Amazon Knits the Safety Net Around Insulin a Little Tighter

One of the biggest problems with the safety net around pharmaceuticals in the United States is not that it is insufficiently generous, but, rather, that no one knows what resources are available to them.

The system is opaque, sometimes intentionally so, and that means that a lot of people who could access cheaper medicines never get them.

And that’s why Amazon’s announcement today that their online pharmacy will automatically apply copay coupons for insulins is getting such great play (it’s in USA Today, Reuters, etc.). It’s not that the coupons themselves are particularly novel. The insulin manufacturers have been working overtime to build out thoughtful programs. It’s just that there’s not been a great way to make sure that patients know about them.

I don’t want to overplay the Amazon element here. The company is still in the early stages of its pharmacy ambitions, so it won’t change the game for everyone, immediately. But the trend toward greater transparency -- for patients -- can’t be anything but a good thing.

Give STAT’s Matthew Herper credit: when he sees a good idea, he sticks with it.

Today, he ran a thoughtful, must-read piece about “a terrible Zen koan: Medicines are both too cheap and too expensive.” His broad point is that the current drug-development system in the United States has the incentives fundamentally wrong: branded drug exclusivity is so short that high prices are a foregone conclusion, and deep research into a drug’s effects is essentially discouraged as a matter of law.

So Matt suggests extending patents and giving a little more certainty to the process. It’s a smart argument, but what impresses me most is that Matt has been tracking on this for more than two decades.

In 2002, he wrote a piece for Forbes that still holds up today, proposing a simple solution: “Current law encourages pharmaceutical companies to do their clinical trials as quickly as they can and still satisfy the FDA. So change it -- and let generic drugmakers and branded pharmaceutical companies mark the day, 15 years after a drug is approved, that its exclusivity expires. If that won't spur medical innovation, nothing will.”

Instead of his simple solution from 21 years ago, Matt laments that we got the IRA, which is already screwing up drug development. “It’s not surprising that a bill that has to be ushered in along partisan lines is not fully thought out,” he wrote in this week’s piece, “or that many of the details are left to bureaucrats.”

It was a big day for reporting on items we’ve already talked about here. But these are important subjects, so:

• The HHS response to the Chamber of Commerce’s IRA lawsuit, which I talked about on LinkedIn over the weekend and again here, yesterday, hit the media. The Hill has the best take, but Endpoints and STAT are also on the story.

• One other legal note: five groups filled with pharma skeptics -- Public Citizen, Patients for Affordable Drugs Now, Doctors for America, Protect Our Care and Families USA -- have asked for permission to file an amicus brief in the Chamber case. Protect Our Care has a release out on their plans, which makes clear which side they’ll be on.

• It’s 10 days late, but the Denver Post noticed that the effort to impose price controls in Colorado is moving forward. Axios riffed off of the Post story.

• There’s a great new Adam Fein piece on the number of PBMs passing through 100% of their rebates to employers. The short version is that more PBMs have 100%-passthrough contracts than they did in 2014. Per Adam, there also seems to be a discrepancy between the number of employers who say they’re in 100%-passthrough arrangements compared to the number of such arrangements that the PBMs claim. The whole thing is worth reading a couple of times. Lots packed in there.

• The problem with drug spending is not really that prices are high, but that we’re maybe using too much drug, argues a STAT op-ed that calls for more research to figure out if we can use lower doses, less frequent dosing or cheaper alternatives without sacrificing benefits.