Advice on How to Think About a System 'Heading Over a Cliff'

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More advice for you from the Cost Curve “2025 Advice” survey.

Bryce Platt had an inspirational message: 

It reminds me of one of football legend John Madden’s favorite quotes: “Don't worry about the horse being blind, just load the wagon.” All we can do is our part.

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Here is ICER’s Sarah Emond’s take on the same theme: 

No argument here. It feels like every executive team, in every corner of the health care universe, should ask itself what “over a cliff” looks like, in practice, and what measures can be taken to reverse that momentum. Assuming its somebody else’s problem is what got us here in the first place. 

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And thoughts from Megan Butterfield at MedAdvisor Solutions:

One the one hand: yes! A thousand times yes! 

On the other hand: achieving “collective success” doesn’t mean that everyone wins on everything. Keeping the system from heading over a cliff may mean that patients, too, will have to compromise. But to Megan’s broader point: patients should be a part of that conversation. 

• For someone who loudly proclaims his irritation about the “Jan. 1 price hike” narrative, I spend a lot of time thinking about it. In some small part, that’s because there are indeed interesting stories buried in those pricing decisions. They just aren’t the stories being told. Anyway: if you want to look at the data itself, Antonio Ciaccia has some updates. And Adam Fein has gone one step deeper on the “price drop” narrative, developing a chart of all of the major medicines that have taken price declines. 

• On LinkedIn, Bill Sairraile tried to do a back-of-the-envelope calculation on how many senior have signed up for Medicare’s “smoothing” provision (officially: the Medicare Prescription Payment Plan). Bill suggests that only about 100,000 benecificiares are availing themselves of the program. I suspect there are some implications here, especially for those who are seeking patient assistance, but haven’t seen any great coverage of what this all means. 

• I’m not sure I’m entirely tracking the argument being made in this op-ed Joe Grogan, the former Trump official. I think he’s suggesting that Trump just not implement key parts of the IRA and disband the CMS office tasked with negotiating drugs prices. Which would be quite the policy move!

• There are two fundamental truths about drug ads. The first is that they are almost certainly protected commercial speech and largely untouchable. The second is that no one likes the commercials. The NYT letters section has some missives that highlight the second truth (while ignoring the first truth). 

• Pretty much everyone is rooting for small PBMs to garner more and more market share, thereby reshaping the business model for the whole industry. A Modern Healthcare piece looked at the outlook for those PBMs in 2025, leaving the distinct impression that the best-case scenario for this year is continued, evolutionary gains. The revolution will have to wait. 

• This is an interesting CBO piece on how the agency would look at sickle cell gene therapies. But it’s mostly an outline of methods, without any real conclusions. Still, worth the click for CGT wonks.

Cost Curve is produced by Reid Strategic, a consultancy that helps companies and organizations in life sciences communicate more clearly and more loudly about issues of value, access, and pricing. We offer a range of services, from strategic planning to tactical execution, designed to shatter the complexity that hampers constructive conversations. 

To learn more about how Reid Strategic can help you, email Brian Reid at [email protected].