Regarding the NYT on drug pricing, copay accumulators, ICER’s new president, march-in rights – and more.
National Pharmaceutical Council
Health policy research on value, evidence, innovation & access for patients.
January 23, 2024
Welcome to NPC This Week! We hope you'll join us each week for a look-ahead at the policy, research, and industry conversations that matter to the future of biopharmaceutical innovation. The DM's are open if you have suggestions - and please share with your network. - Michael Pratt, NPC Chief Communications Officer
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NPC HIGHLIGHTS
Drug Pricing: Last week, The New York Times attempted to explain drug prices in the U.S. NPC President and CEO John O'Brien took to LinkedIn to explain the flaws in the piece, including adding the context that the U.S. leads the world in drug innovation and that, as a percentage, what we spend on drugs compared to overall health spending in the U.S. is one of the lowest of economically-similar countries.
Also: The Wall Street Journal did its own price increase story, burying the important contextual difference between list and net prices far down in the story.
Transparency: NPC Chief Strategy Officer Kimberly Westrich 's weekly column includes some reflections about a STAT report regarding the transparency of Arnold Ventures.
PBMs: Dr. O’Brien joined a panel of leaders as part of Fierce’s JPM Week Virtual 2024 programming Benefit Managers: The Evolving Discussion. The session was moderated by Paige Minemyer is available on-demand after registering for free here.
INDUSTRY NEWS
Cost-Sharing: The Biden administration has dropped its appeal of a federal court ruling that allowed copay assistance to count against a patient’s deductible and out-of-pocket amounts. The HIV+Hepatitis Policy Institute applauded the move.
Follow The Money: Former health insurance leader Wendell Potter highlighted a podcast and study that showed that $41 of every $100 spent in Medicare Part D goes to PBMs.
Employers and Healthcare: Employers are just not sure they’re getting their money’s worth for what they spend on employee health insurance, Axios reported.
IRA’s “Glitch”: The Inflation Reduction Act has a “glitch” that could mean some drugs with price “negotiation” could end up costing patients with high drug spending even more, according to research in Health Affairs. NPC’s recent Health Affairs Forefront piece highlighted several other possible unintended consequences of the IRA.
Recommended by LinkedIn
ICER: In an interview with Pink Sheet, the new president of the Institute for Clinical and Economic Review talked about cell and gene therapy, obesity drugs, and Medicare’s price control program.
ICYMI
340B: Sen. Bill Cassidy, R-La., sent letters to CVS and Walgreens asking several questions about how those two pharmacy giants use and benefit from the 340B program.
March-in Rights: New National Institutes of Health Director Monica Bertagnolli is “walking a tightrope,” STAT says, when it comes to moves to cancel patents of drugs developed with the help of federal government research.
AstraZeneca Foundation: AstraZeneca today announced that Mohit Manrao, SVP and Head of the US Oncology Business Unit, has been appointed as an Officer of the Corporation for the AstraZeneca (HealthCare) Foundation in the role of President.
Senator Sanders: The Vermont independent wants to subpoena company CEOs with a committee vote scheduled for the end of January.
Breast Cancer Treatment: A new study in JAMA showed that better treatment is a big reason for lower mortality.
Weight Loss Drugs: Federal law bars Medicare from covering drugs for weight loss. However, more than 75% of American adults ages 50 to 80 support Medicare coverage of the treatments, according to a University of Michigan poll cited in JAMA Network.
Prior Authorization: Starting in 2027, health insurers in Medicare Advantage and Affordable Care Act plans will have to do prior authorization electronically and must cite specific reasons for denying coverage, according to new federal government rules.
Go Deeper: The regulations don’t apply to prescription drugs, but the Centers for Medicare & Medicaid Services plans to deal with prior authorization for drugs separately, The Washington Post reported. As the Post and Axios noted, the new rules don’t apply to the private insurance plans that cover most Americans. The American Action Forum’s Jackson Hammond analyzed the new rules.
PDAB Watch: There’s not much new in this Minnesota Public Radio piece about the state’s Prescription Drug Affordability Board, except that the state is going to have one.
Drug Importation: Florida’s plan to import drugs from Canada isn't a good idea, one Florida physician wrote in USA Today.
Health Policy Regulatory and Legislative Expertise; Market Innovator
11moThe Wendell Potter - who is an advocate of Medicare for all- analysis is severely cracked, and uninformed. under the Medicare Part D formulas, the rebates they extract go to the plan and thus partially to the bene and to Medicare thru a lower premium and other mechanisms set in law and reg. The big picture is competition works, not that private market competition has failed as liberal pundits claim. The formula for the coinsurance tho needs to be corrected. This kind of uninformed rhetoric will- mark my words- march us to an even larger government takeover of Part D than the IRA. Think ahead.