The epinephrine cost crisis never ended. Policymakers are finally doing something about it.
EpiPens are once again becoming a target for policymakers looking to solve one of American health care’s most egregious cost crises.
Several years ago, exponential price increases that were making it difficult for patients to afford the lifesaving medication drew widespread attention and intense public outrage. The company that makes EpiPens, Mylan, paid a nine-figure fraud settlement with the federal government and introduced a moderately cheaper version of the drug. This didn’t entirely solve the medication’s affordability problem — some patients are still paying in excess of $600 a year for epinephrine — but it did mean the cost of EpiPens stopped getting so much attention.
But that is starting to change. Lawmakers in Colorado are advancing legislation that would cap patients’ out-of-pocket costs for epinephrine, potentially saving families hundreds of dollars every year. Similar proposals in other states are starting to gain traction. Ultimately, experts say, Congress may need to impose a cap on how much patients pay for epinephrine — mimicking the step they took with insulin last year for people on Medicare.
As with insulin, which has recently seen dramatic price cuts recently after a prolonged advocacy campaign, a near-monopoly by Big Pharma led to EpiPen prices skyrocketing. Mylan hiked the price of a two-pack of EpiPens sixfold, from about $100 to $600, in a decade. Out-of-pocket spending doubled, as patients with serious allergies were forced to pay up in order to get access to a medicine that could save their life in an emergency.
In the past few years, new products, including a non-branded version of EpiPen sold by Mylan, entered the market. The hope was that the increased competition would bring prices down.
But in reality, the effect was more muted. Some patients still must pay hundreds of dollars every year for their epinephrine.
There are two problems keeping the price of EpiPen and its peers high. First, it’s a combination of a drug (epinephrine) and the device that delivers the drug. This drug-device combination is governed by a complex web of regulations that prevented the significant price drops you would expect when new competitors are introduced. And second, across the US health system, more of the cost of medical care is being passed on to patients, via high-deductible health plans and other benefit design changes, which means that many people are still exposed to high costs even if the topline price for epinephrine has started to come down.
The renewed focus on EpiPens comes during a time when insulin, another high-profile drug, has received more attention from policymakers. Last year, Congress imposed a $35 monthly cap for Medicare beneficiaries and mandated steep discounts for Medicaid. In response, and with the looming threat of more ambitious action by states, all three of the major US insulin manufacturers have slashed prices for some of their products in the past month.
“We’ve just shown that we can do this for insulin,” said Kao-Ping Chua, a University of Michigan health policy researcher who has studied epinephrine’s costs. “We can improve the affordability of lifesaving drugs.”
Now he and others are hoping that, rather than rest after the recent successes with insulin, policymakers will turn their attention to epinephrine next.
Why are EpiPens so expensive, anyway?
Epinephrine is a naturally occurring hormone in people’s bodies, where it is more commonly referred to by another name: adrenaline. In that function, it is vital to the fight-or-flight response, increasing blood flow to the muscles and kicking a person’s heart into a higher gear.
But since 1901, when it was first isolated by Japanese chemist Jōkichi Takamine and soon after put to use medically, it has also become an important medication primarily (but not exclusively) for people experiencing anaphylaxis — an extreme, and sometimes fatal, allergic reaction that restricts the ability to breathe.
More than 1 million Americans have an epinephrine prescription. It’s not a medicine that they take regularly, like insulin. It is used in emergencies, where it can be the difference between death and survival.
The version of epinephrine most people are familiar with is the EpiPen, an autoinjector most people can use with minimal training that delivers a precise dose. The EpiPen came onto the market in 1983, and, by the mid-2000s, it was still the dominant epinephrine product, with a 90 percent market share and $200 million in annual revenue.
In 2007, Mylan Pharmaceuticals received the rights to produce and sell EpiPens from its previous manufacturer, Merck, which had obtained the rights to produce and sell the drug through a series of mergers and acquisitions since its introduction. Mylan quickly refreshed the product: While the medicine and basic mechanisms were the same, the company made tweaks to the device that allowed it to obtain new patents that would extend its monopoly and stave off production of any generic versions of the EpiPen. The company also entered exclusive contracts with larger entities, like school districts, to protect its market share.
Over the following decade, Mylan also jacked up the list price of a two-pack of EpiPens from $94 to $609 — and, as a result, patients who depended on this medicine in a life-or-death emergency increasingly found it more and more difficult to afford, even as the product itself remained largely unchanged.
According to a 2017 analysis published by Chua and Rena Conti, average out-of-pocket spending on EpiPens more than doubled from 2007 to 2014. The average was up to $75 per year, but that is just an average. Some people were paying less, depending on their health insurance, but other people were paying much more: The percentage of people with an EpiPen prescription who were paying $100 out of pocket annually increased from 4 percent in 2007 to 18 percent in 2014; the percentage of patients with out-of-pocket costs above $250 rose from almost nobody (0.1 percent) to 7.4 percent.
In outlier cases, such as families with multiple children who need an EpiPen prescription, a household could end up spending more than $1,000 annually just to make sure they had enough doses of the drug on hand, Chua told me. More recent research has shown that an out-of-pocket charge of as little as $10 can discourage patients from filling prescriptions.
Stories of the drug being unaffordable for patients began to gain traction in the news around 2016, and Mylan faced significant scrutiny from public officials, including a fraud investigation that ultimately led to a $465 million settlement over improper Medicaid billing in 2017.
The company sought to soften the backlash by introducing an unbranded version of the EpiPen in 2016, the first significant competition to the brand-name EpiPen in years, priced at $300 for a two-pack. Mylan’s patents have also started to expire, and more competitors came to the market in the following years, usually with list prices between $200 and $400.
Over time, the egregious cost of EpiPens faded from the headlines.
The 2 big reasons EpiPens can still be so expensive
But the cost crisis never really left.
The introduction of lower-priced competitors seemed to promise that the epinephrine affordability crisis would ease, and for some patients, prices have dropped modestly. But thousands of families are still struggling to afford this essential medication today.
Chua and Conti updated their research last year, reviewing out-of-pocket spending on EpiPens and their peers from 2014 to 2019. They did find that, in the aggregate, average annual spending dropped from about $115 annually to $75. But there was still a sizable portion of the patient population, about 8 percent of users, who were paying more than $200 per year for their medicine. Most of those patients, about 63 percent, were children, and those families paid an average of $657 annually for their epinephrine.
Digging deeper into the data, two things stuck out to Chua. One, most of the people with high out-of-pocket costs were using non-branded alternatives to the brand-name EpiPen, meaning this was not simply a problem of patients and doctors sticking with a more expensive but well-known legacy product. And two, most of these patients were enrolled in a high-deductible health insurance plan.
Both of those findings reveal why the epinephrine cost crisis persists for some patients, years after the initial outrage.
The first problem — high prices even for generic versions of the drug — is a bit of a surprise, given that competition is the primary mechanism by which the US health system reduces prescription drug prices. In more conventional markets, the introduction of generic competition usually leads to prices dropping by 75 percent of more. But that hasn’t happened with epinephrine.
“The prices of these competing products, it’s lower, but it’s not low,” Chua said. “It appears to be a 50 percent discount. It’s relatively less, but in an absolute sense, it’s still high.”
The problem is that EpiPens and their peers are not simply drugs, but drug-device combinations. The FDA regulates those products differently than other medications.
With a more conventional drug, it is fairly simple for a generic version of a drug to be approved as fully substitutable for the brand-name version. The generic company needs to show its product is similar to the original in its chemistry and, once that happens, doctors can prescribe the generic the same as they would the brand-name drug, or pharmacists are permitted to substitute the cheaper generic for the more expensive brand-name drug when the patient fills their prescription at the drug store.
But that is not the case with drug-device combinations, Conti said. The bar is higher.
“Basically, both the drug and the device have to be proven as equivalent, and it’s much harder to do this with a device,” she said. “Devices have patents, trade secrets, and simple sourcing features that make it very difficult to copy exactly. This, in turn, affects drug delivery in ways that may be difficult to predict.”
That makes it more difficult for a new competitor to gobble up Mylan’s market share by offering a cheap alternative. Instead, after Mylan itself began offering the $300 unbranded version of its EpiPen, competitors that have entered the market have usually set their prices in roughly the same range and tried to peel off customers with more targeted sales pitches, such as smaller injectors that are easier for kids to carry around with them. Prices are not at the forefront.
“This is not what we normally see when you have fully substitutable generics coming into the market,” Chua said. “There’s usually a much greater decrease in price and therefore out-of-pocket spending.”
The stubbornly high list prices of epinephrine flow into the second problem: Patients are shouldering more of the cost of their health care. Most of the patients paying more than $200 per year in Chua and Conti’s research were enrolled in high-deductible health plans.
According to the Kaiser Family Foundation, the percentage of Americans enrolled in employer-sponsored insurance (which covers more than half of the US population) with an annual deductible of $2,000 or more has increased from 7 percent in 2009 to 32 percent in 2022.
People who purchase insurance individually through the Affordable Care Act’s marketplaces can also have deductibles in excess of $2,000 if they do not qualify for certain federal assistance (though most of the customers on those marketplaces do get a discount on out-of-pocket costs).
“Fundamentally, I view this as a problem of insurance benefit design,” Chua said. “We as a society have decided it’s okay for insurance plans to utilize deductibles and coinsurance in this blunt way that treats epinephrine in the same way as an ineffective drug.”
That is the problem policymakers have homed in on with new proposals aimed at making epinephrine more affordable.
How policymakers are trying to make epinephrine more affordable
Fresh off the recent progress in making insulin more affordable, state lawmakers have turned their attention back to EpiPens.
The Colorado House, which had already passed an out-of-pocket cap for insulin in 2021 that became law, approved a similar measure late last month capping out-of-pocket costs for epinephrine at $60 per year. It is now under consideration in the state Senate.
A similar measure introduced in the Rhode Island legislature would require insurers to cover the drug at no cost to the patient. Other bills under consideration in Delaware, Missouri, and Vermont would require insurers to cover epinephrine, which is not currently mandatory, though most health plans do.
Chua said that an out-of-pocket cap would be an effective tool for making epinephrine more affordable. While health insurers may argue, with some justification, that this lets drugmakers like Mylan off the hook, the reality is that setting rules for insurance benefits would be simpler than overhauling how the FDA regulates prescription drugs and devices such as EpiPens.
And because most people only fill an EpiPen prescription once a year, even a $100 annual cap can make a big difference when people are currently paying hundreds of dollars for the drug every year.
But state action can only do so much, because self-insured employer plans — the large employer plans that cover most people with commercial insurance — are not subject to state regulations. They are instead regulated by the federal government. That means Congress would need to act to ensure epinephrine is affordable for all Americans, not just those in certain states with a certain type of insurance.
Congress did secure major wins on drug prices last year, including the introduction of a $35 monthly cap on insulin for Medicare beneficiaries. Chua said a permanent solution could be fairly simple, a variation of the Insulin for All Act that Sen. Bernie Sanders has introduced that would cap insulin costs for all patients, not just those on Medicare.
Patient advocates are trying to maintain momentum after the recent action on insulin, fearing that otherwise, the issue may once again recede to the background, as it did after the initial outrage against Mylan a few years ago.
“I would hope for federal action on this,” Chua said. “This piecemeal approach is not going to affect everybody in the country.”
Trump has already been indicted once. More indictments could be coming.
In retrospect, it’s perhaps unsurprising that Donald Trump, the many-times bankrupt former president and game show host who confessed on video to sexual assault, would be indicted for the most absurd crime imaginable: allegedly falsifying business records to cover up the hush money payments he paid to a porn star, which was itself intended to cover up an extramarital affair Trump allegedly had shortly after his third wife gave birth to his son Barron.
Nor is Manhattan District Attorney Alvin Bragg’s investigation into Trump, which led to this indictment, the only such investigation that could lead to criminal charges against the former president. There are three other known investigations into Trump.
Two are federal; a federal special prosecutor, Jack Smith, took over both last November.
The first federal probe involves an FBI search of Mar-a-Lago, Trump’s Florida compound, which revealed that the former president kept classified documents — including, according to the Washington Post, ones “relating to nuclear weapons.”
There are also some outward signs that this federal investigation into Trump is gaining steam. In a dramatic development last month, one of Trump’s own lawyers, Evan Corcoran, testified before a grand jury about his conversations with Trump.
The second probe, meanwhile, involves what Attorney General Merrick Garland described as “the investigation into whether any person or entity unlawfully interfered with the transfer of power following the 2020 presidential election, or with the certification of the Electoral College vote held on or about January 6, 2021.”
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Win McNamee/Getty Images
And then there’s a fourth criminal probe, in Georgia, investigating whether Trump illegally tried to change the result of the 2020 election. Criminal charges against Trump could potentially arise out of a post-election call with Georgia’s Republican Secretary of State Brad Raffensperger, in which Trump told the state’s top election official that he wanted “to find 11,780 votes.” (Biden defeated Trump in Georgia by 11,779 votes.)
We do not yet know if any of these investigations will end in Trump being convicted of a crime. In all but one of them, we don’t even know if Trump will be formally charged with violating a criminal statute. And, in the one investigation where Trump has been charged — Bragg’s New York-based investigation — there is some legal uncertainty about whether the felony statute Trump was indicted under actually reaches Trump’s alleged actions.
When all of these investigations are complete and all of the potential charges against Trump are resolved, in other words, it is still possible that he will never be convicted of a crime.
Nevertheless, Trump is already the first former US president ever to be indicted. And many of the key facts that could lead to other indictments, including the fact that he kept classified documents at Mar-a-Lago and the fact that he tried repeatedly to overturn Biden’s victory in the 2020 election, are not reasonably in doubt.
The New York indictment of Donald Trump
The Manhattan DA has been investigating financial fraud at the Trump Organization for several years. Bragg’s office has already secured a couple of convictions against Trump’s primary business and one of his close business associates.
Last August, former Trump Organization CFO Allen Weisselberg pleaded guilty to allegations that he did not pay taxes on $1.7 million in compensation — including an apartment, two cars, and private school tuition for family members. He also agreed to testify against the Trump Organization, and this allowed prosecutors to convict the Trump Organization of 17 counts of tax fraud and related financial crimes arising from the payments to Weisselberg.
But Weisselberg did not agree to testify against Trump, and the actual charges against the former president arise out of a separate set of shady transactions: Trump’s alleged $130,000 in payments to adult film actress Stormy Daniels, which were made to cover up an alleged sexual encounter between Trump and Daniels in 2006 (Trump denies that he had sex with Daniels).
Notably, Trump’s former lawyer and fixer Michael Cohen pleaded guilty to federal campaign finance crimes arising out of these hush money payments to Daniels in 2018.
The specific criminal charges against Trump are not yet known, but he’s reportedly been charged with more than 30 counts of business fraud. New York law typically does not make it a crime to pay a former sexual partner to remain silent about an affair. But it is a crime to falsify business records in New York “with the intent to defraud.”
So, if Bragg can prove that Trump mischaracterized his payments to Daniels in the Trump Organization’s own documents in order to cover up those payments, that could potentially allow Trump to be convicted.
There is, however, a catch. Ordinarily, falsifying business records is only a misdemeanor under New York law — meaning that it is a minor crime that is only punishable by up to a year in prison — and that matters because the statute of limitations for misdemeanors is only two years in New York State. So, if Trump is only charged with a misdemeanor, Bragg would have to prove that Trump tried to cover up the payments to Daniels within the last two years — which is unlikely because those payments have been public since at least 2018.
That said, it is possible to charge a defendant accused of falsifying business records with a felony, and the statute of limitations for this more serious felony is five years. To charge Trump with a felony, however, Bragg also has to prove that Trump falsified business records with the “intent to commit another crime or to aid or conceal the commission thereof.”
One possibility is that Bragg could try to link Trump to the federal campaign finance crime Cohen pled guilty to in 2018. But it is far from clear that New York state prosecutors may charge Trump with a felony because he tried to cover up a federal, as opposed to a state, crime.
As Mark Pomerantz, a former prosecutor in the Manhattan DA’s office, wrote in a recent book, the felony statute is “ambiguous” — though it refers to “another crime,” it does not say whether this crime may be a federal criminal act or only an act that violates New York’s criminal law. Worse, Pomerantz writes, “no appellate court in New York has ever upheld (or rejected) this interpretation of the law.”
Alternatively, Bragg could attempt to link Trump to a second violation of New York’s criminal law, but it’s unclear what that second violation might be.
The state of the investigation into Trump’s attempt to steal the 2020 election
The Justice Department’s larger investigation into the January 6 attacks has been going on since they happened, focusing first on the people who stormed the Capitol. Initially, there wasn’t a consensus in the political world about whether Trump had committed crimes with his web of lies about the election. So an investigation into him does not appear to have begun immediately.
We now know that a team of prosecutors began more intensely scrutinizing Trump and his associates in the fall of 2021. About a year ago, this team was “given the green light by the Justice Department to take a case all the way up to Trump, if the evidence leads them there,” according to a recent CNN article.
The probe proceeded quietly at first. In January 2022, the Washington Post reported that “so far the department does not appear to be directly investigating” Trump. But just a week and a half after that article, Deputy Attorney General Lisa Monaco confirmed an investigation into one aspect of Trump’s scheme: fake electors. This was Trump allies’ effort to name Trump supporters as electors in key swing states Biden won, and to have their purported electoral votes submitted to Congress and Vice President Mike Pence and effectively dispute the actual electors’ votes.
“Our prosecutors are looking at those, and I can’t say anything more on ongoing investigations,” Monaco said.
By May, the investigation had subpoenaed many close Trump aides for documents and was asking specifically for info about lawyers who had tried to help him overturn the election. In June, the home of Jeffrey Clark — the official Trump tried to put in charge of the DOJ so he could enlist the Department in declaring the election results fraudulent — was searched by federal agents. The DOJ’s inspector general, Michael Horowitz, is involved in the investigation of Clark since he was a DOJ employee at the time. Rep. Scott Perry (R-PA), who put Trump in touch with Clark, is also a key subject of this investigation.
By late July, the Washington Post reported prosecutors were asking “hours of detailed questions” about Trump’s actions specifically, on topics such as the extent of his involvement with the fake elector push and his effort to pressure Pence to throw out state electoral votes. Then, in September, investigators issued at least 40 subpoenas in a week, this time focusing more on Trump’s political and fundraising operations. More recently, new subpoenas have gone out to state officials Trump tried to pressure.
A growing number of Trump aides have gone in to testify before one of several active Washington, DC, grand juries in recent months. The former president filed a secret suit to try and block testimony of aides like former White House counsel’s office lawyers Pat Cipollone and Pat Philbin, citing privilege concerns, but he lost that suit, and they testified in December.
The new battles are over whether former White House aides like Mark Meadows — and Vice President Mike Pence — will have to testify, or whether they can cite executive privilege. District judges have already rejected their privilege claims, but they may appeal.
Yet though the election investigation certainly seems quite sprawling and serious, we still lack visibility into a few important questions.
First, how strong is the evidence against Trump personally? Have they “flipped” members of his inner circle who can testify that he knowingly committed corrupt activity — or not? Will he be able to get out of charges by claiming (some of) his lawyers advised him everything he was doing was legally permissible?
Second, what is the DOJ thinking about the legal issues at the heart of the case? The House January 6 committee argued that Trump broke four laws in his attempt to stay in power: obstruction of an official proceeding, conspiracy to defraud the United States, conspiracy to make a false statement, and assisting an insurrection. And a federal judge, David Carter, already ruled last year that evidence suggests Trump committed some of these crimes.
Still, though DOJ investigators are clearly taking their investigation very seriously, we don’t know whether they agree with Judge Carter’s analysis of the law or whether they are even entirely sure what they think about it yet. One of Trump’s arguments in defense will likely be that he was engaging in politicking and political speech, not plotting a criminal conspiracy. If he is indicted, that argument would surely reach the Supreme Court at some point.
This is all fairly novel territory and it’s hard to point to a case quite like it. The topic is enormously important, but because Trump’s actions were so unprecedented, there’s much less of a roadmap on what the special counsel’s path forward should be.
The state of the classified documents investigation
The classified documents case before the special counsel seems simpler from both a legal and evidentiary perspective than the election case, but it has its own potential problems.
When the FBI went to Mar-a-Lago in search of classified documents in August 2022, the political world was rife with speculation about what could have justified such an extraordinary action and what Trump might have been up to. Was he selling classified material to the highest bidder? Was he trying to blackmail the deep state? These theories were never backed by evidence, but a Washington Post report that agents were looking for “nuclear documents” suggested this was monumental stuff indeed.
Yet subsequent reports suggested that DOJ prosecutors and FBI agents working on it were not always in full agreement about the strength of the case. According to a Washington Post report in December, the FBI initially wasn’t sure it wanted to take up the case at all. The National Archives had asked them to get involved because they had found classified material in boxes belatedly returned to them by Trump, and they thought more material was missing. Even after Trump appeared to defy a grand jury subpoena to return documents, some FBI agents working on the case “weren’t certain” they had enough probable cause for a search, per the Post.
The search took place in August, and prosecutors claim to have found dozens of classified documents, but exactly what they found remains mysterious. The Post reported some documents had “highly sensitive intelligence regarding Iran and China,” including a description of Iran’s missile programs. The government has expressed concern that the information could jeopardize human intelligence sources. But it is difficult to evaluate those claims because, well, the information is classified.
Meanwhile, the DOJ-FBI divide reportedly persisted. Bloomberg News reported in October that though some DOJ prosecutors thought there was enough evidence to charge Trump with obstruction of justice because he defied the subpoena, some “internal critics,” including in the FBI, are questioning why Trump would be charged when Hillary Clinton wasn’t in her own classified information investigation. (Clinton had some classified information in email chains sent to her personal email account that she had used for work; Trump had paper documents in boxes at Mar-a-Lago.)
Furthermore, yet another Washington Post story suggests that the more ominous and speculative theories about Trump’s motives in keeping classified documents weren’t founded, in investigators’ eyes. They’ve come to believe, instead, that his motive was “largely his ego and a desire to hold on to the materials as trophies or mementos.” That would not get him off the hook for violating classified information law, but it’s certainly less of a clear-cut threat to national security than, say, the attempted selling of documents would be.
Yet Trump is also potentially vulnerable to charges of obstruction and making false statements to the government.
That’s where his attorney, Corcoran, comes in. Corcoran told the government, in June 2022, that Trump had turned over all the classified documents at Mar-a-Lago. But the FBI search two months later revealed that was not true. Investigators reportedly believe that Trump lied to Corcoran, and that’s why they were so interested in getting Corcoran’s testimony.
Special counsel Smith may view these as the most straightforward charges against Trump. And though any charging recommendation Smith makes will go up to Attorney General Merrick Garland for approval, his opinion will carry great weight in determining whether Trump ends up indicted on these fronts this year.
The Georgia investigation into Trump’s attempts to overthrow the 2020 election
In early January 2022, Fulton County District Attorney Fani Willis’s office asked a Georgia court to convene a special grand jury “for the purpose of investigating the facts and circumstances relating directly or indirectly to possible attempts to disrupt the lawful administration of the 2020 elections in the State of Georgia.”
This investigation includes both Trump’s “find 11,780 votes” phone call and the Trump campaign’s attempt to create a slate of fake members of the Electoral College who would fraudulently tell Congress that the state’s electoral votes were cast for Trump.
The special grand jury, whose investigation is now complete, heard testimony from several very high-profile Trump allies, including former New York Mayor Rudy Giuliani and US Sen. Lindsey Graham (R-SC).
While Willis has yet to file charges against Trump or any members of his inner circle, and while the full grand jury report remains sealed, the forewoman of this special grand jury told the New York Times that the report recommends multiple indictments.
The forewoman also said that “it’s not a short list.”
It remains to be seen whether Willis files any charges against Trump. For the moment, Trump’s lawyers are trying to convince an Atlanta court to suppress the grand jury report and to disqualify Willis from the case. But there are a few Georgia criminal statutes that could potentially reach Trump’s conduct after the 2020 election.
Georgia laws make it a crime to willfully tamper with certain aspects of an election, to solicit another person to do so, or to engage in “criminal solicitation to commit election fraud.”
So what should we take away from all of this?
The purpose of a criminal investigation, and ultimately of a prosecution, is to convince a jury to convict a defendant after a full criminal trial has taken place. It is not to provide the media or the public with regular updates about what law enforcement knows about potential suspects.
Especially within the context of federal investigations, these norms exist to protect the investigation — if a suspect learns too much about what information law enforcement is seeking, they could destroy evidence or tamper with witnesses — and to protect potential suspects. When someone is formally charged with a crime, they have an opportunity to vindicate themselves at trial. If they are merely the subject of accusations tossed off by government officials, they have no real way to protect or rehabilitate their reputations.
For these reasons, anyone eager to see how the other investigations into Trump will end must have patience.
Even now that Trump is indicted in Bragg’s investigation, and even if a federal indictment does happen, this will not be the end of the story — far from it. A trial or trials would follow, as would many legal challenges from Trump’s team (some perhaps before sympathetic judges). Trump likely can’t be stopped from continuing his 2024 presidential run except by voters, but despite talk of his recent political woes, he continues to lead almost every poll of a multi-candidate GOP field.
There could be many more twists and turns ahead.
Elon Musk wants to fill your Twitter feed with paid accounts being watched over by a crypto meme.
When Elon Musk took over Twitter, he said he wanted to protect its place as a “digital town square,” where ideas from all corners of the internet could flourish. But soon, if you want your voice to really be heard in the town square, you’ll need to pay.
Musk tweeted that, starting April 15, Twitter will only recommend content from paid accounts in the For You feed, the first screen users see when they open the app. It’s just one of several seemingly random changes Musk has been making to Twitter’s core user experience without explanation. He changed the Twitter homepage’s icon from its classic blue bird logo to “doge” — the cartoonish Shiba Inu dog meme linked to the cryptocurrency dogecoin — and for some users, the app started seemingly inserting tweets from accounts people didn’t follow into the their Following feed.
We don’t know exactly why the doge logo suddenly appeared at the top of the homepage, but there is one relevant piece of news people are pointing to: Elon Musk is currently facing a $258 billion lawsuit alleging that he ran a pyramid scheme to support dogecoin. Musk’s legal team asked a court to dismiss the dogecoin suit a few days before doge appeared on Twitter’s site.
As promised pic.twitter.com/Jc1TnAqxAV
— Elon Musk (@elonmusk) April 3, 2023