The Future of Drug Spending, Plus the Top 10 Pieces of Pricing News From the Past Week

It was another fun week in Drug Pricing Land, but, then again, most weeks end up being fun if you're into geekery.?

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There’s some good stuff in this week's editions: I have a rant about employer pushback on obesity drugs, some deep-ish thinking on Bernie Sanders’ endgame, and perspective about a fascinating study of GoFundMe pages that seems like it is about -- but actually isn’t really about -- diabetic alert dogs.?

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As much as I’d love to pick up one of those threads, it’s probably important to focus on the 30,000-foot view, which was captured in the government’s National Health Expenditures projections. (The press release is here. The publication is here. And the underlying data are here.)

The NHE numbers -- projected through 2031 -- are the best guess about where America’s health care dollar will go. The headline is that overall spending will grow at an annualized rate of more than 5% between now and 2031, hitting a total of $7.2 trillion (!) in 2031.?

The story when it comes to retail prescription drugs is less alarming. Drugs will reduce medical inflation across that period. Spending on retail medicines in commercial insurance plans will only inch up 1.4% next year and 1.1% in 2025. And that’s spending, not prices.

Indeed, per capita out-of-pocket spending on retail prescription drugs will fall over the next decade.?

Medicare is a little more complex. Spending will shoot up over 2024 and 2025 as the Inflation Reduction Act’s Part D out-of-pocket cap juices drug utilizations, but those increases will slow at the tail end of the decade as price-control events of the IRA kick in.?

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What else? How about ... A Subjective List of the 10 Most Interesting Pieces of Value/Pricing/Reimbursement/Access News This Week:

1. The aforementioned GoFundMe study shines a light on one of the most important questions in health care today: where, really, are the holes in the safety net for Americans?
2. Colorado released a neat dashboard that it’ll use to determine which drugs should be subject to an affordability review (which is not neat). Also not neat: the dashboard apparently has some data accuracy issues. Swim at your own risk.?
3. The Washington Post has a piece on how insurers are playing hardball with providers prescribing GLP-1 medicines for weight loss, including threats to report docs to their state medical boards.?
4. Amgen/Horizon filed a response to the Federal Trade Commission’s effort to derail the acquisition. The FTC argued that Amgen would use contracting tricks to protect Horizon drugs from competition. Amgen countered that not only would it not use any tricks, the alleged tricks aren’t even really a thing.??
5. Drug Channels’ Adam Fein had a nice wrap on the 10 companies that release their portfolio-wide gross- and net-price numbers.?
6. Pharmaceutical Strategies Group released its Trends in Drug Benefit Design report. It’s a treasure trove of data, but my biggest takeaway was the suggestion that cost-sharing for consumers is only going to get worse.?
7. Lilly CEO David Ricks’ made the rounds -- including a CNBC hit and a J.P. Morgan event -- and used the opportunity to highlight all the ways that the IRA will harm innovation … and the ways it already has harmed innovation.?
8. Genentech won approval for Columvi, a bispecific antibody for diffuse large B-cell lymphoma. It’s a fixed-duration product: 13 doses over 12 cycles for about $350,000 per course of treatment. Endpoints had the most detail on pricing.?
9. Vital Transformation did a “what-if” analysis of ideas floated by congressional Democrats and President Joe Biden to toughen the IRA and concluded that the proposals would kill literally hundreds of would-be drugs.
10. The Atlantic looked at so-called pay for delay settlements between branded and generic drugmakers. The piece was narrowly focused and didn’t get deep on policy issues, but the article underscored the reality that the next great biopharma policy battle will be around IP.?