THE PROGNOSIS

The drug pricing bill with the best chances of passing Congress is getting a makeover, as its authors and the White House try to make it more attractive in a last-ditch effort to notch a win on lowering drug costs before the 2020 election season.

Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.) are poised to unveil a 2.0 version of their Prescription Drug Pricing Reduction Act of 2019, which caps out-of-pocket costs for Medicare enrollees and requires drugmakers to pay rebates if they hike prices faster than inflation. The revisions, which the White House says it supports, are expected to bring further cost relief to seniors, and aides predict the bill could win much-needed support from more GOP lawmakers.

“The skeleton is the same, but we do believe it will be much more popular with members and their constituents,” an aide working on the legislation told The Health 202.

The effort comes as President Trump is struggling to make good on his promise to lower steep drug prices in the United States. Despite making it a top priority and releasing a blueprint with policy ideas a year and a half ago, his administration has been forced to walk back or delay a number of key initiatives, including a proposal to ban the rebates drugmakers pay to pharmacy middlemen and an index tying the prices of some drugs in Medicare to prices in other countries.

Grassley and Wyden's measure could be the only realistic venue at this point, although it’s looking unlikely Senate Majority Leader Mitch McConnell will schedule the bill for a floor vote in the remaining days before the holiday break. It’s more likely that parts of the bill could be folded into a larger spending bill.

Another obstacle: Grassley and Wyden are retaining their bill’s most controversial provision — the mandatory rebates from pharmaceutical makers — which has caused many Republicans to distance themselves from the legislation.

Nine of 15 Republicans on the Senate Finance Committee voted against the bill over the summer. Several senators who are vulnerable next year — including Sens. Thom Tillis (R-N.C.), Cory Gardner (R-Colo.), Joni Ernst (R-Iowa) and Martha McSally (R-Ariz.) — haven’t signed on to the bill, which the pharmaceutical industry mostly opposes.

Instead, the senators are expected to smooth out when seniors pay the $3,100 out-of-pocket cost maximum they must pay before full coverage kicks in. For seniors with expensive drug needs, those costs can be burdensome at the beginning of the year before the cap has been reached. Senate aides are looking at ways to include a monthly cap so those out-of-pocket expenses are more spread out throughout a plan year.

A senior White House official confirmed to The Health 202 that’s a change it is seeking. “The White House would like to cap out of pocket costs for seniors on a monthly basis,” the official said.

The measure already includes a provision curbing costs for Medicare enrollees with a first-ever annual cap on their out-of-pocket spending. Under current law, seniors must still cover 5 percent of the cost of drugs after their spending is enough to reach what’s known as the “catastrophic” phase of coverage. That leaves some seniors on extremely expensive medications vulnerable to steep costs.

Skyrocketing drug costs have thrown the problem into sharp relief. Now, more than 1 million Medicare patients now have such high out-of-pocket costs that they hit that “catastrophic” phase of coverage. That’s up from 380,000 such patients a decade ago. Some patients must pay $10,000 or more every year for a single drug.

Patient advocate groups have endorsed the Grassley-Wyden measure as well as a Democratic-backed drug pricing bill from House Speaker Nancy Pelosi (D-Calif.), which includes a $2,000 out-of-pocket cap. But they’ve also been pushing for further relief for seniors with the monthly cap now being contemplated by the senators.

“The out-of-pocket cap in the bill is an important protection and improvement for beneficiaries,” said Megan O’Reilly, vice president of AARP’s federal health and family team.

AHH, OOF and OUCH

AHH: Hospital groups are suing the Trump administration over a federal rule that would force them to disclose negotiated discount prices that they give insurers, alleging that the rule is “unlawful, several times over.”

The American Hospital Association and other hospital groups “argued that the administration exceeded its legal authority in issuing the rule last month as part of its efforts to make the health care system much more transparent to patients. The lawsuit contends the requirement to disclose their private negotiations with insurers violates their First Amendment rights,” the New York Times’s Reed Abelson reports.

The Trump administration’s rule is intended to help patients as they shop for various services. “Hospitals should be ashamed that they aren’t willing to provide American patients the cost of a service before they purchase it,” Health and Human Services spokeswoman Caitlin Oakley told the Times in a statement. “President Trump and Secretary Azar are committed to providing patients the information they need to make their own informed health care decisions and will continue to fight for transparency in America’s health care system.”

“The administration’s efforts to push the industry to make more information public to patients faces a real legal challenge, and it has been unsuccessful in earlier attempts,” Reed writes.

OOF: The Trump administration has finalized a rule that tightens work requirements under the Supplemental Nutrition Assistance Program, a change that could mean hundreds of thousands lose access to food stamps.

“Under current law, able-bodied adults without dependents can receive SNAP benefits for a maximum of three months during a three-year period, unless they’re working or enrolled in an education or training program for 80 hours a month,” our Washington Post colleague Laura Reiley reports. “But states have been able to waive this time limit to ensure access to food stamps during the ups and downs of reentering the workforce. Before this rule, counties with an unemployment rate as low as 2.5 percent were included in waived areas.”

The new rule would set the minimum unemployment rate for counties to receive a waiver at 6 percent.

Trump administration officials, who say the change will save the federal government $5.5 billion over five years, estimate 688,000 individuals will be dropped from SNAP because of the change. Officials say the new rule does not affect children and their parents, those over 50 years old, those with a disability or pregnant women.

OUCH: The Smithsonian’s Freer Gallery of Art and Arthur M. Sackler Gallery says it now wants to be known as the National Museum of Asian Art. It's calling the name change a rebranding, and insisting it has nothing to do with the public outcry across the globe over the Sackler family and its role in the opioid crisis, our Post colleague Peggy McGlone reports.

“It’s a shift toward a unified brand and not away from the gallery names,” Deputy Director Lori Duggan Gold said. The new name is meant to help visitors know “that they can expect to see Asian art during a visit to a museum.”

“The change comes as protests continue at cultural and educational institutions that bear the name of the Sacklers, the extended family behind the pharmaceutical giant Purdue Pharma, which manufactures the painkiller OxyContin,” Peggy writes. “Brothers Arthur, Mortimer and Raymond Sackler, who founded a company that became Purdue Pharma, donated to dozens of high-profile institutions, both individually and jointly.”

Photographer Nan Goldin, who has been protesting the institutions to call attention to the source of the family’s wealth, told The Post the change “feels like a mini-victory … The Louvre did it. They were the most courageous and righteous, and hopefully other museums will distance themselves from this name.”

STATE SCAN

— Virginia is the latest state to move to halt its Medicaid work requirements.

Virginia Gov. Ralph Northam (D) has directed his administration to “pause” efforts to get federal permission to implement work rules for Medicaid coverage. 

“A work requirement was just one of several strings attached by conservatives before Virginia’s Republican-controlled General Assembly would agree to expand the program in May 2018. Another would make certain recipients responsible for co-payments, deductibles and monthly premiums,” our Post colleague Laura Vozzella reports

Northam’s administration sent a letter this week to the Trump administration that it wants to hold off on acquiring a waiver to impose the conditions “in light of recent changes in our state legislature, which have generated dynamic policy conversations with regard to the . . . waiver.”

“Given the likelihood that the Governor and legislature will substantially modify these new waiver provisions in the coming months, the Governor has directed us to pause . . . until we have clear policy direction from our State leadership,” Karen Kimsey, director of the Virginia Department of Medical Assistance Services, wrote to the acting director of the Center for Medicaid and CHIP Services.

“Other states that have sought to impose work requirements have run into trouble,” Laura writes. “Federal judges have blocked worked requirements in Kentucky, Arkansas and New Hampshire, while Indiana and Arizona have suspended theirs amid legal challenges, according to the Commonwealth Institute for Fiscal Analysis, a liberal think tank in Richmond.”

HEALTH ON THE HILL

— There is more public support than ever for quality child care and paid parental leave, including from women in Congress and the Trump family. Yet such policies haven't come to fruition, USA Today’s Alia E. Dastagir, Charisse Jones, Courtney Crowder and Swapna Venugopal Ramaswamy report.

It’s in part because of businesses that won’t support such legislation, and small companies that worry it would cost them too much. But there are other reasons there’s a stalemate on the issue: “Nearly half of all Americans still believe kids are best off if one parent stays home with them, preferably the mother. Many say they don't want to pay for child care for other people's kids. Some say federal policies for working parents instead would penalize parents who choose not to work,” they write.

Even as conversations around child care and parental leave pick up momentum, no solution seems within grasp. “Federal proposals for what action to take and how to pay for it diverge wildly,” they write.

— And here are a few more good reads: 

Business
The vice president backed off a plan, pitched by some of his advisers, to levy higher taxes on Wall Street.
Jeff Stein

TRUMP TEMPERATURE

Politics
The chair of the American Bar Association's committee on the federal judiciary said Pitlyk’s “experience to date has a very substantial gap, namely the absence of any trial or even real litigation experience.”
Reis Thebault

MEDICAL MISSIVES

Health
Racing to contain the measles outbreak that has killed 60 people amid low vaccination rates, the government of Samoa has turned to a disease-control tactic going back centuries.
Hannah Knowles
A Southeast Alaska teen is expected to recover after being admitted to an out-of-state hospital on Thanksgiving Day.
Anchorage Daily News
Minnesota officials are taking their fight against vaping to court, alleging that Juul Labs illegally marketed flavored e-cigarettes to children and violated several consumer laws, including fraud.
Minnesota Public Radio

AGENCY ALERT

A top Food and Drug Administration (FDA) official was grilled by members of Congress on Wednesday for declining to answers questions about the agency’s plan to curb youth vaping rates.
The Hill

DAYBOOK

Coming Up

  • The House Energy and Commerce Subcommittee on Health holds a hearing on universal health care coverage proposals on Dec. 10.
  • The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on the FDA’s foreign inspection program on Dec. 10.
  • The Senate Indian Affairs Committee holds a hearing on the nomination of Michael D. Weahkee to be Director of the Indian Health Service on Dec. 11.

SUGAR RUSH