There’s not a whole lot to say about the 340B alternative dispute resolution rules (at least, not a whole lot that I can say). It seems like providers are basically OK with the final version of the rules, which have been pending, like, forever because of legal battles and the usual pokey pace of regulatory rulemaking.
It’s a big deal insofar as there are a lot of disputes about the program, so I suspect we’ll all get to kick the tires on the rules in some real-world settings real quick.
You can read the whole thing here. Here’s what the American Hospital Association has to say. 340B Health and PhRMA’s comments are captured in a good Bloomberg Law article.
To be clear: I’m not down with the nuances here. I know that PhRMA asked for, but did not receive, clarity on the definition of “patient,” but that seemed like kind of a longshot for this kind of rulemaking. Otherwise, it seems to be as expected. I think.
Anyway: hmu if you have a better perspective.
This Axios Pro (paywalled, sorry) interview with PCMA majordomo JC Scott is revealing. In it, Scott makes some unsurprising remarks (they’re going to use the next few months to do a lot of education) and throws out the usual PBM messaging about saving money.
But three points caught my eye:
First off, he kind of throws health plans under the bus when he gets asked what role PBMs have in addressing patient out-of-pocket costs. “It’s up to the plan sponsor, the employer, to make the decision on how they’re going to utilize that value that the PBM has delivered,” he told Axios.
That’s an interesting line — and technically true — but it also contains the seeds of future headaches for PBMs. Mark Cuban has been spending a ton of time encouraging employers to think way harder about this exact decision, and the fate of PBMs may hinge on whether health plans call this bluff.
Second, Scott is using the IRA as a reason to slow-walk PBM reform. “We haven’t even played out the latest raft of changes,” he said. He’s right on that point, too. The IRA is going to put a lot of pressure on payers to start playing all kinds of games, and it’ll be interesting to see how that all works out.
If I had to put money on it, I’d say that the IRA is going to force payers to make decisions that make everyone more mad, not less. Still: noteworthy that Scott is using the IRA as a delay tactic.
Finally, I’m super-curious about how PBMs respond to the critique that they’re killing independent pharmacies. And here, there’s just not that much. I don’t know if it wasn’t a big part of the conversation or if Scott steered around it, but the messaging there didn’t come across.
This chart, from Axios, is one of those visualizations that tells an incredibly important story in an incredibly simple way. In short, integrated health insurance companies now have revenue that amounts to 30% of the entire U.S. health care system. That’s up from 10% about a decade ago, probably because of a combination of creeping incursion of corporate involvement in government programs and an explosion of consolidation and vertical integration.
Vaccines are maybe the best deal going in health care, and this Office of Health Economics paper underscores exactly how good a deal adult vaccination programs are. There aren’t many places in our system where you can get a 19x return on investment … but vaccines can make that happen.
I’m glad that the embarrassing Xavier Becerra testimony on copay accumulators that we talked about yesterday is getting more press pickup … Fierce has a piece out on it now. I find it interesting that there’s been no public effort by HHS to correct those remarks, which only adds to the general impression that no one in the White House cares particularly deeply about the topic.
Speaking of accumulators, the Alliance for Patient Access is having a webinar on the topic in a couple of weeks. Probably a good use of an hour.
We need to start talking about how companies should be thinking and preparing for the second round of IRA price controls (we’re less than a year out from the selection of the next 15 drugs, which is going to have some real doozies). Avalere has a smart piece on how to start that process from a commercial-planning standpoint, and I have lots of ideas from a comms perspective. (As a reminder, I’m not really a newsletter publisher. I’m actually a pricing-and-policy-communications consultant, so if you need a hand, I’d love to help … just hit “reply” to this email.)
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