Patients Get Their Say in the CMS Price-Setting Process. Here’s Hoping Someone Listens

I’m on the road this week, which means I had the pleasure of overhearing a woman explaining the concept of a “beer back” to the patron sitting next to her at the airport restaurant. This was on a Monday. At 6:45 a.m. So someone was clearly expecting to have an even longer week than I am.

Anyway: Curve may be a bit inconsistent in format and timing over the next few days.

Today is the start of CMS’ patient listening sessions, the last opportunity for the public to really weigh in on the price-control elements of the IRA. The first session, looking at Eliquis, starts today at noon.

I wrote in a little more detail in this LinkedIn post over the weekend, but I think these sessions are coming at an interesting point in the dialogue around “negotiations.” It’s becoming clear that while the law will deliver some big wins for certain groups (the government and Medicare patients with big drug bills), it’s neutral-to-negative for everyone else.

And that’s not really how the whole deal was sold, or how it’s being promoted.

The patient sessions are likely to reinforce the reality that not everyone will win, and I expect to hear some concerns about access from the non-winners. I’m not naive: it’s not going to be enough to shift the narrative, but seeds are being planted.

I’m not naive, either, about whether CMS is going to take warnings about access seriously. They’re not. The entire patient-input process was not built to explore — let alone address — patient concerns (as this non-paywalled Pink Sheet story makes clear), so I don’t expect to see the government behavior change.

BTW: I plan on transcribing and uploading all of the sessions. More on that — hopefully tomorrow — once I have that architecture set up.

AbbVie will take a $2.1 billion charge related to the IRA’s impact on Imbruvica sales, which is, I think, the first time a company has formally attributed business impact on the law. Imbruvica is going to be an interesting test case here, given its eroding competitive position.

The Senate Finance Committee will apparently mark up a PBM-regulation bill next week, per STAT, though details remain sparse.

Lots of attention on the CRISPR/Vertex sickle cell disease FDA advisory committee tomorrow, though there is less discussion of the expected price — or the market dynamics around gene therapy — than I might have expected.

The Treasurer of the state of North Carolina is pushing the state to drop coverage of anti-obesity medicines. But his statement makes for an eyebrow-raising read, because he seems to be citing high list prices, not volume, as the underlying problem.

Senate Democrats are pushing to ensure that over-the-counter birth control is covered by insurance when it hits store shelves next year. This one is worth watching, not as much for the policy implications as for the technical implementation. At the risk of stating the obvious: running things through insurance is not easy.

COVID-19 products officially hit the commercial market this week, leading to a flurry of coverage, but not much news. The important question is “How much will this stuff cost”? In the case of Pfizer’s Paxlovid, we got our answer earlier in the month (a list price of about $1,400, but not much detail on what consumers will actually pay). For Merck’s drug, we’re all still in the dark on pricing.

It’s not really pricing/polcy, but — damn — this is a good and important read from KFF’s Larry Levitt and Drew Altman about complexity in health care. I think we all recognize that complexity actively harms patients, but there really isn’t a huge movement to address that problem. I’m hoping that this paper sparks some more discussion and that communicators play a role in getting us closer to the system we all want to see.