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Trump likely to preview Medicare negotiation in speech at HHS. The U.S. pays 180 percent more than other countries for most of the drugs that are given to Medicare patients while they're with a doctor, according to a report out Thursday from the Department of Health and Human Services. The timing of the report suggests that it will factor into President Trump's speech on drug pricing scheduled for later in the day. The Trump administration has already called for allowing private plans to negotiate drug prices under Medicare Part B. "We can and must do better," HHS Secretary Alex Azar tweeted Thursday morning. "I look forward to hearing from @POTUS later today on the administration's efforts to address the high cost of prescription drugs, and our work to put American patients first." A plan to allow the Part B portion of Medicare to negotiate prices would bring prices more in line with what people pay for treatments when they are covered by private health insurance. The Medicare program covers people over the age of 65 as well as certain people with disabilities. HHS Secretary Alex Azar estimates on Twitter that allowing drug companies to negotiate would lower prices by $8.1 billion. The proposal to Medicare Part B fits into the president's rhetoric on drug prices. Trump had suggested when he was running for office that Medicare should be allowed to negotiate drug prices, typically a Democratic promise, but he has since backed off.

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 dailyonhealthcare@washingtonexaminer.com 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.

Opinion: The pre-existing conditions problem is overblown. The idea that 100 million could be at risk by elimination of the Obamacare protections on those with pre-existing conditions is highly misleading. The figure represents the number of people who, in theory, could have trouble finding health insurance if they go uninsured because of some sort of medical condition. But an overwhelming majority of those people already have coverage through their employers and, even before Obamacare, would qualify for COBRA coverage for 18 months after losing or changing jobs. Data available during the pre-Obamacare era suggest that the problem of insurance denials affected maybe a few million people a year. While a problem, it’s one that would be better addressed in a targeted way. Under Obamacare, the desire to protect those with pre-existing conditions has distorted the market, reduced choice, and made health insurance unaffordable for millions of Americans. More here.

E-cigarette makers want the Trump FDA to treat them like the EPA treats emitters. Advocates for e-cigarettes are perplexed as to why the Trump Food and Drug Administration is taking such an aggressive posture against the industry, especially after other agencies like the Environmental Protection Agency have adopted more industry-friendly policies. E-cigarette advocates have said they are disappointed in the FDA’s threats of bans on e-cigarette sales in convenience stores and new regulations. The FDA has ratcheted up scrutiny of the burgeoning industry in response to what the agency calls an “epidemic” of e-cigarette use among minors. “I expected the administration to have a de-regulatory policy as they have done at other agencies like the EPA,” said Jeff Stier, senior fellow at the consumer advocacy group Consumer Choice Center. “I expected that approach [at EPA] that we can protect the environment while still cutting regulations. Why can’t the FDA do the same?” Several advocates who talked to the Washington Examiner said that the FDA’s sharp rhetoric, which is backed up by Health and Human Services Secretary Alex Azar, is lashing compared to other federal agencies’ deregulatory attitudes.

Medicaid enrollment has flattened: Survey. For the first time in a decade, states are reporting roughly flat enrollment in Medicaid, according to a new national survey released Thursday, a product of the stronger economy and tightened eligibility requirements. Nevertheless, costs are rising, in part because of higher prescription drug costs, according to the 50-state survey from the Kaiser Family Foundation. "States largely attribute the enrollment slowdown to a strengthening economy, resulting in fewer new low-income people qualifying for Medicaid," Kaiser said in a release. “Some states also cited new efforts and systems to verify enrollees’ continued eligibility for the program as a factor.”

But while Medicaid enrollment is roughly flat, spending continues to go up. The average combined federal and state Medicaid spending grew by 4.2 percent in fiscal 2018, after a similar increase in 2017. One of the reasons for the spending growth is that states enrolled more seniors and people with disabilities than children and adults, who are "relatively inexpensive to cover," Kaiser said.

Trump signs major opioids legislation just in time for elections. President Trump has signed a wide-ranging bill into law aimed at reducing addiction and deaths from opioids, an issue his administration has called a public health emergency. "Together we are going to end the scourge of drug addiction in America," Trump said ahead of the signing. "We are going to end it, or we are going to make an extremely big dent in this terrible, terrible problem." Sen. Lamar Alexander, R-Tenn., the chairman of the Health, Education, Labor, and Pensions Committee, called the bill "the most important new healthcare law this year" and the opioid crisis the "nation's worst public health epidemic." Sen. Patty Murray, the top Democrat on the HELP committee, said that the crisis was "far from over." "We need to build on our work in this important legislation, which is why Democrats are going to keep fighting for more action and greater investments to provide our communities with the resources they need to address the root causes and ripple effects of this heartbreaking epidemic," the Washington senator said.

McSally latest to tout support for pre-existing conditions protections in ad. Rep. Martha McSally, R-Ariz., released an ad saying that she was “leading the fight to … force insurance companies to cover pre-existing conditions.” McSally is running for an open seat in Arizona against Democratic candidate Kyrsten Sinema, and voted in favor of the GOP healthcare bill that would have allowed states to waive out of the health insurance protections.

FDA approves first new flu treatment in 20 years. Right as the flu season starts to ramp up, the Food and Drug Administration has approved the first new anti-flu treatment in 20 years. The agency on Wednesday approved Xofluza, a pill aimed at treating patients 12 years or older who have had flu symptoms for about two days. There are several anti-viral drugs used to treat the flu after symptoms appear within 48 hours. “Having more treatment options that work in different ways to attack the virus is important because flu viruses can become resistant to antiviral drugs,” said Debra Birnkrant, director of FDA’s Division of Antiviral Products. Last year, more than 80,000 people died from the flu, and another 900,000 went to the hospital. A record 180 children also died last year from the flu, according to data from the Centers for Disease Control and Prevention.

Homeless to receive hepatitis A vaccine under new guidance. The Advisory Committee on Immunization Practices recommended for the first time on Wednesday that homeless people receive vaccinations for the contagious liver disease hepatitis A. Infections are on the rise among homeless people, who are living in encampments around the country and suffer from poor sanitation and hygiene, and the recommendations would make it easier for homeless shelters, clinics, and emergency departments to offer them the vaccine.

Amgen cuts cholesterol drug price to 60 percent. Drugmaker Amgen will slash the cost of cholesterol drug Repatha by roughly 60 percent, bringing the cost from roughly $14,000 a year to $5,850. The company said that it is cutting the list price to “improve affordability by lowering patient copays, especially for Medicare patients.” Amgen added that about 75 percent of Medicare patients that get the cholesterol drug, which is part of a class of drugs called PCSK9 inhibitors, never actually fill their prescriptions because of the high out-of-pocket costs. Amgen isn’t the only drugmaker to cut prices for a failing drug. Merck announced in July it was cutting the price of a hepatitis C drug by 60 percent, but the sales for the drug were already poor.

Hatch demands pharma industry help to clamp down on counterfeit drug sales. Sen. Orrin Hatch, R-Utah, is calling for pharma companies to pool resources to root out sellers of counterfeit drugs. In a letter send Wednesday to industry groups Alliance for Safe Online Pharmacies and Pharmaceutical Security Institute, the Senate Finance Committee chairman called for “test buys” to regulate quality. The World Health Organization has said that one in 10 medical products in low and middle-income countries are substandard or false.

RUNDOWN

Politico GOP alarmed Obamacare attacks could cost them the House

NPR 2018 is the year Democrats got comfortable talking about healthcare again

The Hill $2 million ad buy targets Republicans on entitlements

Forbes Centene rolls out RxAdvance PBM promising drug cost transparency

Associated Press Iowa Hospitals say Medicaid change cost them millions

STAT News Gottlieb ‘extremely worried’ about how to pay for CAR-T therapies

Axios The outrage over insulin prices

Bloomberg Clash on healthcare takes center stage in Arizona Senate race

THURSDAY | Oct. 25

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.