Good morning from Boston, where I’m at the Digital Healthcare Innovation Summit to talk about where we stand and what’s next in the politics and policy of health care. If you’re here, too, don’t hesitate to say hello.
HHS Secretary Alex Azar. Photo: Oliver Contreras-Pool/Getty Image
“In the weeks and months ahead, there is a lot of action — regulatory action that we are working on,” HHS Secretary Alex Azar told me in an interview yesterday.
Driving the news: President Trump signed a bill yesterday to outlaw the “gag clauses” that pharmacy benefit managers (PBMs) sometimes impose on pharmacists, preventing them from telling patients when it would be cheaper to pay cash for a prescription than to use their insurance.
“We still view ourselves as at the advanced stage of beginning at this effort” to lower drug prices, Azar said, reiterating that “everything is on the table if it helps deliver a solution.”
Between the lines: Eliminating pharmacy gag clauses had bipartisan support in Congress, and the PBM industry’s qualms faded very quickly, at least in public.
What’s next: “There’s no one single step that solves all of those issues around drug pricing. We’re chipping away at them,” Azar said.
The bottom line: PBMs continue to take the biggest beating from the Trump administration, though Azar said pharma could still have a turn on the front burner.
The Justice Department yesterday approved the $70 billion merger between CVS and Aetna, clearing the way for a new behemoth in the rapidly consolidating health care industry.
The big picture: Combining insurers and PBMs is so hot right now.
The bottom line: The CVS-Aetna merger is "more defensive than offensive," an industry analyst said earlier this year.
Centene will enter the Affordable Care Act’s insurance markets in 4 new states and expand its offerings in another 6 states where it already sells ACA coverage.
Why it matters: It’s another sign that the ACA’s exchanges are doing OK, despite the past 2 years of policy and political upheaval.
Details: Centene said it will begin selling coverage next year in North Carolina, Pennsylvania, South Carolina and Tennessee.
Yes, but: Low premiums aren’t free, and Centene has been criticized — sued, even — over its tightly limited networks of hospitals and doctors.
Let’s be clear up front: Everything in health policy comes with a tradeoff, including “Medicare for All,” no matter how you define it. Those costs very well may be more than American voters ultimately want to accept.
But President Trump did not lay out those choices particularly well in his USA Today op-ed yesterday. Here's some of what he wrote...
“Under the Democrats' plan, today’s Medicare would be forced to die.”
“The Democratic proposal … would cost an astonishing $32.6 trillion during its first 10 years.”
“As a candidate, I promised that we would protect coverage for patients with pre-existing conditions … I have kept that promise.”
Between the lines: This is a campaign document, designed to fire up and turn out Republican voters, and it's a preview of what's to come as "Medicare for All" enters the political mainstream in 2020.