THE PROGNOSIS

House GOP leaders are making their own eleventh-hour bid for a bipartisan drug pricing deal. And they say House Speaker Nancy Pelosi should it bring to the floor next week instead of her own bill which has only Democratic support.

In a closed-door meeting at 9 a.m. today, the top Republicans on the three main committees with health-care jurisdiction will float among rank-and-file members an extensive proposal to lower U.S. drug prices that considerably overlaps with the bipartisan bill championed by the Senate Finance Committee.

The details will be laid out by Way and Means ranking member Kevin Brady (Tex.), Energy and Commerce ranking member Greg Walden (Ore.) and Education and Labor ranking member Virginia Foxx (N.C.), committee aides told Health 202. The No. 2 House Republican, Steve Scalise (La.), is also expected to make a presentation.

Like the latest version of a Senate proposal from Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.), this House Republican measure will include a first-ever cap on out-of-pocket costs for seniors on Medicare, along with other provisions for which Democrats have previously expressed support. Aides stressed that the proposal, which will be rolled out next week as a 375-page bill, contains no “poison pills” that could prompt Democrats to oppose it.

“There are not rock-hard, Republican-only provisions in here,” a GOP committee aide told me. “It’s a sincere proposal. We would remove things if they want us to.”

Grassley and Wyden are also trying to kick their own bipartisan ball forward over on the other side of the Capitol. This morning, their aides will brief reporters on revisions to their prescription drug pricing bill. The senators hope the changes will be attractive enough to skeptical Republican members that they’ll agree to other parts of the bill they don’t like.

Lobbyists are circulating text saying the Senate bill will reduce seniors’ contributions to 20 percent, compared to 25 percent that was in the original bill, before they hit their deductible in a Medicare drug plan. It may also require drug makers to offer seniors an initial small discount, while reducing the steeper discounts they're required to offer once a senior's spending has reached a certain, high level. 

And out-of-pocket expenses for enrollees with high drug costs will be smoothed out so they can be paid throughout the year instead of all at the beginning (we previously reported on that here). A Finance Committee spokesman said he wouldn’t confirm any details until the reporter briefing.

Here’s the central question amid all these legislative machinations: Whether the White House and Pelosi will be able to reach a compromise to lower drug prices – an issue both parties have said they want to tackle this year and which 2020 voters care deeply about.

With only two weeks left in the legislative year – and the parties embroiled in bitter disputes over impeachment proceedings and competing funding priorities – it’s a steep order for anything to actually happen. 

Senate Majority Leader Mitch McConnell has made no commitments to bring the whole Grassley-Wyden measure to the floor for a vote. There’s a possibility some of its provisions could be tacked onto a big spending bill, though even that remains in question.

And the House GOP bill is a countermove to House Speaker Nancy Pelosi (D-Calif.), who is teeing up a vote next week on a drug pricing bill Republicans and the pharmaceutical industry despise. Pelosi's measure, H.R. 3, would allow the federal government to directly negotiate lower prices with drug makers in the Medicare program. But while it’s likely to pass the Democrat-led House, it’s dead on arrival in the GOP-controlled Senate and has also been panned by the White House.

Republican House leaders plan to hold press conferences and other events next week insisting their measure is a more realistic way of reforming drug prices and accusing Democrats of acting only in a partisan manner. 

Aides said more than half of the bill contains provisions that are also in the Grassley-Wyden measure, which every Democrat in the Finance committee voted for over the summer. They said the bill will “protect access to new medicines and cures, strengthen transparency and accountability and champion competition” and, like the revised Grassley-Wyden bill, will spread out-of-pocket costs for seniors throughout the year.

AHH, OOF and OUCH

AHH: Advocates allege Gilead Sciences delayed development of a safer HIV-fighting drug in order to exploit the patent system and gain profits, our Post colleague Christopher Rowland reports.

“An HIV prevention group called PrEP4All Collaboration filed a petition Wednesday with the U.S. Patent and Trademark Office contending Gilead knew its new, improved drug — approved in 2015 and now part of Gilead’s combination therapies Genvoya and Descovy — was safer,” he writes. “But it alleged Gilead postponed development so it could continue to gain monopoly profits from its older combination HIV drugs, including Viread and Truvada, for a longer period of time, before those drugs went off patent and faced generic competition.” 

Now the group wants the Patent and Trademark Office to reject the company’s request for three additional years on the patent for the newer drug. 

PrEP4All Collaboration’s allegations against Gilead are similar to class-action lawsuits filed in California against the company. Gilead has denied the allegations and said the group’s request before the Patent and Trademark Office lacks merit. 

OOF: There’s been a spike in e-cigarette use by high-school students, according to recently released data from the National Youth Tobacco Survey. 

The data – which was presented to Trump administration officials in September – shows more than 27 percent of high school students and 10.5 percent of middle school students reported using vaping products in the last 30 days, Politico’s Sarah Owermohle reports.

“Last year's youth survey found 21 percent of teenagers used vapes. But a CDC official said the data from 2018 and 2019 were not exactly comparable because officials administered the survey slightly differently this year,” she writes. “For the sixth year in a row, e-cigarettes were the most commonly used tobacco products among both high school and middle school students, according to the survey.” 

OUCH: Trump himself and Vice President Pence have intervened in the ongoing rivalry between HHS Secretary Alex Azar and Seema Verma, the administrator for the Center for Medicare and Medicaid Services, Axios’s Jonathan Swan and Caitlin Owens report

At the vice president’s urging, Azar and Verma met this week to restore the peace. 

“It's an extraordinary intervention at the highest levels of government. And it highlights, as Politico extensively reported, the White House's urgent desire for the heads of Health and Human Services and the Centers for Medicare and Medicaid Services to repair their working relationship,” they write. 

Politico reported late last month about the internal clash between the pair that has become “increasingly bitter” and has hindered the administration’s health-care efforts. 

“At their meeting on Wednesday, Verma raised her concerns directly with Azar about his leadership style,” Jonathan and Caitlin write. “The two officials agreed to try to work better together and that her concerns would be addressed and mitigated going forward, a source familiar with the meeting added.”

OPIOID OPTICS

Another institution is scrubbing the Sackler name. Tufts University will take the name of the Purdue Pharma-controlling family off its buildings and health programs, our Post colleague Susan Svrluga reports.

“The Sackler family name had for years been associated with their generous philanthropy to universities, museums and other causes. But for many people it is now inextricably linked to the nation’s opioid epidemic because the family owns Purdue Pharma, makers of the addictive prescription narcotic OxyContin,” Susan writes. “Tufts is one of many institutions now reconsidering their association with the family.”

The school said it doesn’t plan to give back any of the money donated from the Sackler family or Purdue Pharma, but said it would launch a $3 million endowment in part toward addiction prevention and treatment programs. 

“This decision also acknowledges the countless individuals and families who have suffered so much loss, harm, and sorrow as a result of the opioid crisis,” Tufts University President Anthony P. Monaco said in a statement. “And it acknowledges members of our own community who have struggled on a daily basis with the university’s very public association with the Sackler name.”

AGENCY ALERT

— Verma wrote an op-ed on Fox Business warning that the Medicare-for-all proposals touted by some Democrats would hinder the ‘fiscal sustainability” of the federal program for seniors. 

She praised the efforts by the Trump administration to bolster Medicare and bring down costs for seniors. 

“Nevertheless, it remains true that Medicare faces solvency issues within the next decade,” she writes. “Foolish demands for ‘Medicare-for-all’ threaten the fiscal sustainability of the program, while squandering the many advances this administration has made.” 

“The animating principle behind our successful efforts is this: Medicare should be strengthened for seniors – the people to whom these benefits were promised in the first place,” she adds. “Advocates of ‘Medicare-for-all’ propose a different principle, one that ultimately jeopardizes seniors’ access to high-quality health care.” She urged continued efforts to strengthen Medicare benefits rather than turning the focus on “pipe dreams.” 

HEALTH ON THE HILL

— A poll from Gallup finds most Americans still prefer a private insurance-based health care system. 

The report found 54 percent prefer a private insurance system over 42 percent who say they want a government-run system. Support for a government-run system is up from the 36 percent average support from 2010 to 2014. Along party lines, 65 percent of Democrats say they prefer a government-run system, compared with 13 percent of Republicans who say the same. 

As some Democratic candidates tout a Medicare-for-all plan on the trail, Gallup’s annual Health and Healthcare survey suggests while there is growing support for such a single-payer system, “it remains the minority view in the U.S.” 

INDUSTRY RX

— Working at the luxury gym chain Equinox can mean grueling hours in a demanding environment, the New York Times’s David Yaffe-Bellany reports, citing court records and interviews with numerous labor lawyers and experts as well as Equinox managers and current and former trainers. 

“While the gym offers a well-regarded professional development program, as well as health insurance and other employee benefits that few fitness chains provide, many Equinox trainers, especially beginners, work exhausting schedules,” David writes. “Some say they can spend 70 or 80 hours a week at the gym — many of them unpaid — hustling to recruit clients, waiting between workouts, planning routines and conducting training sessions. In the gym’s draining environment, new trainers frequently last only a few months, unable to cope with the long hours and low starting pay, interviews show.” 

When trainers begin, they start by working about 15 to 20 hours a week putting away equipment at the gym until they start accumulating clients. Some successful trainers can make six-figure salaries, but in reality, many can struggle to accumulate enough clients to live comfortably. 

Equinox and other major gyms have faced legal action over the last 10 years for not properly compensating trainers, David reports. A survey conducted by the American Council on Exercise in 2013 found fewer than half of all personal trainers had health insurance. “It really can be a grind,” said Cedric Bryant, the exercise council’s president. “It’s not for the faint of heart.”

— And here are a few more good reads:

Local
Top neuroscientists say Biogen's experimental drug for Alzheimer's disease appears to have promise as clinical treatment that slows the disease's attack on the brain -- despite the drug's complicated backstory and conflicting data from two clinical trials. If approved by the FDA, it could become the first drug to attack the dementia-causing disease itself and not just its symptoms.
Fredrick Kunkle
Sage Therapeutics’s share price was cut in half, erasing more than $4 billion in market value after the company said an experimental depression drug failed a Phase 3 trial.
Wall Street Journal
Business
The announcement comes after millions of inclined sleepers were recalled for safety concerns and dozens of infant deaths were linked to the products.
Todd Frankel

TRUMP TEMPERATURE

Immigration
Officials detained nearly 2,100 pregnant women in 2018 after ending an Obama administration policy ordering the release of expectant mothers due to health concerns.
Maria Sacchetti

MEDICAL MISSIVES

Africa
Front-line Ebola responders say not enough is being done to protect them.
Max Bearak

REPRODUCTIVE WARS

Politics
More than 350 legal professionals described how their right to a safe and legal abortion has had a profoundly positive effect on their lives.
Deanna Paul
Planned Parenthood is targeting Republican senators in a seven-figure ad campaign over the Trump administration's changes to a federally funded birth control program.

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