KFF Polling Confirms (Again!) That No One Knows Anything About the IRA

Congrats to patient advocate/CEO John Crowley, who will be taking over as the CEO of the Biotechnology Innovation Organization. No one knows the stakes of drug development better than John, and no one knows how to make drug-development attention grabbing. 

If you don’t know of either John’s personal crusade or his star turn, Extraordinary Measures is streaming. It’s free on Pluto and available for a small fee on Amazon Prime. It’s worth the investment.

Leaving aside the merits and harms and limitations of the Inflation Reduction Act, it’s a big deal. It fixes a giant, gaping hole at the center of the Part D benefit — excessive cost-sharing at the extremes — and it inserts the government in the price-setting process at a scale never before seen in the United States, which is a philosophical milestone if nothing else. 

And yet, as I observed over Thanksgiving, no one in Real America has noticed. 

Now there’s more polling data to solidify that point. KFF published the results of polling that was completed early last month, and it turns out no one has any idea that the provisions of the IRA are actually law. Only 32% are certain that there are “negotiations.” Only 23% know about the OOP cap. Thirteen percent are tracking on inflation penalties. 

Those are low numbers. What’s worse is that awareness hasn’t moved in the five months since KFF asked them last. Americans aren’t getting smarter on the IRA. (In fairness, there was a seven-point increase in awareness of negotiations, but a jump from 25% to 32%, with all of the attention around the drug-selection announcement, feels pretty marginal.)

That’s a problem for everyone involved. 

It’s probably an existential crisis for Joe Biden, who isn’t getting credit for a signature achievement at a time when he really can’t afford to forgo credit for anything. And it’s probably an issue for the drug industry, because — somewhat ironically — winning hearts and minds in a campaign against price controls only works if people actually know there are price controls. 

I’m not here to propose a solution. We’re in a place where public opinion no longer seems to be reliably tracking with what’s important or, more generally, what’s reality (that’s not a new disconnect, but it seems to be growing larger of late), and I don’t see any reason why drug prices and policy should be any different. 

But it’s worth acknowledging the reality of where the American people are. I wake up early every morning and soak this stuff in. Whereas the average American wakes up and reads a half-dozen hot takes on Travis Kelce. I’m clearly the outlier here.

And if you’ve read this far: you are, too.

The move by CVS to make drug pricing lower and more transparent has received a lot of ink and a lot of praise this morning (WSJ exclusive is here, gift link), but I’m withholding judgment. Phase 1 of the effort seems designed to elevate a GoodRx-style program, which doesn’t seem novel. Phase 2 — getting PBMs on board — is far more interesting, but I’m not sure I’ll believe it before I see it. Adam Fein said he’s preparing a deeper dive on the fundamentals here, which I look forward to linking to. Antonio Ciaccia’s initial reaction was far more concise: “Buyer beware 2.0.”. 

I’m on the record as believing that the most interesting of the IRA lawsuits is the one filed by AstraZeneca, which focuses less on the big-picture constitutional arguments and more on the nuances of administrative law. AZ formally filed its brief responding to the government’s position in the case, pointing out that the government mostly focused on procedural reasons to throw the case out rather than a substantive defense of its actions. 

This was a smart piece by NPC execs and researchers on the way that the IRA disincentivizes certain kinds of research and marketing approaches by focusing on three drugs (Xarelto, Jardiance, and Tagrisso). But a team from ATI Advisory has pushed a rebuttal of that effort by claiming that the IRA — had it been in place — wouldn’t have changed the business-development decisions around those three products. I’d love to referee the dispute, but I think that if you read both pieces, you’ll come to your own conclusions. Either you believe that cutting the effective period of market exclusivity by 50% or so will have an impact on drug development or you don’t. I find one side of that debate far more plausible than the other. 

I missed the flag that the coming Stelara biosimilar probably won’t be introduced in time to forestall price controls on Stelara, which is likely to create a really weird dynamic in 2026, when we have a price-controlled product competing with a biosimilar. 

Worthwhile stats here, via the Society for Human Resource Management, on employer coverage of weight-loss drugs. The headline is that 27% of those surveyed cover GLP-1 meds for weight loss with 13% more considering such a move. 

Colorado is having issues getting its drug-importation program up and running, according to this Washington Post piece. The Post talks about Colorado’s problems with the Biden administration and drug companies, but there’s a long line of other characters in this drama — including the Canadian government — who also take a dim view of things.