Feb 4, 2019

Taking stock of Trump's drug rebate proposal

Photo: George Frey/Getty Images

Wall Street panicked a little after the Trump administration rolled out its drug rebate proposal, but the stock prices of companies most at risk recovered because there’s still so much uncertainty about how the policy would change their businesses.

The big picture: The proposal would bar pharmacy benefit managers and insurers from accepting rebates from drug companies in Medicare and Medicaid under anti-kickback law. Instead, the two sides could work out fixed-fee arrangements, with rebates flowing directly from manufacturers to patients at the pharmacy counter.

Yes, but: The rule...

  • Would not immediately affect the commercial market, although HHS Secretary Alex Azar wants Congress to pass the proposal into law so it would apply everywhere.
  • Would not touch the other profitable tactics that PBMs have mastered, like spread pricing and generic drug algorithms.
  • Would take a swipe at a flawed rebate system, but push middlemen to raise premiums — which federal actuaries said could raise Medicare spending as much as $196 billion over the next decade.
  • Would almost certainly initiate a lawsuit on antitrust grounds.
  • Would "not have a meaningful impact on our growth or earnings trajectory," David Cordani, CEO of Cigna and its newly acquired Express Scripts, said on an earnings call Friday.

One thing that is pretty certain: Pharma wins. There’s no mandate to lower list prices, and drug companies would get to see competitors' rebates.

Go deeper: The Trump administration's major shakeup in the way we pay for drugs

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Trump touts press briefing "ratings" as U.S. coronavirus case surge

Photo: Drew Angerer/Getty Images.

President Trump sent about a half-dozen tweets on Sunday touting the high television ratings that his coronavirus press briefings have received, selectively citing a New York Times article that compared them to "The Bachelor" and "Monday Night Football."

Why it matters: The president has been holding daily press briefings in the weeks since the coronavirus pandemic was declared, but news outlets have struggled with how to cover them live — as Trump has repeatedly been found to spread misinformation and contradict public health officials.

World coronavirus updates: Total cases surge to over 700,000

Data: The Center for Systems Science and Engineering at Johns Hopkins, the CDC, and China's Health Ministry. Note: China numbers are for the mainland only and U.S. numbers include repatriated citizens and confirmed plus presumptive cases from the CDC

There are now than more than 700,000 confirmed cases of the coronavirus around the world, according to data from Johns Hopkins. The virus has now killed more than 32,000 people — with Italy alone reporting over 10,000 deaths.

The big picture: Governments around the world have stepped up public health and economic measures to stop the spread of the virus and soften the financial impact. In the U.S., now the site of the largest outbreak in the world, President Trump said Saturday he would issue a "strong" travel advisory for New York, New Jersey and parts of Connecticut.

Go deeperArrowUpdated 48 mins ago - Health

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 2 p.m. ET: 704,095 — Total deaths: 33,509 — Total recoveries: 148,824.
  2. U.S.: Leads the world in cases. Total confirmed cases as of 2 p.m. ET: 132,637 — Total deaths: 2,351 — Total recoveries: 2,612.
  3. Federal government latest: The first federal prisoner to die from coronavirus was reported from a correctional facility in Louisiana on Sunday.
  4. Public health updates: Fauci says 100,000 to 200,000 Americans could die from virus.
  5. State updates: Louisiana governor says state is on track to exceed ventilator capacity by end of this week — Cuomo says Trump's mandatory quarantine comments "really panicked" people
  6. World updates: Italy on Sunday reported 756 new deaths, bringing its total 10,779. Spain reported almost 840 dead, another new daily record that bring its total to over 6,500.
  7. What should I do? Answers about the virus from Axios expertsWhat to know about social distancingQ&A: Minimizing your coronavirus risk
  8. Other resources: CDC on how to avoid the virus, what to do if you get it.

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