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Senate inches forward on opioid package after Trump tweet. President Trump’s tweet pressing for action on opioid legislation in the Senate has some senators hoping for movement on a massive legislative package within the next few weeks. A handful of committees are involved in putting together a package to reduce addiction and deaths from opioids, including Commerce, Justice, Finance, and Health, Education, Labor and Pensions. Each have passed opioid legislation aimed at addiction treatment, drug abuse prevention, law enforcement, and medical research. The Senate is putting together its own bill to tackle the opioid crisis rather than take up the House- passed bill from June 22, known as H.R. 6. This means that once the Senate passes its legislation, it will need to be hashed out with the House in conference. “I understand the Senate has hotlined a measure and appears to be working out member issues,” said a House GOP aide. “Going to a conference could be a good way to iron out those differences, but the onus is on the Senate to pass a bill first – H.R. 6 or otherwise.” Sen. Rob Portman, R-Ohio, one of the bill’s sponsors, said Trump’s tweet was a helpful boost for the bill. “It is just a question of finding the time,” he said. Sen. Lamar Alexander, HELP Committee chairman, said deliberations were “coming along well” and that they hoped to present a bill to Senate Majority Leader Mitch McConnell, R-Ky., “soon.”

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Susan Collins: Brett Kavanaugh says Roe v. Wade is ‘settled law.’ Sen. Susan Collins, R-Maine, said that she had an “excellent” meeting with Judge Brett Kavanaugh on Tuesday in which Kavanaugh told her he agrees with Chief Justice John Roberts’ stance on the issue and that Roe v. Wade is settled law. “He said that he agreed with what Justice Roberts said at his nomination hearing, in which he said that it is settled law,” Collins said told reporters. “We had a very good, thorough discussion about that issue and many others.” Collins, who met with Kavanaugh for two hours, said she remains undecided as to whether she will support Kavanaugh’s nomination. “Judge Kavanaugh and I had an excellent meeting,” Collins told reporters, adding that they talked at “great length” about her concerns about his nomination, including abortion. The Maine Republican, who is considered to be one of the main swing votes for Kavanaugh’s possible confirmation, added that she remains undecided and will wait until after Kavanaugh’s hearing before the Senate Judiciary Committee. The hearing is slated to begin on Sept. 4. “Not until after the hearing,” Collins said. “I’ve always waited until after the hearings. “You never know what questions are going to come up at a Judiciary Committee hearing where 21 individuals will be questioning him.”

Chuck Schumer: Brett Kavanaugh saying Roe is settled law is ‘a dodge.’ Senate Minority Leader Chuck Schumer, D-N.Y., chided Kavanaugh Tuesday after the Supreme Court nominee told Collins that Roe was “settled law,” calling that claim a “dodge” and arguing that Kavanaugh hasn’t fully laid out his views on abortion. Schumer made the comments hours after Kavanaugh sat down with Collins and minutes before his own scheduled meeting with the judge. The New York Democrat said Kavanaugh needs to say whether he believes the landmark abortion case was ruled correctly. “Let’s be clear — this is not as simple as Judge Kavanaugh saying that Roe is settled law,” Schumer told reporters. “Everything the Supreme Court decides is settled law until it unsettles it. Saying a case is settled law is not the same thing as saying it was correctly decided.” Collins responded to the Washington Examiner that “every single supreme court nominee in recent times has been very careful not to — as Ruth Bader Ginsburg said — give hints, forecasts or previews on cases likely to come before them. That is why the issue of whether or not a case is considered settled precedent or law is meaningful.”

Pharma industry sales climb despite Trump’s pressure on prices.  Trump’s effort to lower drug prices haven’t hit the pharmaceutical industry’s bottom line yet, but investors are bracing for the potential impact in 2019. Companies tend to raise treatment costs in January, and given the public pressure Trump has personally put on the industry — his involvement forced Pfizer to reverse planned price hikes earlier this year — experts say those increases are likely to be lower. Instead, investors and others say drugmakers might pursue gradual price hikes through the year in an effort to avoid public scrutiny. That could slow some of the momentum the drugmakers gained in the second quarter of 2018, with Roche, Eli Lilly & Co., Novartis, Merck, Jazz Pharmaceuticals, AstraZeneca, Celgene, and others all reporting sales growth, some at double-digit levels. The lingering uncertainty over the shape and impact of Trump’s plans highlights the difficulty the administration faces in trying to revamp a complicated pricing system used by an industry that remains an influential force in Washington.

Maryland gets federal approval to prop up Obamacare insurers. Maryland is the sixth state to win federal approval to create its own reinsurance program in an effort to help lower premiums for people using Obamacare. The state estimated in its federal waiver application that the reinsurance program could lower premiums by as much as 30 percent, according to the Baltimore Sun, which reported the decision. Maryland Obamacare exchange insurers have proposed massive price hikes for 2019, and one plan calling for a rate hike of 91 percent. The state’s Obamacare insurers are worried about the loss of the financial penalty for not having insurance starting in 2019. The other states that have gotten federal approval for a reinsurance program are Minnesota, Alaska, Wisconsin, Oregon, and Maine.

Delaware finalizes three percent rate bump for Obamacare. Delaware’s insurance regulator has finalized a 3 percent rate hike for plans sold on Obamacare’s exchanges next year, a decline from the nearly 6 percent insurers initially requested. Delaware is now officially set to be one of several states to hike rates for the 2019 coverage year, a development that will expose Republicans to Democratic attacks. Democrats charge that consumers will face higher rates overall because of “sabotage” by the Trump administration, a line of criticism that will gain force as Obamacare plans finalize rates just before the 2018 midterm elections. Delaware’s insurance commissioner announced on Tuesday that it approved a 3 percent rate hike for Highmark insurance plans sold on Obamacare’s exchanges, which are part of the individual insurance market used by people who don’t get coverage through a job or the government.

Government panel changes guidance for cervical cancer screening. Women who are 30 and older can opt out of getting a pap smear and instead take an HPV test that checks for cervical cancer, according to new guidance from an influential medical panel. The U.S. Preventive Services Task Force, a government-appointed panel that makes healthcare recommendations, has also advised that women between the ages of 21 and 29 continue having pap smears, but can take the test every three years. The latest recommendations reverse those issued in 2012 that recommended both tests at the same time for women between the ages of 21 and 65. The types of tests don’t feel very different to patients. They still have to lie down on an exam table and place their legs in stirrups, and the tissue is collected the same way. But the guidance is expected to save patients time in terms of otherwise undergoing unnecessary follow-ups or biopsies. The HPV test is also better at detecting potential problems, according to a recent study.

Medicare could have saved nearly $1 billion by using generics, study says. Medicare could have saved nearly $1 billion in 2016 if it used generic versions of pricey combination drug-device products instead of the brand name versions, according to a new study. The study, published Tuesday in the Journal of the American Medical Association, indicates that Medicare is doing an inadequate job of getting doctors to prescribe more generic drugs. The Trump administration released a blueprint in May to tackle drug prices, but it does not include anything to get doctors to prescribe more generics. The report looked at Medicare spending in 2016 for brand-name combination products, which are combinations of drugs and devices. An example of a combination product is a stent that is coated with a drug and implanted in the body. The study looked at the cost of 29 brand-name combination products and the estimated spending for the generic equivalent at the same dose under Medicare Part D, the program’s prescription drug plan. It found that Medicare in 2016 could have saved $925 million if it substituted the brand-name product with the cheaper generic. Sometimes a doctor does not prescribe a generic for their patient if the patient asks for the brand name version or they do not know a generic is available. Medicare needs to change those practices in order to save on drugs, the study concluded.

RUNDOWN

Wall Street Journal What does knee surgery cost? Few know, and that’s a problem

Bloomberg Priced out of health insurance, Americans rig their own safety net

Associated Press Court upholds Pennsylvania governor’s order organizing home health workers

Kaiser Health News Religious conservatives’ ties to Trump officials pay off in AIDS policies, funding

STAT News The Trump administration can’t decide whether drug industry middlemen are the enemy or part of the solution

New York Times A candidate backed medical marijuana. Wells Fargo closed her bank account.

Reuters Pharma industry warns Saudis on German drug curbs