Drug prices have moved to the top of the healthcare policy agenda, at least for the president.
During his first State of the Union address, President Donald Trump called reducing prescription drug prices one of his "greatest priorities," adding, "Prices will come down." The president did not offer any details on how his administration will pursue that goal.
The lack of specific policy actions frustrated Democrats, including Rep. Raja Krishnamoorthi, ranking member of the House oversight committee's healthcare subcommittee. The Illinois Democrat wanted to see a path to draw both sides of the aisle together.
"If he had said, 'In this year, I am going to initiate the negotiation of prescription drug prices under Medicare Part D,' that would be a specific move, and I bet you he would have gotten a lot of claps from our side," Krishnamoorthi said after the speech.
"Why don't you tell us what you're talking about, because if you don't people walk away with kind of a sugar high," he added.
Similar concerns came up during confirmation hearings for HHS Secretary Alex Azar, who entered his post this week with deep Democratic suspicion that his policies will favor drug companies. Azar stepped down last year as head of U.S. operations for Eli Lilly and Co. Although largely short on policy details during his confirmation, Azar did propose bringing some Medicare Part D reforms into Medicare Part B. He flatly opposed the idea of importation or broad negotiation, an approach Trump introduced on the campaign trail.
One area where Trump echoed Azar was a push for generics into the drug market to drive up competition. Trump praised FDA Commissioner Dr. Scott Gottlieb's approval of "more new and generic drugs and medical devices than ever before."
Republicans said that Trump's speech set the right tone and they pushed back on the idea that the president needed to get more specific.
"I think he did the right thing by saying I want us to do this, and saying to Congress: It's up to you to do it," Rep. Virginia Foxx (R-N.C.) said. "He understands Article I (of the Constitution) is about making laws; it's not the executive branch that does that."
Foxx also said she has confidence Trump will act on the rising drug prices.
"I think he is the kind of person who sets his mind to something and when he gives his word—'I'm going to do something about it'—I think he'll do it," Foxx said.
Trump waited until the second half of the speech before mentioning the opioid epidemic, a much-anticipated topic since he has yet to extend the declaration of a public health emergency over opioids; the declaration expired Jan. 23.
"It is terrible. We have to do something about it," Trump said, citing Center for Disease Control and Prevention data that there were 64,000 opioid overdose deaths in 2016, amounting to 174 deaths per day.
His remarks on opioids were tied to tough talk on gang violence and the need to get "much tougher on drug dealers and pushers." In the very next sentence, he said that his administration is also committed to "helping get treatment for those in need, for those who have been so terribly hurt."
He did not offer details on how the administration will address the opioid epidemic.
"To him, those words were important, but it doesn't mean more dollars or different strategies," Krishnamoorthi said.
Senators and aides told Modern Healthcare that the upper chamber has set a "high number" for an appropriation aimed at helping states manage the opioid crisis, but so far it hasn't been announced. According to lawmakers, they plan to include it in an upcoming spending bill, but the timing remains in flux.
The lack of the plan flew in the face of wish lists from hospital groups and patient advocates who wanted to see tangible movement in the effort to combat the crisis.
Ahead of the speech, the Missouri Hospital Association said officials there expected Trump to "direct the administration to renew and expand its commitment to federal resources for the opioid crisis."
"Federal, state and local resources—a commitment at all levels—will be required to reduce the toll," the association said.
Other observers noted that the mention of the crisis without an action plan will likely raise expectations for the next step.
"It's notable that in his State of the Union, the president called for increasing access to treatment to combat the opioid epidemic and not just criminal enforcement," said Jocelyn Guyer, an analyst with Manatt Health. "In the weeks ahead, the key issue to watch is whether his remarks are backed up by a strong push for significant new funding and tools for states and localities to tackle the epidemic."
Talking points released by the White House before the speech emphasized the bipartisan tone Trump would try to strike, but in real time the president didn't shy away from controversy over issues, including immigration and healthcare.
Highly charged comments included his touting of the elimination of the penalty for Americans who fail to buy health insurance, which he called a "cruel tax," adding, "The core of disastrous Obamacare, the individual mandate is now gone." That line drew a long round of applause from Republicans who spent the better part of 2017 trying to repeal the Affordable Care Act.
The point came as House and Senate Republicans mull passage of a bill to fund cost-sharing reduction payments and a reinsurance pool to try to stem premiums for unsubsidized enrollees in the exchanges next year.
Trump also touted the success of the VA Choice Program; proposed reforms to the program stalled in the Senate late last year as House and Senate lawmakers couldn't agree on changes. This month, the White House sent guidance to the Senate Veterans Affairs' Committee in hopes of jump-starting talks again.
Trump opened the address with praise for first responders in the numerous disasters that struck in 2017, but he avoided mentioning additional funding for Puerto Rico, the U.S. Virgin Islands and states battered by hurricanes and fires in late summer and fall. An $81 billion appropriation passed by the House in December failed in the Senate, which is currently tweaking a deal that is expected to include funding for Puerto Rico's Medicaid program.
Those mentions of the disasters rang hollow since they coincided with the Federal Emergency Management Agency ending food relief to Puerto Rico, said the Michelle Lujan Grisham (D-N.M.), chair of the Congressional Hispanic Caucus."He didn't lay a foundation to get the work done to resolve (disaster) issues," Grisham said. "That is what the president does. He says, 'This is absolutely unacceptable and I demand Congress to deliver to me the numbers for the aid package.' He didn't do that, and my takeaway is that they aren't serious about making sure we have disaster relief that will really work."
