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The Health 202: Trump vowed drug companies would lower prices. That hasn't happened yet.

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THE PROGNOSIS

It’s been more than four months since President Trump vowed that drug companies would soon make “voluntary, massive drops in prices.” The president said it would happen in two weeks, and in subsequent speeches, he has touted his administration’s effectiveness on the issue.

But no such major decrease in the cost of prescription drugs has occurred.

Recent analysis from the Associated Press shows that in fact, there have been more price increases than cuts in the months since the president’s May remarks. Some experts say the lack of progress thus far isn't a shock. But others warn it’s not yet realistic to use drug costs to measure the administration’s success.

“I’m actually not surprised by the data,” said Nadina Rosier, the health and group benefits pharmacy practice leader at consulting firm Willis Towers Watson. “It’s fairly unrealistic that by simply meeting with the president, manufacturers are going to lower drug prices because he says please.”

The AP found in the two months after Trump’s prediction of major cuts,  price increases outpaced decreases by a 16.5-to-1 ratio. During that time there were 395 price increases and 24 decreases. The analysis, based on 26,176 list price changes in the United States for brand-name prescription drugs from January through July in the years 2015 through 2018 , also found that there were 96 price increases for every price decrease. But overall, there were also fewer price hikes than in comparable periods in previous years, according to the report.

Simply put: The data signals the administration’s approach hasn’t had an immediate impact on prescription prices.

“I don’t need to look at the analysis to know that, but the analysis supports that,” said Rachel Sachs, an associate professor of law at Washington University School of Law in St. Louis. She said the administration’s drug pricing blueprint announced in May was “more of a set of thoughts on how to address the problem than an actual action plan.”

The administration's 44-page blueprint included a list of policy proposals encouraging drug manufacturers to bring down prescription costs. But the most visible work on the issue has come, perhaps not surprisingly, from Trump's Twitter feed: In July, the president tweeted at drug companies, such as Pfizer, shaming them for any increases, resulting in some short-term success. In July, Pfizer said it would delay hiking prices for dozens of drugs and its CEO later met with Trump at the White House (and Trump  tweeted the accomplishment).

Sachs said some helpful initiatives to lower drug costs have come from the Food and Drug Administration. Joseph Antos, a health-care scholar at the conservative American Enterprise Institute, also pointed to steps taken by the FDA, including expediting approvals for generics, that probably can have “substantial long-lasting effects,” but that won’t have an overnight impact. (The Health 202’s Colby Itkowitz has written about some of the thing that that have come from the agency).

The Department of Health and Human Services says the administration has moved the needle.

An HHS official pointed to its own reports, including one from August that noted that “15 drug companies have reduced list prices, rolled back planned price increases, or committed to price freezes for the rest of 2018.”

“Bottom line: Change of the magnitude proposed by the Trump administration is not going to happen overnight, but there is no disputing that the administration has taken significant action which has begun to move the needle — the market is beginning to react in a way that benefits patients,” the official told The Health 202.

For his part, AEI’s Antos said the president’s remarks promising price reductions were “a matter of mistiming" and referred to it as "modern day jawboning." 

“It’s the kind of announcement that a politician would normally make after you’ve made a deal. But it was released before any deal was struck with anybody,” he said. “It really does characterize the administration’s problem, which is that they didn’t develop the policy, or a series of policies, that to the various parts of the industry were clear enough so you’d get a sense 'If we raise our prices too high, there would be consequences.’ ”

Antos argued that even if the administration had sent a clearer message to the drug industry, it wouldn't mean companies would have immediately lowered prices. 

Holly Campbell, a spokeswoman with Pharmaceutical Research and Manufacturers of America, the industry’s top trade group, acknowledged some patients are "facing a challenge accessing their medicines" at the pharmacy counter, but said that although drug companies set the list price, they’re not what determines what patients pay at the pharmacy counter.

“List prices can fluctuate up or down, but it’s important to know that while the biopharmaceutical company sets the list price, it’s the insurer who ultimately determines what a patient will pay out of pocket,” Campbell said.

Several industry experts emphasized that it was impossible to significantly affect drug prices in just months. In a June hearing, Azar told the Senate Health, Education, Labor and Pensions Committee that drug companies that wanted to make reductions were facing hurdles.

Nonetheless, Sachs said it’s important to examine the administration's claims of victory on the issue. For example, during a rally in Indiana last month, Trump referred to the price-hike delay announced by Pfizer and his tweet urging them to do so.

“Pfizer — and I take my hat off to them — I like them — they increased their prices substantially of drugs,” Trump said. “And I got angry about it. I think it's probably the first time I realized what great power we have here. I got angry.” He added: “Drug prices are coming down like they've never seen. Increases are stopping, like with Pfizer and Novartis.”

“Trump is still out there saying things like drug prices are going to come down in two weeks,” Sachs said. “All of those bold pronouncements —  none of them have come to pass, so it’s worth essentially fact-checking him.”

AHH, OOF and OUCH

AHH: Trump said that protections for preexisting conditions are “safe” during a campaign rally in West Virginia over the weekend. Meanwhile, the Justice Department is backing a lawsuit from several state attorneys general that seeks to overturn the Affordable Care Act, including those preexisting illness protections. And West Virginia's Attorney General Patrick Morrisey is part of the suit.

“I will always fight for and always protect patients with preexisting conditions,” Trump said.

As Bloomberg News's Sahil Kapur points out: 

“Some people think that's not a Republican thing to do. I don't care," Trump added. "And I'll tell you what, all of the Republicans are coming into that position now. All of them. And we'll do it the right way, too.”

OOF: In recent weeks, hundreds of undocumented migrant children who had been housed in foster homes or other shelters have been transferred to a tent city in South Texas, the New York Times’s Caitlin Dickerson reports. The moves are usually taking place late at night, when the children will be less likely to run away, she notes.

In these tent cities, where the children are separated by gender and sleep in rows of bunks, there is no required schooling, and the children have limited access to legal services. Caitlin writes this “mass reshuffling” of children from shelters is happening “as the federal government struggles to find room for more than 13,000 detained migrant children — the largest population ever — whose numbers have increased more than fivefold since last year.”

The tent camp first opened in June for 30 days with a capacity for 400, but Caitlin reports it’s now expected to stay open at least through the end of the year. “[T]he mass transfers are raising alarm among immigrant advocates, who were already concerned about the lengthy periods of time migrant children are spending in federal custody,” she adds.

“The roughly 100 shelters that have, until now, been the main location for housing detained migrant children are licensed and monitored by state child welfare authorities, who impose requirements on safety and education as well as staff hiring and training. The tent city in Tornillo, on the other hand, is unregulated, except for guidelines created by the Department of Health and Human Services.”

OUCH: There have been two confirmed cases of Ebola near the border of Congo and Uganda, leading the World Health Organization to warn that the risk of the virus spreading is “very high,” the Associated Press’s Cara Anna reports.

“The outbreak of the hemorrhagic fever in northeastern Congo is now larger than the previous one in the northwest and more complicated to contain because of a dense, highly mobile population and a rebel threat so serious that some health workers say they’re operating in a war zone,” Cara writes.

In addition, there was a two-day pause in containment efforts because of a deadly attack in Beni.

There were 124 confirmed cases of Ebola as of Friday, including 71 deaths, per the report.

TRUMP TEMPERATURE
Over the span of five hours on Sept. 28, Sen. Jeff Flake (R-Ariz.) dramatically altered the trajectory of Brett M. Kavanaugh’s Supreme Court nomination. (Video: JM Rieger/The Washington Post)

— In case you need a refresher, our Post colleague Amber Phillips has a minute-by-minute breakdown of the drama in Washington on Friday that led to the delay of Brett M. Kavanaugh’s nomination to the Supreme Court after Sen. Jeff Flake (R-Ariz.) demanded an FBI investigation into allegations of sexual misconduct against the nominee.

Minutes after Flake announced he planned to vote to approve Kavanaugh in the Senate Judiciary Committee, he was confronted by two women who oppose Kavanaugh. Flake, as seen below, mostly listened silently:

Protesters blocked Sen. Jeff Flake (R-Ariz.) inside an elevator on his way to a committee vote for Supreme Court nominee Brett M. Kavanaugh on Sept. 28. (Video: Reuters)

From there, there was a swirl of events that included Flake huddling with Sen. Christopher A. Coons (D-Del.) and Sen. Amy Klobuchar (D-Minn.), who then "talked by phone to swing votes who do not sit on the committee, such as Sen. Susan Collins (R-Maine),” our colleague writes. The committee eventually voted along partisan lines to advance the nomination, but only after Flake warned he wouldn't vote for Kavanaugh in the full Senate unless the FBI investigates (a one-week FBI investigation was agreed to and is happening).

Sens. Collins, Lisa Murkowski (R-Alaska) and Joe Manchin III (D-W.Va.) signaled they will hold up their votes without an FBI investigation.

Read from our Post colleague Eli Rosenberg on Coons, who appeared to tear up when telling reporters about the “deep concern” he shares with Flake.  

Over the weekend, the FBI began contacting people after Trump ordered the additional background investigation on Friday.

Sen. Jeff Flake (R-Ariz.) was spotted leaving the Senate Judiciary Committee meeting with Sen. Chris Coons (D-Del.) followed by Sen. Amy Klobuchar (D-Minn.). (Video: Reuters)

The investigation sparked a new debate as "the White House appeared to retain sharp limits on the probe even as President Trump and Republican officials publicly suggested otherwise," our colleagues Mike DeBonis and Josh Dawsey report.

The president tweeted that he wants the bureau to interview “whoever they deem appropriate,” and during Sunday television interviews,  White House officials insisted no limits had been placed on the investigation.

"The squabbling added to the swirl of public confusion over the parameters of the FBI inquiry and who is setting them," our colleagues write. "The order to the FBI was signed by Trump but has not been made public. White House officials have sought to lay responsibility for the details on either the Senate or the FBI."

REPRODUCTIVE WARS

— The Trump administration’s move to review all federally funded research that uses fetal tissue has brought to light a fight between the administration and antiabortion rights groups, who are normally allies, Politico’s Dan Diamond reports.

Dan takes a deep dive into the now-public simmering feud between the groups and the administration. The very antiabortion rights groups that have seen multiple victories under this administration are now calling on Azar to block more than $100 million in research using fetal tissue.

“The battle is forcing HHS officials into making an uncomfortable choice: Can the agency be “pro-life” while also remaining pro-science?,” Dan writes.

While some HHS officials share the concerns from antiabortion groups, not all of them do. While appointees in the Office of the Assistant Secretary for Health are supporting the groups’ requests, an FDA representative told Politico about how fetal tissue use has been critical in “understanding the safety of drugs and vaccines,” and “leaders at NIH, meanwhile, worry that there’s no feasible solution and that their scientific mission will suffer if HHS bows to advocates’ demands."

INDUSTRY RX

— More employers are providing further health-care resources for their employees as the cost of health care rises, the AP’s Tom Murphy reports. Companies “are opening clinics on or near their worksites or bringing in temporary setups to make sure their employees get annual physicals," he writes. 

By 2019, 56 percent of large employers will have on-site or close-by health centers, Tom reports, citing the National Business Group on Health. That's a jump from 47 percent in 2016.

The report also found 12 percent of large employers are considering such health centers for 2020 or 2021, and 30 percent are not currently considering such resources.

“In many cases employers are offering free primary care or charging only a small fee,” Tom writes. “Many believe the cost is worthwhile because they can improve employee health and cut even bigger bills in the future that stem from unmanaged chronic conditions like diabetes or unnecessary emergency room visits.”

— A vice president at Memorial Sloan Kettering Cancer Center in New York will have to hand over his almost $1.4 million stake in a biotech company as part of the center’s revamp of policies regarding corporate relationships, the New York Times’s Katie Thomas and Pro Publica’s Charles Ornstein report.

Previously, Memorial Sloan Kettering did not prevent their employees from accepting personal compensation while representing the institution on corporate boards, a policy common at other cancer centers and research institutions.

“The vice president, Dr. Gregory Raskin, oversees hospital ventures with for-profit companies. As compensation for representing the hospital on the biotech company’s board, Dr. Raskin received stock options whose value soared when the start-up went public a little over a week ago,” Katie and Charles write. “The move to hand over his stake is one of several steps now underway as the cancer center tries to contain a crisis that has already led to the resignation of its chief medical officer and a review of its conflict-of-interest policies.”

“After The New York Times and ProPublica asked about Dr. Raskin’s compensation, Memorial Sloan Kettering said it would change its policy so that he and other employees in similar roles would not profit personally from such arrangements, and that all proceeds would revert to the hospital and its research,” they add.

HEALTH ON THE HILL

The House overwhelmingly approved 393 to 8 a final version of a sweeping package of bills aimed at fighting the opioid crisis. The Senate plans to take it up this week or next, when it is expected to pass easily and then be signed into law by Trump just before the midterm elections. For more on what’s in the bill, read Colby’s piece from last week on the final deal.

— And here are a few more good reads from The Post and beyond: 

MEDICAL MISSIVES

Nobel Prize in medicine goes to cancer immunotherapy researchers (Lenny Bernstein)

In the Nursing Home, Empty Beds and Quiet Halls (The New York Times)

Kellyanne Conway: ‘I’m a victim of sexual assault’ (Alex Horton)

Sexual assault victims are reliving their trauma, triggered by Kavanaugh hearing (Deborah Bloom)

Partisan rage over Kavanaugh allegations erupts into midterm campaigns (Amy Gardner and Mike DeBonis)

The ACLU typically stays neutral about Supreme Court nominees. It didn’t with Kavanaugh. (Kristine Phillips)

Will Beto’s bet on Medicaid expansion pay off? (Politico)

AGENCY ALERT

In rollback of mercury rule, Trump could revamp how government values human health (Juliet Eilperin and Brady Dennis)

New bill would grant FDA power to add off-label uses to generic drug labels (Stat)

Do Migrant Teenagers Have Abortion Rights? Two Volatile Issues Collide in Court (The New York Times)

OPIOID OPTICS

While America wages war on opioids, meth makes its comeback (CNN)

DAYBOOK

Coming Up

  • The Senate Finance Committee holds a hearing to consider the nomination of Andrew M. Saul to be Commissioner of Social Security on Tuesday.
  • Centers for Medicare & Medicaid Services administrator Seema Verma is set to speak at an event hosted by PhRMA on Wednesday.
  • The Senate Special Committee on Aging holds a hearing on patient-fo used care on Wednesday.
  • The Senate Health, Education, Labor and Pensions Subcommittee on Children and Families holds a hearing on rare disease on Wednesday.
SUGAR RUSH

"Saturday Night Live" took on Brett Kavanaugh's testimony denying sexual assault allegations, in the cold open of its 44th season premiere

"Saturday Night Live" took on Brett Kavanaugh's testimony denying sexual assault allegations in the cold open of its 44th season premiere on Sept. 30. (Video: Jenny Starrs/The Washington Post)

Sen. Elizabeth Warren (D-Mass.) said she would "take a hard look at running for president," after the midterm election

At a town hall in Holyoke, Mass., on Sept. 29, Sen. Elizabeth Warren (D-Mass.) said she would "take a hard look at running for president," after the midterms. (Video: Elizabeth Warren)
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