In this issue: Employers eye PBM changes, U.S. drug imports from Canada face hurdles, small-molecules cheaper yet comparable to biosimilars, and more.

November 5, 2024

Welcome to NPC This Week! Today is election day, where Americans will elect a new president, Congress, and state leaders, resulting in more changes to health policy conversations. 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, Devon Bortz and Haley McKeefer.

NPC Highlights

The Evidence Base: In her September and October “Value Viewpoint” guest column for The Evidence Base, NPC Chief Strategy Officer Kimberly Westrich reflects on an action-packed fall centered around thoughtful discussions on critical policy topics like controversial employer cost-shifting programs, potential unintended consequences during IRA implementation, and the ongoing value assessment of cell and gene therapies.

Industry News

Part D OOP Cap to Alleviate Combination Heart Failure Drug Costs: While the Part D cap on out-of-pocket expenditures is expected to reduce the cost burden for enrollees on combination therapies for heart failure in 2025, it remains “unclear what additional benefit the IRA’s price setting provision will provide,” according to a study by USC Schaeffer Center for Health Policy & Economics published in JAMA Network Open.

Employers Eye PBM Changes: The National Alliance of Healthcare Purchaser Coalitions polled 188 employers for its 2024 Pulse of the Purchaser survey and found that 80% of employers are currently using or considering the adoption of a value-based formulary in the near future.

• Go Deeper With Value Viewpoint: In her latest "Value Viewpoint," Ms. Westrich takes a “value lens” approach to the National Alliance’s survey results.
• Go Deeper With NPC Research: An NPC study published in AJMC this summer shed light on employers’ perspectives of rebate guarantees, dependency upon rebate dollars, and the role that pharmaceutical rebates or employer benefits consultants play in their PBM selection.

Challenges for U.S.-Canada Importation: Research from the Canadian Health Policy Institute finds that proposed plans for U.S. states to import prescription drugs from Canada would likely deplete the Canadian supply of certain medicines while failing to generate meaningful savings for American patients.

ICYMI

Health Equity Through Improved Alzheimer Treatment Access: Recent cost-effectiveness research led by health economist Stacey Kowal published in JAMA shows that improved access to Alzheimer disease treatment across 25 racial and ethnic subgroups would add nearly 29,000 QALYs per year to the U.S. population, suggesting improved health equity outcomes in historically marginalized groups.

Clinically Comparable at Lower Costs: Researchers from the Center for the Evaluation of Value and Risk in Health (CEVR) at Tufts Medical Center published a study in Health Affairs showing that small-molecule drugs offer similar magnitudes of clinical improvement at nearly a fourth of the cost as their biosimilar counterparts ($4,728 vs. $16,020).

340B Among the “Biggest Issues” Facing Industry: During a call with investors last week, Pfizer CEO Albert Bourla cited reforms to the 340B Drug Pricing Program as a priority for the pharmaceutical industry. Albert Bourla said that the program creates “significant transfer of funds from where it needs to be used.”

• More on 340B: In an op-ed for RealClearHealth, former Vermont Governor Howard Dean detailed the rapid expansion of and lack of transparency within the 340B Program, calling on lawmakers to “make sure hospitals’ rapidly growing revenue from discounted 340B drugs goes to care for truly disadvantaged patients.”

Call for Regulation on Drug Formulary Decisions: In a commentary for AJMC, Dr. Jan Berger , CEO of Health Intelligence Partners, examines how formularies used by PBMs have transitioned from being a clinical tool to being a financial tool “in direct conflict with the goal of a patient receiving the medicine that will help them the most.” She highlights how “more than 600 FDA-approved medications are now excluded on an annual basis from the formularies of the larger PBMs.”

Patient Group Influence Grows: A PatientView survey of more than 1,100 patient groups found more than 60% of respondents feel their groups help represent patient interests to drug regulators in their countries — an increase from the roughly 20% of patient groups who agreed with that statement six years ago.

Biosimilars Could Face Harm From Price Controls: Mari Serebrov of BioWorld warns that any near-term price reductions caused by Medicare price negotiation could jeopardize “long-term, more sustainable price reductions driven by competition” and particularly discourage biosimilar development.?

Mark Your Calendar

• November 7: At the Galien Forum, NPC President and CEO John O'Brien n 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 7-8: NPC Chief Strategy Officer Kimberly Westrich and Senior Director of Alliances Katherine Lovro will be attending the closed Pharmacy Quality Alliance (PQA) Leadership Summit to connect with medication use quality thought leaders, decision makers, and stakeholders. Learn more about the event here.
• November 12: Join Friends of Cancer Research at their 2024 Annual Meeting on Tuesday, November 12 from 10:00 AM to 3:00 PM ET at The Ritz Carlton of Washington, D.C. Virtual streaming will also be available. Learn more and register to attend the FoCR Annual Meeting 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 15-20: 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 lead 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.