Patients Get Their Chance to Be Heard on Price Controls, If Anyone Is Listening (Plus the Week's Top 10)

This week begins what the Centers for Medicare & Medicaid Services is calling “Patient-Focused Listening Sessions ” around the price-control elements of the Inflation Reduction Act.?

The effort to collect patient feedback on the 10 medicines subject to “negotiations” comes at an interesting point in the process. The law has been on the books for more than a year, and we’ve all had four months to digest CMS’ thinking on how they’ll implement the law.?

So the implications of what the law does -- and does not do -- are finally coming into focus. It’s clear that there will be some big winners. The government, both philosophically and financially, is going to come out ahead. And the 10% or so of Medicare enrollees whose medication bills are extremely high will also benefit hugely from the out-of-pocket caps in Medicare Part D.?

For everyone else, though, the IRA might not deliver. Payers are already warning that premiums in Part D will go up even as formulary coverage narrows and prior authorizations get more demanding. Harvard’s Aaron Kesselheim -- arguably the biggest defender of the IRA on the planet -- admitted as much, telling Fortune that the lack of widespread benefit is “a challenge in messaging for Medicare ”

So that’s the backdrop for the first of the 10 listening sessions, one for each medicine, with 20 individuals given speaking slots per meeting. I suspect that we’ll hear a range of perspectives. Some groups are very much in favor of the concept of price controls that will argue for low, low prices. But my guess is that many more speakers will express access concerns.?

CMS has been fairly explicit that these sessions are for one-way communication: they won’t be asking questions or otherwise providing feedback. That’s led to concern that, perhaps, a parade of 3-minute speeches -- with zero dialogue -- is a lousy way of collecting patient feedback, but here we are. The best we can hope for, I suppose, is that the government is listening … especially to those sounding alarm bells about the way the program is being run.?

(For what it’s worth, I’ll be listening I plan to collect and transcribe all of the statements. I’ll post back here as the transcriptions go live.)

Top 10 Stories of the Week:?

1. Most Americans -- 51% -- have difficulty affording health care, according to a Commonwealth Fund poll . That single number does an effective job of describing the current state of the U.S. health care system.?
2. The appetite for obesity-drug stories means that we’re going to get lots of useful explainers about parts of the health care system that otherwise get ignored. This New York Times piece by Gina Kolata does a masterful job of explaining the list-vs-net distinction, and how it comes into play around obesity.?
3. Along the same lines, the obesity thing is a great way to explain the role of PBM in the finances of vertically integrated insurance companies. So this Wall Street Journal article does a fantastic job of explaining how big insurers could end up paying a ton for obesity meds … and still win, financially.?
4. Middlemen take 70 cents of every dollar that Medicare Part D spends on 45 popular generic drugs, per this JAMA Health Forum study .
5. It looks like the NIH will get a new director, which pundits said is kind of an “L” for Sen. Bernie Sanders , who wanted -- but didn’t really get -- drug-pricing concessions from the White House.?
6. While we’re talking Bernie, I’m still not sure what to make of his attack on what he is positioning as a sweetheart licensing deal. Maybe it’s a sweetheart deal. Maybe the underlying technology isn’t all that. Hard to know right now.?
7. Another PBM added another Humira biosimilar to its formulary … but did so at parity with Humira. What that means -- and AbbVie’s earnings on Friday confirmed it -- is that AbbVie is cutting its net price but maintaining share. The company basically said that it’ll sell about $7 billion of Humira next year, despite the competition.?
8. I loved this STAT piece on why policymakers -- especially Democrats -- have had such a hard time putting hospitals under the microscope (and how and where that might change.)
9. I don’t know if I buy the thesis that the IRA is driving the sudden vogue for antibody-drug conjugates , but it’s hard to argue that the law doesn’t stack the incentives in that direction.?
10. I need to start paying attention to changes to the “voluntary scheme” for pharmaceutical reimbursement in the UK because apparently we’re getting closer to some sort of resolution on what comes next.?