Daily on Healthcare: Lowering drug prices a top priority, says HHS pick Alex Azar

Alex Azar says lowering drug prices would be top priority as Trump’s HHS secretary. Azar said Wednesday that lowering drug prices would be a top priority as secretary of Health and Human Services once the Senate confirms him. “Drug prices are too high,” he told the Senate Health, Education, Labor and Pensions Committee in his prepared testimony. “The president has made this clear. So have I.” Azar, who was deputy secretary of HHS under President George W. Bush, elaborated that his experience implementing Medicare Part D, the portion of the program that pays for medicines, made him qualified to tackle the issue. He also cited his “extensive knowledge of how insurance, manufacturers, pharmacy and government programs work together.” During questioning, he pledged to fight drug makers gaming the system to avoid generic competition even though he used that same system to raise prices when he was chief of Eli Lilly’s U.S. division, during which the company raised the price of insulin. Azar listed three other priorities in his remarks, including lowering the price of health insurance for Obamacare customers, tackling the opioid epidemic, and finding ways for healthcare providers to be reimbursed based on patient outcomes rather than the number of procedures or tests they run.

Nearly 2.8 million sign up for Obamacare. Nearly 2.8 million people signed up for health insurance coverage through the federal healthcare.gov website during the first 25 days of Obamacare’s open enrollment, but the rate of sign-ups appears to have slowed, according to data from the Centers for Medicare and Medicaid Services. The fourth week resulted in an increase of 504,181 sign-ups for plans, compared with the third week, when 798,829 people signed up. The total number number is still higher than last year. During the first 25 days, 2,781,260 signed up for coverage compared to the 2,137,717 people who had signed up in the first 26 days of last year. Still, the shorter open enrollment period means they’ll need to accelerate sign-ups each day to match last year’s open enrollment. Within the total sign-ups, 2,062,975 customers were renewing customers who already have a plan through the exchange and 718,285 are new customers.

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Azar was introduced by his former boss. Former Health and Human Services Secretary Mike Leavitt, who served under Bush, introduced Azar and praised him ahead of his opening remarks. “You can expect good communication on both sides of the aisle,” Leavitt said. “He is an experienced diplomat.” Levitt cited Azar’s experience as deputy overseeing efforts following the Sept. 11 terrorist attacks and following Hurricane Katrina, as well as the implementation of Medicare Part D. “This is a person with great experience in a complex department,” Leavitt said. “He is an extraordinarily good human being.”

Azar defends scaling back the birth control mandate. Azar told senators Wednesday the conscience of employers needs to be taken into account when it comes to providing birth control. The comments come about a month after President Trump scaled back the Obamacare requirement that employers offer birth control with no co-pay. Azar said you “have to balance the woman’s choice with the conscience of employers and others.” Sen. Patty Murray, D-Wash., replied by asking what should happen if a woman’s doctor recommends it but the employer has precedence under federal law. “In terms of insurance to force those very few, less than 200, that would be impacted by the conscience exception to respect their rights and women’s access through insurance,” Azar answered. Trump allowed employers to receive an exemption from providing birth control if they have a moral or religious objection.

Alexander calls for third hearing on drug prices. Sen. Lamar Alexander, R-Tenn., said the Senate Health, Education, Labor and Pensions Committee would hold a third hearing on drug prices Dec. 12. Alexander announced the hearing during the confirmation hearing of Azar, who came under fire from Democrats over his time as a senior executive at drug maker Eli Lilly. The committee has held two hearings on drug prices, but Congress hasn’t taken as much action on high drug prices. Congress did approve bills to speed up the approval of new generic drugs to lower prices but has ignored other changes such as giving Medicare the power to negotiate lower drug prices.

Alexander urges Trump administration to not appoint opioid ‘czar.’ At the hearing, Alexander said he opposes having Trump appoint an “opioid czar” to oversee efforts to tackle the epidemic, saying instead the job should fall to the health and human services secretary. “Some are now saying we need an opioid czar, and I hope you will join me in advising the president that this is a terrible idea,” Alexander told Azar. “The federal government does not need a new czar. Once confirmed, you need to be the one to take charge of leading the federal government response and letting us know how to help.” Those who advocate for a “czar” say that someone overseeing the response to the opioid epidemic could help ensure that the recommendations presented by Trump’s opioid commission, which include a marketing campaign and putting more people with addictions into treatment, are carried out.

Collins inches forward to support GOP tax bill as Trump supports bipartisan deal. Sen. Susan Collins, R-Maine, joined two other GOP senators in a private meeting with Trump, where she said he appeared open to supporting a deal to stabilize the Obamacare exchanges if the Senate passes a repeal of Obamacare’s individual mandate penalties as part of tax legislation. Collins has been concerned about that repeal. Republican senators told reporters Tuesday that Trump also supported a measure from Collins and Sen. Bill Nelson, D-Fla., that would provide $4.5 billion in reinsurance funding to help Obamacare insurers offset the highest medical claims. Collins appeared to be edging toward allowing repeal of the individual mandate despite voting against “skinny repeal” this summer. “I do recognize that there is a big difference between allowing people to choose going without insurance versus what we were faced with last summer and fall where insurance was going to be taken away involuntarily from people,” she said. The two bills would be taken up separately from tax reform, and GOP leadership is still ironing out details on timing.

Republicans will stress it is a short-term deal that will lead back to Graham-Cassidy. Sen. John Thune, R-S.D., a member of GOP leadership, said the caucus has to “figure out exactly what it is we want to do with what the substance of it is, and then we’ve got to find a vehicle.” He said the deal could be a stopgap measure until Congress tries again to repeal and replace Obamacare. “Most of us look at this as a sort of runway to get to what we hope will eventually be something along the lines of Graham-Cassidy where we would do a more systemic fix for Obamacare that shifts money back to the states,” said Thune, referring to a replacement bill from Sens. Bill Cassidy, R-La., and Lindsey Graham, R-S.C., that failed in September. “In the meantime you’ve got to deal with the issues that are cropping up in the foreseeable future.”

Democrats push back on the potential deal. Senate Democrats blasted Trump’s embrace of the bipartisan deals on Obamacare, noting his support is contingent on a repeal of the individual mandate that they are concerned would severely damage insurance markets. But some Democrats refuse to say whether they would bail on the bipartisan bills if the GOP is successful in repealing the mandate. “I’ve said from the start that it makes absolutely no sense to inject chaos into the healthcare system with one hand while trying to stabilize it with the other,” Sen. Patty Murray of Washington said. “The way to avoid this harm isn’t to say you’re going to pass bipartisan legislation like Alexander-Murray or reinsurance — it’s to avoid doing harm in the first place.” Murray said Republicans are using “everything they can to paper over the devastating consequences of their latest step toward healthcare sabotage.” Other Democrats shared Murray’s sentiment. Sen. Ron Wyden of Oregon, noted that if Obamacare gets unraveled, it couldn’t be fixed by restoring the payments to insurers, which Trump halted last month. Sen. Tim Kaine, D-Va., added that repealing the mandate would drive up premiums for everyone by 10 percent.

A ‘pretty remarkable flip-flop.’ Alexander chided Senate Minority Leader Chuck Schumer for previously saying Democrats wouldn’t embrace Alexander-Murray if Republicans repeal the individual mandate. “That would be a pretty remarkable flip-flop,” Alexander said. “Schumer said that every single Democrat would vote for it.”

Mark Meadows is skeptical. The leader of the conservative House Freedom Caucus said he needs to learn more about the deal but hinted at a serious problem for House Republicans to get the deal passed in the House. Meadows told reporters Tuesday that he is talking with the White House Wednesday on the individual mandate. “It is an ongoing negotiation to look at [cost-sharing reduction payments] in the greater aspect, with reinsurance being one of those that functionally ties in to the insurance markets,” Meadows said. But he was then asked about the prospect of adding more funding to Obamacare insurers, a major stumbling block for the potential deal in the House. “Anything that would suggest we are adding money to a failing system would be a difficult sell,” he said.

Leaders still hope to begin voting on tax overhaul Wednesday and to pass it by Friday. Senate Republicans plan to advance the $1.4 trillion tax cut bill today by voting to begin debate on the measure that looks likely to pass in the coming days. Senate Majority Leader Mitch McConnell, R-Ky., adjourned the Senate Tuesday night without setting a firm time for the vote. But Republicans said the plan was to vote on a motion to proceed to the bill Wednesday. “I think it’s going to pass,” Trump said during a White House meeting with McConnell and Speaker Paul Ryan, R-Wis. “It’s going to have lots of adjustments before then.”

Senate Budget Committee clears way for tax bill. Republicans on the committee voted Tuesday afternoon to advance their bill, as two Republicans who had said they might vote against the bill were won over on sending it to the Senate floor. After meeting during lunch wit Trump and fellow Republicans, Sens. Ron Johnson, R-Wis., and Bob Corker, R-Tenn., dropped their opposition and voted to advance the bill, allowing it to pass 12-11 with all Democrats voting against. The committee’s vote means that it can advance through the budget reconciliation process that prevents Democrats from filibustering it. In advancing the bill, the committee also added to it a measure that would open up the Arctic National Wildlife Refuge to oil drilling, a provision backed by Alaska Sen. Lisa Murkowski, who opposed the repeal of portions of Obamacare this summer, contributing to sinking the bill, and was otherwise thought to be one of the Republicans mostly likely to oppose the tax bill.

Capitol Police arrest protesters in wheelchairs at Senate tax bill hearing. The police arrested 36 protesters Tuesday who disrupted the Senate Budget Committee hearing. Protesters, including several people in wheelchairs, entered the committee hearing room and chanted “Shame on you!” because of the way the tax plan would impact Obamacare. “Don’t kill us, kill the bill,” others chanted. Capitol Police then removed the protesters from the hearing, 36 of whom were arrested and charged with disruption of Congress. Two of those were charged with resisting arrest.

Toomey pushes back on characterization of individual mandate repeal as a ‘tax increase.’ The office of Sen. Pat Toomey, R-Pa., is pushing back on how the repeal of the individual mandate penalties is being framed as a tax increase rather than a voluntary subsidy. During the Finance Committee markup of the tax bill, Toomey said that just because the government subsidizes many activities through the tax code, doesn’t mean that when a taxpayer chooses to forego participating in a taxpayer-subsidized activity that he now has a tax increase. “The Advanced Premium Tax Credit is one such example,” Toomey said, referring to the subsidies some customers to lower the cost of Obamacare plans. “This is absolutely not a tax increase. … Now, it is not a tax increase if a person decides they do not want an Obamacare plan and as a result, we don’t send a payment to an insurance company? That’s what this is about, that’s what the Advanced Premium Tax Credit is, it’s a payment to an insurance company.” Congressional Budget Office and Joint Committee on Taxation reports released Monday do not gauge how changes in taxpayer choices affect government subsidies that are provided through the tax code, and do not consider the decision of a taxpayer to voluntarily forgo participating in a taxpayer-subsidized activity. The estimate projects $318 billion in savings over a decade through repealing the individual mandate.

FDA plans to allow more generics to hit the market, which could reduce drug prices. Food and Drug Administration Commissioner Scott Gottlieb said Tuesday that his agency would work to streamline allowing generic copies of complex medicines, such as the EpiPen, to come to market. “Under this guidance, so long as the generic applicant is able to demonstrate with data, where appropriate, that differences in design of the generic product do not affect the clinical effect or safety profile when the generic is substituted for the branded product, the generic product can be approved as a competitor to the branded drug where all other requirements for generic approval are met,” Gottlieb said.

Chris Christie: China exporting fentanyl ‘to kill our people.’ New Jersey Gov. Chris Christie said Tuesday that China’s exports of fentanyl are killing dozens of Americans each day and said more money is needed to prevent the dangerous opioid from entering the country. “You are sending this into our country to kill our people,” Christie said of China at a Tuesday hearing of the House Oversight and Government Reform Committee in Baltimore. Fentanyl has been responsible for a spike in opioid deaths in recent years. A major problem has been that synthetic versions of the drug have been hitting the streets. “The first use can lead to death,” said Christie, who leads Trump’s opioid commission. “It is so lethal that law enforcement officers who come to crime scenes have to be careful.” Christie called fentanyl a “Chinese problem,” since most of it comes from China. He called for an increase in border security and from the U.S. Postal Service to crack down on shipments. “We don’t have the level of enforcement needed,” he said. Christie said more funding needed to fight the epidemic. He pointed to the $1 billion made available in the 21st Century Cures Act last year, but he said that isn’t anywhere near enough. “In New Jersey, we are spending $500 million,” he said. “I am not, quite frankly, impressed with $1 billion from the federal government for the nation.”

Time shortens between HIV infection and diagnosis. The estimated median time from HIV infection to diagnosis fell from 3 years and 7 months in 2011 to 3 years in 2015, according to a report published Tuesday by the Centers for Disease Control and Prevention. Overall, 85 percent of the estimated 1.1 million people living with HIV in 2014 knew their status. CDC estimates about 40 percent of new HIV infections originate from people who don’t know they have HIV. The numbers in the U.S. fell even as the World Health Organization announced that Eastern Europe rates of HIV are rising at an “alarming rate.”  

RUNDOWN

Politico Trump’s pick for HHS messages he is no Tom Price

NPR Epidemic of healthcare waste: From $1,877 ear piercing to ICU overuse

Kaiser Health News Doctors make big money testing urine for drugs and then ignore abnormal results

Wall Street Journal Healthcare clashes loom over Republican legislative agenda

Milwaukee Journal-Sentinel Making an extra $10 could cost you $24,000 more for health insurance

Washington Post Former DEA officials call for repeal of law that weakened enforcement

The Hill GOP bill would limit opioid prescriptions for first-time users

New York Times A failure to heal

Calendar

WEDNESDAY | Nov. 29
Nov. 29-30. New York. Forbes Healthcare Summit. Details.

Began 9:30 a.m. 430 Dirksen. Senate Health, Education, Labor and Pensions Committee hearing on the nomination of Alex Azar for secretary of Health and Human Services. View live Stream.

2 p.m. 2172 Rayburn. Foreign Affairs Subcommittee hearing on “A Global Update on Alzheimer’s Disease.” Details.

THURSDAY | Nov. 30

Nov. 30-Dec. 1. Washington Hilton. 1919 Connecticut Ave. NW. ONC Annual Meeting on “Tackling Barriers to Interoperability and Usability.” Details.

9 a.m. New York. CMS Administrator Seema Verma to discuss the Trump administration’s agenda for Medicare and Medicaid with Avik Roy at the Forbes Healthcare Summit. Details and Stream Live.

10 a.m. 430 Dirksen Senate Health, Education, Labor and Pensions Committee hearing on “The Front Lines of the Opioid Crisis: Perspectives from States, Communities and Providers.” Details.

10 a.m. Rayburn 2123. House Energy and Commerce Committee hearing on the implementation of the 21st Century Cures Act, with testimony from NIH Director Francis Collins and FDA Commissioner Scott Gottlieb. Details.

11:05 a.m. Dr. Nora Volkow, director of the National Institute on Drug Abuse, to discuss the opioid epidemic at the Forbes Healthcare Summit. Stream Live.

Noon. B-318 Sam Johnson Room in Rayburn. Congressional briefing with America’s Health Insurance Plans on “The Value and Future of Employer Health Plans.” Details.

1 p.m. National Press Club. 529 14th St. NW. National Academies to release 2017 Affordable Drugs Report. Details.

FRIDAY | Dec. 1

8:30 a.m. Washington Hilton. 1919 Connecticut Ave NW. CMS Administrator Seema Verma to deliver remarks at the ONC Annual Meeting on “Tackling Barriers to Interoperability and Usability.” Details.

Noon. Dirksen G50. Alliance for Health Policy and Commonwealth Fund event on “What’s Next for Medicare Provider Payment?”  Details.