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Trump Presents Proposal To Lower The Price Of Specific Drugs

The Trump administration proposal is open for public comment for 60 days.

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- President Donald Trump says his plan will stop unfair practices that force Americans to pay much more than people in other countries for some medications — but the plan would not apply to medicines people buy at pharmacies. VOA

Less than two weeks before the midterm elections, President Donald Trump on Thursday announced a plan to lower prices for some prescription drugs, saying it would stop unfair practices that force Americans to pay much more than people in other countries for the same medications.

“We are taking aim at the global freeloading that forces American consumers to subsidize lower prices in foreign countries through higher prices in our country,” Trump said in a speech at the Department of Health and Human Services.

“Same company. Same box. Same pill. Made in the exact same location, and you would go to some countries and it would be 20 percent of the cost of what we pay,” said Trump, who predicted the plan would save Americans billions. “We’re fixing it.”

But consumers take note:

— The plan would not apply to medicines people buy at the pharmacy, just ones administered in a doctor’s office, as are many cancer medications and drugs for immune system problems. Physician-administered drugs can be very expensive, but pharmacy drugs account for the vast majority of what consumers buy.

— Don’t expect immediate rollbacks. Officials said the complex proposal could take more than a year to be put into effect.

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Protesters gather across the Chicago River from Trump Tower to rally against the repeal of the Affordable Care Act, March 24, 2017, in Chicago. VOA

In another twist, the plan is structured as an experiment through a Medicare innovation center empowered to seek savings by the Affordable Care Act. That’s the law also known as “Obamacare,” which Trump is committed to repealing.

Trump has long promised sweeping action to attack drug prices, both as president and when he was running for the White House. He made his latest announcement just ahead of the Nov. 6 elections, with health care high among voters’ concerns.

Under the plan, Medicare payment for drugs administered in doctors’ offices would gradually shift to a level based on international prices. Prices in other countries are lower because governments directly negotiate with manufacturers.

Drugmakers immediately pushed back, arguing the plan amounts to government price-setting.

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Stephen Ubl, president of the Pharmaceutical Research and Manufacturers of America, speaks during a news conference in Trenton, N.J., Sept. 18, 2017. VOA

“The administration is imposing foreign price controls from countries with socialized health care systems that deny their citizens access and discourage innovation,” Stephen Ubl, president of the Pharmaceutical Research and Manufacturers of America, said in a statement. “These proposals are to the detriment of American patients.”

Trump is linking the prices Americans complain about to one of his long-standing grievances: foreign countries the president says are taking advantage of U.S. research breakthroughs.

Drug pricing expert Peter Bach of Memorial Sloan Kettering’s Center for Health Policy and Outcomes called the plan “a pretty substantive proposal” but one that faces “serious political challenges.”

“The rhetoric about finally dealing with foreign freeloading suggests that we are going to take steps to get other countries to pay their fair share for innovation,” Bach added. But that’s “quite literally the opposite of what is being proposed. What is being proposed is that we freeload off of other countries’ ability to negotiate more effectively.”

Democratic leaders on Capitol Hill were dismissive. House Minority Leader Nancy Pelosi of California said if Trump wants to save seniors money, he should seek congressional approval for Medicare to negotiate prices for its main prescription drug program, Part D. Senate Democratic leader Chuck Schumer of New York said, “It’s hard to take the Trump administration and Republicans seriously about reducing health care costs for seniors two weeks before the election.”

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Health and Human Services Secretary Alex Azar speaks during an interview with The Associated Press in New York, Sept. 12, 2018. VOA

The health insurance industry, at odds with drugmakers over prices, commended the administration’s action.

As an experiment, the proposal would apply to half the country. Officials said they’re seeking input on how to select the areas that will take part in the new pricing system. Health and Human Services Secretary Alex Azar said politics would have nothing to do with it.

In advance of Trump’s speech, HHS released a report that found U.S. prices for the top drugs administered in doctors’ offices are nearly twice as high as those in foreign countries. The list includes many cancer drugs. Medicare pays directly for them under its Part B coverage for outpatient care.

Physician-administered drugs cost Medicare $27 billion in 2016. HHS says the plan would save Medicare $17.2 billion over five years. Beneficiaries would save an estimated $3.4 billion through lower cost-sharing.

The plan could meet resistance not only from drugmakers but also from doctors, now paid a percentage of the cost of the medications they administer. However, HHS officials said the plan was designed so it would not cut into doctors’ reimbursements.

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President Donald Trump speaks at a rally endorsing the Republican ticket in Erie, Pennsylvania, VOA

Azar said more plans were being developed on drug costs.

“This is not the end of the road, the end of the journey,” he said. “There is more coming.”

Trump has harshly criticized the pharmaceutical industry, once asserting that the companies were “getting away with murder.” But it’s largely been business as usual for drugmakers even as Trump has predicted “massive” voluntary price cuts.

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A recent Associated Press analysis of prices for brand-name drugs found far more increases than cuts in the first seven months of this year. The analysis found 96 price hikes for every price cut. The number of increases slowed somewhat, and they were not quite as steep as in past years, the AP found.

The Trump administration proposal is open for public comment for 60 days. (VOA)

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“They Don’t Make Prayerful Offerings When They Harvest,” Story Of The Native American Church

“The extraordinary and the phenomenon are not necessarily unexpected, but they are definitely not precluded.”

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The sun sets over the gateway of peyotera Amada Cardenas's house in Mirando City, Texas. Ironwork reflects core Native American Church values of faith, hope, love and charity. VOA

Back in the day, when the “grandmas and grandpas” of the Native American Church (NAC) needed peyote, they would make a 2,000-kilometer pilgrimage from the reservations of South Dakota to the tiny town of Mirando City, Texas, close to the U.S. border with Mexico. That’s where they could find Amada Cardenas, a Mexican-American woman who at the time was the only peyote dealer in Texas.

Cardenas was not Native American, nor was she a member of the NAC. But she understood how sacred the medicine was to church members and defended its use as a religious sacrament to those who sought to ban it.

Amada Cardenas, holding a basket of peyote, outside of her home in Mirando City, Texas, 1994.
Amada Cardenas, holding a basket of peyote, outside of her home in Mirando City, Texas, 1994. VOA

“After Amada’s passing, the peyote distribution system lost heart and seemed to be about monetary compensation,” said Iron Rope, former chairman of the Native American Church of North America (NACNA) and today chairman of the NAC of South Dakota. He is concerned that the remaining three or four peyote dealers in Texas — all non-Native — don’t give “the medicine” the reverence they should.

“They don’t make prayerful offerings when they harvest,” Iron Rope said. “We’ve heard reports about intoxicated harvesters. Sometimes, the medicine that comes to us was mushy or small, and the harvesting technique was not one that would allow regrowth.”

Careless and sometimes illegal harvesting, along with increased land and resource development in Texas, has led to a decline in peyote’s quality and availability. Prices have gone up, and church members worry the cactus, now listed as a vulnerable species, could become endangered.

In 2013, NACNA began researching ways to conserve peyote and its natural habitat.

Lophophora williamsii, more commonly known as peyote, which grows in the wild in southern Texas and Mexico.
Lophophora williamsii, more commonly known as peyote, which grows in the wild in southern Texas and Mexico. VOA

Pan-Native religion

Peyote, or Lophophora williamsii, is a succulent that contains psychoactive alkaloids and only grows in southern Texas and a handful of states in northern Mexico.

Indigenous people have used it ceremonially and medicinally for centuries, as noted by 16th century Spanish missionaries, who condemned it as an evil. Peyote use persisted, however, and by the late 1800s, had spread to present-day Oklahoma, where tribes adapted it to suit their individual spiritual traditions.

In the face of government efforts to ban peyote, peyotists in the early 20th century sought to incorporate as a formal religion. In 1918, an intertribal group established the NAC, which has evolved to include tens of thousands of members across dozens of tribal nations. Members view the church as an important component of healing from historic trauma and reconnecting to tradition.

Peyote was banned in the United States in 1970, but the law was later amended to allow peyote to be used in “bona fide religious ceremonies of the Native American Church.”

Texas allows several peyoteros registered with the U.S. Drug Enforcement Agency to harvest and sell peyote, but only to card-carrying NAC members with proven Native American ancestry.

Peyote buttons are shown in the yard of a peyote dealer in Rio Grande, Texas, Oct. 12, 2007.
Peyote buttons are shown in the yard of a peyote dealer in Rio Grande, Texas, Oct. 12, 2007. VOA

‘A beautiful ceremony’

Unlike other religious denominations, said Iron Rope, the NAC is not a unified theology.

“Different variations of the ceremony have come into play,” he said. “There are Christian aspects to the NAC today and traditional aspects, as well.”

Wynema Morris, a member of the Omaha Tribe of Nebraska and an NAC member, grew up with an understanding of the sacredness of peyote and the religious etiquette surrounding its use.

“It was my own grandfather, Samuel Thomas Gilpin, who actually received peyote early on from the Winnebagos, a neighboring tribe, and passed it on to his sons, my uncles,” she said.

This 1924 photo by Edward S. Curtis is entitled "Cheyenne Peyote Leader." Courtesy: Library of Congress.
This 1924 photo by Edward S. Curtis is entitled “Cheyenne Peyote Leader.” Courtesy: Library of Congress. VOA

Peyote is much misunderstood and maligned, she said, viewed by many anthropologists through the lens of colonial prejudice.

“I don’t like their use of the word ‘hallucinations,’” she said. “You don’t use peyote to get high. You use it to pray and communicate with God — the same God everyone else talks to.”

She described all-night services of prayer, song and meditation.

“The ceremony is beautiful,” she said. “The extraordinary and the phenomenon are not necessarily unexpected, but they are definitely not precluded.”

Sacred gardens

In 2013, NACNA began looking at ways to conserve and sustain peyote for future generations of indigenous Americans, Mexicans and Canadians.

“It was our intent to eventually have our own land and be able to have our own peyote dealer who could understand our concerns as the Native American Church,” said Iron Rope.

The sun sets over "the 605," acreage in Thompsonville, Texas, which the Indigenous Peyote Conservation purchased in 2018 for the conservation of peyote, a sacrament of the Native American Church.
The sun sets over “the 605,” acreage in Thompsonville, Texas, which the Indigenous Peyote Conservation purchased in 2018 for the conservation of peyote, a sacrament of the Native American Church. VOA

In 2017, NACNA and partner organizations formally launched the Indigenous Peyote Conservation Initiative (IPCI). With funding from the Riverstyx Foundation, a nonprofit that supports research of medicinal uses of psychoactive plants, IPCI purchased 245 hectares (605 acres) of land in Thompsonville, Texas, to serve as “Sacred Peyote Gardens.”

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It is their hope that by 2021, “the 605” will house a nursery, residential and guest housing, and youth training, all supported by peyote sales.

“It’s about generations to come,” said Iron Rope. “To reconnect them to the land and to the medicine. And that’s the healing process that we’ve been missing.” (VOA)