Brainstorm Health: Trump Drug Price Speech, Ebola Outbreak, Novartis’ Bad Day

President Donald Trump delivered his long-awaited speech on drug pricing Friday. The president, who once famously said pharmaceutical companies were “getting away with murder” on prices and often sent biotech shares tumbling with his harsh rhetoric, offered a number of proposals meant to tackle the sky-high prescription drug costs borne by many in a plan dubbed “American Patients First.” But most of the proposed reforms may largely spare the drug industry itself—a possible reason that both S&P and NASDAQ biotech indices rose nearly 3% following the address. And a lack of specifics may have fueled 2% to 4% stock spikes for other health care companies like CVS, McKesson, and Express Scripts.

Trump and Department of Health and Human Services (HHS) Secretary Alex Azar laid out the main planks of the drug pricing blueprint in a White House Rose Garden address. The overall message was that players up and down the drug supply chain—including insurers, pharmacy benefits managers (PBMs), pharma firms, and federal agencies—along with foreign governments, are taking advantage of or failing American patients.

The administration’s plan has four main pillars: increasing competition; better negotiation on prices; incentives to lower list drug prices; and reducing patients’ out-of-pocket spending.

These broad goals would ostensibly be achieved through a variety of regulatory and legislative measures. Some are pretty technical, such as giving the Medicare Part D prescription drug program authority to negotiate lower prices for certain drugs under Medicare Part B. Others are more aspirational and politically controversial, such as Trump’s broadsides against foreign countries that supposedly “free ride” by paying less money for drugs than Americans through their single payer systems. It’s unclear how increasing costs for foreign governments and patients would help reduce prices in the U.S., but Trump nonetheless framed the issue as “putting American patients first.” Azar also asserted that pharmaceutical company ads on TV should disclose prices (although he didn’t specify which ones would be listed given the convoluted U.S. price negotiation regimen).

There’s a lot to parse through (you can read the entire blueprint here). But the document also asks more questions than it provides in the way of immediate action, as the University of Pittsburgh professor Walid Gellad noted on Twitter. For instance, will PBMs be forced to share more of the rebates they negotiate with drug makers (a largely opaque process that many critics say is lifting up prices) directly with consumers?

It’s also important to consider what the blueprint doesn’t include—such as a plan to allow Medicare to directly negotiate drug prices and establish a formulary, or permitting lower-priced drug imports from other countries. Those were proposals loathed by the biopharma industry that Trump had previously floated; they didn’t make it into Friday’s speech, drawing a deep sigh of relief from the sector.

I sat down with Steve Ubl, CEO of the drug industry’s main lobbying group, PhRMA, yesterday preceding Trump’s speech. “We fully expect the president will put forward ideas we don’t agree with,” he told me, pointing to the Medicare Part B/Part D initiative. But he also emphasized that other parts of the medical supply chain deserve just as much, if not more, scrutiny than drug makers do. This issue isn’t going away anytime soon—but Trump’s address doesn’t appear to have rocked big pharma’s (or other industry players’) apple cart.

Read on for the day’s news, and have a wonderful weekend.

DIGITAL HEALTH

The VA finalizes its telehealth rule. The Department of Veterans Affairs has finalized a long-awaited rule aimed at increasing veterans' access to telehealth. Proponents of telemedicine have lauded the regulation, which would allow digital doctor visits across state lines, as a possible model for broader digital health policy. (FierceHealthcare)

INDICATIONS

Novartis CEO: 'Yesterday was not a good day.' Novartis CEO Vas Narasimhan has this to say about the company's $1.2 million to Trump lawyer Michael Cohen: “Yesterday was not a good day for Novartis,” Narasimhan wrote in a letter to employees Thursday. “We made a mistake in entering into this engagement and, as a consequence are being criticized by a world that expects more from us. What defines us now is how we respond to this difficult situation.” (Fortune)

THE BIG PICTURE

Tackling the new Ebola outbreak. Congo is facing an outbreak of Ebola in a remote area of the country; there have now been 32 suspected cases including 18 deaths. The World Health Organization (WHO), Reuters reports, is scrambling to prevent a repeat of the 2014 Ebola crisis in Africa, during which the global agency was roundly criticized for its response. “We are very concerned and planning for all scenarios, including the worst case scenario,” said Peter Salama, WHO’s Deputy Director-General of Emergency Preparedness and Response. (Reuters)

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