TOP DEMS PARE BACK DRUG PRICE OVERHAUL — As Democratic leaders race to save Biden’s infrastructure ambitions, they’re also preparing to slim down a core element of his health agenda, POLITICO’s Alice Miranda Ollstein and Megan R. Wilson report. House leaders plan to shrink a drug price negotiation provision at the center of Democrats’ social spending bill — weighing changes like excluding private insurers from accessing rates negotiated by Medicare and reducing the number of drugs that can be haggled over in the first place. The moves represent a capitulation to the party’s centrist wing, and an abrupt about-face from just days ago, when top Democrats insisted they would force a vote on the full drug price overhaul. It’s also a win for big pharma, which has spent more than $171 million lobbying against the proposal and even more on ads and campaign contributions. Yet leadership's appeasement of centrist holdouts risks further angering progressives. The House’s liberal wing has long promised voters a more aggressive version of the bill and is already incensed over the intraparty opposition to the broader package’s price tag. Watering down the drug price provision would also have immediate practical consequences by slashing the amount of savings that could be used to offset other pricey priorities, such as expanding Medicare, Medicaid, Obamacare and home-based care. “It is alarming that a very modest bill could become even weaker,” said Rep. Lloyd Doggett (D-Tex.), the House Ways and Means health subcommittee chair. “I’m aware of how tight our vote is, but I don’t believe any of the changes they’re proposing to H.R.3 do anything other than make it approach meaninglessness.” BOOSTER STRATEGY DIVIDES BIDEN’s COVID TEAM — Top Biden health advisers are at odds over the next stage of the administration’s booster shot strategy, setting up a clash that could alter the course of the broader pandemic response, POLITICO’s Erin Banco reports. The debate centers on whether the U.S. should eventually offer boosters to all adults in hopes of staving off mild breakthrough infections — or whether the additional doses should be reserved for those at risk of severe illness. On one side are CDC and FDA scientists, who believe Covid-19 will continue to circulate well after the pandemic ends. There’s little definitive data that boosters would eliminate cases in vaccinated people, and only a small percentage of those who suffer breakthroughs end up hospitalized. But on the other side are advisers like Anthony Fauci, who has argued against ruling out giving boosters to the broader population. He’s been vocal about his support for widespread distribution, leaning on studies from Israel that show the original vaccines’ efficacy against mild and moderate illness is decreasing. Based on those outcomes, Fauci has contended that boosters should be used to preemptively guard against new vulnerabilities among vaccinated Americans. The dispute is playing out as officials prep for winter when more frequent indoor gatherings could seed a virus resurgence. Besides weighing boosters, the administration has also discussed additional strategies to head off a spike — such as revising mask-wearing guidelines and boosting access to testing. There’s also another factor: The global pandemic fight, which Biden just recently recommitted to leading. The White House has already faced sharp criticism inside and outside the U.S. over its decision to offer third shots when much of the rest of the world’s population has yet to get access to its first. Further opening up that distribution would only invite more questions about how the nation plans to use its so-called arsenal of vaccines. | 
