Apr 22, 2019

Trump administration plows ahead on controversial drug proposal

President Trump and HHS Sec. Alex Azar. (Photo: Nicholas Kamm/AFP/Getty Images)

The Trump administration has no intention of backing off of its controversial proposal to change the way Medicare pays for some prescription drugs, and lawmakers are starting to respond with their own modified versions.

Why it matters: The pharmaceutical industry is adamantly opposed to the proposal, which ties some drug payments to what other countries pay for the same drugs. While this is likely to drive down Medicare's drug costs, it also could be radically disruptive.

The big picture: The administration last year proposed tying Medicare Part B reimbursement rates to what certain other countries pay — including prices set using government controls.

  • The pharmaceutical industry has launched an all-out effort to defeat the proposal, saying it threatens access to innovative treatment.

What they're saying: A senior administration official said it isn't backing down, although it's open to other substantive alternatives.

  • Both Health and Human Services Secretary Alex Azar and the White House "have told stakeholders and the Hill, ‘If you give us a substantive alternative to [the proposal], that is more durable, sustainable than a regulation, we will take that to the president,'" the official said. "Absent an alternative, it’s going to get finalized.”
  • "I think it’d be better for the entire system if we had a bipartisan drug solution that was more sustainable over time than a fight over a regulation," the official added.

Meanwhile, the White House has been having discussions with Speaker Nancy Pelosi's office on what a drug deal could look like on the Hill. The official laid out three areas where there's the most room for a deal.

  • The first is a restructuring of Medicare's prescription drug benefit, which some experts worry encourages high drug costs.
  • The second is "structural reforms" to how Medicare pays for drugs administered by doctors, which is the area targeted by the administration's controversial proposal.
  • The third is things like cracking down on anticompetitive behavior by branded drug companies trying to keep generics off of the market — or "for lack of a better term, low-hanging fruit, which used to be third-rails, don’t touch," the official said.

What we're watching: There's a slew of drug pricing bills being introduced by members of both parties. But there may be particular pressure to do something on Part B, given the administration's threat to implement their proposal if nothing better is presented.

  • House Freedom Caucus Chairman Mark Meadows said he's part of a bipartisan group trying to modify the proposal, specifically by tying Part B rates to those in countries that use market-based measures to determine their drug prices versus government price controls.
  • "At the end of the day, setting prices according to foreign countries is something that is very hard for a number of members of Congress to swallow, but it's certainly something that the president has stated is a priority, so were working with the administration on how to best implement that plan," Meadows said.

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U.S. coronavirus updates: Infections number tops 140,000

Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios

The novel coronavirus has now infected over 142,000 people in the U.S. — more than any other country in the world, per Johns Hopkins data.

The big picture: COVID-19 had killed over 2,400 people in the U.S. by Sunday night. That's far fewer than in Italy, where over 10,000 people have died — accounting for a third of the global death toll. The number of people who've recovered from the virus in the U.S. exceeded 2,600 Sunday evening.

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Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 9 p.m. ET: 721,584 — Total deaths: 33,958 — Total recoveries: 149,122.
  2. U.S.: Leads the world in cases. Total confirmed cases as of 9 p.m. ET: 142,106 — Total deaths: 2,479 — Total recoveries: 2,686.
  3. Federal government latest: President Trump says his administration will extend its "15 Days to Slow the Spread" guidelines until April 30.
  4. Public health updates: Fauci says 100,000 to 200,000 Americans could die from virus.
  5. State updates: Louisiana governor says state is on track to exceed ventilator capacity by end of this week — Cuomo says Trump's mandatory quarantine comments "panicked" some people into fleeing New York
  6. World updates: Italy on Sunday reports 756 new deaths, bringing its total 10,779. Spain reports almost 840 dead, another new daily record that bring its total to over 6,500.
  7. What should I do? Answers about the virus from Axios expertsWhat to know about social distancingQ&A: Minimizing your coronavirus risk
  8. Other resources: CDC on how to avoid the virus, what to do if you get it.

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World coronavirus updates: Cases surge past 720,000

Data: The Center for Systems Science and Engineering at Johns Hopkins, the CDC, and China's Health Ministry. Note: China numbers are for the mainland only and U.S. numbers include repatriated citizens and confirmed plus presumptive cases from the CDC

There are now more than 720,000 confirmed cases of the coronavirus around the world, according to data from Johns Hopkins. The virus has now killed more than 33,000 people — with Italy alone reporting over 10,000 deaths.

The big picture: Governments around the world have stepped up public health and economic measures to stop the spread of the virus and soften the financial impact. In the U.S., now the site of the largest outbreak in the world, President Trump said Sunday that his administration will extend its "15 Days to Slow the Spread" guidelines until April 30.

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