Some days I sit down the pottery wheel and I pull 4 bowls or vases in a row that are fantastic. Other days (like, oh, this Sunday and Wednesday) it all collapses. Here is hoping that all of us get better at staying centered and not collapsing.

I’d Prefer Not. The 2026 Medicare Advantage and Part D final rule came out. The big news was that they decided to not move forward with coverage of anti-obesity medication. (Note, they can be covered for other indications.) The Centers for Medicare & Medicaid Services (CMS) also decided not to move forward with a more extensive formulary review of generics and biosimilars. The rule did move forward with auto re-enrollment for beneficiaries in the Medicare Prescription Payment Plan; all 100 of them. (Just kidding, I have no idea how many are enrolled but I assume the number is lower than would benefit from it.)

Also out, the 2026 Part D Redesign Instructions and 2026 Rate Announcements. MA plans did better than expected for 2026 payment.

U.K.an’t have it all. Stat news had an interesting story about drug spending in the United Kingdom. It’s a capped system so that when drug spending increases past a certain level, drug company rebates go up to make up the difference. Except the rebate is going up more quickly than anticipated (last year 15%, this year 23%) and that’s causing some rumblings from the industry about research and delaying access to patients. Often U.S. policy makers point to other countries and imply that they have figured it out but really, there are no easy ways to balance cost and access.

If Value is in the Eye of the Beholder… I like what NPC sees. This week the Institute for Clinical and Economic Review (ICER) put out a white paper on affordable access to GLP-1 obesity medications, I could write about it but the National Pharmaceutical Council (NPC) does it so much better. The one sentence summary in case brevity is your thing — the ICER report focuses on payer affordability and cost containment in the short term over long term value and doesn’t give enough credit to clinical or economic evidence.

(Not) Made in the USA. Despite what else is going on with tariffs, it appears pharmaceutical tariffs are still on the table and that’s worrisome. Here’s a NYT article (gift link) and the Washington Post (gift link) that cover this issue in more depth.

Here’s my general take on the issue — generics ride on narrow margins (fractions of pennies) and are made abroad because that’s what we’re willing to pay for them. We don’t want the active ingredients made in our backyards and we ignore cut corners because things usually work well enough. Food and Drug Administration (FDA) inspectors do what they can given limited resources (and that was before last week.) Even if we wanted more of it here, manufacturing drugs – particularly sterile injectables – is not easy and expect to pay more than we do today, and increased shortages are likely. For brand drugs we will face more costs that will be folded into premiums and cost-sharing and the government will spend more because they pick up a lot of the cost of the U.S. healthcare system.

Should we encourage more U.S. manufacturing of pharmaceuticals? Yes, if we produced the right drugs here, it would create a more steady supply chain of critical drugs. And here is also friend and near-shoring (if we have friends left.)

Pound Foolish? The U.S. Government Accountability Office (GAO) released a report on how the Food and Drug Administration should coordinate with the rest of the Department of Health and Human Services to address drug shortages. The Biden Administration had set up a coordinating position to work across the agencies on supply chain resilience. As GAO releases this report, the position is being eliminated as of May 2025.

Clip and Save. List of patent expirations.