Azar defends actions on handling of women's reproductive health.
This article first appeared May 14, 2018 on Medpage Today.
By Shannon Firth
WASHINGTON -- Senators attempted to wring details about President Trump's highly anticipated drug price speech from Secretary of Health and Human Services (HHS) Alex Azar during a subcommittee hearing of the Senate Committee on Appropriations Thursday.
The hearing was intended to focus on the FY2019 budget, but senators, in addition to querying Azar on drug prices, solicited his views on Medicaid waivers and the impact of short-term limited-duration plans.
Lowering Drug Prices
Sen. Tammy Baldwin (D-Wis.) pressed the secretary on the issues of drug prices. She noted that the pharmaceutical industry spent over $170 million trying to influence Washington policymakers in 2017 and had reaped $12.1 billion in profits in the first quarter of 2018.
The president is expected to outline his plan to lower drug prices shortly. She said, "I am very interested in hearing what will be included."
Baldwin noted that Azar had given only vague responses when asked the reasons for the high costs of prescription drugs at an earlier confirmation hearing.
"You blamed, and I quote, 'the system for the rising cost of prescription drugs,' but you never singled out the role that drug corporations play in this system."
She asked whether the administration's plan will hold drugmakers accountable for their role in increasing drug prices: "Yes or no?"
"Oh yes, it will," Azar said. "All players will be impacted ... It's a systemic issue which requires a systemic multi-factorial solution. That's what the president will be rolling out tomorrow."
However, when asked whether the president's plan would include provisions forcing drug companies to provide "basic transparency" about their plans to increase a drug's price -- similar to a bill Baldwin co-sponsored with Sen. John McCain (R-Ariz.) called the FAIR Drug Pricing Act -- Azar was more tight-lipped.
"I'm sure you'll understand I'm not in a position to preempt the President of the United States tomorrow, by saying what he will and won't announce," Azar said.
He did offer a few other teasers about the plan. At one point he noted that foreign governments that receive, as he put it, a "free ride" from the U.S. with regard to drug prices would also be targeted in the president's speech, slated for Friday afternoon.
Women's Reproductive Health,
While the new FY 2019 budget maintains the same level of funding for Title X programs -- federal programs focused on family planning and related preventive services, including birth control -- Sen. Patty Murray (D-Ore.) criticized the administration for its plan to exclude Planned Parenthood from participating in the program.
Asked whether Azar would pledge to maintain a network of safety net providers who deliver "the full range of high-quality family planning services" to four million people nationwide, Azar said, "Whatever we would do with Title X will ensure appropriate access to Title X services as well as broader services."
Sen. Jeanne Shaheen (D-N.H.) echoed Murray's concerns, and highlighted her worries over a shift in teen pregnancy prevention towards more abstinence-only education.
"We have the lowest teen pregnancy rates ever ... I don't understand. Why are we fooling around with something that's been working ... to focus on an approach that all of the data that I've seen shows doesn't work?"she asked.
Azar again stated that the administration's approach is to provide access to a "broad range of providers" and philosophies and stressed that one would not be favored over another.
Short-Term Limited-Duration Plans
Murray, and other Democrats, also criticized the administration's plans to expand access to partial-coverage health plans, known as short-term limited-duration plans. Insurers selling such products would be allowed to exclude people with pre-existing conditions or charge them higher premiums. Insurers could also exclude essential health benefits, such as cancer treatment or maternity care, Murray said.
Such features -- banning insurers from charging sicker individuals more or excluding them entirely; and guaranteeing coverage for essential health benefits -- are core protections of the Affordable Care Act, but these plans would skirt them, she said.
As a child, Baldwin was one of those patients with a pre-existing condition, and she said her family struggled to find health insurance.
"Your plan would take us back to those days," she said.
Asked why the administration couldn't simply require the plans to include pre-existing conditions, Azar said there was a need for more affordable and competitive plans.
He emphasized that these very same plans had been available during most of the Obama administration.
"They're not going to be right for everybody" he said, adding that "people need to go in with their eyes open."
However, "for some individuals it may be better than nothing.'
State Waivers
On the issue of state flexibility, Sen. Brian Schatz (D-Hawaii) sought assurances from Azar that he would treat requests for both progressive and conservative waivers related to health plan design fairly. As an example, Schatz suggested that a progressive state might want to pursue a public option.
The secretary responded that HHS had been "very collaborative" in working with Maryland, which has a unique all-payer reimbursement system.
He also noted that the budget proposal offers five states the opportunity to directly negotiate Medicare drug prices.
However, when it came to Medicaid, Sen. John Neely Kennedy (R-La.) appeared to push for less flexibility rather than more.
Kennedy urged that instead of waiting for states to submit waivers that would mandate "community engagement" or work requirements as a condition of Medicaid eligibility, such provisions should be mandatory in all states.
"We don't need to make it optional, and we need you to take the lead ... We're not throwing people out in the cold -- we're going to help them know the dignity of work."