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 Health Care — Presented by PCMA — FDA issues proposal to limit sales of flavored e-cigs | Trump health chief gets grilling | Divisions emerge over House drug pricing bills | Dems launch investigation into short-term health plans Overnight Health Care — Presented by PCMA — Dems push Pelosi on bill allowing federal funding of abortion | Key Republican says Dems left him out of drug pricing talks | Court upholds Ohio law to defund Planned Parenthood | Trump taps acting FDA chief House Dems to push Pelosi for vote on bill that would allow federal funding of abortion 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 GrassleyTreasury expands penalty relief to more taxpayers Overnight Health Care: Senators seek CBO input on preventing surprise medical bills | Oversight panel seeks OxyContin documents | Pharmacy middlemen to testify on prices | Watchdog warns air ambulances can put patients at 'financial risk' Drug prices are a matter of life and death 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 WydenHillicon Valley: Mueller delivers report, ending investigation | FEMA exposed info of 2.3M disaster survivors | Facebook asks judge to toss DC privacy lawsuit | Trump picks his first CTO | FCC settles lawsuit over net neutrality records Treasury expands penalty relief to more taxpayers Overnight Health Care: Senators seek CBO input on preventing surprise medical bills | Oversight panel seeks OxyContin documents | Pharmacy middlemen to testify on prices | Watchdog warns air ambulances can put patients at 'financial risk' 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 WelchBooker takes early lead in 2020 endorsements Divisions emerge over House drug price bills Trump CFO Weisselberg emerges as key person of interest for Dems 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 CummingsTrump, Congress brace for Mueller findings Ex-Georgia candidate calls for probe, says more than a hundred thousand votes went 'missing' Overnight Health Care: Senators seek CBO input on preventing surprise medical bills | Oversight panel seeks OxyContin documents | Pharmacy middlemen to testify on prices | Watchdog warns air ambulances can put patients at 'financial risk' MORE (D-Md.) and Sen. Bernie SandersBernard (Bernie) SandersHere's what the Dem candidates for president said about the Mueller report Booker takes early lead in 2020 endorsements Harris wants Barr to testify on Mueller report as 2020 Dems call for its release 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 DeSantisGillum launches voter-registration campaign Republicans need solutions on environment too Republicans up for reelection fear daylight with Trump MORE (R) on Wednesday proposed importing cheaper prescription drugs from Canada into the state and said that President TrumpDonald John TrumpMueller report findings could be a 'good day' for Trump, Dem senator says Trump officials heading to China for trade talks next week Showdown looms over Mueller report 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