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The Health 202: Democrats see a pathway for their ambitious drug pricing bill

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with Alexandra Ellerbeck

House Democrats passed a sweeping drug pricing bill at the end of 2019.

At the time, it felt like a long shot. Now they might get to see parts of it become law.

Democrats are eyeing the Elijah E. Cummings Lower Drug Costs Now Act as part of their next massive spending package.

H.R. 3 — named for the late Maryland congressman who was a champion for lower drug costs — was passed by the House 15 months ago after it become clear President Donald Trump and House Speaker Nancy Pelosi (D-Calif.) wouldn’t be able to reach an agreement on bipartisan drug pricing reform. 

Democrats knew the bill would die in the Senate, led by the GOP at the time. But it gave them something specific to tout on the campaign trail in 2020 while facing voters worried about the high cost of prescription drugs. 

Now, White House officials are planning to draw from H.R. 3 for their next budget reconciliation bill, my colleagues Jeff Stein and Tyler Pager report. The reconciliation bill, which would be the second for Democrats to pass this year, is taking shape as a $3 trillion infrastructure and jobs package that includes numerous sweeping domestic policy priorities.

“After completing the $1.9 trillion coronavirus relief package this month, Biden administration officials are piecing together the next major legislative priority,” Jeff and Tyler write. “Although no final announcement has been made, the White House is expected to push a multitrillion-dollar jobs and infrastructure plan as the centerpiece of the president’s ‘Build Back Better’ agenda.”

The House proposal would shift power from the pharmaceutical industry to the federal government.

As I reported at the time, HR. 3 would require the Department of 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.

It’s not hard to see why the pharmaceutical industry hates the measure. The Congressional Budget Office has projected it would reduce the prices of negotiated drugs by 55 percent initially and by 40 percent to 50 percent in subsequent years. That would translate to lower costs for both consumers and the government, which would save an estimated $456 billion over the next decade.

Larry Levitt, senior vice president at the Kaiser Family Foundation:

In talking about the bill, Democrats have also stressed 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. The Center for American Progress, a liberal think tank, found that some people with diabetes could save more than $700 on an annual supply of certain types of insulin as a result of H.R. 3.

Muscling the measure through without GOP support would set a very different tone on drug pricing reform.

Even as the two parties butted heads over health care during the Trump administration, hopes persisted that a bipartisan drug pricing measure might succeed. 

Sens. Charles E. Grassley (R-Iowa) and Ron Wyden (D-Ore.) worked closely on a bill that passed the Senate Finance Committee (which they led), while on the other side of the Capitol building a top Pelosi aide was in regular communication with the White House.

There are plenty of smaller measures Congress could advance on a bipartisan basis.

Although most would have far less impact on lowering drug prices compared with direct negotiations between the government and drugmakers.

For example, a bipartisan group of senators are releasing a bill today that requires drug manufacturers to disclose and provide more information about planned drug price increases, including research and development costs. 

It would require manufacturers to notify HHS 30 days before they increase the price of certain drugs. The requirement would apply to drugs costing at least $100, whose prices are increasing by more than 10 percent in one year or 25 percent over three years. Manufacturers would have to provide a justification for each price increase.

The measure was part of H.R. 3, and also passed the Senate Health, Education, Labor and Pensions Committee with bipartisan support. It will “demand answers from drug companies who are jacking up the prices on the medications that Americans need,” said Sen. Tammy Baldwin (D-Wis.), who sponsored the legislation along with Sens. Mike Braun (R-Ind.), Tina Smith (D-Minn.) and Lisa Murkowski (R-Alaska).

Today marks the 11th anniversary of the Affordable Care Act.

Former president Barack Obama praised the sweeping health-care law and criticized GOP governors who didn’t embrace its Medicaid expansion, in a virtual event organized by the Democrat-aligned group Protect Our Care. 

Obama noted the law wasn’t perfect when it was passed — but stressed that over time, it will be improved and expanded upon. He compared the law to a “starter home.”

“You get that first home, you’re building up some equity and you have shelter you didn’t have before,” Obama said. “And then over time, you build and put some additions to the house.”

Brad Woodhouse, executive director of Protect Our Care:

“That is what the American Rescue Plan has now done,” Obama added, referring to the coronavirus relief bill recently signed by President Biden. That measure temporarily boosts premium subsidies in the individual marketplaces and gives more incentive to states to expand Medicaid.

HHS Secretary Xavier Becerra called the law “a game-changer,” in a statement noting its anniversary and reminding Americans the expanded subsidies will be available on starting April 1. 

He also said he’s “committed to building on this monumental progress to bring every American the peace of mind that comes with knowing you can take care of your family without going into debt.”

Meanwhile, Freedomworks is seizing on the anniversary as a chance to highlight Biden’s payroll tax evasions.

The conservative group will release a video that reprises the “Granny Off a Cliff” theme liberals used a decade ago. The video slams the Bidens for using a tax loophole to avoid paying some payroll taxes from 2017 through 2019.

Ahh, oof and ouch

AHH: The Biden administration is enlisting the Christian Broadcasting Network and Nascar in vaccine outreach.

“The administration aims to use such organizations to help persuade conservatives, one of the demographic groups that polls show have significant reluctance to get the coronavirus vaccine,” the Wall Street Journal's Stephanie Armour and Sabrina Siddiqui report.

“The public-service campaign features videos with a new Willie Nelson recording and athletes representing 13 sports leagues and organizations, including the National Football League, Major League Baseball and the National Basketball Association," they write.

A spokesman for the Christian Broadcasting Network said the group welcomes the Biden team’s effort, while Nascar President Steve Phelps said “It's critically important to us that we, as an industry, continue to play a meaningful role in the fight against Covid, including offering our venues to help administer vaccines across the country as quickly as possible.”

OOF: A bumpy Johnson & Johnson rollout is sparking finger-pointing between the Biden administration and states.

Around 2.3 million doses of the single-shot Johnson & Johnson vaccine have been administered, out of 4.3 million doses delivered, raising questions about why so many shots are sitting unused.

“Almost three weeks after the Food and Drug Administration authorized the shots, no one appears to be able to explain why immunizations are lagging. Some states are thought to be intentionally holding back shots, while others say it takes time to inoculate populations like the homebound,” Politico’s Erin Banco and Rachel Roubein report.

The new single-shot J&J vaccine doesn't need subzero storage, and could help harder-to-reach communities get access to coronavirus protection. (Video: Joshua Carroll/The Washington Post)

Politico reports that two senior administration officials attribute the delay to states holding back doses in order to target them for underserved populations, which may be harder to reach with a second shot. 

But multiple state officials say that they are using the vaccine as soon as they get it. Some governors have raised concerns that the CDC’s public vaccine tracker holds them accountable for delivering doses that are actually under the federal government’s control.

OUCH: The spread of coronavirus variants is adding urgency to the nation’s vaccine push.

Infections and new hospital admissions of coronavirus cases are increasing quickly in Michigan and Minnesota. In New Jersey and New York, daily hospital admissions have stopped declining and started to inch up. 

“The developments could augur a long-feared possibility: That another surge could occur even as states are flinging open vaccine eligibility criteria, trying to get shots in arms as quickly as possible,” Bloomberg News’s Emma Court and Jonathan Levin report. A loosening of public health restrictions, pandemic fatigue and events like spring break could also contribute to the spread of the virus.

“We’re on the last straightaway, the last lap of this leg of the race, and it seems in some places the variants are just pulling ahead, just a little bit. But it’s so close,” said Nicholas Reich, an associate professor of biostatistics at the University of Massachusetts at Amherst. “Another four weeks and I’m not sure they’d be able to pull ahead.”

Nationally, hospital admissions are plateauing after declining in January and February. And while deaths are still falling, the pace has declined, CDC director Rochelle Walensky said on Wednesday. 

More on vaccines

AstraZeneca may have only used partial data when it announced the results from a U.S. trial of its coronavirus vaccine.

In a highly unusual rebuke, the National Institute of Allergy and Infectious Diseases said today that the British-Swedish pharmaceutical firm used outdated information from the large-scale trial when it reported the results Monday, “which may have provided an incomplete view of the efficacy data.” 

NIAID urged the company to work with the U.S. Data Safety and Monitoring Board to review the data and release the updated information “as quickly as possible.”

“AstraZeneca had said Monday that the vaccine was shown to be 79 percent effective against symptomatic covid-19 — and that it was 100 percent effective against severe illness,” Erin Cunningham writes. “Scientists are describing the reaction as unusual and unprecedented for the agency.”

The United States is doing little vaccine diplomacy.

“The U.S. accounts for 27% of the world’s coronavirus vaccine production, but 0% of the global supply beyond its own borders,” Axios’s Dave Lawler reports. China, in contrast, has made 33 percent of all of the world’s vaccines and is exporting 62 percent of its doses, in part because it has been more successful at controlling the virus domestically. The European Union is exporting 48 percent of its production of the Pfizer-BioNTech vaccine.

The “Americans first” approach means that the United States will have more vaccine doses than it needs to cover its population, especially when you take into account Americans who say that they don’t want a shot. 

The Post’s Philip Bump reports on how many excess doses the United States could accumulate: “To put it bluntly: The total number of vaccines secured by the United States is almost twice the number needed to vaccinate everyone, even after considering that most of the vaccines require two doses for full effectiveness."

More in coronavirus news

Nursing homes are opening their doors, as coronavirus cases in facilities plummet.

“There have been welcome-back parties, birthday celebrations, coffee hours on the patio and more in recent days, giving older Americans and their families a glimpse into what life may look like in a post-vaccine world,” the Associated Press’s Philip Marcelo, Patty Nieberg and Kimberlee Kruesi report.

The loosening of restrictions comes after federal regulators recommended that facilities allow indoor visits. Coronavirus cases and deaths in the facilities have gone from a peak of 30,000 cases and 7,000 deaths one week in November to fewer than 1,300 cases and 500 deaths last week.

Some families say the changes are long overdue, given that many residents and staff members have been fully vaccinated for weeks.  The Centers for Disease Control and Prevention reports that 1.4 million residents and 1 million staff at long-term-care facilities are fully vaccinated. 

  • The Los Angeles teachers’ union agreed to a plan to reopen classrooms. Under the plan, elementary teachers will be required to return unless they have a medical reason to stay remote. Secondary teachers will teach most classes virtually, Reuters reports
  • Much of the hype around convalescent plasma has faded and demand for it has plunged after several studies raised doubts about its utility. But defenders say that it’s too soon to dismiss the antibody-rich plasma, which has shown promise in some studies that use calibrated doses and a more targeted patient population, Kaiser Health News’s JoNel Aleccia reports.
  • Americans put on pounds during the pandemic lockdowns, according to a small study published in JAMA Network Open. The study, which used data from Bluetooth connected smart scales, found that adults under shelter-in-place orders last spring gained two pounds per month on average, the New York Times’s Roni Caryn Rabin reports.

Elsewhere in health care

A cost-cutting Medicare rule could add costs for patients.

In the final days of the Trump administration, the Centers for Medicare and Medicaid Services began to phase out a requirement that certain surgeries and other services be conducted only when patients were admitted to hospitals as inpatients in order for Medicare to pay for them, Susan Jaffe reports for The Post.

The change is aimed at giving patients and doctors more options and lowering costs by promoting competition. “But they forgot one thing,” Susan writes. “While removing the surgeries from the inpatient-only list, the government did not approve them to be performed anywhere else.”

Patients will still have to get the surgeries in hospitals, even if they aren’t necessarily considered admitted patients. That reclassification could save money for Medicare, which pays less for outpatient services. But for some patients it could mean higher out-of-pocket charges.

Advocates are pushing Biden to ban mint-flavored cigarettes and other tobacco products.

Public health activists are gaining momentum in a campaign to ban menthol cigarettes, which have been aggressively marketed to Black Americans.

“Covid-19 and the Black Lives Matter movement have put new pressure on Congress and the White House to reduce racial health disparities,” the New York Times’s Sheila Kaplan reports

“And there are few starker examples than this: Black smokers smoke less but die of heart attacks, strokes and other causes linked to tobacco use at higher rates than white smokers do, according to the Centers for Disease Control and Prevention. And 85 percent of Black smokers use Newport, Kool and other menthol brands that are easier to become addicted to and harder to quit than plain tobacco, according to the Food and Drug Administration," she continues.

Public health advocates are particularly concerned about the growing use of menthol cigars and cigarillos among Black teenagers. Surveys show that Black teenagers are more likely to smoke cigars or cigarillos than traditional cigarettes.

“I have no doubt that it’s time for a ban on menthol,” said Rep. Karen Bass (D-Calif.) who led the Congressional Black Caucus last Congress. “We should never allow a chemical that is specifically targeted to a population, that increases death, no matter who it is. In this case, it’s menthol and the Black population.”

Sugar rush