You know it is hot when I say, “Let’s go for a walk” and my dog looks at me from the stop of the stairs and refuses to move. At 6:30 in the morning. I hope you’re feeling more motivated than he is.

Same same, not different. Late last year, the Medicare prescription drug benefit proposed (and later finalized) the ability to switch patients to non-interchangeable biosimilars. A pretty big shift in mentality considering that switching studies were required by the Food and Drug Administration (FDA) to get interchangeability status. So either it is important to show interchangeability or it isn’t. Turns out it likely isn’t? This week the FDA released proposed guidance considering changing its tune. Comments due in September.

Trend I’m pondering. As I’ve covered in the past, the Mark Cuban Cost Plus Drug Company (MCCPDC) sells (mostly) generic drugs in a transparent way on their website. Tick off their consumers and they’ll come at you with pitchforks and tell you that it saved their lives because it is affordable. The shark wears a cape in their eyes. And an article in JAMA this week showed that almost 12% of patients on studied generics would have been better off not using their insurance and instead using Mark Cuban’s offering.

Then Ann Lewandowski had a LinkedIn post highlighting a job opening that promoted that it offered GoodRx as a benefit. Add in the obesity drugs and the out-of-pocket and the ability to buy from LillyDirect and, well, are consumers the new payers for prescription drugs? Do they just skip insurance entirely? Indemnity plan remix?

A tale of two providers. Earlier this week Brian Reid covered this 340B Congressional Budget Office (CBO) presentation (with a h/t to Adam Fein who has his own 340B presentation today). The last slide punches through the 340B noise and shows that there are hospitals and there are federal grantees, and one is growing a lot faster than the other in really profitable ways. I’ll let you guess.

It has been hanging out in my brain like an earworm. Those who know 340B knew this to be true but it makes obvious that when we talk about 340B, we need to be clearer about where the problem is. Otherwise federal grantees get looped into the noise and that’s just unfair.

Consistency. MedPAC released its June report to Congress. Two chapters in my flagged reading folder? Getting participation in alternative payment models and Medicare Advantage prior authorization.

Resource for later. The American Cancer Society Cancer Action Network released a report on step therapy in Part D oncology drugs.

Cool but duh? CBO did an analysis on hep C drugs. Savings to be had by using them in Medicaid. Education needed. I’m glad CBO is saying what the rest of us knew in 2014.