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| As the Coronavirus Spreads, Drug Pricing Legislation Remains Stalled | As the Coronavirus Spreads, Drug Pricing Legislation Remains Stalled |
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| WASHINGTON — When President Trump visited Senate Republicans last month for the first time since the coronavirus pandemic began ripping across the country, Senator Charles E. Grassley, the powerful chairman of the Finance Committee, confronted him about whether he still wanted to fulfill his years-old promise of lowering the cost of prescription drugs. | WASHINGTON — When President Trump visited Senate Republicans last month for the first time since the coronavirus pandemic began ripping across the country, Senator Charles E. Grassley, the powerful chairman of the Finance Committee, confronted him about whether he still wanted to fulfill his years-old promise of lowering the cost of prescription drugs. |
| “You started this whole process,” said Mr. Grassley, an Iowa Republican who had drafted such a plan, and whom Mr. Trump had taken to calling early in the morning to discuss the issue. “Are you still interested in signing a bill?” | “You started this whole process,” said Mr. Grassley, an Iowa Republican who had drafted such a plan, and whom Mr. Trump had taken to calling early in the morning to discuss the issue. “Are you still interested in signing a bill?” |
| The president said that he was, according to a person in the room that day, adding that the Senate had “no choice” but to act. But the exchange only underscored that the drive to reduce pharmaceutical costs — once a marquee priority seen by both parties as a political imperative — has stalled at the very moment when people most need a fix. | The president said that he was, according to a person in the room that day, adding that the Senate had “no choice” but to act. But the exchange only underscored that the drive to reduce pharmaceutical costs — once a marquee priority seen by both parties as a political imperative — has stalled at the very moment when people most need a fix. |
| Millions of Americans, including droves of newly unemployed, are stuck with increasing out-of-pocket costs for medication in the middle of a historic health crisis. But the political will to address the issue appears to have faded away. | Millions of Americans, including droves of newly unemployed, are stuck with increasing out-of-pocket costs for medication in the middle of a historic health crisis. But the political will to address the issue appears to have faded away. |
| “The problems are real. They’ve only gotten bigger,” said Tricia Neuman, a drug policy expert who directs the Medicare policy program at the Kaiser Family Foundation. A solution, she said, is on “life support.” | “The problems are real. They’ve only gotten bigger,” said Tricia Neuman, a drug policy expert who directs the Medicare policy program at the Kaiser Family Foundation. A solution, she said, is on “life support.” |
| The politics have hardly changed — prescription drug prices have consistently ranked as the top health care concern for voters heading into the 2020 election — but Senate Republicans have shied away from acting and Democrats have resisted making concessions. | The politics have hardly changed — prescription drug prices have consistently ranked as the top health care concern for voters heading into the 2020 election — but Senate Republicans have shied away from acting and Democrats have resisted making concessions. |
| Now Mr. Grassley, working to salvage the effort, is planning to call for his bill to be included in the next round of coronavirus relief legislation that Congress is expected to consider later this summer, according to a senior Republican aide. | Now Mr. Grassley, working to salvage the effort, is planning to call for his bill to be included in the next round of coronavirus relief legislation that Congress is expected to consider later this summer, according to a senior Republican aide. |
| Senator Mitch McConnell, Republican of Kentucky and the majority leader, who has raised more than $200,000 from pharmaceutical companies so far this election cycle, appears to be in no mood to tackle the issue by bringing Mr. Grassley’s measure to the floor. In December, Mr. Grassley accused him of sabotaging his bill. | Senator Mitch McConnell, Republican of Kentucky and the majority leader, who has raised more than $200,000 from pharmaceutical companies so far this election cycle, appears to be in no mood to tackle the issue by bringing Mr. Grassley’s measure to the floor. In December, Mr. Grassley accused him of sabotaging his bill. |
| Longtime patient advocates now fear that the broad support they built among lawmakers for moving on the issue may be eroding in the face of an even more dramatic health crisis, one that has also prompted a health insurance emergency that has gone largely unaddressed by the Trump administration. | Longtime patient advocates now fear that the broad support they built among lawmakers for moving on the issue may be eroding in the face of an even more dramatic health crisis, one that has also prompted a health insurance emergency that has gone largely unaddressed by the Trump administration. |
| “All of the problems that pre-existed the pandemic are still there, if you’re paying too much for insulin, if you’re paying too much for cancer drugs like I am,” said David Mitchell, who founded Patients for Affordable Drugs and is battling a blood cancer called multiple myeloma. “Nothing has changed, except now we have millions of people who are unemployed who have lost income, who have lost insurance.” | “All of the problems that pre-existed the pandemic are still there, if you’re paying too much for insulin, if you’re paying too much for cancer drugs like I am,” said David Mitchell, who founded Patients for Affordable Drugs and is battling a blood cancer called multiple myeloma. “Nothing has changed, except now we have millions of people who are unemployed who have lost income, who have lost insurance.” |
| Like Mr. Trump, Democrats have said they support a bill to lower drug costs, and the House passed such a measure in December. Former Vice President Joseph R. Biden Jr., the presumptive Democratic presidential nominee, released a sweeping prescription drug plan last summer that went far beyond what Mr. Grassley has proposed. | Like Mr. Trump, Democrats have said they support a bill to lower drug costs, and the House passed such a measure in December. Former Vice President Joseph R. Biden Jr., the presumptive Democratic presidential nominee, released a sweeping prescription drug plan last summer that went far beyond what Mr. Grassley has proposed. |
| Months ago, House Democrats in politically competitive districts were inundated at town hall meetings with questions about drug costs, and assumed the issue would feature prominently in their re-election campaigns. | Months ago, House Democrats in politically competitive districts were inundated at town hall meetings with questions about drug costs, and assumed the issue would feature prominently in their re-election campaigns. |
| Many Republicans in Congress who have fretted about the political risks of their party’s push to repeal the Affordable Care Act, which the Trump administration on Thursday asked the Supreme Court to overturn, had hoped for action on drug costs, eager to show voters that they were willing to address the most pressing health care problems. Mr. Grassley said that during his town hall meetings in Iowa before the pandemic, a quarter of the time was spent discussing prescription drugs. | Many Republicans in Congress who have fretted about the political risks of their party’s push to repeal the Affordable Care Act, which the Trump administration on Thursday asked the Supreme Court to overturn, had hoped for action on drug costs, eager to show voters that they were willing to address the most pressing health care problems. Mr. Grassley said that during his town hall meetings in Iowa before the pandemic, a quarter of the time was spent discussing prescription drugs. |
| “It’s a pocketbook issue,” Ms. Neuman said. “And it is one that candidates who are Republicans and Democrats all talk about.” | “It’s a pocketbook issue,” Ms. Neuman said. “And it is one that candidates who are Republicans and Democrats all talk about.” |
| Americans spend tens of billions of dollars on prescription drugs annually. Public health experts say that level of spending is not surprising given how manufacturers keep debuting new drugs at high prices while raising prices on hundreds of drugs already on the market. | Americans spend tens of billions of dollars on prescription drugs annually. Public health experts say that level of spending is not surprising given how manufacturers keep debuting new drugs at high prices while raising prices on hundreds of drugs already on the market. |
| Prescription medicine use has only intensified during the coronavirus crisis: Express Scripts, a prescription benefit manager with over 100 million customers, saw spikes in March for three-month refills and new prescriptions for conditions associated with higher coronavirus risk. | Prescription medicine use has only intensified during the coronavirus crisis: Express Scripts, a prescription benefit manager with over 100 million customers, saw spikes in March for three-month refills and new prescriptions for conditions associated with higher coronavirus risk. |
| “The problem has expanded,” said Representative Kim Schrier, Democrat of Washington and a pediatrician. | “The problem has expanded,” said Representative Kim Schrier, Democrat of Washington and a pediatrician. |
| Because of border restrictions amid the pandemic, Ms. Schrier said, some in her state can no longer drive to Canada to purchase insulin at a fraction of what it costs in the United States. “There’s this fear that we’re going to run out of medications, so people are trying to get more in hand,” she said. | Because of border restrictions amid the pandemic, Ms. Schrier said, some in her state can no longer drive to Canada to purchase insulin at a fraction of what it costs in the United States. “There’s this fear that we’re going to run out of medications, so people are trying to get more in hand,” she said. |
| Mr. Mitchell said that his group had observed significant price increases on drugs needed for coronavirus patients, including anticoagulants for blood clots. | Mr. Mitchell said that his group had observed significant price increases on drugs needed for coronavirus patients, including anticoagulants for blood clots. |
| “There’s more of a sense of urgency,” said Representative Frank Pallone Jr., Democrat of New Jersey and the main sponsor of the House bill, called H.R. 3, which was given a low number to reflect its top ranking among Democratic priorities. “So many people have lost their jobs. So many people have lost income. They’re more conscious than ever of the price of health care.” | “There’s more of a sense of urgency,” said Representative Frank Pallone Jr., Democrat of New Jersey and the main sponsor of the House bill, called H.R. 3, which was given a low number to reflect its top ranking among Democratic priorities. “So many people have lost their jobs. So many people have lost income. They’re more conscious than ever of the price of health care.” |
| Mr. Grassley’s bill would cap the growth of drug prices in Medicare at inflation level, and impose a $3,100 limit on out-of-pocket costs for tens of millions of seniors and Americans with disabilities enrolled in its drug coverage program. The plan would provide nearly $100 billion in savings, according to the Congressional Budget Office. | Mr. Grassley’s bill would cap the growth of drug prices in Medicare at inflation level, and impose a $3,100 limit on out-of-pocket costs for tens of millions of seniors and Americans with disabilities enrolled in its drug coverage program. The plan would provide nearly $100 billion in savings, according to the Congressional Budget Office. |
| Updated June 30, 2020 | |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | |
| Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. | Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| The House bill goes further in seeking to control the growth of drug costs, calling for the secretary of health and human services to negotiate prices with manufacturers, a provision that is projected to save more than $500 billion over a decade, according to the C.B.O. The House will vote on that provision again as part of a bill it plans to bring to the floor next week to bolster the Affordable Care Act. | The House bill goes further in seeking to control the growth of drug costs, calling for the secretary of health and human services to negotiate prices with manufacturers, a provision that is projected to save more than $500 billion over a decade, according to the C.B.O. The House will vote on that provision again as part of a bill it plans to bring to the floor next week to bolster the Affordable Care Act. |
| The bills have faced predictable but fierce resistance from pharmaceutical companies, which lawmakers say are newly fortified as a result of their work developing coronavirus treatments, including the most sought-after drug — a vaccine — that could arrive next year. | The bills have faced predictable but fierce resistance from pharmaceutical companies, which lawmakers say are newly fortified as a result of their work developing coronavirus treatments, including the most sought-after drug — a vaccine — that could arrive next year. |
| “They feel emboldened,” Mr. Grassley said. “And I think they feel that they don’t have to worry about this bill.” | “They feel emboldened,” Mr. Grassley said. “And I think they feel that they don’t have to worry about this bill.” |
| While the White House has made little progress on the president’s 2018 prescription drug objectives, it has made incremental changes in line with some of the congressional proposals. In May, Mr. Trump announced that seniors with diabetes could enroll starting next year in Medicare drug plans that would cap their out-of-pocket insulin costs at $35 per month. | While the White House has made little progress on the president’s 2018 prescription drug objectives, it has made incremental changes in line with some of the congressional proposals. In May, Mr. Trump announced that seniors with diabetes could enroll starting next year in Medicare drug plans that would cap their out-of-pocket insulin costs at $35 per month. |
| Lowering drug prices is the rare issue for which Americans support more government intervention. Majorities of Democrats and Republicans believe Congress should do more to regulate drug prices. A majority of Americans say they would even accept higher taxes and fewer new drugs being developed if it mean paying less for prescription drugs. | Lowering drug prices is the rare issue for which Americans support more government intervention. Majorities of Democrats and Republicans believe Congress should do more to regulate drug prices. A majority of Americans say they would even accept higher taxes and fewer new drugs being developed if it mean paying less for prescription drugs. |
| The public’s mood is reflected in Washington, where lowering drug prices has been one of the few causes with broad bipartisan support in Congress, giving the issue momentum in a Senate with a thin legislative record. Every Democrat on the Finance Committee voted for Mr. Grassley’s bill, and the dozen Republicans who have pledged support cover the ideological spectrum, from Senator Steve Daines of Montana, a conservative ally of Mr. Trump’s, to the more moderate Senator Susan Collins of Maine. Both are running for re-election this year, as are Senators Joni Ernst of Iowa and Martha McSally of Arizona, who also back the bill. | The public’s mood is reflected in Washington, where lowering drug prices has been one of the few causes with broad bipartisan support in Congress, giving the issue momentum in a Senate with a thin legislative record. Every Democrat on the Finance Committee voted for Mr. Grassley’s bill, and the dozen Republicans who have pledged support cover the ideological spectrum, from Senator Steve Daines of Montana, a conservative ally of Mr. Trump’s, to the more moderate Senator Susan Collins of Maine. Both are running for re-election this year, as are Senators Joni Ernst of Iowa and Martha McSally of Arizona, who also back the bill. |
| Mr. Grassley has lobbied other Republicans on the Senate floor this year, making the pitch that he represents a possible last chance for a measured plan. His Republican successor on the finance committee, Senator Michael D. Crapo of Idaho, may be unfriendlier to reform if Mr. Trump wins a second term, and a Democratic administration, he has said, would pass something even less desirable. | Mr. Grassley has lobbied other Republicans on the Senate floor this year, making the pitch that he represents a possible last chance for a measured plan. His Republican successor on the finance committee, Senator Michael D. Crapo of Idaho, may be unfriendlier to reform if Mr. Trump wins a second term, and a Democratic administration, he has said, would pass something even less desirable. |
| But Mr. Grassley and his colleagues have yet to find a compromise with House Democrats, and the measure has stalled since its approval by the Finance Committee. Democratic and Republican aides in the House and Senate privately say that Mr. Trump, notoriously fickle and uninformed on policy, could hasten a resolution with a phone call to Mr. McConnell, but he has chosen not to do so. Vice President Mike Pence and Alex M. Azar II, the health secretary, have endorsed the legislation. | But Mr. Grassley and his colleagues have yet to find a compromise with House Democrats, and the measure has stalled since its approval by the Finance Committee. Democratic and Republican aides in the House and Senate privately say that Mr. Trump, notoriously fickle and uninformed on policy, could hasten a resolution with a phone call to Mr. McConnell, but he has chosen not to do so. Vice President Mike Pence and Alex M. Azar II, the health secretary, have endorsed the legislation. |
| Late last month, Mr. Grassley met with Speaker Nancy Pelosi and policy aides to see whether a compromise was still feasible, and where components of their bills might go. But little has come of it. | Late last month, Mr. Grassley met with Speaker Nancy Pelosi and policy aides to see whether a compromise was still feasible, and where components of their bills might go. But little has come of it. |
| A final target could be late November, when Congress faces a deadline to extend some health care programs. But by then, in the wake of the election, the political landscape could look far different. And voters may well have already have exacted a political price for Congress’s failure to move on the issue. | A final target could be late November, when Congress faces a deadline to extend some health care programs. But by then, in the wake of the election, the political landscape could look far different. And voters may well have already have exacted a political price for Congress’s failure to move on the issue. |
| “The issue does not go away” without a deal, said Ms. Neuman, the drug policy expert. “The question is, will voters hold candidates responsible for not taking action?” | “The issue does not go away” without a deal, said Ms. Neuman, the drug policy expert. “The question is, will voters hold candidates responsible for not taking action?” |