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HHS Secretary Alex Azar taking press questions. Photo: Chip Somodevilla/Getty Images

HHS Secretary Alex Azar implicitly pushed back yesterday on some of the “meh” reviews that initially greeted the White House’s big plan to lower drug prices. "These are big moves, this is harnessing Medicare, this is negotiation,” Azar told reporters.

Reality check: Yes, there are some potentially significant outcomes on the table here. The catch is that there are no assurances they’ll actually happen.

On negotiations, Azar was talking about moving some drugs from Medicare Part B, which pays fixed prices, to Medicare Part D, where private companies negotiate discounts.

  • The drug pipeline is full of expensive Part B drugs. There are savings to be had there.
  • But, but, but: It’s not clear how many drugs HHS could shift into Part D without congressional approval. It’s not clear how many drugs HHS would want to shift into Part D. And it’s not clear how steep those negotiated discounts would be.

The same applies to rebates. Azar very much sounds like a man who's seriously gunning for pharmacy benefit managers’ rebates — the current system for negotiating bulk discounts on drugs.

  • Maybe, he said, he could reinterpret federal anti-kickback law to eliminate its protection for these rebates. Maybe he could forbid all payments from drug companies to PBMs, and maybe none of the PBMs' fees would be based on drugs’ list prices. Would that apply beyond Medicare? Maybe.

The bottom line: If at the end of all this, Azar’s most ambitious scenarios all come to pass — if PBMs are negotiating discounts for every drug Medicare covers, yet are no longer able to collect fees and rebates based on the high sticker prices of those drugs — it will be hard to deny that the Trump administration took a serious swing at drug prices.

  • But a lot of things have to happen before we get there. HHS needs to get the right answers from its lawyers. It needs some help from Congress. It needs the market to respond as expected. And it needs industry not to scuttle any of this along the way.

Go deeper

1 dead, 14 injured in shooting at Kroger grocery store near Memphis

One person was killed and 14 others were injured Thursday in a shooting at a Kroger grocery store in Collierville, Tenn., near Memphis, the town's spokesperson Jennifer Casey said, per CNN.

What they're saying: "I've been involved in [police work] for 34 years and I have never seen anything like [this]," Police Chief Dale Lane said at a press conference.

3 hours ago - Health

CDC panel recommends Pfizer boosters for high-risk individuals, people 65 and up

Photo: Marco Bello/Anadolu Agency via Getty Images

A key panel at the Centers for Disease Control and Prevention on Thursday recommended the Pfizer-BioNTech coronavirus booster shots for people 65 years old and older, as well as those at high risk of severe COVID-19.

Why it matters: The approval is the near-final step in making the booster shots available to tens of millions of Americans, and comes a day after the FDA approved Pfizer boosters for the two groups. CDC director Rochelle Walensky is expected to announce her recommendation soon.

DHS temporarily suspends use of horse patrol in Del Rio

U.S. Border Patrol agents watch as Haitian immigrant families cross the Rio Grande from Mexico into Del Rio, Texas on Sept. 23, 2021. Photo: John Moore/Getty Images

The Department of Homeland Security on Thursday temporarily suspended the use of horse patrol in Del Rio, Texas a DHS spokesperson confirmed.

Why it matters: The suspension comes after images showing border patrol agents whipping at and charging their horses at migrants surfaced earlier in the week, prompting widespread criticism of the Biden administration's handling of the crisis at the border.