White House Says Has Sent ‘Principles’ for Drug Pricing Reform to Congress

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Source: Reuters

U.S. President Donald Trump has sent “principles” for drug pricing reform to lawmakers, White House spokeswoman Stephanie Grisham said in a statement on Tuesday.

The White House has called for legislation that would:

– “Cap Medicare Part D beneficiary annual out-of-pocket pharmacy expenses

– “Provide an option to cap Medicare Part D beneficiary monthly out-of-pocket pharmacy expenses

– “Offer protection for seniors against the out-of-pocket cost cliff created by ObamaCare

– “Give insurance companies an incentive to negotiate better prices for costly drugs

– “Limit drugmakers’ price increases.”

Pelosi, Seeking to Insulate House Majority, Presses Plan to Lower Health Costs

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Source: The New York Times, by Sheryl Gay Stolberg

Speaker Nancy Pelosi is preparing to unveil a sweeping plan to lower the cost of health care, moving to address the top concern of voters while giving moderate Democrats who face tough re-election races a way to distance themselves from the Medicare for All plan embraced by the progressive left and derided by Republicans as socialism.

The legislation, timed to coincide with the 10th anniversary of the Affordable Care Act, is part of a major push by Democrats to position themselves as the party of health care before the 2020 elections. Former President Barack Obama will support the effort, appearing with Ms. Pelosi at American University in Washington on March 23, 10 years to the day he signed the Affordable Care Act into law.

While the measure has little chance of survival in the Republican-controlled Senate, it is the latest evidence that Democratic leaders, determined to protect their House majority and the moderate lawmakers who helped them to power, are looking for ways to distinguish their rank and file from the party’s presidential nominees.

The plan bears no resemblance to Medicare for All, the national health insurance system championed by Senator Bernie Sanders of Vermont, the self-described democratic socialist. And it omits a “public option” to create a government-run health insurer, an idea embraced by former Vice President Joseph R. Biden Jr., the Democratic front-runner.

In steering clear of the ideas promoted by both leading presidential candidates, Ms. Pelosi is hoping to protect the so-called front-liners who flipped Republican seats in 2018 and delivered Democrats the majority.

The speaker’s new proposal is aimed at reducing costs under the current health bill, according to people familiar with it, who insisted on anonymity to describe a plan that was not yet public. Details are still being finalized, and Ms. Pelosi — who was to meet Monday evening with Democratic committee chairs to discuss a response to the coronavirus epidemic — has not yet shared them with her rank and file. The speaker’s office declined to comment.

The plan could be unveiled as early as this week, though coronavirus could upend that timeline. In eschewing Medicare for All, Ms. Pelosi is turning away from a proposal that does not have the votes to pass the House and has divided Democrats on Capitol Hill.

Instead, the speaker is expected to propose a series of steps to make health care more cost-effective under the Affordable Care Act, including expanding tax credits and subsidies to help people buy insurance and creating a national program to help cover expenses for those with medical conditions. The plan is expected to spotlight ideas put forth by vulnerable freshmen like Representatives Lauren Underwood of Illinois and Angie Craig of Minnesota.

But Ms. Pelosi’s reluctance to embrace Mr. Sanders’s bold vision may draw the ire of her caucus’ left wing, which is pushing for a vote on Medicare for All. Her decision to shy away from the public option is especially notable, given that the House included such a system when it passed its version of the Affordable Care Act in 2009. The provision was later stripped out by the Senate.

“I think it’s way too cautious an approach,” said Representative Ro Khanna, Democrat of California and a national co-chairman of Mr. Sanders’s campaign, though he added that Democrats would most likely embrace any plan that lowered costs, even incrementally.

“No one is opposed to a pragmatic step that’s feasible,” he said. “What we’re opposed to is a lack of imagination and boldness in not giving a vote on policies that economics and health experts are saying is what the country needs.”

But Leslie Dach, a Democratic strategist and the chairman of Protect Our Care, an advocacy group, said it was important for Democrats to spotlight what they could agree on, especially after a string of presidential primary debates where Democrats beat up one another over their health care plans instead of going after President Trump.

“If you do the polling, 80 percent of the people want to lower costs, and they want to protect critical things like pre-existing conditions. That unifies the country and unifies the party,” Mr. Dach said. “What we have had is a debate with tremendous missed opportunities. Democrats should have been up there reminding people what Donald Trump has been doing to their health care, not arguing as much about where they want to go.”

Polls show the public is deeply concerned about the high cost of health care but divided over what to do about it. A recent poll by the Kaiser Family Foundation found that a slight majority of respondents — 53 percent — favored a Medicare for All approach that would cover everyone on a single government plan. A much larger majority, 65 percent, favored a public option.

Republicans have latched onto Mr. Sanders and Medicare for All as a way to paint Democrats as socialists, a strategy that is unlikely to change no matter what proposal Ms. Pelosi puts forth or who becomes the Democratic nominee.

“Voters have watched as the Democratic Party has moved further and further left, to the point where now a majority of their members support canceling private health care entirely for BernieCare,” said Dan Conston, the president of the Congressional Leadership Fund, a political action committee affiliated with House Republicans. Such positions, he said, “make the argument that Democrats have become socialists a particularly effective one, no matter how much they now try to run away from it.”

The Affordable Care Act anniversary comes as the law itself is in fresh peril. It has survived numerous Republican attempts and a vow by Mr. Trump to repeal it, as well as a string of court challenges.

But the Supreme Court, which has twice ruled to leave most of the provisions intact, recently agreed to hear a third case, which could wipe out the Affordable Care Act entirely. When Democrats took over the House in January 2019, they voted to intervene in the case, Texas v. U.S., which was brought by conservative state attorneys general seeking to overturn the law.

Democrats campaigned aggressively in 2018 on lowering costs and protecting health coverage, and they have already taken some steps to make good on those promises.

In May, they passed legislation to reverse Trump administration rules that allowed the expansion of health care plans that did not have to comply with the Affordable Care Act’s mandated coverage of pre-existing medical conditions. And in December, the House voted to lower the rising cost of prescription drugs by empowering the federal government to negotiate prices with pharmaceutical manufacturers.

But like most legislation passed by House Democrats, the two health bills are languishing in the Senate, where Senator Mitch McConnell, Republican of Kentucky and the majority leader, refuses to take them up.

The legislation Ms. Pelosi is drafting is based in part on the Protecting Pre-Existing Conditions & Making Health Care More Affordable Act, a measure introduced about a year ago by the three chairmen whose committees have jurisdiction over health care: Representative Frank Pallone Jr. of New Jersey, the Energy and Commerce chairman; Representative Richard E. Neal of Massachusetts, the Ways and Means chairman; and Representative Robert C. Scott of Virginia, the Education and Labor chairman.

That bill aims to lower health insurance premiums by expanding eligibility for premium tax credits beyond 400 percent of the federal poverty line. It also increases the size of tax credits for people in all income brackets. It would create a so-called reinsurance program, which would provide government funds to help insurers offset the cost of patients with expensive medical conditions. And it would make subsidies more generous for people with incomes below 250 percent of the federal poverty line.

Other Democrats, including Ms. Underwood and Ms. Craig, have put forth similar ideas. Ms. Underwood is the chief sponsor of a stand-alone plan to expand tax credits. Ms. Craig is promoting federal funding for states to run their own programs to reduce insurance premiums.

It is measures like Ms. Pelosi’s — not the kind of systemwide overhaul advocated by Mr. Sanders — that House Democrats want to focus on as they seek to maintain their majority.

“Our front-liners have been very focused on their message, which has been strengthening the A.C.A., making sure we’re continuing to cover pre-existing conditions, and making sure that we resist the constant cuts to Medicaid and Medicare and even Social Security that have been proposed,” said Representative Katherine M. Clark, Democrat of Massachusetts and a member of the leadership. “Whatever’s happening on the national level, I don’t think their strategy is going to change.”

Extended-Release Drugs Could Be Costing U.S. Healthcare System Billions

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Source: The New York Times

If doctors prescribed short-acting medications that must be taken twice a day instead of once-a-day extended-release versions, billions in healthcare costs could be saved, a new study suggests.

Based on Medicare and Medicaid spending between 2012 and 2017, prescriptions for extended-release drugs cost the healthcare system almost $14 billion more than would have been spent on equivalent twice-a-day medications, researchers report in JAMA Network Open.

“It’s not a huge difference in terms of patient convenience, but the cost difference is remarkable,” said coauthor Dr. Ambarish Pandey of the University of Texas Southwestern Medical Center in Dallas.

Pandey and colleagues looked specifically at drugs whose benefits in a twice-a-day version are equivalent to those of the extended-release version. While it’s argued that patients are more likely to stick with their medication schedule if the drug is taken once a day, that hasn’t been proven, Pandey said. “There might be a difference if it was three times a day,” he allowed.

To analyze how much extended-release medications were adding to health-system costs, Pandey’s team reviewed records from the Medicare Part D Prescription data set and the Medicaid Spending and Utilization Data set for 2012 through 2017.

The Medicare database includes medication expenditures for approximately 70% of all beneficiaries of Medicare, the federal health insurance program for people aged 65 and older and the disabled. The Medicaid database contains spending for outpatient drugs by state agencies that administer the federal-state Medicaid insurance program for low-income families.

The researchers winnowed down their list of medications to 20 drugs, which had 37 formulations, 19 of them brand-name and 18 generic.

In 2017, Medicare Part D spent $2.2 billion and Medicaid spent $952 million on extended-release versions of those drugs. The researchers estimate that swapping twice-daily versions for all extended-release formulations that year would have saved Medicare and Medicaid a total of $2.6 billion.

Over the entire 2012-2017 study period, Medicare Part D spent $12 billion on extended-release formulations while Medicaid spent $5.9 billion, and a switch to twice-daily versions would have saved $13.7 billion, they conclude.

The way to fix the problem is for insurers to demand that drug companies reduce extended-release costs to the point where the price is comparable to that of the twice-a-day version, Pandey said.

“If Medicare puts its foot down and says it won’t put the extended-release versions on their formulary unless the price is similar to that of the immediate-release formulations, things will change,” he said.

What’s interesting about this paper is the concept of trying to reduce medication cost by switching drugs rather than trying to get a decrease in price from the pharmaceutical company, said Dr. Walid Gellad, director of the University of Pittsburgh Center for Pharmaceutical Policy and Prescribing.

Gellad commended the authors for focusing on drugs that had a short-acting version with the same therapeutic effects as the extended-release version and for looking only at short-acting drugs that would be taken twice a day as opposed to three or more times a day.

But, Gellad said, that doesn’t mean the drugs are completely comparable. “For example, the diabetes drug metformin is one of the big drivers of savings, but the problem is, a lot of patients get stomach upset with the short-acting form,” he explained.

“Having said that, there are many instances where people could use the short-acting form and wouldn’t be burdened with side effects and would do just as well as with the extended-release form,” Gellad said. “One of the main messages for clinicians is that we should always offer the short-acting form to our patients if they can’t afford the long-acting version.”

Trump Administration Says Drug Makers Will Work Together to Combat Coronavirus

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Source: Reuters, by Jeff Mason

The Trump administration said on Monday it had secured commitments from top pharmaceutical companies to work together to develop a vaccine and treatments to fight the coronavirus.

At a meeting with industry executives at the White House, President Donald Trump exhorted the companies to collaborate to speed the process of getting a vaccine and therapeutics to victims of the virus.

The company leaders indicated a willingness to cooperate with one another, but did not lay out how that would happen.

The White House, which has clashed previously with the pharmaceutical industry over high drug prices and has been struggling in recent weeks to show it is on top of the virus response, saw the meeting as a victory.

“This is all hands on deck. And the news out of this meeting that you’ve already formed a consortia … now we know they will be working together to create therapeutics and ultimately a new vaccine,” Vice President Mike Pence said as the session drew to a close.

The global death toll from the illness caused by the new coronavirus now exceeds 3,000, with more than 60 countries affected. In the United States, there have been more than 90 cases, with six deaths.

Trump pressed the representatives at the table about their timeframes for getting a vaccine ready and took upbeat comments from some of the company leaders to mean that it could be ready to deploy within months.

“You seem to know what the answer is to this,” Trump said. “Get it done. We need it.”

Pressed on whether the vaccine would be ready in the short timeframe he desired, Trump said he had heard from the leaders at the table a range of three to four months to a year. But Anthony Fauci, who heads the National Institute of Allergy and Infectious diseases, stepped in and urged those at the table to correct the president’s impression.

“He’s asking the question: When is it going to be deployable? And that is going to be at the earliest a year to a year and a half,” Fauci said.

Trump, who has sought to suggest a vaccine would be ready before health professionals have indicated, followed up after Fauci’s comments: “You think that’s right?”

Attendees assured him that treatments, rather than a vaccine itself, could be ready before that.

Attendees included the chief executives of Gilead Sciences Inc, Regeneron Pharmaceuticals Inc, Moderna Inc and GlaxoSmithKline Plc as well as research and development executives from Pfizer Inc, Johnson & Johnson and Sanofi SA, all of which are working on vaccines or treatments for the virus.

Even with Trump voicing hope that the companies can accelerate their development as much as possible, executives and other experts have suggested that clinical trials to guarantee a vaccine is safe and effective could mean that it could take a minimum of 12 to 18 months to hit the market.

Antiviral treatments could possibly move faster toward approval.

Pfizer’s chief scientific officer, Mikael Dolsten, told Trump the company had identified compounds that had a high probability of being effective against the virus.

After the meeting, Pfizer said in a statement it had identified some antiviral compounds it owns as potential treatments for coronaviruses and was working with a third party to evaluate them.

It said if they proved to be good candidates and passed toxicology studies, it hoped to start testing them clinically by the end of the year.

Survey: 20 Million Americans Have Crowdfunded to Help Pay Medical Bills

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Source: The Hill, by Jessie Hellmann

An estimated 8 million Americans have started crowdfunding campaigns through websites like GoFundMe to pay for medical expenses for themselves or someone in their households, according to a survey released Wednesday,

Another 12 million Americans said they have started a campaign for someone else, according to the NORC at the University of Chicago survey.

Twenty percent of Americans said they donated to such campaigns.

The proliferation of these online fundraisers to pay for medical bills is a symptom of the increasing costs of health care, even for those who have insurance.

“As annual out-of-pocket costs continue to rise, more Americans are struggling to pay their medical bills, and millions are turning to their social networks and crowdfunding sites to fund medical treatments and pay medical bills,” said Mollie Hertel, a senior research scientist at NORC, in a press release.

“Although about a quarter of Americans report having sponsored or donated to a campaign, this share is likely to increase in the face of rising premiums and out-of-pocket costs,” Hertel added.

GoFundMe casts itself as the “leader in online medical fundraising,” with 250,000 medical campaigns launched on its website each year.

“I would love nothing more than for ‘medical’ to not be a category on GoFundMe,” the website’s CEO, Rob Solomon, told Kaiser Health News last year.

“The reality is, though, that access to health care is connected to the ability to pay for it. If you can’t do that, people die. People suffer. We feel good that our platform is there when people need it,” he added.

The NORC survey found 85 percent of respondents thought the government should be responsible for providing help when medical care is unaffordable.

Eighty-three percent said the same of hospitals or clinics.

The poll was conducted between Nov. 8 and Nov. 16, 2019, and included 1,020 interviews with a nationally representative sample. It has a margin of error of 4 percent.

Trump’s Support for Bipartisan Senate Drug Pricing Bill May Not Be Enough to Push it Into Law

Senate Majority Leader Mitch McConnell, center, shakes hands with Sen. Ted Cruz as Sen. Charles E. Grassley waits before President Trump delivers his State of the Union address on Capitol Hill on Feb. 4.  (Leah Millis/AP)

Source: Washington Post, by Yasmeen Abutaleb and Erica Werner

Senate bill to control prescription drug prices seemed to have everything it needed: bipartisan backing, President Trump’s endorsement and broad public support.

But its status on legislative life support reveals the perils of tackling one of the nation’s most hot-button topics just months before a presidential election. Even though Trump has said he supports the measure, he has stopped far short of trying to ensure its passage.

Complicating matters further, the top Senate Republican and Democrat have yet to embrace the legislation, though for opposite reasons.

“Everybody agrees that prescription drug prices are too high. The dilemma is how do you get there, and we have divisions in the Republican Party on that, and with the Democrats on that,” said Senate Majority Leader Mitch McConnell (R-Ky.). “Whether we can all pull together and get a solution, I’m not prepared to predict today.”

The proposal, introduced over the summer by Sens. Charles E. Grassley (R-Iowa) and Ron Wyden (D-Ore.), would limit price increases in Medicare’s prescription drug benefit to the rate of inflation or otherwise force companies to pay a penalty in the form of a rebate, and it would limit seniors’ out-of-pocket drug costs to $3,100 a year. Some Republicans have said the legislation is akin to price controls, which they have long abhorred.

Prescription drug prices consistently poll as a top voter concern, as many consumers say they cannot afford their medication and prices often rise year after year. They had shown signs of leveling off recently, but prices on hundreds of drugs rose an average of 5.8 percent in January, according to an analysis from Rx Savings Solutions. Medicare spends more than $100 billion per year on prescription drugs.

Trump has publicly supported the bill through tweets and in his State of the Union address this month, when he called on Congress to pass bipartisan legislation and personally recognized Grassley for his leadership on the issue. Vice President Pence gave the bill a nod of support this month in an interview with Fox News. Yet Trump has not lobbied individual senators to support the measure or personally pressured McConnell for action, said four people familiar with the situation who spoke on the condition of anonymity to discuss private deliberations.

Throughout the fall, Grassley said that he asked White House advisers to get Trump involved in winning support for the legislation and speaking publicly about it, but that they were reluctant to involve Trump to that degree. Grassley said he “never got a good reason” as to why advisers did not want to involve the president.

After the House began impeachment proceedings in September, however, Trump and White House staff members were largely consumed by working to keep Senate Republicans unified in supporting the president. Advisers avoided strong-arming members on divisive legislative issues. It remains unclear whether Trump will more directly engage in the coming weeks and months.

Meanwhile, McConnell presided over his party’s unsuccessful attempt to repeal and replace the Affordable Care Act shortly after Trump took office and has since then shown little interest in revisiting health-care legislation, a divisive issue within the Republican Party. For now, McConnell stands as an obstacle to Grassley’s bill. McConnell has not committed to bringing up the legislation for a vote and indicated that he had little interest in doing so because it divides his caucus.

The pharmaceutical lobby is a major contributor to Republicans, including McConnell, and has spent millions lobbying against the bill. Both the drug industry and influential outside conservative groups have said the Grassley-Wyden bill could stifle innovation and interfere in the free market.

Democrats successfully used health care as a cudgel in the 2018 election, retaking control of the House as they repeatedly accused Republicans of trying to undermine coverage for people with preexisting conditions. They could try to replicate this strategy later this year if no action is taken.

Grassley has repeatedly warned that without a vote on his bill, Republicans could lose their majority in the Senate — especially after House Democrats, led by Speaker Nancy Pelosi (Calif.), passed their own progressive bill late last year to lower drug prices. The House bill would allow Medicare to negotiate the price of up to 250 drugs and includes elements of the Grassley-Wyden bill.

Medicare negotiating is highly popular with the public, with 88 percent of people, including more than 90 percent of Democrats and 85 percent of Republicans, favoring allowing the federal government to negotiate drug prices for Medicare beneficiaries, according to a Kaiser Family Foundation poll in October.

Several senior White House and administration officials pointed to Trump’s public declarations of support for the measure and its mention in the State of the Union address as signs that he was on board.

“Many excellent provisions are being considered on Capitol Hill, including Grassley-Wyden, which is a genuine bipartisan approach, and the White House remains in close contact with members as we work to move a solution forward that advances the president’s priorities,” White House spokesman Judd Deere said.

Trump has shown that his personal involvement in legislation can be key, such as when he backed a divisive criminal justice reform bill in 2018 that ultimately passed the Senate by an overwhelming margin and was signed into law. And in 2017, he toured the country to whip up support for a big tax cut package that eventually won congressional approval.

Grassley pointed to Trump’s support of the bill in the State of the Union as one of the biggest boosts of support he could ask for.

“I can’t just rely upon the president saying that if we put a bill on his desk, he’ll sign it,” Grassley said. “Since the president stated this in his State of the Union message, we’ve had a lot of Republicans express interest that probably wouldn’t have.”

Health care has been top of mind for Trump as he gears up for his reelection bid, and exit polls in Iowa and New Hampshire showed it to be a top issue. Last month, Trump called his Health and Human Services secretary, Alex Azar, and yelled at him on speakerphone in the middle of a campaign meeting after he was briefed on internal polls that showed voters trusted Democrats more than Republicans on health care.

Lawmakers face a May deadline over federal funding for community health centers and say they hope to use that deadline to take up other health-related legislation that could address drug pricing and health-care costs. But the effort is complicated by intraparty and partisan divisions, and it remains unclear whether Congress will be able to pass a bill of this magnitude just months before a presidential election.

Grassley said he and Wyden hope to begin discussions with Pelosi in the coming weeks to see if the House would be willing to pass legislation similar to the Senate bill. Some Republicans have expressed skepticism that Democrats would be willing to give Republicans a legislative win on health care, suggesting that instead they plan to use the passage of the House bill to attack Republicans on the campaign trail.

Indeed, although the Grassley-Wyden bill has strong support in the Democratic caucus, it’s uncertain whether Senate Democratic leaders would join an effort to pass it. Senate Minority Leader Charles E. Schumer (D-N.Y.) said he supports the House bill, refusing to say whether he backs the Grassley-Wyden bill.

“We don’t want to settle,” Schumer said. “Our first goal is [the House bill]. Period.”

Those close to McConnell say he is personally opposed to the bill because of price caps it imposes on drug companies and because he does not like to take up legislation that splits his party.

So far, the bill has 12 Republican backers, including several vulnerable senators facing tough 2020 reelection fights. Sen. Joni Ernst (R-Iowa) endorsed the bill on Tuesday; Sen. Martha McSally (R-AZ) endorsed it last week; and Sen. Susan Collins (R-Maine) also is on board. Sen. John Cornyn (R-Texas) voted for the bill in the Finance Committee despite expressing reservations; he said last week that a “pared-down version” would be more likely to find consensus. Grassley said he hopes to have more Republican support soon, but for now he’s far short of the threshold he believes is necessary to win over McConnell.

For Republicans, inaction on prescription drug pricing legislation would be just their latest failure on health care after they spent much of the Obama administration voting to repeal his Affordable Care Act, only to fail to produce a replacement once Trump took office. The Trump administration is now fighting the ACA in the courts, while still claiming the White House will offer an alternative at some later date that would protect people with pre-existing conditions.

By taking on the narrower issue of lowering prescription drug prices, Grassley sought to focus in on one element of the health care industry that receives bipartisan support. But that’s proving difficult for some GOP senators who know the issue is crucial for their constituents but may not be willing to take on the pharmaceutical industry.

Sen. Mike Braun (R-Ind.), a freshman senator and supporter of Grassley’s bill, criticized the health care industry for operating as a “monopoly,” something he said his fellow GOP senators have failed to recognize at their own peril. He predicted Democrats will use it against Republicans once more in the election this year.

“It’ll be the one issue they’ve got on us and they’ll try to take it all the way to November of 2020,” Braun said. “And I don’t know that we can say we’ve got much to hang our hat on.”

Grassley Pushes for Senate Drug Pricing Bill to Pass by May

Chuck Grassley

Source: FiercePharma, by Eric Sagonowsky

As the Democratic primaries roll on and presidential candidates continue to attack the drug industry, one Republican senator is making a big push for his legislation.

Republican Sen. Charles Grassley, who last year introduced a drug pricing bill with Sen. Ron Wyden, recently predicted the legislation will pass a bipartisan vote by May 20, the Daily Iowan reports.

The senator plans to negotiate with House Speaker Nancy Pelosi, fight for more Republican support and get President Donald Trump to back his bill, which he argues has a better chance than others in Congress, the publication says.

The Grassley-Wyden bill out of the Senate Finance Committee would limit price hikes in Medicare to the rate of inflation and implement an out-of-pocket cap for patients. If companies were to raise prices above the rate of inflation, they’d be forced to pay a rebate.

In Congress’ other chamber, House Democrats have passed Pelosi’s more aggressive bill that calls for Medicare price negotiations, penalties for drugmakers that don’t negotiate, an international price index and more.

At the State of the Union speech earlier this month, Trump told lawmakers to “get a bill to my desk” for a signature. In response, Democrats chanted “HR 3,” the name for their bill. Now, Grassley is aiming to get his bill passed during a busy election year.

Within the Trump administration, HHS Secretary Alex Azar has indicated support for the Grassley bill and recently pointed out that pharma companies already agree to price hike limits in their commercial agreements.

“These drug companies already sign contracts with the middlemen with long-term price predictability guarantees,” Azar said at a congressional hearing. “This is not an alien concept to the drug companies. This exists as a commercial practice already; we would just get the benefit for the seniors and our taxpayers through this program.”

As those efforts play out, the administration continues to keep its international price index proposal alive as a negotiating “stick,” Bernstein analyst Ronny Gal wrote in a note last week. Pharma strongly opposes that measure.

Despite Grassley’s effort, the Senate Finance Committee right now “looks unlikely” to pass, Gal wrote. If Republicans in the Senate start getting on board, that’d be an indication that the pharma industry is coming around to the bill, the analyst added.

Also last week, the Wall Street Journal published a detailed account of drug pricing developments over the last few years in Washington, plus possible outcomes from the ongoing back-and-forth. The takeaway? After Republicans generally sided with the drug lobby for many years, new cracks in that support that could lead to increased regulation, WSJ reports.

Trump Pushes Congress to Overcome Drug Pricing Gridlock in State of the Union

Image result for Trump Pushes Congress to Overcome Drug Pricing Gridlock in State of the Union imagesSource: Modern Healthcare, by Rachel Cohrs

President Donald Trump in his State of the Union address on Tuesday called on lawmakers to pass legislation to lower prescription drug prices and derided single-payer healthcare reform as “socialist.”

“I am calling for bipartisan legislation that achieves the goal of dramatically lowering prescription drug prices. Get a bill to my desk, and I will sign it into law without delay,” Trump said.

Senate Finance Chair Chuck Grassley (R-Iowa) has said he wanted more vocal support from Trump for a bipartisan package to lower prescription drug costs Grassley authored with Senate Finance ranking member Ron Wyden (D-Ore.). The bill has stalled so far because conservative Republicans oppose a provision that would force drugmakers to pay back the government for price hikes that outpace inflation.

Trump called out Grassley by name, but did not explicitly call for passage of his and Wyden’s bill.

Despite his tough rhetoric on lowering prescription drug prices, Trump’s biggest ideas have stalled or are still in early stages in the regulatory process. A Kaiser Family Foundation poll published Jan. 30 found that just 30% of adults surveyed approved of how Trump handles prescription drug costs.

Trump did not mention banning surprise medical bills, another contentious issue in Congress. Leaders of the Senate health and House Energy & Commerce committees worked on a bipartisan proposal to ban balance billing, but it stalled at the end of 2019 despite White House support.

Sens. Maggie Hassan (D-N.H.) and Bill Cassidy (R-La.), who have been actively engaged in shaping legislation on surprise billing, said they wished Trump would have brought up the issue.

“I was disappointed that the president did not highlight the need to pass bipartisan legislation to end surprise medical bills, however, which I will keep fighting for in the year ahead,” Hassan said in a statement.

Marc Samuels, founder of the consulting firm ADVI Health, said that Trump could still outline new healthcare policy ideas in his upcoming 2021 budget request, which is expected Feb. 10.

“Though we may have expected more specificity, I think we understand the mechanics of any massive overhaul are harder than we might think and are more suited for a document like the budget or a standalone announcement,” Samuels said.

As he prepared for his re-election campaign, Trump claimed that he would guarantee protections for patients with pre-existing conditions, even though his administration is pursuing a lawsuit that could doom the entire Affordable Care Act, including such protections.

“We will always protect patients with pre-existing conditions — that is a guarantee. And we will always protect your Medicare and your Social Security,” Trump said.

Democratic leaders in both chambers of Congress joined forces before Trump’s speech to blast him for pursuing the lawsuit and failing to support House Democrats’ drug-price negotiation bill.

“The president swears that he supports protections for people with pre-existing conditions, but right now he is fighting in federal court to eliminate this lifesaving protection,” House Speaker Nancy Pelosi (D-Calif.) said.

Trump criticized Democrats who support single-payer healthcare reform and expanding Medicaid to cover undocumented adults.

“We will never let socialism destroy American healthcare,” he said.

Trump also called for Congress to provide an additional $50 million to fund neonatal research and ban late-term abortion.

HHS Secretary Alex Azar said the agency will shift its focus next year to improving maternal health and healthcare in rural areas.

Looking back over the first three years of his presidency, Trump highlighted several healthcare victories. Trump touted his administration’s actions on kidney care, funding to fight childhood cancer and AIDS, and legislation to support the fight against the opioid epidemic. In his 2019 State of the Union address, Trump announced an initiative to reduce new HIV infections by 90% by 2030.

The president also hailed the release of two rules that increase price transparency for both hospitals and insurers. Hospitals sued in December to stop one of the rules, which would force them to disclose the rates they negotiate with insurers.

A federal judge allowed the administration’s expansion of short-term, limited-duration health insurance policies to move forward. The plans, which Trump branded on Tuesday as “affordable alternatives” to exchange plans, don’t have to cover people with pre-existing conditions, nor are they subject to the ACA’s mandates such as coverage for the 10 essential benefits, including mental healthcare, maternity care and prescription drugs.

Trump’s State of the Union Address: 3 Healthcare Takeaways

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Source: Becker’s Hospital Review, by Ayla Ellison

In his State of the Union address Feb. 5, President Donald Trump touched on several health policy issues and reiterated his desire to lower healthcare costs.

Three takeaways:

1. Price transparency. During the State of the Union address, President Trump said more transparency in the healthcare industry would increase competition and bring costs down. He called on hospitals, drug companies and insurers to “disclose real prices.”

“I am asking the Congress to pass legislation that finally takes on the problem of global freeloading and delivers fairness and price transparency for American patients,” he said. “We should also require drug companies, insurance companies and hospitals to disclose real prices to foster competition and bring costs down.”

2. Drug costs. President Trump said he wanted Congress to take action to lower drug costs.

“It is unacceptable that Americans pay vastly more than people in other countries for the exact same drugs, often made in the exact same place,” he said. “This is wrong, unfair, and together we will stop it. We will stop it fast.”

President Trump didn’t say how he wanted to achieve this goal, but his administration recently released a proposal to lower drug prices for Medicare beneficiaries. Under the proposed rule, drug manufacturers would no longer be able to give rebates to pharmacy benefit managers, but they would be allowed to offer discounted prices directly to consumers.

3. Plan to curb HIVDuring the State of the Union, President Trump pledged to end the HIV epidemic in the U.S.

“In recent years we have made remarkable progress in the fight against HIV and AIDS. Scientific breakthroughs have brought a once-distant dream within reach,” he said. “My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years.”

HHS Secretary Alex Azar provided more details on the plan, saying the goal is to reduce new infections by 75 percent over a five-year period and to “end the HIV epidemic in America” by 2030, according to The New York Times.

Mr. Azar said the funds requested by top health officials to achieve this goal will be in President Trump’s budget next month, according to The Washington Post.

Insurers: Price Transparency Rule Puts ‘Staggering,’ Expensive Burden On Us

Image result for Insurers: Price Transparency Rule Puts ‘Staggering,’ Expensive Burden On Us images"

Source: FierceHealthcare, by Robert King

Insurers charge that the Trump administration’s price transparency rule will cost 26 times more than estimated, and the amount of data they must disclose is “staggering.”

Insurer groups blasted the proposed rule released by the Treasury, Labor and Health and Human Services departments late last year that would force insurers to disclose negotiated rates for in-network providers and allowed amounts for out-of-network care. The crux of comments from insurers on the rule focused on the massive burden and cost for implementation and that the data would confuse consumers.

The Blue Cross Blue Shield Association (BCBSA), which represents 36 Blues plans, said that an economic analysis from the firm Bates White found that the total setup and maintenance cost for an insurer to comply with the rule was $13.63 million. That is 26 times higher than the administration’s estimate of $510,000.

“Some plans have indicated they would be forced to run two sets of tools—one designed to meet member shopping needs and another implemented only to meet the requirements of the proposed rule,” BCBSA said in submitted comments.

The rule would require plans to publish machine-readable files with their payment amounts for all health services and items. Insurers would also be required to post a tool that can help consumers get an estimate on out-of-pocket costs for any item or service before they get care.

“The sheer volume of data health plans would be obligated to disclose is staggering,” BCBSA said. “There are more than 94,000 codes that exist currently … covering institutional inpatient, outpatient and professional claims.”

America’s Health Insurance Plans (AHIP) said in comments that the proposal appears to be more targeted at providing data for third-party app developers than “ensuring consumers have access to meaningful, personalized data.”

The Trump administration is essentially asking insurers to share “both their trade secrets and their enrollees’ sensitive personally-identifiable information with app developers that are not bound by the same heightened level or privacy and security rules that apply to health insurance providers,” AHIP said.

Posting just the data also could be confusing for consumers that don’t have the necessary context, argued the Association for Community Affiliated Plans, which represents 67 nonprofit and community-based safety net plans.

“In the absence of quality data, consumers may determine that higher cost equates to higher value, select the higher-cost providers, and ultimately drive up medical expenses,” the group said in comments.

The reaction from provider groups was more mixed. Golden Valley Memorial Healthcare, a rural hospital in Missouri, wants the rule to provide the cost-sharing information to providers as well as patients.

“Patients reasonably turn to providers for this information when contemplating or scheduling health care services, but providers often face barriers in accessing the necessary details from insurers to provide a timely, accurate estimate,” the hospital said in comments.

The American Hospital Association (AHA) said it agrees with the proposal to improve patient access to cost-sharing information. But AHA vehemently disagreed with the proposal for insurers to release all negotiated rates.

AHA argued that the First Amendment of the Constitution doesn’t “permit compelled public disclosure of such confidential and trade secret pricing information.”

The Trump administration also doesn’t have the legal authority to force payers to disclose negotiated rates, AHA said. The Affordable Care Act (ACA) gives the federal government authority to compel certain information regarding coverage, including how a health plan must be certified to be on the ACA’s exchanges.

But AHA contends that the administration can’t require disclosure of negotiated rates, because they refer to price and not coverage.

The AHA is used to making these types of arguments because it is among several hospital groups suing the Trump administration over a final rule that requires hospitals to post payer-negotiated rates. While insurers have also opposed that rule, none have joined the lawsuit.

Last Updated 06/03/2020

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