It’s been kind of a wild week, and you’re all probably due for a slightly less verbose Curve today. (It’s not a shorter newsletter, though … but that’s a problem with volume. C’mon newsmakers: it’s August. Take a short week, would you?)
Here’s a quick summary of what’s popping.
First, in IRA-land:
The DNC dropped its 2024 platform yesterday, and it’s all the stuff that Kalama Harris has been discussing over the last few days. The ambition to extend the IRA is spelled out in more detail: the Dems want to add “at least” 50 meds a year to the price-control list, getting to 500 by the end of the decade. Let me repeat myself: there are not 500 branded medicines in existence that qualify for price controls. It’s a great applause line, though.
Brookings pushed out its assessment of where the “negotiated” savings are coming from in the first round of price controls, asserting that half of the $6 billion in savings that the government may realize will come from Stelara, Enbrel, and Eliquis. As with all of the other math here (e.g. Ben Rome, Anna Kaltenboeck), the Brookings work relies on net price estimates that are something less than precise. That is not to say that the analysis isn’t useful, only that it’s not gospel.
I made a big deal yesterday about WSJ reporting on the breakdown of how the negotiations went, but UW’s Sean Sullivan pointed out that the detail was not some sort of WSJ exclusive, but actually detailed in CMS’ fact sheet. Bad reading comprehension on my part, but still a good WSJ piece! For some more thinking on how the back-and-forth might have gone down, there was a good discussion on the Pink Sheet’s podcast last week.
KFF pushed out their take on the politics of price controls in Health Affairs Forefront. I’m not sure that any of it bucks the conventional wisdom, but it’s a helpful summary.
Fierce has a story about a couple of analyst reports that took a more sober look at the CMS actions last week, identifying a couple of places where things may have gone worse than expected. Leerink examined the Imbruvica price — a 38% haircut off of list for a med without much in the way of rebates — and worried aloud about the fate of future cancer meds. And William Blair suggested the price on Eliquis was, perhaps, lower than it might have anticipated.
Then, everywhere else:
This pictures is worth way more than a thousand words. This is how prices fall after generic introduction in the United States and a handful of peer countries. Yes, brand-name drug prices may be higher. But that’s part of a grand bargain where medicines go generic. And when that happens, no place is better than the United States at driving prices down. The graph via a great JAMA Health Forum article.
In the Department of Hospitals Behaving Badly, KFF Health News has an illuminating piece asking whether nonprofit hospital CEOs should be making seven figures and raising the issue of whether there’s a link between chasing profits and the anemic charity care numbers. No mention of 340B, but it’s certainly possible to ask some uncomfortable questions. And STAT provided a light overview of nonprofit hospital second-quarter numbers, which suggests that — though margins may be thin — most provider seem to be doing fine.
What do payers think about the trend of PBMs creating pseudo-pharma companies in which they white label biosimilars (e.g. Cordavis, Quallent)? They’re generally cool with it, especially if they deliver lower costs, per a survey from MMIT that was published as Drug Channels sponcon. Worthwhile data that may point to where this trend is headed.
I’m interested in where Oregon takes it prescription drug affordability board, especially in light of the rabidly anti-pharma bent of the board’s executive director. The group is considering advocating for an “upper payment limit” and they commissioned an analysis of attitudes around the concept. That analysis was published ahead of a meeting of the PDAB tomorrow, and the chart detailing stakeholder concerns (slides 18 and 19) is especially worth examining.
There have been a rash of papers on the impact of insulin copay caps, so you can add this JAMA Network Open piece to the list. I’m not sure it adds much to the discussion, finding that — sure — caps helped people … who were already paying lots for their insulin. But that’s a group that is probably getting smaller and smaller.
I love it when companies publish HEOR data in peer-reviewed journals. I think it adds to the conversation and builds an evidentiary foundation for meaningful discussions of value. I had missed this great paper from AstraZeneca on Farxiga, which calculates that universal use of the medicine in Medicare patients with cardiovascular-kidney-metabolic syndrome would generate nearly $100 billion in cost offsets over four years. More recently, the folks at Madrigal published a paper on the potential budget impact of Rezdiffra, its new liver-disease drug.
Header image via Flickr user Richard Gillin`.
