THE PROGNOSIS,

According to President Trump, drug companies should today be voluntarily announcing massive reductions in the price of their medicines. 

The president announced his blueprint for addressing rising drug costs in early May and then on May 30 declared that within two weeks companies would willingly drop prices. That would be today. 

Cutting the nation's rising drug costs is a bipartisan goal, and for a time Democrats shared President Trump's campaign vision for cracking down on pharmaceutical companies and giving the government more power to negotiate deals. But Trump has walked back some of those positions, and at a Senate hearing Tuesday morning, the Democrats on the panel let Health and Human Services Secretary Alex Azar know they were not impressed with the White House plan. 

"The only health care price [Trump] has dropped is his former secretary," said Sen. Patty Murray (D-Wash.), during her opening statement, referring to former HHS secretary Tom Price who resigned after it was revealed he traveled on pricey private jets instead of commercial airplanes.

The high cost of prescription drugs is a thorny issue because of the unusually decentralized nature of U.S. health-care system, with many causes and culprits. It's also an issue that Democrats -- and some Republicans -- believe has political resonance leading up to the 2018 midterms, and Democratic lawmakers previewed what they think could be potent lines of attack in their questioning of Azar on Capitol Hill yesterday. That's also true for the issue of whether those with preexisting health conditions can be denied insurance or charged more for it after the Trump administration has now said it won't defend the Affordable Care Act court (more on that below).

 

Some of the toughest criticism came from Sen. Elizabeth Warren (D-Mass.), who wanted to know which companies were lowering prices this week as the president said they would. 

The secretary, testifying before the Senate Health, Education, Labor and Pensions Committee, said that several drug manufacturers wanted to lower prices, but were facing challenges. Azar said those companies feared pharmacy benefit managers would discriminate against them by dropping them from the lists of medicines covered by an insurer.

As our colleague Amy Goldstein reported, Azar’s remarks were consistent with the administration’s portrayal of “middle men,” not the pharmaceutical industry itself, as the root of the nation’s high drug prices. He reiterated that direct government negotiation of drug prices in the vast Medicare program — a longtime Democratic goal that Trump embraced during his campaign — would be ineffective.

Warren cut off Azar several times to clarify that no companies were near cutting prices as the president had said. 

"Mr. Secretary, you said you wanted to get tough on drug companies," she said. "But under your approach, it seems that the drug companies can just keep charging people more and more. The only thing you've done is set it up so maybe if a drug company reduces a price, you can give them a cheap P.R. moment and then let them jack up prices later."

Warren also challenged Azar on the administration's plan to move drugs administered through Medicare Part B to the supplemental Medicare Part D, where pharmacy benefit managers negotiate prices with drugmakers. She wanted assurance that no one on Medicare would end up paying higher prices as a result of the change. Azar responded that protecting Medicare beneficiaries was the primary concern, but did not give Warren the definitive answer she sought. 

"You cannot guarantee that there will not be Medicare beneficiaries who will be paying more," Warren insisted. 

Other Democrats piled on:

  • Sen. Tim Kaine (D-Va.) called it "ridiculous" that President Trump and Azar blame other countries that do have the power to negotiate lower drug prices for the high prices here. He said the U.S. government should be able to approach drugmakers and say it wants the same rates they give to other countries. Kaine said the U.S. government should at least set up a pilot program and try negotiating best prices on a few high-priced drugs. 
     
  • Sen. Tina Smith (D-Minn.) wanted to know why drug companies' stocks went up after Trump announced his proposal. She suggested it was difficult to believe that Azar, who headed Lilly USA, the largest affiliate of pharmaceutical giant Eli Lilly, before being tapped to run HHS, was in good faith pushing for a bill to lower prices.
  • Sen. Bernie Sanders (I-Vt.) asked Azar why Trump went back on his word about allowing FDA-approved drugs to be imported from other countries, specifically Canada. Azar said the president hasn't changed his mind but there needed to be a way to ensure such a practice was done safely. Sanders replied, "I always have a hard time understanding that we can "safely" -- quote, unquote -- import fish, poultry from all over the world, and, somehow, from a highly developed country on our border, we cannot figure out a way to bring those products back into this country."

Azar also parried lots of questions on an issue near-and-dear to Democrats' hearts, and another promise Trump made on the campaign trail: not to roll back the requirement that insurance companies cover those customers who have preexisting conditions. Azar said that he personally supports affordable health care for those with preexisting conditions -- one of the most popular planks of the ACA -- but didn't weigh in on a Trump administration decision not to defend the ACA in court against a lawsuit from states who argue the whole law is invalid because the individual mandate was eliminated as part of last year's GOP tax overhaul.

"Calling it 'a constitutional position . . . not a policy position,' Azar sidestepped grilling on whether he agreed with a legal brief filed last week by Justice Department attorneys stating they would not defend the Affordable Care Act in a federal lawsuit by Texas and 19 other Republican-led states," Amy reports. 

Sen. Maggie Hassan (D-N.H.) called the administration's position a "sick joke," and pointedly queried: “'Will you encourage the Trump administration to change its position?' Hassan challenged Azar, a lawyer and former HHS general counsel. He replied that 'we do believe in finding solutions on the matter of preexisting conditions and the matter of affordability, regardless of the litigation.'

Correction: An earlier version said Trump introduced his drug prices blueprint on May 30. It was first unveiled on May 11. An earlier version said Azar had run Eli Lilly. He ran affiliate Lilly USA.

 

POST PROGRAMMING ALERT: Today, The Post will host some of the country’s leading mental-health experts and policymakers for a live discussion of strategies to address the most pressing mental-health challenges, including the increasing rate of suicide, combating the stigma associated with mental illness and improving access to care for at-risk populations. Speakers include Sens. Brian Schatz (D-Hawaii) and Thom Tillis (R-N.C.) (to be interviewed by your Health 202 author Paige Winfield Cunningham), National Alliance on Mental Illness chief executive Mary Giliberti, National Institute of Mental Health Director Joshua A. Gordon, and New York City first lady Chirlane McCray. Watch the event streamed live here.

AHH, OOF and OUCH

AHH: An assault over tree limbs? Court documents reveal new details on the bizarre dispute between Sen. Rand Paul (R-Ky.) and the man who allegedly assaulted him at his Kentucky home in November. Paul’s neighbor, Rene Boucher, was unhappy with a pile of tree limbs that Paul stacked near the line separating their properties, finding it “unsightly," Roll Call reports. Boucher could see the pile from his back patio, though it was not on his property.

In October, Boucher had the branches taken away in portable dumpsters, but when more appeared, he burned the woodpiles. Paul then made another branch pile where the previous ones were, per the report. But Paul’s Deputy Chief of Staff Sergio Gor called the debris allegations a “false narrative.”

Prosecutors are asking for 21 months in prison for Boucher, whose attorney is asking the federal judge to grant probation. Boucher is expected to be sentenced on Friday.

OOF: Massachusetts has joined a growing list of states and local governments suing Purdue Pharma, the maker of opioid painkiller OxyContin. Massachusetts is the first state to personally name the company’s executives in the suit, the Associated Press’s Allanna Durkin Richer reports. The complaint specifies 16 current and former executives and board members, including members of the Sackler family who own the company, and chief executive Craig Landau.

“The lawsuit alleges Purdue deceived patients and doctors about the risks of opioids, pushed prescribers to keep patients on the drugs longer and aggressively targeted vulnerable populations, like the elderly and veterans,” Allanna reports.

Purdue denies the allegations. “We share the attorney general’s concern about the opioid crisis,” the drugmaker said in a statement. “We are disappointed, however, that in the midst of good faith negotiations with many states, the Commonwealth has decided to pursue a costly and protracted litigation process. We will continue to work collaboratively with the states toward bringing meaningful solutions.”

OUCH: More than a third of American adults are taking medications that carry a risk of depression, including prescription drugs, hormones for contraception, blood pressure medications and heartburn medication, according to a new study published in the Journal of the American Medical Association. The study found 37 percent of adults in the United States take medicines linked to depression -- and people who take multiple drugs linked with depression are also more likely to be depressed, our colleague Carolyn Y. John reports. It was unclear, however, if this was a result of the medications, or if the people had a medical history of depression prior to taking the drugs.

“The work is part of a provocative and growing body of research that documents how polypharmacy — the use of multiple prescription drugs at the same time — has risen in the United States," Carolyn writes. "The number of Americans taking at least five prescription drugs at the same time rose sharply between 1999 and 2012, and the elderly are particularly at risk for dangerous interactions between drugs."

While polypharmacy is growing, it's not always promoting good health and longevity in patients, said study author Dima Qato. “As a pharmacist, when a patient comes in and reports depressive symptoms, I just think it's really important to think about what other medications they are on.”

AGENCY ALERT

— The National Institutes of Health unveiled an outline yesterday on how it plans to spend $500 million from Congress to address the opioid crisis. The plan includes developing new medications to treat addiction, making current treatments more effective, improving overdose-reversing medications and developing new nonaddictive pain drugs and treatments, according to an article published in the Journal of the American Medical Association.

NIH Director Francis Collins and other NIH officials wrote that the effort will be part of the agency's Helping to End Addiction Long-term initiative (HEAL). “Like most other pioneering scientific initiatives, HEAL will focus on a range of objectives, from short-term goals to research priorities that will take longer to bear fruit,” they wrote. “Yet, all will be aimed at the same ultimate vision: a nation of people with far less disabling pain and opioid addiction.”

— A senior career Justice Department official has resigned in the wake of the Trump administration’s refusal last week to defend the ACA in a lawsuit from 20 Republican-led states challenging its requirement to have health insurance, The Post's Devlin Barrett and Matt Zapotosky report. Joel McElvain, who has worked at the Justice Department for more than 20 years, submitted his resignation letter Friday, the morning after Attorney General Jeff Sessions notified Congress the agency would not defend the ACA.

McElvain's departure highlights internal frustration generated by the decision. "The Justice Department’s decision last week reversed years of legal work McElvain and the Justice Department had performed on the issue," Devlin and Matt write. "McElvain and his team were honored in 2013 with the Attorney General’s Award for exceptional service defending the legislation in court. A Justice Department spokeswoman confirmed his resignation takes effect in early July. McElvain declined to comment."

Those who know McElvain described him as an expert lawyer and a well-liked boss. “This is the first I’m hearing it, and it’s a gut punch,” said one person who worked with McElvain for years. “That will be a very big blow to the morale of the [agency’s] civil division, a really sad day for the Department of Justice and a loss for the country.”

HEALTH ON THE HILL

— Yesterday, some prominent Capitol Hill Republicans expressed support for preserving the ACA's insurance protections for people with preexisting health conditions, something that could become a casualty of the Trump administration's request last week for a court to reconsider all of Obamacare now that the mandate is going away (we explained this in Tuesday's Health 202). 

“Everybody I know in the Senate — everybody — is in favor of maintaining coverage for preexisting conditions,” Senate Majority Leader Mitch McConnell (R-Ky.) told reporters. “There is no difference in opinion about that whatsoever.”

Sen. Lamar Alexander, chairman of the HELP committee that grilled Azar on the issue yesterday, called the DOJ's argument in the Texas case "as far-fetched as any I've ever heard." "Congress specifically repealed the individual mandate penalty, but I didn’t hear a single senator say that they also thought they were repealing protections for people with preexisting conditions," Alexander said in a statement.

— The House is pushing forward with its opioids' effort, scheduling 39 bills for votes this week and dozens more for consideration next week. Most of the measures are modest and bipartisan, like one allowing the government to repay up to $250,000 in student loans for some drug-treatment workers who agree to serve in places especially hard-hit by the opioid epidemic or another directing providers to more prominently display substance-abuse problems in patient records.

Some Democrats have been complaining the bills are insufficient given the extent of opioid abuse and overdose in the United States. “Collectively these bills do not go far enough in providing the resources necessary for an epidemic of this magnitude,” Rep. Frank Pallone, top Energy and Commerce Democrat, said in a statement. House Minority Whip Steny Hoyer tweeted this:

— A few more good reads from The Post and beyond:

MEDICAL MISSIVES
To Your Health
In two-thirds of states that allow parents to opt their children out of school immunization requirements for nonmedical reasons, the number of unvaccinated kindergarteners is on the rise, a study found.
Lena H. Sun
Speaking of Science
The findings from the National Academies of Sciences, Engineering and Medicine — among science’s most prestigious institutions — are released as the organizations themselves are under fire for their handling of sexual harassment.
Sarah Kaplan and Ben Guarino
With frustration mounting over lawmakers' inaction on gun control, the American Medical Association on Tuesday pressed for a ban on assault weapons.
Associated Press
INDUSTRY RX
Hospitals and doctors are livid about the trend, and in some cases taking insurers to court.
Politico
The Switch
From Comcast’s potential bid for 21st Century Fox to CVS’s acquisition of Aetna, massive corporations increasingly have been seeking to expand their reach by buying up companies in different lines of business.
Tony Romm and Brian Fung
Pharma giants AstraZeneca and Eli Lilly have scrapped two late-stage trials of an experimental Alzheimer’s drug they were co-developing, the latest blow in the long quest to find a breakthrough for the memory-robbing disorder.
Wall Street Journal
DAYBOOK

Coming Up

  • The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on public health biopreparedness on Friday.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the 340B Drug Pricing Program on June 19.
SUGAR RUSH

Did President Trump sink the re-election effort of South Carolina Republican Rep. Mark Sanford?:

Sen. Time Kaine (D-Va.) celebrated state Sen. Jennifer Wexton's primary win and said Virginia will "help take the House back, take the Senate back:"

Watch a raccoon climb the side of a skyscraper in St. Paul, Minn.: