Net prices, IRA price controls, 340B, biosimilars, and more.

April 9, 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

IRA Price Controls: In an interview with Rose McNulty of the American Journal of Managed Care (AJMC), NPC Senior Director of Research Dr. Julie Patterson discussed the findings of NPC’s recent study on the potential impact of the Inflation Reduction Act on small molecule drug research and development investments toward subsequent indications.?

• From Dr. Patterson: “There are still so many uncertainties about the Inflation Reduction Act's Medicare Drug Price Negotiation Program, both in how it will be implemented and how it will impact patients' access to innovation. What we found was concerning… the IRA may delay access to brand new medicines and may lead to fewer diseases and patient populations getting additional FDA-approved treatment options.”
• Meanwhile: The recent announcement of another procedural step in the implementation of the Medicare Drug Price Negotiation Program was noted with the typical political discourse around the topic.

Value Viewpoint: In her latest “Value Viewpoint,” NPC Chief Strategy Officer Kimberly Westrich analyzes a new report on equity in health technology assessment from the Innovation and Value Initiative and previews AMCP 2024. (We hope to see you in New Orleans!) Subscribe to her weekly newsletter for a fly-around of important value-focused articles, reports, and events.?

Industry News

Net Prices: Although it’s not apparent in the public discourse, net prices for prescription drugs in the U.S. fell by 2.8% in last year’s fourth quarter — the largest decline ever measured by SSR Health.

340B: The 340B program now includes 17,250 active contract pharmacies, outnumbering hospitals and clinics in the program by three-to-one according to the Paragon Health Institute.

• Go Deeper: A separate study released by AIR340B estimated that 85% of disproportionate share hospitals earned more in 340B revenue in 2022 than they incurred in charity care costs.

U.K. HTA: STAT’s Andrew Joseph reports on concerns over a policy decision by the U.K.’s National Institute for Health and Care Excellence, which may jeopardize access to gene therapies in the country.

ICER’s UPI Protocol: The Institute for Clinical and Economic Review released a research protocol for the next Unsupported Price Increases (UPI) report. The full UPI report is expected to publish in December 2024.

• Go Deeper: Read NPC’s concerns regarding the 2023 UPI Report from December: “Unsupported Policy Information.”

ICYMI

Personalized Medicine – In STAT News, Edward Abrams and Christopher Wells of the Personalized Medicine Coalition discussed the leaps in gene-based treatments for patients and the challenges in adoption that remain ahead.

• From the Commentary: “It is incumbent upon this generation of health care and life sciences leaders to do the hard work that will be required to imagine and build a better health system that prioritizes more institutional spending on the most cost-effective prevention and treatment strategies while protecting people from increased out-of-pocket costs.”

Copay Accumulators: CMS’s final 2025 exchange rule was silent on enforcing a federal court decision that effectively banned the use of copay accumulators.

• Go Deeper: The final exchange rule clarified that individual and small group plans in the commercial market may not designate covered drugs as non-essential health benefits.

Gene Therapies: States are expected to review coverage of a newly approved gene therapy to treat metachromatic leukodystrophy on a “case-by-case basis.”

PBMs:? In The Hill, Tonya Winders, chair of the American Respiratory Care Foundation, called on Congress and the President to increase affordability of inhaled respiratory medicines by reforming “one of the true drivers of high health costs — pharmacy benefit managers.”

Biosimilars: An analysis of IQVIA data revealed that health plans and patients missed out on $6 billion in savings last year as a result of rebate schemes by pharmacy benefit managers to impede biosimilar uptake.

Mark Your Calendar

April 15-18: NPC's research and leadership teams will be attending and presenting at #AMCP2024 in New Orleans, LA.

April 18: NPC President and CEO John O’Brien will join Nkarta Therapeutics CEO Paul Hastings, Christie 55 Solutions Partner and Executive Director Richard Bagger, and other distinguished speakers at the Rutgers Business School’s Annual Healthcare Symposium. This year’s theme is “Innovation and Patient Access After the Inflation Reduction Act” Learn more and register here!?

April 30: Dr. O'Brien will be participating in a panel discussion focused on the future of value-based contracting as part of Asembia's Specialty Pharmacy Summit, April 28–May 2, 2024, in Las Vegas.

May 5-8: NPC will be participating in the ISPOR 2024 conference in Atlanta.

May 8-9: Join the National Health Council for its 2024 Science of Patient Engagement Symposium! Taking place at the historic National Press Club in Washington, D.C., the theme this year is “Patient Experiences Through Their Lifespan.”

May 16: At the Financial Times U.S. Pharma and Biotech Summit in New York City, Dr. ?O’Brien will join a panel on “Solving the U.S. Drug Pricing Problem.” Dr. O'Brien will be joined by Sarah Emond, President and CEO, the Institute for Clinical and Economic Review, and Greg Baker, CEO, AffirmedRx. Save 20% off your in-person or digital registration with the code FTNPC. Register here!