The Health 202: Democrats sharpen attacks on Trump administration on drug prices and pre-existing conditions

Wednesday , June 13, 2018 - 8:45 AM

Paige Winfield Cunningham

(c) 2018, The Washington Post.

WASHINGTON - According to President Donald Trump, drug companies should today, Wednesday, be voluntarily announcing massive reductions in the price of their medicines.

When the president announced his blueprint for addressing rising drug costs on May 30, he declared that within two weeks companies would willingly drop prices. That would be today, Wednesday.

Cutting the nation’s rising drug costs is a bipartisan goal, and for a time Democrats shared President Trump’s campaign vision for cracking down on pharmaceutical companies and giving the government more power to negotiate deals. But Trump has walked back some of those positions, and at a Senate hearing Tuesday morning, the Democrats on the panel let Health and Human Services Secretary Alex Azar know they were not impressed with the White House plan.

“The only health care price [Trump] has dropped is his former secretary,” said Sen. Patty Murray, D-Wash., during her opening statement, referring to former HHS secretary Tom Price who resigned after it was revealed he traveled on pricey private jets instead of commercial airplanes.

The high cost of prescription drugs is a thorny issue because of the unusually decentralized nature of U.S. health-care system, with many causes and culprits. It’s also an issue that Democrats - and some Republicans - believe has political resonance leading up to the 2018 midterms, and Democratic lawmakers previewed what they think could be potent lines of attack in their questioning of Azar on Capitol Hill Tuesday. That’s also true for the issue of whether those with pre-existing health conditions can be denied insurance or charged more for it after the Trump administration has now said it won’t defend the Affordable Care Act court.

Some of the toughest criticism came from Sen. Elizabeth Warren, D-Mass., who wanted to know which companies were lowering prices this week as the president said they would.

The secretary, testifying before the Senate Health, Education, Labor and Pensions Committee, said that several drug manufacturers wanted to lower prices, but were facing challenges. Azar said those companies feared pharmacy benefit managers would discriminate against them by dropping them from the lists of medicines covered by an insurer.

As our Post colleague Amy Goldstein reported, Azar’s remarks were consistent with the administration’s portrayal of “middle men,” not the pharmaceutical industry itself, as the root of the nation’s high drug prices. He reiterated that direct government negotiation of drug prices in the vast Medicare program - a longtime Democratic goal that Trump embraced during his campaign - would be ineffective.

Warren cut off Azar several times to clarify that no companies were near cutting prices as the president had said.

“Mr. Secretary, you said you wanted to get tough on drug companies,” she said. “But under your approach, it seems that the drug companies can just keep charging people more and more. The only thing you’ve done is set it up so maybe if a drug company reduces a price, you can give them a cheap P.R. moment and then let them jack up prices later.”

Warren also challenged Azar on the administration’s plan to move drugs administered through Medicare Part B to the supplemental Medicare Part D, where pharmacy benefit managers negotiate prices with drugmakers. She wanted assurance that no one on Medicare would end up paying higher prices as a result of the change. Azar responded that protecting Medicare beneficiaries was the primary concern, but did not give Warren the definitive answer she sought.

“You cannot guarantee that there will not be Medicare beneficiaries who will be paying more,” Warren insisted.

Other Democrats piled on:

- Sen. Tim Kaine, D-Va., called it “ridiculous” that President Trump and Azar blame other countries that do have the power to negotiate lower drug prices for the high prices here. He said the U.S. government should be able to approach drugmakers and say it wants the same rates they give to other countries. Kaine said the U.S. government should at least set up a pilot program and try negotiating best prices on a few high-priced drugs.

- Sen. Tina Smith, D-Minn., wanted to know why drug companies’ stocks went up after Trump announced his proposal. She suggested it was difficult to believe that Azar, who headed the pharmaceutical giant Eli Lilly before being tapped to run HHS, was in good faith pushing for a bill to lower prices.

Sen. Bernie Sanders, I-Vt., asked Azar why Trump went back on his word about allowing FDA-approved drugs to be imported from other countries, specifically Canada. Azar said the president hasn’t changed his mind but there needed to be a way to ensure such a practice was done safely. Sanders replied, “I always have a hard time understanding that we can “safely” - quote, unquote - import fish, poultry from all over the world, and, somehow, from a highly developed country on our border, we cannot figure out a way to bring those products back into this country.”

Azar also parried lots of questions on an issue near-and-dear to Democrats’ hearts, and another promise Trump made on the campaign trail: Not to roll back the requirement that insurance companies cover those customers who have pre-existing conditions. Azar said that he personally supports affordable health care for those with pre-existing conditions - one of the most popular planks of the ACA -- but didn’t weigh in on a Trump administration decision not to defend the ACA in court against a lawsuit from states who argue the whole law is invalid because the individual mandate was eliminated as part of last year’s GOP tax overhaul.

“Calling it ‘a constitutional position . . . not a policy position,‘ Azar sidestepped grilling on whether he agreed with a legal brief filed last week by Justice Department attorneys stating they would not defend the Affordable Care Act in a federal lawsuit by Texas and 19 other Republican-led states,” Amy reports.

Sen. Maggie Hassan, D-N.H., called the administration’s position a “sick joke,” and pointedly queried: “Will you encourage the Trump administration to change its position?‘ Azar, a lawyer and former HHS general counsel, replied that “we do believe in finding solutions on the matter of preexisting conditions and the matter of affordability, regardless of the litigation.”

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