Gilead Demands $2,340 Per Medicare Patient's Life; Patients Og Private Insurance Will Pay Much More-- Why Hasn't The Company Been Nationalized Yet?

Let me make a 9-part Wendell Potter Twitter thread into a couple of narrative paragraphs. It starts with the whistleblower and former VP of Cigna wanting to puke:

I honestly wanted to vomit when I read this press release from UnitedHealth disclosing how huge its windfall profits over the last 3 months have been, while millions of Americans lost their jobs & health insurance & over 100k lost their lives. You have to wade through 2 paragraphs of complete BS about how “compassionate” UnitedHealth’s employees are, before getting to the real purpose of the release: telling shareholders just how richer they are now.

But there’s a problem for UnitedHealth here... When I was at Cigna, I'd help write quarterly earnings releases. I know the tricks corporate flacks use to try to soften bad news. In UnitedHealth’s case, the bad news was an incredible embarrassment of riches!

That won’t look good to the rest of the country. What to do? Their flacks knew people would be outraged by their profiting off of the pandemic, so they began the release with self-congratulatory nonsense about how the company had “expanded its #COVID19 response efforts” to “address the urgent needs of underserved communities.” You have to wade through that crap before finding that the company had its most profitable quarter EVER, making over $6.6 BILLION in profits, as thousands of other companies had to shut their doors & lay off millions.

Even that $6.6 billion number obscures just how much the company made. They took in $9.2 billion in profits from its operations, nearly 2x what it made over the same 3 months last year. The net profit margin of its insurance business nearly tripled, from 5.4% to 14.3%. Get this-- its “medical loss ratio” (how much it actually pays in medical claims for every dollar it collects in premiums) dropped like a rock, from 83.1% to 70.2%. In other words, during a pandemic, the company paid far less than usual to help people with medical issues! These numbers should make your blood boil & remind you that insurers are unnecessary middlemen. UnitedHealth made all this $ while the number of people “served” by them fell by more than 1.1 million. This game will continue as #COVID19 slams big states like Florida & Texas. I knew insurers would thrive during #COVID19, as elective procedures were cancelled. But the size of UnitedHealth’s windfall shocked even me. It says all you need to know about our health care: During a crisis, millions are suffering, but insurance companies are booming.

This kind of thing makes most of my twitter followers do more than just want to vomit. A little poll I put up yesterday:

There is a growing consensus that Gillead Science's remdesivir seems to cut the risk of death in some patients with severe COVID-19. Gilead has kept the supply low and the prices high and is certainly profiteering gigantically now charging $390 per vial.

In a statement, Gilead Sciences chairman and CEO Daniel O’Day said the company has set a price for governments of developed countries of $390 per vial. Based on current treatment patterns, the vast majority of patients are expected to receive a 5-day treatment coursing using 6 vials of remdesivir, which equates to $2,340 per patient.

In the US, the same government price of $390 per vial will apply. Because of the way the U.S. system is set up and the discounts that government healthcare programs expect, the price for U.S. private insurance companies, will be $520 per vial.

Gilead has entered into an agreement with the U.S. Department of Health and Human Services (HHS) whereby HHS and states will continue to manage allocation to hospitals until the end of September. After this period, once supplies are less constrained, HHS will no longer manage allocation.

“In the developing world, where healthcare resources, infrastructure, and economics are so different, we have entered into agreements with generic manufacturers to deliver treatment at a substantially lower cost. These alternative solutions are designed to ensure that all countries in the world can provide access to treatment,” O’Day added.

U.S. taxpayers underwrote the cost of developing remdesivir. Because of a nightmare, corrupt neo-liberal president from Arkansas, Gilead was set free to rip off those same American taxpayers. Daniel O'Day should be tried and thrown in prison with his board of directors. Trump will never do that; neither will Biden. Gilead is licensing the drug to pharmaceutical companies in India, Egypt and Pakistan. "These licensing allow the companies to gain the technology used for remdesivr from Gilead and manufacture them at their own scale for faster availability to the public. Additionally, the agreement lets these companies set their own prices for the generic product they produce. The licenses are royalty-free until the World Health Organization declares the end of the Public Health Emergency of International Concern regarding COVID-19, or until a pharmaceutical product other than remdesivir or a vaccine is approved to treat or prevent COVID-19, whichever is earlier, Gilead said." Generous of the American taxpayer, isn't it? Watch this, especially if you were brainless enough to have not voted for Bernie:





So where does Trump come in? Because you know if there's some dirty money to be made by ripping people off, he's there, right? Yesterday, CNBC reported that Bernie and Elizabeth Warren slammed the Trumpist regime for giving the Gilead crooks a "windfall" deal. They-- and allied senators-- said "the deal will give Gilead up to $500 million in revenue borne almost entirely by American taxpayers, 'in whole or in part' through higher insurance premiums. 

“Outside analysts have concluded that ‘The deal is amazingly good for Gilead’s executives and shareholders and amazingly bad for everyone else-- bad for taxpayers, terrible for public health, and unethical,’” the lawmakers wrote in the later dated Thursday. “We are therefore requesting information from the Department to help us better understand why President Trump-- or whichever Administration officials were responsible-- would strike such an expensive deal, and what steps the Administration is taking to ensure sufficient supply of the drug.”

...The deal gives the U.S. more than 500,000 treatment courses of the antiviral drug for U.S. hospitals through September, the Department of Health and Human Services announced June 29. That represents 100% of Gilead’s projected production for July and 90% of production for August and September, according to the agency. Gilead said it would sell remdesivir for $520 per vial in the U.S. to patients with private insurance and $390 per vial to federal insurance programs like Medicare as well as foreign countries. The majority of patients treated with remdesivir receive a five-day treatment course using six vials of remdesivir, the company said. That would bring the cost to $2,340 for foreign and U.S. Medicare patients and $3,120 for U.S. patients with private health coverage.

That means Gilead is charging “American health insurers the highest prices in the world,” the senators wrote.

“In other words, America’s private health insurers-- and, ultimately, all families and businesses that pay for these costs via health insurance premiums-- will be paying $860 more than governments in other countries will pay,” the lawmakers wrote in the letter.

There are no Food and Drug Administration-approved treatments for Covid-19, which which has infected more than 13 million people worldwide and killed at least 584,000, according to data compiled by Johns Hopkins University.

Remdesivir, which was being developed as early as 2009, was granted an emergency use authorization by the FDA in May after the National Institute of Allergy and Infectious Diseases released preliminary results from a study that showed Covid-19 patients who took the drug usually recovered after 11 days, four days faster than those who didn’t take it.

When Azar announced the agreement last month, he called it “an amazing deal to ensure Americans have access to the first authorized therapeutic for COVID-19. To the extent possible, we want to ensure that any American patient who needs remdesivir can get it.

Careerism Vs Courage-- How Will They Play Out In The Impeachment Vote?

Saturday morning, I pointed out on Twitter that though Pelosi managed to hold the entire Democratic caucus together to pass H.R.-3, her rather weak drug price reduction bill, just before the vote, the Republicans offered a way to kill the legislation via a Motion to Recommit. That failed but 3 super-conservative fake-Democrats voted with all the Republicans for it-- Blue Dogs Josh Gottheimer (NJ), Mikie Sherrill (NJ) and Ben McAdams (UT). Another Twitter user, Maria, offered up a typical excuse for this kind of bad vote: "NJ is big Pharma territory."

What she meant is that several drug companies are based in New Jersey. The Big PhRMA companies-- Pfizer, Amgen-- Eli Lilly, AbbVie, Merck, AstraZeneca, Abbott Labs, Bristol-Myers Squibb, Novartis, GlaxoSmithKline, Milan, Bayer, etc-- give millions of dollars in bribes to many members of Congress annually. Last cycle, New Jersey's delegation did pretty well. Among the current House members, the biggest amounts went to:

• Frank Pallone (D)- $117,200
• Bonnie Watson Coleman (D)- $59,812
• Josh Gottheimer (Blue Dog)- $49,280
• Bill Pascrell (D)- $45,500
• Don Norcross (New Dem)- $38,900
• candidate Mikie Sherrill (Blue Dog)- $35,311
• candidate Tom Malinowski (New Dem)- $24,097
• Donald Payne (D)- $20,800
• candidate Andy Kim (D)- $19,018
• Chris Smith (R)- $12,250
• candidate Jeff Van Drew (Blue Dog)- $7,228

But the impetus for bribery from these savvy companies--and from their lobbyists-- follows power, not geography. Pallone didn't get a lion's share of loot ($694,170 since he was elected) because he represents Middlesex and Monmouth counties, but because he is chair of the House Energy and Commerce Committee and can-- and does-- protect the drug companies from progressive legislation like Medicare-for-All. The 5 current House members who have taken the most in bribes from PhRMA are those who serve their masters best, not those who live in their districts:

• Fred Upton (R-MI)- former chair of Energy and Commerce- $943,531
• Anna Eshoo (D-CA), chair, Energy and Commerce's Heath Subcommittee- $891,815
• Kevin McCarthy (R-CA)- corrupt minority leader- $849,550
• Steny Hoyer (D-MD)- corrupt majority leader- $719,572
• Frank Pallone (D-NJ)- chair of Energy and Commerce- $694,170

A warning from progressive California congressional candidate Cenk Uygur: "Drug companies don't give politicians money for charity, they do it to buy them. And unfortunately it works. Everyone knows these are bribes. The only people who won't acknowledge it are corporate politicians on both sides and the corporate media. This is a sick system that lets people die for profit. Any politician that takes money from the drug companies is selling out their voters on behalf of their donors."

On Friday evenings, Chris Hayes has taken to doings his MSNBC shows in front of a live audience. This week one of his guests was Ohio Senator Sherrod Brown (D). In his last couple of seconds on the air, Brown managed to blurt out one of the most crucial things he has ever said about electoral politics and how it impacts American politics. Unfortunately an ad was calling and it never got discussed on the show: "If politicians are willing to lose an election, they're always better at their job." That idea goes beyond geography, beyond sources of campaign funds, beyond ideology, even beyond partisan affiliation. It goes to character-- integrity, honesty, sense of honor... courageousness. Nothing else much matters in politics without it.

It's the opposite of political careerism. And it speaks to the real reason why craven and cowardly political hacks like Gottheimer, Sherrill and McAdams were willing to cross the aisle and vote with the GOP to kill a bill that would reduce the cost of medicine for their constituents in Bergen County, in Morris County and in Salt Lake County.

In the next few days, Pelosi will tell Hoyer to call an impeachment vote. Several Democrats in difficult districts have already announced they intend to vote to hold Trump accountable for his on-going criminal behavior. One, putrid New Jersey Blue Dog Jefferson Van Drew (widely expected to bolt the party and seek reelection as a Republican) has said he is absolutely voting against impeachment. He's not even in a prohibitively red district. Obama won the NJ-02 district comfortably both times he ran. Trump won in 2016-- 50.6% to 46.0%-- not because the district had suddenly turned red, but because Hillary was such a lousy candidate for the working class voters who dominate the district. The PVI is just R+1, not that much of a stretch for a Democrat.

There are no normal Democrats talking about voting against impeachment, but there are around a dozen from the Republican wing of the Democratic Party who are... all Blue Dogs and New Dems, of course. These are the other Democrats besides Van Drew who are most likely to vote against impeachment... along with their districts' PVIs. (Notice that 3 are in blue districts.)

• Collin Peterson (Blue Dog-MN)- R+12
• Anthony Brindisi (Blue Dog-NY)- R+6
• Ben McAdams (Blue Dog-UT)- R+13
• Kendra Horn (Blue Dog-OK)- R+10
• Chrissy Houlahan (New Dem-PA)- D+2
• Mikie Sherrill (Blue Dog-NJ)- R+3
• Angie Craig (New Dem-MN)- R+2
• Dan Lipinski (Blue Dog-IL)- D+6
• Elissa Slotkin (New Dem-MI)- R+4
• Xochitl Torres Small (Blue Dog-NM)- R+6
• Ed Case (Blue Dog-HI)- D+17

Some of the least courageous of the usual wafflers have aleady come out to say they are voting to impeach the bastard, including Elaine Luria (VA), Max Rose (NY), Conor Lamb (PA), Colin Allred (TX), Susan Wild (PA), Susie Lee (NV) and Tom O’Halleran (AZ). O'Halleran, a former Republican legislator currently pretending to be a Democrat, is now a Blue Dog. He has a very intense primary from progressive activist Eva Putzova and that has, of late, moved him towards the mainstream on issues-- like this-- where he would be more comfortable voting with the Republicans. In his announcement Friday, he said that "Trump abused the power of the presidency and broke his oath of office when he bribed the nation of Ukraine by withholding military aid they had already been promised in exchange for help investigating a political opponent. I will vote to impeach the President because this bribery and abuse of power violated the constitution and put our national security and our international relationships at risk." It's lucky we have Putzova pushing him so hard.

Last summer progressive Democrat Teresa Tomlinson called for impeaching Trump. She's running for a Senate seat held by an extreme Trump partisan, David Perdue. At the time, Tomlinson wrote that "It’s fear that cripples the Democratic Party. Fear of our policies, fear of who we are, and fear of the Republicans. Yes, fear is what has politically cost us in the last many election cycles. One cannot lead if one is afraid. The thing about leadership is that people want their leaders to be brave. They care less about what you think on the issues than whether you have the moxie to fight for them and the strength of conviction to tell them what you really think... That’s what the Right can’t stand about The Squad. Those women are fearless about their beliefs. They refuse to be bullied, and that is dangerous to the Republican playbook of shaming scared Democrats into milk toast, mealy-mouthed, baby-splitting positions that are equivocal and stand for nothing. American voters revile those who won’t tell the people what they think. Even if you don’t support the policies-- or certainly some of the statements-- of The Squad, you can’t deny that you appreciate that they unabashedly tell the world what they think." She continued with a statement all Democrats wavering and quivering in fear-- especially an arch-coward like Brindisi-- should study:

Impeachment is not about undoing the last election or impacting the next. It certainly is not about the polls as the Founding Framers made perfectly clear in Federalist Paper, No. 66. It is about stopping a president who would abuse and misuse the power of the presidency so that not another day passes-- not another circumstance presents itself-- where a president, unfit for duty because of the commission of High Crimes or Misdemeanors (defined as misdeeds) can inflict his/her poor judgment on the office, the country, or the people. Oh, if only impeachment proceedings had been instituted sooner, the damage that might have been averted.

Instead, Democrats are afraid of what the Republicans will say about it-- what the bullies will do to us on the way home. So, we cut through the alley to avoid the fight and controversy. We detour our duty of leadership and good government. Commencing impeachment proceedings is about employing the constitutional duty that our elected leaders were sworn to do-- not about mitigating to the finish line and hoping no one notices that we wouldn’t use the tools entrusted to us to keep the American system on the rails. All Democrats, and many Independents and Republicans, understand that Donald Trump has committed High Crimes or Misdemeanors, so if this conduct doesn’t warrant the commencement of impeachment proceedings, then what would? We must seriously consider the example of tolerance for harmful conduct at the highest levels of our government we are creating.

The key to winning is that you don’t aim to win, you aim to lead. If you lead, the winning takes care of itself-- or at least you move the needle so profoundly you set up the next winner, as did Stacey Abrams in Georgia with her heroic non-loss in Georgia. She was who she was and voters responded to that.

That’s not fear, that’s winning.

Do You Think That Trump Is The Only One Motivated By Corruption In The Battle Over Drug Prices? Wake Up

Medicare-for-All Will Never Pass And Drug Prices Will Remain High Until Pelosi And Wendell Primus Are Gone From Congress

The public-- Republicans, Democrats, Independents, non-voters-- everyone wants cheaper drug prices, but the prices continue to rise. The public wants Congress to do something about it. But nothing-- a whole lot of nothing-- is getting done. PhRMA charges what the market lets them get away with. As Sam Baker pointed out in Politico over the weekend, "the most expensive drug in the world-- a gene replacement therapy that treats spinal muscular atrophy-- came to market earlier this year, with a sticker price of $2.1 million in the U.S. That drug is a groundbreaking new therapy, but prices also continue to rise for old, familiar products that people depend on every day-- most notably, insulin

This week, the House is going to vote on a very modest and unsatisfactory bill that Pelosi has been pushing and that progressives are embarrassed over. Trump prefers Chuck Grassley's Senate bill, which McConnell isn't thrilled with and which the right won't vote for. To pass it, it would take a lot of arm-twisting of conservative Republicans that Trump will never do, plus all the right-of-center and moderate Democrats. And then it would have pass the House. Big PhRMA opposes all the bills-- especially the effective one, H.R.1046 that Lloyd Doggett (D-TX) introduced and is backed by 127 Democratic co-sponsors. Doggett's bill is the only one that would crack down on PhRMA and it is being backed by Democrats from progressives like AOC (NY), Barbara Lee (CA), Ro Khanna (CA), Pramila Jayapal (WA), Raul Grijalva (AZ), Ayanna Pressley (MA), Jerry Nadler (NY), Ilhan Omar (MN), Katie Porter (CA), Jamie Raskin (MN), Ted Lieu (CA), Rashid Tlaib (MI), Andy Levin (MI), and Jan Scxhakowsky (IL) to even some of the most cowardly conservatives like Charlie Crist (Blue Dog-FL), Elissa Slotkin (New Dem-MI), Max Rose (Blue Dog-NY), Dan Lipinski (Blue Dog-IL), Abigail Spanberger (Blue Dog-VA), Gil Cisneros (New Dem-CA), Debbie Wasserman Schultz (New Dem-FL), Stephen Lynch (New Dem-MA) and Elaine Luria (New Dem-VA).

Back to Politico: "The big picture: The pharmaceutical industry almost always gets its way in Washington. The industry's top two trade organizations, together, spent more than $35 million on lobbying in 2018, more than they've ever spent before. That doesn't include individual companies' contributions, nor does it include any of the industry's campaign contributions, which are substantial."

Cenk Uygur, the progressive reform candidate running for the open congressional seat in a district in the suburbs north of Los Angeles (CA-25) told us this morning that "Drug companies don't give politicians money for charity, they do it to buy them. And unfortunately it works. Everyone knows these are bribes. The only people who won't acknowledge it are corporate politicians on both sides and the corporate media. This is a sick system that lets people die for profit. Any politician that takes money from the drug companies is selling out their voters on behalf of their donors."

This is a list of current House members who have taken the most in bribes from the health sector (which includes Big PhRMA) since 1990. All of them have been in top leadership and committee positions to prevent any movement on meaningful reform. All of them belong in prison:

• Frank Pallone (D-NJ)- $6,610,354
• Steny Hoyer (D-MD)- $4,970,630
• Michael Burgess (R-TX)- $4,466,629
• Kevin McCarthy (R-CA)- $4,403,284
• Fred Upton (R-MI)- $4,276,714
• Kevin Brady (R-TX)- $3,611,054
• Greg Walden (R-OR)- $3,468,191
• Anna Eshoo (D-CA)- $3,207,836
• John Shimkus (R-IL)- $3,026,262
• Nancy Pelosi (D-CA)- $2,944,209
• Ron Kind (D-WI)- $2,869,860
• Richard Neal (D-MA)- $2,869,426

On Friday, Adam Cancryn and Sarah Karlin-Smith, writing for PoliticoPro, reported that House progressive leaders were testing support for an effort to block Pelosi’s bill, "amid rising frustration over the crafting of the Democrats’ signature legislation.

The Congressional Progressive Caucus circulated a questionnaire asking its members if they would be willing to oppose a procedural vote on the bill-- effectively stalling the top Democratic priority-- unless Pelosi agrees to make a series of changes moving it further left, or allow votes on progressive amendments." Pelosi, who has a bizarre relationship with Big PhRMA and with their lobbyists and "ex"-lobbyists, hit the ceiling.

Few progressives have publicly suggested opposing the drug pricing legislation up until now, even as they complained of being locked out of negotiations over its specifics. The Progressive Caucus has struggled in the past to marshal its diverse membership against major Democratic priorities, and Pelosi’s drug pricing bill is seen as key to keeping Democratic control of the House in 2020.

But progressives' anger with top Democrats reached a new pitch Friday, after Politico reported that leadership weakened a key provision authored by Rep. Pramila Jayapal (D-WA) and approved by the Education and Labor Committee in October.

“I don’t know why I’m having to fight so hard for an amendment that already passed through committee,” Jayapal said.

The bill originally directed the federal government to study how it could require drugmakers to refund money to employer-sponsored health plans when the companies raised prices above the inflation rate-- and then issue regulations based on those conclusions.

Yet in a private meeting with advocacy groups on Thursday, top aides led by Pelosi health adviser Wendell Primus said they were cutting the regulations mandate, effectively reducing it to a simple call for a study, people who were in the room said.

You may have noticed that Blue America is in the middle of a fundraiser for Pramila's campaign. It's because of this kind of thing that we're trying to help her. Who else is going to stand up to Primus who is exactly as anti-healthcare as any garden variety Republican. There is no presence more detrimental to healthcare policy in Congress than Wendell Primus. You can help-- and maybe win a Nirvana gold record award-- by clicking on the Blue America Nirvana thermometer above.

Cancryn and Karlin-Smith continued that "Progressives have unsuccessfully pressed leadership for months to make changes in the bill that would fully eliminate the ban on Medicare’s ability to directly negotiate drug prices, increase the number of drugs the government can target for direct negotiation and make negotiated prices available to the uninsured." Big PhRMA's man inside Pelosi's office warned that Pramila and other progressives are "gravely misreading the situation if they try to stand in the way of the overwhelming hunger" for Pelosi's bill that most people view as slightly better than nothing.

The last-minute changes have left liberals irate over what they characterized as a leadership attempt to steamroll the left wing on a top priority.

Leaders had vowed to allow rank-and-file members to help shape the bill for months, they said, only to speed the legislation to the floor in the final weeks of the year. Now, they said, they were quietly watering down language that progressives touted as the element that justified supporting a bill they otherwise saw as far too timid.

“For many of my residents at home, constantly there’s this lack of a sense of urgency they feel is coming out of this chamber,” said Rep. Rashida Tlaib (D-MI). “If we’re not going to take this head-on right away, it’s not going to make a difference.”

In an interview, Rep. Alexandria Ocasio-Cortez (D-NY) characterized the drug pricing bill as the latest in a string of issues where Democratic leaders ignored progressive lawmakers.

Meanwhile, Doggett, the congressman from Texas who actually wrote the good drug pricing legislation said "I've tried to be positive throughout this and talk about improving the bill, rather than opposing the bill, but it would be really difficult to vote for it if no improvements are made... We are setting the standard, we are setting the model for what a Democratic president would do on prescription drugs."

Trump Promised Lower Drug Prices... But He Has Moscow Mitch Blocking Both Democratic And Republican Bills That Would Do That. Why Is He Such A Dick?

I was on the phone a few minutes ago, talking with a super-progressive running for a congressional seat in central Texas and she brought up Lloyd Doggett, chair of the House Ways and Means Health Subcommittee, and more progressive than anyone else in the Texas congressional delegation. Some people consider his bill, the Medicare Negotiation and Competitive Licensing Act of 2019 (H.R.1046) too radical; it would help too many working families and infuriate too many Big PhRMA executives, lobbyists and donors. Doggett's bill "requires the Centers for Medicare & Medicaid Services (CMS) to negotiate with pharmaceutical companies regarding prices for drugs covered under the Medicare prescription drug benefit. (Current law prohibits the CMS from doing so.) The CMS must take certain factors into account during negotiations, including the clinical- and cost-effectiveness of the drug, the financial burden on patients, and unmet patient needs. If the CMS is unable to negotiate the price of a drug, such drug is subject to competitive licensing in order to further its sale under Medicare, notwithstanding existing government-granted exclusivities. Additionally, for one year after a drug is provided under a competitive license, such drug is also subject to specified price limitations; if the drug is not offered at such prices, the drug is subject to additional licensing that furthers its sale under any federal program (e.g., Medicaid)." Doggett has 127 co-sponsors, all Democrats.

The bill was too much for Pelosi and Hoyer and it remains bottled up in Frank Pallone's Energy and Commerce Committee, where Pallone will make sure it never sees the light of day. Instead, Pelosi passed a meh bill-- better than nothing but not nearly as good as Doggett's bill.

But even that bill, that passed the House with bipartisan support-- and a nod from Trump-- is being prevented from getting a debate, let alone a vote, by Moscow Mitch in the most dysfunctional Senate in American history. Marianne Levine and Sarah Karlin-Smith reported on the morass the struggle to lower the cost of drugs is experiencing in the GOP-controlled Senate for Politico over the weekend.

An even less helpful bill was approved by the Senate Finance Committee (19-9) but the Finance Committee chair who's sponsoring it, Chuck Grassley (R-IA), says McConnell won't even let that one come to the floor. He said Trump-- who is probably just pretending to want to lower drug prices-- would have to lean on Moscow Mitch and tell him to put it up for a floor vote. There's no question that it would pass, but Trump doesn't really want it to pass, as long as he doesn't get the blame for it not passing.

The standstill-- even on an issue that has bipartisan backing and the support of a fickle president-- reflects the unceasing gridlock of today’s Senate and how difficult it is to move any major legislation through the upper chamber.

With Democrats in control of the House, the GOP-controlled Senate has shifted virtually its entire focus to confirming Trump’s judicial nominees where bipartisan votes aren’t needed. And heading into an election year, McConnell is loath to bring up issues that divide his caucus or risk alienating powerful industry groups. Legislative activity will only decline further if and when the Senate holds an impeachment trial that will further polarize the Capitol.

“I’ve said to people here, if you’ve been here four years or less you’ve never seen the Senate,” said Senate Minority Whip Dick Durbin (D-IL) “And you would have loved it. It was an interesting place. We had bills, and amendments ... we did big things.”

Senate Republicans have unsurprisingly ignored a raft of liberal measures passed by the Democratic House, including bills to curb gun violence or overhaul election laws. But even ostensibly less controversial legislation to reauthorize the Violence Against Women Act or strengthen retirement security have also run aground amid partisan bickering.

The only measures regularly moving are must-pass bills to avoid a shutdown, and lawmakers are still struggling to reach a long-term deal to fund the government.

McConnell has made no secret that stacking the judiciary with conservatives is a top priority. But he also argues that the Senate could do more if the House wasn’t stalling on matters like the United States-Mexico-Canada trade agreement or the annual defense policy bill.

“If [Democrats] are going to keep plowing ahead with their impeachment obsession, they cannot abdicate their basic governing responsibilities at the same time,” McConnell said recently.

Speaker Nancy Pelosi is pushing her own legislation to curb the cost of prescription drugs, but McConnell has said it has no chance in the Senate.

Most Republicans have long opposed federal intervention when it comes to the cost of prescription drugs, but public support for action as well as Trump’s embrace of the issue may be shifting the party’s stance.

The GOP leader said in September that the Senate’s next steps on prescription drugs were “under discussion” and that the chamber is “looking at doing something on drug pricing.” Still, McConnell has demonstrated little interest in taking up Grassley’s bill, which would cap seniors’ out of pocket costs on drugs in Medicare and penalize companies that levy large price increases, among dozens of other measures aimed at lowering spending on medication.

That’s despite Trump saying he likes Grassley’s bill “very much” and top White House aides throwing their support behind the legislation.

Health industry sources closely tracking the Senate proposal, say McConnell’s office is not making an effort to help the White House get his members on board.

Asked whether McConnell would bring the bill to the floor, one Republican senator said, “I can’t imagine... It’s like Grassley, and a couple of Republicans and all the Democrats on the committee.”

Grassley has acknowledged that any action on his bill is likely slip into 2020 and that the measure currently doesn’t have enough support to pass in the Senate.

Grassley and Sen. Ron Wyden (D-OR), the bill’s coauthor and the Finance Committee’s ranking member, are trying to make changes to the bill to garner more Republican backing.

“This bill may not have 60 votes today, but when Republicans wake up to the fact that 22 of them are up for reelection and in every state it’s an issue ... they are going to soon realize that this is the road to do something responsible,” Grassley said at an event late last month . “But we’re not there yet.”

Since the legislation advanced out of the Senate Finance Committee in July, administration officials including Health and Human Services Secretary Alex Azar and Joe Grogan, director of the White House Domestic Policy Council, have been on the Hill pushing the bipartisan bill with little to show for it.

The measure was approved by the panel on a 19-9 vote, with six Republicans joining all Democrats and nine Republicans opposed. A chairman advancing a bill through committee over the opposition of most in his party is an unusual event, but the fact underscores Grassley’s commitment to moving ahead.

GOP senators who voted against the bill largely cited a proposed change to Medicare’s prescription drug benefit that they say is akin to implementing government price controls; it would impose financial penalties on companies that raise prices faster than inflation.

Grassley has said provision is necessary to keep Democrats on board with the bill. But even some of the Republicans who voted for it in committee have indicated they might not support final passage on the floor if that language remains.

Another large health policy package with bipartisan support has also faced headwinds.

The Senate HELP Committee approved a bill this summer that would aim to prevent surprise medical bills, raise the legal age to buy tobacco to 21-- a priority of McConnell’s-- and increase competition in the drug industry. While the White House hasn’t backed the package explicitly, Grogan penned an op-ed this past Wednesday calling on lawmakers to “come back to Washington in December ready to vote to protect patients from surprise medical bills.”

Momentum on the legislation stalled after pushback from doctors and dark money groups over how to resolve “surprise” bill disputes between insurance companies and health care providers. Senate GOP leadership hasn’t given any assurances it would bring the measure to the floor, though one Senate Republican aide said it could become part of an end-of-year spending package.

“I hope we can come up with a consensus document the leaders could attach to any piece of legislation they want to attach it to,” HELP Chairman Lamar Alexander (R-TN) told reporters recently. “I think sooner or later people are going to say, ‘We’d like to do more than confirm judges and talk about impeachment.’”

Indeed, the Senate has not been doing much legislating these days. Republicans have instead prioritized the confirmation of judicial and executive branch nominees, even changing Senate rules to speed up the process. So far this Congress, the Senate has held 268 votes on nominations, compared to 98 votes on legislation.

The House has sent more than 300 bills over to the Senate, and Democrats are quick to point out that many of them have Republican support.

I spoke about this drug pricing issue with the two most progressive Senate candidates running for Republican-held seats this cycle, Betsy Sweet in Maine and Andrew Romanoff in Colorado. Andrew, the former speak of the Colorado House, is in a tough election race with two conservatives, John Hickenlooper, the establishment Democrat in the primary, and Trumpist Cory Gardner in the general. Health care-- he's a Medicare-for-All proponent-- is one of the top issues motivating his campaign. He told me that "The high cost of health care is driving more than half a million Americans into bankruptcy each year-- and 35,000 to an early grave. We need senators who will stand up to the drugmakers and the insurance companies, not do their bidding. But that won’t happen until we put an end to the corrupting influence of corporate cash and elect lawmakers who no longer owe their seats to the industries they’re supposed to be regulating."

Betsy Sweet has a similar situation. Chuck Schumer picked an easy to manipulate, middle of the road candidate in Maine, just the way he did in Colorado. "Apparently," Betsy told, "the political money from big PhRMA is more important to Mitch McConnell and his Senators than the bankruptcies  and lack of medical care millions are experiencing from unaffordable prescription drugs. Medicare for All and universal coverage the ultimate answer. The bills being held up are steps in the right direction. Inaction is unacceptable. Senator Susan Collins ought to be demanding publicly that McConnell take action on this."

Midnight Meme Of the Day!

by Noah

Gee, look at this pair of drug-pushing assclowns. Someone even gave the daddy a medal. You almost have to give the Sackler Cartel some kind of credit. After all, they wanted to be honest upstanding citizens of the world and didn't want to do anything illegal like selling heroin or crack. No, they used some of that good old American capitalist ingenuity and invested their money in something worse but legal! Yay, Purdue Pharma! How long before our "I Hate The World And Everything That lives" president gives all of the Purdue Pharma's Sackler family a special "El Chapo Medal Of Freedom" award?

El Chapo was lazy, and, a loser. He must know that now that he is in a jail cell he can't tunnel out of. He's probably green with envy that he didn't have the smarts to sell legal drugs that kill people, but, hey, he was old school; not the Sacklers! Now they are trying to settle with the individual states of the country they attacked with their plague of oxycontin while reportedly trying to hide some of their billions. How long before they put on disguises and disappear faster than Jeffrey Epstein's madam? They are literally buying their freedom. They aren't spending one day, one hour, one minute in jail for taking the tobacco model and pushing it to new murderous lows. "Here America. Here world. Here's a nice safe drug that will ease your pain! Don't you worry, it's safe. First one's free. Have a sample, and if you have worries, don't worry, we have something for that, too!" Of course it isn't safe, but they knew all that, just like the tobacco companies knew that their beloved product gave people cancer and the oil companies knew they were hastening death-dealing global warming and GM knew their Corvairs were unsafe at any speed. It's an old, old story and it just gets worse and worse because corporate pigs in suits and the bankers who love them get worse and worse as human beings.

The Sacklers and their Purdue Cartel are going to be paying out what for them is pocket change, even though their hideous press flacks and monstrous lawyers will bitch and moan that the fines are so unfair, so unfair. Puh-leeze. Anything short of truck-draggings over salted broken glass before being tossed in a dungeon for life is what's unfair. But, as I said, they are buying their way out of it. Now, ask yourselves how they bought into into it. How did these death merchants get approval from judges and the FDA? Three guesses and the first two don't count because you only need one if you have half a brain. They got their evil product to us the old fashioned way. The cops were on the take.

Don't go thinking the pols in Washington will do anything but a whitewash investigation, if that. Big Pharma's lobbyists are busy filling more delivery bags with cash as you read this.

By The Time McConnell Drops Dead Or Is Defeated For Reelection, Will Prescription Drugs Cost Any Less?

Drug prices are too high for many reasons, but there is just one person blocking a fix: MoscowMitch

I have to admit that Pelosi’s plan to lower drug costs is more progressive than I-- or anyone else-- expected. It certainly isn't the Lloyd Doggett plan she's kept bottled up in committee, but it's a lot closer than anyone thought she would go. If passed-- McConnell will kill it and anything like it-- it would permit Medicare to negotiate with drug makers for reasonable prices on 250 commonly-used and over-priced medicines. The price they come up with isn't just for Medicare users, but for all consumers. (And it abandons the stupid proposal from Blue Dogs and other conservatives to use third-party arbitration.) Pelosi's touch is that the plan dramatically alters the way Medicare divides responsibility for drug costs between pharmaceutical companies, insurers and taxpayers. The plan would set the maximum price of a drug at 1.2 times what other wealthy countries pay for it. a step in the right direction... but a baby step-- and NOTHING like what Bernie's and Pramila Jayapal's Medicare-for-All plan would accomplish.

Companies that refuse to negotiate in good faith would be fined-- which isn't as good as what Doggett's bill would do, basically ending their patent protection by allowing other companies to begin selling generic versions. All Republicans plus Democrats who take bribes from the pharmaceutical companies oppose this. The biggest drug company allies are the members who have taken the most in bribes from the drug makers. These are the dozen worst currently serving (in Congress, not in prison, where they belong):

• Fred Upton (R-MI)- $933,531
• Anna Eshoo (D-CA)- $882,315
• Kevin McCarthy (R-CA)- $835,950
• Steny Hoyer (D-MD)- $692,322
• Frank Pallone (D-NJ)- chair, House Energy & Commerce- $688,670
• Greg Walden (R-OR)- $632,603
• Jim Clyburn (D-SC)- $607,108
• Ron Kind (New Dem-WI)- $445,703
• Michael Burgess (R-TX)- $438,000
• Richard Neal (D-MA), chair, House Ways & Means- $388,600
• Brett Guthrie (R-KY)- $382,500
• Diana DeGette (D-CO)- $381,275

Pelosi's plan would also force drug companies that have raised the price of drugs covered by Medicare by more than the inflation rate since 2016 to lower the price.

How do we know any of this is true-- since Pelosi's bill isn't publicly available yet? On Monday, drug stocks fell sharply, particularly pharmaceutical giants AstraZeneca and GlaxoSmithKline when word got out that Congress is going to finally crackdown on runaway prescription drug prices. Ro Khanna, a strong Medicare-for-All advocate issued a statement after Pelosi's plan started circulating:"I am pleased Speaker Pelosi’s plan takes on outrageously high drug prices through direct negotiation as opposed to private arbitration, as recommended by me and my colleagues in the Progressive Caucus,” said Rep. Khanna. “I am also proud that the Speaker has drawn from parts of my Prescription Drug Price Relief Act with Senator Sanders, ensuring that we don’t pay more for drugs than citizens in other countries. I hope the Speaker considers eliminating the reported 250-drug cap on negotiations. We should not bind our hands when it comes to lowering health care costs."

As she mentioned earlier this week, progressive California Central Valley congressional candidate Kim Williams explained that while she and her teams were knocking on doors all summer "the topic that came up most was healthcare. We've heard story after story about people who are on the brink of homelessness because of medical debt. We also lack care, and I, myself, have to drive two hours to get to my doctor often after waiting weeks to get an appointment. One in four adults live below the poverty line here and two-thirds of our kids are on some form of federal assistance. And if the national average holds true for this district, at least twenty percent of our residents are choosing between medicine and food. Is now really the time to be playing political football? And what is the point of holding on to a majority if you're going to put politics over people's lives? Every crisis families in this district face is directly tied to political neglect, and it's long past time for change.

Kim backs Medicare-for-All. The thermometer above is so that you can contribute to candidates for Congress who are campaigning on a Medicare-for-All plank  In light of what she had to say, let me reprint something published by the NY Times yesterday: "About 27.5 million people, or 8.5 percent of the population, lacked health insurance for all of 2018, up from 7.9 percent the year before, the Census Bureau reported Tuesday. It was the first increase since the Affordable Care Act took full effect in 2014, and experts said it was at least partly the result of the Trump administration’s efforts to undermine that law." And that's what happens when you vote for conservatives.

J.D. Scholten also backs Medicare-for-All. "Lowering the cost of prescription drugs is a no-brainer," he told me. "As I’m driving around my district in Sioux City Sue, I frequently stop into gas stations and see a donation box on the counter for someone who just got sick or just got into an accident. The skyrocketing cost of prescription drugs plays a huge role in the unaffordability of our healthcare crisis. Ultimately, this all comes back to money. Big Pharma and healthcare lobbyists have wormed their way into Washington and have politicians bought and paid for. The healthcare and pharmaceutical industries pay for access and the ability to write legislation that benefits themselves meanwhile Americans across the country are forced to choose between life-saving prescription drugs and their rent. Big pharma shouldn’t be holding the health of Americans hostage, and politicians shouldn’t be giving them the tools to do it. My campaign is proud to refuse corporate PAC money and supports Doggett’s bill to negotiate drug prices and Medicare for All. Meanwhile, my opponent, Steve King refused to co-sponsor Lloyd Doggett's bill to lower drug prices, continues to take corporate PAC money, and peddles his own selfish agenda at the expense of Iowa’s 4th district."

Will Joe Biden Hand the Marijuana Industry to Big Pharma?

Image source: A 2009 article in Hemp News entitled "Big Pharma Eyes Medical Marijuana." They've had their eye on this market for a while.

by Thomas Neuburger

According to recent reports, Joe Biden's plan for marijuana decriminalization calls for expunging criminal records of those convicted of marijuana use (a good and necessary thing), but it also calls for moving marijuana from the Schedule I drug list, which includes cocaine and heroin, to the Schedule II list, which treats it like penicillin and your asthma inhaler.

The offered reason for the shift is that this would "allow the government to research" marijuana according to a senior Biden campaign official, "who briefed reporters on his plan."

The problem with this proposal is that it hands control of marijuana production and distribution to the same people who control the production and use of all other Schedule II drugs — the pharmaceutical industry.

What could go wrong? Vox writer Cliff Roberts explains:

Would making weed Schedule II—intended only for strictly controlled pharmaceutical drugs, and not recreational nor wellness products, the rubrics under which cannabis is often marketed and sold to Americans—make more sense? It might, but here's the catch: Drugs listed under Schedule II (which include cocaine and methamphetamine as well as prescription opiates like fentanyl) are available legally but only under strict Food and Drug Administration controls. That is, only with a doctor's prescription, only after a lengthy FDA-overseen approval process that can include years of clinical trials (and then sold only via a licensed pharmacy), and only for limited applications.

In other words, there are no Schedule II drugs grown, processed, and sold in the way cannabis is brought to market in the United States, either—so that label, too, is probably inadequate. More to the point, if strictly enforced to the letter, Biden's marijuana policy could rip cannabis away from its current producers and sellers and hand over control of commercial weed to corporate interests instead.

"If the federal government actually enforced the CSA [Controlled Substances Act] Schedule II [on cannabis in a Biden administration], then almost all current state-legal activities would be banned and could be shut down," said Jonathan Caulkins, a professor at Carnegie Mellon University's Heinz College who has served as co-director of the nonpartisan RAND Corporation's Drug Policy Research Center.

Needless to say, "weed entrepreneurs are worried. Some seemed downright terrified."

Would a Joe Biden administration actually hand Big Pharma total control over the growth and distribution of marijuana? Would he actually give such a large and unpopular gift to corporate America?

Given his extensive record of giving large and unpopular gifts to corporate America, why should anyone think he wouldn't?
  

Trump Is Pretending He Wants To Finally Help With Out-Of-Control Drug Prices

After my successful cancer treatment-- which included a full stem cell replacement operation-- I quickly realized I would be taking a lot of drugs for the rest of my life, including some very expensive ones. I was looking at-- even with insurance (Medicare Part D, the one part of Medicare-- written and passed strictly by Republicans-- that sucks) thousands of dollars a month. Prices have gone up since Trump entered the White House, despite his oft-repeated promises to lower them. I turned to Canada for one of the most expensive of the drugs, VIMPAT (lacosamide, around $1,093.78 a month). No Canadian pharmacy online will sell it to Americans through the mail. It's something like $90 in Thailand-- where I've been getting it-- and I'm hearing just as inexpensive in Mexico. Yesterday, Trumpanzee was bragging how he's waving his magic wand and making drug prices "for our great seniors" less expensive. Health and Human Services Secretary Alex Azar: "Today's announcement outlines the pathways the Administration intends to explore to allow safe importation of certain prescription drugs to lower prices and reduce out of pocket costs for American patients. This is the next important step in the Administration's work to end foreign freeloading and put American patients first."

The Washington Post seemed skeptical: "The Trump administration on Wednesday," wrote Yaseem Abutaleb and Laurie McGinley, "said it was taking steps that might eventually lead to the importation of some lower-cost prescription drugs from Canada, an idea supported by President Trump but long opposed by many Republicans, including some of his own aides."

This was from Azar's live presentation yesterday:

For too long, there’s been a lot of talk on drug prices and no action. Drug companies have insisted we can have new cures or affordable prices, but not both.

I’ve been a drug company executive-- I know the tired talking points: the idea that if one penny disappears from pharma profit margins, American innovation will grind to a halt.

I’m not interested in hearing those talking points anymore, and neither is the President.

High prescription drug prices... are a serious threat to the health and well-being of too many Americans. President Trump has told us at HHS to fix this problem, and we will.

The problem has multiple parts: high list prices, overpaying in government programs, high out-of-pocket costs, foreign-government freeloading. They are connected in a way that attempting to squeeze one end of the balloon won’t lead to lasting change.

But the complexity of the problem is no excuse for inaction or incrementalism. There are plenty of actions we can and will take administratively to shake up this system.

We do want to hear from industry, patients, and other stakeholders about what they think of the full range of changes we put out in our blueprint

. That’s because we’ve proposed a set of changes that are more sweeping than any drug-pricing initiative ever, more bold than any set of proposals set forth before.

I’m sure that pharmaceutical manufacturers took note on Friday when the President pointed out that they are one of the most aggressive industries when it comes to lobbying. Pharma spends more than $175 million a year trying to understand what the President and I are thinking.

So I’m going to save pharma some money and tell you what the President and I have planned. Pay attention, as there’s a lot on the way.

There are four strategies for reform set out in the administration’s drug-pricing blueprint: improved competition, lowering out-of-pocket costs, enhanced negotiation, and incentives for lower list prices. On each of them, we’re going to start taking action today.

I want to start with negotiation, because it’s so important-- and there’s been some confusion on it, for a while now.

You heard President Trump make it clear on Friday how important tougher negotiation is.

That is exactly what our plan brings to Medicare, in an effective and targeted fashion. We are going to make negotiation more effective than it is today in our retail drug program, Part D, and bring negotiation to where it doesn’t exist, in physician administered drugs, Part B.

In Part D, we’ll be giving Medicare plans the same negotiating power that private sector plans already have-- we know this approach works.

Let me briefly lay out how this will happen. We know right now that Medicare Part D is not getting the deals it should on some expensive, important drugs.

For instance, there are six types of drugs that are automatically put into Part D categories that are called “protected classes,” because they’re vital to treating some serious conditions.

Part D spends about $30 billion a year on these drugs. That’s almost 10 percent of what our entire country spends on drugs each year.

Yet Part D plans are hamstrung by current rules from really negotiating over drugs in these protected classes-- allowing Pharma to run up huge profits on patients who desperately need these often-expensive drugs.

For example, the company that makes one of the 10 most common drugs in these categories raised that drug’s price 20 percent in the last 12 months. That particular drug, in 2015, cost $11,500 per month. Under Medicare Part D, that means seniors using the drug will typically owe an extra $115 every month. They just went from paying $575 per month to $690 per month, at a time when the average Social Security check is $1,400.

Typical private-market discounts for these drugs are in the 20 to 30 percent range. The average discount across all of these protected drugs in Medicare Part D is just 6 percent, and for some of them it’s 0.

A 6 percent discount-- I’m sorry, that is not negotiating.

This administration has it within our authority to provide Part D plans with new tools to negotiate for these drugs.

For one-third of Medicare Part D spending, we can go from where plans effectively aren’t negotiating, to plans having real power to negotiate.

These are important drugs for patients with potentially debilitating conditions, so we will go about these reforms transparently. This process will not restrict patient access, but expand it through lower costs.

It’s important to understand that, because it isn’t true of the alternatives. You’ve probably heard before that Medicare could save tons of money by negotiating directly for drugs.

This just isn’t true, and you don’t have to take my word for it. The Congressional Budget Office, when it was run by Peter Orszag, who went on to work for President Obama, found that the idea of direct negotiation would generate almost no savings. The same conclusion was reached by President Obama’s Office of Management and Budget when it assessed the proposal in his budget.

The only way that direct negotiation saves money is by doing something this administration does not believe in: denying access to certain medicines for all Medicare beneficiaries, or setting prices for drugs by government fiat.

We don’t believe either of these proposals would put American patients first. They would move us toward the kind of socialized medicine systems that have such a notorious reputation for poor quality and access. This stacks right up there with the false promises of Obamacare: that if you like your plan, you can keep it, and if you like your doctor, you can keep seeing him.

But I don’t expect these ideas to go away, no matter how unlikely they are to work. If the pharmaceutical industry wants this idea off the table entirely, the only way is to come to the table with us, to engage in meaningful negotiation with Medicare Part D plans, and to stop the price hikes.

The President is also going to bring smart negotiation to billions of dollars’ worth of drugs in a part of Medicare where there is currently no negotiation at all. That’s Medicare Part B drugs, those administered in a physician’s office.

Right now in Part B, essentially as soon as a drug is approved by the FDA, it’s covered. Medicare gets a bill for the drug, composed of the standard price plus a 6 percent markup, and we pay it.

Compare that with the negotiation in Part D: Plans determine whether a drug should be covered or whether an alternative is superior. Plans negotiate discounts, rather than just paying full price.

You can imagine what happens when you’re developing a drug: It’s often much more appealing for the drug to go into Part B than D. Perversely, some of these drug development decisions are being driven by government reimbursement systems, rather than what’s best for the patient.




In short order, we will be issuing a request for proposal to make new use of an alternative system for buying Part B drugs, a Competitive Acquisition Program. We believe there are more private sector entities equipped to negotiate these better deals in Part B, and we want to let them do it.

More broadly, the President has called on us to merge Medicare Part B into Part D, where negotiation has been so successful on so many drugs. This is how we follow through on his promise to do smart bidding and tough negotiating for our seniors.

Before closing on negotiation, I want to be clear: This is a topic the President and I have discussed at great length, and the idea of direct negotiation in Medicare has come up. He is tired of the government getting bad deals on the drugs seniors need, and I couldn’t agree more.

We formulated this plan with fixing that problem as the No. 1 priority, and the President is following through on his promise. What we came up with is the smart, effective approach to tougher negotiation, and a more aggressive approach than has ever been tried before in our programs.

Another key way to bring down costs using our market-based system is through more competition. Thanks to thriving generic drug competition, Americans get better prices on generics than most European countries, but we can go further.

FDA Commissioner Scott Gottlieb, who is here today, has made it a top priority to stop drug manufacturers from gaming our patent system to block generic competitors.

In one of the most notorious examples, pharma companies use FDA safety rules or commercial distribution restrictions to block generic drug manufacturers from having access to samples of the branded drug.  Those samples are needed to perform the testing that gets generic drugs approved, giving consumers safe and effective lower-cost medications.

We know that certain brand name manufacturers are abusing the system by blocking access to samples, and hiding behind FDA’s rules when they do it. FDA is going to begin publicly identifying drug companies suspected of engaging in these abusive practices. The agency has already received more than 150 inquiries from generic manufacturers about challenges with access-to-product samples from brand manufacturers.

It’s time to shed light on these practices and call out the manufacturers who may be abusing the rules that built our free market for drugs. They’re using laws intended to promote the public health to pad their profits instead.

I want to raise a final point in the context of competition: Many people may be familiar with proposals to give our seniors access to cheaper drugs by importing drugs from other countries, such as Canada. This, too, is a gimmick. It has been assessed multiple times by the Congressional Budget Office, and CBO has said it would have no meaningful effect.

One of the main reasons is that Canada’s drug market is simply too small to bring down prices here. They are a lovely neighbor to the north, but they’re a small one. Canada simply doesn’t have enough drugs to sell them to us for less money, and drug companies won’t sell Canada or Europe more just to have them imported here.

On top of that, the last four FDA commissioners have said there is no effective way to ensure drugs coming from Canada really are coming from Canada, rather than being routed from, say, a counterfeit factory in China. The United States has the safest regulatory system in the world. The last thing we need is open borders for unsafe drugs in search of savings that cannot be safely achieved.

You can’t improve competition and choice in our drug markets with gimmicks like these-- you have to boost competition and price transparency. That informs our third strategy, to reduce Americans’ out-of-pocket drug costs.

Today, some pharmacy benefit managers set contracts with pharmacies that prevent your neighborhood pharmacist from telling you when you could get a better deal on a drug by paying cash than by using insurance.

That’s because, when you use your insurance, the pharmacy benefit manager gets a cut of the deal-- when you pay cash, they don’t.

You ought to know how you can get the best deal possible, and your pharmacist should be able to tell you how. So this week, CMS [Centers for Medicare & Medicaid Services] will be sending a letter to all Medicare Part D plan sponsors saying that we consider such behavior unacceptable.

If pharmacy benefit managers really believe in doing right by the patients they work for, there’s no reason they can’t end this practice and release pharmacists from these gag clauses, right now.

Ending gag clauses is part of a much broader effort CMS will be undertaking to bring more transparency to our drug markets. You ought to know how much a drug costs and how much it’s going to cost you, long before you get to the pharmacy counter or get the bill in the mail.

We want to consult with industry on how to get to that point, but [CMS] Administrator [Seema] Verma, whom we’re glad to have here today, is going to make it happen.

The final strategy we’re getting to work on, immediately, is a new set of incentives on list prices. Right now, our entire system-- both industry practices and government rules-- encourages higher and higher list prices. It’s time for drug prices to go down, not up.

One particular example is a deal that the Affordable Care Act contained for the pharmaceutical industry: Congress put a cap on the penalty that drug companies had been paying when they raised prices faster than inflation.

Yes, you heard that right: Congress put a limit on how much companies would have to pay when they jacked their prices up beyond inflation.

That means drug companies can keep raising their prices rapidly, soaking up new profits from private insurance without paying any penalty in the Medicaid program. And this isn’t just a few medications: There are now more than 2,500 drugs that have hit this cap.

President Trump and I are working with Congress to look at overturning this cap and restoring the brake on runaway price increases.

But we can take more action to create incentives for lower list prices, too.

Right now, Medicaid pays for drugs based on something called the Average Manufacturer Price, or AMP.

In calculating what Medicaid pays, we ignore that the private sector isn’t paying anything like the AMP-- they are actually paying the AMP minus a significant rebate.

If Medicaid is supposed to be getting a better deal than the private sector because it serves our most vulnerable, why not incorporate the private sector rebate into the AMP, lowering it significantly?

Just this change could drop what manufacturers get paid on many Medicaid drugs by 30 to 40 percent or more.

As big as such a change would be, believe it or not, it’s a relatively incremental step in our plan. We can go a lot bigger.

We believe that the entire system of pharmacy benefit managers negotiating rebates needs to be re-examined. Right now, we’re asking a pretty straightforward question: What if, instead of the current system where drug companies get paid rebates and middlemen take a cut, we just had fixed-price discounts?

This would fix the situation where even the pharmacy benefit manager, who is hired to help keep prices low, makes money from higher list prices.

Pharmacy benefit managers are also getting paid by both sides of a transaction: the insurance companies, who pay a fee as their customers, and the drug companies they’re supposed to be negotiating against, who give them a cut of the rebates they receive and other fees.

It is easily within our power to forbid remuneration from pharmaceutical companies-- to eliminate rebates, align interests, and end the corrupt bargain that keeps driving list prices skyward.

We’re also going to be looking at how pharmaceutical companies interact with the American public.

As of today, we have FDA and CMS working to examine how to require drug companies to post their list prices in direct-to-consumer advertising. When patients hear about a wonderful new drug, they should know whether it costs $100 or $50,000. A patient might even pay for a doctor’s appointment to discuss a drug, not knowing that the price puts it totally out of reach, and that’s unfair.

Drug companies don’t have to wait on us. Today, I am calling on America’s pharmaceutical manufacturers to level with the American public-- be honest about what you’re trying to charge us, put your list price in your ads.

We believe Americans should know which drug companies are gouging consumers and which ones are being good actors for our communities.

So we’ll go beyond direct-to-consumer advertising: This week, CMS will be unveiling updates to its drug-pricing dashboard, which will offer much more detail than ever before about which companies are raising prices.

On top of that, I will be having regular meetings with CMS Administrator Verma and others to examine where prices are rising, and why.

That, of course, complements every conversation I have with the President-- where, as I mentioned Friday, drug pricing tends to be the first thing we talk about, and the last.

He’s now laid down a marker about the need for reform. I can imagine he is going to be very interested in the next company that takes a price increase not justified by inflation or change in clinical benefit. I can tell you I wouldn’t have wanted to be the one to do that.

On the other hand, I expect the President will be interested in hearing which companies lowered their prices and took other actions to support the changes we want to make.

I should say that, because I have been in business-- in this business-- I understand that companies have systems that work and market positions that help them succeed.

But markets only work when they’re open to forces for change.

The American system works incredibly well in so many ways because we have a free market.

But right now, we have a drug pricing system that is protected from market forces-- that is set up to benefit the manufacturers and the middlemen, not the patients.

We are open to all potential solutions for fixing this problem-- assuming they are effective, safe for patients, and respect our seniors’ choice and access.

Industry leaders have an opportunity to get started on changing our system, today.

These have mostly been Democratic Party proposals and ideas but it's good that Trump is backing them a bit. Vermont, Colorado and Florida already have drug importation statutes on the books. Writing about Trump's plan's for the Washington Post yesterday, Yasmeen Abutaleb and Josh Dawsey had a different narrative: White House Races To Come Up With Health-Care Wins. "White House advisers," they wrote, "scrambling to create a health-care agenda for President Trump to promote on the campaign trail, are meeting at least daily with the aim of rolling out a measure every two to three weeks until the 2020 election. One of the initiatives would allow states to import lower-priced drugs from Canada and other countries and another would bar Medicare from paying more than any other country for prescription drugs, according to two senior administration officials and lobbyists-- controversial ideas in line with Democratic proposals. Yet it remains unclear the administration has the legal authority to execute some of these policies without Congress. The White House is already facing fierce pushback on some proposals from Republicans on Capitol Hill and the pharmaceutical industry, which will likely go to court to challenge any measure it opposes.

The furious push reflects the administration’s sense of vulnerability on an issue that Democrats successfully used in 2018 to win control of the House of Representatives. White House officials are eager to inoculate the president against a repeat of that strategy in 2020-- and reduce the GOP disadvantage on an issue that pollsters say plays to Democratic strengths. Most of the Democratic presidential candidates have made health-care proposals, including Medicare-for-all plans, key to their campaigns. Health care is already playing a starring role in the debates and Democrats are sure to assail Trump for his attempts to eliminate coverage for millions of people by challenging the Affordable Care Act in court.

“President Trump has said we will protect people with preexisting conditions, lower drug prices, end surprise medical bills, and make sure Americans get the highest quality of care they deserve,” said White House spokesman Judd Deere. “While the radical left has sweeping proposals for a total government takeover of the health system that will hurt seniors and eliminate private insurance for 180 million Americans, the Trump administration is working on real solutions.”

Some, however, are doubtful a flurry of executive orders and new regulations would have an immediate effect on consumers’ pocketbooks. What is clear is that the approach, which includes White House support for a bipartisan Senate bill to cap Medicare drug price increases to the rate of inflation, is putting congressional Republicans in a tough spot: Embrace Trump’s agenda and abandon conservative precepts about interference in the marketplace, or buck the president on one of his top priorities.

While Republicans have largely fallen in line with Trump on free trade and immigration even when he has blown up GOP orthodoxy, many rely heavily on donations from the pharmaceutical industry and are reluctant to sour those relationships.

One lobbyist, who spoke on the condition of anonymity, described being stunned at a recent White House meeting when Domestic Policy Council Director Joe Grogan said the administration would not let Democrats run to the president’s left on lowering the prices of prescription medicines.

In another tense meeting, top pharmaceutical executives were told bluntly “it wasn’t in the industry’s best interests” to block the bipartisan Senate bill backed by Trump. If it failed, they were told, they’d see “the president of the United States negotiating with Nancy Pelosi [on allowing the government to negotiate drug prices in Medicare],” said a person familiar with the meeting.

That looks pretty evenly corrupt doesn't it? That was just last cycle. Let's look at who-- currently in the House-- has been taking the biggest bribes from the drug companies since 1990. And, yes, the implication is that all of these men and women should be expelled from the House and tried and imprisoned. All share responsibility for high drug prices.

• Anna Eshoo (D-CA)- $1,664,131
• Fred Upton (R-MI)- $1,548,456
• Kevin McCarthy (R-CA)- $1,491,350
• Frank Pallone (D-NJ)- $1,399,417
• Greg Walden (R-OR)- $1,147,395
• John Shimkus (R-IL)- $1,092,215
• Steny Hoyer (D-MD)- $1,079,072
• Michael Burgess (R-TX)- $949,074
• Kevin Brady (R-TX)-$891,333
• Ron Kind (D-WI)- $872,129
• Jim Clyburn (D-SC)- $823,843
• Brett Guthrie (R-KY)- $802,513

What about the Senate? Sure these are the dozen worst crooks-- currently in the Senate-- in terms of taking bribes from drug makers. They should all also be in prison. The prices we pay for medicine would probably be far less than half. Keep that in mind when you go to the polls this cycle. MoscowMitch bears the greatest responsibility and he is up for reelection.

• Mitt Romney (R-UT)- $2,739,142
• Richard Burr (R-NC)- $1,570,212
• MoscowMitch (R-KY)- $1,340,771
• Bob Casey (D-PA)- $1,225,195
• Roy Blunt (R-MO)- $1,081,856
• Patty Murray (D-WA)- $1,046,938
• Robert Menendez (D-NJ)- $976,534
• Chuck Schumer (D-NY)- $939,789
• Rob Portman (R-OH)- $936,580
• Marsha Blackburn (R-TN)- $915,381
• Chuck Grassley (R-IA)- $876,460
• John Cornyn (R-TX)- $827,415