Separating rhetoric from reality on Trump drug pricing moves


With help from Rachana Pradhan and Victoria Colliver

DRUG PRICING PROGRESS? LET’S DO A PULSE CHECK — President Donald Trump and his lieutenants have engaged in a flurry of activity, but the administration’s ambitious rhetoric still hasn’t translated into meaningful price cuts — yet.

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Among Thursday’s developments:

— Pfizer CEO at the White House. POLITICO’s Sarah Karlin-Smith and Andrew Restuccia scooped that Pfizer’s Ian Read met with Trump on Thursday, about a week after the company announced it would pause some price hikes.

Four HHS officials including Deputy Secretary Eric Hargan and the agency’s point person on drug pricing, Dan Best, separately met with pharmaceutical executives to reinforce the administration’s message and press for more action. More.

— Merck the latest company to announce price cuts, though there’s a catch. The pharma giant announced a 60 percent cut to Hep C combination drug Zepatier — which produced $0 in U.S. sales in the first quarter after rebates, NYT’s Katie Thomas flagged — while making 10 percent cuts to some other low-profile products.

— Administration also pushes regulatory changes. A proposed rule just sent to OMB calls for removing safe harbor protections for drug rebates paid to insurers and pharmacy benefit managers, Sarah also reported.

The FDA, meanwhile, is forming a working group to look at the possibility of importing off-patent or off-exclusivity prescription drugs, in hopes of spurring competition for products with only one manufacturer. The move would represent a shift from a few months ago, when HHS Secretary Alex Azar said on a POLITICO Pulse Check podcast that he’s worried about the safety of some imported drugs.

— The optimistic read: Two months after a Rose Garden speech, Trump and his lieutenants are keeping pressure on the drug industry and starting to score modest wins, with more changes to come.

— The cynical read: The drug companies’ concessions have been small and while the president took a victory lap on Twitter on Thursday — “We are making a big push to actually reduce the prices, maybe substantially, on prescription drugs,” Trump wrote — there’s no evidence yet of systemic change.

— Messaging alert: Every time that Azar celebrates a drug company’s pricing pause, he makes sure to do two things: (1) give credit to Trump and (2) celebrate putting the “American Patient First.”

KENTUCKY: MATT BEVIN REVERSES ON MEDICAID BENEFIT CUTS — Kentucky plans to reinstate dental and vision benefits for hundreds of thousands of Medicaid enrollees that the governor cut following a court setback over his planned Medicaid overhaul, POLITICO’s Rachana Pradhan scoops.

State officials told health plans on Thursday that the benefits will be reinstated at the start of August but Medicaid will retroactively cover claims dating back to the start of July. Bevin’s decision earlier this month to suspend coverage of the services caused a firestorm among consumer groups and Democratic lawmakers. More for Pros.

The timing was no coincidence: Bevin’s decision came after CMS opened a new 30-day comment period for Kentucky’s stalled Medicaid waiver – a move POLITICO first reported on Wednesday as officials plot to move forward with work requirements and other changes.

The agency said it was accepting new feedback “to ensure that interested stakeholders have an opportunity to comment on the issues raised in the litigation and in the court’s decision.” Comments will be accepted through Aug. 18. See comment page.

THANK GOODNESS IT’S FRIDAY PULSE — Where your author will spent part of the weekend prepping for a Monday podcast interview with a former HHS secretary. (The conversation should appear on our PULSE CHECK feed next week.) Feel free to send guesses about guests and all tips to ddiamond@politico.com.

Catch all the highlights from Tuesday’s Pro Summit. Video clips, event content and more are now available from a full day of incisive policy conversations. View Summit Highlights.

View the latest POLITICO/AARP poll to better understand Arizona voters over 50, a voting bloc poised to shape the midterm election outcome. Get up to speed on priority issues for Hispanic voters age 50+, who will help determine whether Arizona turns blue or stays red.

What role will Hispanic voters over 50 play in Arizona this fall? Read POLITICO Magazine’s new series “The Deciders” which focuses on this powerful voting bloc that could be the determining factor in turning Arizona blue.

** A message from PhRMA: Middlemen make more money when your medicine prices increase. We think that should change. That’s why we are advocating for reforms that prevent pharmacy benefit managers and other entities in the supply chain from being paid off the list price of a medicine. https://onphr.ma/2Jt6bap **

Brookings looks at Medicare’s physician payment incentives. The USC-Brookings Schaeffer Initiative for Health Policy event is framed around a provocative question: “can the Merit-Based Incentive Payment System be salvaged?” Details and livestream. OMB’s Joe Grogan was scheduled to speak but pulled out of the event.

Alliance for Health Policy examines individual insurance market. Speakers include Georgetown’s Sabrina Corlette, the Commonwealth Fund’s Sara Collins and Washington State insurance commissioner Mike Kriedler. More.

Here are the congressional districts with the highest opioid prescription rates. Alabama-4, represented by Rep. Robert Aderholt, had nearly 1.7 opioid prescriptions per person in 2016, according to new research in the American Journal of Public Health. Kentucky-5, Tennessee-3, Tennessee-1 and Alabama-1 rounded out the top five. See study.

Trump administration says about 15 percent of migrant families have been reunited. In a Thursday court filing, the administration said 1,606 children age 5 to 17 were now deemed eligible for reunification, with the rest either ineligible — because a parent had a criminal record, remained in custody, or waived reunification — or “not yet known to be eligible.”

Thus far, only 364 children in that age group have been reunited, according to the court filing.

The government’s own physicians warn about conditions in the centers. Two physicians who serve as Homeland Security experts wrote that years of investigations have revealed serious medical risks in the centers, with some children going days without necessary care, the New York Times’ Miriam Jordan scooped.

“In our professional opinion, there is no amount of programming that can ameliorate the harms created by the very act of confining children to detention centers,” the physicians said in a letter to the Senate’s Whistleblower Protection Caucus. More.

Groups sue HHS for documents on new conscience division. Two groups supporting abortion rights are suing the agency for ignoring Freedom of Information Act requests on its new conscience and religious freedom division.

The Center for Reproductive Rights and the National Women’s Law Center submitted FOIAs in January and March asking HHS to disclose the complaints the agency used to justify the division’s creation. They also asked HHS to produce communications with anti-abortion advocates like the Family Research Council and the Heritage Foundation, which have supported the agency’s new conscience division and have close ties to several HHS leaders. More for Pros.

California: Nearly 9 percent rate hike predicted for exchange customers. Next year’s projection is below some of the projected double-digit rate hikes proposed around the country, POLITICO’s Victoria Colliver reports. More for Pros. But exchange officials say the increase would have been about half that – around 5 percent – had the federal government kept Obamacare’s individual mandate penalties.

All 11 plans that participated in Covered California this year will return for 2019, which officials say reflects the exchange’s continuing commitment to marketing and outreach, and to the state’s relatively healthy risk mix.

California: Leading gubernatorial candidate attacks rival on abortion rights. Gavin Newsom, flanked by NARAL and Planned Parenthood officials, on Thursday said that the state’s women are “profoundly” endangered by both the Trump administration’s efforts to nominate a Supreme Court justice to roll back abortion rights and by his opponent, Republican candidate John Cox.

Gottlieb’s ‘milk’ comments draw unlikely response: A parody by The Onion. The FDA commissioner’s comments at POLITICO Pro’s summit — when he said the Trump administration would crack down on using the term “milk” for nondairy products like soy — prompted a parody by the popular comedy site. (The nutty story quickly bounced around agency headquarters on Thursday, multiple sources told PULSE.)

By Victoria Colliver

Does Anthem’s tough talk on emergency room bills save the insurer money even if it ultimately pays the claims?More from Margot Sanger-Katz and Reed in the New York Times.

Why trying to avoid blame for a problem you made worse (like, for example, Republicans on health care) may make things tough in the future (like, for example, Republicans in November), Paul Waldman opines in the Washington Post.

STAT’s Casey Ross and Orly Nadell Farber talk to health experts about Atul Gawande’s listening tour before he takes over the Amazon-JP Morgan-Berkshire Hathaway venture that still desperately needs a better name. More.

Just days before the start of 22nd International AID Conference in Amsterdam, report warns of complacency in AIDS prevention, Susan Brink writes for NPR.

ACLU attorney Brigitte Amiri writes about her experience trying to stop the Trump administration from blocking an undocumented teenager’s attempt to have an abortion – Supreme Court nominee Brett Kavanaugh’s only abortion case – in the ACLU’s Speak Freely blog.

** A message from PhRMA: A medicine’s rebate – rather than its actual price – often determines if it is covered or where it sits on a formulary. This creates an unfair system in which patients can be stuck paying higher list prices regardless of the discount their insurer receives. Reforms to prevent PBMs and others in the supply chain from being paid off the list price of a medicine can fix broken incentives and make the system work better for patients. https://onphr.ma/2Jt6bap **



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