Back to back. Arnold Ventures put out the latest anti-pharma talking points (h/t Brian Reid) and here were two back to back –
- The average annual price of widely used specialty drugs before rebates reached $84,442 in 2020.
- In 2022, 37% of Americans reported they could not afford a $400 emergency expense, making paying for high drug copayments more difficult to manage.
Here’s the problem, it really isn’t about the cost of drugs. I mean you could take that drug price and reduce it 98% and the 25% cost share would still be too high for a lot of beneficiaries. It’s a different problem. We need to be clearer about what we are trying to solve for.
Drafting comments now. Things that caught my eye in the last Friday’s fun day of Medicare negotiation guidance.
- In the pharmacy payment process/Medicare transaction facilitation (MTF), the 340B claims identification is voluntary.
- While data exchange with the MTF is mandatory, the Centers for Medicare & Medicaid Services (CMS) is CONSIDERING having a voluntary MTF payment facilitation functionality where the MTF could help facilitate the financial transaction but manufacturers would have to pay for that function. Leaves the door open for vendors to come in and offer that service. (Seems unnecessarily chaotic). Hi McKesson – the floor is yours.
- CMS acknowledges patient listening wasn’t awesome and is looking for better ways to incorporate patient feedback. Cutting off patients who have a condition that makes speaking difficult isn’t a good look when you’re claiming to listen. BUT it was the first time and they are learning. This is a process.
- CMS reiterates they will be making sure that negotiated drugs are disadvantaged on formularies. If you’re a competitor, parity would work.
Peachy keen. ISPOR was in Atlanta this week. AJMC captures the highlights from an (understandably) packed house session featuring Kristi Martin from CMS. Sounds like potentially a little frustration (my read) that they are tied to certain processes because of the Inflation Reduction Act (IRA). Where there is more flexibility, they are looking at making some changes to things like patient engagement (see guidance above.)
But what really caught my eye was the work being financed by the Commonwealth Fund. Inmaculada Hernandez, PharmD, PhD, professor at the University of California San Diego, spoke about how they are replicating negotiations for the first 10 drugs selected and then publishing their findings as a way of bringing additional transparency to this process. They already put out a piece back in December about the therapeutic alternatives. Hefty and so worthwhile. I can’t wait to read more.
More ISPOR-ation. The National Pharmaceutical Council (NPC) had a poster on how annual increases for spending aren’t accounted for in the Institute for Clinical and Economic Review (ICER) annual Unsupported Price Increase (UPI) report. I question why this report even matters with inflationary penalties that came out with the IRA. Plus they use medical inflation which was super low last year (0.5%) so they could be looking at drugs that went up 2.5%. Meh.
NPC also had a fantastic poster on the hidden costs of 340B on employers and how there are impacts of 340B down the chain. In the study, a 4.2% increase in the cost of drugs due to the 340B program, corresponded to a $5.2B increase in costs for self-insured employers and their workers. But why look at a PDF when you can see Kimberly Westrich talk about it?
Dream a little dream. This article from Stat News on value-based pricing made the rounds this week and, if you didn’t see it, you should read it. I see it as aspirational. It seems like something must change – high cost/high rebate is not working for pharma (or patients.)
Save a loonie, lose access. It isn’t like it is going brilliantly in other countries. Forbes article from Sally C. Pipes on how Canada is faring.
Moo. Cow cuddling put on hold for bird flu. I mean the e coli picked up from a week at farm camp was already pretty bad. Banana bags and Zofran bad.