Bernie Demands a Drug-Pricing Plan

Plus Dispiriting Research About GoFundMe and Diabetic Alert Dogs

Author

Brian Reid
June 13, 2023

Coming to you late today. Blame the Department of Motor Vehicles.

Bernie Sanders has decided to take a hostage in his efforts to push for ever-more-aggressive drug-pricing policies: he won’t support President Joe Biden’s NIH nominee, Monica Bertagnolli, until he sees a “comprehensive” plan around drug pricing from the administration.

There is a certain absurdity to this; Endpoints’ Zach Brennan pointed out on Twitter that it is “hard to hammer the WH on drug pricing when this is literally the first admin ever to get Medicare negotiations across the finish line.” And HHS already has a drug-pricing plan, though one without a lot of details or urgency.

Accompanying Sanders’ demand was a report from his committee looking at pricing of medicines based on NIH-licensed technology, which looked more closely at 15 medicines from the past 20 years.

There is some reading between the lines on all of this that I need to do. More in the Arc tomorrow.

the arc

The response of Horizon and Amgen to the Federal Trade Commission lawsuit seeking to derail Amgen’s acquisition of Horizon is a great read because it gets into the nitty gritty of what’s actually possible and likely when it comes to bundled rebates. (If you don’t like legal writing, here’s the Endpoints story.)

Bundled rebates, you may recall, is at the core of the FTC’s objection. It’s the idea that Amgen may link discounts on its hottest-selling medicines with rebates and formulary placement for Horizon’s products, thus making it hard for competitors to enter the market.

Leaving aside the fact that Amgen has promised not to use a bundled rebate strategy (and is willing to commit to that promise in a legally binding way), Amgen makes a compelling point that they wouldn’t be able to bundle rebates in the way that the FTC thinks they might, even if Amen did want to be extra dastardly.

Here’s the important bit of explanation.

First, TEPEZZA® and KRYSTEXXA® both are primarily reimbursed through medical benefit plans, rather than pharmacy benefit plans. In the medical benefit context, bundled discounting is rare. And cross-benefit bundling, i.e., bundling between medical benefit products like Horizon’s TEPEZZA® and KRYSTEXXA® and pharmacy benefit products like Amgen’s Enbrel®, is even rarer – if it is ever done at all – due to a number of logistical, economic, legal and regulatory barriers. Indeed, Amgen does not have any contracts that bundle a pharmacy benefit product with a medical product today, and has no plans to try to pursue such a bundle in the future.

I am imagining the lawyers reading this out loud in the voice of the principal from Billy Madison. The attorneys showed great restraint in not appending “and may God have mercy on your soul” to the end of that graf.

Anyway: everyone seems to think that this FTC suit is so much saber rattling, and I suspect that the Amgen/Horizon response will only underscore that point.

quick turns

  • Last month, there was a tidy piece in JAMA Health Forum showing that 340B hospitals used generics at about the same rate as 340B hospitals. The point was to show that the 340B program wasn’t pushing the use of more expensive products, where hospitals could profit off of the spread. But according to Drug Channels’ Adam Fein, that analysis was too tidy and full of questionable methodological choices. He has a comment to the article (click the tab all the way to the right) that lays out his argument.

  • Speaking of Adam, he has the definitive writeup of all the companies that have pushed out their 2022 list- and net-price changes. There are 10 companies on the list. Novartis, which used to make both figures available, is no longer making those data available, marking the first time a company has rolled back a transparency effort.

  • “InvestigateTV” hardly seems like the kind of outlet that you’d count on for in-depth reporting, but they have a nicely packaged, consumer-friendly piece on the impact of PBMs on the practice of medicine. Well worth the watch/read.

  • Biogen’s Chris Viehbacher gave a talk in Boston, and he addressed the price of the Alzheimer’s medicine Leqembi (Biogen is partnered with Eisai on the compound). Here is the nut graf: “[It] ‘is certainly a high price when you look at where median income is,’ he told hundreds of business and medical leaders gathered at the Westin Boston Seaport Hotel for the forum, sponsored by the Mass General Brigham health system. ‘But these two companies [Biogen and Eisai] have literally spent billions of dollars just on the clinical development costs ... and let’s not forget [investments in] the 10 drugs that also failed along the way. It’s hard to do innovation, and also have low [drug] prices,’ Viehbacher said.”

  • It’s paywalled, but trust me that this Annals of Internal Medicine analysis of 350 GoFundMe campaigns around diabetes does not reflect well on the American health care system. The details paint an interesting picture of the actual struggles of patients: 6% of the campaigns analyzed talked about using funds for insulin, but 21% requested money for a diabetic alert dog.

  • The American Medical Association’s annual meeting featured a debate around reforms to Medicare Part B and the practice of paying doctors the cost of a drug, plus a fixed percentage.

There are a couple of things that may be worth your attention tomorrow:

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