Happy International Women’s Day. Best display of International Women’s day I’ve ever seen was in Russia when I was studying abroad. They took it SERIOUSLY. Not just a LinkedIn Holiday.

Cat-astrophe? No, just a political speech – not reality. President Biden talked about increasing the number of negotiated drugs up to 50 a year. Not sure how we’d have the bandwidth to get that done in a responsible way. I suppose if you just did the formula (Non-federal average manufacturer price minus a %) it is possible. But if it is a negotiation (in any sense), it will take effort and resources. Speaking of resources, Medicare is looking for some additional contracting muscle behind the whole process. Having seen the RFP, I applaud the effort. This is way too much work to get done and hiring the right mix (in the right quantities) is hard. Contracting makes sense.

I was intrigued by the commercial coverage cap of $2,000 on prescription drugs. I imagine that would cause a lot of high premiums but I’ll leave the math to Milliman and other actuaries.

Moment in the Sun. Yesterday we had our 4 for the price of 1 day in court in New Jersey. The District Court of New Jersey heard oral arguments BMS, Janssen, Novartis and Novo Nordisk. The coverage seems to be mostly paywalled at this point but Stat News did a nice job summarizing it all. Like the exchange that this will cost pharma an arm (and a retort that they have other appendages and can afford to lose an arm.) But the judge also questioned if it was like the movie the Godfather (excellent reference).

Yes, I focused on the Rx section. MedPAC conducted focus groups with beneficiaries and 93% of Medicare Part D beneficiaries say their coverage is good/excellent, and that is before the redesign. Some of the issues were around the difference from their previous commercial coverage and Medicare but that is to be expected. Medicare coverage just has different parameters. A lot of overall concern on cost and use of GoodRx to afford prescriptions. And complaints on prior authorization and step therapy.  People are strange. A man in Germany got the COVID vaccine 217 times. He’s “fine” and still showed response when he got another COVID vaccine but there are so many whys that are unanswered.

But have you seen the price of prosciutto? Yes, brand name drugs are more expensive in the United States compared to other countries, thanks KFF. My favorite part was the acknowledgment that everything costs more in the United States. Grocery shopping internationally is a treat. Even walking around some posh grocery stores feels like I’m holding a coupon that says 20% off.

Will that be one email or two? I was waiting for this to become a “a thing” and am surprised it took this long. Providers are leaning into charging for patient emails. The patient out of pocket, when there is one, averages about $25.

340B is B-A-N-A-N-A-S. This is a rabbit hole of an article on 340B from 46Brooklyn and the distribution of discounts. I highly recommend it if you’ve been trying to make sense of 340B and don’t know where to start. But you’ll need to settle in – it is not a breezy read. If your attention span is not there (and no shame), long story short – patients lose out on 340B and everyone else makes money. And there are ways to make it more equitable and spread the savings around but profits.