Most days, I want this newsletter to serve as an opportunity to pause and meaningfully chew on the issues of the day. To layer in context and nuance and snark. To create content that leaves you thinking, even if the ground traveled is already well-trod.
I don’t generally succeed, but — hey — shoot for the moon, right?
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Today is not one of those days. I’m a day behind anyway, and there are a million little snippets that I don’t want to lose track of. Among those snippets:
Robert Kennedy Jr. is going to get confirmed. The full Senate voted along party lines to move the nomination along. Buckle up.
The budget blueprint pushed by House Republicans is looking for $880 billion in cuts from the Energy and Commerce Committee, which is widely seen as code for “cut Medicaid.” FWIW, the chair of the committee thinks that’s a tall order, but even a fraction of $880 billion puts patients at risk.
Are we going to get PBM reform as a part of that bill? I mean, Modern Healthcare has a bunch of lawmakers who would like that, but not a lot of confidence in any specifics.
CVS CEO David Joyner used his earnings call yesterday to defend PBMs. “Our work is a critical counterbalance to the monopolistic tendencies of drug manufacturers. This is why PBMs are needed and why manufacturers fight so hard to limit our capabilities,” he told the money folks, along with some other strong words. Pull up the transcript and crtl-F for “PBM” for the good stuff.
PhRMA is weighing in, via amicus briefs, on the 340B “rebate model” lawsuits. PhRMA’s take largely mirrors arguments made by the companies who filed suit, but it’s never wise to discount the legal chops of those folks.
I had a fun chat with Clay Farris from Mostly Medicaid about 340B, in which my goal was to give an overview in a way that would leave a curious layperson more informed about what’s going on with the program. That’s always a tall order, but it’s probably a more important task — at this point — than trying to score rhetorical points about the definition of “patient.
Speaking of “good layperson summaries of 340B,” Bill Sarraille has a fantastic Real Clear op-ed that will serve as a clear-eyed introduction to 340B for policymakers new to the topic.
Given my readership, you’ve probably seen Adam Fein’s new writeup on accumulators and maximizers. If you haven’t, it documents the jawdropping continued growth of accumulators/maximizers.
Patients for Affordable Drugs has a new “report” on “myths” about the IRA. None of the links in the PDF work, and every👏 single 👏 clapback they attempt is either out-of-date or lacks context. If anyone plans on taking it seriously, I’m happy to go through it line by line, but I’m really hoping it gets ignored. Look, I think there is an intellectually honest defense of the IRA that can be mounted. This ain’t it.
What’s Trump going to do with drug pricing policy? Don’t tempt me. Even I’m sick of the GIF. But if you’re interested in one edge of the range of possibilities, here is video from a Federalist Society event where the former chief counsel of the FDA, among others, makes the case the Trump could halt IRA implementation while the legal challenges work their way through the system.
Speaking of efforts to pause IRA price controls, here’s a letter to Trump from We Work for Health’s Dan Leonard pushing the president to “freeze implementation of the Inflation Reduction Act’s drug pricing provisions.”
The process of moving from “foundational scientific discovery” to “commercial product” is always fraught, and this ProPublica piece captures some of the collateral damage of that process for the SMA treatment Zolgensma. I think the piece gets the pricing story wrong, FWIW. I don’t know what the economic model is for gene therapy right now, but it’s definitely not creating geysers of profits.
ICER will work with HTA bodies from Canada and the UK on an effort to research cost-effectiveness models.
Last spring, CMS said that Alzheimer’s meds would put financial strain on Medicare, estimating $550 million in impact this year and $3.5 billion next year. Biogen just announced earnings (less than $140 million in Leqembi sales on the year), so we know thet CMS’ guess overshot reality by a factor of three, which is, like, really, really bad estimating. Whenever someone claims that a new technology is going to lead to obscene and immediate jumps in spending, they’re usually wrong.
While we’re talking earnings nuggets, here’s a surprising one (to me, anyway) via All Things Biosimilars from Andrew Bourgoin: Amgen recorded $2.2 billion in biosimilars sales in 2024. A bigger number than I would have guessed!
Worthwhile white paper from Avalere (commissioned by Novo) on how IRA “negotiations” should look at meds with more than one indication. The short version is that they’re not currently doing it in a way that’s very useful for patients.
There has been some good commentary on what can be done — and whether enough is being done — to respond to the assault on science. Right now, there are a couple of open letters from NPLB looking from signatures: this one on NIH/NSF funding and this one one trying to protect FDA staffing. I know members of Congress are listening, too, actions notwithstanding. I’m sure that’s just scratching the surface, and I’m open to more suggestions on action steps.
