PBMs and rebates, accumulators and maximizers, an IRA potpourri—and more.

January 3, 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 DM's are open if you have suggestions - and please share with your network! - Michael Pratt , NPC Chief Communications Officer

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In This Issue: PBMs and rebates, PBMs and accumulators, an IRA potpourri, ICER’s misstep, PDABs, and march-in rights.?

NPC Highlights

ICYMI: IRA Considerations for CMS: The recent commentary from NPC President and CEO Dr. John M. O'Brien and Genentech's Dr. Jan Hansen in Value in Health about the Centers for Medicare & Medicaid Services' drug price control process has received an Editor's Choice designation, meaning it is currently free to access.

Industry News

PBMs and Rebates: The Wall Street Journal wrote about how pharmacy benefit managers and insurers don’t “play ball" when drug manufacturers try to offer lower-cost, unbranded versions of the drugs patients need.?

Accumulators and Maximizers: Sens. Tim Kaine, D-Va., and Roger Marshall, R-Kan., took the lead in urging the Health and Human Services Department to enforce a ruling limiting copay accumulators. Their letter, signed by 17 other senators, also pushes for legislation that would ban accumulators and force insurers and PBMs to count copay assistance toward a patient’s deductible or out-of-pocket maximum. For more on the recent court ruling, check out what patient advocates are saying.

IRA: Over the holiday break, the Inflation Reduction Act’s provisions continued to generate discussion, debate, and, in some cases, action:

• The Congressional Budget Office told two leading House members that venture capital funding for drugs continues to rise despite the Inflation Reduction Act.
• That said, the CBO said it is looking for new research about drug development , including “about how changes in pharmaceutical companies’ expected future profits affect the development of drugs with differing characteristics, such as small- or large-molecule drugs or those that target certain diseases or patient populations (such as the elderly).”

• In The Hill, Joe Grogan reminds us of another downside to the IRA: it's going to make seniors pay more if they have high drug costs because the new law shifted those costs from the government to the Medicare Part D plans.?
• Friend-of-the-newsletter Brian Reid kept us entertained over the break with his Cost Curve Fight Club. The “10 Selected Drugs” for price controls won the "fight," a nod, as Brian put it, not to the list itself but to the newness of the step toward greater government involvement in drug pricing.?

Costs and Benefits: The Institute for Clinical and Economic Review missed the boat in evaluating the cost-effectiveness of innovative weight-loss drugs , BIO Chief Policy Officer John Murphy III wrote in Real Clear Health because it ignored some key facts about net prices.?

In the States: Many state legislatures begin meeting in early January, and STAT suggests that some will debate whether to create prescription drug “affordability” boards , following a trend that started in Maryland five years ago.?

ICYMI

March-in Rights: In an op-ed for The Hill, Merrill Matthews throws more cold water on the idea of the federal government canceling drug patents to reduce costs.?

Drug Shortages: NPR looked at the role that falling prices for generic drugs have had on shortages of important medicines that hospitals need every day.?

Cost Control: Dr. Zeke Emanuel says value-based pricing for health care services may actually be helping hold the line on health care costs. A MedPAC Commissioner responded to the piece on LinkedIn.?