This week is going to be a bit zany with travel. That’s going to wreak havoc on the Cost Curve publishing timetable. Please bear with me, because I suspect there will be plenty to talk about.
Last week saw a couple of important FDA approvals pass with little notice. Roche announced that two new subcutaneous formulations had been greenlit: its workhorse Ocrevus MS med and Tecentriq, which is a PD-L1 cancer drug.
Both medicines had been approved as infusions, and the new versions mean that patients can get the treatments in a faster, more convenient form. In the case of Ocrevus, the sub-q version will be priced at parity with the old version. (I haven’t seen any details on the Tecentriq pricing.)
But it has to be noted that the approvals carry with them some interesting IRA implications.
These meds are part of a wave of similar reformulations that are made possible when the original medicines are combined, in a fixed dose, with another drug. That makes the new version, technically, a combination drug that resets the IRA clock. Reuters had a good look at the phenomenon a year ago.
That might not immediately be a huge deal for Ocrevus and Tecentriq, but two of the biggest medicines in the IRA Class of 2028 are Opdivo and Keytruda, and subcutaneous versions of both of those meds are expected before those price controls kick in.
All of this sets up an interesting world in which there will be price-controlled (and, later, biosimilar) infused versions of popular medicines competing against easier-to-take injections. I know we’re still a few years away from seeing how that all plays out, but there’s going to be a lot on the line when that day finally arrives.
There’s an irony underlying this smart JAMA Network Open article that looks at how dramatically out-of-pocket costs will drop for patients taking oral cancer meds because of the IRA’s out-of-pocket cap.
Per the study, last year, before the cap went into effect, patients were faced with more than $11,000 in out-of-pocket drug costs, the side effect of the lack of a cap to spending in the Part D benefit design. Patients were responsible for 5% of their medicine costs, even after they’d paid thousands via their deductible and their coinsurance.
Fast-forward a year, and that $11,000 is closer to $4,000 with the 2024 cap, which is around $3,500. Next year, when the cap hits $2,000, that number will be even lower.
So where’s the irony?
The patients who going to benefit most from the out-of-pocket cap are those with high-priced Part D drugs, which means those on oral cancer drugs. They are, in the short term, the big winners.
But oral cancer drugs, in the long run, are basically doomed by the price-control provisions of the IRA.
The incentives inherent in the law favor drugs aimed at younger people over seniors, biologics over pills, and medicines for a single indication over those that see post-approval research (to expand into earlier lines of therapy, for instance).
What falls into the category of small-molecule drugs aimed at Medicare populations that require post-approval development? Oral cancer meds. So the future stable of those kinds of therapies will almost certainly be smaller because of the IRA.
The law giveth, and it taketh away.
Are we done talking about M3P? HECK NO WE’RE NOT DONE TALKING ABOUT M3P.
First off, the government pushed out a series of educational materials on the Medicare Prescription Payment Plan a few minutes before 5 p.m. on Friday (which is how you maximize the impact of your communications /s), including this fact sheet that goes into some depth about how things will work.
Second, I know that we talked at length here about what we were going to call this program, and you all settled on “M3P.” But I’ve heard tell by some folks on the payer side that CMS is asking that “M3P” not be used, and that the preferred abbreviation is “MPPP.”
In other words, we can’t even agree on how to refer to the Medicare Prescription Payment Plan, let alone explain its contents. It’s going to be a long open enrollment season. Sigh.
Elsewhere:
I’m not sure that any of the “maximum fair price” analysis from ATI Advisory in this Health Affairs Forefront is technically new — I feel like all of the key points have been made in one forum or another in the last month or so — but it’s a great summary of all of the different ways of looking at how the first ten prices shoot out. A worthwhile bookmark for the chart alone.
The same insurance companies that push patients to 90-day, mail-order prescriptions when it benefits them also appear to be working overtime to make limit the size of the anti-naseau scripts for cancer patients, per this agonizing AP article. It also includes this zinger, from MD Anderson’s Fumiko Chino: “Insurance companies and pharmacy benefit managers are somehow weirdly ending up in my exam room, standing between me and my patients.”
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