There are some weeks where your long-term success could be impacted if you’re not on top of what’s happening, this isn’t one of those weeks. But these things are cumulative so, if need help on the regular with strategy and health policy (like figuring out what you need to pay attention to, help understanding the negotiation explanations), shoot me an email. A few things got my attention this week…

Where does the $ go?: PhRMA knocked it out of the park with this BRG report on the pharmaceutical supply chain. It clearly shows that pharmaceutical pricing gets picked off by various stakeholders and the manufacturer retains only about half (49.9%). Which is why it is also so hard to make big changes – whiat stakeholder is going to volunteer to have revenue taken away? The report also covers the growth in rebates and the 340B program. This is a save-it-for-a-PowerPoint or talking points kind of report.

Checking the Box: If you think you’re up for Medicare negotiation in the next few years, add checking out the explanations of the 2026 negotiated drugs to your 2025 to-do list. Each of the 10 drugs gets a ~30 page zipped file walking through indications and competitors looked at and a summary of the meetings with the manufacturer.

Is it a deep dive into how they arrived at the price? No. The PDFs are repetitive and seem like a “checking the box” exercise. But it is SOMETHING and gives a bit of a clue on what they are considering when they think about competitors, etc. And with this much money at stake, something is better than nothing (but I’d prefer more – please and thank you.)

Good Question, Still No Answer: What is a specialty drug? How do you define it? A conversation I remember having 15+ years ago (I remember I was sitting in my office at Avalere and I think I was talking with the National Pharmaceutical Council about it.) We went back and forth whether it was price or distribution or something else that defined it. Turns out we still don’t have an answer – but a nice review of the question.

Ship Might Have Sailed: One opinion might not matter much, but if it is Joe Grogan, I tend to pay attention. Before RFK came more boldly into the picture, my bet was on Joe Grogan running parts of health policy behind the scenes. And because I’m not sure anyone knows anything about what might happen, I’ll still give anything he writes some time. In this op-ed he says that the Inflation Reduction Act shouldn’t be fixed and points out the failings of the IRA (standalone prescription drug plan demonstration, independent pharmacies threatening to not cover the negotiated drugs, etc.) but… as of January 1, Part D beneficiaries have an out-of-pocket cap of $2,000. I am not sure that horse can (or should) be put back in the barn.

While on the subject of Part D and redesign, there was a bit of a buzz on LinkedIn this week about whether beneficiaries had signed up for the Medicare Prescription Payment Plan (spreading out costs over the course of the year.) My guess – no. And that’s okay. Most beneficiaries won’t benefit from the program and, those that would, are likely to go hunting for information in a “just in time” manner. Do I wish it had all gone smoother (pun somewhat intended)? Sure. What I want to see now … pharmaceutical manufacturers educating doctors and their staff about the program so they can be aware of it if patients express concerns about cost. Same for pharmacy staff. But for perspective, we’re 10 days into a program. We have time to do better.