THE PROGNOSIS

It’s do-or-die time on drug pricing when Congress returns to Washington in a few weeks.

That’s how stakeholders are viewing the whole messy effort to take major action to lower the high prices of prescription medicines in the United States — a top-polling worry among voters that President Trump has repeatedly promised to tackle.

If lawmakers don’t find a bipartisan way forward this fall, prospects for anything substantial happening will fade as the 2020 election ramps up and Democrats become even less willing to play ball.

“I think, honestly, if Congress doesn’t act on drug pricing by January … then it becomes very, very difficult because we’ll be in full election mode then,” David Mitchell, founder of the activist group Patients for Affordable Drugs Now, told me.

Trump has made clear — extremely clear — that he wants to deliver something he could term a “win” on prescription drugs by ramping up pressure on pharmaceutical companies and ultimately lowering prices. He has two main routes: either through legislative action, which would have to come from a deal struck between the administration and the Democratic-led House, or through executive branch regulations.

But the whole project, opposed fiercely by the pharmaceutical industry, is convoluted, and its outcome is still unclear.

As we’ve previously detailed in The Health 202, the clearest legislative route is through a bipartisan but nonetheless controversial bill capping, for the first time ever, how much drugmakers could increase the prices of medications in the Medicare program.

Senate Finance Committee Chairman Chuck Grassley (R-Iowa), under heavy pressure from the administration to advance the measure, is furiously lobbying his fellow Republicans to support the legislation, after just six voted to pass it in committee last month. Toward that end, he and Sen. Ron Wyden (Ore.), the committee's ranking Democrat, are eyeing some modifications including getting at the rebates collected by pharmacy benefit managers and ensuring more of the bill’s savings go directly to seniors.

Consumer advocates are working hard, too. Today, Patients for Affordable Drugs will launch a seven-figure ad campaign in six states targeted at Republican senators who Mitchell told me he considers persuadable. The ads, which urges support for the Grassley measure, will run in Iowa, Louisiana, Texas, Ohio, Montana and Indiana.

The version of the ad running in Iowa:

Then there are the administration’s actions. Health and Human Services Secretary Alex Azar has suffered two hefty setbacks, recently tabling an aggressive proposal banning pharmacy rebates and seeing a court block a separate regulation requiring the display of drug prices in television ads.

But he and Trump have at least two other irons in the fire: a proposal to tie some Medicare drug prices to an international index and a potential executive order to allow some drug imports from Canada.

And then there’s the move Republicans would dislike most of all: Allowing Medicare to negotiate directly with drugmakers for lower prices. House Democrats are expected to roll out their own proposal along those lines next month, but House Speaker Nancy Pelosi’s (D-Calif.) office has been engaged with the administration in discussions about a potential deal.

Grassley has warned his fellow Republicans that they might have to swallow such actions if they don’t support his bill.

“Look at what’s down the road,” Grassley said after the Finance Committee’s 19-to-9 vote advancing the bill. “It seems to me the Grassley-Wyden approach is a very mild approach to what could come out. There ought to be a realization on the part of Republicans about this and there ought to be a realization on the part of pharmaceutical companies where they would be.”

If there weren’t already enough factors in play, consider this: a challenge to the Affordable Care Act that could end up dismantling the whole law. The U.S. Court of Appeals for the 5th Circuit is expected to rule on the high-profile lawsuit this fall. If it strikes the health-care law, that could spell doom for any bipartisan effort on health care this year, period, given the administration’s refusal to defend the law in court.

But for now, patient advocates are remaining hopeful.

“I’m not trying to be Pollyanna, but everyone wants to do something on drug pricing,” Mitchell said. “In both parties there is strong energy to do something. The question is how much.”

To readers: The Health 202 will publish on Tuesdays, Wednesdays and Thursdays this week and next and will take a break the week of Aug. 26 before returning full-time in September.

AHH, OOF and OUCH

AHH: One of the largest-ever surveys on views about abortion found that although support for the procedure remains steady, there are deepening partisan divides on the issue.

A 54 percent majority of Americans say abortion should be legal in all or most cases, while 40 percent say it should be illegal, according to the Public Religion Research Institute survey released yesterday, our Washington Post colleagues Ariana Eunjung Cha and Scott Clement report. But the survey found the gap between Democrats and Republicans on support for the procedure increased from 28 to 36 points in the past four years.

In no state are there more than a quarter of residents who reported supporting a total ban on abortions. “States with the largest proportion of residents who say abortion should be illegal in all cases are Louisiana at 23 percent; Mississippi at 22 percent; and Arkansas, Nebraska, Tennessee at 21 percent,” our colleagues write. “Many of these same states have moved to restrict abortion in recent months through legislation, administrative measures, and in courts.”

OOF: Two counties in California are suing the Trump administration to try to stop it from implementing a new  rule making it more difficult for legal immigrants to obtain a green card if they use public benefits such as food stamps or housing assistance.

“Officials with Santa Clara County and San Francisco said in a lawsuit filed Tuesday that the ‘public charge’ rule ‘coerces’ legal immigrants into dropping out of public health, food and housing programs, which could lead local governments to carry the burden of millions of dollars in public assistance,” our colleague Maria Sacchetti reports. “The jurisdictions asked a judge with the U.S. District Court for the Northern District of California to block the policy immediately.”

The Health 202 wrote yesterday about new public charge rule, under which officials could consider the age, health, assets, financial and family status, education level and resources when considering whether to approve a green card.

“Lawyers for Santa Clara County and San Francisco said the Trump administration is trying to scare immigrants away from desperately needed public assistance, and they warn that the broader community could suffer from higher local assistance costs or the spread of diseases due to a lack of health care,” Maria writes. “Untreated tuberculosis or Zika could lead to public outbreaks, they say.”

— California Attorney General Xavier Becerra also announced last night he's preparing to sue the Trump admnistration on behalf of the entire state. 

"We think it’s un-American" Becerra told CNN's Anderson Cooper last night. "It’s unlawful and it would destroy good portions of our economy if we were to allow a rule like this to take effect."

OUCH: An influential national panel of health experts is now recommending that doctors screen all adult patients for illicit drug use. It’s the first time the U.S. Preventive Services Task Force, an independent panel appointed by the Department of Health and Human Services, is making such a recommendation, in hopes that such screening by health-care providers can slow the opioid epidemic.

The draft guidelines said “that health providers should attempt to determine whether their patients 18 or older are using illicit drugs, including nonmedical use of prescription drugs. But the panel said it did not have enough information to decide whether all adolescents should be screened,” our Post colleague Lenny Bernstein reports

The panel cited a 2017 national survey that found 11.5 percent of Americans ages 18 and older were using illegal drugs. That year, 70,237 people died of drug overdoses across the country, Lenny writes. The task force “suggested several questionnaires, administered by health care providers or taken by patients on their own, that it said were effective in picking up illicit drug use.”

HEALTH ON THE HILL

— The House Judiciary Committee is expected to return a week early from its August recess to consider a set of gun-control measures, but our Post colleagues Rachael Bade and Paul Kane report there’s disagreement among Democrats privately over what measures to advance.

While Democrats agree on expaning background checks and have also united around ideas including so-called “red flag” laws and the restriction of high-capacity magazines, there’s disagreement about whether to approve legislation to reinstate an assault weapons ban that expired 15 years ago. Rep. David N. Cicilline (D-R.I.), a member of Speaker Nancy Pelosi’s (D-Calif.) leadership team, wants to vote on an assault weapons ban; Pelosi’s team “worries that the chamber won’t have the votes to pass that bill, however, and hopes to focus instead on supporting gun legislation that could garner bipartisan backing.”

In the meantime, Democrats have publicly targeted Senate Majority Leader Mitch McConnell (R-Ky.) for inaction on gun legislation, including for refusing to take up a background checks bill the House has already passed.

— In the wake of recent mass shootings, Democrats are calling on the Senate to return from recess to consider the House background checks bill and urging Pelosi to call the House back into session to pass other aggressive gun measures. And just like that, the issue of the August recess has become a political cudgel amid a the gun-control debate, Paul writes.

And Trump told reporters yesterday he believes the Senate Republican leader is poised to act on at least one gun measure. “I am convinced that Mitch wants to do something,” Trump said. “He wants to do background checks.”

 — Over the weekend, volunteers working with the advocacy arm of the Alzheimer’s Association pushed Democratic candidates at the Iowa State Fair about their plan to fight the disease.

The volunteers, with the Alzheimer’s Impact Movement, want the issue to be central ahead of the 2020 campaign, Stat’s Nicholas Florko reports, and volunteers have been swarming campaign events across the country.

“But a candidate’s stance on any disease — whether it be cancer, Alzheimer’s or heart disease — isn’t going to win him or her the election, according to Bob Blendon, a Harvard University professor and an expert on health care politics,” Nicholas writes. “While voters care about disease — and Alzheimer’s consistently ranks among the most important diseases to voters — the issue alone is unlikely to swing voters, he said.”

But for advocacy groups, a key strategy is to get candidates to talk about and advance the issue, a way to increase the odds that politicians will take action on the issue in the future. To that end, some Democratic presidential candidates have released plans to address Alzheimer’s, including Sen. Amy Klobuchar (D-Minn.), who released a plan that includes expanding what services are covered by Medicare, and former Texas congressman Beto O’Rourke, who has called for doubling funding for federal research on Alzheimer’s.

— And here are a few more good reads: 

TRUMP TEMPERATURE
Critics worry the delays come at a steep cost: Medicare paying for millions of unnecessary exams and patients subject to radiation for no medical benefit.
Kaiser Health News
OPIOID OPTICS
It can be hard enough finding a doctor who prescribes buprenorphine, a medication used to treat opioid addiction. But patients also report difficulty with pharmacies that refuse to stock the drug.
NPR
MEDICAL MISSIVES
The flight attendant, who had reportedly received one of two immunizations, had been in a coma since April.
Morgan Krakow
Two Ebola patients who were treated with new drugs in the city of Goma in eastern Congo have been declared “cured” and returned to their home. Top doctors fighting Ebola quickly used the case on Tuesday to press the message that people can recover from the potentially deadly disease if they seek proper care.
Associated Press
INDUSTRY RX
Juul, worried about further damage to its reputation as it tries to remake its public image, has filed lawsuits and a complaint with the International Trade Commission.
New York Times
States increasingly expect to see insurers enter or re-enter ACA marketplaces next year. That’s a critical sign that these exchanges are growing less risky for insurers despite ongoing political an…
Kaiser Health News
DAYBOOK

Today

  • The House Financial Services Committee holds a hearing in Los Angeles on the homelessness crisis.
SUGAR RUSH

Why the Iowa State Fair is key for presidential candidates: