THE PROGNOSIS

President Trump once promised he would let the federal government force drugmakers to negotiate lower drug prices covered by Medicare. Yesterday, Democrats moved forward on such a policy without his help.

In a remarkable show of unity, House Democrats passed their own legislation allowing the government to directly negotiate lower prices under Medicare’s prescription drug program — something the law currently prohibits. Not a single Democrat defected on the 230-to-192 vote, after House Speaker Nancy Pelosi (D-Calif.) revised the bill earlier this week to satisfy the demands of progressives and quell their threatened revolt.

The measure requires the health and human services secretary to negotiate with the manufacturers of 50 to 250 branded medicines every year. Prices would be capped at 120 percent of a drug’s average price in Australia, Canada, France, Germany, Japan and the United Kingdom. If manufacturers charge more — or if they raise prices faster than inflation — they would face steep fines.

The policy, if ever enacted, would represent a major shift of power from the pharmaceutical industry to the U.S. government, which currently has far less leverage than governments of other advanced economies in determining the price of medicines.

Politico's Sarah Ferris:

It won’t become law anytime soon, however, given opposition from the GOP-led Senate and the White House — not to mention the pharmaceutical industry.

But it gives Democrats something specific to tout on the campaign trail next year while facing voters worried about the high cost of prescription drugs. The Democratic Congressional Campaign Committee plans to cite the measure in ads targeting vulnerable Republicans in swing districts, my Washington Post colleague Yasmeen Abutaleb reports.

Pelosi said it “delivers on President Trump’s promise to the American people” — a reference to Trump’s support in 2016 for allowing direct negotiation. The president initially held fire on Pelosi’s bill, as both their aides tried to hash out a deal, but he and his advisers have since condemned it publicly.

“We’ve been trying to do this for a number of years. Today we will,” Pelosi said on the House floor. “We’re finally giving Medicare the power to negotiate lower drug prices.”

The vote on H.R. 3 further sours an effort on lowering drug prices that seemed headed for success earlier this year but is now closer to failure. There is significant overlap between the two parties on measures that could help move the needle, such as provisions to stop drugmakers from gaming the system to extend their monopolies on certain medicines. 

Pelosi did allow a vote on an alternative measure offered by House Republicans they said contained only bipartisan provisions. But only eight Democrats voted for it in a sign the Thursday afternoon vote series was far more about political messaging than anything else.

In speeches on the House floor, in news conferences on Capitol Hill and in releases flooding my inbox, lawmakers advanced competing narratives about the potential effects of Pelosi's bill on Americans’ ability to access both established treatments and cutting-edge cures.

— If you listened only to Republicans, you might fear the bill could stymie the development of new medicines because they would be less profitable for companies to develop. Republicans stressed a projection from the Congressional Budget Office that eight fewer drugs would enter the U.S. market during the first decade and about 30 fewer drugs would be introduced during the subsequent decade.

“I don’t think you have to trade that reduction in innovation and new cures for lower prices,” said Rep. Greg Walden (Ore.), the ranking Republican on the Energy and Commerce Committee. “I think you can have both.”

Former Food and Drug Administration chief Scott Gottlieb advanced this argument in a Wall Street Journal op-ed, arguing that a price ceiling would strip incentives away from drug developers to invest in unproven new treatments that can nonetheless yield huge returns.

“Many drugs targeted by H.R. 3 for government price controls are examples of the innovation we should try to encourage,” Gottlieb wrote.

Rep. John Joyce (R-Pa.):

— But Democrats like to stress other aspects of the CBO’s analysis. The agency has projected the Pelosi bill would reduce the prices of negotiated drugs by 55 percent initially and by 40 percent to 50 percent in subsequent years. That would mean lower costs for both consumers and the government, which would save an estimated $456 billion over the next decade.

Democrats also emphasized the huge disparity between prices U.S. patients pay and those in other countries — especially when it comes to widely used medications such as insulin. An analysis by the Center for American Progress, a liberal think tank, found that some diabetics could save more than $700 on an annual supply of certain types of insulin as a result of H.R. 3.

“The American people are fed up with paying three, four or 10 times more than people in other countries for the exact same drug,” House Energy and Commerce Chairman Frank Pallone Jr. (D-N.J.) said. “I now hope Senator McConnell will follow through on President Trump’s repeated promises to ‘negotiate like crazy’ and take up this bill. We cannot afford to wait.”

Rep. Lloyd Doggett (D-Tex.):

From advocacy organization Patients for Affordable Drugs Now:

AHH, OOF and OUCH

AHH: The Senate voted 72 to 18 to confirm Texas oncologist Stephen Hahn to be the next commissioner of the Food and Drug Administration. 

The MD Anderson Cancer Center top official will take the helm of the agency as it grapples with numerous ongoing political and health challenges, including an anticipated response to the spike in youth vaping, as our Post colleague Laurie McGinley reports

At his confirmation hearing last month, Hahn called the youth vaping crisis “important” and “urgent” and said he doesn’t “want to see another generation of Americans become addicted to tobacco and nicotine and I believe that we need to take aggressive to stop that.”

“Sen. Richard J. Durbin (D-Ill.), who endorsed Hahn as commissioner on Wednesday and strongly favors a ban on flavored e-cigarettes, said the Texas cancer doctor might find himself responsible for implementing a vaping policy that will prove ineffective,” Laurie writes. Durbin said Hahn “may find himself in a compromised position soon.”

Other issues facing the FDA include drug importation, the regulation of CBD products and the sales of unapproved treatments by commercial stem cell clinics. 

OOF: The Trump administration has granted a waiver for South Carolina to impose work requirements on beneficiaries of its Medicaid program. 

It’s the first state that has not expanded Medicaid to acquire such permission. It’s also the “11th state with similar requirements approved by the federal Centers for Medicare and Medicaid Services since its administrator, Seema Verma, announced nearly two years ago that she would welcome proposals from states that wanted to compel Medicaid recipients to work as part of what she described as an effort to give them ‘the right incentives to live healthier, independent lives,’” our Post colleague Amy Goldstein reports.

“The is no reason for anyone who can work not to be working, especially if that person is able-bodied and is receiving public assistance,” Republican Gov. Henry McMaster said at an event yesterday alongside Verma. “Without meaningful work, life loses its joy and meaning.”

The administration’s move to grant the state permission even as the policy has been repeatedly blocked in federal court “signals that despite the litigation, the administration is continuing to strive for a conservative reshaping of the nation’s largest public insurance program,” Amy writes. 

The agency says the program will add an estimated 45,000 people to its Medicaid rolls, but “documents acknowledge that perhaps 7,100 could lose coverage.” 

Meanwhile, a coalition of 21 patient and consumer groups are denouncing the decision. Emily Stewart, executive director of health-care advocacy group Community Catalyst, called it a “new low in the Trump administration’s quest to strip away health coverage for our nation’s low-income residents.” 

OUCH: The latest data from the Centers for Disease Control and Prevention shows 52 people have now died of the rash of mysterious vaping-linked illnesses in 26 states and the District of Columbia. 

There have also been 2,409 confirmed hospital cases of the illnesses as of Dec. 10 in every state as well as Washington and two U.S. territories. The agency noted that the number of reported cases is slowing, with data suggesting the outbreak may have peaked in September, but states are still reporting new hospitalizations each week. 

The patients who have died ranged in age from 17 to 75, and more deaths are being investigated. 

MEDICAL MISSIVES

— Democratic presidential hopeful Mike Bloomberg is in “outstanding health,” according to a letter released by his personal doctor. 

The 77-year-old former New York mayor is the second septuagenarian presidential contender to release such a note from his physician following a letter released last week by a doctor for Sen. Elizabeth Warren’s (D-Mass.), our Post colleague Michael Scherer reports.

The letter added that Bloomberg has no medical concerns that would prevent him from serving as president. Stephen Sisson, Bloomberg’s internist at Johns Hopkins University School of Medicine, noted that he has undergone previously reported coronary stent placement for a blocked artery in 2000 and has had small skin cancers removed. He takes medication to control his cholesterol levels and a blood thinner for atrial fibrillation that was diagnosed in 2018. 

“Mr. Bloomberg is in great physical shape. He exercises several times a week and plays golf avidly. He has maintained an active pilot’s license,” the physician wrote. 

Other candidates in the current presidential field — which is the oldest in history — have vowed to release their medical details before the Iowa caucuses, including former vice president Joe Biden and Sen. Bernie Sanders (I-Vt.).

AGENCY ALERT

— An alarming internal report from an Immigration and Customs Enforcement whistleblower details medical care in ICE jails that led to two patients who had preventable surgeries and two who received improper medication, BuzzFeed News’s Hamed Aleaziz reports. Such improper care also led to four deaths, one “from meningitis following ‘grossly negligent’ care.” 

“The allegations appear in an explosive Department of Homeland Security memo … containing reports of detainees being given incorrect medication, suffering from delays in treating withdrawal symptoms, and one who was allowed to become so mentally unstable he lacerated his own penis and required reparative surgery,” Hamed writes. “... The allegations were laid out in a March 20 memorandum signed by Cameron Quinn, DHS’s officer for Civil Rights and Civil Liberties, and sent to top ICE leadership. The memo describes the whistleblower as someone within the ICE Health Service Corps, or IHSC, which provides medical care and oversight for detainees in the agency’s custody.” 

A former senior ICE official told the publication that “some at the agency brush away allegations of substandard medical care … The official said it was unlikely that the agency would dramatically alter or add resources to its medical care system.”

— And here are a few more good reads: 

HEALTH ON THE HILL

Politics
"The pot calling the kettle black is not something that we should do," a Democratic committee member said.
Reis Thebault
Judiciary Committee has long been the arena for the nation’s culture wars.
Politico

INDUSTRY RX

NFL
The Department of Justice charged 10 former players with defrauding the NFL's health care fund for retired players.
Adam Kilgore and Rick Maese
CVS Health Corp said on Thursday it will make it easier for patients with advanc...
Reuters

STATE SCAN

National
The lawsuit alleges drug smuggling is a well-known issue in Michigan's prison facilities and that efforts to flag it were met with retaliation against staff and prisoners.
Kim Bellware

OPIOID OPTICS

Major League Baseball
In another significant change to the sport’s drug policy, marijuana will be removed from the list of drugs of abuse.
Dave Sheinin

BRAIN WAVES

Africa
Rarely is the aftermath of animal testing so visible — and so hungry.
Danielle Paquette

DAYBOOK

Coming Up

  • The Senate Judiciary Committee holds a hearing on the opioid crisis on Dec. 17.

SUGAR RUSH