Portman Also Questions HHS Secretary on Timing of Joint Concept of Operations Between HHS & DHS for Unaccompanied Minors
WASHINGTON, D.C. – At a Senate Finance Committee hearing today, U.S. Senator Rob Portman (R-OH) expressed his concern over the rising cost of some naloxone drugs, and pressed Department of Health and Human Services (HHS) Secretary Alex Azar to increase transparency of the CMS drug pricing dashboard.
In addition, he questioned the HHS Secretary on the status of the Joint Concept of Operations between HHS and the Department of Homeland Security (DHS) that will govern how the two agencies coordinate their efforts to protect unaccompanied minors from human trafficking and abuse. The JCO originally was due on February 22, 2017. After a Permanent Subcommittee on Investigations hearing in April, the agencies committed to finalizing the JCO by July 30, 2018.
The subcommittee had previously found in 2016 that HHS had failed to establish procedures to protect UACs, such as conducting sufficient background checks on sponsors and following up with sponsors and UACs to ensure UACs’ welfare.
A transcript of his remarks can be seen below and a video can be found here:
Portman: “Before we talk about drug pricing in a second, let me just comment briefly on this. As you know, we’ve spent a couple of years studying the issue of unaccompanied kids, UACs, and HHS has, in my view, a very difficult job to do, which is to help with regard to kids who come without their parents. These are unaccompanied kids. Now we have added to that with the separation of kids from parents, which I think was a bad idea. I commend the president for the executive order which changes that approach, we’ve now got to deal with the kids that are already in this system. Even though you have a very tough job to do, as you may know, in the Obama administration and in the Trump administration, I have not felt as if HHS has done a very good job in very tough situations because they have not come up with this agreement between the Department of Homeland Security and HHS. There is a memorandum of understanding and a commitment to come up with an operating agreement so we can understand where the handoff occurs and who is in charge. As recently as April this year we had hearing on this, and HHS said they were willing to take a fresh look at the question of who has responsibility for these kids once they leave HHS detention facilities or are placed with a sponsor. My concern is, nobody is responsible. I got involved in this initially because of these eight children who ended up coming from Guatemala and ended up in an egg farm in Ohio because they were given to their traffickers during the Obama administration rather than to a family that was going to take care of them. So my question to you today – and again I’ll get to drug pricing in a second after you answer my question – one, you are taking a fresh look at this as I understand it. You have a July deadline to come up with this understanding, I don’t know if you follow it this closely, but are you on track with the operations agreement with DHS and who is going to be accountable or responsible for these children once they leave a federal government agency’s custody and go off with a sponsor?”
Mr. Alex Azar, Secretary of Health and Human Services: “So, we have a memorandum of agreement with the Department of Homeland Security to ensure adequate and full vetting of any potential sponsor. These are relatives, they’re either parents or aunts, uncles, adult relatives.”
Portman: “Well, in the case of the egg farm, they were traffickers.”
Secretary Azar: “Well obviously there was a mistake there, something happened. So, we have to have a…”
Portman: “This is how we get out of it right? So better screening, that’s a good thing.”
Secretary Azar: “Exactly, once they’re placed with a sponsor, they are no longer subject to our jurisdiction. We cannot pull a child back from a relative. We don’t have the legal authority and they are then under the state and local child welfare laws, as well as they are subject to any immigration proceedings they may have. We don’t have any authority to go out and pull a child back from a sponsor once they’re in that sponsor’s custody. That would be local child welfare, authorities. We learn about it and would let the authorities know.”
Portman: “I want to get on drug pricing for a second here, but one of the concerns obviously is that we weren’t even, and this goes back to the Obama administration again and the first part of the Trump administration, we’re not even telling the states that the kids are even in their jurisdiction, so it’s kind of hard for child welfare to step in. Again, there’s an issue of getting these kids to their hearings. That’s the idea, we think that more than half of them are not even showing up for their hearings, which is the whole idea, to get them with a family pending their immigration status. So, we have some work to do still. I know you’re aware of that. I just wanted to be sure you knew that we were going back and forth with your team and we expect to have this operations agreement by July as was committed to during our April hearing.
“On drug pricing, for a second, I know Senator Stabenow talked about an issue that is a big deal to me, which is how do you deal with the opioid crisis and the people who need naloxone, which is this miracle drug that reverses the effects of an overdose and specifically the EVZIO cost increases, $575 for a naloxone auto-injector in 2014, just four years ago. Today, over $4,000 for one of these things. So you go on to your dashboard, which I applaud you for, you can go on to your dashboard now and see drug pricing information more transparently. But it is very confusing because it shows Part D spending per unit, this is for Medicare obviously, increase from $739 to $4,500 and the list price was actually below both of these. When we push on this, we’re told that this doesn’t include other information like the manufacturer’s rebates or their price concessions which seems to run the other way. We’ve been pushing on this and trying to get HHS to give us an answer. Why can’t all that information be on the dashboard. If consumers are really going to have the transparency that you want and we want, why can’t we also include what’s going on with regard to the rebates or other price concessions?”
Secretary Azar: “Well taking it beyond the naloxone and that particular drug instance, disclosing publicly-negotiated rebate rates is disclosing highly-confidential information. Let’s say we took just any other regular drug and we started publicly disclosing negotiated discounts, they’re could be very serious anti-competitive issues with that, as there would be if Walmart were forced to disclose their Tide discounts. Their competitors would love to have that information more than anything. So, we have to be careful here and we’re happy to get you whatever information we have, but that’s just an initial reaction on that issue of disclosing whatever the discounted rate would be on a particular product.”
Portman: “These drugs are bought by the taxpayer, not Tide. Tide is bought by some taxpayers, but it’s a different issue so, one, with regard to us getting the transparency and consumers on Medicare and Medicaid, I would think we’re going to end up there. We have to figure out a way to end up there and provide that information. Thank you.”
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