Value assessment frameworks, rare diseases, PBMs, prior authorizations, copay accumulators, and more.

March 5, 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

Want this newsletter in your inbox? Subscribe here!

NPC HIGHLIGHTS

Value Viewpoint: In her latest LinkedIn post, NPC Chief Strategy Officer Kimberly Westrich covered AMCP’s recent summary of an important forum about value assessment frameworks.?

Rare Diseases: A moving op-ed from a mother expressing frustration about the FDA’s slow action on rare disease treatments that could help her son linked to NPC research about the Inflation Reduction Act’s impact on innovation. Also citing the research was House Budget Health Care Task Force Chairman Michael Burgess, R-Tex., in a statement issued on Rare Disease Day last week.

INDUSTRY NEWS

PBMs: The White House held what it called a listening session on Monday that focused on pharmacy benefit manager practices, though none of the big PBMs were present. Mark Cuban got the lion’s share of attention for his colorful criticism of how PBMs treat independent pharmacies. For more: Endpoints coverage here, Politico coverage here, and STAT’s coverage here.?Meanwhile, even though the Federal Trade Commission began its probe of PBMs more than 18 months ago, no company has turned over “sufficient documents and data” to be in full compliance of the FTC request, FTC Chair Lina M. Khan said in a letter to Sen. Charles Grassley, R-Iowa.

• Also: It’s widely expected that Congress will not reach consensus on any PBM-related legislation this year.?

IRA Impact: Pfizer suggested to investors that it is focusing on biologics instead of small molecule drugs because of the IRA, Biospace reported.

More on Rare Diseases: The House Energy and Commerce Committee held a hearing last week focused on treatments for rare diseases and potential changes to the IRA that would encourage more treatments. The National Organization for Rare Disorders pushed hard for the hearing and for action, but Politico reported that senior House Democrats are reluctant to open up the IRA for any changes.

Prior Auth: Medicaid requirements for prior authorization in order to get hepatitis C medications have been dropped in 28 states, Politico reported.

• But: Utilization management moves like prior authorization have risen sharply in Medicare Part D plans, raising concerns about the impact on patient health, according to research in Health Affairs. Three of the four authors are from the University of Southern California; USC put out a summary of the study in a press release.

White House: Speaking of the White House, Politico is trumpeting news that the Biden administration is set to announce a task force to tackle “high healthcare costs.” Details are virtually non-existent, though more news seems likely on Thursday when President Biden delivers the State of the Union speech.

ICYMI

CoPay Accumulators: Two-thirds of the insurance plans on Affordable Care Act marketplaces have copay accumulator and accelerator programs, according to research done by The AIDS Institute. The group surveyed individual plans available for 2024 on the health insurance marketplaces in the 32 states and Washington, D.C. that do not have laws restricting use of copay accumulators for those plans. At least one plan in every jurisdiction but Hawaii and the District of Columbia has a copay accumulator and accelerator program, The AIDS Institute research showed.?

Part D: Because of additional costs from the IRA, premiums for Medicare Part D plans are likely to increase next year, Politico reported.?

• Reminder: NPC research has shown that patients have broad access to drugs that Medicare is targeting for its drug price control program.

In the States: Oregon suspended part of its drug transparency law that had been found unconstitutional.?

Cost Sharing: In an opinion piece on JAMA Network, two Harvard University researchers write that cost sharing often doesn’t work well, especially for sicker patients. Among their proposals: better insurance benefit designs that reduce or eliminate cost-sharing for high-value care.?

• NPC Research: High patient out-of-pocket costs hurt medication adherence without saving money.?

MARK YOUR CALENDAR

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.