Searching for simple solutions on healthcare policy is “like hunting squirrels with a shotgun," said a high-level OMB official responsible for vetting such proposals.
It works ultimately, but there won’t be much left to eat with that approach, said Joseph Grogan, the associate director for health programs at the White House Office of Management and Budget.
That's why, even though the “fallacy of simple solutions” has been part of the Trump administration’s approach to tackling its biggest healthcare priorities, the challenge of lowering prescription drug prices is going to be full of complex fixes, Grogan said.
As an example, he pointed to the “American Patients First” blueprint, a guiding document for the effort which includes complex goals like modernizing Medicare Part D.
The White House's plans for Part D were first outlined in its budget proposal, which was released in February. Grogan said updating Medicare’s drug benefit is a “centerpiece” of the administration’s plans, which includes giving Part D sponsors more power to negotiate with drug manufacturers. Giving payers more leverage to deal with pharma would let them sort out these issues themselves to some degree, Grogan said.
“Frankly, I want them in a cage match fighting this out,” he said, as he addressed reporters about his priorities at a briefing in D.C. Thursday morning.
Since Alex Azar was confirmed as secretary of Health and Human Services in January, Grogan said the agency has been able to shift its priorities to drug pricing. Former Secretary Tom Price, M.D., who resigned amid a scandal over his use of private planes for travel in September, had spent much of his time at the department instead focused on assisting with the Republicans’ stalled efforts to repeal and replace the Affordable Care Act.
The administration hasn’t softened its view of the ACA under Azar, however, even if momentum on repealing it has slowed. Grogan called the ACA a “poorly crafted law” that was “held together by the previous administration by duct tape and wire.”
One piece of the puzzle that OMB and its counterparts are actively working on at present is around streamlining and increasing access to medical devices. Though he declined to specify what programs are likely to roll out in the future, Grogan said that “the sky’s the limit” on what they’re willing to do in this area.
Part of the problem, he said, is that regulations are rarely able to keep up with the pace of innovation, and this is clear in the device space. The U.S. is no longer the top place in the world to launch a new medical device, Grogan said, and there is also less private equity investment in devices.
“From our perspective, everything is on the table” to increase access and provide better transparency, Grogan said.