THE PROGNOSIS

The doorway is narrowing for President Trump and House Speaker Nancy Pelosi (D-Calif.) to broker a deal on lowering drug prices as Democrats pursue impeachment — but neither side has shut the door quite yet.

Administration officials met early this month with top Pelosi health aide Wendell Primus to discuss the speaker’s drug pricing proposal, for which the Congressional Budget Office released a partial cost estimate on Friday. The White House has notably refrained from criticizing the Pelosi bill — which would allow the federal government to directly negotiate lower prices for hundreds of Medicare drugs — even as congressional Republicans slam it.

Indeed, the Pelosi bill contains plenty that Trump might like, including tying some prices in Medicare to lower prices in other advanced economies — an approach the president has sought as a way to stop foreign “freeloading” off higher prices in the United States. Lobbyists and wonks say it’s possible to imagine a path forward for Trump and Pelosi, who have both promised to take on the high cost of prescription drugs.

But what began as a bipartisan effort this year could easily fracture as political tensions rise — and nothing ultimately happens to reduce the skyrocketing prices borne by American patients. 

“A bipartisan deal seems highly unlikely at this point,” said Shawn Gremminger, senior director of federal relations for the liberal patient advocacy group Families USA, adding that “it was only ever going to happen with Trump leaning hard on wary Senate Republicans.”

“With that not likely at this point, it is hard to see how a compromise can actually happen,” he said. “Plus, progressive voices making the case to not ‘give Trump a win’ on drugs are only growing louder, meaning even that side is likely to back off.”

The impeachment wheels will certainly be turning as Congress returns to Washington today after a two-week break:

—U.S. ambassador Gordon Sondland — who will be asked about Trump’s efforts to persuade Ukraine to investigate former vice president Joe Biden — will be deposed before House investigators on Thursday.

—On a Friday call with her caucus, Pelosi emphasized the focus of the inquiry should remain on Trump’s interactions with Ukraine, even as some Democrats have suggested the probe should be expanded.

“Democrats are doubling down on their Ukraine probe at lightning speed, scheduling additional closed-door depositions with Trump officials, including former National Security Council official Fiona Hill, and issuing new subpoenas to Trump associates for documents,” my colleagues Rachael Bade and Mike DeBonis report.

With this backdrop, it’s difficult to imagine all the pieces coming together for drug pricing changes, which would be difficult even under the best of circumstances. Pelosi has said she will continue negotiating on drug pricing even amid the impeachment investigation, but Trump called it a “camouflage” as she seeks election wins next year.

Then there’s the intense opposition from the pharmaceutical industry, whose influential lobbying group held a media briefing last week to lay out its opposition to not just the Pelosi bill but also a bipartisan proposal from the Senate Finance Committee.

“This will have a huge, negative impact on our members, but also for the ecosystem as a whole,” Stephen Ubl, president of the Pharmaceutical Research and Manufacturers of America, told reporters on Thursday. “This would be nuclear winter for organizations that rely on private investment for financing.”

In a shift from where PhRMA has stood in the past, Ubl notably said he’s open to and even wants legislation to lower drug prices — as long as it’s “balanced.”

The group supports legislation called the Creates Act, which would prevent branded drugmakers from guarding their medications so other companies can't develop alternatives. But it especially wants a ban on rebates drugmakers pay to pharmacy benefit managers and a cap on patient out-of-pocket costs in Medicare — both of which would raise costs for insurers, not drugmakers.

“I think we would like to see a balanced package emerge from the legislative process this year … as long as that product is balanced, that we actually solve the problems,” Ubl said.

Ubl said it would be “unfortunate” were the impeachment proceedings to derail drug pricing legislation — and said he thinks there is still room for a bipartisan deal.

“I think both the administration and Congress have a vested interest in some form of legislative accomplishment,” he said.

To Ubl’s point, lawmakers and policymakers are certainly talking a lot about drug pricing restructuring, both publicly and behind the scenes.

Administration officials have met with Republican Hill staffers, who would have a lot of work to convince their bosses to get on board with legislation allowing direct negotiations in Medicare. Republican staffers with the Energy and Commerce Committee and Ways and Means Committee hosted industry lobbyists in meetings last week, an aide told me.

Joe Grogan, head of the White House Domestic Policy Council, said he and other officials had a “great” conversation with Primus when they met to discuss a path forward. Grogan said he thinks there’s “an opportunity” to get there — but also said “it is a shame that [Democrats] have gotten distracted at this point.”

“We’ll see how all this stuff around impeachment ends,” Grogan said at an event held by the research firm Prevision Policy.

AHH, OOF and OUCH

AHH: A panel of federal appeals court judges appeared skeptical about the Trump administration allowing states to mandate that some adults work to maintain Medicaid coverage, our Post colleague Amy Goldstein writes.

A Justice Department attorney, Alisa Klein, told judges that the administration believes work requirements improve people’s health and can help them toward getting jobs and acquiring private health plans, which would alleviate the burden on public funds.

But during oral arguments in a pair of cases over Medicaid work requirements in Arkansas and Kansas, all three judges repeatedly said senior Trump health officials had neglected to consider that people would lose health insurance under the new rules, Amy writes.

“The other things you say may be laudable goals, but to say they outweigh the principal goal [of Medicaid] seems a bit strange,” Judge David B. Sentelle, the only Republican on the panel, told the attorney.

The cases could have major consequences for other states that have sought to implement such requirements.

OOF: Federal judges in New York, California and Washington state ruled against the Trump administration’s “public charge” rule to block immigrants from acquiring green cards if they are dependent or may become dependent on public benefits such as Medicaid.

The rule, which was set to take effect on Tuesday, would assess immigrants’ use of services including food stamps, housing or health care. The judges' decisions were the latest setback for the administration that has prioritized efforts to tighten the nation’s immigration system, our Post colleague Nick Miroff reports. New York Judge George B. Daniels called the rule “unlawful, arbitrary and capricious.”

Ken Cuccinelli, the acting director of U.S. Citizenship and Immigration Services, signaled the administration would appeal. “An objective judiciary will see that this rule lies squarely within long-held existing law,” Cuccinelli said in a statement. “Long-standing federal law requires aliens to rely on their own capabilities and the resources of their families, sponsors, and private organizations in their communities to succeed. The public charge regulation defines this long-standing law to ensure those seeking to come or stay in the United States can support themselves financially and will not rely on public benefits.”

“U.S. immigration laws have long held provisions allowing the government to bar immigrants who are considered at risk of becoming dependent on public support, but the Trump administration’s initiative would expand the types of benefits that could be taken into consideration, including Medicaid, food assistance and federal housing vouchers,” Nick reports. “Immigrant advocates and officials in several jurisdictions have claimed the measures have had a chilling effect even before their implementation, discouraging families from seeking medical care, shelter and food.”

OUCH: Federal health officials say some patients sickened with the mysterious vaping-related lung-illness are being hospitalized a second time. Authorities continue to investigate the spate of illnesses that has sickened at least 1,299 people across the country. At least 28 people have died in the outbreak.

“We are aware of a handful of patients who have been readmitted for clinical care after discharge for lung injury,” said Anne Schuchat, the principal deputy director at the Centers for Disease Control and Prevention, our Post colleague Lena H. Sun reports

“The hospital readmissions have taken place as quickly as five days and up to 55 days after discharge, Schuchat said. It’s not known what triggered the relapses. In some cases, patients had resumed vaping,” Lena adds. “It’s also possible that initial lung damage made patients more vulnerable to other illness. Another possibility, she said, is that treatment with steroids, which many clinicians have been using to care for such injuries, may ‘set you up for increased infection risk.’ ”

“We are not seeing a meaningful drop-off in new cases, and unfortunately many more people have been hospitalized with lung injury each week,” Schuchat said during a news conference. Officials still don’t know what’s causing the illnesses and she added there may end up being more than one cause.

HEALTH ON THE HILL

— The House Energy and Commerce Committee and the Massachusetts attorney general’s office are both investigating whether manufacturers of vaping products used social media bots to push their products and market e-cigarettes with misleading information.

The committee sent information requests to five manufacturers, calling for details including what usernames were used and whether the bot accounts noted their ties to the companies, the Wall Street Journal’s John D. McKinnon reports. It’s the latest probe from lawmakers and officials into how such products are being marketed and sold amid concerns about youth vaping.

“Two major players, Reynolds American Inc. and Juul Labs Inc. haven’t used bots, according to spokesmen. NJOY LLC also hasn’t used bots, according to a person familiar with the matter. Japan Tobacco International USA Inc. said it hasn’t used bots either. Another firm contacted by the House committee, Fontem Ventures, didn’t respond to requests for comment,” John reports.

“Social-media bots are programmed accounts that automatically conduct tasks such as generating messages and reposting content,” he adds. “There is nothing inherently wrong with their use, which is widespread on the internet. But they can be used for everything from pumping up a user’s social-media following to padding an online advertisement’s audience to amplifying phony marketing claims.”

OPIOID OPTICS

— A bankruptcy judge ruled to temporarily halt legal action against Purdue Pharma and its embattled owners, the Sackler family.

The ruling pauses action for three weeks in the numerous state and federal lawsuits against the company and Sackler family members. During that time, the opioid manufacturer “agreed to address one of the key concerns — access to more information about the Sacklers’ finances — raised by state attorneys general who objected to including the family in the temporary injunction,” our Post colleague Renae Merle reports.

The company had initially asked for a 180-day stay. “The company argued that halting litigation was necessary to allow progress on a tentative settlement with more than 2,600 plaintiffs who have accused Purdue of deceptively marketing its blockbuster opioid pain pill, OxyContin,” Renae reports. “Without that protection, the Sacklers had said they may back out of the settlement, valued at $10 billion to $12 billion. As part of that deal, the Sacklers agreed to relinquish control of their firm and contribute at least $3 billion to the settlement.”

— Renae and our colleague Lenny Bernstein wrote last week about why the company chose to file for bankruptcy in White Plains, N.Y., despite being headquartered in Connecticut and incorporated in Delaware.

“Large corporations have considerable flexibility in choosing where to file bankruptcy. Purdue’s choice didn’t surprise bankruptcy experts,” they wrote. “ … Sens. Elizabeth Warren (D-Mass.) and John Cornyn (R-Tex.) introduced legislation last year to tighten the rules around where companies can file for bankruptcy, but the bill was not brought up for a vote.”

MEDICAL MISSIVES

— California’s Pacific Gas & Electric proactively cut off the power to hundreds of thousands of customers last week to curb potential wildfire risk.

The rolling outages that lasted from early Wednesday until the power was restored for all customers Saturday were especially stressful for residents who rely on electricity for a variety of medical needs, such as machines to help with sleep apnea.

“Few understood what the challenges would be until they were in the dark: a mom who couldn’t refill her son’s medication for bipolar disorder; a man with schizophrenia who couldn’t quiet the voices in his head without the television on; the people on dialysis who had to travel to another town,” the Los Angeles Times’s Anita Chabria and Taryn Luna report. “In El Dorado County, just northeast of Sacramento, an elderly man died minutes after apparently losing power to his CPAP machine, according to a report from the local fire agency, though an autopsy listed severe coronary artery atherosclerosis as the cause of death.”

In Lake County, which is one of the poorest in the state, there are 2,000 residents who get in-home services because of disabilities or because they are elderly. “There seemed to be little in the way of a safety net beyond inexpensive meals at the senior centers and charging stations around the lake set up by PG&E. Many complained that reliable information was hard to find,” Anita and Taryn write.

— And here are a few more good reads: 

The Democratic presidential candidates agree on many gun control measures, like an assault weapons ban. But they’re split on other ideas, like a federal gun registry.
New York Times

AGENCY ALERT

Arkansas’ experience in implementing work requirements for Medicaid recipients—a program halted by a federal judge—illustrates the potential pitfalls for the growing number of states pursuing their own measures.
Wall Street Journal
The department of health and human services advised doctors that cutting off pain patients' prescriptions could do more harm than good.
ABC News

INDUSTRY RX

After being contacted by BuzzFeed News, the platform took down some of the videos. Vaping-related injuries continue to climb by the day.
BuzzFeed
True Crime
Experts say Kaylene Bowen-Wright's behavior suggests a diagnosis of Munchausen by proxy.
Kayla Epstein

STATE SCAN

California will become the first state in the nation to require public universities to provide access to abortion pills on campus under a bill signed by Gov. Gavin Newsom on Friday.
Los Angeles Times

DAYBOOK

Coming Up

  • The Senate Special Committee on Aging holds a hearing on national, state, and local solutions to better support seniors on Wednesday.
  • The House Veterans’ Affairs Subcommittee on Oversight and Investigations holds a hearing on Assessing VA’s Systems for Protecting Veterans from Clinical Harm on Wednesday.

SUGAR RUSH

The Fact Checker's running list of Trump's false or misleading claims: