent or guardian. Users are also forbidden from using ChatGPT for “suicide” or “self-harm,” and from bypassing any of ChatGPT’s protective measures or safety mitigations.When Raine shared his suicidal ideations with ChatGPT, the bot did issue multiple messages containing the suicide hotline number, according to his family’s lawsuit. But his parents said their son would easily bypass the warnings by supplying seemingly harmless reasons for his queries, including by pretending he was just “building a character.”OpenAI’s new filing in the case also highlighted the “Limitation of liability” provision in its terms of use, which has users acknowledge that their use of ChatGPT is “at your sole risk and you will not rely on output as a sole source of truth or factual information.”Jay Edelson, the Raine family’s lead counsel, wrote in an email statement that OpenAI’s response is “disturbing.”“They abjectly ignore all of the damning facts we have put forward: how GPT-4o was rushed to market without full testing. That OpenAI twice changed its Model Spec to require ChatGPT to engage in self-harm discussions. That ChatGPT counseled Adam away from telling his parents about his suicidal ideation and actively helped him plan a ‘beautiful suicide.’ And OpenAI and Sam Altman have no explanation for the last hours of Adam’s life, when ChatGPT gave him a pep talk and then offered to write a suicide note,” Edelson wrote.(The Raine family’s lawsuit claimed that OpenAI’s “Model Spec,” the technical rulebook governing ChatGPT’s behavior, had commanded GPT-4o to refuse self-harm requests and provide crisis resources, but also required the bot to “assume best intentions” and refrain from asking users to clarify their intent.)Edelson added that OpenAI instead “tries to find fault in everyone else, including, amazingly, saying that Adam himself violated its terms and conditions by engaging with ChatGPT in the very way it was programmed to act.”OpenAI’s court filing argued that the harms in this case were at least partly caused by Raine’s “failure to heed warnings, obtain help, or otherwise exercise reasonable care,” as well as the “failure of others to respond to his obvious signs of distress.” It also shared that ChatGPT provided responses directing the teenager to seek help more than 100 times before his death on April 11, but that he attempted to circumvent those guardrails.“A full reading of his chat history shows that his death, while devastating, was not caused by ChatGPT,” the filing stated. “Adam stated that for several years before he ever used ChatGPT, he exhibited multiple significant risk factors for self-harm, including, among others, recurring suicidal thoughts and ideations.”Earlier this month, seven additional lawsuits were filed against OpenAI and Altman, similarly alleging negligence, wrongful death, as well as a variety of product liability and consumer protection claims. The suits accuse OpenAI of releasing GPT-4o, the same model Raine was using, without adequate attention to safety. OpenAI has not directly responded to the additional cases.In a new blog post Tuesday, OpenAI shared that the company aims to handle such litigation with “care, transparency, and respect.” It added, however, that its response to Raine’s lawsuit included “difficult facts about Adam’s mental health and life circumstances.”“The original complaint included selective portions of his chats that require more context, which we have provided in our response,” the post stated. “We have limited the amount of sensitive evidence that we’ve publicly cited in this filing, and submitted the chat transcripts themselves to the court under seal.”The post further highlighted OpenAI’s continued attempts to add more safeguards in the months following Raine’s death, including recently introduced parental control tools and an expert council to advise the company on guardrails and model behaviors.The company’s court filing also defended its rollout of GPT-4o, stating that the model passed thorough mental health testing before release.OpenAI additionally argued that the Raine family’s claims are barred by Section 230 of the Communications Decency Act, a statute that has largely shielded tech platforms from suits that aim to hold them responsible for the content found on their platforms.But Section 230’s application to AI platforms remains uncertain, and attorneys have recently made inroads with creative legal tactics in consumer cases targeting tech companies.If you or someone you know is in crisis, call or text 988 to reach the Suicide and Crisis Lifeline or chat live at 988lifeline.org. You can also visit SpeakingOfSuicide.com/resources for additional support.Angela YangAngela Yang is a culture and trends reporter for NBC News.
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