If you want to search Cost Curve back issues or link to anything you read here, the web links and archive are online at costcurve.beehiiv.com. You can subscribe there, too.
INFLECTION POINT/ Bhattacharya Isn’t Getting Into Pricing Debates
I’m not sure what the point of Senate confirmation hearings is anymore. When I was younger, it seemed like the exercise sometimes yielded useful perspective that might inform a lawmaker’s consideration. Perhaps times have changed, or perhaps I was just naive back then. (Or both!)
Regardless, we seem to be in an era of congressional kayfabe, where everything is for the ‘gram and nothing is illuminated.
That said, yesterday’s conversation with would-be NIH chief Jay Bhattacharya was notable for one exchange: Bernie Sanders pressed Bhattacharya on whether he would push the NIH for “reasonable price” provisions in dealings with industry. Bhattacharya demurred, punting the question to Congress. “I’ll take that as a ‘no,’” Sanders quipped.
I don’t think anyone expected this administration to be stocked with patent-breaking anarchists, but lots of unexpected things seem to be happening lately, so it’s worth noting the exchange.
THE ARC/ Lots and Lots of Research to Paw Through
One of the dangers of a week where all kinds of big, interesting things are happening is that the little, interesting things get thrown in a stack at the edge of the desk to be dealt with later.
That stack is mostly made up of research papers that don’t necessarily herald revolutionary new perspectives but nonetheless bring the kind of evolutionary understanding that creates the foundation for change.
The pile is getting big.
So, in an effort to clear the decks, here’s what I’m reading:
Payers rarely cite health technology assessments in their drug coverage policies, with only 450 out of 14,033 citations in the policies tracked back to an HTA, according to Tufts work published in the Journal of Managed Care and Specialty Pharmacy. The most-cited HTA was the UK’s NICE. ICER came in at #2.
Also in JMCP, this work from NPC’s Kimberly Westrich and colleagues is a call for employers to leverage claims data to better understand health inequities in the workforce. This kind of thinking has suddenly — with dangerous implications — fallen out of vogue, so I’m thrilled to see this kind of paper out there.
Tufts researchers have a piece in Health Affairs Forefront floating a “mend it but don’t end it” approach to CMS’ “coverage with evidence development” program that might better balance the need to cover new technologies with efforts to ensure post-coverage data collection.
Health Affairs published an analysis of biologics that had patents challenged under a mechanism known as “inter partes review,” finding that challenges under that pathway tended to lead to biosimilar introduction. The work was led by Arnold-funded law prof Sean Tu from West Virginia and concluded with an appeal to protect inter partes review from efforts to weaken the process.
TRAJECTORY/ Launch Price Communication Report: Skyclarys
One of my goals for 2025 is to bring more unique content to Cost Curve. It’s part of an effort to build the publication out as a broader value-add that goes even further beyond the news to generate insights and analysis that are unavailable elsewhere.
Reid Strategic has gathered an immense amount of background on medicines that have been launched over the past three years, tracking when and how launch prices have been disclosed, as well as how those pricing decisions have been covered by a curated group of 13 media outlets.
Those numbers have been boiled down into one-page “Launch Price Communications Reports.” The Reid Strategic LPCR library now has dozens of these one-pagers, and the time has come to begin to share them with subscribers.
The first is for Skyclarys, a treatment for Friedrich’s ataxia. At the time of its approval in 2023, the medicine was owned by Reata, which was subsequently bought by Biogen. Here’s how the pricing disclosure looked:
QUICK TURNS/ Novelizing PBMs, Quantifying the Impact of Prior Auths, and the “Arnold Playbook” at Work
I love this so much. A new book by a trial lawyer/novelist has a PBM executive as the chief villain in a thriller. It might be too early to suggest that PBMs have crossed a certain cultural threshold, but it feels like we’re getting closer and closer to a major motion picture about PBMs, starring Willem Dafoe as the cunning CEO and Jenna Ortega as the indefatigable mom-turned-patient advocate.
This is a reminder that the Sanofi Pricing Principles report is worth your time. I talked about this a bunch yesterday, and I don’t usually repeat myself. But I’m hoping that some media start picking around the data Sanofi presented to expand the story that’s being told around 340B and PBMs. This item is my effort to manifest that coverage.
Every single finding in this American Medical Association survey of doctors about prior auth is jaw-dropping. The short version: The impact of prior auths is more widespread and more dramatic than you probably think.
I’ve written for a while on the genius of the “Arnold Playbook.” The “playbook” isn’t real. It’s the way to describe how groups funded by Arnold Ventures effect policy change by building a foundation of academic papers that can then be deployed in other realms. Here’s what that looks like in practice: Harvard’s Arnold-funded PORTAL group just sent CMS every paper they’ve written on the 15 medicines up for “negotiations.” The flywheel they’ve built is really impressive.
Adam Feuerstein at STAT published a dark take on the current state of the biotech industry today. It’s hard to ascribe a single factor that is responsible for the poor financial performance of biotech (particularly earlier-stage companies), given all of the pressures, from high interest rates, to increasingly complex science, to a lukewarm M&A environment. But at some point, people are going get louder with questions about the degree to which the policy environment is playing into all of this.
Cost Curve is produced by Reid Strategic, a consultancy that helps companies and organizations in life sciences communicate more clearly and more loudly about issues of value, access, and pricing. We offer a range of services, from strategic planning to tactical execution, designed to shatter the complexity that hampers constructive conversations.
To learn more about how Reid Strategic can help you, email Brian Reid at brian@reidstrategic.com.
