Let’s be honest, health policy has sort of taken a backseat when it comes to what we’re all tracking these days. And that’s okay. If you’ve taken a deserved timeout, let me catch you up on what caught my eye.
Ice Ice Baby. The House of Representatives Committee on Oversight and Accountability released a report on pharmacy benefit managers alongside their hearing where they grilled 3 heads of PBMs. The focus of the hearing was more pointing to a problem (preference for high cost/high rebate drugs and chain pharmacies rather than independent.) Less focus on solutions. But, then again, solutions don’t make great talking points and are HARD. If any of this was easy, we would have done it by now.
That being said, U.S. Representatives Jake Auchincloss (D,-MA) and Diana Harshbarger (R-TN) introduced the Pharmacists Fight Back Act. The bill focuses on PBMs working with federal programs and looks to help patient choice in pharmacies and pharmacy reimbursement. While tough in an election year, the advocacy support is cool to see with the pharmacist white coats very visible during the hearing.
Where to start? Employers. The National Pharmaceutical Council released a paper based on a national survey of employer drug benefit decision makers for organizations with self-insured pharmacy benefits and found that rebate guarantees, and benefit consultants were really important. While I happen to think both things can be great, there are a lot of ways that these things can work that disadvantage the employer. You might think that there is transparency but if you don’t know the ins and outs of this world, I bet someone is making money off the employer in ways that they can’t even guess at. But that’s Mark Cuban’s message.
For now? The Pink Sheet put out an analysis that the U.S. had faster novel drug approvals than Europe; 37 of the 48 drugs studied were approved in the U.S. first with a median faster approval rate of 5.1 months. BUT the pharma world was spinning yesterday when, during an earnings call, the AstraZeneca CEO said Europe might get the future indications approvals and not the U.S. because of the Inflation Reduction Act penalty for orphan drugs. As soon as a drug has a non-orphan indication, the negotiation clock starts back to the first approval which could mean non-orphan indication means immediate negotiation eligibility.
MP3. Late last week the Centers for Medicare & Medicaid Services (CMS) released the final Part II guidance on the Medicare prescription drug program’s (Part D) smoothing program. This is where beneficiaries can spread their out-of-pocket costs out over the course of the year. No one seems to think this roll-out will go well. Medicare Prescription Payment Plan doesn’t exactly roll off the tongue and explaining it to people isn’t easy. And they need to sign up with their plan and not at the point of sale. I know there is a lot going on and the $2,000 cap is really the win but, if there is going to be a program that could help beneficiaries, why not do it right?