Bernie Sanders’ new rules: HHS nominees must commit to drug price cuts

By: Rachel Roubein; The Washington Post

Bernie Sanders threatens to block Biden health appointees who are too soft on drug industry

Sen. Bernie Sanders (I-Vt.) is warning the White House: Health and Human Services nominees who aren’t prepared to “stand up and fight” the drug industry will likely lose his vote.

“I will strongly oppose any future nominee to a major federal health agency who is not prepared to significantly lower the price of prescription drugs in this country,” the Senate health panel chair wrote to President Biden last week, in a letter shared with The Post.

Sanders said his new rules apply to any upcoming health nominee — whether an agency director or assistant secretary — he stressed in an interview with The Health 202. And as head of the Health, Education, Labor and Pensions Committee, Sanders has the power to slow-walk nominees, assuming he schedules their confirmation hearings at all.

“I want action here. I want this administration and its nominees and its appointments to start addressing the prices of the high costs of prescription drugs,” he said.

The details

It’s not an empty threat. Sanders has opposed Biden’s nominees before — a point he underscored in his letter to the president.

“As you know I voted against the confirmation of Dr. Robert Califf, the head of the FDA, because of his unwillingness to stand up to the greed of the pharmaceutical industry,” Sanders wrote. (Califf, a cardiologist who worked at Verily and spent years working with drug companies on clinical trials, was confirmed in a narrow 50-46 vote last year; allies defended Califf’s work with the drug industry and said his perspective would be useful to the Food and Drug Administration.)

Sanders’s threat has also grown sharper given the narrow margins in the Senate. With Sen. Dianne Feinstein (D-Calif.) recuperating from an illness in California — effectively leaving Democrats with a 50-49 majority — Sanders could block a Biden health nominee if he joined with Republicans in a party-line vote. 

Eye on NIH

What does this mean for Biden’s likely nominee to lead the National Institutes of Health? The Post and others have reported that Monica Bertagnollia cancer surgeon who leads the National Cancer Institute, is set to be nominated as NIH director. Bertagnolli has prior work with biotech companies; a list of her disclosures is at the bottom of this 2019 blog post as president of the American Society of Clinical Oncology.

Sanders sidestepped questions on Bertagnolli’s candidacy, and it’s not yet clear if he would support her. A source familiar with the situation said that Sanders in March proposed three potential NIH directors to the White House: Aaron Kesselheim of Harvard Medical School, Vincent Rajkumar of Mayo Clinic, and Sarah Szanton, dean of the Johns Hopkins School of Nursing. Sanders also personally discussed their candidacy with White House Chief of Staff Jeff Zients, the source said.

Beyond NIH, it’s not clear when the next major health agency opening will be. While HHS Secretary Xavier Becerra and CDC Director Rochelle Walensky have faced internal frustrations, both have survived past the midterms, often a time when the White House makes personnel changes.

Bernie’s thinking

Sanders’s rationale: “Fundamental changes” in HHS policies are “long overdue.” The senator said that he has long-standing concerns that health leaders aren’t using all of the tools at their disposal, citing decisions at the Centers for Medicare and Medicaid Services, FDA and NIH.

“No drug therapy, no matter how effective and life-saving it might be, is worth anything to the person who can’t afford it. Further, the high cost of prescription drugs has resulted in tens of billions of unnecessary costs to Medicare, Medicaid and other federal programs,” Sanders wrote to Biden.

For instance, he pointed to NIH’s rejection of a petition by prostate cancer patients to allow the government to step in and license patent rights to another manufacturer for pricey cancer drug Xtandi as an example of a policy that he wants the agency to reverse.

Sanders also said that the agency needs to take a harder line with the private sector, citing how NIH supported Moderna’s research and development of its mRNA vaccine but has struggled to influence the company’s subsequent financial practices, even as its founders became billionaires.

NIH should tell industry partners, “We are prepared to help you develop prescription drugs, on dementia, on Alzheimer’s, on cancer, whatever it may be, we’re prepared to put money into it,” Sanders said. “But on the other hand … you’re not going to be able to charge any price you want.”

What’s next: Expect Sanders to underline his stance at today’s Senate HELP markup of drug-price legislation that he’s steering with Sen. Bill Cassidy (La.), the panel’s ranking Republican.

“What I will say [Tuesday] at the markup is this is a good start. It is a modest start. We are going to go a lot, lot further,” Sanders said, touting next week’s hearing on insulin prices as another opportunity to push the industry.