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What happens if Roe v. Wade gets overturned? There is, to be sure, a long and winding road to overturning Roe. To start, it’s no guarantee that the Senate will confirm Brett Kavanaugh to the Supreme Court. Even if he were confirmed and all other conservative justices were on board with overturning the ruling, it’s still not a lock that Kavanaugh would cast the deciding vote to strike it down. There are also plenty of possible ways justices could chip away at abortion rights without fully overturning the ruling. If Roe is overturned, however, the decision to legalize abortion would fall to states and popular opinion, and voting patterns would play a much larger role in determining abortion policy. Political trench warfare would ensue. Kimberly Leonard with a detailed look at how this scenario could play out on the policy front.

Welcome to Philip Klein’s Daily on Healthcare, compiled by Washington Examiner Managing Editor Philip Klein (@philipaklein), Senior Healthcare Writer Kimberly Leonard (@LeonardKL) and Healthcare Reporter Robert King (@rking_19).  Email [email protected] for tips, suggestions, calendar items and anything else. If a friend sent this to you and you’d like to sign up, click here. If signing up doesn’t work, shoot us an email and we’ll add you to our list.

Industry weighs in on Trump’s drug pricing plan. The drug industry’s main lobbying arm has proposed limiting how much drug middlemen can pocket for selling medicines, a position it is calling a “bold new stance.” The middlemen, known as pharmacy benefit managers, have taken heat from the Trump administration for their purported role in high prices that patients pay for medications. Pharmacy benefit managers negotiate drug prices for health insurance companies, but have been accused of not passing on savings from rebates to patients. The Pharmaceutical Research and Manufacturers of America, or PhRMA, has proposed in public comments that these groups receive a flat fee for the share of negotiating and selling a drug, rather than a share of the list price. The latest position was included in public comments posted about the Trump administration’s blueprint to lower drug prices for patients. The Pharmaceutical Care Management Association, which represents the pharmacy benefits managers, disputes that it is responsible for the high costs patients pay for drugs and said in its public comments that policies shouldn’t undermine their ability to negotiate rebates. The ideas in the blueprint failed “to address the root cause of rising drug costs: high list prices,” the group wrote.

Patient groups weigh in on drug price blue print. Several groups representing patients weighed in on various parts of the proposal. The American Cancer Society Cancer Action Network recommended allowing people on Medicare to use copay discount cards when generics or biosimilar drugs are unavailable and letting pharmacists tell patients about how they can get medicines at a lower cost. The Council for Affordable Health Coverage backed a proposal to allow government programs such as Medicare to pay for the type of value that drugs bring to patients, meaning how effective they are, and 40 left-leaning consumer groups, including Families USA, said that the federal government should directly negotiate drug prices. Health officials have signaled they will not be pushing this approach; Health and Human Services Secretary Alex Azar has pointed to estimates from the nonpartisan Congressional Budget Office that direct negotiation won’t generate any new savings. They have instead advocated for targeting in new trade agreements the low prices that other countries pay for U.S.-manufactured drugs.

Susan Collins expresses doubt on Trump proposal to post drug prices on ads. Sen. Susan Collins, R-Maine, expressed some doubt over a portion of Trump’s drug pricing plan that would require companies to list the cost of medications in their commercials. “I’m not convinced that’s the answer, but we do need to address that,” Collins said, answering a question about how it’s often difficult for consumers to know how much their prescription drugs cost. The ad pricing proposal is one of several put forward by the Trump administration to lower the cost of drugs for patients. A recent poll from the Kaiser Family Foundation found that it has support from 76 percent of the public. Collins said she was concerned that patients would tune out when given these advisories because several factors play into how much a customer ultimately pays for drugs. It’s possible that all the different contingencies would be listed in an ad, including whether someone is insured or covered under Medicare, or mentioned that rebates could be part of the ultimate cost of a drug, she said. “I don’t know how you would figure out what price to list,” she said, but stressed that better transparency on pricing was important. “We have to find a better way to figure out this opaque system.”

Democrats ask Trump to backtrack on Obamacare risk adjustment program. The Trump administration should reverse its decision to stop an Obamacare program that collects and pays out billions of dollars to health insurance companies, a group of Democrats said Monday. The action will “further destabilize the individual and small group markets that millions of Americans rely on for health insurance,” five Democrats wrote in a letter sent to Health and Human Services Secretary Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma. The payments, known as “risk adjustment,” are intended to reduce incentives for health insurers to try to bring in only healthy customers and avoid customers with pre-existing medical conditions that need ongoing treatment, such as cancer or diabetes. The Trump administration announced July 7 that it was putting them on hold. Democrats said they were concerned that insurers may choose to leave Obamacare or increase what they charge for premiums. Without the funds, certain health insurers that have healthier customers will have higher profits, while those with sicker customers are expected to amass losses.

District Court rules against Planned Parenthood lawsuit challenging family planning grant changes. A federal court struck down a challenge from Planned Parenthood against changes from the Trump administration to family planning grants under Title X. The women’s health and abortion provider sued the administration back in May to challenge changes to the program that would prioritize grants to abstinence-only education. The group charges that the Title X funding announcement made back in February removes all references to contraception and clinical standards for care. It instead prioritizes funding for entities that emphasize abstinence-only education, according to a release from Planned Parenthood late Monday. Three Planned Parenthood affiliates sued back in May to roll back the changes. U.S. District Court Judge Trevor McFadden, who was appointed by Trump, ruled against Planned Parenthood on late Monday, the group said.

House passes bill to revamp over-the-counter drug approvals. The House passed via a voice vote on Monday a bill to completely revamp and modernize how over-the-counter drugs are approved by the Food and Drug Administration. Currently the FDA has a series of drug monographs for certain ingredients, doses or labeling. An OTC drug maker must ensure their product meets these monographs in order to reach the market. But a major problem has been that the monographs haven’t been updated in decades. ““Our current process for approving over-the-counter products is cumbersome, slow, and inefficient,” said Rep. Bob Latta, R-Ohio, the bill’s sponsor, in a statement. The bill seeks to speed up approvals for newer and safer OTC products to the market. It lets the FDA make scientific determinations for OTC ingredients through the administrative order process, which is more efficient than the current rule-making process, according to a release from Latta on the bill.

FDA will consider whether almond, soy, coconut drinks can call their products ‘milk.’ The Food and Drug Administration will consider how it will enforce the definition of “milk” on beverage companies that use that name on products not coming from a cow but from plants such as almonds or rice, commissioner Scott Gottlieb said Tuesday. The move, Gottlieb acknowledged, is likely to result in lawsuits against the FDA. The process would take roughly a year as the FDA collects public comments. The dairy industry has been facing competition from alternatives including rice, soy, coconut, and almond milk, and has been pressing Congress and federal regulators to stop the companies that sell these alternatives from defining their products as “milk,” “yogurt” or “cheese.” Gottlieb pointed out that regulations from the FDA define milk as a “lacteal secretion” from an animal, typically a cow. “An almond doesn’t lactate,” Gottlieb said. “The question is, ‘Have we been enforcing our own standard of identity?’ The answer is: probably not.”

FDA considering some prescription drugs to be made available over-the-counter. The agency is also hinting that some nonprescription drugs could be made available over-the-counter. The FDA released new regulatory guidance on Monday that outlines ways to convert some nonprescription drugs to OTC. “Clearly, not all prescription drugs can or should be available directly to consumers,” Commissioner Scott Gottlieb said on Monday in a statement. “Many require a professional diagnosis and oversight to ensure the benefits of use outweigh the risks. But other, select types of drugs, are appropriate for nonprescription use if we are able to ensure access to resources that will help patients determine if the medicine is right for them.” Gottlieb said that the standard for approving an OTC drug remains the same. The guidance outlines new approaches that a drug could take to become OTC. Health and Human Services Secretary Alex Azar praised the guidance in a statement Tuesday. “The agency’s new guidance will offer innovative ways for drug manufacturers to give patients over-the-counter access to drugs they need to treat or manage conditions, offering consumers greater convenience and more affordable options by not having to obtain a prescription,” he said.

Trump-era politics force Corporate America to take sides on hot-button issues. Spurred by shareholders, employees or their own political ambition, U.S. business leaders are engaging more forcefully in public debates over hot-button policy issues. It’s a trend taking shape as business’ steadfast backing of traditional GOP orthodoxy splinters amid fiery debate over Trump’s actions on immigration, gun control and healthcare. While some company executives say there’s a vacuum of leadership, both domestically and internationally, that they feel obligated to fill, their willingness to criticize the White House has some conservative investors concerned that companies are caving to liberal activists, a move they warn could ultimately alienate Republican voters and hit profits.

Murray and Alexander engage in ’he said, she said’ over failed Obamacare stabilization package. Sens. Patty Murray, D-Wash., said that she still wants to return to the Obamacare stabilization package that collapsed earlier this year, but her GOP counterpart Sen. Lamar Alexander, R-Tenn., remains miffed. Democrats remain interested in “finding commonsense solutions,” Murray said at a Senate Health, Education, Labor and Pensions Committee hearing on health costs Tuesday. “In addition to resuming that bipartisan work to addressing rising healthcare premiums we can work to find common ground on other challenges that they face.” Murray and Alexander worked together on a stabilization package to fund insurer payments and reinsurance for Obamacare, but the effort collapsed in March after a disagreement on abortion funding. Alexander said that Democrats “pulled the rug out from under us” when they objected to making new funding under the bill compliant with the Hyde amendment. The spending rider bans federal funding from covering abortions.

Alexander said there is no ‘sabotage’ because of lower insurance prices. Alexander also pushed back on Democrats attacking the Trump administration for “sabotaging” Obamacare’s exchanges. “As far as a Trump administration sabotage, if there was one it didn’t work because predicted prices are down,” he said. Alexander was referring to a proposal from Tennessee Obamacare insurers to decrease prices for 2019. However, several states that have announced rates have said that Trump administration moves like expanding access to cheaper plans with fewer benefits and the repeal of the individual mandate starting in 2019.

RUNDOWN

The Hill GOP chairman in talks with Trump officials on restarting Obamacare insurer payments

NPR and ProPublica Health insurers are vacuuming up details about you and it could raise your rates

CNN Government shuts down website for doctors searching for treatment guidelines

Kaiser Health News States attacking ACA would suffer most if shield on preexisting conditions were axed

Bloomberg Walmart names Humana veteran to run its health and wellness unit

New York Times Hospitals challenge Medicare payments, with help from Judge Kavanaugh

Reuters Mylan signs U.S. license deal on Humira biosimilar with AbbVie

Politico Democratic governors campaign as last line of defense on abortion