THE PROGNOSIS

Have you heard about the trendy new approach to lowering prescription drug spending? Copy other countries.

The Trump administration and Sen. Bernie Sanders (I-Vt.) are strange bedfellows on drug prices. But they’re both eyeing similar approaches to lowering the country’s astronomically high spending on prescription medicines: pegging U.S. drug prices to lower international levels.

Sanders proposed a bill Tuesday incentivizing companies to develop cheaper generic versions of brand-name medications that the government determines to be “excessively priced” in comparison to the median price in Canada, the United Kingdom, Germany, France and Japan.

This is similar to an idea advanced in October by Health and Human Services Secretary Alex Azar, whose agency is experimenting with pegging some Medicare payments to an index based on sales prices in those five countries plus 11 more: Austria, Belgium, the Czech Republic, Finland, Greece, Ireland, Italy, Portugal, Slovakia, Spain and Sweden.

Both proposals stem from the reality that drug prices are much higher in the United States because the government doesn’t engage in price-setting, unlike in many other countries with similar economies. That means pharmaceutical companies pocket a lot more money in this country — and rely more heavily on their U.S. profits to pay for developing new medications.

Trump and Sanders have adopted similar rhetoric when they talk about the issue, even though the Republican president and the self-described democratic socialist senator couldn’t be further apart on other topics such as taxes and immigration. The United States pays unfairly high prices for prescription drugs, they argue, even as other countries demand — and obtain – steep discounts.

Sanders tweeted this Tuesday:

And from Azar:

It’s not the first time Trump and Sanders have shared common ground. During their 2016 campaigns, both candidates advocated allowing Medicare’s prescription drug program to directly negotiate lower prices with drugmakers and private companies. Trump has since backed away from that idea, but HHS surprised many with its bold suggestion of  creating an international price index (which I explained in this Health 202).

Granted, HHS’s experiment is quite limited in scope. It applies only to drugs administered to Medicare patients by doctors themselves and will last just five years. The experiment — called a “demonstration” in administration-speak — won’t start until sometime after the Centers for Medicare and Medicaid Services propose a rule early next year.

Sanders’s proposal, also sponsored by Rep. Ro Khanna (D-Calif.), would go much further by affecting all drugs, including those purchased by Americans with private health insurance. If HHS determined a drug price to be excessive, the secretary would be directed to strip its maker of exclusivity rights and open the door for competitors to develop a generic version.

Sanders gave a nod to Trump’s Part B proposal but emphasized that his approach would help the more than 150 million Americans who get private health coverage from their employer. The monthly cost for the popular insulin Lantus (used for diabetes) could fall from $387 to $220 and the medication Humira (used for arthritis) could fall from $2,770 to $1,576, according to some examples provided by Sanders’s office.

There’s little to no chance Sanders’s bill will advance in Congress. Many Republicans aren’t enthused even about Trump’s limited Part B demonstration, because it smacks of government price-setting.

There is something else Sanders shares with the president: strong resistance from the pharmaceutical industry. A spokeswoman for the Pharmaceutical Research and Manufacturers of America said both proposals would be “devastating" if implemented.

“This legislation would have the same devastating impact on patients as the administration’s proposed International Pricing Index model,” PhRMA spokeswoman Nicole Longo said in a statement provided to The Health 202.

“Patients in countries whose governments set prices wait years for new medicines and have far fewer treatment options,” she added. “These policies reduce investment in research and development, slow progress in creating tomorrow’s cures and will result in Americans having access to fewer new medicines.”

PROGRAMMING NOTE: Happy almost Thanksgiving from The Health 202 team. We won't be publishing on Thursday and Friday, so enjoy your week, maybe make this roasted red pepper mac n cheese, and we'll be back in your inbox on Monday.

AHH, OOF and OUCH

AHH: The Trump administration has reinstated permission for Kentucky to impose work requirements for its Medicaid beneficiaries after a judge had blocked its ability to do so.

CMS says it has approved the work requirements to start in April, our Post colleague Amy Goldstein reports, nine months after the rules were initially set to take effect.

“Kentucky has been a lightning rod in the administration’s rewriting of the rules for the public health insurance system for poor Americans by inserting long-held conservative ideas — about individual responsibility and a limited government helping hand — for the first time in the history of a program run jointly by the federal government and states that began under the War on Poverty of the 1960s,” Goldstein writes.

Kentucky was the first state to win approval from the administration to create such rules for Medicaid beneficiaries. Days before the requirements were set to take effect, Judge James E. Boasberg of the U.S. District Court for the District of Columbia ruled the state could not move ahead with plans “because federal health officials had not adequately considered the requirement’s impact on the program’s central purpose — providing medical assistance to a state’s citizens,” Goldstein reports.

Instead of an appeal, CMS reopened the state’s proposal for another round of public comment, and with Tuesday’s approval, made clear that “the version CMS just approved is substantially the same as the original with a few different nuances, such as a more explicit monitoring requirement about its effects,” our colleague writes.

Amy adds that because the case is still open, an attorney with the Kentucky Equal Justice Center said the plaintiffs will again ask that the requirements be found illegal. A similar lawsuit is also pending in Arkansas, the first state to put its Medicaid work requirements into effect.

OOF: A new report from the Veterans Affairs Department’s internal watchdog has found there were errors in the way the agency doled out benefits to veterans diagnosed with Amyotrophic Lateral Sclerosis, a devastating neurological disease commonly known as ALS.

VA Inspector General Michael Missal “found that dozens of veterans suffering from ALS were deprived of financial support because staff mishandled their benefits claims,” our Post colleague Lisa Rein reports.

She writes officials with the internal watchdog are worried the Veterans Benefits Administration is skimping because of pressure from lawmakers and other groups to get through a backlog of claims.

“Of 960 claims that were examined by Missal’s office, 430 contained errors,” Rein reports. “Of those, 230 claimants were awarded the wrong benefits, the inspector general’s report says. Most received no money or were underpaid. In other cases, officials could not determine whether the benefits VA paid were too low or too high.”

OUCH: Check your fridge, and your Thanksgiving Day shopping lists. The Centers for Disease Control and Prevention is warning that romaine lettuce is not safe to eat in any form.

The agency is warning people to throw away any romaine lettuce they have purchased, warning restaurants not to serve the greens and stores not to sell it, “no matter where or when the lettuce was grown,” and even if some lettuce has been eaten and no one has gotten sick. The agency's food safety alert is in response to a new outbreak of illnesses caused by a dangerous type of E. coli bacteria, our Post colleagues Joel Achenbach and Lena H. Sun report.

The CDC says 32 people across 11 states have been sickened by contaminated romaine lettuce, with 13 people hospitalized and one person suffering a form of kidney failure. Meanwhile, the Public Health Agency of Canada says 18 people have been infected by the same strain of E. coli linked to romaine lettuce.

“This advice includes all types or uses of romaine lettuce, such as whole heads of romaine, hearts of romaine, and bags and boxes of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, and Caesar salad,” the CDC said. “If you do not know if the lettuce is romaine or whether a salad mix contains romaine, do not eat it and throw it away.”

MEDICAL MISSIVES

— When he was a U.S. attorney, Matthew G. Whitaker imposed some of the country's harshest sentences on drug offenders, our Post colleague Michael Kranish reports.

Whitaker, now the acting attorney general, spent about five years as the U.S. attorney for the Southern District of Iowa. Based on findings from a nationwide analysis conducted by Iowa federal judge Mark W. Bennet, Whitaker’s office “was more likely than all but one other district in the United States to use its authority to impose the harshest sentences on drug offenders.”

Kranish notes the Bush administration had pushed for strict sentences on repeat offenders, and that Congress had passed in 1970 legislation that gave U.S. attorneys the authority to lengthen prison terms dramatically, a tool that gave Whitaker “discretion to impose longer jail times than other parts of the country.”

“Whitaker’s record on drug sentencing is newly relevant after President Trump ousted Jeff Sessions as attorney general this month and replaced him with Whitaker, who was Sessions’s chief of staff,” Kranish reports. “Trump last week announced his support for legislation that would give judges more discretion in sentencing nonviolent drug offenders and reducing prison terms. Sessions had opposed the bill. Now Whitaker, as acting head of the Justice Department, is in a powerful position to try to influence the outcome.”

—The U.S. Preventive Services Task Force, an influential panel of medical experts, is now recommending  physicians offer preventive medication to individuals who are at high risk of acquiring HIV.

The task force is also recommending that more doctors have a conversation about preventive drugs with their patients, our Post colleague Lenny Bernstein reports. The panel “estimated that 1.2 million people are eligible for the daily drug regimen, which is very effective at preventing HIV infection, but only 78,360 took the medication in 2016,” he reports. 

“Pre-exposure prophylaxis, known as PrEP, is a combination of two drugs — tenofovir disoproxil fumarate and emtricitabine — made by Gilead Sciences and marketed as Truvada,” Bernstein adds. “Taken daily in a single pill, the FDA-approved medication greatly reduces the chance of acquiring HIV, according to research cited by the task force. The Centers for Disease Control and Prevention says that PrEP cuts the risk of contracting HIV through sex by more than 90 percent and reduces the risk by more than 70 percent for intravenous drug users.”

The medication is also quite pricey. According to drugmaker Gilead, the cost is nearly $1,676 for a 30-day supply. Bernstein adds “most insurance covers the drugs, but critics have cited out-of-pocket costs as perhaps the biggest obstacle to staying on the medication.”

— After a physician, a pharmacy resident and a police officer were killed at a Chicago hospital on Monday night, physicians and nurses across the country expressed agony over the latest instance of gun violence that one doctor said “hits too close to home,” as our Post colleague Lindsey Bever reports.

The shooting at Mercy Hospital & Medical Center in Chicago also follows after the National Rifle Association called on doctors earlier this month to “stay in their lane,” and not weigh in on gun policy.

“It sparked a backlash from medical professionals across the United States and abroad, voicing their disdain on social media with the hashtag #ThisIsOurLane,” Bever writes. “After the Chicago shooting, the medical community returned to Twitter, extending prayers and pledging to fight. The victims were identified as Chicago Police Officer Samuel Jimenez; an emergency room doctor, Tamara O’Neal; and a first-year pharmacy resident, Dayna Less, according to the Chicago Tribune.”

STATE SCAN

— Many people who have been run out of their homes following the deadly Camp Fire in Northern California are older — the town of Paradise, Calif., was largely a retirement community. And a quarter of the population is 65 and older.

It’s a population which evacuated, mostly leaving behind medications, wheelchairs, walkers and other medical essentials and who are now living in makeshift communities, making do with the resources they have, as Brian Rinker reports for Kaiser Health News.

“Altogether, around 50,000 people are thought to have evacuated, now staying in motels, cars, shelters and a makeshift camp at Walmart in Chico,” Rinker writes. “But the elderly refugees often need more support, especially with chronic conditions and infections that incubate and spread in close quarters. Some need dialysis but can’t get it. Others have respiratory illnesses aggravated by smoke. One woman in a Yuba City shelter was recovering from cancer surgery with a stapled wound.”

There are doctors and a nurse who come by to write prescriptions, but “for more complicated conditions the shelter struggles to meet the need,” Rinker reports.

Below, Rinker interviews a 72-year-old man who “just barely” escaped the fire alive:

INDUSTRY RX

— In the District of Columbia and five other cities, Uber will launch a wheelchair-accessible service, working with MV Transportation, which says it’s the nation’s leading paratransit company, our Post colleague Faiz Siddiqui reports.

Uber, which has “long been criticized for its lack of wheelchair-accessible vehicles,” Siddiqui reports, says the new service will have 15-minute wait times for customers with disabilities for UberX-equivalent fares.

“We believe that ridesharing has the potential to significantly improve mobility for people with disabilities,” Uber CEO Dara Khosrowshahi wrote in a blogpost announcing the move. “But we know there is more that can be done, and believe that ridesharing can further improve options for riders who use motorized wheelchairs or scooters and want reliable access to wheelchair-accessible vehicles.”

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

National
Co-workers of Tamara O'Neal, a 38-year-old emergency room physician killed at Mercy Hospital on Monday, praised her skill and personality.
Michael Brice-Saddler
Walgreens Boots Alliance and Humana are in preliminary discussions to take equity stakes in each other, as health-industry players scramble for tie-ups that will help them compete in a rapidly evolving environment.
Wall Street Journal
Senator Maggie Hassan met with constituents in Concord Monday to hear about their concerns over health care. Participants in the round-table discussion
New Hampshire Public Radio
It is the largest outbreak in North Carolina since the chickenpox vaccine first became available in 1995.
The New York Times
Apple is in discussions with the Department of Veterans Affairs to provide portable electronic health records to military veterans.
Wall Street Journal
Grade Point
Lou Anna Simon faces two felony and two misdemeanor counts after police said she lied during an investigation of former sports medicine doctor Larry Nassar.
Susan Svrluga
Local
University calls for precautions.
Martin Weil
HEALTH ON THE HILL
Fact Checker
Republicans often suggest they were just one vote from victory. But there were negotiations and many more votes to come, with the outcome in doubt.
Glenn Kessler
Nancy Pelosi, a complicated political figure, saved the Affordable Care Act from Democratic destruction.
The Intercept
REPRODUCTIVE WARS
DAYBOOK

Coming Up

  • The American Enterprise Institute holds an event with CMS Administrator Seema Verma on "The new Medicare physician payment regulation" on Nov. 27.
  • The Heritage Foundation holds a discussion about fetal tissue research on Nov. 27.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on reducing health care costs on Nov. 28. 
SUGAR RUSH

President Trump pardons two turkeys, named Peas and Carrots:

Trump jokes House Democrats will try to subpoena pardoned turkeys: