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Trump pressures Azar on drug prices; FTC commissioner backs Medicare negotiating

President Donald Trump admonished Health and Human Services Secretary Alex Azar last week during an impromptu phone call for failing to fulfill the administration's promises to lower U.S. drug prices, according to multiple reports.

SNL Image

HHS Secretary Alex Azar and President Donald Trump
Source: AP Photo

During a Jan. 16 meeting with his campaign advisers, Trump became frustrated over polling results that showed Americans continue to favor Democrats over the current administration and Republicans in handling healthcare issues, including lowering drug prices, the New York Times, the Washington Post and other news outlets reported, citing unnamed sources.

The sources said Trump called Azar during that meeting, putting the blame on the HHS secretary.

The White House did not deny the phone call between Trump and Azar took place. A spokesman, however, told S&P Global Market Intelligence there was "no daylight" between the White House and HHS.

House Speaker Nancy Pelosi, D-Calif., got her drug pricing bill through her chamber in December 2019 and Senate Finance Committee leaders Sens. Chuck Grassley, R-Iowa, and Ron Wyden, D-Ore., convinced their panel in July 2019 to adopt their bipartisan legislation to lower medicine costs for Medicare beneficiaries. But Trump has yet to deliver on his 2016 campaign promises to reduce drug prices.

The Pelosi and Grassley-Wyden bills, however, have languished in the Senate waiting for Majority Leader Mitch McConnell, R-Ky., to bring them to the floor.

With the reelections of 22 Republican senators hanging in the balance, Grassley suggested Jan. 8 that Trump should be "speaking up more" in favor of the Senate Finance Committee leaders' bipartisan legislation, given the high priority the issue remains for Americans.

Trump has struggled to get the proposals from his May 2018 drug pricing blueprint implemented.

A rule that would have forced drugmakers to disclose their list prices in TV ads was struck down by a district judge in July 2019. An appeals court appeared skeptical during Jan. 13 oral arguments that HHS had the authority to implement such a mandate.

In July 2019, Trump abandoned a proposal to ban rebates paid by drugmakers under secret deals to middlemen, like pharmacy benefit managers and health insurers.

The administration's proposal to develop an international pricing index model, which was later shifted to a "favored nations" approach, has lingered at the White House Office of Management and Budget since June 2019.

HHS' plan to import drugs from Canada and other foreign nations could take years to implement.

In addition, Trump has failed to fulfill his 2016 campaign promise to provide a replacement for the Affordable Care Act.

Trump and his administration are supporting a lawsuit that seeks to invalidate the ACA in its entirety, including the protections for patients with preexisting medical conditions — litigation a majority of Americans oppose.

During his Jan. 16 call with Azar, Trump also said he regretted getting personally involved in the administration's vaping policy, according to the Times and the Post.

FTC commissioner backs Medicare price negotiations

Meanwhile, Christine Wilson, who was appointed to the Federal Trade Commission by Trump in September 2018, suggested Medicare should be given the authority to negotiate drug prices with biopharmaceutical makers — the key provision in Pelosi's bill.

The federal government as a price-taker is a problem, Wilson said during an address at a Jan. 16 forum hosted by the Council for Affordable Health Coverage, whose members include a number of drugmakers, insurers and PBMs.

Pelosi's bill would give the federal government the power to negotiate the prices on up to 250 medicines that lack competition in the U.S on behalf of the Medicare program and the commercial insurance market.

SNL ImageHHS Secretary Alex Azar swearing in FDA Commissioner Stephen Hahn
Source: U.S. Department of Health and Human Services

"I think that's great," Wilson said. "I'd like to see it expanded."

Complex drugs lack competition, House leaders say

Also last week, the bipartisan leaders of the House Energy and Commerce Committee called on U.S. Food and Drug Administration Commissioner Stephen Hahn to explain why there continues to be a lack of generic competition for older complex medicines.

Those products include drug-device combinations consisting of a small-molecule chemical agent that requires the use of a metered-dose inhaler, like those for asthma, or certain injectable drugs, such as those for multiple sclerosis.

"The length of time leading to the approval of some recently approved complex generics raises questions of whether additional actions may be necessary to encourage the development of these products," the lawmakers said in their Jan. 17 letter to Hahn.

They asked Hahn to provide a list of all complex generic drugs approved by the FDA since Oct. 1, 2016, and a list of product-specific guidelines for companies making those products the agency has issued.

Supreme Court to revisit ACA contraceptive mandate

The U.S. Supreme Court on Jan. 17 said it would hear arguments in two consolidated cases involving the ACA's cost-free contraception mandate — the third time the justices have reviewed the 2010 law's birth control requirement.

At issue is whether the Trump administration had the authority to expand the conscience exemption to the contraceptive coverage mandate and if its failure to let the public comment before the final rules were issued rendered those regulations invalid.

In July 2019, the U.S. Court of Appeals for the 3rd Circuit upheld a district court's December 2017 preliminary injunction barring implementation of the final rules.