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Alex Azar fires back at critics of drug pricing plan: ‘The president is doing exactly what he said.’ President Trump’s top health chief pushed back Monday against critics of the White House’s drug pricing proposal, who had accused the president of moving away from a campaign pledge to allow Medicare to directly negotiate drug prices. “I don’t know what they’re talking about,” Health and Human Services Secretary Alex Azar said on the Hugh Hewitt show. “This is the president doing exactly what he said. He’s going to harness the power of Medicare to negotiate on behalf of seniors and taxpayers. And he’s going to have improved bidding for these programs. I don’t get it. I don’t know what they’re talking about.” The latest blueprint from the White House, released Friday, contains a provision that allows Part D plans in Medicare, the program’s drug prescription plan, to prompt pharmacy benefit managers and insurers to share more of the rebates they get from drug makers with consumers. It also would allow private companies more negotiation power on the drugs delivered in a hospital or doctor’s office, through the Medicare Part B program. The proposal does not allow the Medicare program to directly negotiate, which would involve more government authority. Trump had said during his campaign that he would back such a proposal, and his critics seized on his recently announced drug plan as ineffective without it. In a speech at HHS headquarters later Monday, Azar said he and Trump had discussed Medicare negotiations several times. “The idea of direct negotiation in Medicare has come up,” he said, but that they had determined the approach ultimately presented was the “smart, effective” way. “This is how we follow through on his promise to do tough bidding and negotiation for our seniors,” he said. “We formulated this plan with fixing that problem and the president is following through on his promise.”

Azar takes a swing at the pharmaceutical industry. During his speech Monday, Azar noted that drug companies often say that if prices are controlled, then innovation and patient access will suffer. “For too long, there’s been a lot of talk on drug prices, and no action,” said Azar, who was a former executive at pharmaceutical giant Eli Lilly. “Drug companies have insisted we can have new cures or affordable prices, but not both. I’ve been a drug company executive — I know the tired talking points: the idea that if one penny disappears from pharma profit margins, American innovation will grind to a halt. I’m not interested in hearing those talking points anymore, and neither is the president. He has told us to fix the problem and we will.” Full remarks.

He also hits the media. “Do you think the mainstream media wants President Trump to be viewed as being successful and tough and bringing down drug prices for our citizens? Probably not, and so we’re going to have to fight through and around them so people understand just how comprehensive, how bold and how much this is in keeping with his promise to use the power of Medicare, but the right way, the effective way to negotiate discounts for our people and enhance the bidding in our programs,” he said on the radio program.

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This week: GOP tests the waters on work requirement for food stamps. Welfare reform faces a critical test in Congress this week when the House considers legislation that would bolster work requirements for food stamp recipients. The changes are included in the 2018 Agriculture and Nutrition Act, an $867 billion bill authorizing farm programs as well as the Supplemental Nutrition Assistance Program, also known as food stamps, for the next five years. Republican leaders and House Agriculture Committee Chairman Mike Conaway, R-Texas, are eager to advance the SNAP reforms, but it’s not clear if the legislation can pass the House. Democrats are poised to unite against the bill, and Republicans are not certain they can win over the vast majority of their own conference to get the approximately 215 votes that will be needed to pass it with a simple majority. Some lawmakers representing SNAP-dependent districts are uneasy with the changes, which would require 20 hours of training or work for those in the program under 60 who are able bodied and do not have young children. Conservatives say they like the SNAP reforms but also want changes on the agriculture side of the bill to curb costly subsidies. In other instances, individual lawmakers are seeking amendments to specifically help agriculture workers in their districts.

Here’s what we learned about Trump’s drug pricing proposal:

Trump administration wants to require drug companies to post prices on ads. The Trump administration proposed requiring drug companies to disclose the list prices of their drugs as part of their advertising. Azar said the FDA would be “immediately” looking into the proposal. “Think about all the time everybody spends watching drug company ads, and how much information companies are required to put in them,” Azar said in the White House Rose Garden on Friday. “If we want to have a real market for drugs, why not have them disclose their prices in the ads, too? Consumers would have much more balanced information, and companies would have a very different set of incentives for setting their prices.”

Trump plans to end ‘total ripoff’ gag rule on drug prices for Medicare plans. Trump’s plan would ban for Medicare’s prescription drug program a “gag rule” that prevents pharmacists from informing consumers about cheaper ways to pay for drugs. The change affects plans only on Medicare Part D. A federal effort to ban gag rules for all health plans has languished in Congress. “This is a total rip-off, and we are ending it,” Trump said in a speech in the White House Rose Garden Friday afternoon. Under the gag rule, the pharmacy benefit manager, which buys pharmaceuticals for an employer or union-sponsored health plan, tells the pharmacy that it cannot tell the consumer that the product is cheaper if he pays for it with cash rather than using insurance.

Trump pledges to eliminate ‘drug middlemen,’ go after unfair countries. Trump said his administration is “very much eliminating the middlemen” who have contributed to high drug prices. Trump’s rhetoric mirrors other criticisms from top administration officials about middlemen called pharmacy benefit managers who negotiate with drug makers on behalf of employer and union health plans. He also took aim at foreign companies that get pharmaceuticals for much less than U.S. consumers. Trump did not divulge any specifics on how he would eliminate pharmacy benefit managers, which are a multibillion-dollar industry. But none of the actions in the blueprint aims to eliminate the pharmacy benefit manager’s role. PBM giant Express Scripts appeared to take Trump’s comments in stride. The company lauded Trump for recognizing that drug companies charge too much. “It is clear, based on today’s comments, that our role has never been more important to improving healthcare,” the company said. Trump also said the administration will target in new trade agreements the low prices that other countries pay for U.S.-manufactured drugs.

The reaction:

Big Pharma largely unscathed. The U.S. pharmaceutical industry emerged mostly unscathed from the plan, thanks to its sidestepping of changes to a Medicare program that benefits the drugmakers. The companies had grown increasingly concerned the Trump administration would seek to adjust the rates that the federal health insurance program uses to pay for treatments that must be administered by a physician, commonly known as Medicare Part B. Former President Barack Obama had attempted to do that, and the pharmaceutical industry spent millions of dollars successfully combating it. The S&P Pharmaceuticals Select Industry Index climbed more than 2.5 percent after Trump’s speech. The pharmaceutical lobby, however, is already attacking the blueprint. The Pharmaceutical Research and Manufacturers of America said changes to Part B “could raise costs for seniors and limit their access to lifesaving treatments,” a similar argument the group used to push back against the Obama proposal.

Democrats praise some Trump proposals. Democrats found a few things to like in Trump’s plan to lower prescription drug prices, but blasted him for backing off his campaign proposal to allow Medicare to set drug prices. Democratic Sen. Claire McCaskill, who is in a tough re-election battle in Missouri, said she was “glad” Trump wanted to ban the “gag rule” in Medicare’s prescription drug program that prevents pharmacists from informing consumers about cheaper ways to pay for drugs. Rep. Diana DeGette, D-Colo., said she was pleased that the president proposed allowing people on Medicare to receive generic drugs at no cost to them. Still, many Democrats criticized the plan. “President Trump offered little more than window dressing to combat the rising cost of drugs – a problem that is pinching the pocketbook of far too many Americans,” said Senate Minority Leader Chuck Schumer, D-N.Y.

Azar says public should ‘trust us’ on drug prices. Azar on Friday shrugged off questions about whether he can be trusted to lower drug prices because of his prior work for the pharmaceutical industry. “Trust us by our actions and by the deeds in the blueprint,” Azar said at a White House press briefing. “It is the hardest-hitting plan ever proposed by a president.” Azar’s time in the pharmaceutical industry was a topic of rampant criticism from Democrats during his confirmation as HHS secretary last year. Azar said drugmakers currently have no incentive to lower list prices of pharmaceuticals. “You put yourself at a disadvantage with lower list price,” he said. “Every other person in system makes money off a high list price.” Azar said the “entire system” is built for increased prices and creates perverse incentives for drug companies to charge more.

Senate Dems press Novartis on payments to Trump fixer Michael Cohen. High-ranking Senate Democrats are pressuring the head of Novartis for information on the pharmaceutical giant’s consulting contract with Trump’s former attorney Michael Cohen. Novartis revealed that it paid Cohen $1.2 million through shell company Essential Consultants for healthcare advisory services in early 2017. While similar arrangements are common in Washington, his lack of healthcare experience prompted immediate criticism. “The Senate Finance Committee has a duty to ensure that pharmaceutical companies providing services to federal health programs are conducting business in a legal and transparent manner,” Sen. Ron Wyden, D-Ore., the panel’s top Democrat, wrote in a letter to Novartis CEO Vasant Narsimhan. Wyden asked the company to turn over any contracts outlining the work between Novartis and Cohen, further details on the payments made to Cohen, and details on how the contract was approved within the company.

Democratic super PAC launches six-figure ad buy. An outside Democratic group has launched a six-figure ad campaign focused on reproductive rights in an effort to mobilize millennial women. The digital ads from American Bridge’s Women Rights Initiative urge women to rally against the Trump administration and threats to abortion rights policies. The ads, which will run nationwide on Instagram, Twitter, and Facebook, link to a website detailing “extreme” policy changes made by Trump and HHS that it says limit women’s access to a full range of health services.

Why it will be years before Trump’s transgender military cases are settled. A federal district court in Seattle has scheduled a trial for the lawsuit against Trump and his proposed transgender policy for the military, but do not expect judgment anytime soon. A pretrial conference in the Karnoski v. Trump case is set for the end of May 2019 with a five- to 10-day bench trial to follow, according to court filings last week. The active-duty transgender troops and prospective recruits who filed the Karnoski suit are wrangling with the Justice Department over the discovery process and turning over documents related to Trump’s July tweet announcing a service ban.

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