State of the Union and the state of play

Several pressing topics could come up during President Trump's State of the Union address tonight, including the largest deployment of military force near Iran since the Iraq war and the Supreme Court ruling against his primary tariff tool.

"I'm going to be making a speech tomorrow night and it's going to be a long one because we have so much to talk about," Trump said Monday.

The question is whether, and what, the president will talk about on health care. He's been hot and cold on the issue, but his most recent comments suggest that he plans to make health care a central theme in the midterm elections this year.

The administration seeks to take control of the health care narrative in response to attacks from Democrats over rising health insurance costs and health secretary Robert F. Kennedy Jr.'s moves to limit access to vaccines. But there is no clear path for health care legislation this year.

Trump's desire to codify most-favored nation drug pricing in law is especially unlikely. The consulting firm Capital Alpha Partners puts the odds of MFN legislation at "well under 20%."

Why? Neither party wants it or needs it. Republicans in Congress don't like it, and they shot down the idea last year. They also don't need the savings from lower drug prices now that tax cuts are in place. Conservative groups hate it. Democrats are loath to help Trump get a win, and they'd prefer to build on their Medicare drug price negotiation program.

Lastly: "Codify what?" Capital Alpha asks. "The terms of the industry-WH deals haven't been made public or disclosed to Congress. We'd need to see indications that the deals have been shared with leadership and health care committee chairs or that the WH is shopping its own legislation to change our views."

Read more about the political dynamics surrounding health care legislation this year.

fda

Safe, effective, and politically beneficial

Since the 1960s, drug and medical device makers have had to show that products are safe and effective for their intended use. Now, lobbyists are emphasizing a third factor: the political benefit to President Trump, according to Daniel Payne and Lizzy Lawrence.

Pressuring the FDA to approve products is not new, but the approach is becoming increasingly common, and blatant. And the White House is increasingly involved.

An HHS spokesperson said nothing has changed and the agency is driven by "gold-standard science." But industry sources disagree.

$11.7 million

That's how much three Trump-connected firms drew from drugmakers in 2025, up from $2.2 million in 2024, Daniel and Lizzy report. Many of the drugmakers behind that hiring spree are the same companies that signed drug pricing deals with the White House.

Drug industry spending also is up in general. The sector had its largest single-year increase in lobbying spend on record — $61 million — according to OpenSecrets..

Read more about which firms are cashing in and whether the drug industry investment is paying off.

gene therapies

Bespoke gene therapies

The FDA released new guidance yesterday for approving gene editing-based treatments and other drugs for patients with unique or rare mutations, Jason Mast and Lizzy report.

The idea is to give researchers a way to get approvals for treatments that are too rare to attract big pharma, and that affect too few people for big randomized trials. However, there is reason to believe the Trump administration might open the path to drugs that could treat larger populations, too, even though those treatments could be studied in larger, more traditional clinical trials. That worries ethicists and FDA scholars.

cdc

Two and a half months

That's how long Ralph Abraham lasted in the role of the No. 2 official at the CDC, according to Helen Branswell.

That's a little more than six Scaramuccis, my favorite political unit-of-time measurement.

The former Louisiana surgeon general resigned, effective immediately, according to a statement posted on CDC's website on Monday. He was the top official actually residing in Atlanta, where CDC headquarters are located. NIH Director Jay Bhattacharya became the acting CDC director following the exit of Jim O'Neill, who was also juggling two jobs. But Bhattacharya isn't expected to relocate to Atlanta or spend much time there.

What we're reading

DOJ, Ohio attorney general accuse OhioHealth of driving up prices, crowding out competition, STAT
Inside RFK Jr.'s push against the flu vaccine that he links to his voice condition, The Washington Post
In first speech to her FDA staff, Høeg says she'll scrutinize RSV shots and SSRIs in pregnancy, STAT
The Protein-Bar Delusion, The Atlantic
RFK Jr.'s days of going wild on health may be over, Politico