THE PROGNOSIS

Pharmaceutical makers are barely tapping the brakes when it comes to raising the price of their medications in 2020 — even after heavy pressure from lawmakers last year to stop doing so.

Analysts say list prices for hundreds of top branded drugs will grow faster than inflation this year, although drug companies will avoid the double-digit spikes of years past. AbbVie will hike the price of Humira, its top-selling arthritis medication, by more than 7 percent. Pfizer will raise prices on more than 50 drugs and GlaxoSmithKline will do likewise on more than 30 drugs.

The price hikes ensure the Trump administration and Congress will continue decrying the cost of prescription drugs this year — even if they continue to do little about it. 

House Speaker Nancy Pelosi (D-Calif.), arguing for a bill supported mostly by Democrats:

Congress ended 2019 with a whimper on the drug pricing issue, failing to advance a bipartisan Senate bill and including only a small part of it in the year-end spending deal. As for President Trump, he has also run up against walls despite frequently complaining about prices. All his administration has released is a preliminary proposal to allow some drug importation and a requirement for drugmakers to post list prices in television ads, although that has been blocked by a court.

And now the outlook for drug prices in 2020 is virtually unchanged from last year, according to GoodRx, an online prescription cost service. 

Among companies that have so far announced their pricing intentions for the year, 491 drug prices are increasing by an average of 5.2 percent, according to data compiled by the firm. That’s less than 2018’s 8 percent average price hike on 580 drugs, but no improvement over 2019.

Price increases for some of the most commonly prescribed drugs are hovering between 3 percent and 6 percent. List prices for Jardiance and Tradjenta, two non-insulin drugs used to treat diabetes, will rise 6 percent. Premarin, which helps with menopause, will go up 5 percent, and the HIV drug Truvada will go up 4.8 percent.

The administration has frequently argued that an acceleration in generic drug approvals will stem the tide by allowing more competitors. But that hasn't yet been the case for AbbVie's mega-blockbuster brand-name drug Humira, my colleague Christopher Rowland reports.

"The Food and Drug Administration has approved five generic versions of Humira — the world’s biggest-selling drug with global revenue of $20 billion — and two of them have come within the past six months," Chris writes. "But so far the generic biologic drugs (called “biosimilars’’ in industry parlance) have failed to lower costs and make the therapies more accessible to patients."

AbbVie increased Humira's price more than 7 percent this year after raising it 19 percent in 2017 and 2018. "The cost of Humira, which is injected via syringe, was more than $72,000 a year on prescription drug websites this week and is not expected to come down until at least 2023," Chris writes.

"Humira’s price has defied gravity — and been ensconced as a frequent rhetorical target on Capitol Hill — through AbbVie’s aggressive use of patents and deals with generic manufacturers to forestall competition," he adds. The generic competitors, facing a thicket of patents AbbVie has obtained to try to maintain exclusive rights, have reached a settlement which means their alternatives to Humira won't be available until 2023.

Antonio Ciaccia, an analyst for the firm 3 Axis Advisors, told me he expects to see slightly more medications overall undergo a price hike compared to last year.

And some companies have yet to announce anything this year about where they’re setting drug prices — notably, the large insulin makers Novo Nordisk and Eli Lilly. Furthermore, the companies that have already announced could make more pricing changes mid-year, something typically done around June or July.

But there may be a tiny bright spot in all of this. Ciaccia says his firm’s data indicate the average increases are somewhat lower than in 2019 – possibly a sign of the heightened public scrutiny of the industry. Just one medication — CotemplaXR, used to treat ADHD — is getting a price increase of more than 10 percent, Ciaccia noted.

“Overall, I think drugmakers have moderated their approach to price increases over the last few years,” he told me.

Some pharmaceutical makers have pledged to keep price increases below 10 percent. That’s a common threshold set by state regulators for when a company must provide a rationale for a price increase.

“Everyone is keeping it well under the speed limit, if you will,” Ciaccia said.

Here’s something else to consider. A handful of branded drugs — many of them sold by Pfizer — are undergoing dramatic and unprecedented price cuts. The company is cutting its steroid Medrol by 90 percent and slashing its medicine Zyvox, which treats bacterial infections, by nearly 98 percent.

They’re not blockbuster drugs by any means, but it’s highly unusual for drugmakers to make such deep cuts, Ciaccia said.

AHH, OOF and OUCH

AHH: The cancer death rate in the United States fell at a record level in 2017, largely because of gains against lung cancer. The American Cancer Society reports that deaths declined 2.2 percent in 2017 — the biggest single-year drop ever reported, our colleague Laurie McGinley reports.

"The improvement in 2017, the most recent year for which data is available, is part of a long-term drop in cancer mortality that reflects, to a large extent, the smoking downturn," Laurie writes. "Since peaking in 1991, the cancer death rate has fallen 29 percent, which translates into 2.9 million fewer deaths."

Ned Sharpless, director of the National Cancer Institute, said the data reinforces that “we are making steady progress” on cancer. "For lung cancer, he pointed to new immunotherapy treatments and so-called targeted therapies that stop the action of molecules key to cancer growth," Laurie writes. "He predicted that the mortality rate would continue to fall 'as we get better at using these therapies.' Multiple clinical trials are exploring how to combine the new approaches with older ones, such as chemotherapy."

"Sharpless expressed concern, however, that progress against cancer would be undermined by increased obesity, which is a risk factor for several malignancies," Laurie adds.

OOF: American health-care costs are so high that they basically amount to a heavy tax, say Princeton University economists Anne Case and Angus Deaton.

Households in the United States pay an extra $8,000 a year compared to households in Switzerland, the nation with the next-most-expensive system. Case and Deaton argue that amounts to an $8,000 “poll tax,” which means it’s imposed on individuals regardless of their ability to pay, our Post colleague Heather Long reports. 

“Despite paying $8,000 more a year than anyone else, American families do not have better health outcomes, the economists argue. Life expectancy in the United States is lower than in Europe,” Heather adds. “… Case and Deaton, a Nobel Prize winner in economics, made the critical remarks about U.S. health care during a talk at the American Economic Association’s annual meeting, where thousands of economists gather to discuss the health of the U.S. economy and their latest research on what’s working and what’s not.”

OUCH: Major drugstore chains have sued doctors across northeast Ohio, arguing doctors are the ones who should be held responsible for the nation’s opioid crisis. The chains themselves are facing an October trial in a major federal opioid case.

“CVS, Walgreen Co., Walmart, Rite Aid and other major pharmacy chains said opioid prescribers bear responsibility for the prescription narcotic crisis, but unlike the drugstores, have not been sued by Cuyahoga and Summit counties,” our Post colleague Lenny Bernstein reports. “In legal papers filed Monday, they contended that doctors and other prescribers should have to pay some of the penalty if the drugstore chains are found liable at trial.”

The pair of Ohio counties sued the major drug chains in 2018, alleging they did not stop the diversion of prescription drugs to the black market. U.S. District Judge Aaron Polster allowed the counties to include failures by pharmacists in their accusations, which spurred the new suit.

“This complaint is required to respond to the unsubstantiated allegations by plaintiffs that pharmacists should not have filled prescriptions, written by doctors, for FDA-approved opioid medications,” a spokesman for Walgreen Co. told The Post in an email. “We strongly believe that the overwhelming majority of prescriptions dispensed were properly prescribed by doctors to meet the legitimate needs of their patients.”

STATE SCAN

— A new study in Health Affairs found expanding Medicaid led to improved health in Southern states. In expansion states, declines in health status were 1.8 percentage points less likely, the Hill’s Peter Sullivan writes. 

Most of the states that have not yet expanded Medicaid are in the South. 

The report “examined 12 Southern states, including those that have accepted the expansion of Medicaid under the Affordable Care Act, like Kentucky, West Virginia, Arkansas and Louisiana, and those that have not, like Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina and Tennessee,” he adds. 

HEALTH ON THE HILL

AHH: The American Action Network, a conservative nonprofit group with ties to Republican congressional leaders, has launched a $4 million ad campaign that attacks House Speaker Nancy Pelosi’s (D-Calif.) signature drug pricing proposal and backs an alternative GOP plan. 

“The American Action Network, which received $2.5 million from PhRMA in 2018, has derided the Pelosi drug pricing plan as socialism,” Stat’s Nicholas Florko reports. “The group spent $2.5 million in the weeks before the December House vote on ads opposing the Democratic package.” 

The advertising campaign is a "striking show of support for the GOP bill, which party leaders rushed to introduce the same week that the House was set to vote on Pelosi’s bill in December," he adds. 

The ads will air in 28 GOP lawmakers’ districts, targeting Republicans including Reps. Kevin Brady (R-Tex.) and Greg Walden (R-Ore.), as well as Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Finance Committee Chair Chuck Grassley (R-Iowa). 

— Grassley said in an interview on CNBC that he is hoping to push Pelosi to abandon Democrats' bill and instead support his bipartisan legislation. 

He said his bill, introduced with Sen. Ron Wyden (D-Ore.), is the “only bipartisan bill that can get through the United States Senate. The president supports it. We have bipartisan support in the Senate.” 

“The main thing we have to do is if we can convince Speaker Pelosi that the bill she passed before Christmas can’t get through the United States’ Senate, because it can’t get 60 votes,” he said. He said if she could get the Grassley-Wyden bill through the House floor, “that brings pressure on the leadership of the United States Senate to get our bill up.”

The measure would establish an out-of-pocket maximum for Medicare beneficiaries and limit drug cost hikes at the rate of inflation. “The bill has stalled due to lack of support from Senate Republicans,” CNBC’s Berkeley Lovelace Jr. reports. “Senate Majority Leader Mitch McConnell of Kentucky has not scheduled the bill for a vote.” 

— The Women’s March will replace its annual demonstration in the nation’s capital with a week of smaller and more targeted events, our Post colleague Marissa J. Lang reports. There will still be a march, but there won’t be a featured group of individuals addressing a crowd or any musical performers. 

"The week-long series is the latest in a cascade of changes the group has undergone since September, when the organization’s three inaugural — and controversial — board members were replaced by a diverse cast of 16 women amid allegations of anti-Semitism, infighting and ineffective leadership," Marissa writes. 

"The shake-up comes at a critical time for the organization," she adds. "With the 2020 presidential election approaching, experts have said it can no longer afford the distractions and controversies that have muddled its message and loomed over its every move."

REPRODUCTIVE WARS

— An 18-year-old has been charged with intentionally damaging a Planned Parenthood building in Delaware, the New York Times’s Johnny Diaz writes. 

He allegedly drove to the location at about 2:15 a.m. Friday and was recorded by surveillance cameras standing on the building’s porch and spray-painting the phrase “Deus Vult” — “God wills it” in red letters. He then allegedly stepped off the porch, lit an incendiary device and threw it at the building’s front window, which was closed. 

“The teenager, Samuel James Gulick, of Middletown, Del., was charged on Monday with three counts: maliciously damaging a building used in interstate commerce through the use of fire or destructive device; intentionally damaging a facility that provides reproductive health services; and possession of an unregistered destructive device under the National Firearms Act, according to a news release from the United States Attorney’s Office for the District of Delaware,” Johnny adds. 

— And here are a few more good reads: 

The average delivery now costs more than $4,500—even with insurance.
The Atlantic

MEDICAL MISSIVES

LOS ANGELES (AP) — Alex Trebek has a message of support for Congressman John Lewis as both fight pancreatic cancer. “We’re starting a new year, and let’s see if we can’t both complete the...
Associated Press
For years, scientists poured their hearts into work to develop vaccines. And, for years, they saw promising work smash up against unscalable walls.
Stat

INDUSTRY RX

Efforts to deliver on high-profile issues are colliding with the broader partisan battle over health care.
Politico

DAYBOOK

Today

  • The House Energy and Commerce subcommittee on health holds a hearing on legislation to “improve Americans’ health care coverage and outcomes."
  • The Bipartisan Policy Center hosts “20/20 Health Care Series: A Snapshot of Early Primary Voters."

Coming Up

  • The House Veterans’ Affairs subcommittee on economic opportunity holds a hearing on “resources to address veteran hunger” on Thursday.

SUGAR RUSH