Overnight Health Care — Presented by National Taxpayers Union — Drug pricing fight centers on insulin | Florida governor working with Trump to import cheaper drugs | Dems blast proposed ObamaCare changes

Welcome to Wednesday's Overnight Health Care.

Lawmakers are beginning to seriously target insulin price hikes, Florida's Republican governor says he will get the administration to approve a drug importation plan, and top Democrats are urging the Trump administration not to proceed with proposed changes to ObamaCare.

We'll start with insulin:


Drug pricing fight centers on insulin

Lawmakers are zeroing in on the skyrocketing cost of insulin as they work to combat high drug prices. Congressional Democrats, Republicans and the Trump administration say that lowering drug prices is a priority, and drugmakers are on the hot seat.

Insulin could prove an easy target in that push. The drug hasn't changed much since it was first discovered nearly 100 years ago, and as newer forms of the drug have been introduced, the price has climbed.

What's the state of play? There are now simultaneous bipartisan and bicameral probes from the top health care committees. In the House, the Energy and Commerce Committee's oversight subcommittee, led by Rep. Diana DeGetteDiana Louise DeGetteOvernight Energy: EPA to reconsider cost benefit analysis of air pollution rules | Interior gets new rules on free concert tickets | Dem challenges EPA for skipping hearing House Democrats press leaders to start Trump impeachment WHIP LIST: Democrats who support an impeachment inquiry against President Trump MORE (D-Colo.), is investigating the main insulin makers over "skyrocketing costs." In the Senate, bipartisan Finance Committee leaders have also pledged to investigate spiking insulin prices. Committee Chairman Chuck GrassleyCharles (Chuck) Ernest GrassleyTrump-Pelosi fight threatens drug pricing talks Overnight Health Care — Presented by PCMA — Senators unveil sweeping bipartisan health care package | House lawmakers float Medicare pricing reforms | Dems offer bill to guarantee abortion access Bipartisan senators reveal sweeping health care package MORE (R-Iowa) is a free-market Republican who has long been an adversary of the drug industry.

Will the attention lead anywhere? Sen. Ron WydenRonald (Ron) Lee WydenManning: Additional Assange charges are feds 'using the law as a sword' Overnight Health Care — Presented by PCMA — Senators unveil sweeping bipartisan health care package | House lawmakers float Medicare pricing reforms | Dems offer bill to guarantee abortion access Democratic senator warns of threat to press freedom in new Assange charges MORE (D-Ore.), the top Democrat on the Finance Committee, said he is optimistic the bipartisan interest in reducing drug prices will lead to action, especially with insulin. DeGette said she thinks the findings of the investigation will lead to substantial policy reforms, especially since Energy and Commerce is the committee of record on health care issues. The goal is to hold a hearing on the issue "soon," DeGette said, but noted the investigation will be much larger.

More on their efforts here.





And some related insulin news:

A bill introduced by Rep. Peter WelchPeter Francis WelchDemocrats talk subpoena for Mueller Bernie Sanders is hypocritical on most significant campaign issues Booker takes early lead in 2020 endorsements MORE (D-Vt.) on Wednesday would let patients import cheaper insulin from Canada and other countries.

"Prices for insulin have gone through the roof and are hammering diabetes patients who cannot live without this life-saving medicine yet cannot afford to pay for it," Welch said in a statement.

The bill would legalize importation of insulin from Canada by patients, pharmacists and wholesalers for two years before expanding to other countries with safety standards similar to the U.S.

Welch's proposal would require that the Food and Drug Administration certify and inspect all foreign exporters of insulin, and patients would still need prescriptions to buy it.

Context: A similar bill introduced last month by Rep. Elijah CummingsElijah Eugene CummingsNancy Pelosi fends off impeachment wave — for now House Democrats, Trump lawyers ask appeals court to expedite subpoena case Lawmakers call for 'time out' on facial recognition tech MORE (D-Md.) and Sen. Bernie SandersBernie Sanders2020 Democrats join striking McDonald's workers Billionaire's M gift to Morehouse grads points way to student debt solution Poll: Nearly half of Clinton's former supporters back Biden MORE (I-Vt.) is more broad and would allow the importation of qualifying prescription drugs, excluding controlled substances. Welch co-sponsored that measure.

Given the current makeup of Congress, it's not clear if either can pass. But Senate Finance Chairman Chuck Grassley (R-Iowa) supports importation in some circumstances. Trump said he supported drug importation while running for president but has since backed off. Meanwhile, the FDA is looking at allowing importation in very limited circumstances.

More on Welch's bill here.


Talking about drug importation, this would be pretty big news if it pans out...


Florida GOP governor working with Trump to import cheaper drugs from Canada

Florida Gov. Ron DeSantisRonald Dion DeSantisDHS official: Florida one of the 'best' states on election security, despite 2016 Russian hack Florida teacher arrested for loaded gun in backpack told reporter: 'Ask DeSantis' Trump officials not sending migrants to Florida after backlash MORE (R) on Wednesday proposed importing cheaper prescription drugs from Canada into the state and said that President TrumpDonald John TrumpNASA exec leading moon mission quits weeks after appointment The Hill's Morning Report — After contentious week, Trump heads for Japan Frustration boils over with Senate's 'legislative graveyard' MORE had given his support to the idea.

Why it matters: Importing drugs from abroad is traditionally a Democratic idea. But here two Republicans, DeSantis and Trump, are giving their support to the proposal.

"I want you to know I spoke personally to President Trump on both Sunday and Monday about this," DeSantis said. "He's not only supportive, he's enthusiastic, and he wanted me to tell all of you here today that he supports what we're doing and he will take the necessary executive actions to make sure that we can act under this 2003 law."

What to watch: This proposal is still in its early stages. DeSantis needs to work with the state legislature. But he says Trump's on board. Will the Trump administration really end up approving the move?

Read more here.


Health spending on the rise

U.S. health expenditures are projected to grow at an average annual rate of 5.5 percent every year for the next decade and will represent 19.4 percent of gross domestic product in 2027, according to estimates from the Centers for Medicare and Medicaid Services (CMS).

Among the major payers, average annual spending growth in Medicare (7.4 percent) is expected to exceed that in Medicaid (5.5 percent) and private health insurance (4.8 percent) over the same period, mostly as a result of higher enrollment growth.

On prescription drugs, spending is expected to rise an average of 5.6 percent annually between 2018 and 2027. According to CMS, the rise is due to employers and insurers pushing patients with chronic conditions to adhere to medications better, and higher utilization of new, expensive drugs on the market.


The industry group for pharmacy benefit managers is urging Congressional leaders to speak out against HHS' proposed rebate rule

The proposal, released last month, aims to lower drug prices by eliminating some of the rebates drug manufacturers give PBMs and insurers. Drug companies would instead be encouraged to pass those discounts directly to patients instead.

But the Pharmaceutical Care Management Association (PCMA) says these rebates are a "key tool" PBMs use to save consumers and patients money.

"By eliminating this cost-saving tool and not replacing it with a viable alternative to allow continued negotiation, the administration risks substantially increasing premiums for Medicare beneficiaries," PCMA President and CEO JC Scott wrote in the letter to House and Senate leadership.

"HHS is moving forward with this proposal on an unprecedented and unrealistic timeline. We ask you to urge HHS not to finalize the proposed rule and to oppose legislation that would broaden its scope." 

HHS officials argue the proposal wouldn't significantly raise premiums, and it would force companies to lower their sticker prices.




What we're reading

On health care, 2020 Democrats find their first real fault lines (The New York Times)

Industry, analysts clash over scope of balance billing legislation (Modern Healthcare)

Ebola vaccine will be provided to women who are pregnant, marking reversal in policy (Stat)


State by state

Florida bill aims to protect pre-existing conditions from 'catastrophic' ObamaCare repeal (South Florida Sun Sentinel)

Hundreds protest bill to repeal Arizona law on babies born alive during abortions (Arizona Republic)


From The Hill's opinion page:

Life-saving gene therapies are here -- we need to get them to patients