It was with much gusto and fanfare that President Trump announced in October an effort to tamp down spending on certain Medicare drugs by aligning payments with other countries pay, promising such a move would go far toward his vow to lower prescription drug spending in the United States.

But writing the regulations is proving tricky, complicated by vigorous pushback from not just the pharmaceutical industry, but also doctors, hospitals and even some patient advocates. Lobbyists told me early spring is a target for proposing the rules — although the Centers for Medicare and Medicaid Services didn’t confirm that. But it’s unclear whether the agency will follow through with all the components of the rule Health and Human Services Secretary Alex Azar promised.

Of course, Trump may be unwilling to back away from his pledge. He’s already frustrated by recent reports that drug companies are going through with some large price increases in 2019, calling Azar and other top officials to the White House on Tuesday to berate them over the issue and demand results.

Azar tweeted this on Wednesday:

Pharmaceutical companies are, of course, blasting the effort, which involves Medicare’s Part B program covering medicines distributed in doctors' offices. Instead of paying doctors the average U.S. sale price of a drug, Medicare would peg payments to a new international index of drug prices in other countries with similar economies — effectively lowering the price Medicare pays. It would be carried out as a five-year experiment, affecting 50 percent of the country.

But it’s not just drugmakers who are pushing back. Nearly 4,000 comments were submitted to CMS by the Dec. 31 deadline in which other big health industry players aired fears the rule would hurt their bottom line --  or even have the opposite of its intended effect by hurting patient access to lifesaving medication.

America’s Health Insurance Plans, the major insurance lobby, worried that reduced Part B payments might prompt drugmakers to shift costs to other parts of the industry. The American Cancer Society asked that oncology drugs — which make up 42 percent of Part B spending — be excluded from the experiment so patients don’t find it harder to access them.

And hospitals and doctors are upset about two additional components of the experiment CMS is suggesting. The agency is looking at setting up a first-time system inside Medicare in which drugs would be sold to vendors instead of directly to providers. It would remove incentives for doctors to prescribe pricier drugs by paying them a flat fee for storing the medications instead of a fee based on a percentage of the drug’s price.

The American Hospital Association suggested the experiment would prompt third-party vendors to add new fees; so did the American Medical Association, which also wrote in comments that using vendors could create more unnecessary paperwork for already overloaded doctors.

Yet the administration is still getting pats on the back from some quarters. Yesterday, Patients for Affordable Drugs announced it will spend about $1 million on digital ads applauding the Part B effort. The ads, which will run on Facebook, Twitter, YouTube and Google, urge viewers to contact their members of Congress to voice support for the proposed rule.

The group was founded in 2017 by David Mitchell, a blood cancer patient whose treatment to stay alive costs $440,000 worth of drugs annually.

“We’re standing up in support of this change because America’s prescription drug pricing system is broken, and patients need change now,” Mitchell said in a statement announcing the ad buy.


AHH: Louisiana officials unveiled a new payment model for hepatitis C treatments that our Post colleague Carolyn Y. Johnson writes is meant to “dramatically increase the number of people who can be cured of the liver-damaging disease and provide a model for others struggling to afford the medications.”

Louisiana would be the first to use this plan, known as the "Netflix model," to pay for pricey hepatitis C treatments. Under the model, the state would pay a subscription fee to a drug company in exchange for unlimited access to the drug.

“I’ve had conversations with a number of governors, to make sure they’re aware of what we’re doing — and if and when we’re successful, we’re going to have something worthy of emulation and replication around the country,” Louisiana Gov. John Bel Edwards (D) said.

Louisiana is soliciting bids from drug companies for the contract, and Carolyn writes the state is aiming to treat 10,000 people with hepatitis C by 2020. By comparison, about 1,000 people were treated last year at a cost of $35 million.

OOF: Sen. Susan Collins (R-Maine) is calling on the Department of Health and Human Services to move ahead with the administration’s vow to take on the drug rebate system. Collins sent a letter this week to the agency citing reports of the dozens of drugmakers who started the year hiking the price of hundreds of prescriptions, the Wall Street Journal’s Jared S. Hopkins reports.

The Maine Republican, who chairs the Senate Special Committee on Aging, called the increases “shocking" but added “they are unfortunately not unusual, nor are they unexpected.” She referred to the shadowy rebate structure, saying while consumers may pay less after rebates, discounts and insurance payments, “the opacity of these financial interactions… conceal incentives that distort the pharmaceutical market.”

In an interview, Collins told Jared she's not ready to say rebates should be banned entirely.  But she added this: "I don’t like the idea of interfering with the marketplace but the marketplace is failing here."

OUCH: New data from the Centers for Disease Control and Prevention shows the rate of drug overdose deaths among women spiked sharply from 1999 to 2017.

The agency’s Morbidity and Mortality Weekly report found during that time period, there was a 260 percent increase in the overdose death rate for women ages 30 to 64. “In that time, drug overdose deaths involving antidepressants, cocaine, heroin, prescription opioids, synthetic opioids and benzodiazepines such as such as Xanax and Valium all increased,” CNN’s Jacqueline Howard reports.

While the death rates saw increase for drug categories across the board, Jacqueline reports there were notable spikes in deaths related to synthetic opioids, which increased 1,643 percent; heroin, which rose 915 percent; and benzodiazepines at 830 percent. The data also found the rate of overdose deaths associated with any opioids spiked 492 percent.

In the CDC report's summary, its authors wrote such overdose deaths "continue to be unacceptably high, and targeted efforts are needed to reduce the number of deaths in this evolving epidemic, including those among middle-aged women."


— Senate Finance Chairman Chuck Grassley (R-Iowa) expressed opposition to a proposal from Sen. Bernie Sanders (I-Vt.) and Rep. Elijah Cummings (D-Md.) to allow the government to negotiate directly with drug companies as a way to lower drug prices. "I don't want to mess with the government negotiating prices with the private sector," Grassley told reporters, the Hill’s Jessie Hellmann reports. He also said such a plan would not advance in the Senate.

At a news conference to introduce their bills on Thursday, Cummings and Sanders criticized the Trump administration’s limited efforts to bring down drug prices despite vowing to do so. “I say to the president: No more talk, no more tweet. No more commotion, emotion and motion and no results,” Cummings said.

Their package also includes a bill to peg U.S. prices to median prices in five countries and a proposal to end the ban on Americans buying medicines from other countries.

Meanwhile, Grassley and Sen. Amy Klobuchar (D-Minn.) separately introduced a measure Wednesday to allow importation of approved drugs from Canada. “For decades, safe and affordable prescription drugs have been for sale just across the border, but legally out of reach for American families,” Grassley said in a statement.

— For its first hearing of the new Congress later this month, the House Oversight and Reform Committee will address drug prices. In a statement, Cummings, chairman of the panel, said the hearing will help launch a “broad review of the skyrocketing prices of prescription drugs.” The hearing is scheduled for Jan. 29.

— Beto O’Rourke -- the former congressman and potential 2020 presidential candidate -- got quite personal on social media yesterday, broadcasting his trip to the dentist on Instagram Stories. It’s “perhaps a new level of intimacy” for the former Democratic Senate candidate, who has become known for unscripted broadcasts on social media, our Post colleague Eli Rosenberg writes. “The story began with an image of his face stuffed with dental tools, the rubber-gloved hands of a dental hygienist nearby.”

“So, I’m here at the dentist,” he said as the technician removed tools from his mouth. The video is one in a series he has posted about people’s lives at the U.S.-Mexico border. In it, he introduces his dental hygienist, Diana, who speaks about the community at the border.

The video even earned praised from the American Dental Association. “The ADA recommends everyone visit a dentist regularly and we’re happy to see former Rep. O’Rourke is doing that today!” the group told the Daily Beast. “Instagramming from the dentist, however, is a personal preference.”


— In Maine, newly sworn-in Gov. Janet Mills has moved swiftly to expand Medicaid after voters approved expansion via ballot measure more than a year ago.

Mills announced Thursday that more than 500 residents in the state have already gained coverage under the expanded program, Maine Public Radio’s Patty Wight reports, following on a promise the Democrat made to make addressing the program a day-one priority in office.

Mills and the acting commissioner of the state Department of Health and Human Services, Jeanne Lambrew, held a meeting to discuss ideas on how to reach out to and enroll the estimated 70,000 low-income residents in the state who are eligible for expanded Medicaid coverage. The health department said it has submitted necessary paperwork to federal officials to get expansion expedited for retroactive coverage beginning July 2, the initial deadline for expanding coverage. It was delayed because of opposition from former Republican governor Paul LePage, who said the state legislature needed to find funding for the program.

— And here are a few more good reads: 

“We’ll get you covered,’’ said the Democratic California governor, who made the statement while unveiling his $209 billion state budget.
Answer Sheet
The findings support reports by teachers nationwide about a rise in student bullying after the election, but this shows that the increase, at least in Virginia, was seen in areas that supported the president.
Valerie Strauss
A whole slate of 2020 Democratic hopefuls are suddenly fixating on the same policy target: high prescription drug prices.
Despite evidence that mifepristone can help recovery from miscarriages, access to the medicine, which is commonly used to provide abortions, remains limited.
Maryland Politics
Maryland’s Senate president announced he is getting chemotherapy for prostate cancer that wasn’t halted by previous treatments.
Jennifer Barrios
The rise of consumer genetic tests has provided law enforcement with new tools that have the potential to break open cold cases.
Daron Taylor and Taylor Turner
Regulators had accused Mutual of Omaha of denying policies to applicants, mostly gay men, who took medication to protect against the infection.
New York Times
Thomas Donohue, the president and CEO of the Chamber of Commerce, on Thursday vowed to use all of the Chamber's resources to fight single-payer health care proposals. 
The Hill
New Hampshire has announced a new initiative in which it will analysis insurance claims data to better understand the opioid crisis and come up with policies to combat it.
Associated Press

Coming Up

  • Brookings India and Tufts University hold a roundtable on ‘Opportunities for India Beyond 2019: The Future of Health and Geopolitics’ on Jan. 15.
  • The Council for Affordable Health Coverage and the Partnership for Employer-Sponsored Coverage hold a summit on health policies and politics in the 116th Congress on Jan. 15.
  • Politico hosts an event on health care innovators on Jan. 16.



Furloughed federal employees and supporters protested the ongoing government shutdown: