Overnight Health Care: Azar defends approach on drug rebates | Trump presses Senate to act quickly on opioid crisis | Kentucky governor's Medicaid lawsuit tossed

Overnight Health Care: Azar defends approach on drug rebates | Trump presses Senate to act quickly on opioid crisis | Kentucky governor's Medicaid lawsuit tossed

Happy Monday, and welcome to Overnight Health Care. The Senate is beginning to work through amendments to the labor, health appropriations bill, Bernie SandersBernard (Bernie) SandersNewsom endorses Kamala Harris for president Business, conservative groups slam Trump’s national emergency declaration Poll: Sanders, Biden seen as most popular second choices in Dem primary MORE is fact-checking the fact checkers on "Medicare for all," and Kentucky Gov. Matt Bevin (R) lost again in federal court.

But first some drug pricing news...


HHS Secretary Alex Azar is downplaying concerns from congressional Republicans over the administration's pending action on prescription drug rebates.

House Energy and Commerce Committee Chairman Greg WaldenGregory (Greg) Paul WaldenFormer Ryan aide moves to K street Overnight Health Care — Presented by PCMA — Lawmakers pay tribute to John Dingell's legacy on health care | White House denies officials are sabotaging ObamaCare | FDA wants meeting with Juul, Altria execs on youth vaping House members hint at bipartisan net neutrality bill MORE (R-Ore.) and Senate Finance Committee Chairman Orrin HatchOrrin Grant HatchOrrin Hatch Foundation seeking million in taxpayer money to fund new center in his honor Mitch McConnell has shown the nation his version of power grab Overnight Health Care — Presented by PCMA — Utah Senate votes to scale back Medicaid expansion | Virginia abortion bill reignites debate | Grassley invites drug execs to testify | Conservative groups push back on e-cig crackdown MORE (R-Utah) have asked the White House's Office of Management and Budget for a full economic analysis of a pending proposed rule regarding prescription drug rebates.

Azar said Monday he wasn't worried about that request.


"I take the letter and the request as completely consistent with our approach, which is that when dealing with important segments, and large segments, of the economy... it is appropriate for us to follow the right processes and be thoughtful," Azar said in a press call with reporters focused on the 100-day anniversary of the administration's release of its drug pricing blueprint.

Azar has hinted that the administration might eliminate the drug rebates pharmacy benefit managers (PBMs) get from drug companies. These rebates keep drug prices high for consumers, Azar says.

"What we know is that the status quo is not tenable, and the president will not allow the status quo to continue," Azar said.


Other drug pricing developments.

--Dan Best, Azar's senior adviser on drug pricing reform, was also on the call. He said a recently formed drug importation working group at the Food and Drug Administration has had its first meeting and is "outlining its plan of action."

The working group will examine how the U.S. can import pharmaceuticals from abroad in limited circumstances, such as when a dramatic price increase makes the drug difficult to obtain domestically.

--Azar also disputed claims that he's coordinating with drugmakers to attack PBMs.

In response to a question from Sens. Elizabeth WarrenElizabeth Ann WarrenNewsom endorses Kamala Harris for president Constitutional conservatives need to oppose the national emergency Poll: Sanders, Biden seen as most popular second choices in Dem primary MORE (D-Mass.) and Tina SmithTina Flint SmithContractor back pay not included in shutdown deal Push to include contractor back pay in funding deal hits GOP roadblock Dems seeking path to Senate majority zero-in on Sun Belt MORE (D-Minn.) about whether he is coordinating with drugmakers, Azar said: "I make it a practice not to blame any individual parts of the drug channel, but to blame all parts of the drug channel" for high drug prices.

"Massive structural financial incentives" keep list prices high, he said, and HHS will change the rules of the road to "ensure we get lower prices," Azar added.

Warren and Smith have been in contact with PBMs about comments Azar made at a congressional hearing last month, in which he blamed PBMs and drug distributors for blocking drugmakers from lowering list prices.

In letters to Warren and Smith, PBMs and drug distributors disputed the accusations.


President TrumpDonald John TrumpTrump nominates ambassador to Turkey Trump heads to Mar-a-Lago after signing bill to avert shutdown CNN, MSNBC to air ad turned down by Fox over Nazi imagery MORE presses Senate on opioid crisis: 'No more delay!'

President Trump on Monday urged the Senate to pass a bill aimed at stopping the flow of synthetic opioids into the U.S.

Trump called it "outrageous" that fentanyl -- a synthetic opioid 50 times stronger than heroin -- is "pouring into the U.S. postal system from China."

"We can, and must, END THIS NOW!" Trump tweeted. "The Senate should pass the STOP ACT -- and firmly STOP this poison from killing our children and destroying our country. No more delay!"

Context: The bill he is referring to was passed by the House in June but still languishing in the Senate. The upper chamber hoped to pass a package of bills aimed at addressing the opioid epidemic by Labor Day, but that's beginning to look more and more unlikely.

A spokesman for Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellGreen New Deal Resolution invites big picture governing ‘Contingency’ spending in 3B budget deal comes under fire Coulter defends Paul Ryan: This is 100 percent Trump's fault MORE (R-Ky.) said the epidemic remains a priority for him and that he is working out a time to bring it to the floor.

Why it matters: A congressional report released in January found that those selling fentanyl online in China prefer to use the U.S. Postal Service rather than private shippers, because the sellers think there's less of a risk that U.S. Customs and Border Protection will seize the package.

Read more here.


Hold on... A top lobbying group is opposing parts of the House opioid bill.

Powerful lobbying groups are pushing back against a House-passed bill intended to address the growing opioid epidemic. America's Health Insurance Plans led eight industry groups in a letter to Senate leadership Monday, asking that they oppose a provision in the House measure.

The controversial provision: The provision, passed as part of the House opioids package in June, would require private insurance plans pay more to cover kidney disease before Medicare becomes the primary payer.

The proposed change is meant to offset the costs of the bill, which includes a wide range of measures intended to fight the epidemic.

The objection: "While we strongly support congressional efforts to address the opioid epidemic, we are very concerned about offsets that would reduce the ability of private health plans to provide comprehensive, affordable health care coverage," the groups wrote in a letter to Senate Majority Leader Mitch McConnell (R-Ky.), Minority Leader Charles SchumerCharles (Chuck) Ellis SchumerHouse Judiciary Dems seek answers over Trump's national emergency declaration Mandatory E-Verify: The other border wall Trump says he 'didn't need to' declare emergency but wanted 'faster' action MORE (D-N.Y.), and the Republican and Democratic leaders of the Senate Finance Committee.

Shifting more costs to private insurance companies would "burden health plans at a time they are already facing challenges in maintaining affordable coverage," they wrote.

Who signed the letter? The American Benefits Council, American Federation of State, County and Municipal Employees, Blue Cross Blue Shield Association, Service Employees International Union, ERISA Industry Committee, United States Chamber of Commerce and UAW. The groups are among the most powerful trade associations in Washington.

Read more here.


Bevin lawsuit against Medicaid activists tossed.

A federal judge in Kentucky on Monday dismissed a counter-lawsuit brought by Gov. Matt Bevin (R) against a group of citizens who sued to stop his plan to implement controversial Medicaid work requirements and other restrictions.

The judge ruled that Bevin's lawsuit "does not explain how the Commonwealth would be injured" by the challenge to his proposed Medicaid restrictions.

The backstory: group of activists in Kentucky sued to block the work requirements from being implemented. The lawsuit claimed that work requirements were unconstitutional. So Bevin turned around and sued them back, except his lawsuit was filed in Kentucky, rather than in D.C. Bevin argued that the state would be forced to end its Medicaid expansion if the activists' lawsuit was successful and the waiver invalidated.

So what happened? U.S. District Judge Gregory Van Tatenhove was skeptical of that claim and noted that if Bevin decided to roll back the state's Medicaid expansion, it could not be blamed on the original lawsuit. Kentucky offered "no authority in support of its position that any future economic harm it might suffer would be traceable to Defendants," Van Tatenhove wrote.

Read more on today's decision here.


Sanders hits 'Medicare for all' fact checks as 'riddled with errors'

There was a good old wonky health-care debate playing out on Twitter Monday, involving Sen. Bernie Sanders (I-Vt.), CNN's Jake Tapper, and a host of supporting characters.

In a series of tweets on Monday, Sanders criticized a fact check from Tapper.

What's at issue? A conservative study that Sanders has been touting from the right-leaning Mercatus Center at George Mason University. Sanders has said the study showed that his plan would reduce total U.S. health spending by $2 trillion over 10 years.

But: In a video on CNN's website, Tapper said Sanders's claim "lacks a lot of context" and said that the author of the study, Charles Blahous, says Sanders is not being accurate.

So who's right? The debate centers on assumptions about how much doctors and hospitals would be paid under Sanders's "Medicare for all" plan.

The Mercatus study does find that U.S. national health spending would decline by about $2 trillion over 10 years under Sanders's plan. But that is because the study accepted Sanders's proposal to cut payments to doctors and hospitals down to the rates that Medicare currently pays.

Some experts doubt those cuts would be feasible, given that they could lead to damaging losses and financial problems for hospitals.

If the numbers are changed so that the cuts to doctor and hospital payments are not as steep, there is no longer $2 trillion in savings, and there in fact could be an increase in total spending.

Look for more debates over Medicare for All numbers like this as the proposal gains prominence among Democrats.

Read more here.


Rescheduled: Oral arguments in the lawsuit from Texas and other red states over ObamaCare will now take place September 5. If that date sounds familiar, it's because that's the second day of confirmation hearings for Supreme Court nominee Brett Kavanaugh. The timing is likely just a coincidence; the original date was Sept. 10, which is Rosh Hashanah.

But, politics: Still, the overlap can give Democrats more ammunition about the consequences Kavanaugh's confirmation will have on health care. The Texas lawsuit is considered by many experts to be a long shot. But there's a chance that however the case is decided initially, the appeal could make it all the way to the Supreme Court, where Kavanaugh will likely be seated. Texas and other conservative states are seeking a victory in order to overturn ObamaCare. Democrats argue Kavanaugh would be inclined to rule against the law, because he is a conservative Trump appointee.


Ebola crisis worsens in Congo.

At least 10 health-care workers have been infected with the deadly Ebola virus as they battle an outbreak in an eastern province of Congo, officials said over the weekend, as concerns mount that the number of cases is growing faster than public health officials can respond.

The Congolese Health Ministry said Friday that at least 90 people had been infected in several regions of North Kivu province and neighboring Ituri province. Forty-nine people have died, including one of the 10 health-care workers who had been infected.

The Health Ministry and the World Health Organization (WHO) expect more cases to emerge in the coming weeks. The Ebola virus disease carries an incubation period of up to 21 days, meaning it can take as long as three weeks for an infected person to show symptoms.

Our Reid Wilson has more here.


Join The Hill Wednesday, Sept. 12 for "A Healthy Start: Infant and Early Childhood Nutrition," featuring Reps. Nanette Barragán (D-Calif.) and Bobby ScottRobert (Bobby) Cortez ScottVirginia congressional delegation says it's 'devastated by’ Richmond Turmoil The Hill's 12:30 Report: AOC unveils Green New Deal measure | Trump hits Virginia Dems | Dems begin hearings to get Trump tax returns Aides say Virginia Democrat knew about sexual assault allegation against lt. governor MORE (D-Va.), and Administrator of the Food and Nutrition Service Brandon Lipps. Editor in Chief Bob Cusack will sit down with the headliners to discuss maternal, infant, and early childhood nutrition, and what steps can be taken to establish healthier eating patterns across all communities. RSVP Here.


What we're reading:

The man who sold America on Vitamin D - and profited in the process (Kaiser Health News)

I'm coping with cancer by reporting on it (Politico)

This E.R. treats opioid addiction on demand. That's very rare. (The New York Times)


State by state:

Mainers in limbo as state doesn't confirm Medicaid denials (Maine Public Radio)

Judge weighs decision on whether Nebraska voters will see Medicaid expansion petition on ballot (omaha.com)

Louisiana uninsured rate drops since expansion of Medicaid (Associated Press)