Sarepta Gets An A+ For Its Value Comms (Plus the Definitive, Ranked List of the Week's Drug Pricing News)

We all made it to the weekend. Congrats! As a reminder, Cost Curve Weekend is my weekly wrap of all things value/access/reimbursement. If you’re looking for news and perspective delivered every day, subscribe to the daily Cost Curve email here. 

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There is an emerging best practice** for how biopharma companies should talk about price and value when they launch a new medicine. It goes a little something like this:

1. Be transparent. It's hard to take a company seriously if they claim to value value ... but can't be bothered to talk about it.
2. Show your math. It's 2023. Value can be measured. And there's no reason, if you've serious about aligning with value and you've run the numbers, you shouldn't share them.
3. Note the bubble. The list price is not what payers will pay, and certainly not what patients will pay. Explaining the gross-to-net bubble is complex and irritating, but it’s critical context. 
4. Pluck the “value flower.”  There are a lot of elements of value, not all of which are incorporated into every framework. We should still talk about those elements.
5. Validate your approach. Who else believes in your value ? Economists? Advocates? Endorsements help overcome the natural skepticism to corporate pronouncements about value.
6. Access is a part of the equation, too. Are payers on board? Is the company pushing novel models to help ensure patients don't fall between the cracks? What do assistance programs look like? For patients, value is only a virtual if it's a gateway to access. 

** A cynic could argue that best practice is to dodge these questions altogether, and I can point to a dozen meds in the past year where being super-quiet has kept uncomfortable questions at bay. But hiding the ball on price has insidious, industry-wide reputational effects. When it doubt, err on the side of transparency.  

Anyway: Sarepta announced FDA approval of Elevydis, its gene therapy for Duchenne muscular dystrophy, and it pretty much nailed the value-comms best practice (you can see their approval-call deck here). 

Sarepta was transparent (#1), spending a good chunk of their analyst call talking about price. They showed their math (#2) with a peer-reviewed publication. They talked about the discounting (#3) they expected (“you should be modeling a gross to net adjustment in the mid-20% range,” the CEO told analysts). They designed their own value flower slide (#4), which is the first time I’ve seen that in an approval deck. And they talked about expectations around insurance coverage (#6) (“We have some innovative concepts that we’re working on with payers. They would be different than an outcome-based approach.”

Really impressive. You can nitpick about the lack of validation, others have been more detailed about novel access approaches, and the underlying math could (but hasn’t!) engender some debate. But as a communications effort, this is A+ work. 

(Not a client, BTW. This is just credit where it’s due.)

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The Definitive List of the 10 Other Most Interesting Bits of Value/Pricing/Access/Etc. News This Week:

1. IRA Lawsuits. Individually, the IRA lawsuits -- BMS and PhRMA entered the fray this week -- are mildly interesting. In aggregate, they’re downright fascinating. I have a clip-n-save reference, and STAT has a bit on the strategery. 
2. Coupon Landscape in Obesity. This consumer-oriented VeryWell Health piece on how to keep diabetes/obesity drug costs down is worth the read, and I’m definitely keeping an eye on how coupon programs in this space are working. 
3. Net Drug Prices Are Falling. SSR Health says so, referencing first-quarter data. This isn’t a surprise, but it bears repeating. 
4. Campaigning Around Access. I find that celebrity campaigns in pharma tend to serve mostly as a marker of commitment to a drug or therapeutic area. So the fact that Lilly is launching a campaign around its insulin access program featuring a big league baseball star is significant (to me, anyway).  
5. FTC’s New Antitrust Campaign. This Endpoints piece is a must-read if you want to understand the game the FTC is playing around antitrust enforcement in PhRMA.
6. Clarity (of a Sort) on Alzheimer’s Reimbursement. CMS dropped some additional details on how the registry that will be required for Alzheimer’s med reimbursement will work. But there are still a lot of holes. (Here is a good list of what CMS should be considering.) 
7. Obesity Med Access, Government Payer Edition. Efforts are afoot to make sure that both Medicare and Medicaid patients get access to GLP-1 therapies.  
8. Six Good Questions About 340B. A group of Senators is asking 340B covered entities to explain exactly how they’re helping patients. The answers will be illuminating, I’m sure, but they won’t be public. 
9. A Hardy Look at the IRA. Genentech’s Alexander Hardy gave a great interview to Endpoints that touches on nearly every industry pain point. 
10. What’s Mark Cuban Up To, Anyway? Becker’s Payer Issues is trying to figure out what box to put Cuban’s company in, highlighting the recent pivot to be a covered benefit.