The Health 202: The era of bipartisan work on lowering drug prices might be over

“I think we’ve got to take bold action on prescription drug prices,” Wyden (Ore.) told reporters yesterday. “We’re going to be looking at all the tools to get this done.”

President Trump made lowering prescription drug prices a major promise during his campaigns. But despite some efforts, there has been major pushback from Capitol Hill and the pharmaceutical industry and not much has actually been accomplished.

Ten House Republicans joined Democrats yesterday to impeach President Trump a second time, amid near-chaos in the chamber and uncertainty about where Trump’s exit leaves the GOP, my colleagues reported.

“Democrats and Republicans exchanged accusations and name-calling throughout the day, while Trump loyalists were livid at fellow Republicans who broke ranks — especially [Rep. Liz] Cheney — leaving the party’s leadership shaken,” Mike DeBonis and Paul Kane write.

Focusing on direct negotiation, as Wyden urged yesterday, would cut Republicans out of the picture.

Back in 2019, Wyden tried very hard to keep Republicans on board such an effort, as he pushed for a limited, bipartisan bill co-written with Sen. Charles E. Grassley (R-Iowa). That measure would have capped out-of-pocket costs for Medicare enrollees and required some rebates from drugmakers. But after passing in committee, the measure languished as Senate Majority Leader Mitch McConnell (R-Ky.) refused to bring it to the floor.

It’s possible to imagine Democrats getting 60 votes to pass such an effort, now that they’ll control the Senate. After all, a half-dozen Finance Committee Republicans voted for it.

But in remarks slamming McConnell, Wyden yesterday said the majority leader proved his ultimate unwillingness to enact any significant drug pricing reforms under heavy pressure from the pharmaceutical industry.

Democrats, Wyden said, should now move aggressively to lower drug prices after years of delays.

“If Mitch McConnell and pharma — two very powerful forces — had been willing to go to the Senate floor, we would have been able to get an enormous vote,” Wyden said. “My bottom line is issues like prescription drugs have been kicked down the road again and again and again.”

He didn’t rule out using a budget reconciliation measure — which requires just 50 votes — to pass a more aggressive drug pricing bill than Republicans are willing to support. In the normal legislative process, Democrats will have to get at least 10 Republicans on board with legislation because it takes 60 votes to avoid a filibuster.

A starting place could be H.R. 3 — the bill the Democratic-led House approved at the end of 2019 allowing the health secretary to directly negotiate with drug companies for lower prices. That provision would lower federal spending by about $456 billion over a decade, but it could also result in 40 fewer new drugs being developed over the next two decades, according to the Congressional Budget Office.

Yet Wyden acknowledged difficulties in pursuing this course of action. For example, there are strict rules around what can go into a budget reconciliation bill. Democrats will be limited to just two such bills — one for this year and one for next. Plus, they have many competing policy priorities.

This effect is one reason the pharmaceutical industry — and thus many Republicans and some Democrats — hate the idea so much. Because of its vast market power, the government can secure far lower prices when it negotiates for drugs directly (the GOP also argues that direct negotiations would dampen new drug development).

A new report by the Government Accountability Office, provided first to The Health 202, found that Veterans Affairs pays 54 percent less for a unit of drugs than Medicare’s prescription drug program. The report, requested by Sen. Bernie Sanders (I-Vt.), compared how much the government pays for drugs provided through the two programs. 

The price differences partly stem from how the two programs are structured.

VA can save so much money partly because it directly purchases drugs from manufacturers on behalf of all of its nine million enrollees. 

But Medicare Part D has less leverage with drugmakers. Private insurance plans contract with the government to provide pharmacy benefits. Then each plan, on its own, negotiates prices with manufacturers. So while the program covers 42.5 million people — far more than the VA — its negotiating power is dispersed among many different plans.

In its report, the GAO compared the 2017 prices of 399 top drugs in each program. It also found:

• Of the 399 drugs in the sample, 233 were at least 50 percent cheaper in VA than in Medicare. One hundred six drugs were at least 75 percent cheaper.
• Just 43 drugs were cheaper in Medicare than in VA.
• The price differences between the two programs were greater on average for generic drugs.
• The VA’s prices were 68 percent lower than Medicare prices for 203 generic drugs and 49 percent lower for the 196 branded drugs.

There are statutory discounts available to VA, which also lower its costs for drugs. VA also has more direct control over the medications it will cover, allowing it to steer patients toward certain lower-priced drug options.

All of this bolsters arguments for allowing direct negotiations in Medicare, Sanders argues.

“There is absolutely no reason, other than greed, for Medicare to pay twice as much for the same exact prescription drugs as the VA,” he said, in a statement provided to The Health 202. “If the VA can negotiate with the pharmaceutical companies to substantially reduce the price of prescription drugs, we must empower Medicare to do so as well.”

Daily death tolls from the virus topped 4,000 deaths on both Tuesday and Wednesday, bringing the total number of deaths in the United States to more than 383,000, according to Washington Post data. That’s close to double the daily death rate during the first surge last spring.

And now there are new, more transmissible variants of the virus.

Scientists have been tracking the spread of more-contagious variants first identified in the United Kingdom and South Africa. While they are currently thought to account for a relatively small portion of cases in the United States, they could spread quickly. Trevor Bedford, a computational biologist at the Fred Hutchinson Cancer Research Center, told NPR that he predicted that the U.K. variant, B.1.1.7, could become the dominant variant in the United States by March.

Meanwhile, researchers at Ohio State University’s Wexner Medical Center and College of Medicine announced that they discovered another new variant of the virus that is similar to the mutation found in the United Kingdom but probably originated in the United States. 

President-elect Joe Biden is scheduled to give a speech on the economy at 7:15 tonight, according to Punchbowl News. According to his transition team, “he will outline his vaccination and economic rescue legislative package to fund vaccinations and provide immediate, direct relief to working families and communities bearing the brunt of this crisis and call on both parties in Congress to move his proposals quickly.”

Experts are optimistic about clinical trial results, which could come in the next two weeks. Unlike the Pfizer-BioNTech and Moderna vaccines, which must be frozen and require two shots, the Johnson & Johnson vaccine requires a single shot and can be stored in a refrigerator for months.

“But the encouraging prospect of a third effective vaccine is tempered by apparent lags in the company’s production,” the New York Times’s Carl Zimmer, Sharon LaFraniere and Noah Weiland report. “Federal officials have been told that the company has fallen as much as two months behind the original production schedule and won’t catch up until the end of April, when it was supposed to have delivered more than 60 million doses, according to two people familiar with the situation.”

Johnson & Johnson’s vaccine is an entirely distinct model from the currently approved inoculations. Rather than using mRNA, the company built its vaccine from a virus that causes common colds. Johnson & Johnson also took an early gamble: While proceeding with clinical trials for a two-dose vaccine promised more likelihood of success, it opted to push forward with trials for a one-dose vaccine, which, if effective, could help provide immunity quicker.

Paul Stoffels, Johnson & Johnson’s chief scientific officer, said that if the vaccine receives approval from the Food and Drug Administration, he hopes that the company can contribute to vaccine efforts sometime in March.

“The results from most of the antigen tests that have been sent to states have been unreported, according to separate data from the COVID Tracking Project at The Atlantic and the U.S. Department of Health and Human Services, leaving gaps in our knowledge of the pandemic,” the Atlantic’s Whet Moser reports. “In some cases, the tests are not getting used at all.”

Antigen tests are faster, cheaper and easier to perform than the standard coronavirus tests. While they are less accurate than PCR tests, the ability to do more of them could make up for lower sensitivity. In many cases, frequent testing with lower-sensitivity tests may provide better protection than less frequent but more accurate testing.

“But for an effective antigen-testing plan to work, the tests have to be given frequently and the results quickly reported. While PCR tests are done at labs, which are practiced in reporting results to health agencies, antigen tests are intended for places such as schools and nursing homes, which have to develop their own reporting systems,” Whet writes.

Journalists and health officials have been warning about holes in coronavirus data for months since the summer, but little progress seems to have been made in filling the reporting gaps. 

Last month, the Department of Health and Human Services said that federal officials have not received results from the majority of the 50 million antigen tests that have been distributed to the states. Similarly, data from the COVID Tracking Project shows that states that antigen tests make up only about 10 percent of tests results reported in states that separate figures based on test type. If those numbers are extrapolated nationwide, it would mean results have been reported from only about a quarter of the tests the government has distributed to date.

Slaoui submitted his resignation at the request of the Biden administration but will stay on for a month to help with the transition, CNBC’s Meg Tirrell reports. “It’s not clear who will take scientific lead for the Biden team focused on Covid vaccines or if someone will be appointed to that role,” she adds.

Slaoui had said he intended to step down after two vaccines achieved FDA approval, which occurred last month, but last week he said he “decided to extend that in order to ensure that the operation continues to perform the way it has performed through the transition of administration.”

While the production and distribution of vaccines has fallen short of predictions made by Slaoui and other health officials last year, the development of the vaccines themselves and their approval in record time has been widely seen as a major success.

“Although states and federal health groups laid out broad guidelines on how to prioritize who gets the vaccine, in practice what’s mattered most was who controlled the vaccine and where the vaccine distribution was handled,” Kaiser Health News’s Phil Galewitz writes.

At Jupiter Medical Center in South Florida, 40 extra doses of vaccines went to the hospital’s board of directors and their spouses over 65, even while some of its workers were left unvaccinated. At least three other South Florida hospital systems offered vaccines to donors before the general public. 

In some hospitals that have prioritized vaccinating staff members based on age, administrators and personnel who don’t work with patients have received vaccines before front-line employees. Meanwhile, hospitals have struggled with unpredictable shipments of vaccines and a surprisingly low demand among some staff members.

Still, epidemiologists caution that there is still much that we don’t know about the virus.

“Their prediction of its becoming like common cold coronaviruses is where I’d put a lot of my money,” said Marc Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Public Health. “But I don’t think it’s absolutely guaranteed.” 

There may be a historical antecedent for a deadly viral scourge settling down into something far more benign: Some historians think that a pandemic in 1890 that killed 1 million people around the globe was actually OC-43, one of four coronaviruses circulating today that cause the common cold. 

“The White House will not be able to make good on President Donald Trump’s campaign promise to give older Americans discount cards to use for medicine, said four officials with knowledge of the deliberations, citing time pressures and still-unfinished planning,” Politico’s Dan Diamond reports.

“It would take days to get all the sign-offs we still need, plus the time to print the letters and make the cards,” one official involved in the process told Politico. “We ran out of time.”

Trump blindsided his aides in September with a surprise announcement that Medicare recipients would receive $200 drug discount cards. Officials scrambled to come up with a plan to make the cards a reality but quickly ran into legal and logistical obstacles.

“Meanwhile, some Trump officials began questioning whether the Trump administration was rushing to lay the groundwork for announcement letters and cards that couldn’t be sent until February or March and would go out bearing Biden’s name instead. That would have conflicted with Trump’s own characterization of the plan,” Dan writes. 

“I will always take care of our wonderful senior citizens,” Trump said on Sept. 24 when he announced the drug card plan. “Joe Biden won’t be doing this.”