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.
I’m not sure what to make of the Politico report that Robert Kennedy, Jr. expressed support for march-in rights at a meeting with Senate Finance Committee staffers.
I mean, I trust the reporters — taking the word of professional journalists is my default setting — and even the Kennedy team’s denial is something short of watertight. (His spox told Politico that “this did not occur the way Democrats have described it,” which is different from just saying “this did not occur.”)
It’s not hard to spin this into a classic Trump health care either/or (to borrow Axios’ framing): On the one hand, the government breaking patents with minimal due process is anathema to conservatives. (It’s the major plot point in Atlas Shrugged!) On the other, Trump seems to want to push the limits of the administrative state, and march-in would be quite the expression of that power.
My assumption is that the former seems more plausible than the latter. But am I confident? Eh.
After all: nobody knows.
Unlike Trump health policies, “nobody knows” does not apply to IRA implementation. Indeed, it looks like everyone knows the conventional wisdom is converging around a dispiriting conclusion that the introduction of “maximum fair prices” for the first 10 medicines to get price controls is going to be messy.
Yesterday brought a couple of arguments to buttress the “messy” theory.
The National Community Pharmacists Association submitted comments to CMS noting that a third of its members are planning on refusing to stock at least one of those 10 price-controlled drugs. (Another 60% are considering the move.)
The pharmacists are concerned about the plumbing of the system: they have to buy the medicine at the regular price up front, and they get made whole from the manufacturers after the medicine is dispensed. This will all happen following an entirely new process that’s not yet set up.
So that’s not good.
Also not good: the Association for Accessible Medicines, in their comments to CMS, noted that Medicare Part D plans are far, far less likely to cover generic medicine than commercial plans, instead opting for more-profitable branded drugs.
This is bad for the generics industry, but it’s also a useful preview of how PBMs may treat MFP drugs. Anything that PBMs can do to shift patients away from those meds benefits them financially. And though CMS does have a formulary review process, the AAM comment is a reminder CMS has not always been great at identifying and stomping out shenanigans.
I’m not rooting for chaos here. Whatever philosophical issues I may have with the IRA, I certainly don’t want to see collateral damage from an operational POV.
But am I confident? Eh.
I spend a lot of time whining about media stories about January 1 price increases, but the reality is that there are interesting questions that can be asked about individual medicines, even if the widely reported aggregate numbers are essentially meaningless.
The Wall Street Journal’s annual story on the topic spends a lot of time on the meaningless stuff, but — by looking at some specific drugs — there was the seed of something insightful. But those seeds never really grew, and I’m not sure anyone will learn much.
ELSEWHERE:
There’s more polling data from KFF on health care and trust. The data isn’t really in the wheelhouse of this newsletter, but the stuff on vaccines, in particular, is pretty scary and worth tracking on. It’s also yet another set of evidence points showing that most people view science through the lens of politics, which is also scary.
Interesting perspective from The Hill: Everyone in DC seems (somewhat) confident that PBM reform will pass this year — the cost-savings from the measures will help offset the giant tax cuts that seem to be the bigger priority — but it’ll probably be a tiny part of a big, partisan bill that will mean that Democratic champions of reform will probably end up voting against it.
Not sure there’s much new in CNBC’s wrapup of health policy talk from pharma at #JPM25, but if you’ve been on a two-week Arctic expedition and want to catch up, it’s not a bad summary.
I haven’t been tracking the Hawaii PBM suit very closely, but given that it seems to keep rolling on, I should probably keep a closer eye on things.
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.
