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Trump breaks with traditional Republicans on Medicare drug price plan.  President Trump outlined a new proposal Thursday to lower Medicare prices for certain drugs by tying them to the prices paid overseas, decrying European “freeloaders” who get lower prices for prescription drugs. “We are taking aim at the global freeloading that forces American consumers to subsidize lower price in foreign countries through higher prices in our country,” Trump said at a speech at the Department of Health and Human Services in Washington Thursday. “The same company, same box, same pill made in the exact same location and you will go to some countries, and it will be 20 percent the cost of what we pay and in some cases much less than that.” To go along with Trump's remarks, the administration released a request for comment on a proposal to allow Medicare to determine the price it pays for certain drugs based on the cheapest price that another nation pays. HHS believes the new payment model would lead to a projected total $17.2 billion in savings over five years. The administration also wants public comment on letting private plans negotiate for drugs administered in doctors' offices and reimbursed by Medicare. The proposal would phase in the change over five years. At first, HHS would only roll it out to half of the country.

Congressional Republicans responded with caution to the proposal, which is sharply breaking with GOP orthodoxy. Republicans in Congress have traditionally opposed the government setting the prices of prescription drugs, and favored using market forces to boost competition and fix high drug prices. Responding to Trump's speech, GOP Reps. Greg Walden of Oregon and Kevin Brady of Texas, chairmen of the key committees with oversight over drug prices, did not say whether they supported the proposal. Sen. Orrin Hatch, R-Utah, chairman of the Senate Finance Committee, was also cautious in a statement his office gave to the Washington Examiner. “Proposals aimed at addressing prescription drug prices must not hamper innovation or access to new drugs that have the ability to cure diseases,” he said.

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Trump kicked off his drug pricing speech with a swipe at Obamacare. “I'm thrilled to be here at the Department of Health and Human Services, and I want to thank everybody,” Trump said. “I understand that it's been decades since the last president came here. And I'm very surprised that President Obama didn’t come here for Obamacare. Explain that one to me. But he didn’t.” According to HHS, the last person to visit was former President George W. Bush

PhRMA blasts Trump's 'socialized' drug pricing plan. The country's largest pharmaceutical lobbying group said Thursday that Trump's plan to control drug spending would jeopardize access for seniors and patients with disabilities, likening the proposal to socialized healthcare systems in Europe. "The administration is imposing foreign price controls from countries with socialized healthcare systems that deny their citizens access and discourage innovation," said Stephen Ubl, president and CEO of the Pharmaceutical Research and Manufacturers of America, or PhRMA. "These proposals are to the detriment of American patients." Ubl suggested that asking for a similar price as other countries pay is an unfair comparison, particularly because people in the U.S. have access to medicines an average of two years earlier. He said that people would be particularly at risk if they have illnesses such as cancer, rheumatoid arthritis, and other autoimmune diseases. The pharmaceutical industry has long argued that the pricing model in the U.S. is better than elsewhere, saying that they need to charge high prices in order to develop future drugs. The process, they say, is an expensive, lengthy endeavor that isn't always successful. "We oppose changes to Medicare that threaten patient access to innovative, lifesaving medicines and are disappointed the administration put the needs of patients aside with these proposals," Ubl said.

Democrats meanwhile are very skeptical. Democratic lawmakers took the occasion to again fault President Trump for attempting to repeal Obamacare. Rep. Elijah Cummings, D-Md., called the proposal encouraging, but said that “it’s hard to know whether the administration will actually implement this proposal in a way that would lower drug prices for seniors.” Cummings cited his own encounter with Trump last year during a meeting in the Oval Office. He said that he introduced a bill to give Medicare the power to negotiate directly with drugmakers to lower prices, a reform that Trump repeatedly touted throughout his 2016 campaign. “Instead, President Trump and congressional Republicans have spent the last two years sabotaging our healthcare system and targeting protections for people with pre-existing conditions,” Cummings said.

Administration officials bristle at proposal being compared to Obama-era experiment. The Obama administration also tried to make changes to the payments under Medicare Part B. Under Part B, Medicare reimburses the doctor for the average sales price of the drug plus four percent of that price to compensate for handling and storage. The Obama administration proposed an experiment to cut that, but the experiment was quickly scuttled after a massive outcry from the GOP-controlled Congress and various medical groups. But Azar quickly bristled when asked about how the proposed model Trump announced compared to Obama’s demonstration. “It risked putting practices under water by taking revenue from doctors without touching the underlying issue of out of control prices and foreign free-riding,” Azar said during the Brookings Institution event.

But that fight back in 2015 offers a preview of what is to come for Trump. A major reason why Obama’s demonstration was scuttled was due in part to blistering opposition from oncology doctors worried about loss to operating capital from the cut to the reimbursement. That same fight will likely emerge from this proposal if statements delivered after Trump’s proposal are any indication. The Community Oncology Alliance, which represents oncology practices, cautioned the administration against disruptive changes to the current Part B drug distribution and cancer care delivery system, which is time-proven as effective and efficient for patients with patients.” The American Medical Association took a cautious approach, saying that it “raises a number of questions and we need to have a greater understanding of the potential impact of the proposal on patients, physicians, and the healthcare system.

White House credits Trump deregulation for $26 billion in drug savings. Trump's deregulatory agenda has reduced spending on pharmaceuticals by $26 billion since his inauguration, White House officials claimed in a new report Thursday. The document, published by the Council of Economic Advisers, aims to makes the case that government regulations were overly burdensome in getting generic drug applications reviewed for safety and brought to market. They say that having more drugs in the market, especially if they are cheaper generics, can help drive down prices. "We find that growth in relative drug prices has slowed since January 2017, that generic drugs are being approved at a particularly rapid pace, and that savings from new generic entrants totaled about $26 billion as of July 2018," the document concludes. Under the Trump administration, the FDA has approved a record number of generic drugs. The document touts Trump signing the reauthorization of a bipartisan bill that makes drugmakers pay a fee to the government when they apply to have their medicines reviewed, as well as a Food and Drug Administration plan to prioritize the approval of generics.

Obamacare premiums 6 percent higher in 2019 after Trump actions: Analysis.  Obamacare premiums in 2019 will be 6 percent higher because of actions by the Trump administration that many Democrats say amount to "sabotage" of the healthcare law, according to a new analysis. Nationwide premiums for the 2019 coverage year are expected to either slightly decline or only go up by modest single digits. But premiums for all plans sold on Obamacare's insurance exchanges are expected to be 6 percent higher next year because the Trump administration did not expand access to cheaper plans, according to the analysis released Thursday from the research firm Kaiser Family Foundation. Reasons for the 6 percent bump include the repeal of the individual mandate’s financial penalty in 2019. Another cause is regulations from Trump to expand the duration of short-term plans and boost access to association health plans, which allow a groups and individuals to band together to buy insurance. Kaiser also noted the Trump administration’s decision last year to end payments to insurers called cost-sharing reduction payments.

Administration says no sensitive information compromised in Obamacare breach. A portion of the Obamacare website that helps connect customers with agents and brokers to buy health insurance has been put back online after facing a hack earlier this month. Officials from the Centers for Medicare and Medicaid Services said that no banking, tax information, or protected health information had been exposed during the breach. The agency is continuing to assess what information was compromised and will be notifying customers who were affected. The portion of the website that was affected is known as the "Direct Enrollment pathway," and CMS previously reported that information from 75,000 people was potentially compromised. After people who were affected are notified, CMS will be allowing them to register for free credit protection, including identity theft insurance and identity restoration services. Officials haven't yet said who is responsible for the hack, which CMS noticed Oct. 13. The agency declared the breach Oct. 16 and deactivated the accounts for 10 days. An official with the Office of the Inspector General for HHS said Friday that they are still investigating the breach, but declined to provide further information when asked if they had any leads.

Altria to take its e-cigs from the market. Cigarette giant Altria Group is taking its e-cigarette pods off the market and discontinuing the sale of most of its flavored e-cigarettes in response to concerns from the Trump administration that children are increasingly using the products. Its products, known as MarkTen and Green Smoke brands, take up only a small portion of the e-cigarette market. The FDA recently asked the company and five others to submit a plan for how it would reduce teen vaping. Altria is the parent company of Philip Morris, and last year submitted documentation to the FDA for iQOS, an electronically heated device. The company is seeking approval to market the product and is hoping the FDA will determine it is less harmful than traditional cigarettes. Altria also announced Thursday that it supported raising the legal smoking age to 21.

Opinion: There is operatively no difference between Republicans and Democrats on pre-existing conditions. The battle over coverage for pre-existing conditions has become a central front in the 2018 midterm elections, but however heated their rhetoric and whatever their positions have been in the past, there is operatively no difference between Republicans and Democrats on the issue. What I mean by that is no matter who controls Congress at the end of this process, Obamacare's ban on allowing insurers to deny coverage to those with pre-existing conditions is going to remain intact. The reality is that whatever statements Senate Majority Leader Mitch McConnell, R-Ky., may make, he lacks the votes to repeal Obamacare in general, and specifically the pre-existing condition regulations. More here.


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Associated Press Kentucky attorney general announces eighth opioid lawsuit

Roll Call Democrats in governors races pounce on Trump’s new Medicaid waiver rules

Buzzfeed Democrats are running on Obamacare in places where they lost on Obamacare

Fierce Healthcare Jeff Sessions announces more prosecutors for crackdown on opioid providers

Politico Trump’s drug price plan falls flat in healthcare messaging war

Washington Post FDA set to approve potent opioid for market despite adviser’s objections


FRIDAY | Oct. 26

Oct. 25-26. Ronald Reagan Building and International Trade Center. 1300 Pennsylvania Ave. NW. Medicaid and CHIP Payment and Access Commission October meeting. Details.

MONDAY | Oct. 29

National Press Club. Book event on “Bad Advice” by Dr. Paul Offit. Details.

THURSDAY | Nov. 1 open enrollment begins, runs through Dec. 15.