Medicare drug access, Bernie Sanders’ hearing, Bayh-Dole, QALYs, PBMs, and more.

February 13, 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, NPC Chief Communications Officer

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NPC HIGHLIGHTS

Drug Access: A new research letter from NPC published in JAMA Health Forum showed that Medicare beneficiaries had wide access to many of the drugs selected in the first round of the Inflation Reduction Act’s drug pricing program, supporting concerns that the IRA’s pricing program may lead to the unintended consequences of more access restrictions. The publication, “Medicare Part D Coverage of Drugs Selected for the Drug Price Negotiation Program,” was co-authored by NPC’s Julie Patterson, PharmD, PhD; Tyler Wagner, PharmD, PhD; and Jon D. Campbell, MS, PhD and NPC President and CEO John M. O’Brien, PharmD, MPH. The IRA’s redesign of Medicare Part D is widely expected to prompt insurers to impose more utilization management tactics in response to the IRA’s perverse incentives, and the new NPC research shows it may hit hardest on medicines patients are accustomed to obtaining easily.

Senate Hearing: Sen. Bernie Sanders, I-Vt., summoned pharmaceutical company CEOs to Capitol Hill last week for a widely covered hearing; it was an event of “political theater” that prompted NPC’s John M. O’Brien to call for an “honest conversation” about how health care in the United States actually works.??

• Also: Rare in the media coverage was MarketWatch’s focus on the difference between list and net prices. The American Action Forum’s Jackson Hammond also wrote about that, and the fact that net prices have been declining. For other coverage, here’s Axios, Politico, and The Washington Post. Former HHS Secretary Tom Price, along with Job Creators Network Foundation President Elaine Parker, wrote an op-ed for The Hill criticizing the Sanders hearing and highlighting access challenges in countries that impose price controls.

Bayh-Dole: NPC filed comments with the National Institute of Standards and Technology in opposition to using so-called march-in rights to cancel drug patents based on pricing. Several academic groups also registered their opposition, as did BIO. Meanwhile, the Federal Trade Commission is in favor. Veteran health care patent lawyer Al Engelberg, writing in Health Affairs, said that government agencies exercising march-in rights move won’t help lower drug prices.?

Value Assessments: In her latest column on LinkedIn, NPC Chief Strategy Officer Kimberly Westrich focused on a Health Affairs Forefront piece from two Tufts University researchers about whether drugs are valued appropriately. She highlighted key recommendations and flagged the importance of more holistic approaches for optimizing the value of health dollars, including the reform of PBM and health insurer practices.?

INDUSTRY NEWS

Health Care Costs: In one of the more interesting stories of the past week, Tina Reed of Axios detailed the effort of one Montana company to find ways to cut its health spending without cutting employee benefits. Getting better deals with providers was, for the most part, far more the solution than drug costs.

PBMs: A House committee approved legislation that would ban spread pricing, where PBMs charge insurers more than they paid pharmacies. The Washington Post and Endpoints had details. ?

ICYMI

QALY: The House passed a bill that would ban federal programs from using the quality-adjusted life year, or QALY, from being used as a metric for determining a drug’s value.??

Prior Auth: Several state legislatures are considering new restrictions on how insurers use prior authorization requirements that make it more difficult for patients to get the treatments their doctors say they need, KFF Health News reported.?

MARK YOUR CALENDAR

Saturday, Feb. 24: At the ACCESS 2024 International Annual Meeting & Expo in Miami, NPC's John O'Brien will discuss the impacts of the Inflation Reduction Act alongside Lisa Nelson of Novartis, Sean Sullivan of the University of Washington School of Pharmacy, and Nancy McGee of Lumanity.??

Thursday, Mar. 14: At the Innovation and Value Initiative’s 5th Annual Methods Summit, NPC’s Jon Campbell will join a panel to discuss Real Option Value, an approach in value assessment that calculates the benefit patients and caregivers receive from treatments that extend life, giving patients the chance to benefit from future treatment advances.?