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The Health 202: House Democrats are pushing forward their drug pricing bill again

with Alexandra Ellerbeck

Democrats are pushing forward with an aggressive measure to lower drug prices, even as its future remains murky.

Today and tomorrow, two key House committees will hold hearings on H.R. 3 — a bill allowing the federal government to directly negotiate with drugmakers for lower prices on some pharmaceuticals. 

House Democrats, who ran last year on lowering the price of prescription drugs, already passed the bill in late 2019. But now they say they’re teeing up the measure so it’s ready to go whenever there’s an opening. The hearings “show Democrats are taking concrete steps to get the drug-pricing piece ready and marked up and done so it can be put in whatever vehicle makes sense,” said Henry Connelly, communications director for House Speaker Nancy Pelosi (D-Calif.).

It’s a chance for congressional Democrats to reiterate their promises to lower prescription drug prices.

They’ll discuss the high cost of brand-name drugs with patients, patient advocates, economists, legal experts and activists who will testify before the House Energy and Commerce Committee this morning and before a subcommittee of the Education and Labor Committee tomorrow morning.

It’s an issue Democrats ran on last year. So there was significant pushback when President Biden backed away from including H.R. 3 in the big spending proposal he laid out last week, instead asking Congress to pass the measure.

The following day, Pelosi told reporters “there is big interest in our caucus” for taking on drug prices.

“This is an essential issue for us,” she said.

In prepared remarks shared in advance with The Health 202, House Energy and Commerce Chairman Frank Pallone (D-N.J.) will say at today's hearing he looks “forward to moving H.R. 3 through the committee once again and for it to become law this year.”

But how, when — and even whether — Democrats might be able to move on parts of H.R. 3 is about as clear as mud.

With almost no Republican support, they’d need to use the budget reconciliation process, which allows them to pass legislation through the Senate with just a simple majority. 

Democrats are aiming to push through two reconciliation bills this year; Pelosi has said she wants to move the first package through the House the first week of July. But trillions of new spending proposed by Biden in his infrastructure and “Families First” plans, combined with technical requirements in the budget reconciliation process, means there are multiple ways the whole messy process could play out.

Pelosi’s party certainly doesn’t have the votes to pass H.R. 3 through the normal legislative process. And it’s unclear whether Democrats want to act on drug prices badly enough to risk hindering other priorities. Yet Pelosi insisted the pathway to passing H.R. 3 isn’t important.

“Whether it’s one bill or another isn’t important,” she said. “It’s … the path we’re on.”

H.R. 3 could help Democrats pay for other stuff.

The proposal would allow the secretary of the Department of Health and Human Services to negotiate directly with drugmakers in the Medicare program for lower prices for the 125 drugs that account for the highest spending in Medicare Part D, the 125 drugs that account for the highest spending in the United States and insulin products. An index based on prices in six other countries would serve as a price ceiling. 

The Congressional Budget Office has estimated it would save the federal government about $456 billion over a decade. That’s money Biden could use to pay for his spending plans, which include two years of tuition-free community college, prekindergarten for all 3-year-olds and 4-year-olds, and paid family and medical leave for American workers, among other provisions.

The president spent yesterday defending his proposals to raise taxes on corporations and high-income earners to pay for his spending plans, casting his initiatives as a matter of fairness during a speech at a community college in Portsmouth, Va., John Wagner reports.

“I don’t want to punish anybody, but everybody should chip in. Everybody should pay something,” he said as he touted his American Families Plan.

But right now, Biden is proposing $1.5 trillion in tax hikes on wealthy Americans and investors to fund it.

“The White House aims to raise money through a sizable increase in enforcement by the Internal Revenue Service, as well as approximately doubling the capital gains tax rate for those earning more than $1 million per year,” John writes.

“Biden is also pitching a separate jobs and infrastructure plan that would be paid for in part by raising the corporate income tax. Together, the plans carry a price tag of about $4 trillion.”

Ahh, oof and ouch

AHH: The Food and Drug Administration is set to authorize the Pfizer-BioNTech coronavirus vaccine for teens.

The agency is expected to approve the vaccine for children ages 12-15 by early next week.

“Families and pediatricians have been eager for a vaccine to become available for children, particularly in advance of the next school year,” The Post's  Carolyn Y. Johnson reports.

The pending regulatory action, first reported by the New York Times, comes after clinical trials found that the vaccines offered similar protection in teenagers as in adults. There were 18 cases of covid-19 in the trial, all among people who had received the placebo. If the vaccine is approved, the Centers for Disease Control and Prevention’s vaccine advisory panel will meet to discuss recommendations for its use.

Former FDA commissioner Scott Gottlieb predicted on Sunday that 10 million teenagers could be vaccinated before the fall. But children are already at low risk from the virus, and some epidemiologists and global health advocates say that scarce supply of the vaccines would be better targeted at high-risk adults in other countries.

“I do think we need to have a national and global conversation about the ethics of our vaccinating kids, who are low risk for serious complications from the virus, when there aren’t enough vaccines in the world to protect high-risk adults from dying,” Jennifer B. Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security, told the New York Times.

OOF: CVS and Walgreens account for the majority of wasted vaccine doses.

“The Centers for Disease Control and Prevention recorded 182,874 wasted doses as of late March, three months into the country’s effort to vaccinate the masses against the coronavirus. Of those, CVS was responsible for nearly half, and Walgreens for 21%, or nearly 128,500 wasted shots combined,” Kaiser Health News’s Joshua Eaton and Rachana Pradhan report.

While it’s not clear why the pharmacy giants accounted for much more vaccine waste than states and federal agencies, CVS has said that nearly all its early waste occurred during rollout efforts aimed at vaccinating residents and staff in long-term-care facilities under the Trump administration. 

“One thing is clear: Months into the nation’s vaccination drive, the CDC has a limited view of how much vaccine is going to waste, where it’s wasted and who is wasting it, potentially complicating efforts to direct doses to where they are needed most,” Joshua and Rachana write.

OUCH: Experts say the United States will not reach herd immunity anytime soon, if ever.

“[T]hey are coming to the conclusion that rather than making a long-promised exit, the virus will most likely become a manageable threat that will continue to circulate in the United States for years to come, still causing hospitalizations and deaths but in much smaller numbers,” the New York Times’s Apoorva Mandavilli reports.

Early in the pandemic, many experts predicted that once 60 to 70 percent of Americans had immunity, either from natural infection or vaccinations, the virus would run out of people to infect. But amid the spread of more contagious variants of the virus, experts now put the herd immunity threshold at 80 percent. Polls show that 30 percent of Americans say they don’t want a vaccine.

And even if the country achieved a high level of immunity nationally, there would still be communities with lower vaccination rates where the virus could spread. Yet vaccinations will still allow the country to drive down infections, hospitalizations and deaths, especially among the most vulnerable. Over time, public health officials may be better able to target localized outbreaks.

More in coronavirus news

Moderna will supply 500 million doses to the World Health Organization’s Covax initiative.

The company’s announcement could give a much-needed boost to the WHO-backed vaccine campaign. 

“However, the deal will do little to alleviate short- and medium-term supply concerns. Under the agreement, the company will work with Covax to supply 34 million doses at its ‘lowest tiered price’ by the end of 2021, with the option for 466 million shots available in 2022,” The Post’s Emily Rauhala and Erin Cunningham report.

The announcement comes as advocates call on U.S. health officials to do more to pressure Moderna to share its vaccine, which was developed with significant support from the U.S. government.

Pfizer, partnering with BioNTech, and Moderna have created effective coronavirus vaccines that scientists hope will lead to medical breakthroughs using mRNA. (Video: Joshua Carroll, Brian Monroe/The Washington Post)
Some vaccine skeptics are willing to reconsider.
  • Kim Simmons, a 61-year-old small-business owner in Illinois, changed her mind about getting a vaccine after watching a Johns Hopkins University doctor on C-SPAN make the case for the shots. 
  • Lauren Bergner, a 39-year-old homemaker in New Jersey, wants a shot to make it easier to attend New York Yankees games, where proof of vaccination is required. 
  • And Elizabeth Greenaway, a 34-year-old communications consultant in Pennsylvania, decided she would get vaccinated to ensure that she would be around to care for her 2-year-old daughter, who has a rare health condition, The Post’s Dan Diamond reports.
Participants in an April 29 focus group describe what made them decide to get vaccinated against the coronavirus. (Video: Courtesy of Frank Luntz and de Beaumont Foundation)

“The emergence of these mind-changers suggests that at least some vaccine-wary Americans are willing to reconsider when their concerns are addressed by those they regard as credible,” Dan writes. “Their conversions — along with those of 16 other former skeptics who joined a focus group last week — have drawn intense interest from White House officials and public health experts, hoping to re-create those moments for the tens of millions of Americans who remain in the ‘no’ camp.”

Lessons from the focus groups and accompanying polling also informed a new series of public service announcements produced by the de Beaumont Foundation and featuring Republican doctors in Congress, which are set to be released Monday,” he continues.

Elsewhere in health care

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