Daily on Healthcare: Amazon and CVS-Aetna news could shake up healthcare

Amazon and CVS-Aetna news could shake up healthcare. Though the Washington health policy world is typically focused on the proposals coming out of Congress and the executive branch, two bits of corporate news that emerged Thursday have the potential to disrupt the U.S. healthcare system more than a lot of legislation could. First, the St. Louis Post-Dispatch reported that Amazon has obtained wholesale pharmacy licences in 12 states.  Though Amazon has made no formal announcement, the news immediately fueled speculation that the e-commerce giant was exploring the idea of taking its low-cost model into the delivery of prescription drugs. Though this was seen as a threat to retail chains such as CVS, the Wall Street Journal later reported that CVS Health is in talks to purchase health insurer Aetna. If that merger, which has not yet been confirmed by either company let alone approved by shareholders and regulators, were to go through, it would create a behemoth with a significant footprint in healthcare financing and delivery. The combined company would have a major insurance arm, a pharmaceutical benefit manager that negotiates drug prices with pharmaceutical companies, a retail pharmacy chain, and health clinics. A federal judge blocked a $37 billion merger between Aetna and Humana in January, citing antitrust issues.

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Trump declares opioid abuse a public health emergency, the ‘worst drug crisis in American history.’ President Trump on Thursday declared opioid abuse a national public health emergency. Trump described the rise in opioid abuse as “the worst drug crisis in American history and even, if you think about it, world history.” “The fact is this is a worldwide problem,” Trump said. “It’s just been so long in the making. Addressing it will require all of our effort and it will require us to confront the crisis in all of its very real complexity,” Trump added. Drawing on the experience of his brother Fred’s death due to alcoholism, Trump spoke about how Fred encouraged him from an early age to avoid alcohol or other addicting substances. The president, who does not consume alcohol, said he never had a desire to drink or use drugs due to his brother’s early insistence. “The fact is, if we can teach young people, and people generally, not to start, it’s really, really easy not to take them,” Trump said. The president said not drinking or smoking were “two of the good things” he didn’t do growing up. “We won’t talk about the bad things,” he said to laughs from the audience. First lady Melania Trump spoke ahead of the president, and said she had taken an interest in the effort because of the ways opioids have affected children. She noted that she had met with first responders and families affected by the crisis and encouraged listeners to see beyond the stigmas associated with addiction, and to talk about struggles openly. “I have learned so much from those brave enough to talk about this epidemic,” she said. Some members of Congress criticized the president’s actions, however, because the declaration did not explicitly call for additional funding. But New Jersey Gov. Chris Christie, who oversaw the recommendations put forth by a commission on opioid abuse, praised the president and said that it was Congress’s job to appropriate the money. “That’s Congress’s job. Congress’s job is to appropriate … I’ve read the Constitution. The money starts with them,” he said to questions from reporters who asked about whether Trump had done enough. Christie said that he and Trump had discussed the issue of addiction for more than 15 years. Some critics on Twitter also accused Trump of replicating the failed drug policies of the 1980s which told teens “just say no” to drugs. Christie pushed back on the criticisms, noting that Trump’s approach also involved treatment. “There’s prevention … intervention, which the justice department is taking care of … and there’s treatment,” Christie said. “The president stood up today there and said firmly, loudly and directly that all three are necessary.”

Democrats say Trump must back up opioid declaration with money. Congressional Democrats urged Trump to commit to more funding to fight the opioid epidemic, charging that his emergency declaration Thursday isn’t enough. Democratic leaders and several lawmakers said Trump’s declaration was a good first step but much more is needed to be done to combat an epidemic that federal data shows kills 91 Americans each day. “It is deeply concerning that this declaration, which comes a full three months after the President’s Commission on the Opioid Crisis’ report, fails to authorize federal funding to help those Americans locked in a life-or-death struggle with opioid addiction,” said House Minority Leader Nancy Pelosi. Pelosi also asked when “will the administration send us a serious request for funding to fight this crisis?” Rep. Sander Levin, D-Mich., asked if the declaration “represents a real plan of action or just words on a piece of paper.” “To date, the president and Republicans have moved in the wrong direction, proposing $1.2 billion in cuts to the Centers for Disease Control and Prevention, eliminating the Prevention and Public Health Fund, and cutting $1.4 trillion from Medicaid,” Levin said, referring partly to cuts in Obamacare repeal bills. “And a preliminary proposal from his administration even called for cutting the Office on National Drug Control Policy by 95 percent.” Sen. Maggie Hassan, D-N.H., also called for additional funding to combat the epidemic. “He should also use the public health emergency to immediately direct Health and Human Services to negotiate lower prices for naloxone, which would help expand access to the lifesaving overdose reversal drug,” she added. Rep. Elijah Cummings of Maryland also called for lower prices of naloxone. Republicans praised the declaration and some also called for more legislation to address the epidemic. “While Congress has made some progress in addressing this crisis by enacting the Comprehensive Addiction and Recovery Act and the 21st Century CURES Act last year, we can and must do more,” said Sen. Rob Portman, R-Ohio. He then listed four bipartisan bills that address prescription drug monitoring, stopping the spread of synthetic opioids such as fentanyl and lifting a cap on Medicaid funding for mental health and substance abuse facilities.

House will vote on CHIP re-authorization next week. The House will vote next week on a bill that will fund the Children’s Health Insurance Plan and community health centers, House Majority Leader Kevin McCarthy, R-Calif., said Thursday. The funding formally expired Sept. 30 as Congress allowed it to lapse, but states have several months until they run out of money. Some states, however, are beginning to run low on funding beginning in November. “We wanted to get this done long ago, but the reason why we’re doing it next week is because Minnesota’s about to run out of money,” McCarthy said in remarks on the House floor. In order to pay for the programs, which must be re-authorized every five years, Republicans included cuts to Obamacare’s prevention and public health fund and added premiums to Medicare beneficiaries who make more than $500,000 a year. Democrats have said they do not want to cut one program to fund another. The program has bipartisan support but Democrats and Republicans in the House have been fighting over the specifics of where funding should come from, and have failed to reach an agreement. The bill passed the House Energy and Commerce Committee earlier this month, but its chairman, Rep. Greg Walden, R-Ore., said he would hold off on moving the bill forward to see whether more consensus could be reached.  The House version may not be part of final legislation. In the Senate, the Finance Committee approved a CHIP bill but hasn’t said how it would be funded. Sen. Ron Wyden, the committee’s top-ranking Democrat, told reporters that productive talks were continuing. McCarthy slammed Democrats for failing to arrive at a deal with Republicans.  “Only yesterday I was told Democrats said they don’t want to do anything and we should just go forward,” he said in his floor remarks. “That is not the way this place should work.”

Lawmakers promote Prescription Drug Take Back Day. Lawmakers on both sides of the aisle are trying to get the word out over the 14th National Prescription Drug Take Back Day this Saturday, which is a way to dispose of excess prescription drugs safely. “As our nation continues to battle the devastating opioid crisis, it is important everyone looks for ways to be part of the solution,” according to a release from the House Energy & Commerce Committee. Public health agencies warn consumers not to just flush excess prescription drugs down the drain because it could contaminate water sources. “Although there is no current evidence that these pharmaceuticals in the environment are responsible for any negative health effects in humans, keeping our water clean is an important public health goal,” CDC said. Overprescribing of prescription painkillers has also been identified as a key driver of the opioid epidemic where 91 Americans die each day from opioid overdoses. Such take back days are a way to avoid diversion of excess drugs.

Former HHS Secretary Sylvia Burwell eschews criticism of Trump, praises bipartisan deal. Former Health and Human Services Secretary Sylvia Burwell on Friday praised a bipartisan deal to stabilize Obamacare’s markets that has yet to win support from President Trump and key GOP leaders. “Their marketplace stabilization bill and the process through which it came together represents the way that we can get things done,” Burwell said Friday at American University’s law school on Friday. Burwell is president of American University and served as HHS secretary under former President Barack Obama. These were her first remarks dedicated to healthcare and were absent of criticism of President Trump or his administration that other Obamacare allies have said are trying to sabotage the law. She declined to comment on Trump’s changes to open enrollment, including shortening the enrollment period and cutting ad funding, after her remarks.

RUNDOWN

The Hill Trump’s Obamacare move may bolster the law

Axios What Trump’s opioid plan will and won’t do

Bloomberg Amazon threat causes shakeout in healthcare industry

Kaiser Health News Beyond the shattered lives and bodies, money worries weigh on Las Vegas victims

STAT News In White House opioid plan, advocates see a major puzzle piece missing: Naloxone

Reuters U.S. opioid crisis could spread to Europe

NPR Does smoking pot lead to more sex?

Modern Healthcare Hospitals warm to CMS bundled payments as agency cools off on them

Calendar

FRIDAY | Oct. 27

Oct. 26-30. San Francisco. World Conference of Science Journalists. Details.

Oct. 26-28. American University. Event on “Next Steps in Health Reform 2017.” Includes discussion with former HHS Secretary Sylvia Burwell. Details.

SUNDAY | Oct. 29

Oct. 29-Nov. 2. Gaylord National Resort & Convention Center. Obesity Week international conference. Details.

TUESDAY | Oct. 31

8:30 a.m. Aetna third quarter earnings call. Details.

WEDNESDAY | Nov. 1

First day of Obamacare open enrollment.

Nov. 1-3. Renaissance Hotel Downtown. U.S. News & World Report Healthcare of Tomorrow event. Details.

THURSDAY | Nov. 2

8:30 a.m. Cigna to release third-quarter earnings results. Details.