Jul 19, 2018

The White House's next move on drug prices

Trump and HHS Secretary Alex Azar speak at a White House event on drug prices. Photo: Chip Somodevilla/Getty Images

The Trump administration's next steps on drug pricing could come quickly: The White House budget office is reviewing a new proposal to change the way pharmacy benefit managers — the middlemen between drugmakers and the pharmacy counter — get paid.

What I'm hearing: Even by the standards of the drug supply chain, this is likely to be an extremely complex and in-the-weeds rule. It's not entirely clear how much of PBMs' payment structure the administration can change on its own, without any help from Congress.

What they're saying: “While we cannot comment on pending regulations, the President’s ‘American Patients First’ blueprint to lower drug prices and reduce out-of pocket costs clearly states that we are looking at removing safe harbor protections for drug company rebates. It should not come as a surprise that this would require rulemaking," HHS spokesperson Caitlin Oakley said.

Driving the news: The administration took another significant step on drug pricing yesterday — arguably its most impactful step to date — when Food and Drug Administration Commissioner Scott Gottlieb rolled out a new plan to spark the development of more biosimilar drugs.

  • Biosimilars are, in effect, generic versions of highly complex (and very expensive) biologic drugs. Biologics look like the future of drug development, but the biosimilars market has been slow to heat up.
  • Yesterday's announcement may not pay immediate dividends, but building a competitive market now could definitely yield noticeable savings in the future — even though these products likely won't offer the same steep discounts we're used to with traditional generics.

"This week, we will see more action to reform drug pricing in America than we have seen in a number of years," Health and Human Services adviser Dan Best says in a blog post.

  • For the most part, Best's post rounds up what the administration has done so far and criticizes "some in the media" for "still claiming that the Trump Administration’s plan for reforming drug pricing isn’t delivering."

Reality check: A strong market for biosimilars would make a big difference for future patients. Changes in the PBM industry could, too — PBMs are powerful players who operate in near-total secrecy. President Trump's plan has the potential to affect change.

But some of what HHS is hyping is just not that big a deal.

  • For example, Best touts the recent announcements that Pfizer and Novartis would delay their most recent round of price increases — which Trump himself also noted on Twitter this morning.
  • Here's some context from my colleague Bob Herman: The list price of Novartis' cancer drug Gleevec has gone from $26,000 in 2001 to $146,000 in 2017. And it's not going down — it's just staying put, temporarily, at $146,000.

Taking a five-month breather on price increases is more of a public relations play than a business strategy, and it's far from structural change that would affect future price hikes. To wit: Pfizer's now-delayed increases are set to kick back in at the end of the year.

Go deeper

Amid racial unrest, a test at the polls

Photo: Stephen Maturen/Getty Images

Eight states plus D.C. are holding primary elections today following a week of intense protests across the country over the brutal police killing of George Floyd.

Why it matters: It's the first major test for voting since the national outcry. Concerns over civil unrest and the police — as well as the coronavirus and expanded absentee voting — could reduce the number of voters showing up in person but heighten tensions for those who do.

Axios-Ipsos poll: America’s big racial divide on police, virus

Data: Ipsos/Axios survey; Note: ±3.2% margin of error; Chart: Andrew Witherspoon/Axios

A new Axios-Ipsos poll finds that America has a massive racial gulf on each of our twin calamities — trust in police, and fear of the coronavirus.

  • 77% of whites say they trust local police, compared with just 36% of African Americans — one of many measures of a throbbing racial divide in Week 11 of the Axios-Ipsos Coronavirus Index, taken the week George Floyd was killed by a white policeman in Minneapolis.
Updated 49 mins ago - Politics & Policy

Updates: George Floyd protests nationwide

Police officers wearing riot gear push back demonstrators outside of the White House on Monday. Photo: Jose Luis Magana/AFP via Getty Images

Protests over the death of George Floyd and other police-related killings of black people continued for a seventh day across the U.S., with President Trump threatening on Monday to deploy the military if the unrest continues.

The latest: Four police officers were struck by gunfire while standing near a line in St Louis on Monday after a peaceful demonstration, Police Chief John Hayden said early Tuesday. They were all taken to hospital with non-life threatening injuries. He said a small group of people had thrown rocks and fireworks at police officers.