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Trump to highlight generic drugs as key to lowering prices. President Trump on Friday will explain how bringing more generic drugs to the market faster can help lower prices for patients, according to his health chief. Health and Human Services Secretary Alex Azar told a Senate Appropriations Committee hearing that the administration’s goals are to balance “the need to support innovation and the development of the next generation of therapies” with patient access, including affordability. Trump also will use his planned Friday speech to ensure government programs have better tools to negotiate drug prices. Patients, he said, “are being asked to assume more of the costs of drugs when they show up at the pharmacy or get the bill at the hospital or doctor’s office.” Trump is expected to deliver remarks on drug pricing on Friday, with Azar present.

Trump to also push foreign countries to pay more. Azar said  the administration would be “going after this question of foreign governments that free-ride off of American innovation.”

He signaled that the U.S. would not be heading in the same direction as some of these other countries, in which the government plays a more prominent role in setting drug prices, but would use the current elements that already exist, including approaches to “make them better so we pay less and of course get foreign governments to pay more.”

More from Azar’s testimony here.

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Healthcare a top issue for Democratic voters in 2018 midterms. Democrats cite healthcare as the top issue for the 2018 midterm elections, according to a new poll. But high costs, not Obamacare, is the major issue concerning voters. The poll released Thursday by the research firm Kaiser Family Foundation showed that 30 percent of Democrats rank healthcare as the top issue, with 19 percent of independents ranking it No. 1, second behind the economy and jobs at 22 percent. For Republicans, 15 percent list healthcare as the top issue, fourth behind the economy, immigration, and gun policy. “Large majorities of Republican (66 percent), Democratic (78 percent), and independent voters (72 percent) say that if a candidate for Congress supports bringing down prescription drug costs, they would be ‘more likely’ to vote for that candidate,” Kaiser said. Similar large majorities also said they would support a candidate who brings down health and insurance costs.

John McCain: Obama thanked me for my vote killing Obamacare repeal. Republican Sen. John McCain says former President Barack Obama called to thank him after his dramatic vote against his party’s Obamacare repeal bill last year. In a copy of his forthcoming book, “The Restless Wave,” obtained by the Daily Beast, McCain said he appreciated the call from Obama. “Among the people who called to thank me was President Obama,” McCain writes. “I appreciated the call, but, as I said, my purpose hadn’t been to preserve his signature accomplishment but to insist on a better alternative, and to give the Senate an opportunity to work together to find one.” Before McCain turned his thumb down to signal his no vote, he received a call from Trump urging him to support the bill. The call came after Vice President Mike Pence tried to lobby McCain on the Senate floor to vote with their party. Obama didn’t call ahead of the vote to try to sway McCain’s vote, the senator said. “He hadn’t called to lobby me before the vote, which I had appreciated,” McCain wrote.

House panel advances 25 opioid bills. The House Energy and Commerce Committee on Wednesday advanced 25 bills tackling the opioid crisis to the full House for a vote. The bills focus on different facets of the opioid crisis. Federal data shows that more than 42,000 Americans died in 2016 due to an opioid overdose. “These bills will help protect our communities and bolster enforcement efforts, strengthen our prevention and public health efforts, and address coverage and payment issues in Medicare,” said Rep. Greg Walden, R-Ore. One of the bills aims to give pharmacists educational materials to help them detect fraudulent prescriptions of opioids, aiming to clamp down on rampant overprescribing of the powerful painkillers. The committee plans to hold another hearing on May 17 to advance another raft of more than 20 opioid bills. Walden told reporters Tuesday that floor time will be up to House leadership. “They are very aware of our work, and no decisions have been made yet as to how these might get packaged up,” he said.

CBO: Children’s insurance coverage won’t be affected by rescission cuts. The White House’s proposal to cut $7 billion from the Children’s Health Insurance Program wouldn’t reduce the number of kids with insurance, according to the nonpartisan Congressional Budget Office. The plan drew widespread condemnation from Democrats and critics for cutting the popular bipartisan program. However, the CBO said Wednesday that the number of children with insurance under the program would not be affected. The $7 billion in cuts is part of a larger package of $15 billion in spending cuts the White House sent to Congress Tuesday. The package would cut $5.1 billion from leftover funding that wasn’t used under CHIP, which provides grants to states to provide insurance for low-income children. It also would cut $1.9 billion in emergency funding for the program.

FDA warns companies about enticing kids with e-cigarette flavors. The Food and Drug Administration warned four manufacturers and retailers about selling liquids used in e-cigarettes with labeling or advertising that make them resemble kid-friendly foods such as soda or pancakes. The agency’s enforcement action on Thursday is the latest part in a broad crackdown on sales and advertising to minors of e-cigarettes. Last week, the agency and the Federal Trade Commission went after 13 makers and sellers of liquids that look like juice boxes, candy or cookies. “Companies putting children at risk or enticing youth use are on notice. If you target kids, then we’re going to target you,” FDA Commissioner Scott Gottlieb said.

Confidence in paying medical bills falls. In 2018, 62.4 percent of adults said they were very or somewhat confident they could afford their healthcare, down from a high of nearly 70 percent in 2015, according to the Commonwealth Fund Affordable Care Act Tracking Survey. Additional findings show that about half of people with incomes less than 250 percent of the federal poverty level, which is $30,150 for an individual, were confident they could afford care if they were to become very sick. This percentage is down from 60 percent in 2015 and about 20 percentage points lower than the rate for adults with higher incomes. The tracking survey was conducted over the phone among people between the ages of 19 and 64, and focuses on people who have Obamacare and Medicaid through the expansion.

McCaskill: Fentanyl seizures have increased dramatically. The Department of Homeland Security is seizing a lot more shipments of the illicit opioid fentanyl, with the overwhelming majority occurring at U.S. ports of entry, a new report found. The amount of fentanyl seized by federal customs officials increased from 564 pounds in 2016 to 1,370 pounds in 2017. Sen. Claire McCaskill, D-Mo., who released the report, said it illustrates the need to boost staff and tools at U.S. ports of entry. “There is no silver bullet to solving this influx of opioids, but at the very least we need to ensure that our ports are adequately staffed and equipped to deal with this problem — and right now that’s simply not the case,” McCaskill said. Fentanyl is 50 times more potent than heroin and has become an increasing driver of opioid deaths. In 2016, more than 42,000 Americans died of a drug overdose, with more than half of those deaths attributed to fentanyl and other synthetic opioids, according to federal data.

FDA files for permanent injunction against stem cell clinics. The Food and Drug Administration has filed complaints in federal court seeking permanent injunctions against two stem cell clinics that market unapproved products. The injunctions are being sought against U.S. Stem Cell Clinic LLC in Sunrise, Fla., and California Stem Cell Treatment Center Inc., which has several locations in California. “Cell-based regenerative medicine holds significant medical opportunity, but we’ve also seen some bad actors leverage the scientific promise of this field to peddle unapproved treatments that put patients’ health at risk,” Gottlieb said. “In some instances, patients have suffered serious and permanent harm after receiving these unapproved products. In the two cases filed today, the clinics and their leadership have continued to disregard the law and more importantly, patient safety. We cannot allow unproven products that exploit the hope of patients and their loved ones.”

Novartis cooperating with Mueller team after paying Michael Cohen $1.2 million for healthcare consulting. Pharmaceutical giant Novartis said it has been questioned by special counsel Robert Mueller after revealing it paid Trump’s personal lawyer $1.2 million for healthcare consulting. “Novartis cooperated fully with the Special Counsel’s office and provided all the information requested,” Novartis spokeswoman Sofina Mirza-Reid said Wednesday. “Novartis considers this matter closed as to itself and is not aware of any outstanding questions regarding the agreement.” The acknowledgment comes after Novartis was named in a document Tuesday night made public by Michael Avenatti, the lawyer representing porn star Stormy Daniels. Novartis said it entered into a one-year agreement with Essential Consultants in February 2017 because executives believed Cohen “could advise the company as to how the Trump administration might approach certain U.S. healthcare policy matters, including the Affordable Care Act.”

Advocacy groups ask for halt on Medicaid work requirement approvals. Advocacy groups are asking the Trump administration to stop approving states’ changes to the Medicaid program until it addresses issues raised in a government oversight report. The report, issued in February by the Government Accountability Office, concluded that the federal government did not evaluate changes that states made to the Medicaid program in a timely or complete way, and that it failed to make the evaluations public when it did. The changes to Medicaid, granted through waivers approved by the administration, can involve a range of policies, whether allowing states to cover more treatment for addiction or allowing them to set up work requirements for people who are enrolled in the program. The advocacy groups that sent the letter on Wednesday oppose the work requirement waivers in particular. Kentucky, New Hampshire, Arkansas, and Indiana have had work requirements accepted, but legal battles are ahead and opponents say the requirements will result in people becoming uninsured.

E. coli illnesses linked to lettuce expand to 29 states. Four more states have reported E. coli contaminations in romaine lettuce, the Centers for Disease Control and Prevention reported Wednesday. Twenty-eight more people have become ill, bringing the total to 149 people in 29 states. Florida, Minnesota, North Dakota, and Texas were added to the rolls. Data collection can take time to reach the CDC, meaning that there may be several other instances of people getting sick that haven’t been reported. The total count comes from data as of April 25. The strain of E. coli that has circulated begins to sicken people roughly five days after they eat infected lettuce, and they remain ill for about a week with vomiting, bloody diarrhea, and stomach cramps. The E. coli strain also can cause other severe symptoms, such as a type of kidney failure. Of those who have reported illnesses, 64 spent time in the hospital and 17 of them had the kidney syndrome. The CDC reported last week that one death in California had been linked to the illness.

House bill aims to save moms during childbirth. A House bill introduced Wednesday would expand the amount of time that new moms could remain on Medicaid, in an effort to reduce the number of pregnancy or childbirth-related deaths. “Too many mothers have died already,” said Rep. Robin Kelly, D-Ill., who introduced the legislation. “Too many kids are growing up without a mother. Too many families are living a nightmare that doesn’t end.” The bill is being introduced in the face of federal data showing that maternal mortality is rising. Because lawmakers are not certain what is contributing to the increase, the bill introduced Wednesday, the Mothers and Offspring Maternal Mortality Awareness, or MOMMA, Act also would allow for better reporting.The Medicaid provision, a government-funded program that offers medical care for pregnant women, would be expanded to a year after birth. Half of births in the U.S. are covered by Medicaid, and after delivery women are allowed to stay on the program for 60 days, and after that many women go uninsured.

Toxic ‘vog’ from volcano Kilauea threatening to spread across Hawaii island chain. A change in wind patterns could have dangerous consequences in Hawaii later this week as residents are dealing with an erupting volcano. Kilauea, on Hawaii’s Big Island, erupted on Thursday. Since then, lava has flowed from fissures, wrecking dozens of structures and forcing thousands of residents to evacuate. Also seeping from these fissures is poisonous gas known as “vog.” According to the Hawaii Interagency Vog Information Dashboard, vog is “hazy air pollution caused by the volcanic emissions from Kīlauea volcano, which are primarily water vapor, carbon dioxide, and sulfur dioxide gas.” The vog has only beset the southern and western side of the Big Island, but an expected shift later this week in the northeasterly trade winds could mean trouble for other islands in Hawaii, including Maui, Oahu, Lanai, and Molokai. The sulfur dioxide in the vog can cause respiratory problems, including irritation and difficulty breathing and concentrated levels of it can be deadly.

RUNDOWN

Washington Post Thirdhand smoke is widespread and may be dangerous, mounting evidence shows

Axios Democrats go vague on healthcare ahead of midterms

The Hill The ‘forgotten people’ of the opioid epidemic

Governing As other states have abandoned efforts, New Jersey passes individual mandate

New York Times To lower drug costs at home, Trump wants higher prices abroad

HuffPost Sudden departure of White House global health security head has experts worried

STAT News WHO officials fear latest Ebola outbreak in Congo could spread to big cities

Kaiser Health News For the babies of the opioid crisis, the best care may be mom’s recovery