Overnight Health Care — Sponsored by PCMA — Drug pricing, opioids on tap next week

Happy Friday! And welcome to Overnight Health Care, sponsored by the Pharmaceutical Care Management Association. 

For next week, we’re putting together the clues to figure out what President Trump’s drug policy speech will entail. An array of opioid bills are set for mark-up before the full House Energy and Commerce Committee, and the panel’s investigative subcommittee will put pharmaceutical distributors in the hot seat. Health and Human Services Secretary Alex Azar will speak to hospitals and a House committee will put a spotlight on changes to veterans health care.

But first, ICYMI on Friday: 

• Vice President Pence’s doctor resigned, the latest fallout from the scandal surrounding the failed nomination of Ronny Jackson, President Trump’s pick to lead the Department of Veterans Affairs. Jennifer Peña was a physician in the White House Medical Unit, which Jackson led prior to his nomination. Multiple reports said she was one of the people who accused Jackson of misconduct, which helped sink his bid to lead the VA. Read more here.
• In South Carolina, the state Senate blocked legislation that would have implemented a wide-ranging ban on abortions early Friday night after a Democratic filibuster.  Read more here.
• A trio of Democratic senators urged the Food and Drug Administration (FDA) to remove ultra-high dose opioids from the market as policymakers grapple with how to stem the tide of the opioid epidemic. But the proposal isn’t without controversy, with one pain group worrying pulling powerful opioids from the shelves would be unsafe for patients who need the medicines to manage their pain. Read more here.
• Today is the one-year anniversary of the House passage of its ObamaCare repeal bill, the American Health Care Act. Three House Democratic committee leaders used that anniversary to call on Speaker Paul Ryan (R-Wis.) to hold a vote on their legislation to stabilize ObamaCare, called The Undoing Sabotage and Expanding Affordability of Health Insurance Act. Read more here.

***

Sponsored content – Pharmaceutical Care Management Association

Where PBM tools are used, a new report shows net spending – including the combined impact of drug prices, generic vs. brand drug use, and the overall number of prescriptions – declined by 2.1% last year. Spending increased in 2017 through channels not managed by PBMs. Learn how PBMs are part of the solution to reducing Rx costs at DrugBenefitSolutions.com.

***

Big week on drug prices

President Trump’s big speech on actions on drug pricing is finally expected next week. It was originally slated for Tuesday, though now there are rumors it could be pushed until later in the week. No one seems to know exactly what will be proposed, but here are some possibilities we’re hearing:

• FDA Actions. Commissioner Scott Gottlieb hinted in a speech this week that he wants to issue guidance to crack down on delay tactics that slow cheaper generic drugs coming to market.
• Medicare Part B changes. The administration has floated these before, to make payments more efficient in this section of Medicare or shift some drugs into Medicare Part D, where there is more competition. One option, according to a lobbyist, is to revitalize a program called the competitive acquisition program, from the 2003 Medicare Modernization Act.
• Rebate changes. The administration could move forward with rumored actions on passing discounts and rebates on to consumers, something supported by drug companies.
• Surprises. No one is pretending they know exactly what the administration will announce.

Next week: Bye recess, hello Congress.

Opioids: Cities, counties, tribes and other health-care stakeholders have filed hundreds of lawsuits against pharmaceutical distributors, alleging they didn’t report suspicious quantities of opioids, sometimes shipped in large volumes to small, rural areas.

• In Kermit, W.Va., one pharmacy received nearly 9 million hydrocodone pills over two years. The town’s population: 392.  
• In statements about the lawsuits, the Healthcare Distribution Alliance has said: “Given our role, the idea that distributors are responsible for the number of opioid prescriptions written defies common sense and lacks understanding of how the pharmaceutical supply chain actually works and is regulated. Those bringing lawsuits would be better served addressing the root causes, rather than trying to redirect blame through litigation.”

On Tuesday, a House Energy and Commerce subcommittee will get the chance to grill executives from the top distributors in a hearing billed as examining concerns about distribution and diversion.

The panel has been investigating the issue for about a year.

Key quote: “Through their testimony, we hope to gain a more complete picture of the crisis that unfolded in West Virginia and across our nation. As we work to develop solutions to combat the opioid crisis, we must fully understand the root causes of it,” Rep. Gregg Harper (R-Miss.), the subcommittee chairman, said in a video previewing the hearing.

ALSO: The full House Energy and Commerce Committee has scheduled mark ups for over 50 opioid bills, the first of which will be Wednesday. The final committee mark up is slated for May 17, as the panel’s chairman, Rep. Greg Walden (R-Ore.), aims to put legislation to the House floor by Memorial Day weekend.

Democrats balked at the timeline during a health subcommittee mark up last week, saying many of the bills were still in draft form and awaiting technical assistance.

VA health changes get scrutiny.

It’s been somewhat lost in the high-profile controversy over Ronny Jackson, but the Veterans Choice Program is running out of money. The House Veterans Affairs Committee on Wednesday will mark up a bill that, among other things, would provide $5.2 billion to keep the Choice program funded.

The Choice program was meant to be temporary. It was created in the wake of the 2014 wait-time scandal. It allows some veterans to see private doctors, but only in cases where they have to wait more than 30 days for an appointment or drive more than 40 miles to a facility.

The issue: Reauthorizing Choice shouldn’t be a problem, but the legislation under consideration aims to create an entirely new program to allow veterans access to private-sector care paid for by the VA. It would eliminate the current waiting period and distance requirements and allow veterans to seek community care outside the VA if veterans and their providers agree it’s the best method of treatment.

Will there be fireworks? According to Committee Chairman Phil Roe (R-Tenn.), the bill broadly includes the Senate’s language on community care and caregivers. It’s backed by all major veterans groups, included the Koch-backed Concerned Veterans for America. But a version of the legislation was supposed to be included in the recently passed omnibus spending package, and House Democrats blocked it because they were worried it would go too far towards privatizing the VA.

***

Sponsored content – Pharmaceutical Care Management Association

Pharmacy benefit managers (PBMs) have outlined several policy solutions to ensure patients receive opioid prescriptions when safe and medically appropriate. One important solution would be requiring e-prescribing of controlled substances in Medicare (S. 2460 / H.R. 3528, the Every Prescription Conveyed Securely Act). A new study by the Opioid Safety Alliance finds this could save taxpayers $13 billion over 10 years.

***

Other things we’re watching:

• Health and Human Services Secretary Alex Azar will speak on Wednesday at the American Hospital Association’s annual conference in Washington, D.C.
• Insurers will be filing their ObamaCare premium requests for 2019, and they’re expected to be higher than last year’s. Watch for both Democrats and Republicans to point fingers.

What we’re reading

The U.S. can’t keep up with demand for health aides, nurses and doctors (CNN Money)

‘Pharma Bro’ Shkreli Is In Prison, But Daraprim’s Price Is Still High (Kaiser Health News)

Gottlieb pushes back against criticism of ‘breakthrough’ designation (Stat News)

State by state   

States Aren’t Meeting Residents’ Mental Health Needs, Study Finds (US News and World Report)

Here’s what Iowa women are saying about the ‘fetal heartbeat’ abortion ban (Des Moines Register)

New Hampshire House approves funds for DCYF, mental health services (The Concord Monitor)