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House Democrat wants to know why a pharma insider is overseeing Trump’s drug pricing reform

Rep. Keith Ellison sent a letter Monday to HHS Secretary Alex Azar inquiring about the appointment of Daniel Best to oversee drug pricing reform.

Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

House Democrats want to know why the Trump administration is letting a former pharmaceutical industry insider oversee its plans to fulfill President Donald Trump’s promises to bring down drug prices.

Rep. Keith Ellison (D-MN), one of the top progressives in the House and deputy chair of the Democratic National Committee, sent a letter Monday to HHS Secretary Alex Azar inquiring about the appointment of Daniel Best to oversee drug pricing reform. Best most recently worked at CVS CareMark before starting at HHS last week. He also worked at Pfizer for four years in the early 2000s.

”Given Mr. Best’s career working for the pharmaceutical and pharmacy industry, the decision to hire him poses significant potential for conflicts of interest, placing him in a position to make decisions that may pit the income of his former employers against the interests of patients in reducing prescription drug prices,” Ellison said in the letter, shared exclusively with Vox.

Ellison flagged past drug price hikes at Pfizer and a lawsuit filed against CVS CareMark by HIV patients over access to drugs. In general, pharmacy benefits managers are under the microscope of both parties these days for their role as mysterious administrators with great power over drug transactions.

The Congress member includes a string of questions about who was involved in hiring Best, whether outside groups (particularly pharmaceutical lobbying groups) were consulted, and how Best will prevent any potential conflicts of interest from getting in the way of his job description.

HHS told me “we have received the letter and will respond” when I asked about the concerns Ellison raised.

A letter from a Congress member of the opposing party questioning the executive branch happens all the time. But Ellison’s letter lands in the middle of an interesting moment for the administration on one of its most high-profile issues.

As we have covered before, Trump took an unorthodox position for a Republican during the campaign by advocating for an active government role in bringing down drug prices. It is an issue he has returned to again and again, including in his first State of the Union speech.

Yet the consensus of policy experts is that aside from some good work on generics by the FDA, the Trump administration is not really doing much yet to address drug costs.

The drug industry can take some credit for that, both mounting a successful messaging campaign that has placed more of the spotlight on health insurers and PBMs while also being more proactive about pushing some policy ideas it’s more comfortable with (like generics and value-based contracting) to crowd out those it doesn’t like (more direct federal price-setting).

The industry has and would point out, too, that Trump’s outspokenness on the issue has helped encourage some self-restraint on the part of drug makers when it comes to prices and that the uproar over drug prices therefore hasn’t caught up with the facts on the ground. They’d also remind you that the Trump administration is far from over — and they are right.

Azar, a former drug executive himself, started his tenure promising to take up this key campaign promise. And HHS has at least signaled an interest in some intriguing proposals, like moving certain drugs out of Medicare Part B (where there is no price negotiation) into Part D (where there is, by the private plans that administer its benefits) or allowing states to set up drug formularies in their Medicaid programs.

But then there are reports like the one from Inside Health Policy, which suggested HHS might deny Massachusetts’s proposal to pursue one of those policies, a Medicaid drug formulary. The report said that HHS was worried that drug makers could sue and win to block it and that the agency was worried about other states following the same strategy.

Law professors Rachel Sachs and Nicholas Bagley examined those rationales for Health Affairs last week and found them wanting. They make a persuasive case that HHS is perfectly within its legal rights to approve the Massachusetts waiver and they also questioned why HHS would worry about setting a precedent for Medicaid drug formularies when it is eagerly encouraging states to establish Medicaid work requirements.

”If none of these explanations hold water, a more alarming possibility comes into focus. The Trump administration may have succumbed to lobbying from the pharmaceutical industry,” they wrote. “We hope that’s not the case. It would be unlawful for CMS to deny an otherwise-legal waiver just because it threatens industry’s bottom line.”

Some might argue that having officials who have worked in the industry could be the most well-informed people to outline strategies for bringing down its costs. But the appointment of somebody like Best, paired with the actual actions by the administration so far, doesn’t point to the aggressive campaign on drug prices that Trump promised.

There is one other dynamic here I’d be negligent not to mention: When Trump talked about drug companies “getting away with murder,” he was borrowing directly from Bernie Sanders and the most progressive wing of the Democratic Party, of which Ellison is a member.

So the Congress member’s letter can be viewed as not only an attempt to hold the administration accountable and shine a light on possible conflicts of interest, but also as an attempt to reclaim an issue — one at the top of the mind of American voters — where Trump had muddied the traditional Democratic and Republican lines.

Trump might have campaigned on standing up to pharma, but, Ellison alleges, his administration is not doing anything of the sort — in fact, quite the opposite.

This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.