Patient no more. A few weeks ago I wrote about how thanks to the HIV Hepatitis Policy Institute, the Diabetes Leadership Council and the Diabetes Patient Advocacy Coalition and their suit against the Department of Health and Human Services, accumulator programs were dealt a blow. They can only be used if it is for a branded drug with a generic equivalent. This week the Biden Administration said that they will not be enforcing the ruling and instead are appealing the decision. I understand that there are pros and cons to accumulators (particularly from a payer perspective) but to double-down on a ruling while at the same time touting the success of patient cost-sharing changes in Medicare Part D seems inconsistent.

Eye on the prize. You may not like the Affordable Care Act but it’s done a lot of good. 46 million uninsured down to 26 million. And even more than half of today’s uninsured qualify for government aid. Vox has a great story on how states are managing healthcare.

Look, if it was easy, it wouldn’t be a problem. This week the White House announced steps they were taking to shore up the nation’s drug supply chain by using the Defense Production Act to make more essential medicines in America and mitigate drug shortages. The Department of Health and Human Services (HHS) will also have a Supply Chain Resilience and Shortage Coordinator. They will also invest $35 million in key starting materials for sterile injectables. All good moves but just steps, not leaps, in the right direction. What would I do?

Vertical alignment under review. This week Sen. Elizabeth Warren (D-Mass.) and Sen. Mike Braun (R-Ind.) asked HHS to look into whether the ownership of pharmacies by health plans is contributing to high drug prices.

Avoiding the death of the local pharmacy. Along those lines, the Washington Post ran a story about the decline in the number of pharmacies partially caused by the larger companies driving decisions about preferred pharmacies, etc. Solution? Government programs should increase reimbursement rates; typically they pay less than private insurers. And states should look at pharmacy benefit manager practices.