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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Insulin price caps are on the horizon

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Good morning — where today we're flashing back to this 2019 take-your-child-to-work day gem. How one kid described their dad's job: “He does his work, and he does it each time.”

Below, the Biden administration announced high vaccination rates for federal workers and a key drug pricing champion is running for the Senate. But first:

It's almost like Democrats want the GOP to oppose insulin price caps

Insulin has long been the poster child for high drug prices – and now lawmakers are taking action.

President Biden’s economic package includes a cap on the cost of the lifesaving medication for the millions of people who get their health coverage through Medicare or private plans. The measure has largely flown under the radar amid politically divisive policies, like drug price negotiations meant to curb the sky-high costs of medicine.

Curbing insulin costs is politically popular – and Democrats seem aware that Republicans could anger voters by challenging such caps.

Over the weekend, Senate Majority Leader Chuck Schumer (D-N.Y.) devoted his news conference in New York to the sprawling legislation’s $35 per month cap on insulin. Republicans have supported insulin caps, but Schumer suggested the GOP may challenge the $35 cap when the parties soon spar over what policies can be included in the economic package (some parts might be struck under a budget maneuver Democrats are using to advance the package without GOP votes).

Schumer essentially fired a warning shot to Republicans, insisting they “not attempt to kill this provision.” 

  • “Today I’m announcing that as majority leader, I’ll do everything I can to keep the provision in the BBB,” he said, referring to the name of the legislation, the Build Back Better Act.

Republicans have not yet revealed what they may challenge out of the bill’s health care provisions in the legislation, particularly those that are politically popular, like drug pricing measures. Yet, the GOP has been in lockstep against the roughly $2 trillion bill overhauling federal health-care, education, climate, immigration and tax laws, and the process Democrats are using to pass it.

The legislation

The cost of insulin — which has been around for roughly a century — has doubled or, in some cases, tripled over the past decade, according to a bipartisan Senate report. The provisions on insulin in Democrats' economic package would take effect in 2023, and come as a wave of states have implemented caps on its cost in state-regulated plans.

Allies of the measure pushed the policy in the days leading up to the House’s vote on Biden’s economic package. 

  • For instance: Nearly 15,000 American Diabetes Association advocates contacted lawmakers. (The House passed the social spending bill Friday, where changes are now expected in the Senate.)

The cost of insulin has also led Republicans to propose legislation limiting what patients must pay for it.

  • House Republicans have an alternative to Democrats’ drug pricing measure, which includes a monthly $50 cap on insulin and its supplies after Medicare patients hit their deductibles. In the Senate, the top-ranking Republican lawmakers on the chamber’s health panels have a bill that includes making permanent a pilot project giving those on Medicare the option to get a voluntary prescription drug plan where insulin only costs $35 a month.
The politics

Lawmakers have been itching to drive down patients’ cost for insulin for years. The effort has been a rare showing of bipartisanship, where Democrats and Republicans have brought drugmakers into the congressional hot-seat to bash the drug’s skyrocketing cost. 

But if the cap passes in Democrats’ bill, it’s a tangible benefit to voters the party would likely campaign on in the midterm elections.

  • “I think reducing the price of insulin is one of the most important and popular items in this entire bill,” said Leslie Dach, who founded Protect Our Care, a Democratic-aligned health-care advocacy group.

The key question now is whether the Senate parliamentarian will go for insulin caps at all.

The parliamentarian is essentially the arbiter of what policies are allowed under the process Democrats are using to pass the economic package with their slim majorities on Capitol Hill. Meetings that could potentially scrub provisions violating those arcane rules are expected to really kick in next week, per multiple sources.

  • A GOP leadership aide said there’s bipartisan support for an insulin pricing solution, and insisted Republican opposition is to the entirety of the social spending bill. Republicans declined to comment on if they’ll contest whether the insulin measure complies with the Senate’s strict rules.
  • How Democrats view a challenge: “If Republicans want to defend higher insulin prices going into an election year, that’s a win for Democrats,” a Democratic aide said.


Daily coronavirus cases are ticking up ahead of Thanksgiving

The seven-day average of reported coronavirus infections has increased by 18 percent, Centers for Disease Control and Prevention Director Rochelle Walensky said at a Monday news conference. Hospital admissions are up 6 percent.

  • Cases have been increasing throughout November, raising fears that colder weather and more time spent indoors could fuel another surge in cases. The weekly average for coronavirus cases is now over 90,000, up from around 72,000 just a month ago, according to data from The Post.
  • Federal officials have been citing the uptick as a reason that more Americans should get booster shots going into the holidays.
  • They are also imploring the unvaccinated to get shots. Recent CDC data shows that unvaccinated adults are six times as likely to test positive for the coronavirus and 14 times as likely to die of covid-19 compared with vaccinated people.

Vaccines make it possible to have a safe, and nearly normal holiday, federal officials say. Anthony Fauci, the nation’s top infectious-disease expert, told The “Post Reports” podcast that if everyone is vaccinated, people “should feel good and safe” about enjoying a typical Thanksgiving meal.

The Biden administration released some data on agency vaccinations

More than 90 percent of 3.5 million federal employees covered by the Biden administration’s vaccine mandate have received at least one dose, and a “vast majority” of those have been fully vaccinated, Jeff Zients, White House coronavirus response coordinator, said Monday.

The White House announced earlier in the day that 95 percent of federal workers had complied with the mandate, a figure that includes workers who have pending or approved religious or medical exemption requests. 

A full agency-by-agency breakdown will be released Wednesday. But here’s what we know so far, per Zients:

  • 98 percent compliance at the IRS, with nearly 25 percent of employees getting vaccinated after the president announced the requirement
  • 99 percent compliance at the FBI
  • 98 percent compliance at U.S. Customs and Border Protection
  • 93 percent compliance at the Transportation Security Administration
  • And 99 percent at the Transportation Security Administration, The Post's Annabelle Timsit, Bryan Pietsch and Lateshia Beachum report.

Here’s what else you need to know:

  • The U.S. Army awarded Pfizer-BioNTech $1.4 billion to produce an additional 200 million doses of its coronavirus vaccine for international donation, Lateshia writes.
  • Vice President Kamala Harris said racial disparities in vaccine uptake between Black and Latino adults and other groups have largely closed, The Post’s Eugene Scott reports.
  • The White House announced $1.5 billion to help get rid of a shortage of doctors and nurses in underserved communities, our colleagues Akilah Johnson and Danielle Douglas-Gabriel report.

From our notebook

Drug pricing champion runs for Senate: Democratic Rep. Peter Welch — Vermont’s only House member — announced his bid to succeed retiring Sen. Patrick Leahy. 

  • “Welch pledged in his statement to work to expand access to child care and paid family leave, pass a Green New Deal, lower health-care and prescription drug costs, protect abortion rights and safeguard voting rights,” our colleague John Wagner reports.

In the health-care arena, Welch has long led the charge to let the federal government directly negotiate lower drug prices with pharmaceutical companies. Failing to do so in Biden’s sweeping economic package would be “political malpractice,” Welch told The Health 202 earlier this year.

  • Democrats included drug negotiation provisions in the legislation the House advanced Friday, but the measures don’t go as far as many, such as Welch, are seeking. He’s suggested he’d continue to push for more reforms in the coming years.

Industry RX

Elizabeth Holmes testifies again today

For a third time, the start-up founder will testify in a trial in which prosecutors are trying to prove she misled investors about the capabilities of her company’s blood-testing technology. She faces 11 charges of wire fraud and conspiracy to commit wire fraud and has pleaded not guilty. So far, her testimony has largely focused on what she knew about Theranos’s relationships with pharmaceutical companies, Rachel Lerman reports.

“The prosecution rested its case last week after calling 29 witnesses during more than two months of trial,” Rachel writes. “Holmes, who has since softened her look by wearing shades of blue and wearing her hair down in waves, took the stand in her own defense Friday in a surprise move. It was previously unclear whether Holmes would speak on her own behalf, a move that outside lawyers say can be a strategic but risky move.”

On the Hill

House panel wants former FDA commissioner Hahn to sit for an interview.

The committee probing the government’s coronavirus response has asked to talk with former Food and Drug Administration commissioner Stephen Hahn on Dec. 13. They also want him to turn over relevant documents from last year, such as on President Donald Trump’s efforts to boost some drugs still unproven as coronavirus treatments, our colleague Dan Diamond reports. 

  • For instance: Democrats say they have questions about White House officials and Trump allies pressuring the FDA to increase access to hydroxychloroquine and chloroquine — malaria drugs Trump publicly touted as virus cures despite a lack of evidence. The panel cited messages from Amy Abernathy, a top FDA deputy, who in April 2020 warned Hahn of the risks of the drugs, Dan writes.

The panel is also probing the White House’s role around the FDA’s decision to authorize convalescent plasma as an emergency treatment, though scientists said more research was needed. In their letter, Democrats cited internal emails where Hahn praised an erroneous talking point about the treatment, but one he retracted after he repeated it at a news briefing with Trump.

Sugar rush

On the National Mall, we asked kids about everything from turkeys to transformers. (Video: Dave Jorgenson/The Washington Post)

Thanks for reading! See y'all tomorrow.