Tagged Prescription Drugs

Mulvaney: Trump Brought Down Drug Prices For The First Time In 50 Years

President Donald Trump announced last month that the GOP will become “the party of health care,” and news reports suggest he intends to make it a top issue in his reelection campaign.

So when Mick Mulvaney, the acting White House chief of staff, touted the administration’s work on prescription drug prices — a hot-button issue that has drawn scrutiny from across the political spectrum, and one that voters say should be a top priority — we were intrigued.

On “Fox News Sunday” April 7, Mulvaney said: “Drug prices in this country actually came down last year for the first time in 50 years. That’s because Donald Trump’s president.”

This statement is particularly hard to prove affirmatively. Drug prices are measured through a host of metrics and affected by all sorts of political and economic forces.

We reached out to the White House for more explanation. Its staff directed us to a report published last October by its Council of Economic Advisers, as well as to data suggesting the consumer price index for prescription drugs declined in January 2019 compared with January 2018.

But experts who reviewed that data said it doesn’t necessarily support Mulvaney’s claim — and certainly not by the magnitude he suggests.

A Broad Brush, And Some Missing Data

We interviewed five experts who all agreed that, no matter which metric was used, evidence is lacking to unequivocally say drug prices decreased last year. The most generous reading came from Matthew Fiedler, a health economist at the Brookings Institution: It’s “within spitting distance of something that’s true.”

But with more examination, the claim’s veracity became murkier.

“Drug prices” can refer to many things: a list price, a net price (what is paid after rebates, or the discounts negotiated by insurers or other payers), the pharmacy’s price or total national spending on prescription drugs.

Let’s start with the latter. Data from the Kaiser Family Foundation shows total spending on prescription drug prices has climbed during the past several years. (KHN is an editorially independent program of the foundation.) In 2018, total spending continued to grow, just at a slower pace. That’s a positive trend, experts noted, but it isn’t the same thing as spending going down.

“It doesn’t mean we’re spending less money on drugs than before,” said Stacie Dusetzina, an associate professor of health policy at Vanderbilt University.

We also examined the CPI data the White House provided. It could suggest that in the past year prescription drugs’ list prices have indeed dropped, and even by a meaningful amount.

But the CPI data doesn’t account for whether manufacturers lowering their list prices have also changed the size of the rebates they provide. That’s essential information in understanding if the real price of a drug — what insurance pays and, ultimately, what consumers pay — has actually changed.

These trend lines also vary depending on the 12-month period they cover, argued Walid Gellad, an associate health policy professor at the University of Pittsburgh. January to January could show a list price decrease, but July to July could show an increase.

Plus, the CPI data includes only drugs sold through retail, or about three-fourths of all prescriptions. That excludes many high-priced specialty meds sold only via mail order, argued Michael Rea, who heads Rx Savings Solutions, a consulting firm.

It also paints with a broad brush — obscuring, many said, just how many list prices are continuing to climb.

This year, the list price of more than 3,000 drugs went up, while the price of only 117 went down, according to data compiled by Rx Savings Solutions. Last year, an analysis by the Associated Press revealed that, from January to July, 4,412 branded drug prices went up, while 46 were cut.

So, Mulvaney’s downward price claim didn’t come out of thin air. But interpreting the data to mean that drug prices are down ignores crucial parts of the prescription drug marketplace.

The White House’s Work

Mulvaney also said Trump has played a key role in bringing down drug prices. When we asked the administration what he meant, a spokesman pointed to their efforts to bring more generic drugs to market — a boost the White House said has fueled competition and helped make lower-price alternatives available to consumers.

But there’s no evidence yet to suggest that the boost in generic drug approvals has that effect. Experts said it takes time for these products to reach the marketplace, create competition and demonstrate a measurable impact on prices.

Indeed, many of those generics, while approved, never went to market. This White House assertion also doesn’t account for high-priced, branded drugs that lack a generic counterpart.

Yes, Trump’s tough talk — accusing pharma companies of “getting away with murder” — may have persuaded some drug manufacturers to hold off on increasing their prices — at least temporarily, or until after the government releases key stats on how many prices have gone up, Dusetzina said. But it’s hard to separate that phenomenon from the pressure also levied by Congress and state legislatures.

For what it’s worth, the administration has proposed many new policies meant to curb drug prices, many noted, such as eliminating some kinds of rebates, or changing how Medicare Part B pays for drugs. But none of those have taken effect — so they haven’t brought prices down.

Our Ruling

Mulvaney said, “Drug prices in this country actually came down last year for the first time in 50 years. That’s because Donald Trump’s president.”

At first glance, CPI data could conceivably support the argument that the list prices for some prescription drugs dipped. But that data doesn’t include many high-priced specialty drugs that drive costs up, and the pattern it illustrates can change based on the time frame selected.

The CPI data set obscures the individual drugs for which the list prices have increased — with far more going up than down. It also does not account for a drug’s true “net price.”

Mulvaney’s statement also does not reflect trends showing that, nationally, spending on drugs has continued to climb, even if that growth has slowed. There is also no evidence to support the argument that Trump himself is responsible for changes in drug pricing.

This claim has an element of truth, but it ignores key facts and context that would give a very different impression. We rate this claim Mostly False.

The Blame Game: Everyone And No One Is Raising Insulin Prices

A casual observer of Wednesday’s House Energy and Commerce subcommittee hearing might think insulin prices just go up by themselves.

After all, the key industry executives filed opening statements to the congressional panel outlining patient-assistance programs, coupons and discounts — a range of price reductions that might make one think this life-or-death diabetes medication is easily affordable to the patients who need it.

In fact, the price of insulin nearly doubled from 2012 to 2016 alone, triggering national headlines about the resulting hardships — sometimes deadly — suffered by people with the Type I-version of the condition who are left to ration insulin because it is too expensive for them to use as prescribed.

The three drug manufacturers that make insulin — Eli Lilly, Novo Nordisk and Sanofi — joined three pharmacy benefit managers — CVS Caremark, Express Scripts and OptumRx — to testify before the Oversight and Investigations panel at its second hearing probing the corporate maneuvers behind the skyrocketing costs.

Pharmacy benefit managers, or PBMs, are the go-between companies that negotiate with drugmakers on which medicines will make insurance plans’ lists of covered drugs and how much insurers’ plans will pay for them.

The subcommittee members came looking for a fight. The often-contentious hearing featured Republicans and Democrats alike hammering the witnesses about prices, repeatedly asking questions: Why not just lower the list price? Do you really think the market is working? How do you sleep at night?

“I want to congratulate all of you today for accomplishing something we’ve been trying to do in Congress, and that is to create bipartisanship,” said Rep. Buddy Carter (R-Ga.), who isn’t even on the committee but came to ask questions, anyway. “This is going to end. I have witnessed it. I have seen what you’ve done.”

Chairwoman Diana DeGette (D-Colo.) asked each of the witnesses the direct question: Why were insulin prices rising?

In response, manufacturers and PBMs pointed fingers at one another while seated at the same witness table.

The manufacturers cast rebates as the root of the problem. Rebates are discounts paid by a drugmaker to a PBM, and those savings are generally not passed on to the customer at the pharmacy counter.

“Seventy-five percent of our list price is paid in rebates and discounts to secure access,” said Mike Mason, a senior vice president for Eli Lilly.

But PBM executives had a very different view.

“I have no idea why the prices are so high, none of it is the fault of rebates,” said Amy Bricker, a senior vice president for Express Scripts.

Manufacturers painted themselves as victims, saying they were forced to raise their list prices to compensate for the ever-growing rebates demanded by PBMs to keep their insulin on drug formularies (the list of drugs covered under an insurance plan).

But then PBMs saw things very differently. The real drivers of the sky-rocketing costs are the high list prices set by manufacturers along with the lack of generic alternatives, noted Dr. Sumit Dutta, OptumRx senior vice president and chief medical officer. And the PBMs also claimed to wear the white hat in this battle because without their rebate system prices would go up and no one would be advocating for patients.

Overall, the subcommittee members seemed exasperated by these circular arguments.

The response when Eli Lilly’s Mason mentioned his company’s recently introduced lower-priced insulin highlighted this impatience.

“It took 15 years and global public outcry to do it?” said Rep. Joseph Kennedy (D-Mass.), who was visibly frustrated that none of the drugmakers could explain how prices were set.

Subcommittee members also pounded the executives on some traditional weak spots, topics such as CEO pay and corporate profits.

Rep. Raul Ruiz (D-Calif.) asked each witness what they were willing to give up for patients to have access to less expensive drugs. He interrupted each answer, telling them the status quo isn’t good enough.

“Somebody’s getting richer,” Ruiz said. “Somebody is making money on the backs of our patients.”

Can Someone Tell Me What A PBM Does?

It was back-to-school day at the Senate Finance Committee hearing Tuesday morning. In the third of a series of hearings on rising drug prices, the senators seemed focused on getting an answer to one central question: What the heck is a pharmacy benefit manager?

Pharmacy benefit managers, or PBMs, are the go-between companies that negotiate with drugmakers on which medicines will make insurance plans’ lists of covered drugs and how much insurers’ plans will pay for them. This amount often involves rebates paid by the drugmaker to the PBM, and those savings are generally not passed on to the customer at the pharmacy counter. But when a consumer uses his or her health coverage to fill a prescription, PBMs are involved in paying the claim and setting the amount the consumers owes.

PBMs and drug manufacturers are prominent players in the drug-pricing pipeline and each group has been trying to blame the other for soaring prices. PBMs increasingly seem to be in the hot seat — specifically targeted in a public relations campaign by the Pharmaceutical Research and Manufacturers of America, the powerful and influential trade association of the drug industry.

The hearing attracted so many people that some spectators were turned away. Well over a dozen reporters were on hand to cover the proceedings.

Representatives from Cigna, CVS Caremark, UnitedHealthcare’s OptumRx, Humana and Prime Therapeutics, all PBMs, testified on the ins and outs of their little-understood industry, disputing the idea that they are simply “middlemen” taking their cut, but rather pharmacy experts looking for the most effective and cheapest drugs for their clients.

Though they’ve been around for decades, the new attention on PBMs had senators playing catch-up, trying to sort out and demystify exactly what they are and what they do.

“Despite this vast influence over what often amounts to life and death, many consumers have very little insight into the workings of PBMs,” Sen. Chuck Grassley (R-Iowa), chairman of the Finance Committee, said in his opening statement.

Sen. Ron Wyden (D-Ore.), the panel’s ranking member, called PBM negotiations “the most gnarled, confounding riddles,” before giving the packed committee room a lesson in “PBM 101.”

“What PBMs do to earn all those profits is a mystery,” Wyden said.

Sen. John Cornyn (R-Texas) used his time to ask a series of five yes-or-no questions to the all-male panel.

“I’m trying to understand the basic features of the contracts between manufacturers and PBMs,” he said. “I need to establish basic facts about how it works.”

Senators pressed the witnesses for answers about their relationships to manufacturers. Did PBMs ever persuade drug companies to set a higher list price so the PBM could have more flexibility to negotiate a rebate? They all answered no.

Some lines of questioning were less fruitful than others.

“Are there any other egregious anti-consumer practices in your industry you’d like to highlight?” Sen. Debbie Stabenow (D-Mich.) asked.

The complete silence suggested there were not.

Sen. Sherrod Brown (D-Ohio) brought up the Trump administration’s proposal to eliminate drug rebates as a means of negotiation. He also used his question as an opportunity to call attention to Health and Human Services Secretary Alex Azar’s past job as an Eli Lilly executive and to hint at how drug companies also were part of the problem.

“So to recap, PBMs do not set drug prices,” Brown said. “The administration rule will not change that fact.” Then Brown got to the point that numerous surveys have shown is a primary health care concern among Americans: high drug prices. “Most importantly, absolutely nothing in the proposed rule would require Secretary Azar’s former employer or any other pharma company to lower their price for insulin or any other drug,” he said.

“We should be focused on solutions that would lead to lower drug prices, like my legislation to allow Medicare to negotiate on behalf of all Part D drugs and to prohibit price gouging,” Brown added.

The witnesses said the key to lowering drug prices was not increased public transparency around the process or having the government negotiate drug prices. Instead, they advocated more competition in the drug market, something that would affect their favorite foe — drug manufacturers — the most.

“It sure looks to me like you all are taking deliberate actions to pad your bottom line at the expense of patients,” Grassley said.

Can Someone Tell Me What A PBM Does?

It was back-to-school day at the Senate Finance Committee hearing Tuesday morning. In the third of a series of hearings on rising drug prices, the senators seemed focused on getting an answer to one central question: What the heck is a pharmacy benefit manager?

Pharmacy benefit managers, or PBMs, are the go-between companies that negotiate with drugmakers on which medicines will make insurance plans’ lists of covered drugs and how much insurers’ plans will pay for them. This amount often involves rebates paid by the drugmaker to the PBM, and those savings are generally not passed on to the customer at the pharmacy counter. But when a consumer uses his or her health coverage to fill a prescription, PBMs are involved in paying the claim and setting the amount the consumers owes.

PBMs and drug manufacturers are prominent players in the drug-pricing pipeline and each group has been trying to blame the other for soaring prices. PBMs increasingly seem to be in the hot seat — specifically targeted in a public relations campaign by the Pharmaceutical Research and Manufacturers of America, the powerful and influential trade association of the drug industry.

The hearing attracted so many people that some spectators were turned away. Well over a dozen reporters were on hand to cover the proceedings.

Representatives from Cigna, CVS Caremark, UnitedHealthcare’s OptumRx, Humana and Prime Therapeutics, all PBMs, testified on the ins and outs of their little-understood industry, disputing the idea that they are simply “middlemen” taking their cut, but rather pharmacy experts looking for the most effective and cheapest drugs for their clients.

Though they’ve been around for decades, the new attention on PBMs had senators playing catch-up, trying to sort out and demystify exactly what they are and what they do.

“Despite this vast influence over what often amounts to life and death, many consumers have very little insight into the workings of PBMs,” Sen. Chuck Grassley (R-Iowa), chairman of the Finance Committee, said in his opening statement.

Sen. Ron Wyden (D-Ore.), the panel’s ranking member, called PBM negotiations “the most gnarled, confounding riddles,” before giving the packed committee room a lesson in “PBM 101.”

“What PBMs do to earn all those profits is a mystery,” Wyden said.

Sen. John Cornyn (R-Texas) used his time to ask a series of five yes-or-no questions to the all-male panel.

“I’m trying to understand the basic features of the contracts between manufacturers and PBMs,” he said. “I need to establish basic facts about how it works.”

Senators pressed the witnesses for answers about their relationships to manufacturers. Did PBMs ever persuade drug companies to set a higher list price so the PBM could have more flexibility to negotiate a rebate? They all answered no.

Some lines of questioning were less fruitful than others.

“Are there any other egregious anti-consumer practices in your industry you’d like to highlight?” Sen. Debbie Stabenow (D-Mich.) asked.

The complete silence suggested there were not.

Sen. Sherrod Brown (D-Ohio) brought up the Trump administration’s proposal to eliminate drug rebates as a means of negotiation. He also used his question as an opportunity to call attention to Health and Human Services Secretary Alex Azar’s past job as an Eli Lilly executive and to hint at how drug companies also were part of the problem.

“So to recap, PBMs do not set drug prices,” Brown said. “The administration rule will not change that fact.” Then Brown got to the point that numerous surveys have shown is a primary health care concern among Americans: high drug prices. “Most importantly, absolutely nothing in the proposed rule would require Secretary Azar’s former employer or any other pharma company to lower their price for insulin or any other drug,” he said.

“We should be focused on solutions that would lead to lower drug prices, like my legislation to allow Medicare to negotiate on behalf of all Part D drugs and to prohibit price gouging,” Brown added.

The witnesses said the key to lowering drug prices was not increased public transparency around the process or having the government negotiate drug prices. Instead, they advocated more competition in the drug market, something that would affect their favorite foe — drug manufacturers — the most.

“It sure looks to me like you all are taking deliberate actions to pad your bottom line at the expense of patients,” Grassley said.

Consumers Rejected Drug Plan That Mirrors Trump Administration Proposal

Unraveling how much of a prescription drug price gets swallowed by “middlemen” is at the forefront of Tuesday’s drug price hearing in the Senate. One thing bound to come up: rebates.

Both major political parties have shown interest in remedying high drug prices, and drugmakers have bemoaned how rebates to middlemen keep them from reaping every dollar associated with those price tags.

Pharmacy giant CVS Health criticized the Trump administration’s proposal to end these post-transaction discounts as they apply to Medicare. Yet, in January the company rolled out a Medicare drug plan that experts say is similar “in spirit” to the administration’s proposal.

The CVS Caremark plan wasn’t popular with customers, and CVS Health, which owns CVS Caremark, was quick to point this out as evidence that consumers prefer the current rebate system.

“We had a very, I would say, small number of seniors enroll in that program,” Larry Merlo, CVS Health’s CEO said on a February earnings call with investors. “And we think one of the barriers to that was the increase that we saw in the monthly premium.”

The CVS plan’s premium was $80 a month, which is about double the average Medicare Part D monthly charge. But since it is designed to pass on a portion of rebates directly to patients at the pharmacy counter, certain patients would wind up with smaller out-of-pocket costs than they previously paid.

“Even very well-informed consumers would not necessarily understand that a higher premium plan in this case means that they’re incurring smaller amounts at the point of sale,” said Rachel Sachs, an associate law professor at Washington University in St. Louis who specializes in health care.

So why did only 25,000 people sign up for the plan, called SilverScript Allure? Either consumers didn’t want the plan or perhaps they just didn’t understand it?

We’ll break it down for you.

Untangling Jargon: The Way Things Are And How They Could Change

A pharmacy benefit manager, or PBM, handles drug claims for health insurance companies. The big ones are Express Scripts, CVS Caremark and OptumRx. Every time you fill a prescription and use your drug plan, your PBM is involved in paying the claim and determining how much money you owe the cashier.

A rebate is a discount the PBM negotiates with a drug manufacturer off the price the drugmaker sets, which is called a list price. Rebates are not made public, and they typically don’t get passed on to the patient at the pharmacy counter in the form of a lower copayment, experts say.

When the drugmaker eventually pays the rebate back to the PBM, the PBM often uses this money to lower premiums, which are the monthly fees that Medicare Part D plans charge beneficiaries. They differ for each drug plan.

In a way, patients taking drugs with high list prices and big rebates wind up subsidizing other patients’ premiums, said Erin Trish, the associate director of the University of Southern California Schaeffer Center for Health Policy and Economics. Premiums on average haven’t substantially increased in more than a decade, but it may be “unfair” to the patients paying higher prices for drugs at the pharmacy counter.

“Some may argue, ‘They’re sicker… Maybe they should [pay more],’” Trish said. “Look. We decided everyone should pay the same premium in this market. [Rebates] shouldn’t be a roundabout way to make a subset of beneficiaries pay more.”

That could all change under a new Trump administration proposal that would ban rebates as they exist today. The negotiated discounts would be applied at the pharmacy counter, meaning discounts would be passed on to patients as out-of-pocket costs that are calculated based on the discounted price, not the higher list price.

For patients taking drugs with high list prices and large rebates, like insulin, it could mean noticeable savings, Sachs said. For patients taking drugs without big rebates, like generics or brand-name drugs without other branded competition, they’re not likely to see much change at the pharmacy counter.

Everyone, however, will see premiums go up. It’s unclear yet how much, but Trish said the SilverScript Allure plan CVS Caremark is offering isn’t necessarily the best indicator. Consultants hired by the Department of Health and Human Services estimated premiums will go up $3.20 to $5.64 per month if the rule takes effect in 2020. The average Medicare Part D premium for 2019 was $41.21, according to the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

So Why Didn’t Patients Want The CVS Caremark Plan?

It’s not clear how well seniors shopping for drug plans understood the SilverScript Allure plan, among their many options. They could see it had a high premium, but no deductible. They might not have realized it required smaller payments on drugs at the pharmacy counter.

Research shows that the premium is the most important factor seniors consider when choosing a plan, Sachs said.

On top of that, people are unlikely to leave their current plans even if there’s a better one available.

What’s more, we don’t know how well CVS Caremark marketed the plan to seniors who would benefit. They wouldn’t tell us, despite multiple calls and emails.

OptumRx, a competing PBM, started offering customers similar discounts at the pharmacy counter — but for people with commercial insurance, not Medicare or Medicaid. Unlike CVS Caremark, it has a web page with basic language, like “point of sale discounts mean lower costs,” and a link to request more information about switching. OptumRx did not respond to a request for comment.

PBMs: Helping Or Hurting?

Rebates for individual plans and drugs are confidential, but in Medicare Part D, they’ve increased on average from 9.6% of total spending in 2007 to 19.9% in 2016, according to annual reports to the Medicare boards of trustees.

So it’s perhaps unsurprising the brand-name drug trade group, the Pharmaceutical Research and Manufacturers of America, said it “applaud[s]” the proposal to overhaul the rebate system. PhRMA says it pushes them to raise prices in order to offer larger rebates, because drugs with larger rebates often get preferential treatment by PBMs.

Still, PBMs offer the benefit of batting down net prices (the price after rebate), and keeping down drug spending overall.

There are multiple estimates on how much the rebate proposal would cost the Centers for Medicare & Medicaid if it took effect, and they indicate that unless there are other changes to Medicare Part D, it would likely cost more money than the current system, Sachs said.

“It is startling to see the administration moving forward so rapidly with this proposal without a better understanding of how different actors might respond,” she said. As a result, there’s a “huge amount of uncertainty” over how this could all play out.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! The question for the day is: If there were a drug that would turbocharge your brain, would you take it? I’ve seen enough sci-fi movies to make me, uh, less than enthused about the idea, but as my second cup of coffee of the day has yet to kick in, I find it interesting to ponder.

Anyway, on to this roller coaster of a news week!

Republicans on the Hill have been quietly pretending they might wake up and this renewed focus on the health law will all have been a fever dream. But Democrats are doing their best to make sure everyone knows exactly where everyone stands on President Donald Trump’s recent legal attacks. On Wednesday, the House Dems officially voted to condemn the president’s decision to tell the courts to nullify the entire health law instead of just parts of it. In practice, this means nothing, but it puts Republicans on record of once again voting against popular health law provisions.

Trump, meanwhile, softly backpedaled on his promises that Republicans were coming up with a “spectacular” replacement plan before 2020. This came after a talk with Senate Majority Leader Mitch McConnell — who essentially channeled his inner Ariana Grande and said thank u, next to the issue that has left the party with political bruises the past two years.

But Trump is remaining steadfast in his message that Republicans need to reclaim health care as a winning topic for 2020. “We can’t run away” from health care, he said. “We’ll lose.”

The bumpy week, for some, was a reminder of the surprises that could be in store for the upcoming election season.

The Wall Street Journal: Democrats, Trump Try to Keep Spotlight on Health Care

The Associated Press: Pivoting on Pledges, Trump Explores Art of the Climb-Down

Bloomberg: Trump Says GOP `Blew It’ on Health Care and Must Run on New Plan

Politico: Killing Obamacare Kills Trump’s Health Agenda, Too


Going on name only, the Violence Against Women Act sounds like one of the least controversial bills out there, but a closer look at its history reveals fault lines. The House this week passed its version of the legislation (which is geared toward protecting women from violence and domestic abuse and has to be renewed every few years), but don’t expect smooth sailing the rest of the way. This time the underlying drama stems from a new provision that expanded law enforcement’s ability to strip domestic abusers of their guns.

The New York Times: A Brief History of the 25-Year Debate Over the Violence Against Women Act


Fill-in-the-blank copycat bills powered by special interests and businesses have infiltrated the legislative process to a shocking extent. USA Today, The Arizona Republic  and the Center for Public Integrity has an amazing two-year investigation that examined nearly 1 million bills in all 50 states and Congress to root out legislation that was nearly identical to others. These measures touched on almost every subject imaginable, from sugary drinks to “right-to-try” legislation to abortion to gun control. The investigation found that these bills are often drafted with deceptive titles, include misleading information on the extent of expert or public support, and push agendas that override the will of voters. Be sure to check out this story — it has examples of the bills, data and charts, and all kinds of fun goodies to delve into.

USA Today: Abortion, Gun Control: How Special Interest Groups Push Legislation


A veritable flurry of movement on drug pricing bills is coming up in the next week or so, with legislation and hearings that will focus on PBMs, the price of insulin, transparency, public accountability for pharma and more. With that as context …

Express Scripts this week announced that it is capping the price of insulin at $25 per month. Under the new plan, employers who cover their workers through Cigna and Express Scripts can opt into the program, and the extra costs will be picked up by the three drugmakers that sell insulin — Eli Lilly, Novo Nordisk and Sanofi. Advocates deemed the decision nothing but a PR move, saying it does little to address the actual problems of high list prices for people who aren’t lucky enough to be on one of the plans.

The New York Times: Express Scripts Offers Diabetes Patients a $25 Cap for Monthly Insulin

Stat: House Committee to Weigh Bills Aimed at Shedding Light on High Drug Prices


“One medical emergency, that’s all it would take to wipe me out financially,” is something I’ve heard friends worry about time and again, so a grim new report about the reality of paying for health care in America came as no surprise. Over the past year, Americans have borrowed $88 billion (billion! with a b!) to pay for health care. A survey went on to report that nearly half of Americans are haunted by fears of medical-related bankruptcy, and 1 in 4 people have skipped needed care because of the cost. Not only that, about 70% of respondents across the political spectrum said they had no confidence in their elected officials to bring prices down.

The New York Times: Americans Borrowed $88 Billion to Pay for Health Care Last Year, Survey Finds


This technically happened last Friday, but not in time for the Breeze: The Trump administration approved a work-requirements waiver for Utah — just days after similar restrictions were struck down for both Kentucky and Arkansas. The Utah story is even more nuanced, though, because voters in that state approved full expansion of the program. Lawmakers have been scrambling to put rules into place ever since the ballot measure passed.

The New York Times: Trump Administration Approves Medicaid Work Requirements in Utah

Meanwhile, both HHS Secretary Alex Azar and CMS Administrator Seema Verma have been quietly trying to sell states on applying for block grant waivers, with Verma, in particular, pushing Alaska to become the first in the nation to apply. A legal challenge would almost certainly follow any such decision.

The Hill: Trump Administration Urging Alaska to Be First to Apply for Medicaid Block Grant


In the same vein as this happened late last week but you should know about it: The Trump administration announced the recipients of $250 million in Title X federal family planning grants, including a chain of anti-abortion clinics designed to siphon off patients from Planned Parenthood. The group had been turned down last year because it doesn’t provide birth control other than natural family planning and abstinence. Meanwhile, Planned Parenthood and its affiliates saw a steep drop in what it had been previously receiving — going from about $50 million-$60 million to $16 million.

Politico: Millions in Family Planning Grants Given to Groups and States Fighting Trump’s Policy Changes


In the miscellaneous file this week:

• A look at how a former congressman has become a one-man gate-keeping operation when it comes to lobbying the VA.

Politico: Millions in Family Planning Grants Given to Groups and States Fighting Trump’s Policy Changes

• A wild investigation into how high-speed chases, while frowned upon in other agencies, are a strategy often used by the Border Patrol, despite the fact that they can often end in gruesome injuries and death.

Los Angeles Times/ProPublica: Border Patrol Agents Are Granted Wide Latitude When Trying to Catch Drivers Seeking to Enter U.S. Illegally

• Torture, rape, murder and other violence in the Alabama prison system is “severe and systematic,” a new Department of Justice report finds. Fair warning, the details are pretty disturbing, but it’s worth a read.

The New York Times: Alabama’s Gruesome Prisons: Report Finds Rape and Murder at All Hours

• Can getting drugs to treat libido issues or thinning hair be as easy as ordering off a restaurant menu? That’s what these new types of websites offer: a way for patients to self-diagnose their problems and then get a sign-off from a doctor whom they don’t even meet with. The sites often don’t include warnings about side effects of the medications, and it’s entirely unclear whether their doctor-screening process follows any kind of standards.

The New York Times: Drug Sites Upend Doctor-Patient Relations: ‘It’s Restaurant-Menu Medicine’

• The “lede” on this story was a cold reality check about the intersection of public health fears and prejudice when it comes to vulnerable populations. Rockland County, N.Y., where one of the country’s largest measles outbreaks is rippling through the Jewish Orthodox community, is serving as a model of how those tensions can boil over in times of crisis.

The New York Times: An Outbreak Spreads Fear: Of Measles, of Ultra-Orthodox Jews, of Anti-Semitism

• “Healthy Holly” may sound like an innocuous children’s book, but the controversy surrounding it — and its author, Baltimore Mayor Catherine Pugh — will likely bring down several careers.

The Baltimore Sun: As a Maryland Senator, Pugh Pushed Bills to Benefit Hospitals While Getting Book Payments From Medical System


And make sure to check out this fun history on how the concept of personal space is hard-wired into our brains. Have a great weekend!