Tagged Prescription Drugs

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! A quick programming note before we dive into the week that was absolutely jampacked with news: The Friday Breeze is going on a little hiatus (as yours truly explores Vietnam for a few weeks). I’ll be back in your inboxes Oct. 11, but you can always keep up to date through our host of other newsletters by adjusting your KHN email preferences here.

Now on to what you may have missed!

To be frank, if you missed Thursday’s Democratic presidential debate, you didn’t actually miss much in the way of developments on the candidates’ health care positions. But the sharp divide between the moderates (build upon existing framework) and progressives (sweeping systematic changes) was on display — confirming for perhaps the millionth time that health care will be front and center in the 2020 election.

The Washington Post: September Democratic Debate Highlights: Democrats Argue Over Health Care, Guns, Immigration

Beto O’Rourke drew praise from his rivals for how he handled the aftermath of the mass shooting in his hometown, El Paso, Texas — and also went big and bold on his gun control plan. “Hell, yes, we’re going to take your AR-15,” he said, in a declaration that in elections past would have been a nuclear bomb on a candidate’s campaign.

Los Angeles Times: Beto O’Rourke: ‘Hell, Yes, We’re Going to Take Your AR-15’

The “babies in cages” line is a go-to for many Democrats criticizing the Trump administration’s treatment of immigrant children in U.S. custody. It made for an awkward moment for former Vice President Joe Biden, who was part of the Obama administration that used the same facilities. “We didn’t lock people up in cages,” Biden said. “We didn’t separate families.” But a fact check shows that neither of those protestations is accurate.

The Associated Press Fact Check: Dems Draw Link Between Trump, El Paso Murders

And some people were left wondering after Thursday night: Where are the abortion questions? Considering all the developments that have occurred in the reproductive rights sphere over the past few months, debate watchers (and the candidates themselves!) were frustrated by the omission.

The New York Times: Marathon Democratic Debate Includes No Questions About Women’s Issues

Amid an ever-escalating outbreak of a lung disease that public health officials still haven’t gotten a handle on, President Donald Trump announced that he plans to ban flavored e-cigarettes. A look behind the scenes from Politico shows that first lady Melania Trump — who can be fairly reticent when it comes to public policy — was a driving force behind the president’s decision, which bucks traditional Republican thinking on the matter.

The New York Times: Trump Administration Plans to Ban Flavored E-Cigarettes

Politico: Melania Versus the Vapers

Trump’s decision was just the latest in a broader shift toward public health issues ahead of the 2020 elections. Voters routinely rank health care as high on their list of priorities, but Republicans have been grappling with the reality that Democrats have the edge on things like insurance and costs. So where does that leave them? Looking elsewhere to rack up victories and build talking points.

Politico: From Vaping to Opioids: Trump Redefines Health Care for 2020 Run

And in that vein, Trump startled California leaders this week when he sent a delegation of officials to check out the state’s homeless crisis. As you can imagine, the governors and mayors — who have been on the receiving end of verbal elbow throwing from the president over the issue — had a less-than-thrilled response to Trump’s interest. The message from the governor’s office: “If the president is willing to put serious solutions — with real investment — on the table, California stands ready to talk. He could start by ending his plans to cut food stamps, gut health care for low-income people, and scare immigrant families from accessing government services.”

The Washington Post: Trump Officials Get Look at Los Angeles Homeless Crisis

Los Angeles Times: Trump Team’s Homeless Tour of L.A. Sparks Suspicions, Concerns

Details of House Speaker Nancy Pelosi’s much-awaited drug-pricing plan dropped this week and the proposal looks far more aggressive than some had expected. It would allow Medicare to negotiate prices on the top costliest 250 drugs, and then those prices would be available to all consumers, not just Medicare beneficiaries.

The political takeaways:

— If Trump was bluffing about his own drug-pricing rhetoric, Pelosi is calling him on it. Some of the ideas — like pegging costs to what other countries pay for the drugs — are straight out of his playbook. She could also be looking to back Senate Republicans into a corner on the issue.

— But some people say the progressive plan is a signal that any bipartisan hopes should be curtailed. If Pelosi had thought she could get something through the Senate, the plan would have lined up closer to the anticipated blueprint. This way, she avoids a battle with the left flank of her chamber.

Politico: Pelosi Tries to Split Trump, Republicans Over Drug Pricing

The Washington Post: Pelosi Bill Aims to Negotiate Medicare Prices On Top 250 Drugs, Penalize Manufacturers That Don’t Comply

Purdue Pharma announced a tentative settlement with thousands of municipal governments nationwide and nearly two dozen states. Essentially, the company would be dissolved, a new one would be formed to sell OxyContin (with profits going to the plaintiffs) and Purdue would donate drugs for addiction treatment and overdose reversal. The Sackler family would be personally on the hook for $3 billion.

That last bit has been a sticking point with the states that aren’t interested in the settlement — many see that as far too low a penalty for the family. The states in favor of the deal like the idea of avoiding the uncertainty of a trial.

The New York Times: Purdue Pharma Tentatively Settles Thousands of Opioid Cases

For the first time in a decade, the number of uninsured Americans rose despite a strong economy. The Census Bureau report found an estimated 27.5 million people, 8.5% of the population, without coverage in 2018 (which is an increase of 1.9 million uninsured people, or half a percentage point). Democrats pounced on the numbers.

The Associated Press: Share of Uninsured Americans Rises for 1st Time in a Decade

With Congress back in session, Democrats were adamant about pushing Republicans into acting on gun control. Both Pelosi and Senate Minority Leader Chuck Schumer urged Trump to resist the NRA’s influence and “seize this moment,” because Senate Majority Leader Mitch McConnell has repeatedly said he is not interested in even thinking about legislation that Trump wouldn’t sign.

The New York Times: Pelosi and Schumer, in Push for Gun Safety Legislation, Urge Trump to Defy N.R.A.

Meanwhile, the gun lobby has been bombarding the White House, gaining access to Trump, and meeting with senior officials over the president’s expected gun violence proposal. But advocates on the other side can’t even get in the door.

Politico: Inside the Gun Lobby’s Push to Sway Trump

Several companies are being lauded for their decision to wade into the gun debate with their requests that consumers don’t open-carry firearms into the stores. Are they trying to play both sides? Because legal experts say they could go further than mere “requests,” and they’ve decided not to.

The New York Times: Stores Could Just Ban Guns, But Open-Carry Foes Back Requests as a Step

And I’m always a sucker for a good history lesson:

The New York Times: How Congress Passed an Assault Weapons Ban in 1994

So … it turns out Medicaid can function like a loan and not just government aid. For those of us who weren’t covering health policy in 1993 when then-President Bill Clinton signed the Medicaid Estate Recovery Program into law (making it mandatory that states seek repayment for Medicaid debts), The Atlantic offers a terrifying look at what happens when states come a-knockin. One woman received a 28-page, $198,660.26 itemized bill for “every Band-Aid, every can of Ensure” her mother used while on Medicaid.

The Atlantic: Medicaid Debt Can Cost You Your House

In the miscellaneous file for the week:

  • So, what’s up with all these blood pressure medication recalls? How did carcinogens get past the FDA’s regulation process? Well, it turns out that while the FDA has a rigorous approval process for new drugs, 90% of medications are generics. And those? They receive a lot less scrutiny.

Bloomberg: How Carcinogen-Tainted Generic Drug Valsartan Got Past the FDA

  • Frontline did an investigation into the Legionnaires’ disease outbreak linked to Flint’s water crisis and found that 115 people died of non-viral pneumonia. The official death count? 12.

PBS NewsHour: Flint’s Deadly Water

  • Any reader of the Breeze knows I can’t resist a superbug story, and this one is fairly traumatizing: It looks at how skilled nursing facilities — which are often understaffed and ill-equipped to handle rigorous quality control — have become the “dark underbelly” of drug-resistant infections.

The New York Times: A Breeding Ground for a Fatal Scourge: Nursing Homes

  • City leaders in Austin, Texas, found a workaround to strict regulations on providing public funding for abortions. If it can’t pay for the procedure itself, the city will help with auxiliary costs like transportation and child care.

Texas Tribune: Texas Told Cities They Couldn’t Fund Abortion Providers. So Austin Is Funding Abortion Access Instead.

  • Why would a gay New York City council member want to repeal a ban on conversion therapy? It’s for the greater good, he says.

The New York Times: New York City Is Ending a Ban on Gay Conversion Therapy. Here’s Why.

And that’s it from me for a bit! Have a great rest of the month!

KHN’s ‘What The Health?’: Despite Booming Economy, Uninsured Rate Ticks Up

Can’t see the audio player? Click here to listen on SoundCloud.

The annual report from the Census Bureau, released this week, found that 27.5 million Americans were without health insurance last year, an increase of nearly 2 million from 2017. The 0.5 percentage point increase in the uninsured rate — to 8.5% — was the first in a decade and came as unemployment and other economic indicators have been good.

Meanwhile, the Trump administration signaled that it is moving to ban flavored vaping liquid used in e-cigarettes. Companies making the products have been accused of marketing to underage users with flavors like mango and bubble gum.

And Congress is back from its summer break, with legislation to address rising prescription drug prices and surprise medical bills still on the agenda.

This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Tami Luhby of CNN and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s podcast:

  • The Census Bureau’s report this week defied usual economic models. Normally, the more people employed, the more people insured.
  • Health advocates blame a variety of actions by the Trump administration for the lower rate of insured Americans. Those include policies intended to deter people from staying on or signing up for Medicaid; the elimination of the tax penalty for not having coverage; and the announcement that immigrants’ use of public benefits such as Medicaid could affect their ability to get a green card allowing them to live and work in the U.S.
  • The biggest surprise in the Census Bureau report was the increase in children without insurance. Coverage for kids has generally been a bipartisan goal on Capitol Hill. It’s not clear what caused that drop. It could just be a result of differences in how the survey was conducted, or it may be another sign of immigrants worried about whether using public insurance could lead to their deportation.
  • The administration’s announcement that it is moving forward on a ban of flavored vaping products comes as worries grow among parents and public health officials about an epidemic of lung problems around the country. Among those worried parents is first lady Melania Trump.
  • House Speaker Nancy Pelosi appears to be inching closer to releasing her plan to curb high drug prices. It’s not clear yet whether President Donald Trump will sign on to her effort. But Sen. Chuck Grassley (R-Iowa) is seeking support for his more modest plan instead, arguing to his Republican colleagues that if they don’t stand with him, they may be forced to accept Pelosi’s legislation if she manages to make a deal with the president.
  • Opponents of some of the legislation to curb surprise medical bills appear to have made progress over Congress’ August recess with a major advertising campaign saying the measures would hurt local hospitals and doctors. Advocates say the legislation is not dead, but the strong momentum it had is waning.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: Vox.com’s “This life-threatening pregnancy complication is the next frontier in the abortion debate,” by Anna North

Joanne Kenen: The New York Times’ “Nursing Homes Are a Breeding Ground for a Fatal Fungus,” by Matt Richtel and Andrew Jacobs

Rebecca Adams: Kaiser Health News’ “‘UVA Has Ruined Us’: Health System Sues Thousands Of Patients, Seizing Paychecks And Claiming Homes,” by Jay Hancock and Elizabeth Lucas

Tami Luhby: The New York Times’ “Bernie Sanders Went to Canada, and a Dream of ‘Medicare for All’ Flourished,” by Sydney Ember

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcherGoogle PlaySpotify, or Pocket Casts.

Congress Rakes In Millions From Drugmakers

Members of Congress raked in almost $4 million from pharmaceutical manufacturers and their trade groups in the first six months of 2019. Two members — Sen. Chris Coons (D-Del.) and Sen. Thom Tillis (R-N.C.) — each received over $100,000. Rep. Greg Walden (R-Ore.) is $5,000 shy of qualifying for the “million-dollar club,” a group of current members who’ve received $1 million or more since 2007.

The pharmaceutical industry has a long history of seeking to influence legislation by donating to the committees controlled by powerful members of Congress. As they return from recess and drug-pricing legislation comes into focus, find out how much your state’s representatives and senators took from the industry by examining KHN’s exclusive “Pharma Cash to Congress” feature.

Legislation To End Surprise Medical Bills Has High Public Support — In Both Parties

Nearly 8 in 10 Americans support legislation to protect people from surprise medical bills, a new poll from the Kaiser Family Foundation shows.

That support persisted no matter which party was asked: 84% of Democrats, 78% of independents and 71% of Republicans said they support surprise billing legislation, according to the poll. (Kaiser Health News is an editorially independent program of the foundation.)

Surprise bills are the unexpected ― and often expensive — charges patients receive after getting care from a doctor or hospital not in their insurance network. The issue has attracted a lot of attention in recent years, with ongoing projects like KHN-NPR’s “Bill of the Month” series and Vox’s look at emergency room bills illuminating the scope of the problem. The White House and both parties on Capitol Hill have expressed interest in finding ways to protect consumers from the practice.

But Congress has been bombarded by relentless attack ads and deep-pocketed lobbying against legislation that would end surprise billing.

And with lawmakers returning to work this week after the summer recess, some of the supporters of legislation on Capitol Hill worry that effort may destroy their chances of passing an effective law.

Critics claim that the primary legislation under consideration — in which a patient’s insurance would pay the out-of-network provider based on the average of what other doctors nearby are paid — would result in doctors and hospitals being paid less.

But the KFF poll found 57% of respondents support passing legislation to address the problem even after hearing the critics’ argument.

And as Democratic and Republican politicians alike discuss dismantling the ACA, whether through implementing a “Medicare for All” plan or ruling the existing law unconstitutional, the poll also found the public has some reservations about making drastic changes to the health system.

Ahead of Thursday night’s Democratic presidential debate, the poll found that 55% of Democrats and Democratic-leaning independents prefer a presidential candidate who wants to build on the ACA. About 40% said they prefer one who wants to replace it with a Medicare for All plan, which some advocates such as Democratic presidential candidate Sen. Bernie Sanders suggest would provide a single health plan for the entire country and replace all private insurance.

Those numbers are nearly identical to the findings in KFF’s last tracking poll in July.

KFF’s new poll showed the polarization that could undermine Democrats’ chances of unifying behind a single presidential candidate in 2020: 14% of Democrats and Democratic-leaning independents said they would vote only for a candidate who wants to replace the ACA with Medicare for All.

It also found 69% of all Americans support a government-administered public option health plan that consumers could opt into, a policy former Vice President Joe Biden included in his health plan. About 41% of Republicans said they support a public option.

That said, the poll shows many respondents do not see the difference between the policies that Democratic candidates are pitching: About 47% said a public option and a Medicare for All plan are similar.

The new poll also shows that support for the Affordable Care Act has hit an all-time high among Democrats, with 84% saying they view it favorably. The ACA became law in 2010.

KFF’s findings confirm that the Donald Trump presidency has galvanized Democratic support for the ACA, former President Barack Obama’s signature domestic policy. The percentage of Democrats who favor the law has increased by 11 percentage points since February 2017.

Among other policy questions, 70% of those surveyed said lowering prescription drug costs should be a major health care-related priority for Congress, and 69% said maintaining the ACA’s protections for those with preexisting conditions should be a top priority.

The KFF poll was conducted Sept. 3-8, with researchers surveying 1,205 adults by landline and cellphone, in English and Spanish. The margin of error is plus or minus 3 percentage points.

States Pass Record Number Of Laws To Reel In Drug Prices

Whether Congress will act this year to address the affordability of prescription drugs — a high priority among voters — remains uncertain. But states aren’t waiting.

So far this year, 33 states have enacted a record 51 laws to address drug prices, affordability and access. That tops the previous record of 45 laws enacted in 28 states set just last year, according to the National Academy for State Health Policy, a nonprofit advocacy group that develops model legislation and promotes such laws.

Among the new measures are those that authorize importing prescription drugs, screen for excessive price increases by drug companies and establish oversight boards to set the prices states will pay for drugs.

“Legislative activity in this area is escalating,” said Trish Riley, NASHP’s executive director. “This year, some states moved to launch programs that directly impact what they and consumers pay for high-cost drugs.”

And more laws could be coming before year’s end. Of the handful of states still in legislative session — including California, Massachusetts, Michigan, New Jersey, Ohio and Pennsylvania — debate continues on dozens of prescription drug bills. In New Jersey alone, some 20 proposed laws are under consideration.

“Both Democrat and Republican leaders have shown a willingness to pursue strong measures that help consumers but also protect state taxpayer dollars,” said Hemi Tewarson, director of the National Governors Association’s health programs.

Riley, Tewarson and others note, however, that states can go only so far in addressing rising drug prices, and that federal legislation would be necessary to have a major impact on the way the marketplace works.

Federal lawmakers are keeping a close eye on the state initiatives, Tewarson said, to gauge where legislative compromise may lie — even as Congress debates more than a dozen bills that target drug costs. Political divisiveness, a packed congressional schedule and a looming election year could stall momentum at the federal level.

The pharmaceutical industry has opposed most — though not all — state bills, said Priscilla VanderVeer, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, the industry’s main trade group.

“We agree that what consumers now pay for drugs out-of-pocket is a serious problem,” said VanderVeer. “Many states have passed bills that look good on paper but that we don’t believe will save consumers money.”

Limiting Gag Rules For Pharmacists

At least 16 states have enacted 20 laws governing the behavior of pharmacy benefit managers. The so-called PBMs serve as middlemen among drugmakers, insurance companies and pharmacies, largely with pharmaceutical industry support.

Those laws add to the 28 passed in 2018. Most of the new laws ban “gag clauses” that some PBMs impose on pharmacists. The clauses, written into pharmacy contracts, stop pharmacists from discussing with customers whether a drug’s cash price would be lower than its out-of-pocket cost under insurance.

With widespread public outrage over gag clauses pushing states to act, federal lawmakers got the message. In October, Congress passed a federal law banning such clauses in PBM-pharmacy contracts nationwide and under the Medicare Part D prescription drug benefit. The Senate passed it 98-2.

Even so, many of this year’s PBM laws contain additional gag clause limitations that go beyond the 2018 federal law.

Importing Cheaper Drugs

Four states — Colorado, Florida, Maine and Vermont — this year have enacted measures to establish programs to import cheaper prescription drugs from Canada and, in Florida’s case, potentially other countries. Six other states are considering such legislation.

Medicines in Canada and other countries are less expensive because those nations negotiate directly with drugmakers to set prices.

“This is an area where states once feared to tread,” said Jane Horvath, a consultant who has advised Maryland and Oregon, among other states, on prescription drug policy. “Now both Republicans and Democrats view it as a way to infuse more price competition into the marketplace.”

Hurdles remain, however. A 2003 law allows states to import cheaper drugs from Canada but only if the federal Health and Human Services Department approves a state’s plan and certifies its safety. Between 2004 and 2009, the federal government halted nascent drug import efforts in five states.

Even so, momentum for importation has built in recent years in states and Congress as drug prices have continued to rise. And the Trump administration this summer threw its support behind the idea.

Florida Gov. Ron DeSantis, a Republican and close ally of President Donald Trump’s, signed his state’s measure into law on June 11, claiming he did so after Trump personally promised him the White House would back the initiative.

On July 31, HHS announced an “action plan” to “lay the foundation for safe importation of certain prescription drugs.” The plan includes a process to authorize state initiatives. It also requires formal regulatory review, including establishing Food and Drug Administration safety criteria. That process could take up to two years.

Two big problems remain: In the weeks since the announcement, the Canadian government has opposed any plan that would rely solely on Canada as a source of imported drugs. The pharmaceutical industry also opposes the plan.

Creating Drug Affordability Boards

Maryland and Maine enacted laws this year that establish state agencies to review the costs of drugs and take action against those whose price increases exceed a certain threshold.

New Jersey and Massachusetts are debating similar legislation this year.

Maryland’s law establishes a five-member board to review the list prices and costs of drugs purchased by the state and Maryland’s county and local governments. The board will probe drugs that increase in price by $3,000 or more per year and new medicines that enter the market costing $30,000 or more per year or over the course of treatment.

If approved by future legislation, upper payment limits on drugs with excessive price increases or annual costs would take effect in January 2022.

“My constituents have signaled loud and clear that bringing drug prices down is one of their top priorities,” said state Sen. Katherine Klausmeier, a Democrat representing Baltimore, who sponsored the legislation.

Maine’s law also establishes a five-member board. Beginning in 2021, the board will set annual spending targets for drugs purchased by the state and local governments.

Increasing Price Transparency

This year, four states — Colorado, Oregon, Texas and Washington — became the latest to enact laws requiring drug companies to provide information to states and consumers on the list prices of drugs and planned price increases.

The majority of states now have such transparency laws, and most post the data on public websites. The details vary, but all states with such laws seek to identify drugs with price increases above 10% or more a year, and drugs with price increases above set dollar values.

Oregon’s new law, for example, requires manufacturers to notify the state 60 days in advance of any planned increase of 10% or more in the price of brand-name drugs, and any 25% or greater increase in the price of generic drugs.

“That 60-days’ notice was very important to us,” said Rep. Andrea Salinas, chair of the Oregon House’s health committee, who represents Lake Oswego. “It gives doctors and patients advance notice and a chance to adjust and consider what to do.”

Listen: India Gives Opioid Makers A Huge And Growing New Market

KHN senior correspondent Sarah Varney discussed the changing attitudes toward opioid painkillers in India with NPR’s Rachel Martin on “Morning Edition” Thursday.

Varney traveled to India to report a two-part series on the issue in partnership with The Guardian.