Tuesday morning, I spent the first half of the day convinced it was Wednesday, and yet, despite that mental setback, the rest of the week has flown by. Feels like a win.
Killing me softly. Overall, glad to see the stories recognizing how the uncertainty of federal research dollars is impacting NIH summer internships, graduate school spots (gift link) and post-doc openings. If the U.S. wants innovation, need people to have career opportunities train them. We could wipe out years of potential researchers if we are not careful. My husband did an NIH summer internship (way back when), and it was career-shaping and completely amazing. The idea that students will not have that opportunity is heart-breaking.
Occam’s razor. Big picture if you did not pay attention to anything this week, know that Medicaid is likely to get rocked soon. It is almost impossible to get big budget savings without making cuts to Medicaid. Congressional Budget Office (CBO) confirmed it this week.
Weighing unintended consequences. Maryland’s State Senate is considering legislation to extend upper payment limits beyond drugs purchased by public insurance plans to drugs purchased by any provider in the state. I have been doing a deep dive into prescription drug affordability boards (PDABs), and I think the downsides parallel to what we are seeing with the maximum fair price implementation (i.e., pharmacies and cash flow/revenue, plans picking high cost/high rebate, patients not seeing any savings.) More on that to come.
Oh, what fun. The uptake in the Medicare Prescription Payment Plan (Medicare prescription drug plan feature where patients can spread cost out over the year) is likely pretty low but, even with low enrollment, it is a headache for pharmacies. Pharmacies are facing confusion on claims processing and plan help lines are providing confusing information and steering patients towards mail order.
On a roll. More on unintended consequences… Cencora wrote a paper on how the Inflation Reduction Act could hurt innovation for orphan drugs, drugs with pediatric indications and small molecule drugs.
If a tree falls in a forest. This week the Institute for Clinical and Economic Review (ICER) published a report on two drugs (Trelegy Ellipta and Breo Ellipta) selected for 2027 Medicare negotiation. The analysis found that these drugs over an advantage over generics because they allow patients to take the treatment once a day rather than twice a day. How will this be factored into Medicare’s negotiation? Unclear.
Louder for the people in the back. Alex Azar doubled down on paying providers based on value, not fee-for-service. He says that 20% of providers are enthusiastic and another 60% could get there.
