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Trump administration proposes altering rule on drug rebates

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(Reuters) – The Trump administration has proposed a rule that would scale back protections currently in place that allow rebates between drug manufacturers and insurers and pharmacy benefits managers, according to the Office of Management and Budget (OMB) website.

Bloomberg first reported the existence of the proposed rule, which comes as the administration works to implement a wide-ranging plan to lower prescription medicine prices. The U.S. Department of Health and Human Services on Wednesday night sent the proposed rule to the OMB.

Details of the proposed rule have not yet been made public, but its title on the OMB site refers to removing the safe harbor protection for rebates from the anti-kickback law.

The move is the first concrete sign that the Trump administration has started to review the legal status of these rebates since Food and Drug Administration Commissioner Scott Gottlieb raised the idea early this year that they should not be exempted from anti-kickback law.

The anti-kickback law makes it illegal to pay an incentive for drugs or services that Medicare, Medicaid or other federal healthcare programs cover.

Shares of drug wholesalers such as AmerisourceBergen Corp and McKesson Corp , and pharmacy benefit managers, including CVS Health Corp and Express Scripts , fell slightly on Thursday on the move.

The administration has placed blame on “middlemen” such as pharmacy benefits managers – which administer drug benefits for employers and health plans – and health insurers for driving up drug prices by demanding hefty rebates in exchange for the broadest access to patients. Health and Human Services Secretary Alex Azar and Gottlieb have questioned whether rebates provided by drug manufacturers should remain protected by federal law.

Health and Human Services and OMB did not immediately respond to requests for comment.

U.S. President Donald Trump made lowering prescription drug prices a top priority during his 2016 presidential campaign. In May, his administration unveiled a drug pricing blueprint that included broad proposals for lowering prices that largely spared pharmaceutical manufacturers and instead went after pharmacy benefits managers. Pharmaceutical stocks rose after the blueprint’s release.

JP Morgan analyst Lisa Gill said Wall Street overreacted to the proposal submitted on Wednesday because rebates are only one component of pharmacy benefits managers’ profit streams.

“If there are any changes around rebates they can adjust other aspects of the pricing model to ensure they are being paid fairly for the value they are adding,” Gill wrote.

 

This article was from Reuters

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Bernie Sanders, House Progressives Release Bill To Cancel Student Debt

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Democratic presidential candidate Sen. Bernie Sanders, I-Vt., pauses while speaking during a forum on Friday, June 21, 2019, in Miami. (AP Photo/Brynn Anderson)

WASHINGTON (AP) — Days before the first Democratic presidential debates, Sen. Bernie Sanders and House progressives rolled out legislation to cancel all student debt, going farther than a signature proposal by Sen. Elizabeth Warren as the two jockey for support from the party’s liberal base .


By canceling all student loans, Sanders says the proposal would address an economic burden for 45 million Americans. The key difference is that Warren’s plan considers the income of the borrowers, canceling $50,000 in debt for those earning less than $100,000 per year and affecting an estimated 42 million people in the U.S.

Questions face both candidates about how to pay for all of that plus their proposals for free tuition at public colleges and universities. But the battling ideas highlight the rivalry between senators who have made fighting economic inequality the cornerstones of their 2020 presidential campaigns.

Sanders vowed at a Monday news conference that his plan “completely eliminates student debt in this country and the absurdity of sentencing an entire generation, the millennial generation, to a lifetime of debt for the crime of doing the right thing. And that is going out and getting a higher education.” He appeared alongside the proposal’s House sponsors, Reps. Ilhan Omar, D-Minn., Pramila Jayapal, D-Wash., and Rep. Alexandria Ocasio-Cortez, D-N.Y., with American Federation of Teachers President Randi Weingarten also in attendance.

His bill and Warren’s plan are part of their broader appeal to liberal voters on issues such as health care, technology and education.

That appeal is likely to be fleshed out this week during the first Democratic debatesTwenty candidates are set for the showdown, with Warren part of the lineup on Wednesday and Sanders appearing a day later. The events come as Warren appears to be cutting into Sanders’ support from the left.

Sanders’ effort at one-upmanship on student loans, named the College For All Act, would cancel $1.6 trillion of debt and save the average borrower about $3,000 a year, according to materials obtained by The Associated Press. The result would be a stimulus that allows millennials in particular to invest in homes and cars that they wouldn’t otherwise be able to afford. It would cost $2.2 billion and be paid for — and then some — by a series of taxes on such things as stock trades, bonds and derivatives, according to the proposal.

The universal debt relief is designed partly around the idea that it would mostly benefit Americans who can’t afford college tuition without loans, according to a senior Democratic aide who spoke on condition of anonymity because the legislation wasn’t yet public.

Warren’s plan, which she plans to introduce as legislation alongside Rep. Jim Clyburn, D-S.C., would be paid for by imposing a 2% fee on fortunes greater than $50 million. Warren projects the levy would raise $2.75 trillion over 10 years, enough to pay for a universal child-care plan, free tuition at public colleges and universities, and student loan debt forgiveness for an estimated 42 million Americans — with revenue left over. Critics say top earners would find ways around such penalties.

One key difference between Sanders’ and Warren’s plans is their differing treatment of high earners: Warren wrote that her plan would offer “no debt cancellation to people with household income above $250,000,” or the top 5%. Sanders would extend the benefit even to wealthy borrowers.

Asked on Monday about that decision, Sanders told reporters that he believes in “universality” and added: “In other areas we are going to demand that the wealthy and large corporations start paying their fair share in taxes.”

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Natural Disaster

Seven Dead, Dozens Trapped In Cambodia Building Collapse

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PHNOM PENH, June 22 (Reuters) – Seven people were killed when an under-construction building in Cambodia collapsed early on Saturday, an official said, as rescuers struggled to reach dozens of missing workers feared trapped under a mountain of twisted steel and rubble.


Twenty-two people were injured in the collapse of the seven-storey Chinese-owned project in the coastal town of Sihanoukville, west of the capital Phnom Penh.

M<ore than 30 people were still missing and feared trapped inside, said Oar Saroeun, spokesman for the local province of Preah Sihanouk.

“The steel structure has collapsed on itself and we don’t dare move it,” Saroeun told Reuters. “We can only wait and listen for any signs of life…

“We are afraid more of it will collapse on them…. We will work through the night to remove the steel.”

Photos of the scene shared on social media showed groups of rescuers working their way through a crumpled heap of steel girders and concrete.

Preah Sihanouk province and its largest town, Sihanoukville, has seen a rush of investment in recent years from China, especially into the casino, property and tourism sectors.

Home to Cambodia’s largest port and a Chinese Special Economic Zone connected to Beijing’s Belt and Road initiative, the town is also undergoing a construction boom to serve those growing crowds of Chinese tourists and investors.

The collapsed building is Chinese-owned, according to Saroeun.

Police have detained four people, including three construction supervisors, for questioning in relation to the accident, according to a statement from the province.

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Migrant Crisis

Attorneys: Texas Border Facility Is Neglecting Migrant Kids

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FILE - In this Wednesday, May 22, 2019 file photo migrants mainly from Central America guide their children through the entrance of a World War II-era bomber hanger in Deming, N.M. A panel of appeals court judges in California will hear arguments in the long-running battle between advocates for immigrant children and the U.S. government over conditions in detention and holding facilities near the southwest border. (AP Photo/Cedar Attanasio, File)

EL PASO, Texas (AP) — A 2-year-old boy locked in detention wants to be held all the time. A few girls, ages 10 to 15, say they’ve been doing their best to feed and soothe the clingy toddler who was handed to them by a guard days ago. Lawyers warn that kids are taking care of kids, and there’s inadequate food, water and sanitation for the 250 infants, children and teens at the Border Patrol station.


The bleak portrait emerged Thursday after a legal team interviewed 60 children at the facility near El Paso that has become the latest place where attorneys say young migrants are describing neglect and mistreatment at the hands of the U.S. government.

Data obtained by The Associated Press showed that on Wednesday there were three infants in the station, all with their teen mothers, along with a 1-year-old, two 2-year-olds and a 3-year-old. There are dozens more under 12. Fifteen have the flu, and 10 more are quarantined.

Three girls told attorneys they were trying to take care of the 2-year-old boy, who had wet his pants and had no diaper and was wearing a mucus-smeared shirt when the legal team encountered him.

“A Border Patrol agent came in our room with a 2-year-old boy and asked us, ‘Who wants to take care of this little boy?’ Another girl said she would take care of him, but she lost interest after a few hours and so I started taking care of him yesterday,” one of the girls said in an interview with attorneys.

Law professor Warren Binford, who is helping interview the children, said she couldn’t learn anything about the toddler, not even where he’s from or who his family is. He is not speaking.

Binford described that during interviews with children in a conference room at the facility, “little kids are so tired they have been falling asleep on chairs and at the conference table.”

She said an 8-year-old taking care of a very small 4-year-old with matted hair couldn’t convince the little one to take a shower.

“In my 22 years of doing visits with children in detention, I have never heard of this level of inhumanity,” said Holly Cooper, who co-directs University of California, Davis’ Immigration Law Clinic and represents detained youth.

The lawyers inspected the facilities because they are involved in the Flores settlement, a Clinton-era legal agreement that governs detention conditions for migrant children and families. The lawyers negotiated access to the facility with officials, and say Border Patrol knew the dates of their visit three weeks in advance.

Many children interviewed had arrived alone at the U.S.-Mexico border, but some had been separated from their parents or other adult caregivers including aunts and uncles, the attorneys said.

Government rules call for the children to be held by the Border Patrol for no longer than 72 hours before they are transferred to the custody of Health and Human Services, which houses migrant youth in facilities around the country.

Government facilities are overcrowded and five immigrant children have died since late last year after being detained by Customs and Border Protection. A teenage mother with a premature baby was found last week in a Texas Border Patrol processing center after being held for nine days by the government.

In an interview this week with the AP, acting Customs and Border Protection Commissioner John Sanders acknowledged that children need better medical care and a place to recover from their illnesses. He urged Congress to pass a $4.6 billion emergency funding package includes nearly $3 billion to care for unaccompanied migrant children.

He said that the Border Patrol is holding 15,000 people, and the agency considers 4,000 to be at capacity.

“The death of a child is always a terrible thing, but here is a situation where, because there is not enough funding … they can’t move the people out of our custody,” Sanders said.

The arrival of thousands of families and children at the border each month has not only strained resources but thrust Border Patrol agents into the role of caregivers, especially for the many migrant youth who are coming without parents.

But children at the facility in Clint, which sits amid the desert scrubland some 25 miles (40 kilometers) southeast of El Paso, say they have had to pick up some of the duties in watching over the younger kids.

A 14-year-old girl from Guatemala said she had been holding two little girls in her lap.

“I need comfort, too. I am bigger than they are, but I am a child, too,” she said.

Children told lawyers that they were fed oatmeal, a cookie and a sweetened drink in the morning, instant noodles for lunch and a burrito and cookie for dinner. There are no fruits or vegetables. They said they’d gone weeks without bathing or a clean change of clothes.

A migrant father, speaking on condition of anonymity because of his immigration status, told AP Thursday that authorities separated his daughter from her aunt when they entered the country. The girl would be a second grader in a U.S. school.

He had no idea where she was until Monday, when one of the attorney team members visiting Clint found his phone number written in permanent marker on a bracelet she was wearing. It said “U.S. parent.”

“She’s suffering very much because she’s never been alone. She doesn’t know these other children,” said her father.

Republican Congressman Will Hurd, whose district includes Clint, said “tragic conditions” playing out on the southern border were pushing government agencies, nonprofits and Texas communities to the limit.

“This latest development just further demonstrates the immediate need to reform asylum laws and provide supplemental funding to address the humanitarian crisis at our border,” he said.

Dr. Julie Linton, who co-chairs the American Academy of Pediatrics Immigrant Health Special Interest Group, said CBP stations are not an appropriate place to hold children.

“Those facilities are anything but child friendly,” said Dr. Julie Linton. “That type of environment is not only unhealthy for children but also unsafe.”

The Trump administration has been scrambling to find new space to hold immigrants as it faces criticism that it’s violating the human rights of migrant children by keeping so many of them detained.

San Francisco psychoanalyst Gilbert Kliman, who has evaluated about 50 children and parents seeking asylum, says the trauma is causing lasting damage.

“The care of children by children constitutes a betrayal of adult responsibility, governmental responsibility,” he said.

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