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ASHINGTON — Nancy Pelosi sent Democratic House members home for summer recess with a three-point plan to “own August”: talk about the economy, talk about President Trump, and talk about health care costs — specifically, exorbitant prescription drug prices facing Americans.

It’s easy to see why drug pricing gets such prominent billing. Polls have consistently shown that voters hold a decidedly negative view of pharmaceutical companies, that they trust Democrats more on health care, and that they believe high drug costs should be a top priority on Capitol Hill.

And already, candidates are introducing bills and commissioning studies on the issue, spurred by town halls that feature constituent after constituent demanding action to bring down the bills they face at the pharmacy counter. The bills, the studies, the best town hall sound bites — all get cut into television ads that tout a given candidate’s work.

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But it’s more complicated than Pelosi’s push or the rush of new ads might suggest. Some Democrats are closely allied with the the drug industry itself, and the party at large has not yet coalesced around a single, cohesive platform on pharmaceutical costs.

“The Democrats do not have a concise drug plan,” said Robert Blendon, a Harvard political scientist who has commissioned recent polling on drug pricing issues. “Most big plans that help candidates usually come in presidential years where somebody can articulate it. The Democrats would have to agree on a plan, and they would have to have most candidates running on one — that doesn’t exist.”

Since June, the Democratic Congressional Campaign Committee has written nothing on the issue on a campaign blog updated almost daily — focusing instead on health insurance markets and out-of-pocket health costs. And while a spokesman was insistent that party infrastructure viewed drug costs as a signature issue, many of the ads the campaign committee cited in an email to STAT focused far more on health insurance.

In some ways, President Trump is also making it harder for Democrats to find a cohesive message on the issue, as the party has been forced to navigate a string of perceived victories from Trump on pharma issues — namely temporary price freezes announced by Pfizer, Novartis, Roche, and Bayer.

Democrats have a counterpoint, of course: the price freezes, they argue emphatically, are ineffectual PR ploys initiated by the spectre of an angry presidential tweet. Blendon added that it’s unlikely voters will respond to the price freezes — given a recent Politico/Harvard poll that showed few voters were even aware the Trump administration had a drug pricing blueprint.

And it’s not just Trump making it tough for the Democrats to gel around a drug pricing message: Unlike other health care issues that split lawmakers on almost perfect partisan lines, some top Democrats are very willing to accept campaign cash from big-name manufacturers and their lobbyists.

Despite the lack of an overarching strategy, a handful of candidates have already worked to make the issue central to their campaign.

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At the top of the heap is Sen. Claire McCaskill, the Missouri Democrat who is among the most vulnerable senators up for reelection this fall. In the past two years, she’s orchestrated numerous investigations into pharmaceutical manufacturers and distributors seen as having contributed to the opioid crisis. And last month, as the top Democrat on the Senate’s chief oversight committee, she released an analysis showing Medicare could save $2.8 billion per year if it directly negotiated drug prices with manufacturers.

All of it is fodder for her messaging on the campaign trail.

“One of the top concerns I’ve heard from Missouri families is the skyrocketing cost of prescription drugs,” McCaskill, who has held 50 town halls in the past year, told STAT. “I’m going after the pharmaceutical companies, and I’m trying to go after a system that’s broken. I don’t care how big and powerful they are.”

Recent polling data shows pharmaceutical companies are deeply unpopular, with voters viewing them unfavorably by a 71-21 margin. Independent voters and Democrats also trust Democrats in Congress far more than Trump on drug pricing issues: a 42-30 spread overall and a 41-12 lead among independents, according to a poll from the Democrat-aligned firm Global Strategy Group.

Another senator in a state Trump won in 2016, Sen. Tammy Baldwin (D-Wis.), used a recent ad to highlight a bill she introduced with Sen. John McCain (R-Ariz.) that would allow for the importation of cheaper drug alternatives from Canada.

Lowering prescription drug costs is such a high-profile issue, in fact, that an outside group has formed specifically to force candidates into discussing it: Patients for Affordable Drugs, which is led by a longtime patient advocate, David Mitchell, and relies on the political savvy of Ben Wakana, formerly the top communications staffer for Barack Obama’s health department.

“Any politician worth their salt would be talking about drug prices, given how important it is to the electorate,” Mitchell said in an interview. “It’s really a kitchen-table issue. People live it every day.”

But Mitchell stressed that drug pricing is not a partisan issue. His group (via its political extension, Patients for Affordable Drugs Action) has already endorsed the reelection bid of an incumbent Republican, Rep. David McKinley of West Virginia, and has planned a half-million-dollar ad campaign on his behalf.

While the group has waded into just two races so far, Mitchell promised his team would become involved in races featuring candidates from both parties, including Democrats who accept pharmaceutical industry contributions and “carry drug companies’ water for them.”

The other race currently on Mitchell’s radar: the New Jersey reelection campaign for Sen. Bob Menendez (D), whose opponent is the former CEO of the drug maker Celgene, Bob Hugin. A recent ad produced by Patients for Affordable Drugs Action tagged Hugin as “the guy who made a killing,” and focuses on his company’s repeated decisions to hike the price of the cancer drug Revlimid. Hugin has struck back by highlighting Menendez’s repeated votes against drug importation.

For many other Democrats, however, campaigning on drug prices is more about making grandiose statements about policies not yet proven to be politically realistic — and it isn’t a central issue.

Several, led by Rep. Lloyd Doggett of Texas, responded to many of the price freezes with the party’s most aggressive bill to date on Medicare negotiation — one that would allow the Department of Health and Human Services to effectively negate patent exclusivity on a drug if the manufacturer could not negotiate an agreement with Medicare.

The main trade group for drug makers, PhRMA, has made it clear that it opposes those aggressive pitches, and pushed instead to get candidates — and Washington more broadly — interested in other targets, like pharmacy benefit managers.

“Unfortunately, many of these proposals would do nothing to address what patients care most about: rising out-of-pocket costs for medicines. Instead, we should pursue reforms to address the misaligned incentives in the system,” Robert Zirkelbach, a spokesman for PhRMA, told STAT.

A few Democrats have found their own ways to speak out against pharma’s influence in Washington — spurred by the DCCC, which has said that specifically tailored strategies tend to prove most effective.

Elissa Slotkin, a former CIA analyst running as a Democrat in Michigan’s 8th Congressional District, has made a pharmaceutical “shield law” a campaign issue. The one-of-a-kind restriction, she said, makes it dramatically more difficult more the state and local governments to sue drug companies for causing public health issues — in this case, namely the opioid crisis.

Slotkin’s opponent, Rep. Mike Bishop (R), blocked attempts to repeal the law when he was the majority leader in Michigan’s state Senate.

“Rep. Bishop refused to allow its repeal here in Michigan,” Slotkin said. “Now that he’s in Congress, he’s giving tax breaks to the pharma industry and taking money from the same drug companies that Michiganders are suing. He has been doing their bidding for the last 20 years.”

Some candidates are even aligning themselves with the Trump administration on pharmaceutical industry issues. Sen. Joe Donnelly (D-Ind.), who is among the senators most likely to lose their seat come November, even ran an ad highlighting his work with the Trump administration on a so-called right-to-try law, a longtime priority for Vice President (and fellow Hoosier) Mike Pence that will give some dying patients a different pathway for accessing experimental and unapproved treatments.

The diverse strategies Democrats are employing on the issue underscore just how intense is the political instinct to find some way — any way — to take on pharmaceutical companies.

Indeed, that instinct is not partisan, nor particularly new. As a candidate, Trump touted the concept of Medicare negotiating drug prices — a concept his administration has not pursued.

One playful ad from Patients for Affordable Drugs even quotes Trump, as a candidate, complaining that Medicare does not negotiate drug prices — then rolls video of Sen. Bernie Sanders (I-Vt.) making the same argument.

“The best proof point in the power of this issue is that Donald Trump ran on a promise to stand up for the forgotten man by reducing drug prices,” said Jesse Ferguson, a Democratic operative who consulted on the Global Strategy Group poll. “The problem is he got to Washington and forgot them.”

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  • The US subsidizes the world’s healthcare as we pay inflated prices that support R&D. EU and Canada pay a fraction of what the US pays. Why? Because the higher the price the more money companies make. Implement reference pricing like EU countries have and watch the prices fall.
    Large Pharma and the US Government has wasted $Trillions on ideas that are nothing but long shots while most breakthroughs come from Universities (largely funded by Federal Programs).
    The system is built to take money from the taxpayers. Isn’t CRISPR mostly overhyped to make insiders and VCs rich.
    Martin Shkreli, and most large Pharma CEOs were saying the same things!

    • Our “Government” has been taken over by industry insiders. It is no longer “our government” the current administration merely weaponized the influence the profiteers. The mass media which is owned by the same billionaires, is effectively censoring the facts. Most Democrats are treadling lightly, they are either misinformed, bough off, or afraid to challenge Big Pharma. They don’t even ask what the facts are, they choose the facts supplied by the industries.
      If people actually had all of the facts they would be terrified! The Media and outlets like this are not giving the full picture. The healthcare system in this country could be described as Genocidal.

  • But they do have a plan! To continue selling us out to Big Pharma. Just like Obama. Why mess with a winning formula? Oh wait …

  • We from outside the United States watch with bemusement and amazement at healthcare in general and pharmaceutical prices specifically and wonder how a nation who put a “Man on the Moon” in the late 1960s can’t get the “Pill on the Palm” even in 2018. The system is so broken (with the Pharma merrily denouncing Pharmacy Benefit Managers while both laugh all the way to the bank) that it really does not deserve to survive.

    Perhaps the time for “Creative Destruction” and maybe have a Single Payer System. Complicated? Not really, all the countries in Western Europe have it (they are all democracies) and even North Korea has it.

    It would be laughable except for the people that have to suffer – does freedom of choice, free market come before basics?

    healthcareforall@everywhere.exceptUSA

    • Maybe you should ask yourself why it was America who put a man on the moon. Also, ask yourself why it is America who had to help the rest of the world win not one but two world wars. And why is it America the rest of the world turns to for leadership during a crisis? The difference in America is it used to allow individualization. It didn’t used to be the responsibility of the US government to step into the lives of it’s citizens in issues such as healthcare. And I think this idea of letting people take care of themselves and not to rely on others is a good thing. It didn’t raise a bunch of whiners to take care of in a nanny state

    • American media created a blind spot, they replaced factual information with scare stories about “Socialized Medicine.” The number of dead Americans, who died due to lack of health insurance, is censored here in the Land of Liberty. They present healthcare as a choice, or a “Free Market.” The number of injured people who can’t work anymore because they could not get healthcare access is also censored. Advertising replaced healthcare facts.

      Venture Capitalists are funding biased “research” into ‘Complimentary and Alternative Medicine.” Even “Wellness” has been weaponized, used to stigmatize low income people, who can’t afford healthcare, or a day off from work. The number of injuries and deaths, due to Alternative Medicine are not counted. They don’t count how postponing actual healthcare with CAM, can be deadly. They only advertise the “Benefits.”
      The so called “opiate epidemic” or the number of women dying in childbirth, should have been a wake up call, but the media re-framed it all. They came up with counter stories blaming the victims. In the US the number of women who experience adverse events in childbirth is censored, replaced with “faith based” nonsense and advertising.

  • Here is a “plan”:

    1) Activate / Support the “Direct Primary Care” (DPC) provisions of the ACA whereby primary care physicians can provide value for cost to patients that includes: community-focused care, preventive care, acute care, chronic care, palliative care, gynecological care, integrated care (including mental health care & same day evaluation) with discounted (to greatly discounted) lab testing, imaging, ambulatory surgery, urgent care, drug dispensation (via wholesale suppliers like Andameds)….etc.
    2) Support wholesale drug suppliers like Andameds having national negotiated TRANSPARENT pricing without middlemen profiteering (as Pharmacy “benefit” Manager) and with both direct physician AND COMMUNITY PHARMACIST involvement in the dispensation AND patient education components of taking BOTH prescription and OTC medications that includes guaranteeing that a carcinogen will not contaminate drugs such as valsartan, that USA suppliers will be preferred, that 3D CAM printers will produce (under close scrutiny) generic medications on demand, especially in the hinterlands AND that PHYSICIANS, COMMUNITY PHARMACISTS & TELE-Nurses will work together to assure the best proven outcomes possible at the lowest possible cost WITH a GOAL of keeping as much money as possible spent by community members subscribing to DPC IN THE COMMUNITY as opposed to landing in the filthy lucre pockets of an out of state Pharmacy “benefit” Manager, Drug Supplier or even Manufacturer outsourcing production to China so carcinogens can be mixed with meds as in the current system of ceding ALL production to China.
    3) Support “wrap around” catastrophic health care insurance (as also specified in the ACA) from a MUTUAL health insurance company whereby health insurance policy holders are de facto stock holders in the MUTUAL company with OVERALL financing via progressively financed (FROM BIRTH) HSA’s connected to an HSA-investment Bank that securely invests HSA funds so that there can be tax free in and tax free out vesting of funds for health care (with a COMMUNITY FOCUS), education (including health care literacy) and pension funds with wellness incentives built in to help build up personal and family wealth rather than face bankruptcy from medical expenses as is the current trend.
    4) Support networked DPC and DSC (Direct Specialty Care) that can do Comparative Effectiveness Studies so that there is the opportunity to actually finance innovative care while striving for continuous quality improvement, cost-beneficial care AND the community training of Clinical Medical Assistants, Pharmacy Technicians, Community Health Workers, Comparative Effectiveness & Continuity of Care Facilitators, Psychiatric Social Worker Apprentices and Mesh-networking of HIT and local OFF THE GRID energy production and distribution SPECIALISTS, thereby guaranteeing even more health care money spent by community members STAYS in THE COMMUNITY even while PHARMA get greatly reduced costs for getting FDA certification.

    • The system is too corrupt to “Advocate.” We can see what they did with the ACA. They allowed every industry with a profit motive to render it almost useless. The democrats framed any critique of the ACA, as right wing nonsense. They are still in paid denial, since they took money from the benefactors of the ACA.
      In my state the republican governor did everything she could to undermine healthcare, education, and social services. Our Democrats stood idly by, and only responded to nonsense the media created. They took money from Religious Hospitals who were deliberately undermining women’s healthcare, along with covering up corruption, greed and bad outcomes. The local ‘Newspapers” act as Public Relations outlets for our expensive and bad healthcare providers.
      One of our Democrats took many and acted as a consultant for the Insurance companies. They re-framed this as if she was”helping” her constituents. Our Democrats are so corrupted that they refuse to discuss Healthcare For All. They came out with a “Medicaid Buy In.” In our state Medicaid is not really about providing healthcare, it is about money and jobs. They shifted most Medicaid recipients to low income non profit clinics, with limited resources. They did a cost benefit analysis, and Specialists and even Physicians are not really necessary. They replaced Doctors with Physicians Assistants or Nurse Practitioners. A patient on Medicaid can wait years to see a specialists, and it is not that much better for people with good insurance.
      The healthcare providers, insurance companies and big pharma come first, and patients are a secondary consideration. They keep touting the fact that due to the ACA more people have insurance. Healthcare outcomes are still bad, suicide and drug addiction rates are climbing. Half of the deaths attributed to the “Opiate Epidemic” were sick people over 50. In our state suicide is under-counted. Our Democrats are in denial since they not only took money from the Healthcare Industry, they continue to ignore issues with healthcare.
      Right now they are pretty complacent, believing their votes are assured in spite of the corruption. After all look at the destructive insane forces on the other side. They have failed their constituents utterly. just looking at their half hearted response to the racist, greed mongering, nightmare rolling across our country. They are benefiting too, and they took money from the same sources the republicans did.

  • We have already seen the Republican “Plan.” That was to put even more industry insiders on our boards to Gaslight the public. The Democrats are still in denial over how Medicare for All, would fix this overnight. The Democrats took money from the same Industry ghouls who paid the Republicans. The very same ghouls that hide behind industry created data gaps, and promote Alternate Facts.

    • Another sarcastic comment, though Medicare and Medicaid now do not resemble each other. Most people have a really misinformed idea about how any of it works. Medicaid already has 50 different programs in 50 different states. In many states the reimbursements are so small, there is no incentive for any Physicians to provide care. A lot of the money is dedicated to buying over priced Pharma products, and making local politicians appear to have created jobs.

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