Press Briefing by Press Secretary Sarah Sanders and HHS Secretary Alex Azar
Yes.
Q Mr. Secretary, there are a couple of notorious examples in the last couple of years of drug companies buying drugs that have been on the market for years and suddenly raising their prices extraordinarily. Is there anything in this blueprint that addresses that?
SECRETARY AZAR: There is.
Q For example, the EpiPen situation a couple of years ago.
SECRETARY AZAR: Yep. There is. So one of the elements on increasing the power of negotiation that we're doing in this plan is if a sole source generic drug, which is what these instances that have gotten so much attention in the past several years - this is when you have one generic drug out there - and if there is any increase in price by a sole source generic, we are going to allow the drug plan to reopen their drug formulary immediately and take action against that drug. Whereas right now, they have to wait for the end of the year and the new plan cycle. They can immediately go after the drug, come up with alternative drugs, or create preferential treatment for other drugs over that one right away if there's any increase of price of a sole source generic.
Yes.
Q Yes. So you're talking about the increases in drug prices, while in areas like Maryland and Virginia, insurers are talking about double-digit health insurance premium increases. There's a Maryland regulator that said something like, the ACA is in a death spiral, kind of echoing past words of the President. What are you doing to deal with that? Does HHS just accept these premium predictions as reality? What are you doing to reduce those costs?
SECRETARY AZAR: So some of these premium submissions right now, it is the very beginning of a process that happens with state regulators around those insurance designs. These price increases were happening under President Obama. They continue because of the structural infirmities in how Obamacare was designed. This is why the President has been so adamant about producing alternative, affordable options for patients. Because for so many - the 28 million forgotten men and women in this country have been forced out of the individual market, and are sitting there without insurance, even though with the promise they would have accessible, affordable, competitive insurance that they could keep.
You know, 6.7 million Americans paid $3.1 billion in the Obamacare taxes for the privilege of not buying insurance they couldn't afford and didn't want. And 80 percent of them make $50,000 or less. So we're trying to bring short-term plans as an option for people. We're trying to bring association health plans out of the Labor Department as options for people. The President is just - we want to keep looking for more options to get people out of some of the traps that the Obamacare system has created of these high-cost and uncompetitive plans for people.
Yes.
Q Mr. Secretary, I have a question about another issue at HHS, actually. The Justice Department has indicated the Department is set to change an Obamacare rule that would bar medical practitioners from denying medical treatment to transgender people, including gender reassignment surgery. Will HHS repeal that rule?
SECRETARY AZAR: I'm not familiar with that particular issue. So I'm going to talk about drug prices. I'm not familiar with that. I'll look into that when I get back over to the Department. Thank you.
Yes.
Q Mr. Secretary, thank you. So you talked about Medicare Part B negotiating better prices. That is the same thing that the President referred to when he said that other countries' socialized medicine systems are ripping us off. Why is that okay for Medicare, but not for other countries?
SECRETARY AZAR: So the difference is having entities negotiate in a competitive environment. So what happens in some of these socialist countries - I dealt with them in the past. What they do is they say, "You don't come into this country unless you pay this low price. And here's a low, below-market, noncompetitive price. You either pay it or you don't come into this country." And they don't really care if the people of their country don't get access to that drug, and people aren't informed even that they don't have access to that medicine in these rationed systems.
And so that's completely different from what we're doing where we're harnessing the power of the private negotiating market to negotiate deals. So for instance, the way Part D works - the system that we want to try to emulate and use tools from in that Part B - is one drug plan might say, "I'm not going to cover this drug because I didn't get a good enough deal." And then another plan might cover that drug because they think they got a good enough deal. But the key is the senior citizen is in the driver seat. They get to say, "All right, then I'm going to choose - I need that drug, I'm going to buy this plan and I'll pay the premium for that plan because I want insurance there." You know, if you're in a socialized country, it's one-size-fits-all. You can't exit, except getting on an airplane to America where you can get access to that medicine.
Yes.
Q Mr. Secretary, thank you. When people hear about this plan, read about this plan over the upcoming days, they're presumably going to learn about yourself, as well. And they might say, "Wait a minute. Somebody who was a pharma executive is now going to be the one in charge of lowering drug prices. How is that going to work?" Your pitch to Americans that they can trust you to oversee this effort would be what?
SECRETARY AZAR: I'd say trust us by our actions and by the deeds in the blueprint. Over 50 action plans that are hard hitting. It's the hardest-hitting plan ever proposed by a President across the entire spectrum of every player in this industry to drive down drug prices and make drugs more affordable. And this is - I know this from having been on the other side running a drug company and these issues - which is, I actually looked at if you could lower drug prices. It didn't work for any one company.
This is how perverse the system is. You put yourself at a disadvantage in the system by having a lower list-price drug than others - again, because every player system makes more money as a percent off of that list price. This is precisely why I'm so excited to be here in government, with knowledge that I've got and this team has about how we can change the rules of the road and actually change the system so that we can reverse those incentives to make that work, make those choices work, bring down drug prices, and make things more affordable.
Q Are you suggesting that when you were running a big pharmaceutical, that one of the reasons why you couldn't lower the price was because you were at a disadvantage? And do you regret -
SECRETARY AZAR: The math doesn't work.
Q - that it's gotten to this point, as somebody who was in that position?
SECRETARY AZAR: The system doesn't make that work. My job now, with the President's commission, is to make that work so that the incentives work to actually bring prices down, charge less on the list price. That's exactly what we're about, is to fix that, because no one company on their own can change that dynamic. The entire system actually is built for increased prices and high prices. This plan reverses those dynamics.
Q The President said in the Rose Garden that you guys were going to try to stop pharmaceutical companies from using patents to extend their monopolies. I'm wondering if you'd walk through exactly what patent process you plan to change, if it's going to extend beyond what we saw in the budget proposal a few months ago, and whether we should expect to see, sort of, increased enforcement on pay-for-delay deals.
SECRETARY AZAR: So I'll give you one or two examples of the kinds of abuses we're talking about. You know, to be able to bring a generic drug to market, or a biosimilar to market, you actually have to prove that your version, your copy of it, is bioequivalent to the innovator medicine. Well, you have to have access to that medicine to be able to run the tests and studies.
Well, what some companies are doing is locking down access to those medicines, hiding behind what are called the REMS programs, these safety programs of FDA. And even when FDA says, "No, no, no, you can share that for clinical trial testing, no problem," they're also creating limited distribution agreements with distributors to not allow these generic companies access to them. And that's one of the things we're going to be going after to make sure that these kind of anticompetitive behaviors that don't allow the affordable medicines to get to market, that we blow those away.
Well, thank you all very much. A very complex system, of course. A multi-factor, multi-stakeholder approach. It is the President - it's the most comprehensive approach ever. Look forward in the days and weeks ahead to keep engaged with you, to help walk you all through the different elements of it as you get a chance to digest it. Thank you.
MS. SANDERS: Thank you, Mr. Secretary. A couple more notes.
On behalf of the President and the First Lady, I'd like to wish a very happy birthday to America's oldest living veteran of World War II, Richard Overton. Richard, who lives in Austin, Texas, is turning 112 years old today. He served in the Pacific Theater from 1942 to 1945 as part of the all-black Engineer Aviation Battalion. Happy birthday, Richard, and thank you for your service.
Speaking of birthdays, and those with a lot of candles on their cake, I'd also like to wish General John Kelly a happy birthday.
And finally, looking ahead to Sunday, Happy Mother's Day. And as a note of free advice, don't forget to call your moms. You might even buy flowers if you feel inclined.
And with that, I will take your questions.
Jonathan.
Q Sarah, on the Kim Jong-un summit, we're told that the summit will be a day long, possibly extending to a second day. What is the best-case scenario for what can be accomplished in a single day? What does the President think can be done in a single day with Kim Jong-un?
MS. SANDERS: I'm certainly not going to get ahead of those conversations. As you stated, we plan for a full day of meetings on the 12th with some time reserved to carry over if necessary. Certainly the best outcome would be an agreement for complete and total denuclearization. But this is the beginning part of these conversations. I'm not going to get ahead of what we expect for that day, but certainly that would be, I think, the best outcome. And we've been pretty upfront about that.
Q Do they think that can actually happen in a day? Or is this -
MS. SANDERS: Again, I'm not going to get ahead of this conversation and the process. But there have been several conversations that have taken place leading up to both - Secretary Pompeo has had now two meetings that have been part of this process. So it's not just one day that is - you have to look at the broader picture. But certainly we have that time set aside at this point.
Justin.
Q I wanted to ask about the auto meeting earlier today. I know attendees of these sort of spitball sessions can often leave with the impression that the President agrees with their position. So I wanted to see if you could clarify both if the President or administration has agreed to open negotiations with California on a national CAFE standard, rather than, sort of, the dual system that could exist. And -
MS. SANDERS: We haven't finalized what that looks like, but today was a part of that conversation, part of the discussion on how best to move forward. We're going to continue these conversations. As we have a specific announcement on that front, we'll let you know.
John.
Q If I could come back to North Korea. The President says that he believes that it's Kim's intention to denuclearize. But when you listened to Kim Yong-chol, who's in charge in North Korea of North-South relations, he said, listen, the reason why we're doing all this is because our nuclear program is complete; the reason why we're shutting down our test site is because we don't need it anymore - our nuclear program is complete. I mean, it's kind of akin to somebody who builds a house and then enters a negotiation to tear it down. What gives you confidence that Kim actually wants to take apart something that he just built?
MS. SANDERS: Look, the President is going into this with eyes wide open, as he said many times, and we'll see what happens. But this is certainly a process that has moved in the right direction. We've seen some signs of goodwill from North Korea just this week, with the three Americans brought back home; also the stopping of the ballistic missiles tests; them stopping with their research and development on their nuclear program. And we're going to continue to push for complete and total denuclearization. We're also going to continue maximum pressure until we see that happen.
Q But again, stopping the ballistic missile testing, stopping all this testing, according to Kim Yong-chol is because they don't need it anymore; they're done. It's kind of like, you can put the saws and the hammers away because the house is done.
MS. SANDERS: Again, the President has been very clear that we're going into this; certainly, we would like to see something happen. But as he has said many times, we'll see what happens. And we hope not just for North Korea, but for the entire world, that they do the right thing and that this goes forward in the way that I think everyone would like to see.
Eamon.
Q Thanks, Sarah. This week, the CEOs of AT&T and Novartis both said that they thought it was a mistake for their companies to work with the President's lawyer. Does the President think it was a mistake for his lawyer to work with them?
MS. SANDERS: I think that this further proves that the President is not going to be influenced by special interests. This is actually the definition of draining the swamp, something the President talked about repeatedly during the campaign. And for anything beyond that, I would direct you to the President's outside counsel.
Q Explain one way this is the definition of draining the swamp. I mean, this is companies paying for information (inaudible).
MS. SANDERS: I think it's pretty clear that the Department of Justice opposed the merger, and so certainly the President has not been influenced by any - or his administration influenced by any outside special interests.
Blake.
Q Sarah, thank you. You said in this room the other day that it is unlikely there's going to be an infrastructure bill this year. That was supposed to be the signature legislative item of 2018 for Republicans and this administration. Can you lay out for us what exactly is this White House's legislative agenda for this year?
MS. SANDERS: Certainly we'd love to see something done on immigration. It's something the President has been talking about for a long time. We've laid out the principles and the priorities that we'd like to see as part of an immigration package. There's still some movement on that front, and we would still like to see something happen. We'd love for Congress to actually show up, do their jobs; Democrats to stop opposing good legislation and actually fix our broken immigration system.
Q So is it fair to say, from that answer, that immigration is now the signature priority item this year?
MS. SANDERS: It's been a constant priority for the President and something we'd certainly still like to see.
David.
Q Sarah, thank you. Two questions. We've heard a lot about White House aide Kelly Sadler and her comments about Senator McCain, reportedly saying in a meeting that the President shouldn't worry about the Senator's opposition to the nomination of Gina Haspel because he is "dying anyway." Meghan McCain, his daughter, wondered aloud today why Kelly Sadler still has a job here at the White House. Does she still have a job?
MS. SANDERS: I'm not going to comment on an internal staff meeting.
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