Reporter

THE PROGNOSIS

As the Trump administration sought credit last week for its efforts to lower drug prices, a mother in Long Island took to Twitter — the president's favorite medium — to lament the exorbitant cost of her daughter's insulin. 

For Doreen Rudolph, the tweet she fired off early Saturday was similar to many she had before about her daughter's lifesaving diabetes medication. But this time, for reasons she can't quite explain, her words went viral. By Monday, 68,000 had liked it, 23,000 retweeted it and 2,700 had replied to it with suggestions and offers to help. Even Andy Slavitt, who ran the Centers for Medicare and Medicaid Services for the last two years of the Obama administration, retweeted Rudolph, alerting his 211,000 followers to her situation:

The intense response to Rudolph's tweet displays the outrage Americans feel about the sometimes exorbitant prices they pay for drugs in the United States, which for some top-selling medicines can cost seven times more here than abroad.

I spoke with Rudolph Monday night, who has been overwhelmed by the outpouring of support from strangers. A year ago, Rudolph had created a GoFundMe page to help her daughter, who had just turned 26 and could no longer stay on her parents' health insurance, afford her insulin. Even with the best plan she could buy through her job at a nonprofit organization caring for foster children, Rudolph's daughter had to spend $1,310.87 for 90 days' worth of insulin. 

Since her tweet went viral, people found Rudolph's old fundraising page and donated $6,000 within 48 hours. That, plus $2,000 previously raised, will more than pay for a year's worth of her daughter's medication.

But health care by GoFundMe is not a sustainable model. And Rudolph is now, from the thousands of messages she's received, more aware than ever that this is not her problem alone. Yes, her family's financial situation became a little easier overnight because of a tweet, but there are millions of families still facing the burden of expensive, critical medication, she said. 

“This is something she can’t do without, You can’t live without your insulin, you die,” Rudolph told me. “It should be affordable, there shouldn’t be a profit on that. I understand it’s a business, but when EpiPens went up there was a public uproar -- this is the same thing. I’m waiting for the government or someone to force them to be fair.”

Now, the Trump administration is turning its attention to drug pricing. In May, the president revealed a White House blueprint for lowering costs. In that announcement, the president guaranteed drug companies would begin reducing prices of their own volition. 

That did not happen in any meaningful way. 

Just in the past week, the administration suddenly put its efforts to lower prices into overdrive and rolled out in rapid succession a series of policy ideas it said the White House was pursuing. The Food and Drug Administration announced a plan to allow some commonly prescribed drugs to be sold over the counter. The next day, FDA Administrator Scott Gottlieb put out a plan for bringing biosimilars, which are essentially generics of complicated drugs, more quickly to market. 

At the same time, Health and Human Services Secretary Alex Azar directed Gottlieb to form a working group to consider importing drugs from overseas in certain limited circumstances when the domestic version priced people out. And the administration also sent a proposal to the Office of Management and Budget that would reduce protections allowing drug companies to offer rebates to insurers and pharmacy benefit managers, which some blame for high drug costs. 

Also last week, piggybacking on Pfizer's temporary retreat from raising drug prices after a public scolding from Trump, several other major drug manufacturers said they wouldn't increase prices at the typical midyear mark, and some even said they'd lower prices on some drugs. 

The administration spent most of last week touting its own efforts. When the New York Times editorial board questioned whether the White House was serious about getting tough on drug companies, Azar fired back in a letter to the editor, writing, “As we continue implementing our blueprint to put American patients first, President Trump is going to keep proving the doubters wrong.”

He also appeared on Fox Business Network last week to talk about the administration's efforts and said the drug companies are "seeing the writing on the wall."

Walid Fouad Gellad, who runs the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh, said the Trump White House deserves credit for talking and thinking about ideas to lower drug prices, but said it's way too early to be declaring any victories. 

“It’s going to take a lot of time and there's a lot of hurdles in the way, but that’s not what you want to explain when you want to show how you’re lowering drug prices,” he told me. “Ultimately they are going to have to be willing to upset some stakeholders including the pharmaceutical industry. The only way you know you’re really lowering prices is revenue is going to fall for these pharmaceutical companies.”

Gellad said Trump can probably take some credit for some drug companies halting price increases, but such action doesn't count as fundamental change to the drug market if companies are just temporarily reacting to presidential pressure. 

Rachel Sachs, a law professor with an expertise in drug policy at Washington University in St. Louis, largely agreed. 

“We haven't seen an action yet that would materially impact a pharmaceutical company's bottom line,” she said. And as for the drug companies who seemed to kowtow to the president, she pointed to reporting that showed many of the price cuts were on old drugs that are a low percentage of market sales. 

“They tend to be more political theater than beneficial to patients,” she said. 

“These are not significant concessions; in some cases they’re not concessions at all,” she told me. “They are a far cry from the real price decreases the administration has promised. At the same time, it is doing some things that could be impactful, we just don’t know yet.”

Meanwhile, if Trump was hoping his drug-pricing efforts would be a win with voters in November, a new POLITICO-Harvard T.H. Chan School of Public Health poll released Monday found only 27 percent of Americans know about Trump's plan. 

So, what does all of the White House's rhetoric and proposals mean for Rudolph and her daughter's access to affordable insulin medicine?

When Rudolph wrote her tweet over the weekend, she said she was feeling frustrated about their situation. Twitter is one social media platform her daughter doesn't use, so she can vent there freely.

"We were at the point, when is this going to stop?" she told me she was thinking. "How much more can it drain you? How many more jobs can you work and never get ahead?"

But for now, experts tell me, there's nothing the federal government is doing that will make any significant difference in what Rudolph must pay to keep her daughter healthy.

Correction: An earlier version referred to Fox News Business. The network is Fox Business Network.

AHH, OOF and OUCH

AHH: The Senate easily confirmed Trump’s pick to lead the Veterans Affairs Department yesterday. Robert Wilkie was confirmed on a bipartisan 86-to-9 vote, “elevating the top Pentagon official and Washington insider to lead an agency that serves a key constituency for President Trump but has floundered amid political infighting,” our colleague Lisa Rein reports.

Wilkie is the first VA secretary not to receive a unanimous Senate confirmation, but Lisa notes the 9 "no" votes mainly came from Democrats who are potential candidates for president in 2020, including Sens. Bernie Sanders (I-Vt.), Cory Booker (D-N.J.), Kamala D. Harris (D-Calif.) and Kirsten Gillibrand (D-N.Y.).

Sen. Dianne Feinstein ­(D-Calif.) also voted against Wilkie, saying in a statement she couldn’t support his nomination over “many controversial policies and elected officials.”

“Wilkie’s confirmation had been all but assured since his May nomination to succeed David Shulkin, a hospital executive and holdover from the Obama administration who clashed with the White House and the team of political appointees at VA,” Lisa writes.

Trump tweeted praise for his nominee following the vote: 

OUCH: Chemicals in food can harm children and are linked with health complications such as obesity, the American Academy of Pediatrics is warning in new guidelines that urge families to cut down on processed foods and plastic packaging that can increase the exposure to such chemicals.

The top pediatricians group “is also calling for more rigorous testing and regulation of thousands of chemicals used as food additives or indirectly added to foods when they are used in manufacturing or leach from packaging and plastics,” the New York Times’s Roni Caryn Rabin reports.

Roni adds: “Among the chemicals that raised particular concern are nitrates and nitrites, which are used as preservatives, primarily in meat products; phthalates, which are used to make plastic packaging; and bisphenols, used in the lining of metal cans for canned food products. Also of concern to the pediatricians are perfluoroalkyl chemicals, or PFCs, used in grease-proof paper and packaging, and perchlorates, an antistatic agent used in plastic packaging.”

The statement made recommendations that include consuming more fresh and frozen fruits and vegetables, avoiding processed meats, avoiding microwaveable foods and beverages that are enclosed in plastic, avoiding placing plastic in the dishwasher and using plastic alternatives. The statement also acknowledged that “[i]nsofar as these modifications can pose additional costs, barriers may exist for low-income families to reduce their exposure to food additives of concern. Pediatricians may wish to tailor guidance in the context of practicality, especially because food insecurity remains a substantial child health concern.”

OOF: New research suggests women’s reproductive history may indicate the likelihood they could develop Alzheimer’s, our Post colleague Tara Bahrampour reports.

A study of 14,595 long-term Kaiser Permanente patients found women who had three or more children had a 12 percent lower risk of developing dementia later in life compared with women who had fewer children. Years between a woman’s first menstrual period and menopause also affected the likelihood of dementia, as the study found women who didn’t get their period until 16 or 17 had a 31 percent higher risk than women whose periods began at 13. Further, women who began menopause at 45 or earlier were at a 28 percent higher risk of dementia than women who stopped menstruating later than 45 years old, Tara reports. The report also found each reported miscarriage increase a women’s risk of dementia by 8 percent.

Study author and staff scientist at the division of research at Kaiser Permanente Northern California Paula Gilsanz told Tara one reason could be “cumulative exposure to estrogen” throughout a woman’s life, which could protect against dementia.

TRUMP TEMPERATURE

— Yesterday, the Trump administration said in a new filing that 463 migrants have been deported without their children, an acknowledgment that the number of parents deported without their families during the administration’s “zero tolerance” border crackdown is more than was previously reported.

The reported number amounts to about one-fifth of the parents who were separated prior to a June 20 executive order ending family separations, our colleague Nick Miroff reports.

“Monday’s filing included no additional explanation, but the government is scheduled to brief the court Tuesday afternoon about its progress in the reunification effort, and will probably provide more details about the whereabouts of the 463 parents,” Nick writes. The Trump administration is also facing a looming Thursday deadline to reunite migrant children ages 5-17 with their parents.

The Trump administration is pushing back against guidelines from the World Health Organization to limit antibiotic use in animals, which the WHO is recommending as a way to preserve the antibiotics' effectiveness, Bloomberg News's Andrew Martin and Jared S. Hopkins report.

Guidelines from the WHO first released in November urged against giving healthy animals antibiotics to promote growth or prevent disease and suggested limiting use to sick animals or healthy animals that are living near sick animals, urging limited use of the drugs “critically important for human medicine.” “Instead, the U.S. is helping draft an alternative approach that appears more favorable to agribusiness,” Andrew and Jared write.

USDA press secretary Meghan Rodgers “said the WHO should have waited until agencies with expertise in agriculture and animal health endorsed the guidelines or should have collaborated with them in the first place,” Andrew and Jared report. David Wallinga, a senior health officer at the Natural Resources Defense Council advocacy group and member of the panel that wrote the guidelines, criticized the USDA for “thumbing its nose” at the United Nations health agency. Wallinga told Bloomberg the Trump administration’s response “wasn’t a complete surprise from an administration that consistently puts the profits and interest of powerful industries, like the meat and pharmaceutical industries, over the health of the American people.”

HEALTH ON THE HILL

— In this final week before they head out of town for August recess, House lawmakers are set to consider health-care-related bills that include:

  • A bill related to modernizing health-savings accounts
  • A bill to expand health-savings accounts and increase access to lower premium health plans
  • A bill to repeal the medical device excise tax
  • A bill to improve the national suicide hotline
  • A bill to support clinical nurse specialist programs.
  • A bill to allow people eligible for the Indian Health Service to qualify for health-savings accounts

A full list of the bills being considered on the House floor this week can be found here.

— The Senate will probably delay voting on its opioid bill until the post-election lame duck session in the fall, as senators grapple with the Supreme Court nomination and other agenda items. Senators had hoped to get the opioid response approved this summer, Politico’s Jennifer Haberkorn and Brianna Ehley report, noting that a representative for Senate Majority Leader Mitch McConnell (R-Ky.) said the bill is still a “tremendous priority.”

The timing could also impact red-state Democrat incumbents ahead of November, including Sens. Joe Manchin III (W.Va.), Joe Donnelly (Ind.) and Bob Casey (Pa.), whose states are particularly affected by opioid misuse.

STATE SCAN

— Democratic gubernatorial candidate Ben Jealous is pushing back on the charge in an attack ad by Maryland Gov. Larry Hogan (R) that criticizes Jealous’s single-payer health care proposal.

Hogan’s ad says Jealous’s “risky plan for health care will cost at least $24 billion a year. Every year,” but our Post colleague Steve Thompson notes the $24 billion figure “was gleaned from state analysts who based their work on a study suggesting such plans could save money overall.”

A summary of an analysis from the Maryland’s Department of Legislative Services, cited in Hogan’s ad, “says the government would have to spend $24 billion to fund the system,” Steve writes. “The analysis did not say how much state residents and businesses are spending now on health insurance, so whether costs overall would increase or decrease — and by how much — was not clear.”

“Jealous has acknowledged that his single-payer plan would be funded by tax increases — as any single-payer plan must be,” Steve writes. “His contention is that, overall, with health-care premiums and costs rising sharply, people would save more paying the government to cover their health care than they could in the current market.”

Jealous is pushing for states to tackle such single-payer health care plan on their own, as Democrats increasingly push such plans as part of their new mantra, as The Health 202 wrote this month.

— Insurers in Pennsylvania’s Obamacare marketplace are proposing a lower average rate hike in 2019, dropping the requested increase to 1 percent after calling for a 4.9 percent increase in June. The state’s insurance regulator cited “lower insurer expenses for cost-sharing reduction payments covering deductibles, co-payments, and coinsurance for lower income customers,” as some of the reasons behind the lower request, the Washington Examiner’s Robert King reports.

The rates are not yet finalized but will be before before the beginning of open enrollment in November.

REPRODUCTIVE WARS

— A new poll from NBC News and Wall Street Journal found that a large majority of American voters want Roe v. Wade to remain the law of the land. The poll shows 71 percent say the law should not be overturned, compared with 23 percent who say the ruling should be.

The poll’s findings mark a record amount of support for the ruling – the high levels of support for the decision and calls for overturning the law mark two records in the poll’s history.

Broken down by party, 88 percent of Democrats, 76 percent of independents and 52 percent of Republicans support keeping Roe in place. The poll found 39 percent of Republicans want the ruling overturned.  

MEDICAL MISSIVES

— A new study published Monday reveals the first indication of the transmission of Ebola from a female survivor, “highlighting the continued risk for a resurgence of cases and the potential for large-scale outbreaks long after there is no longer active disease spread,” our Post colleague Lena H. Sun reports.

It’s been four years since the Ebola epidemic in West Africa sickened more than 28,000 people and killed more than 11,000. Since then, there have been few cases of transmission, including via the semen of male survivors, Lena reports, as well as one report suggesting the spread from a survivor's breast milk.

Lena writes the study published in the Lancet Infectious Disease journal does not indicate how the woman infected her husband and sons, though researchers suggested it could have been from physical contact with bodily fluids.

“One of the biggest mysteries about Ebola, one of the world’s deadliest pathogens, has been recurrent disease in survivors,” Lena writes. “Even after patients have fully recovered, virus particles have been detected in semen, breast milk, spinal fluid and the inside of the eye.”

— And here are a few more good reads: 

More than 80 rural hospitals have shuttered over the last eight years. So why hasn't the government stepped in to help?
Mother Jones
Health & Science
Some departments use “street-level psychiatry” to de-escalate conflicts and provide aid.
Nathaniel Morris
As more lawsuits pile up against USC for its handling of a campus gynecologist accused of sexually abusing patients, the chair of the university’s board of trustees said he wanted to see the litigation resolved “as quickly as possible.”
Los Angeles Times
Unusually hot days have profound effects on mental health and human physiology.
The Atlantic
INDUSTRY RX
On Leadership
Fiat Chrysler’s announcement that hard-charging CEO Sergio Marchionne was replaced following “unexpected complications" from surgery offered few details -- but more than were required.
Jena McGregor
DAYBOOK

Today

  • The House Ways and Means Subcommittee on Human Resources holds a hearing on the opioid crisis and implementing the Family First Prevention Services Act.
  • The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on “Examining Advertising and Marketing Practices within the Substance Use Treatment Industry."
  • The House Veterans Affairs Committee holds a hearing on “Assessing Whether VA is on Track to Successfully Implement Appeals Reform."

Coming Up

  • The Senate Energy and Commerce Subcommittee on Health holds a hearing on the 21st Century Cures implementation on Wednesday.
  • The Senate Health Education Labor and Pensions Committee holds an executive session on Wednesday.
  • The Bipartisan Policy Center holds an event on the future of health care on Wednesday.
  • The Food and Drug Administration Antimicrobial Drugs Advisory Committee holds a meeting on Thursday.
  • The House Energy and Commerce Subcommittee on Health holds a hearing on “An Update on the Merit-based Incentive Payment System” on Thursday.
SUGAR RUSH

Does Sean Spicer have regrets?

Fox News booked the wrong Democratic candidate. She had a lot to say: