House leaders are eyeing early May for a vote on measures aimed at lowering the high cost of prescription drugs, as Democrats and Republicans alike try to prove they’re serious about taking on the troubling issue this year.
The potential legislative package would draw from a slate of bills recently passed by House Ways and Means and House Energy and Commerce, the two top committees with health-care jurisdiction. These bills include measures requiring more transparency from drug middlemen and drug makers, banning branded drug makers from stifling competition by paying off generic makers or limiting their ability to withhold drug samples.
The measures, while they would bring more transparency and competition to highly complex and opaque world of drug prices, are relatively limited in scope. But they may be all Congress is able to pass on a bipartisan basis.
Still, lawmakers in both parties say they’re determined to do something -- after spending the last few months hauling industry executives up to Capitol Hill and demanding that they explain why prices are higher than in any other country.
“It’s our duty to understand how the system is working today and what we can do to improve it,” Senate Finance Chairman Chuck Grassley (R-Iowa) said at a Tuesday hearing where five pharmacy benefit manager executives testified.
The House and Senate committees with health-care jurisdiction have held nearly a dozen hearings on drug costs so far this year. They’ve launched investigations into why drug makers have hiked prices so dramatically in recent decades. They’ve brought in top drug executives and makers of the top-prescribed insulins to browbeat them over charging patients so much for life-saving medications.
“The status quo is not going to continue – it can’t,” Rep. Joe Kennedy (D-Mass.), told executives for Sanofi, Eli Lilly, Novo Nordisk, CVS Health, Express Scripts and OptumRx at an Energy and Commerce oversight subcommittee hearing yesterday.
Kennedy chided the executives for shifting blame onto other parties, as the drug makers blamed pharmacy benefit managers for demanding huge rebates and the PBMs complained that drug makers push list prices ever higher.
“I can tell you how frustrating it is to be on this side of the dais and watch everyone of you do this,” Kennedy said.
House Energy and Commerce Committee:
Nobody should have to stockpile insulin in their fridge. Today, we’re demanding answers from manufacturers and pharmacy benefit managers about why the price of insulin continues to skyrocket out of control. #InsulinHearing https://t.co/o25sU0WzTm— Energy and Commerce Committee (@EnergyCommerce) April 10, 2019
From the Kaiser Family Foundation:
Total Medicare #PartD spending on insulin increased by 840% from $1.4 billion in 2007 to $13.3 billion in 2017, including what Medicare, its beneficiaries and drug plans pay (before rebates). https://t.co/fLJdY7jW5D pic.twitter.com/VnxNT3gq8P— Kaiser Family Foundation (@KaiserFamFound) April 10, 2019
Bloomberg Government's Alex Ruoff:
Mike Mason of Eli Lilly said 70% of the price for the company's insulin products are to account for rebates (these are meant to be discounts to make drugs more affordable).— Alex Ruoff (@Alexruoff) April 10, 2019
Pharmaceutical Care Management Association, the lobbying group for PBMs:
#PBM #rebates are just 31% of the discounts and #rebates from manufacturers. Or, conversely: PBM rebates are just 45% of the rebates from manufacturers. #drugpricecs #drugpricing #pharma #biotech #diabetes #Insulin @EnergyCommerce— PCMA (@pcmanet) April 10, 2019
Kennedy’s frustration is shared by many members of Congress, who at hearings have tried to corner executives into admitting they share some of the blame for high drug prices. The pressure coming from Capitol Hill has already prompted several drug makers to announce savings programs for certain medications; Express Scripts said last week it will ensure many patients pay no more than $25 per month for insulin and yesterday Sanofi announced a program to lower insulin costs to $99 a month for uninsured patients.
But how much drug makers should actually worry remains to be seen. The Trump administration has backed away from the president’s campaign promises to allow the government to directly negotiate lower drug prices in the Medicare program – an approach Republicans view as price fixing. But the administration has still been unusually aggressive on the matter, proposing to link some Medicare drug payments to an international index.
The Chamber of Commerce and the American Conservative Union has vocally opposed that idea, which the administration has yet to propose as a formal rule. Grassley, too, has appeared skeptical of it. But Health and Human Services Secretary Alex Azar told Stat News he’s optimistic that GOP members of Congress are carefully considering the idea.
“Let me put it this way: I don’t think you’ve seen any Republican leadership or Republican chairman come out firmly against what we’re doing,” Azar told Stat. “They’re remaining open-minded and considering it.”
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AHH: The Trump administration has appealed a pair of federal court rulings that blocked programs in Kentucky and Arkansas requiring able-bodied Medicaid beneficiaries to work in order to qualify for coverage.
A federal judge in Washington had said the Trump administration had been “arbitrary and capricious” in allowing the work requirements without considering the impact on vulnerable individuals, our Post colleague Amy Goldstein reports.
“The appeals are part of a series of attempts by the administration to persist with policy changes — largely involving health care, the environment and immigration — that federal courts have blocked,” she adds.
Arkansas Gov. Asa Hutchinson (R), who had urged the Trump administration to appeal, applauded the Justice Department’s move, and said “he understood that the department plans to ask the D.C. circuit for an expedited appeal — a move that the governor said ‘should put this case in the position to get to the United States Supreme Court, if necessary, in a timely fashion.’”
OUCH: As suicide rates are increasing nationwide, the rate of suicide deaths among older adults may be overlooked. This important but troubling six-month investigation from Kaiser Health News and PBS NewsHour found “older Americans are quietly killing themselves in nursing homes, assisted living centers and adult care homes.”
Kaiser Health News conducted an analysis of data from the University of Michigan and found hundreds of suicides by older adults every year may be related to long-term care. “Thousands more people may be at risk in those settings, where up to a third of residents report suicidal thoughts, research shows,” Melissa Bailey and JoNel Aleccia write.
These suicides are raising questions about the facilities where they're taking place. “[T]he fact that frail older Americans are managing to kill themselves in what are supposed to be safe, supervised havens raises questions about whether these facilities pay enough attention to risk factors like mental health, physical decline and disconnectedness — and events such as losing a spouse or leaving one’s home,” they write.
Representatives of the long-term care industry insist suicides at these facilities are tragic but rare. “I think the industry is pretty attuned to it and paying attention to it,” David Gifford of the American Health Care Association told Melissa and JoNel, acknowledging mental health issues in older adults should be addressed. “I don’t see this data as pointing to a problem in the facilities.”
OUCH: The Centers for Disease Control and Prevention says there have been at least 587 confirmed cases of an emerging fungus infection officials are calling a “serious global health threat.”
The nearly 600 cases of Candida auris infections have emerged over the last few years and have been largely reported in the New York City area, Chicago area, and in New Jersey, the North Jersey Record’s Kaitlyn Kanzier and Lindy Washburn report. The CDC said by the end of February, the infections had spread across 12 states.
“Found in hospitals and long-term care facilities, it can quickly lead to death in patients who have weakened immune systems or other underlying serious medical problems,” Kaitlyn and Lindy write. “More than one in three patients with an invasive infection of the fungus has died, the CDC said.”
— Sen. Bernie Sanders (I-Vt.) unveiled a revised version of his Medicare-for-all plan, calling for a replacement of the current “dysfunctional” health-care system that he said it based on “greed and profiteering.”
“Together we are going to end the international embarrassment, of the United States of America, our great country, being the only major nation on earth not to guarantee health care to all as a right,” Sanders said at an event on Capitol Hill. “This is a struggle for the heart and soul of who we are as American people.”
The Health 202 yesterday previewed Sanders’s ambitious, expanded plan that goes far beyond what he initially introduced back in 2017.
Sanders’s event unveiling the plan alongside activists and medical industry professions “underscored how much headway Sanders has made among Democrats in pushing what was viewed as a fringe idea during his last presidential bid,” our Post colleagues John Wagner and Sean Sullivan report. Fellow 2020 contender Sen. Kristen Gillibrand (D-N.Y.) and Sen. Jeff Merkley (D-Ore.) joined the kick-off event.
In a statement, White House press secretary Sarah Sanders panned the proposal, instead touting a plan the president has vowed to produce.
“Self-proclaimed socialist Senator Bernie Sanders is proposing a total government takeover of healthcare that would actually hurt seniors, eliminate private health insurance for 180 million Americans, and cripple our economy and future generations with unprecedented debt,” Sarah Sanders said. “The Trump Administration is working on realistic solutions to provide Americans with the options and control they want, the affordability they need, the ease they expect, and the quality they deserve, rather than forcing a government takeover of the healthcare system.”
GOP lawmakers piled on the criticism after Sanders’s event.
Senate Majority Leader Mitch McConnell (R-Ky.):
From the Green New Deal to Medicare for None, it’s ironic that so many Democrats are choosing to pivot to socialism just as Republican policies are helping create an incredible economic moment for the American people.— Leader McConnell (@senatemajldr) April 10, 2019
Sen. Marsha Blackburn (R-Tenn.):
Medicare for All would 1) eliminate the private health insurance plans of over 181 million Americans, 2) put private health insurance companies out of business and 3) increase taxes on middle class families. Medicare for All = Medicare for None.— Sen. Marsha Blackburn (@MarshaBlackburn) April 10, 2019
Others praised the plan. Sen. Mazie Hirono (D-Hawaii):
Health care is a right, not a privilege reserved only for those who can afford it. We must move toward universal coverage to ensure everyone can afford high-quality, comprehensive health care. Medicare for All is one way to get there, and I am proud to be a cosponsor.— Senator Mazie Hirono (@maziehirono) April 10, 2019
— Senate Republicans may try to force a vote on the Medicare-for-all bill as a way to put their Democratic colleagues on the spot. It’s a similar strategy that Senate Majority Leader Mitch McConnell (R-Ky.) used on the “Green New Deal” recently.
“McConnell has not yet said whether he’ll bring the health care bill, introduced Wednesday, up for a vote, but some Republicans are hopeful he will,” Politico’s Marianne Levine, Adam Cancryn and Alice Miranda Ollstein report. “I think it deserves a full debate and a vote and see how many Democrats who are co-sponsors actually support it,” Sen. John Barrasso (R-Wyo.) told them.
— The Democratic candidates for president have so far embraced gun control more enthusiastically than in any recent election, a notable shift our Post colleague Matt Viser writes is reflective of a move to appeal to highly educated voters in cities and suburbs.
The shift also signals a “general-election battle that could test the party’s liberal surge against a deep attachment to gun culture in many parts of the country, including some areas that Democrats hope to wrest from President Trump,” Matt writes.
By comparison, he recalls former president Bill Clinton touted his participation in duck hunts as a candidate, even though he favored gun restrictions.
“The political calculus has changed pretty dramatically,” said John Feinblatt, president of Everytown for Gun Safety. The shift has in part been driven by a spate of school shootings and the activism that has emerged as a result.
Four years ago, The Post found 15 of 17 Republican contenders owned at least 40 guns among them. In a survey of the 18 Democrats currently running, The Post found six own guns.
— The U.S. Court of Appeals for the 5th Circuit granted a motion yesterday to hold a hearing in July on the lawsuit backed by the Trump administration to overturn the Affordable Care Act, the Associated Press reports.
The order from Judge Leslie Southwick does not specify the date of oral arguments, but defenders of the ACA are expecting them to take place between July 9 and July 12.
The order follows a request from the Justice Department to expedite the hearing, thought the request indicated other parties in the case did not oppose the timeline. “For the sake of protecting America’s families, the misguided lawsuit against the ACA must be resolved quickly,” California Attorney General Xavier Becerra, who leads the coalition of states defending the health care law, said in a statement.
More, #breaking: Per the 5th Circuit's court schedule, we now anticipate a hearing in TX v US, in which the health of millions of Americans are on the line via the ACA, to take place at some point between 7/9 & 7/12... #AffordableCareAct #ProtectOurCare— Sarah Lovenheim (@lovenheim) April 10, 2019
— Federal prosecutors have charged British drugmaker Indivior with deceiving health-care providers in a "nationwide scheme" over its drug Suboxone that's used to treat opioid addiction. The indictment alleges Indivior convinced them the treatment was “safer, less divertible, and less abusable than other opioid-addiction treatment drug,” prosecutors said, Bloomberg’s Drew Armstrong and Riley Griffin report.
“Federal prosecutors in the Western District of Virginia said Indivior’s deceptions had contributed to an epidemic that has killed thousands of people,” they write. They allege the company marketed the drug in a way that promoted misuse, and looked to help “connect patients to doctors it knew were prescribing Suboxone and other opioids to more patients than allowed by federal law, at high doses, and in suspect circumstances.”
But Indivior’s chairman Howard Pien insists the government misread the science around the medication. “We wish the Justice Department had taken an alternative path, because their indictment simply can’t be justified based on any fair reading of the facts or the law,” he said in a statement.
— And here are a few more good reads:
- The National Academies of Sciences, Engineering and Medicine holds a workshop on health literacy in clinical trials.
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