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Good morning ... D.C. readers: Join Axios' Mike Allen tomorrow morning for a look into what 2019 holds for health care policy.

  • HHS Secretary Alex Azar will be joining the program, in addition to Sens. Tim Kaine and Lamar Alexander and Rep. Seth Moulton. RSVP here
1 big thing: Probe into generics “cartel” expands

Photo: George Frey/Getty Images

Last year, we knew the multistate lawsuit against generic drug manufacturers — alleging anticompetitive behavior like price-fixing and squashing generic competitors — involved at least a dozen companies and 15 drugs.

That has since exploded to include at least 16 companies and 300 drugs, the Washington Post reports.

We knew this could be big. Axios' Bob Herman reminds us that when state attorneys general opened the investigative floodgates last year, they warned:

“The Plaintiff States continue to investigate additional conspiracies…and will likely bring additional actions based on those conspiracies at the appropriate time in the future.” 

The bottom line: “This is most likely the largest cartel in the history of the United States,” Joseph Nielsen, Connecticut’s assistant attorney general, told the Post. The companies say the lawsuit has no merit.

The big picture: Government reports over the years have long sounded the alarm over “extraordinary price increases” among generic drugs. And as we recently reported, generic drugs are ripe for price games because of all the middlemen that are involved.

2. NIH seeks alternatives to fetal tissue

The National Institutes of Health will release a funding opportunity soon for research into a potential replacement for fetal tissue.

Flashback: HHS announced in September that it was pulling back on federally funded research that relied on fetal tissue — a move anti-abortion advocates had pushed for.

  • Some scientists worried about the change, because fetal tissue is used in a lot of research.

So the NIH is looking for an alternative, and will spend up to $20 million over the next 2 years.

  • Specifically, it said it's looking to "develop and/or further refine human tissue models that closely mimic and can be used to faithfully model human embryonic development or other aspects of human biology ... that do not rely on the use of human fetal tissue obtained from elective abortions."
3. NHS bans fax machines

No way to run a health care system. Photo: Getty Images

Britain’s National Health Service does many things that would be unthinkable in the U.S., but this one may take the cake: It’s banning fax machines.

  • NHS’ leadership has banned the purchase of new fax machines at NHS facilities, and wants to phase them out entirely by the spring of 2020, according to The Guardian.
  • The country’s Royal College of Surgeons says there are about 8,000 fax machines still in use within the British health care system, a number it called “absurd.”

Faxes still account for as much as 75% of all medical communication in the U.S., Vox reported earlier this year.

4. U.S. has more drugs but worse results

As the pharmaceutical industry fights the Trump administration's plan to tie some Medicare payments to other countries' drug prices, it has argued that higher U.S. prices give the U.S. better access to new drugs.

That's true, Axios' Caitlin Owens reports this morning, although the differences in access don't seem to help much, given that the U.S. still has such poor health outcomes.

Between the lines: In 2017, the U.S. approved more drugs than the EU did: 36 drugs were approved in both countries, 52 were only approved in the U.S. and 15 were only approved in the EU, per the NDA Group, a drug development consultancy.

  • “Some drugs that were approved in only one jurisdiction will be approved relatively quickly in the other jurisdiction but others might be delayed,” American Enterprise Institute’s Alex Brill says.
  • A 2016 Health Affairs study found that while the U.S. accounted for 55.8% of all cancer drug spending in 2014 in the 9 countries it evaluated, it only received 12.6% of the total economic value gained by saving lives through cancer treatment that year.

The other side: Some experts question pharma's implication that lower prices would make drugmakers less interested in a market as big as the U.S.

  • "What is the implication here? That if the U.S. pays lower prices then drugs will come on the market more slowly here? Why would drug companies delay entry to the U.S. market?" says Peter Bach, of Memorial Sloan-Kettering Cancer Center.

Go deeper.

5. Obama plugs ACA enrollment

Screenshot from Twitter

With Affordable Care Act enrollment lagging well behind last year's results, former President Obama jumped into the PR mix yesterday to encourage young people to sign up.

  • The short video, which Obama shared on Twitter, revisits "Between Two Ferns" and the Obama administration's other efforts to create viral moments that would drive interest in HealthCare.gov.

Yes, but: Obama is obviously still popular with plenty of people, including many younger people, but it'll be hard to turn around sagging enrollment numbers with any sort of outside influence — even Obama.

  • Enrollment advocates have said consistently that nothing's as powerful as the resources the federal government can bring to bear, and those resources have been slashed.

Watch the video.