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HHS Sec. Alex Azar. Photo: Sarah Silbiger/CQ Roll Call

A big part of the Trump administration's plan to lower drug prices is now dead, White House spokesman Judd Deere confirmed to Axios.

Why it matters: The administration is backing away from an effort to change the way money flows through federal health care programs — one of the most sweeping elements of its drug-pricing blueprint. That's bad news for pharma, and the move will put pressure on other parts of the administration's plan, which is also bad news for pharma.

How it works: The now-dead proposal would have overhauled the rebates collected by pharmacy benefit managers — the middlemen between insurance plans and drug companies.

  • They negotiate discounted prices in the form of a rebate, but keep some of those rebates for themselves as profit.
  • Trump's proposal would have banned that arrangement in Medicare and Medicaid, requiring PBMs to pass the rebates on to patients at the pharmacy counter and find a different way to bring in their own revenues.

What they're saying: “Based on careful analysis and thorough consideration, the President has decided to withdraw the rebate rule," Deere said.

  • "The Trump administration is encouraged by continuing bipartisan conversations about legislation to reduce outrageous drug costs imposed on the American people, and President Trump will consider using any and all tools to ensure that prescription drug costs will continue to decline," he added.

Between the lines: This is very bad news for the pharmaceutical industry, which blames middlemen for high drug prices and vocally supported the proposed rebate overhaul. It's very good news for insurers and PBMs.

  • Independent critics of the proposal argued it did nothing to require drugmakers to lower their prices and would've cost taxpayers hundreds of billions of dollars.

What's next: This will increase the pressure for the administration to finalize its other major drug-pricing push — which the pharmaceutical industry loathes.

  • That proposal would set Medicare's prices for certain drugs based on the prices other countries pay. It likely "will be the executive order of choice," a source close to the administration said.
  • The plan is also controversial among Republicans, who are hesitant to set drug prices.

What we're watching: The administration is also open to a controversial proposal being discussed in the Senate that would limit how much drug companies can increase their prices within Medicare's drug benefit.

  • "Driving down outrageous price hikes in prescription drug prices is a priority for the President, and a policy like an inflation cap for Part D drugs is something the Trump administration is seriously considering," a senior administration official said.

Go deeper: The complicated politics of Trump's rebate rule

Go deeper

Ex-Theranos CEO describes alleged abuse by former boyfriend and company exec

Illustration: Aïda Amer/Axios

On her fourth day of trial testimony, ex-Theranos CEO Elizabeth Holmes described her 10-year romantic relationship with former president Ramesh "Sunny" Balwani as controlling, and said he would sometimes "force me to have sex with him when I didn’t want to."

Why it matters: While Balwani has also been similarly charged with fraud, the two are being tried separately, in part because some of Holmes' defense hinges on blaming him.

Amazon ordered to redo union vote in Alabama

Photo: Patrick Pleul/picture alliance via Getty Images

A U.S. National Labor Relations Board (NLRB) official on Monday called for a re-vote in a union election at an Amazon warehouse in Bessemer, Alabama.

Why it matters: The move could set the stage for another organizing drive at the e-commerce giant, which has, so far, fought off unionizing efforts in the U.S.

Pentagon to probe 2019 Syria strike after reports of dozens of civilian casualties

Secretary of Defense Lloyd Austin on Nov. 20. Photo: Mazen Mahdi/AFP via Getty Images

Defense Secretary Lloyd Austin has ordered a new investigation into a 2019 U.S. airstrike that killed around 80 people, including dozens of women and children in Syria, the New York Times reports.

Why it matters: The move comes after the Times reported this month that the Pentagon attempted to keep the strike and casualties under wraps, failing to investigate the decision behind it even after questions were raised internally.

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