The Breast Cancer Death Rate Is Way, Way Down. There’s a Lesson In That.

Yesterday, feeling snarky, I asked a rhetorical question: “What has United done for anyone lately?”

The point, in the context of yet another set of record profits for UnitedHealth Group, was to raise the issue of the benefits delivered by various parts of the health care system. Lots of parts of the system do indeed make a lot of money. It’s important to ask what that money catalyzes.

That’s not just a way to knock insurance companies. It’s a standard that I hope gets applied to the drug industry, too. At the end of the day, profits need to deliver something beyond investment returns. They need to incentivize the kind of system we all want to see.

A couple of hours after I hit “send” on yesterday’s newsletter, this JAMA research dropped. It’s a must-read look at breast cancer mortality since 1975, and the news is good. Like, really, really good. 

Deaths per 100,000 women have fallen from 64 to 27. And most of that improvement — 75% of the drop in death rates — has been because of better treatment. 

As the authors put it: “The reduction in population-level mortality may be uniquely associated with new treatments.”

It’s important to note that most of the innovation that drove the decline is now available in generic or biosimilar form. It’s the gift that keeps on giving, and an underappreciated element of the U.S. system, which is the best in the world at driving use of lower-cost generics. 

Of course, 27 deaths per 100,000 is still too many, which is why there’s a need for continual investment and continual incentives.

But if the outcome at the end of the day is a massively reduced death rate and a cheap, effective backbone of care, it’s clear that investment is worth it. And whatever we’ve done to incentivize research over the past half-century is well worth continuing.

I’m still digging out from J.P. Morgan (and then a long weekend of house hunting amidst extreme weather), so there’s still a lot to get through. Here’s what’s still rattling around my brain: 

Damn, this is a thoughtful piece on access — or the lack thereof — to Zurzuvae, the new postpartum depression drug. This is an example of several overlapping trends, including disparities in access and the huge difficulty of securing coverage for new medicines. It’s hard to read about because this is a medicine that addresses a huge unmet need in a way that appears to be cost-effective. Every part of the health care system should be pushing mothers in need toward this medicine. Instead, the opposite seems to be happening. 

The Biden administration will not, in the end, challenge a legal decision that cut the legs out from copay accumulator programs. This is a huge victory for the advocates that worked hard to draw attention to this issue. And it’s a huge victory for the idea that advocacy works and that sustained pressure can lead to policy change. Some days, it feels like our best voices are just shouting into the wind.  

ISPOR put out their annual look at the top 10 trends for the year to come. Drug pricing is #2, value measurement is #7. Yes, it includes the phrase “value flower.”

Here’s another story on the Jan. 1 price-change phenomenon. It’s by NPR, and it’s well done, but I don’t think there’s anything new in it. I’m still waiting for the next update to the Brand Name List Price Change Box Score, if we’re being honest. 

My hot take on state-level prescription drug affordability boards is that — regardless of whether you think they’re a good idea from a philosophical standpoint — they’re really, really hard to operationalize. Getting the right people with the right data and the right processes is tricky, and doing that with state government resources is pretty close to impossible. Anyway: the state of New Jersey’s PDAB is struggling because they haven’t named anyone to serve on it. That’s the easy part!

This is a great clip-and-save explainer from KFF on the removal of caps in the Medicaid Drug Rebate Program.

If I had better editorial judgment, I’d create a blanket ban on writing about the introduction of legislation in the absence of some evidence that it will actually get seriously considered. By that standard, I probably shouldn’t have linked to the piece about patent reform yesterday or reference this new bill that would allow the government to contract for value assessments with nonprofits or academics.