THE PROGNOSIS

President Trump and House Speaker Nancy Pelosi (D-Calif.) could hardly be more at odds — but behind the scenes, they’re still grasping at a bipartisan deal to lower the high cost of prescription drugs.

Pelosi’s office and the White House confirmed that the speaker's top health aide, Wendell Primus, spoke on the phone last week with Joe Grogan, director of the Trump's Domestic Policy Council. The conversation follows a meeting earlier this month between top administration health officials and Primus, who has been acting as the main go-between as the White House seeks broad action on drug prices.

“The lines of communication have been open on this topic with the speaker’s office,” White House spokesman Judd Deere told The Health 202.

Pelosi spokesman Henry Connelly stressed the conversations aren’t “negotiations” but instead center on the speaker’s own drug pricing legislation, which would allow the federal government to directly negotiate lower prices with private companies in Medicare’s prescription drug program.

But for Pelosi to get that bill passed into law — or at least elements of it — she would need approval from Trump, who has in the past supported the idea of allowing direct negotiations even though it’s anathema to congressional Republicans.

Were the pair to arrive at any agreement on drug prices, it would be in the face of enormous odds. In their public interactions, Pelosi and Trump have reached new levels of animosity in recent weeks, as she pursues an impeachment inquiry while he tweets angry insults at her.

Democrats' case for impeachment was strengthened yesterday, with testimony from the senior U.S. diplomat in Ukraine, the Post's Dan Balz writes. William Taylor's recounting of events "directly contradicts the president asserts that military assistance was withheld for months as Trump was demanding an explicit statement from Ukraine’s President Volodymyr Zelensky confirming that he would launch investigations the president wanted," Dan writes.

Meanwhile, this is how Trump has been tweeting about Pelosi over the past few weeks:

Yet Pelosi has dismissed the idea that Trump’s comments would cause her to stop working with him on the issue of high drug costs. She told reporters last week the president’s comments are “not important, in that regard.”

“We will do what we need to do for the good of the American people, and that has nothing to do with him,” Pelosi said. “There may be some collateral benefit to him, when we successfully achieve something for the American people, but there is no reason not to do it because there is a collateral benefit to him.”

If the two were to strike a deal, it would probably be within the next few weeks, before Congress leaves town for the Thanksgiving holiday. Meanwhile, Pelosi is moving quickly to get her own legislation through the House — although she’s running up against some resistance from liberals in her caucus.

In a private caucus meeting yesterday, multiple top Democrats complained the Pelosi legislation — now named the “Elijah E. Cummings Lower Drug Costs Now Act,” after the longtime congressman who died last week — doesn’t go far enough in allowing direct negotiations for Medicare, Politico reports.

The bill requires that the government negotiate lower prices for at least 35 drugs per year but no more than 250 drugs. While the pharmaceutical industry has complained that would eventually allow negotiations for virtually every drug covered by Medicare, House progressives have raised the opposite concern — that most drug prices would never be covered by the legislation.

Rep. Lloyd Doggett (D-Tex.) is among the loudest skeptics of the Pelosi measure as it currently stands, expressing frustration it doesn’t go far enough. The progressive group Public Citizen has also been demanding changes, including one that would completely remove a provision in the law explicitly banning the health and human services secretary from direct negotiations over drugs provided in Medicare.

Reps. Rosa DeLauro (D-Conn.) and Katie Porter (D-Calif.) argued during the caucus meeting that Democrats shouldn’t limit the number of drugs that could be negotiated, members present told Politico's Sarah Ferris and Heather Caygle. DeLauro acknowledged to them that “there are questions about the numbers of drugs covered.”

Yesterday the House Ways and Means Committee became the third committee to pass the Pelosi bill, after a markup that began in the morning and stretched into the evening. As in prior hearings, Republicans voiced deep disapproval of the bill, saying it amounts to government price-fixing and charging it would quash drug innovation.

"Republicans will not accept the cruel Democrat ‘trade-off’ of fewer cures," said Rep. Kevin Brady (Tex.), the committee's ranking Republican. "It’s not worth it to deny the hope of new medicines and cures from making their way to our loved ones. But that’s exactly what could happen if this bill ever becomes law."

FierceHealthcare's Robert King: 

S&P Global News's Donna Young: 

Bloomberg Government's Alex Ruoff: 

Rep. Drew Ferguson (R-Ga.): 

But polls show Americans in both political parties are deeply concerned about the cost of prescription drugs and want elected officials to do something about it. If Trump and Pelosi broker a deal, it will be because they both think it will provide an advantage to them among voters heading into the 2020 election.

“The polling has been clear that voters want to see progress on drug pricing and will vote accordingly,” said Rodney Whitlock, a former health policy aide to Sen. Chuck Grassley (R-Iowa). “It shouldn't be that surprising that staff are working to see what is possible. Given the policy overlap, compromise is clearly plausible.”

AHH, OOF and OUCH

AHH: A new analysis suggests an Alzheimer’s drug deemed a failure earlier this year was actually effective.

In March, clinical trials were suspended because an independent monitoring board said that treatment did not offer much hope of success. Now the board has reversed its position on aducanumab after new data from the discontinued studies showed that at high doses the drug reduced cognitive decline in patients with early Alzheimer’s, our Post colleague Tara Bahrampour reports.

Drug manufacturer Biogen now says patients who received the antibody saw “significant benefits on measures of cognition and function such as memory, orientation and language.” The company is planning to move forward to seek regulatory approval for the therapy in the United States as it also pursues discussions with international regulatory agencies.

“The FDA said on Monday that Biogen could file for approval for the drug; the company expects to do so in early 2020. Biogen said it aims to offer it to patients who were previously enrolled in those studies,” Tara reports. “If approved, aducanumab would become the first therapy to reduce the clinical decline of Alzheimer’s disease."

OOF: Numerous states and school systems are now letting students take mental health days.

Over the summer, Oregon enacted such a law that enables students to take days off school for mental health reasons. Before the new law, students there had five days of excused absences for physical illnesses, doctor appointments or family emergencies. In Utah, the state changed its definition of a legitimate excused absence to include mental health issues. There are similar laws in the works in Colorado, Florida and Washington.

These changes are emerging as youth are seeing increased rates of depression, anxiety and suicide, our Post colleague William Wan reports.

Hailey Hardcastle, a 19-year-old who helped advocate for the Oregon law told William: “High school can be a lonely, difficult place to begin with. But there’s so much more pressure these days — getting into college, the social pressure, even just the state of the world and what you’re exposed to with climate change, and everything going on with politics. A lot of times it can feel like the world is about to end.”

OUCH: Pacific Gas & Electric, California’s largest utility, warned residents in Northern California that more than 200,000 customers could experience preemptive power shut-offs as a way to curb wildfire risks amid dangerous fire conditions. Of the residents who could be impacted, 9,197 are “medical-baseline” customers who need electricity for various health reasons, our Post colleague Matthew Cappucci reports.

 “Each customer has been notified of the possible shut-off; electric-dependent customers with medical issues who have not responded to PG&E’s notification will be visited by a company employee,” he writes.

The company told residents there will be community resource centers available starting today that will have restrooms, bottled water, electronic-device charging and air-conditioned seating for anyone affected by the outages.

HEALTH ON THE HILL

— The Republican Study Committee, a group of House conservatives, says it has delivered on Trump's promise earlier this year that Republicans would be “the party of health care.” The group released a plan yesterday to repeal or reshape much of the 2010 Affordable Care Act, using its subsidies for private plans to instead fund insurance pools for high-risk patients and turning the money for Medicaid expansion into a block grant to states.

The plan would retain some of the ACA's protections for patients with preexisting conditions but undo its ban on annual and lifetime limits on covered benefits and its requirement that insurers cover preventive services for free. It would also let states decide which “essential health benefits” insurers must cover for enrollees. More than half of the 66-page document is spent criticizing the ACA and single-payer proposals.

“I had occasion to talk to the president again this morning and reminded him today is the big day for the rollout,” said RSC Chairman Mike Johnson (R-La.). “He was very encouraged by that and told me we should 'Go get 'em.' We are fulfilling the promise he's made and we all made when we ran for office.”

— Democratic presidential contender and former Texas congressman Beto O’Rourke rolled out part of a disability proposal last week to expand health-care coverage for medical equipment. It’s a plan that was in part inspired by his sister, Erin, who was born with intellectual disabilities.

O'Rourke spoke with our Post colleague Jackie Alemany in the first interview in which he’s talked in detail about Erin, saying his diability plan will be rolled out soon.

“It focuses on addressing what O’Rourke calls an ‘institutional bias that exists in federal funding and priorities right now’ against those with disabilities,” Jackie reports. “O’Rourke wants to ensure disabled individuals receive long-term home and community-based services and that the federal government provides states with additional funding for the disabled community. The proposal will also bolster existing protections supporting disabled individuals.” That includes a Supreme Court ruling that allows disabled individuals the right to live in a community with public support, rather than in an institution, and that requires that they can receive care in their own homes.

After Erin graduated from high school in Texas, she lived with O’Rourke. That’s when his family discovered there was a 18 to 20-year wait list to receive state-supported disability services. It’s also when he realized it was critical to provide his sister with some sort of independence.

“Making sure she received the help and care she needed really made an impact on me — as does meeting so many of these families with physical and intellectual disabilities who are working so hard to make sure their family members should live life to their full potential,” O’Rourke told Jackie.

REPRODUCTIVE WARS

— This week, a new massive Planned Parenthood clinic is opening in Illinois. It's set to be one of the largest abortion clinics in the Midwest region.

The clinic aims to serve about 11,000 women a year and is double the capacity of the clinic it’s replacing. It’s 15 miles from downtown St. Louis in Missouri, a state with strict abortion restrictions that has only one remaining abortion clinic.

“Its size says as much about the future as the present: With the Supreme Court’s shift to the right, activists on both sides of the abortion divide are adjusting their strategy, anticipating that Roe v. Wade, the 1973 Supreme Court decision that extended federal protections to abortion, might eventually be overturned and that some states would jump at the chance to ban abortions,” the New York Times’s Sabrina Tavernise reports. “For abortion rights advocates, one response is already taking shape: centers like this one that could provide services to women throughout their region — who could come from states where abortion is legal and states where it is not.”

“In a post-Roe world, this is crucial to our mission," said Yamelsie Rodriguez, president of Planned Parenthood of the St. Louis Region and Southwest Missouri, about establishing access for the region. 

Mallory Quigley, a spokeswoman for antiabortion group Susan B. Anthony List told Sabrina the new clinic signals the need for federal legislation limiting abortion. “It’s sickening to see Planned Parenthood set up these mega-centers,” Quigley said. “There’s no doubt that places like Illinois, California and New York are unlikely to change in the near future.”

— And here are a few more good reads: 

National
In Michigan, a Supreme Court ruling and an obscure law could help antiabortion groups pass more restrictions without the Democratic governor or a popular vote.
Reis Thebault
More than half of the patients accessing health care through Title X clinics are women of color and a third are Latina.
NBC News
Prescription drug companies and trade groups shelled out millions of dollars to lobby Congress as it considered legislation aimed at reining in skyrocketing drug prices, according to new lobbying disclosure reports. 
The Hill

TRUMP TEMPERATURE

Politics
About 13.4 million children were automatically certified for free school meals in the 2016-2017 school year.
Joe Davidson

MEDICAL MISSIVES

For the first time, U.S. health regulators have judged a type of smokeless tobacco to be less harmful than cigarettes, a decision that could open the door to other less risky options for smokers.
Associated Press

INDUSTRY RX

Business
“We were forced to write fake reviews for our products ... which came directly from Sunday Riley herself,” the Reddit allegation said. The Federal Trade Commission confirmed it.
Lateshia Beachum

DAYBOOK

Today

  • The House Veterans' Affairs Subcommittee on Economic Opportunity holds a hearing on protecting benefits for all servicemembers. 

SUGAR RUSH

If you buy a MAGA hat, where does your money go?