The Washington PostDemocracy Dies in Darkness

The Health 202: The pandemic has closed the window for fixing the drug pricing system in 2020

with Paulina Firozi

It was supposed to be the year of fixing the U.S. drug pricing system. 

Instead, the novel coronavirus pandemic is preoccupying Congress, making it nearly impossible for even President Trump to force attention on the issue ahead of the November election.

Congress is negotiating another massive coronavirus relief bill, yet it’s devoid of any broad measures to lower prescription drug prices. Lobbyists and advocates acknowledge drug pricing legislation has sunk low on the list of priorities for lawmakers, even after the powerful Senate Finance Committee and the House passed in 2019 measures aimed at reducing drug prices and momentum seemed to be building during this election year toward a deal with the White House.

Lawmakers are distracted – understandably so. They’re scrambling to respond to the pandemic’s economic devastation, which has left 34 million Americans out of work. Yesterday, the death toll in the United States passed 150,000, punctuating the country’s failure to contain the virus despite widespread shutdowns throughout the spring.

“The signals we have received from Capitol Hill seem to say Congress will unfortunately punt this issue to 2021,” said Ben Wakana, executive director of Patients for Affordable Drugs, a nonpartisan group that advocates lowering drug prices.

It’s a deep disappointment to lawmakers and advocates who had hoped 2020 would be the year to take on the pharmaceutical industry. 

They’ve argued the pandemic only reinforces the need to give Americans relief from steep pharmaceutical costs.

“Covid did not make the problem of high drug prices go away; it made it worse,” Wakana said. “Millions of people are losing their jobs, millions of people are losing their health insurance.”

Sen. Charles E. Grassley (R-Iowa), co-author of legislation regarded as the best chance for a bipartisan deal, noted in a Fox News op-ed that it’s been one year since the Finance Committee passed his bill — and argued the pandemic makes such measures even more urgent.

“It’s inconceivable to delay commonsense drug pricing reform with covid-19 breathing down the neck of every American,” Grassley wrote, along with Sen. Martha McSally (R-Ariz.).

Even the president hasn’t been able to spark much energy around the issue.

Last Friday, Trump issued a series of executive orders aimed at nudging drug prices lower — a move that mostly just put more force behind initiatives his administration was already pursuing or had sought but then tabled.

Then, in a pair of tweets yesterday, he slammed the pharmaceutical industry for opposing most of the orders and claimed they would result in cutting drug prices by half (how he arrived at that claim is unclear).

Trump’s orders are largely regarded as political messaging leading up to the November election and unlikely to result in any real changes anytime soon. The reaction from lawmakers was muted; Republicans are largely skeptical of the approaches and Democrats are unwilling to give approval to virtually anything Trump does before the election.

“I see no way drug pricing gets in [the coronavirus relief bill],” said Chris Condeluci, a health policy consultant.

Plus, Trump's executive orders don’t actually create new policies — they just direct federal agencies to move forward in the process of rulemaking. And the Trump administration may have only six more months, depending on the results of November's contests.

The two most consequential presidential orders have to do with an index tying some Medicare drug prices to prices in other countries and a ban on rebates paid by drugmakers to pharmacy middlemen. 

A long-awaited rule about how the index would work was repeatedly delayed last year, amid heavy opposition from the pharmaceutical industry. And the ban on rebates, while supported by drugmakers, was tabled after an analysis found it would result in somewhat higher premiums for seniors under Medicare. 

The rebate ban stands the best chance of movement before the November election, lobbyists say, but even that is a tall order. That’s partly because Trump attached more conditions to it through his executive order, adding a clause saying the health and human services secretary must certify a rebate ban wouldn’t result in any increased costs for seniors or federal spending.

It’s also a strange dynamic for Trump to slam drug companies even as he pleads with them to develop a coronavirus vaccine.

The government is giving several developers billions of dollars to work on a vaccine. And drugmakers, recently under fire for their approach to drug pricing, have been working to rehabilitate their public image after years of heavy criticism for their pricing practices.

Drug company executives, who refused to attend a White House meeting yesterday, have complained to the administration that it’s pushing the executive orders even as it presses for developing and manufacturing vaccines, my colleagues Yasmeen Abutaleb and Josh Dawsey reported.

“The research-based biopharmaceutical industry has been working around the clock to develop therapeutics and vaccines to treat and prevent covid-19,” Steve Ubl, president and chief executive of PhRMA, the largest drug industry trade group, said in a statement. “The administration’s proposal today is a reckless distraction that impedes our ability to respond to the current pandemic — and those we could face in the future.”

Ahh, oof and ouch

AHH: Resistance to mask wearing has hobbled the nation's pandemic response.

 “The mask is the simplest and among the most effective weapons against the coronavirus in the public health arsenal. Yet from the start, America’s relationship with face coverings has been deeply fraught,” Griff Witte, Ariana Eunjung Cha and Josh Dawsey report. “Faulty guidance from health authorities, a cultural aversion to masks and a deeply polarized politics have all contributed. So has a president who resisted role modeling the benefits of face coverings, and who belittled those who did.” 

As a result, public health experts say the United States wasted one of the best opportunities to combat the virus’s spread, and in the meantime, fell behind other nations that embraced masks sooner. 

“In interviews, elected leaders, health specialists and mask advocates say it did not have to be that way — and very nearly wasn’t,” they write. 

U.S. officials have been forthcoming in acknowledging how their advice shifted — back in February, federal officials as well as the World Health Organization were recommending against face coverings, and insisting masks needed to be preserved for front-line workers. 

But once there was a policy shift, Anthony S. Fauci, the nation’s top infectious-disease expert, said the problem was that senior administration officials were not on board, including Trump, who was foremost among those uninterested in touting masks. 

OOF: Maryland’s health department warned the state would stop paying for weekly coronavirus tests for nursing home staff. 

“State officials say nursing homes should be able to pay for the tests through funding they received from the federal Cares Act. But industry advocates say there is not enough money to cover those costs and other pressing pandemic-related needs, especially for small, independent facilities,” Rebecca Tan and Rachel Chason report. 

The state has mandated that nursing homes test all staff members each week and offered to pay for homes that couldn’t afford it on their own. 

“Last week, however, the health department informed industry advocates that the state would stop conducting and sponsoring employee testing. The agency said facilities should establish their own testing arrangements with laboratories by Aug. 14,” Rebecca and Rachel write. 

“In response to questions about what would happen to facilities that do not have the funds, Mike Ricci, a spokesman for Gov. Larry Hogan (R), said: ‘We expect the vast majority of facilities to have plans in place, but there’s a range of options depending on the situation.’ He said the state will continue paying for testing for residents at facilities where there are coronavirus outbreaks.”

OUCH: Twitter penalized Donald Trump Jr. for posting misinformation about hydroxychloroquine and ordered him to delete the tweet. 

 “The tweet, which featured a viral video showing a group of doctors making misleading and false claims about the coronavirus pandemic, was directly tweeted by Trump Jr.'s account. That contrasts with his father, who retweeted multiple tweets from others showing clips of the same video to his 84.2 million followers Monday night,” Rachel Lerman, Katie Shepherd and Taylor Telford report

“… Trump shared clips from the video — which claims that masks and shutdowns are not needed to stop the spread of the virus — as he shared 14 tweets over half an hour defending the use of hydroxychloroquine, an antimalarial drug that the president has repeatedly promoted, and attacking Anthony S. Fauci, the nation’s top infectious-diseases expert.” 

The social media giant said it would limit the president’s son’s account for 12 hours, preventing him from tweeting and retweeting or liking posts during that time. Facebook also removed the same viral video from its site after it was viewed by more than 14 million people. 

Meanwhile, Trump defended his promotion of the viral video. 

“Trump has repeatedly used his White House coronavirus task force briefings as a platform to advocate the drug. The Food and Drug Administration last month revoked an emergency use authorization for the medication, saying it was 'unlikely to be effective,’” Hannah Knowles and Laurie McGinley write for The Washington Post’s live blog. 

But at his briefing, Trump doubled down on the clips containing misinformation. He described as “very impressive” a Houston doctor in the video who dismissed wearing masks and promoted hydroxychloroquine as a cure. “I thought her voice was an important voice, but I know nothing about her,” the president said.

The Daily Beast’s Will Sommer has a deep dive here on Stella Immanuel, describing her as a “pediatrician and a religious minister” who “has a history of making bizarre claims about medical topics and other issues.”

Congress on coronavirus

Trump dismissed the new $1 trillion Senate GOP coronavirus package as “sort of semi-irrelevant.”

The president was asked if there were any elements of the legislation released Monday after days of delay that he opposed. “Yeah, there are, actually. And we’ll be talking about it. There are also things that I very much support,” Trump said. “But we’ll be negotiating. It’s sort of semi-irrelevant because the Democrats come with their needs and asks and the Republicans go with theirs.”

“At the Capitol, meanwhile, Senate Majority Leader Mitch McConnell (R-Ky.) disavowed a key Trump administration priority in the bill — funding for a new FBI headquarters — while the second-ranking GOP senator suggested that Congress might be unable to make a deal in time to avert the expiration of emergency unemployment benefits on Friday,” Erica Werner, Seung Min Kim and Jeff Stein report

McConnell doesn't support $1.8 billion for a new FBI building, which the administration had pushed for. Calling it non-germane, he said “when we get to the end of the process, I would hope all of the non-covid-related measures are out.”

They add: “Democrats want to spend three times more than the $1 trillion in the GOP package, and they support continuing the $600 weekly enhanced unemployment insurance benefits that expire days from now. The GOP plan would slash the $600 payments to $200 per week until states can transition to a complex new system aimed at replacing 70 percent of what a person earned before they lost their job. Republicans argue that the current benefit gives people an incentive to stay out of work.” 

Meanwhile, Democrats are opposed to the liability shields included in the plan, which are meant to protect health-care providers and schools, among others, from lawsuits if employees become sick.

Around the world

Hong Kong was once lauded as a model for handling the pandemic, but now the city is dealing with a new and more severe wave of infections. 

The surge of cases is a result of a mutated strain of the coronavirus that scientists say may be more contagious than the initial strain, Shibani Mahtani reports. 

She adds Hong Kong is now “emerging as a cautionary tale. Medical experts have blamed large gatherings and government exemptions that allowed certain groups to enter the city without the 14-day quarantine period and virus test mandatory for everyone else.”

Cases there are setting records daily, though the numbers are modest when compared with the surge in the United States. As a result, isolation wards are filling, and new restrictions have been put in place. For one, masks will now be required even for those exercising outdoors. 

“We are facing this third wave partly due to poor bureaucratic management and a new, more infectious strain of the virus — so there are two problems at the same time,” Gabriel Choi Kin, president of the Hong Kong Medical Association, told The Post.

Nations in Europe are hoping to avoid a resurgence in coronavirus cases.

That’s especially true in places such as Belgium, where there has been a spike in infections that have led to newly tightened social restrictions.

“The reported rise in cases across several countries follows weeks of stability that had ushered in a growing sense of normalcy. A wave of reopening measures had come and gone without significant ill effect. People went to movies, dined at restaurants and started working from offices again,” Loveday Morris, Michael Birnbaum and Fiona Weber-Steinhaus report. “But virologists had always warned that successful reopening was dependent on citizens remaining vigilant with mask-wearing and distancing measures. And there are signs adherence has been slipping.” 

Agency efforts

A new Veterans Affairs inspector general report unveils failures by staff members at a D.C. hospital that preceded a veteran’s suicide. 

The report “revealed not only poor communication and poor judgment by multiple mental health and emergency room staff, but it exposed an insensitive call by the emergency department’s attending physician: ‘[The patient] can go shoot [themself]. I do not care,’ the physician was heard shouting, dismissing the veteran’s symptoms,” Lisa Rein reports.

The report said the physician called for hospital police to remove the veteran, and it also found the medical staff “discharged the patient without a thorough understanding of the patient’s withdrawal management needs.”

“The report comes as the Trump administration tries to tout its efforts to fight the persistent problem of veteran suicides, which have been stuck for years at about 20 per day, a far greater number than suicides among the population that did not serve in the military,” Lisa reports. “VA Secretary Robert Wilkie, as part of an effort to put a spotlight on his tenure as Trump runs for reelection, made an audacious claim to the conservative media site OAN this month: ‘President Trump is the first president since the 1890s who recognized the scourge of veteran suicide.’”

She adds: “Wilkie has touted a public health campaign Trump and VA launched in June that calls for improved research, community partnerships and other measures to fight veteran suicide, but some veterans advocates and lawmakers say the measures are not ambitious enough.” 

Coronavirus latest

And here are a few more stories to catch up on this morning: 

The Trump administration's response: 
  • Trump complained during a White House coronavirus briefing that Fauci’s popularity is higher than his own. “We’ve done pretty much what he and others, Dr. [Deborah] Birx and others who are terrific, recommended,” Trump said, referring to Fauci. “And he’s got this high approval rating. So why don’t I have a high approval rating with respect — and the administration — with respect to the virus?” The comments came in response to a question about a since-deleted retweet that claimed Fauci misled the nation on the effects of hydroxychloroquine, Colby Itkowitz reports for The Post’s live blog.
Industry efforts:
  • The federal government is planning to give Kodak a $765 million loan so the company can start making pharmaceutical ingredients, Jeanne Whalen reports. “The company plans to establish a new division, Kodak Pharmaceuticals, that will focus on the building blocks used to produce generic drugs, according to a joint statement from Kodak and the lending agency, the U.S. International Development Finance Corporation, or DFC,” Jeanne adds.
There’s more to learn about the virus: 
  • Scientists reconstructed the virus’s evolution and found the novel coronavirus may have circulated in bats for decades, according to a new study led by a researcher at Pennsylvania State University’s Center for Infectious Disease Dynamics. “Tracing the virus’s lineage is crucial early in an outbreak because it can allow health authorities to separate people from the pathogen’s animal host, and later to help avert future health crises,” Bloomberg News reports. “The researchers warned that other virus lineages in bats could have the potential to spread to humans.”

Sugar rush

The 2020 Emmy nominations are in and a mix of new and old are rounding out the top categories. Here’s what you need to know. (Video: The Washington Post)