THE PROGNOSIS

Congress is pouring pressure on drugmakers and pharmacy middlemen to ease steep insulin prices for patients with diabetes. And there’s a sign today their scrutiny is starting to prompt action.

Major health insurer Cigna and Express Scripts, its recently acquired pharmacy benefit manager, announced this morning it will ensure patients in its commercial plans will have to pay no more than $25 for a 30-day supply of insulin, even before meeting their annual deductible. The discounts could potentially affect around 700,000 of its patients — mostly people with employer-sponsored coverage — who had an insulin claim last year, a spokeswoman told Health 202.

“For people with diabetes, insulin can be as essential as air,” said Steve Miller, Cigna’s chief clinical officer. “We need to ensure these individuals feel secure in their ability to afford every fill so they don’t miss one dose.”

The company expects to roll out the program later this year for insurance plans that work with Express Scripts and in 2020 for Cigna plans. Glen Stettin, chief innovation officer for Express Scripts, told me the company has struck agreements with the country’s three insulin manufacturers — Eli Lilly, Novo Nordisk and Sanofi — for discounts on the insulin so the insurance company won’t have to eat all the costs.

Stettin insisted the company’s announcement isn’t tied to recent scrutiny by lawmakers on Capitol Hill, who have been holding hearings in the House and Senate on drug prices, and have specifically fixated on insulin prices.

“We’ve been at this for a little while,” he said. “This is what I would say is the latest in a string of things we’ve been doing to try to support better care for patients generally and people with diabetes specifically.”

But Express Script’s move comes while under a harsh spotlight, as one of several leading pharmacy middlemen often accused of failing to pass on to patients discounts provided by drugmakers. It, along with CVS Health and Optum — the country’s leading pharmacy benefit manager (PBMs) — will appear at the latest Senate Finance Committee hearing on drug prices next week.

Finance Chairman Chuck Grassley (R-Iowa) and ranking member Ron Wyden (D-Ore.) sent the three PBMs letters yesterday asking them to explain their own role in the higher prices paid by patients at the pharmacy counter.

“While manufacturers set the list price for insulin, pharmacy benefit managers play a critical role in the pricing of insulin on which people living with diabetes depend,” the senators wrote. “It is unclear whether PBMs are appropriately leveraging their power for the benefit of taxpayers and patients.”

The big three insulin makers are also expected on Capitol Hill next week for their own grilling. 

They’ll testify next week before the House Energy and Commerce’s Oversight subcommittee, its chairwoman Diana DeGette (D-Co.) announced yesterday, in an initial hearing about insulin prices. They’ve also been targeted by Grassley and Wyden, who kicked off their own insulin investigation with letters demanding an explanation for insulin prices hikes by as much as 500 percent.

Insulin is a particularly striking case study as lawmakers go after the problem of impossibly expensive prescription drugs in the United States. For one thing, a huge number of Americans live with diabetes; of the 30 million Americans with the illness, 7.4 million rely on insulin.

Plus, insulin is a hormone every single person needs to stay alive. For patients with Type 1 diabetes whose bodies don’t produce any insulin (including your Health 202 author), access to insulin is quite literally a matter of life or death.

“American families are suffering from the ongoing and staggering price hikes of insulin,” Energy and Commerce Chairman Frank Pallone (D-N.J.) said at yesterday’s hearing.

Insulin list prices have indeed skyrocketed over the past two decades. The average price of insulin nearly tripled between 2002 and 2013, according to the American Diabetes Association.

Senate Finance examined prices for some of the most commonly prescribed types of insulin. It found prices for Eli Lilly’s short-acting Humalog increased 585 percent between 2001 and 2015. Novo Nordisk’s Novolog – another short-acting insulin used during mealtimes – cost 87 percent more in 2019 compared to 2013.

And Sanofi’s Lantus, a long-acting insulin used to keep blood sugars stable throughout the day, became 77 percent more expensive between 2013 and 2019.

The price hikes have frustrated patient advocates and lawmakers, who have stressed there’s no logical reason for why drug makers would so dramatically raise prices for a medication whose chemical makeup hasn’t significantly changed.

“Under normal circumstances, the laws of economics, you would expect these trends to decrease – not increase – prices,” said Rep. Mike Burgess (R-Tex.).

TRUMP TEMPERATURE

— In a long and rambling speech that prompted laughter but also head shakes among attendees, President Trump targeted health care last night at the annual National Republican Congressional Committee spring dinner. He appeared to acknowledge that Democrats have gained the upper hand on health care politically, but vowed once again that the GOP “will be the champion of preexisting conditions ... not only for politics, it's also the right thing.”

"They have health care right now," he said of Democrats, according to a pool report. "We have to take that away from them. We have to protect and cannot run away from a thing called preexisting conditions.”

Reading from the teleprompter at the dinner, Trump said he’s working with Republicans “to come up with a great health-care plan that is far less costly to the people." And he reiterated such a plan would wait until after the 2020 elections. "I will be asking that this be my first vote immediately after the election," he said, telling Republican lawmakers in the room: “You’re going to win your elections based on healthcare... It's a great incentive for the voters to vote for you." 

Trump predicted the GOP would win back both chambers of Congress and retain the White House.

HEALTH ON THE HILL

— Earlier in the day, Democrats seized on the president’s tweets on Monday punting the issue of health care until after the presidential election.

“Last night the president tweeted that they will come up with their plan in 2021,” Senate Minority Leader Chuck Schumer (D-N.Y.) said at a rally calling on the administration to defend the Afforable Care Act in a challenge from GOP-led states. “Translation: they have no health care plan. It’s the same old song they’ve been singing. They’re for repeal. They have no replace.” 

The president’s abrupt abandonment of his push to once again try to repeal and replace Obamacare caught congressional Republicans off guard, our colleagues Erica Werner and John Wagner report. The late-night tweets from Trump followed a conversation with Senate Majority Leader Mitch McConnell (R-Ky.), who told reporters he “made it clear to him we were not going to be doing that in the Senate” during the campaign season.

The No. 2. Senate Republican John Thune (S.D.) said a delay on health care made sense, explaining Trump “looked at the possibility that anything could move, I mean the idea that he could get a Democrat House to agree with the Republican Senate on something he wants to try to get enacted.” Sen. John Cornyn (R-Tex.), however, said Trump’s tweets did not take the pressure off the GOP to come up with a plan.

More from Cornyn via Erica: 

From Politico's Alice Mirana Ollstein: 

— In comments in the Oval Office yesterday, Trump insisted Republicans would unveil a health-care plan "at the appropriate time," and pointed fingers at Democrats for making health care a political issue, our colleagues Erica and Seung Min Kim report. "Despite the punt, officials at the White House continued meetings to discuss a potential health-care plan, led by Domestic Policy Council chief Joe Grogan, and circulated principles earlier Tuesday, according to a senior aide," they write.

AHH, OOF and OUCH

AHH: A new poll from Politico and Morning Consult found most voters are skeptical of Trump’s latest promises on health care. Fifty-nine percent said they don’t have much trust or any trust at all in the president on the issue. Instead, voters appear to see the issue as one that will be handled by Democrats.

The poll found 45 percent of voters say they trust Democrats in Congress on health care, compared with 35 percent who chose Republicans in Congress. A 54 percent majority of voters said they have some or a lot of trust in Democrats in Congress to protect the health-care system or improve it, compared with 41 percent who said they trust congressional Republicans or 41 percent who said they trust Trump on the issue.

“The poll also shows that a plurality of voters support the law Trump is seeking to strike down: Obamacare. Nearly half, 47 percent, approve of the law — more than the 41 percent who disapprove of it,” Politico’s Steve Shepard writes. “The survey did not ask about a still-nonexistent Republican replacement for Obamacare, but it did find majority support for a Medicare-for-all health care system, in which all Americans would get their health insurance from the government. Fifty-two percent of voters support a Medicare-for-all system, while 35 percent oppose it.”

OOF: A pair of Republican lawmakers took a step towar trying to force a vote on the House floor on a bill that would require medical protections for infants born alive during abortions.

House Minority Whip Steve Scalise (R-La.) and Rep. Ann Wagner (R-Mo.) have introduced a discharge petition, which would force a floor vote on the "Born-Alive Abortion Survivors Protection Act" if 218 lawmakers sign the petition. 

GOP lawmakers say the aim is to get Democrats to disclose where they stand on the issue, Politico's Melanie Zanona reports. “They can’t hide from anyone. They have to take a position," House Minority Leader Kevin McCarthy (R-Calif.) said.

"The bill has three Democratic co-sponsors, but just one — Rep. Dan Lipinski of Illinois — has added his name to the petition," Melanie writes. "Freshman Rep. Ben McAdams (D-Utah), who is not a co-sponsor, also signed on to the petition. By the end of the day, the effort had secured 191 signatures."

In a statement, Jacqueline Ayers, vice president for government relations and public policy for Planned Parenthood Federation of America, called the filing “yet another out of touch attack on women’s health and rights – based on dangerous lies. Republican leadership is shaming women and criminalizing doctors for a practice that doesn’t exist in reality.”

OUCH: The embattled Sackler family that owns Purdue Pharma has asked a judge to dismiss the lawsuit brought by the Massachusetts attorney general over the company’s role in the opioid crisis. In a motion delivered to AG Maura Healey, lawyers for the family say the suit contains “misleading and inflammatory allegations," our Post colleagues Katie Zezima and Lenny Bernstein report.

“We are confident the court will look past the inflammatory media coverage generated by the misleading complaint and apply the law fairly by dismissing all of these claims,” Sackler family members said in a statement. 

The lawsuit "says that individual members of the Sackler family engaged in acts of deception and misconduct to make as much money as possible from sales of OxyContin, a powerful prescription painkiller," Katie and Lenny write.

"Healey accuses the family of disregarding addiction and safety in the name of profit, saying that members of the family directed sales representatives to push high doses of the drug while knowing its potential dangers. The family instead says that it acted in a routine way for members of a corporate board: reviewing voluminous documents, including budget presentations, spreadsheets and reports about Purdue’s nationwide operations."

Members of the Sackler family will pay $75 million in personal funds as part of a $270 million out-of-court settlement agreement Purdue made with the state of Oklahoma last week. 

AGENCY ALERT

— For some patients who had transplants before they enrolled in Medicare, the program may not pay for the anti-rejection drugs needed to keep the body from rejecting a new organ, the New York Times’s Gina Kolata reports.

The American Society of Transplantation calls it an “emerging and alarming problem.”

“[M]ost organ transplants go to to younger patients. According to the transplant society, 72.3 percent of liver transplant patients, 65.3 percent of heart transplant patients, and 59.7 percent of lung transplant patients are insured outside of Medicare at the time they receive new organs,” Gina writes. “Patients who were not on Medicare at the time of their transplants are required to get their anti-rejection drugs through Medicare’s drug program, Part D, which is handled through commercial insurers.”

But those insurers may refuse payment for the medication, claiming that they may not have been approved for use by the patient.  Center for Medicare and Medicaid Services spokesman Johnathan Monroe told the Times the agency is making it a top priority to “to ensure that beneficiaries have access to the medications they need, including immunosuppressant drugs.”

OPIOID OPTICS

— And here are a few more good reads: 

MEDICAL MISSIVES
The confrontation followed a POLITICO report that Primus called Medicare for All an unhelpful distraction during a closed-door meeting.
Politico
Two Democratic senators rolled out a proposal Tuesday that would allow anyone to buy Medicare plans, a proposal they say is a more realistic than proposals like Medicare for all that would eliminate private insu
The Hill
As the Trump administration pushes less regulated health insurance plans that don’t have to follow Obamacare rules, patients are at growing risk of getting duped.
Los Angeles Times
INDUSTRY RX
A new wave of websites turns physicians into mere gatekeepers for popular lifestyle drugs, increasing public health risks, experts say. The sites say they ease connections with doctors.
New York Times
REPRODUCTIVE WARS
President Trump launched into a diatribe against socialism, late-term abortion and reveled in the fact that Joe Biden seems to have been “taken care of” in a sharp-edged speech at the National Republican Congressional Committee spring dinner last night.
Jacqueline Alemany
Natural Cycles is a fertility-tracking app the couple had built five years earlier. It’s also the first, and still the only, mobile application cleared for marketing as a certified contraceptive in Europe.
Bloomberg
STATE SCAN
Coakley will work on JUUL’s government affairs team, according to the company, which noted she has already been consulting for several months.
Boston Globe
Homeless patients accounted for about 100,000 visits to California hospitals in 2017, marking a 28% increase from just two years earlier. Health officials attribute the surge to the overall rise in…
Kaiser Health News
DAYBOOK

Today

  • The House Appropriations Subcommittee on Agriculture, Rural Development, Food and Drug Administration and Related Agencies holds a hearingon the FDA budget request for 2020.
  • Sen. Bill Cassidy speaks at the American Enterprise Institute discussion on paid family leave.
  • The House Veterans Affairs Committee holds a hearing on the Veterans Affairs budget request for 2020.
  • The House Appropriations Subcommittee on Defense holds a hearing on Defense health programs.
SUGAR RUSH

House Speaker Nancy Pelosi (D-Calif.) said allegations of unwanted touching against former vice president Joe Biden don’t disqualify him from the presidential race: