Bernie Sanders’ showdown with pharma CEOs is coming to a head

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Bernie’s subpoena showdown

We’re less than a week away from a scheduled vote on subpoenaing the CEOs of two drugmakers, J&J and Merck. They would be the first subpoenas issued by the Senate HELP committee in more than 40 years, if the vote happens and goes in Chair Bernie Sanders’ favor. Sanders (I-Vt.) is publicly continuing his pressure campaign with a press conference today. It’s clearly part of his strategy, as he got the CEO of Starbucks to testify last year without the subpoena vote actually occurring.

Subpoena votes require a simple majority of the committee’s vote, so if all Democrats backed the effort, it could succeed without Republican support. I did an informal whip count of the Democrats on the HELP committee in the halls on Tuesday (and touched base with some offices too). Here’s what they said:

• Sen. Tim Kaine said he’s likely to vote yes. “My feeling is that testifying before the Senate is an honor, and people should appear voluntarily. And my understanding is at least one of the CEOs is going to. I think they all should,” he said.
• Sen. Chris Murphy said he would vote yes on the subpoena, and will try to join Sanders at his press conference
• Sen. Tina Smith said she plans to vote yes.
• A spokesperson said that Sen. Tammy Baldwin plans to support the subpoena vote.
• Sen. Bob Casey was noncommittal in the hallway, but his office followed up with a statement in writing: “These CEOs shouldn’t need a subpoena to compel them to testify. They should come before Congress and answer questions about drug costs.”
• Sen. Patty Murray ignored the question. (This is pretty normal behavior. Some senators like answering questions in the hallways more than others!) Her office did not provide an on-the-record statement.
• A spokesperson said Sen. Maggie Hassan doesn’t typically share her votes ahead of time.
• Sen. Ed Markey’s office didn’t respond to my inquiry, but he is appearing at the press conference with Sanders today, which is a clear indication of support.

Zyn enters the culture war

Senate Majority Leader Chuck Schumer (D-N.Y.) reportedly wants the FDA and the FTC to probe the oral nicotine product known as Zyn. Schumer is no stranger to calling for crackdowns on popular products — he’s done similar with Four Loko and Logan Paul’s line of energy drinks. The problem for Schumer this time around is that many users of Zyn are very passionate, and very very online. For the uninitiated: Zyn, a so-called nicotine pouch, has become particularly popular among certain conservative men, the most notable being Tucker Carlson, who recently said “I use Zyn every second that I’m awake.”

Schumer’s remarks have prompted meme-laden backlash on social media, in conservative news outlets, and especially among Republican members of Congress. Rep. Marjorie Taylor Greene (R-Ga.) called for a “Zynsurrection.” Rep. Richard Hudson (R-N.C.), the chair of the House Republicans campaign arm, tweeted a photo of him in camo proudly holding a Zyn with the message: “Big Brother Schumer doesn’t want us to chew or smoke.” Rep. Mike Collins (R-Ga.) tweeted a new version of the so-called Gonzales flag. The National Republican Senatorial Committee joined in too.

But can Zyn actually rally Republican voters? One expert on the intersection of health policy and politics says that while the issue won’t single handedly sway voters, it could mobilize those in the Republican party who are already aggrieved about alleged government overreach.

“The issue itself is not going to sway millions of voters, but it’s another example for a party that is running [on a message of reducing] the size of those regulatory agencies,” said Bob Blendon, a professor emeritus of health policy and political analysis at Harvard T.H. Chan School of Public Health. “They’re just making a point that if you vote for us, we defend your rights to make your own individual decisions.”

A nonprofit PBM in Africa aims to flip industry script

Maisha Meds created an app to help pharmacies manage their medications, and it acts as a liaison with major international aid organizations in Africa — but it really doesn’t want you to call it a PBM.

The animosity toward PBMs in the United States, which is playing out every day in Washington as lawmakers explore tighter regulations for the industry, led the organization to spurn the moniker as it fundraises. Organizations including USAID, the Gates Foundation, and Pfizer have taken notice and contributed.

In a new story out today, I examine the lessons the nonprofit’s model could hold for the PBM industry at large, and how it manages to subsidize products with clear public health benefits for patients.

Too big to fail?

Following a report in our sister publication the Boston Globe this week on Steward Health Care’s grave financial position, the entire Massachusetts congressional delegation has asked Steward for a briefing on the system’s financial position and its future plans for its Massachusetts facilities.

“The burden of Steward hospital closures would be borne primarily by the Massachusetts residents who already experience the greatest challenges accessing health care,” the lawmakers said in an 11-way joint statement.

Steward is the third-largest hospital operator in the state, and its situation raises concerns about who would serve patients if hospitals were to close. Steward is talking to state officials about its plans as well, and has until the end of the month to make a plan to satisfy its lenders.

A Medicare negotiation split screen

With HHS set to send its opening offers to pharmaceutical companies next Thursday in the new Medicare drug price negotiation program, I asked two drug pricing experts at Johns Hopkins whether they thought we’d get any inkling of what the offers are. Here’s what they said:

Mariana Socal: “It is possible that these prices on February 1 will be confidential and will be limited to the participants in the negotiation. And I would also say that typically, the pharmaceutical industry is not very excited about transparency and about their prices being publicly available.”

Gerard Anderson: “I have been around Washington for 40 years. And secrets are not something that people in Washington are able to keep….my guess is that by February 2, one or all of you will have some information on this thing.”

In the mood to make Anderson’s prediction come true on Feb. 1? You know where to find me!

What we’re reading

• Tyson Foods drops CVS for upstart pharmacy benefit manager, as industry upheaval over cost concerns spreads, CNBC
• As NIH grant runs out, Dog Aging Project founders look to raise up to $50 million, STAT
• Elevance Health reports $856 million profit despite drop in Medicaid enrollment, Forbes
• FDA OKs — but doesn’t require — a non-cancer-causing chemical for sterilizing devices, STAT