Good morning. If you, like me, got stuck on an airplane for hours last night because of the weather ... misery loves company.
📺 Coming up on "Axios on HBO": We dig into the GOP's looming Texas-sized problem with Reps. Will Hurd and Dan Crenshaw. And, former pastor Joshua Harris, who inspired a generation of evangelicals, discusses — for the first time — why he's renouncing his faith. Watch 6pm Sunday.
Today's word count is 890, or ~3 minutes.
Illustration: Eniola Odetunde/Axios
One of the Democratic presidential candidates' leading ideas to lower drug prices would come with intense legal battles and thus an uncertain fate.
Why it matters: Democrats' plans to seize drugmakers' patents could give patients some relief from high drug costs, if they work, but they'd be testing the boundaries of the law in order to get there.
What they're saying: Sens. Kamala Harris, Elizabeth Warren and Bernie Sanders have said they'd use "march-in rights" to take away the patents on expensive drugs. South Bend, Ind. Mayor Pete Buttigieg has also said he'd rely on similar tools.
How it works: "March-in rights" come from a decades-old, bipartisan law that allows the government to award a generic competitor the rights to make and sell a patented drug that was developed using public funding, in certain circumstances.
Yes, but: There's a formal process to challenge individual uses of the authority, and it would also be vulnerable to challenges about whether it should exist at all in this context.
The other side: The use of march-in rights "will only jeopardize our country's ability to deliver new medicines to address our most costly and challenging diseases," said Tom Wilbur, a PhRMA spokesperson.
Georgia Gov. Brian Kemp. Photo: Kevin C. Cox/Getty Images
Georgia Gov. Brian Kemp released a set of waiver proposals yesterday that would remake the individual market, the Atlanta Journal-Constitution reports.
Between the lines: Kemp's proposal — which must be approved by the federal government — would move more control over ACA dollars to the state while attempting to lower premiums in the individual market.
Details: Controversially, the exchange market would be brought under state control, including how subsidies are structured and distributed. Plans would no longer have to cover all of the ACA's essential health benefits for enrollees to receive subsidies.
What we're watching: This is only step one. Kemp is expected to detail on Monday another waiver proposal that could lead to a limited Medicaid expansion, per AJC.
On the other hand, Indiana announced yesterday that it's temporarily halting its Medicaid work requirements because of a lawsuit, per the Wall Street Journal.
If Express Scripts is any kind of bellwether for drug rebates — pricing discounts that drug manufacturers pay to pharmacy benefit managers so their drugs get put on the drug coverage lists — then those dollars are continuing to rise, Axios' Bob Herman reports.
By the numbers: Cigna, which bought Express Scripts last year, said it is owed almost $4 billion in rebates from pharmaceutical companies as of Sept. 30, according to new investor documents. That's up almost $600 million since the start of this year.
Between the lines: PBMs don't keep all of those dollars. A lot goes back to large employers, governments and health plans as a way to lower premiums.
Go deeper: The drug rebate curtain
Procedural mistakes in end-of-life care have led to wrongful deaths, according to a pair of investigations from ProPublica.
Details: Doctors have turned to family members even when patients still had the ability to decide on their care, Axios' Marisa Fernandez writes.
The impact: Providers are now facing lawsuits that say "extreme measures had been taken to keep a patient alive even when such measures were not what the patient or family wanted," per ProPublica.
Read the investigations:
A grieving widow's slide into depression landed her in a hospital for five nights, which then turned into a $29,894.50 medical bill that her insurance didn't cover, Kaiser Health News reports with NPR.
Why it matters: The woman had an association health plan. Her story illustrates how these plans can backfire on patients.