Axios Vitals

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GOP leaders are trying their best to put a lid on President Trump's talk of a new and wonderful health care plan that would define the Republican Party for 2020.

"Not any longer," Senate Majority Leader Mitch McConnell said yesterday when asked whether he and Trump differ on health care.

• McConnell said he spoke to Trump Monday and "made it clear to him that we were not going to be doing that in the Senate."
• RNC Chair Ronna McDaniel and Trump campaign manager Brad Parscale also "tried to tell the president they could not understand what he was doing," The New York Times reports.

Rhetorically, Trump has kicked the can past 2020, just after pushing his administration to dive back into — and escalate — the legal fight that hurt Republicans so badly in 2018.

• "I wanted to delay it myself," Trump said in the Oval Office yesterday, denying that McConnell forced his hand. "I want to put it after the election, because we don't have the House."

Reality check: It's still the Justice Department's position that the courts should strike down the Affordable Care Act. As long as this lawsuit is still active — and that will be a while — it'll be accurate for Democrats to say on the campaign trail that Trump is trying to end protections for pre-existing conditions.

• In the short term, Trump's rhetorical punt to 2021 may dampen the intensity of questions about how Republicans would rebuild a new system for individual coverage — questions the party has struggled to answer for the past 9 years.
• But in the end, the only good way out is for the Trump administration to lose this case.

Trump's move to strike down the Affordable Care Act through the courts suggests he's still playing to the GOP base. But even the GOP base likes the individual benefits of the law and doesn't want to lose them, the Kaiser Family Foundation's Drew Altman and Mollyann Brodie write in today's column.

By the numbers:

• More than half of Republicans support the law's pre-existing conditions protections.
• Even wider majorities like other ACA benefits — like closing the "doughnut hole" in Medicare prescription drug coverage, eliminating copayments for preventive services, letting young adults stay on their parents' plans, and low-income subsidies.
• That's even though 7 in 10 still say they want the Supreme Court to overturn the law.

The bottom line: Even as a base-pleasing strategy, the latest court strategy doesn’t really work — and it hands the Democrats a huge political opportunity.

Read the column.

My colleague Bob Herman reports this morning that AbbVie is facing a growing class-action lawsuit over accusations that its "anticompetitive conduct" has kept at bay cheaper alternatives to the blockbuster Humira.

What they're saying: The suing parties include cops in Miami, city employees in Baltimore, pipefitters and electricians in Minnesota, and grocers and construction workers in New York.

• AbbVie obtained hundreds of patents on Humira as a way "to deter any potential competitor" from easily making cheaper copycats after Humira's original patent expired, the lawsuits allege.
• The company struck deals with several competing drug manufacturers that stipulate biosimilar versions of Humira can't come out in the U.S. until 2023.
• They're also suing Amgen, which struck a deal with AbbVie to give Amgen's biosimlilar 5 months of exclusive sales in exchange for holding off until 2023.

The other side:

• An AbbVie spokesperson said "the plaintiffs' allegations are factually inaccurate and legally baseless," and that "AbbVie's settlement agreements resolved complex intellectual property issues and provide biosimilar access more than 10 years before our last Humira patent expires."
• An Amgen spokesperson added the company's settlement with AbbVie "was pro-competitive, and not anticompetitive, because it allows Amgen's product to come to the U.S. market years before the expiration of all of AbbVie's asserted patents."

The big picture: "It's not an antitrust violation to obtain a patent, but what happens when you get 100 patents?" said Michael Carrier, an antitrust and intellectual property professor at Rutgers University. "At some point, does that cross a line?"

A new crop of tech startups is making prescription drugs available without ever needing to look a doctor in the eye.

These aren't the sketchy overseas sites that have been advertising Viagra for years. But they're still doing an end-run around doctors' traditional role in the system.

New York Times reporters obtained several prescriptions without speaking to a doctor. Here's what they found:

• These sites — with names like Roman, Hers, Hims and Kick — advertise blood-pressure medication, Viagra and low-libido treatment Addyi. Some are marketed for uses the FDA hasn't approved, which is illegal.
• Users simply fill out an online questionnaire, then get a note back from a doctor saying they've been approved and their drugs are in the mail.
• One such response came back without even the doctor's name.

How it works: These sites, NYT explains, are not health care companies in the same way Uber argues it isn't a transportation operation — they're all just platforms. The doctors who sign these prescriptions work for third parties, and are paid an hourly rate for medical consultations.

Why it matters: These sites flout the idea that doctors use their clinical expertise to find the right treatment for the right patient, reducing them to more of a formality.

• Realistically, though, this is not too far from how it often works with in-person doctors' visits. That's why pharma companies spend so much money on TV ads urging you to "talk to your doctor" about their products.

John Bardis, a former HHS assistant secretary under the Trump administration, said in a speech Tuesday that employers need to take a tougher stand on health care costs.

Why it matters: If employers take Bardis' advice, hospitals and drug companies are in big trouble.

Details, from Axios' Caitlin Owens: Speaking at the West Health Healthcare Costs Innovation Summit, Bardis said employers aren't maximizing their leverage over a health care industry that uses the fee-for-service system to make as much money as it can.

• Instead of trying to constrain rising hospital and drug prices, employers have so far responded by increasing workers' deductibles.
• "We can no longer afford to give a blank check to our health care delivery system, and shame on us if we do," he said.
• While hospital systems often point to their low margins,"it's hard to hear when they're increasing these costs by inflating their expenditures," he said.
• This is a change of tune for Bardis. He previously founded MedAssets, which helped hospitals maximize their payments from employers.

Flashback: Mounting frustration from employers and employees could put cost controls on the table faster than you might think.