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That’s an idea Republicans typically resist. Yet some leading GOP members, even if privately skeptical, are holding their fire or even expressing cautious support.

“I do like it,” Sen. Bill Cassidy (R-La.) told reporters yesterday. “If we compare our prices to a market basket of other rich nations — not Zimbabwe, but Germany — then you get a sense of reasonableness as to what the American taxpayer is paying.”

That sentiment from Cassidy, a conservative who has long characterized the Affordable Care Act as allowing government overreach, shows the public pressure lawmakers are feeling to do something to lower prescription drug prices in the United States, which are unquestionably many times higher than in other countries.

The proposal for an international index doesn’t go nearly as far as allowing the United States government to directly negotiate lower prices for Medicare’s sweeping prescription drug program, an idea Trump pushed during his campaign but then backed away from. But other countries do set much lower prices for medicines, and linking Medicare prices to their rates would, in a sense, allow the United States to hitch a ride on the price-fixing wagon.

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A majority of voters appears to favor the idea of tying Medicare payments to lower prices in other countries. In a Kaiser Family Foundation poll released Friday, 74 percent of Democrats and 54 percent of Republicans expressed support for the idea.

Azar’s index idea tests Republicans on how far they’re willing to go in enabling the federal government to determine prices for drugs paid through Medicare — a massive program that tends to set the tone for the nation’s private plans. Republicans were muted in their response when Azar first laid out the idea of an index. Five months later, some are still cagey on how they feel about it.

One key senator to watch is Chuck Grassley (R-Iowa), who heads the powerful Senate Finance Committee. So far, Grassley has said only that he’s withholding judgment until after HHS actually proposes a rule.

“I will answer the question the same way I’ve tried to answer it for two months now,” Grassley recently told reporters. “This proposal is out there for discussion. I’m going to wait until the final product goes out under the administrative procedures act and comment at that point.”

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Grassley even suggested Azar presented the idea as a way of getting the pharmaceutical industry’s attention — but may not follow through with an actual proposal.

“This is just my gut feeling — it’s not something I’ve heard from Azar — I think Azar’s approach is to get people to the negotiating table,” Grassley said. “I would suggest to you there might be something that would negate the necessity for going ahead with new regulations.”

The index would apply only to drugs dispensed directly by doctors to Medicare patients — and HHS would need help from lawmakers to make it permanent. Without legislation passed by Congress, the agency could only implement the index as a five-year experiment and it would apply to just half of Medicare’s “Part B” doctors program.

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It’s one of several ways the agency says it’s trying to realign incentives all along the drug supply pipeline so that pharmaceutical makers lower list prices and pharmacies and insurers pass along more savings to patients. But it’s also the idea that has raised the most ire among groups typically aligned with Republicans.

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U.S. Chamber of Commerce chief executive Tom Donohue has called the proposal “an assault on our free enterprise system.” The Chamber is running cable, digital and print ads the first half of March urging the administration to abandon the idea, which it characterizes as “foreign price controls.”

Earlier this week, the FreedomWorks Foundation issued a report pushing back on the idea and charging the administration would be exceeding its legal authority.

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A pricing index “assumes that governments have the ability to efficiently set prices for any good or service,” Patrick Hedger, FreedomWorks policy director, said in a statement. “Government price controls always result in inefficiencies because prices do nothing more than transmit information.”

AHH, OOF and OUCH

AHH: Marijuana is getting some pot-sitive signals form 2020 presidential candidates. Sen. Cory Booker (D-N.J.) is reintroducing his Marijuana Justice Act to legalize marijuana on the federal level and expunge convictions for marijuana possession. Four of his fellow Democratic presidential contenders will co-sponsor it.

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Sens. Elizabeth Warren (D-Mass.), Kirsten Gillibrand (D-N.Y.), Kamala D. Harris (D-Ca.) and Bernie Sanders (I-Vt.) also co-sponsored the bill when Booker first introduced it in 2017, but the measure was never brought up for a vote, our Post colleague David Weigel reports. Sen. Jeff Merkley (D-Ore.), who is considering his own presidential run, and Sen. Michael F. Bennet (D-Colo.), who could join the pack too, are also co-sponsors.

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“It’s not enough to simply decriminalize marijuana,” Booker said in a statement announcing the new version of his bill. “We must expunge the records of those who have served their time. The end we seek is not just legalization, it’s justice.”

“Any of them would be the first nominee of a major political party to endorse the legalization of marijuana; Sanders, as a candidate in 2016, had called for the drug to be decriminalized,” David writes.

OOF: Amid an anti-vaccine movement and measles outbreak nationwide, an Arizona state lawmaker took to Facebook to criticize the state for pushing vaccinations. Republican State Rep. Kelly Townsend, a five-term state lawmaker who our Post colleague Timothy Bella writes is “no stranger to making controversial and befuddling statements on social media,” wrote this:

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“Dearest friends and people of Arizona, it seems we are prepared to give up our liberty, the very sovereignty of our body, because of measles,” Townsend wrote. “I read yesterday that the idea is being floated that if not enough people get vaccinated, then we are going to force them to. The idea that we force someone to give up their liberty for the sake of the collective is not based on American values but rather, Communist.”

A state House committee recently advanced three bills that could make it easier to get exemptions from vaccination requirements. But Arizona Gov. Dough Ducey (R) has threatened to veto legislation that would mean fewer vaccinations.

"I'm pro vaccination. I'm anti-measles," Ducey told reporters this week, the AP reports. "I'm not going to sign any law that doesn't' promote or extend vaccinations in the state of Arizona…We want to see more of our kids being vaccinated rather than fewer."

In an interview with The Post, Townsend acknowledged the studies supporting vaccines but defended her right to opt out of them. “My child is at risk from being injured from a vaccine and your child is potentially at risk if my son catches something," she told The Post. "Whose child is more important? Where’s the line?”

OUCH: Amy Klobuchar, one of the senators seeking the 2020 presidential nomination, may have compromised her reputation as a consumer defender by advocating strongly for the medical device industry, the Associated Press reports. The medical device industry employs nearly 30,000 people in the state, with Minnesota viewed as the industry's capital.

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"During her time in the Senate, Klobuchar has advanced proposals championed by the medical device industry that some consumer advocates claim would put patients’ safety at risk, a review of her record by The Associated Press and the International Consortium of Investigative Journalists found," the AP writes. "Safety and regulatory concerns relating to medical devices have come under scrutiny since the AP, ICIJ and other media partners began publishing a series of investigative stories about the industry in late 2018."

"Klobuchar has pushed the federal Food and Drug Administration to approve medical devices faster and called for a greater presence of industry-backed experts at the agency," the AP continues. "Not all of her proposals became law, but bills she introduced called for reducing the use of randomized clinical trials for some devices and limiting the amount of information FDA reviewers can ask of companies when evaluating devices."

HEALTH ON THE HILL

— One day after a separate vote to expand federal background checks for gun purchases and transfers, the House passed legislation to extend the background check window to at least 10 days.

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The Enhanced Background Checks Act of 2019, which passed on a 228 to 198 vote, looks to close what’s known as the “Charleston loophole,” referring to the gunman behind the 2015 massacre of nine black parishioners at a South Carolina church who was able to buy a gun after a three-day background check didn’t turn up a prior conviction.

Before the vote, House Majority Whip James E. Clyburn (D-S.C.), who led the effort behind the bill, delivered an impassioned floor speech referencing the shooting, our Post colleague Felicia Sonmez reports.

“The members of this august body need to think a little bit about the value of those lives. Are they more valuable than the inconvenience a gun purchaser may have by having to wait 10 rather than three days to make a purchase?” he said.

The American Academy of Pediatrics praised the passage of the bill, calling gun violence a “public health epidemic and must be addressed that way.” "On the heels of yesterday's passage of the Bipartisan Background Checks Act of 2019 … we are one step closer to making our communities safer for children and their families,” Kyle Yasuda, AAP president, said in a statement. “Pediatricians applaud lawmakers for their bipartisan action, and now urge the U.S. Senate to follow suit without delay.”

But Trump has threatened to veto both bills, which have a low chance of advancing through the Republican-controlled Senate.

— A coalition of progressive organizations sent a letter to House Democratic leaders calling on them to pursue incremental legislation to bring down prescription drug prices and specifically urging them to look beyond Medicare negotiation on its own.

“We believe there may be opportunities to enact into law incremental legislation, such as legislation that makes it easier for generic drugs to come to market. Congress can and should pursue such legislation,” wrote the group of 16 organizations, including the Center for American Progress, Social Security Works, Families USA and the AFL-CIO. “Although Medicare negotiation is a much-needed reform, it is not the only solution needed to reach most Americans. We need reforms that lower stratospheric launch prices for new drugs and prevent price gouging on existing drugs for all payers.”

The letter notes that private insurance covers 56 percent of the nation’s population, calling for legislation to “lower prescription drug prices for seniors, middle-class families, and lower-income families, regardless of whether they are covered by Medicare, private insurance, or Medicaid.”

INDUSTRY RX

— The Blue Cross Blue Shield Association issued a list of policy proposals intended to expand health-care coverage and reduce individual marketplace premiums. The group suggests its proposals could expand coverage to more than 4 million additional people and shrink premiums by a third.

BCBSA, whose insurers have been some of the most successful in Affordable Care Act marketplaces, suggests enhancing tax credits to make coverage cheaper by making sure no one pays more than 12 percent of their income on insurance, creating a federal funding system to support people with serious medical needs and expanding outreach efforts.

“We believe everyone should have access to coverage and care, no matter who you are or where you live,” said Scott Serota, president and chief executive of the organization that represents the 36 locally owned and independently operated Blue Cross and Blue Shield companies. “The individual market is a critical source of coverage for people from all walks of life, and it should be strengthened to make coverage more affordable while protecting those with pre-existing conditions.”

AGENCY ALERT

— The Food and Drug Administration issued a warning to Canadian drug company CanaRx about sending “unapproved” and “misbranded” medications to the United States and warned U.S. consumers not to use drugs from the company.

“The FDA action comes amid a growing clamor over high drug prices in the United States that includes a Senate hearing Tuesday at which top pharmaceutical executives were grilled about the costs,” our Post colleagues Lenny Bernstein and Laurie McGinley report. Importing cheaper prescription drugs from Canada and other major countries has been floated as one way to bring down costs for American consumers, and our colleagues report that “Congress has repeatedly approved legislation allowing drug importation over the last 20 years that has never been implemented.”

In an interview with The Post, FDA Commissioner Scott Gottlieb insisted the move wasn’t “timed with anything. This isn’t politically motivated. This is our bread and butter. This is public health protection 101.”

But Lenny and Laurie write that Chicago-based attorney for CanaRx Joseph Morris expressed confusion about the move. “We have not had any prior warnings, threats, complaints or communications with the FDA at all,” Morris said. “They seem to think we’re an Internet pharmacy contracting with plan sponsors to supply medications.”

But he said the company only sells drugs — in their original packaging — made by brand-name companies such as Pfizer and Merck that are licensed by the FDA.

— And here are a few more good reads:

TRUMP TEMPERATURE

MEDICAL MISSIVES

REPRODUCTIVE WARS

DAYBOOK

Coming Up

The Coalition to Stop Opioid Overdose and the Mental Health Liaison Group host a briefing on Capitol Hill on the addiction workforce on March 6.

SUGAR RUSH