In this issue: Assessing copay offset programs, the first round of MFPs, patient access, the state of 340B and charity care, and more.

October 29, 2024

Welcome to NPC This Week! We hope you'll join us each week for a look-ahead at the policy, research, and industry conversations that matter to the future of biopharmaceutical innovation. The DMs are open if you have suggestions — and please share with your network. - Michael Pratt and Devon Bortz

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NPC Highlights

Assessing Copay Offset Programs: At an AMCP Nexus meeting earlier this month, NPC Chief Strategy Officer Kimberly Westrich sat down with AMCP Associate Vice President of Congressional Affairs Adam Colborn to discuss cost-shifting programs at the state and federal levels, such as copay accumulators and maximizers and alternative funding programs.

• NPC’s Kimberly Westrich in AJMC: “These cost-shifting programs are extracting value from medicines that's intended for patients, and it's at the expense of patients’ pocketbooks and health.”

Lessons From the First Round of MFPs: Last week, NPC President and CEO John O'Brien joined Dr. Gregory Daniel of Eli Lilly, Dr. Inmaculada (Inma) Hernandez of the University of California – San Diego, and Dr. Sean Sullivan of the University of Washington for an open ISPOR webinar on the “IRA Part III: Medicare’s Maximum Fair Prices for the First 10 Negotiated Drugs and Anticipated Cost Savings.” If you weren’t able to attend the live event, you can log in with your ISPOR account to watch the full recording here.

Value Viewpoint: In her latest "Value Viewpoint," Ms. Westrich spotlights ISPOR’s 2024 Health Economics and Outcomes Research Award honorees and reviews ICER’s Final Evidence Report of three medicines for the treatment of transthyretin amyloid cardiomyopathy (ATTR-CM).

Industry News

The Patient Experience on Drug Access: The latest Patient Experience Survey from PhRMA/Ipsos captures that 4 in 10 Americans experience barriers from their insurance, with over two-thirds of respondents strongly agreeing on “cracking down on practices … like step therapy and prior authorization that can limit patient access to medicines.” Axios reports that these survey results come as policy discussions include calls for more PBM and insurer transparency .

Breaking Down Copay Accumulators: KFF published an issue brief on copay adjustment programs, how they work, and their impact on consumers. The brief explains how discounts offered by manufacturers and intended to reduce patient costs are pocketed by insurers and notes that federal regulators “have not yet fully addressed” the use of the programs.

• Go Deeper: For more on this topic, check out recaps of an #AMCPNexus session featuring Ms. Westrich on “What You Need to Know About Copay Accumulators, Maximizers, and Alternative Funding Plans,” courtesy of Managed Healthcare Executive and AJMC .

The State of 340B and Charity Care: The Health Equity Collaborative (HEC), a coalition of “national, public health, patient advocacy and multicultural organizations,” issued a white paper criticizing the rapid expansion and misuse of the 340B program and calling for reforms like enforced transparency requirements and a national standard for charity care.

• Go Deeper: HEC cites NPC President and CEO John O’Brien from a 2022 STAT commentary : “If hospitals, contract pharmacies, and third-party administrators have more data that can add more detail to this discussion, the research community must be given access to it so their work can restore confidence that the [340B Program] is helping those it is supposed to help.”

ICYMI

Development Pathways for Cancer Treatments & the IRA: NPC’s recent research in Therapeutic Innovation & Regulatory Science (TIRS) on “ Subsequent Indications in Oncology Drugs: Pathways, Timelines, and the Inflation Reduction Act” and Dr. O’Brien’s corresponding LinkedIn commentary were featured in an article by OncoDaily.

PBMs Under Fire for Uneven “Math”: Adding to The New York Times ’ investigation published earlier this month, KFF Health News’ Andy Miller details what he called “PBM math” — unequal rates of reimbursement, higher costs, and reduced access for patients who choose independent pharmacies over retail chains.

• More From HLTH 2024: Healthcare Dive spoke with several healthcare executives on the floor of HLTH 2024 in Las Vegas last week, including Paul Markovich , President and CEO of Blue Shield of California, who called the PBM business model “a dead man walking.”

Adoption of Real-Time Prescription Benefit Tools: Since 2021, Medicare administrators have required Part D plan sponsors to implement real-time prescription benefit tools that display out-of-pocket drug cost estimates in the electronic health record at the point of prescribing. New research in JAMA Health Forum found that two-thirds of hospitals have adopted the tools, though gaps still remain for hospitals that are small, for-profit, and/or rural.

Shaping the Future of U.S. Science: Writing for Nature, Jeff Tollefson and Richard V. discuss how U.S. leadership in science and R&D “hinges, in no small way, on the November election” as federal legislators “play a pivotal part in setting the course for the U.S. scientific enterprise for years to come.”

Maryland PDAB Moves Forward: Maryland’s Prescription Drug Affordability Board is one step closer to applying upper payment limits on certain prescription drugs in the state after a legislative committee approved an action plan in a 16-5 vote.

• Go Deeper: Read the primer from the NPC research team published in Health Affairs Forefront . It details uncertainties and potential unintended consequences of states implementing upper payment limits through PDABs.

DPNP Behind the Scenes: STAT ran a piece from the CMS Director of the Center of Medicare on "how we executed the first round of drug price negotiation."

Mark Your Calendar

November 7: At the Galien Forum, NPC President and CEO John O’Brien will join a panel discussion on “BioPharma Pressure Points: PBMs, Pricing, Access, and the Global Supply Chain.” Joining Dr. O’Brien for the conversation: Ariel Katz, Co-Founder and CEO of H1, Daniel Mendelson, CEO of Morgan Health, JPMorgan Chase & Co., Janet Woodcock, Former Principal Deputy Commissioner of the U.S. FDA, and Ezekiel Emanuel, Vice Provost for Global Initiatives at the University of Pennsylvania.Learn more and register to attend the Galien Forum here.

November 13: NPC President and CEO John O’Brien will speak at the Alliance for Health Policy’s 2024 Post-Election Symposium on Wednesday, November 13. Learn more and register to attend here.

November 15: Headed to ACCESS EU ‘24 and/or ISPOR Europe 2024? Make sure to connect with NPC! On Friday, November 15 at ACCESS EU, NPC Chief Science Officer Jon Campbell will speak during a plenary session on lessons and implications for market access after the first round of the U.S. Medicare Drug Price Negotiation Program. Learn more and register to attend ACCESS EU and ISPOR Europe 2024.

November 18-20: Will you be at the National Alliance Annual Forum in Arlington, VA? If so, be sure to connect with the NPC team! First up, on November 18 from 2:15 – 3:45 PM, NPC Chief Strategy Officer Kimberly Westrich will be leading a PBM Misalignment Initiative workshop. The next day, November 19, from 11:30 AM – 12:25 PM, NPC President and CEO John O’Brien will join a panel discussion on “Unlocking Value: Building Trusted Tools to Assess High-Value Care.” Dr. O’Brien will speak alongside Sarah Emond, EVP & COO of ICER, Shawn Gremminger, President and CEO of the National Alliance of Healthcare Purchaser Coalitions, and Caroline Pearson, Executive Director of the Peterson Center on Healthcare. Learn more and register to attend the National Alliance Annual Forum here.