A whirlwind of a week. I regrouped on Wednesday and got a run in and some pottery wheel time and then it all fell apart again (in a good way) on Thursday where I forgot to leave my desk for hours and hours. One of those “I love working” and forget time exists. So much to see this week!
Charting Progress? KFF put together some charts on drug pricing in the United States. They highlighted that we don’t know how much more the United States really is above other countries because of rebates. Here’s a zinger – 73% of the public thinks that more regulation is needed for drug pricing. Gross to net isn’t exactly a fun sell.
Hearing Nothing. Yesterday the Senate Committee on Health, Education, Labor and Pensions had a hearing on drug pricing where they pulled up the CEOs of Johnson & Johnson, Merck and Bristol Myers Squibb. The NYT had a quick overview of the proceedings. The hearings weren’t meant to problem solve or even drive toward solutions. It was noisy. The CEOs stuck to their message that prices are high but so are rebates and that the United States has access to innovation faster than anywhere else.
Before the hearing started, I read John O’Brien’s post on what would be ideal – to have a real conversation and stop talking past each other. As the hearing progressed, it was just the usual. So knock me over with a feather when Senator Paul abandoned the politics of the day and said what one of the main talking points should have been – if you want less expensive innovation later, pay for it now. His tone was almost incredulous about the naivete and anger of those against the industry. I was amused.
On the pay now, save later theme. We saw this innovation now/generics later come up in Health Affairs and this BMC article I highlighted last week.
Smooth over, they got this one. I had plans on writing a blog about how the Part D benefit change to allow for “smoothing” (spreading out-of-pocket costs over the course of the year) was actually kind of messy. I blocked off time to do it and, well, I got beat. Whew. Cross that off my list. Then again, I have examples and chart in mind so maybe I’ll do a spin on it. Let me know if you’re interested.
Ab-vantage. Abbvie is still crushing it with Humira even with the biosimilars on the market. It won’t last forever (I think?) They have held on longer than most of us thought they would. The force (of rebates) is strong with this one.
Donut Forget Part D. KFF had a nice release on the number of beneficiaries that might benefit from the Medicare Part D out-of-pocket cap ($2,000) starting in 2025. They estimate 1.5 million people would have benefited in 2021 from this type of cap and that, over time, millions more would have. Between 2010 and 2021, 5 million beneficiaries had expenses over $2,000/year out-of-pocket.
Squawk Box. Vertically integrated behemoth of a healthcare company, CVS is out saying that they may need to cut Medicare Advantage benefits because of the proposed rate changes for 2025.
Other stuff out there…
The House is looking at PBM reform but it is limited to the Federally Employee Health Benefit plans. I mean it seems like this could be done by the Administration without legislation but that’s probably not the point.
Go Fund Me as recommended by your doctor.
Quality Adjusted Life Years (QALYs) and whether they should be encouraged or banned is back in the spotlight.