Beyond The "Blueprint": The Next Stage For US HHS Drug Price Policy

Upcoming transition in HHS drug pricing policy staff reinforces the Trump Administration's shift away from the 2018 "Blueprint” and towards engaging with bipartisan Congressional legislation – and spotlighting executive action as coming from the White House in the context of the upcoming Presidential campaign.

US Center for Medicare principal deputy director John Brooks will add responsibility for the Department of Health & Human Services drug pricing policy to his portfolio following the departure of senior advisor on Drug Pricing John O’Brien, who will be leaving his position later this month. HHS Secretary Alex Azar announced the changes on 12 August.

In one sense, the transition sends a message of continuity: Brooks’ first role at HHS was as a senior counselor to the HHS Secretary (then Tom Price). He left the role to join the White House domestic policy council soon after Azar was confirmed as Price’s successor – and John O’Brien replaced him on Azar’s staff.

But in another sense, the departure of O’Brien marks an end to what might be called the “Blueprint” phase of the drug pricing activity in the Trump Administration.

O’Brien played a key role in developing the “Blueprint,” released with much fanfare by Azar and President Trump in May 2018. (Also see "Trump Drug Pricing Plan Includes Part D Surprises, Challenges PBM Business Model" - Pink Sheet, 11 May, 2018.)

O’Brien worked in tandem with the first senior advisor on drug pricing, Dan Best, to develop the blueprint and roll out the first phase of administrative actions that followed. O’Brien then stepped in as the head of the effort when Best passed away in late 2018. (Also see "HHS Senior Advisor O’Brien Emerges As Azar’s Lead On Drug Pricing In 2019" - Pink Sheet, 17 Dec, 2018.)

The Post-Blueprint Playbook

That history suggests one message beneath the staff transition: the prominence of the policy development effort within HHS is being diminished by redefining a role that once had co-champions to be a part-time function for Brooks.

Many of the high-profile items in the “Blueprint” have either been implemented (elimination of “gag clauses”), blocked in court (the DTC disclosure rule), or abandoned (the rebate rule, changes to Medicare “protected classes”).

Many more were always envisioned as legislative proposals, and the Administration is now focused primarily on working to enact a bipartisan bill using the Senate Finance Committee effort as a vehicle. 

At the same time, the White House is ready to take a more direct role on messaging with the goal of “owning” the pricing issue heading into the 2020 campaign. (Also see "US Drug Pricing Debate Enters Critical Phase: Two Visions For 2021" - Pink Sheet, 25 Jul, 2019.)

The recent preview of an FDA “import action plan” serves in that context as the first of the “post-Blueprint” events. (Also see "Trump’s Maximum Pressure Campaign On US Drug Pricing" - Pink Sheet, 1 Aug, 2019.)

And Azar’s statement on O’Brien’s departure may also serve as something of a valedictory address to the “Blueprint.”

“Prices and out-of-pocket costs are lower, and will go lower still, because of the work we did to execute on President Trump’s American Patients First blueprint,” Azar said. “John was one of the key architects of that blueprint, he was one of the key leaders in its execution, and we are grateful for his service.” Brooks “will continue delivering on President Trump’s vision for lower drug prices, lower out-of-pocket costs, and more affordable healthcare for all Americans,” Azar added.

John Brooks' Fourth Post In Administration

Brooks was a member of the Trump HHS “landing team” during the transition and has held three positions in the Administration. He originally served as counselor Price, then as a health advisor in the White House Domestic Policy Council, before returning to HHS in March of this year as the principal deputy director at the Center for Medicare in CMS.

Brooks joined the transition team from MITRE, where he was a senior principal and head of the health policy department. At that time, the Trump transition team highlighted his role in “giving strategic advice to federal health agencies implementing the ACA, Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA), IMPACT Act and other key healthcare legislation,” In addition, “Brooks is experienced in statutory analysis, regulatory development and alternative payment models.” 

Before joining MITRE, he was a private equity M&A associate at the law firm Vinson and Elkins and an analyst and manager at defense contractor Raytheon. He has a law degree and an MBA.