PDAB-adieu. This week Governor Youngkin vetoed a bill that would have established a prescription drug affordability board (PDAB) in the state. The PDAB would have had authority over state-sponsored and state-regulated health plans. Younkin said that the PDAB would have determined drug availability solely on cost rather than unique patient needs and the opinions of healthcare providers. Access for the win?

Go Big or Go Home? The Centers for Medicare & Medicaid Services is currently “negotiating” for ten drugs for 2026. Ten drugs were named. Packages of information were sent in. Prices were made. Prices were countered. Counteroffers were rejected and here we are.

In Health Affairs Forefront, there is a piece by the team at the Duke-Margolis Center which goes into the implications of these negotiations. Many of the drugs in this first set come from highly competitive, highly rebated classes such that the rebates are already higher for the products than the ceiling price formulary set by the Inflation Reduction Act. The paper suggests this will become the baseline unless there are comparators that drive the price lower.

If you wanted to hear my guess, I’d tell you that this is what I’m assuming too. But, NO ONE KNOWS WHAT CMS IS THINKING. Okay, scratch that, some people who are part of the negotiations know what is going on with their drug, but they are under CDAs not to say a word.  Usually, I have a good sense of policy and the logic behind it but this is the first time this has been done. It’s an election year.

They Might Not Have Stayed in Their Lane Either. Not my usual topic but I liked the behind the scenes of the emergency department in Frisco, CO and the ski injuries see. Even mountainside urgent cares have superb ortho departments compared to other places I’ve skied. #beentheredonethat

Unexpected. Lately I’ve liked the stories about medical debt being purchased and done away with by different entities – for pennies on the dollar, it felt like it should wipe away stress. A study done by the National Bureau of Economic Research suggests that there were small increases in access to credit, but it didn’t improve mental health.

Medical debt is the past for these individuals and not the present. It simply doesn’t likely go far enough to help them with their current state/issues. I was discouraged but I’m not done with the idea. I can’t believe that it doesn’t help overall, but it likely needs to be done in tandem with other efforts.

Data Desert. Despite calls for transparency, what feels like basic Medicare Advantage data (like out-of-pocket) is still not available. Quick dive by Kaiser Family Foundation. All good questions given that Medicare Advantage costs more than fee-for-service Medicare.

ICYMI … This week on LinkedIn I also wrote about

• ICER’s request for public comment on their Unsupported Price Increase protocol.
• Quick thoughts on the Notice of Benefit and Payment Parameters (NBPP)