Earnings Calls Are Chockablock With Policy Talk This Month: MFN, PBMs, 340B, and More

INFLECTION POINT/ CEOs Suddenly Have a Lot to Say About Policy

Some quarters go by and pharma CEO end up never uttering a word about health policy. It feels incongruous to my ear because I spend so much time focused on it, but the absence of extended discussion is a reminder that sometimes it really is all about R&D and commercial execution. 

The quarter? It’s about a lot more. 

There were extended comments from both Pfizer’s Albert Bourla and Novartis’ Vas Narasimhan yesterday. I’ll excerpt some of the more interesting ones below, but I’ll be creating a separate resource that captures more comprehensively, by topic, CEO earnings call commentary.

Apex subscribers will get access to that resource tomorrow. 

Here’s what caught my eye. 

• Narasimhan’s take on “most favored nation” was nuanced, and that nuance is worth keeping in mind: “I think MFN, if it's as previously conceived and limited to Part B drugs, for Novartis: highly manageable. If it's MFN in Medicare Part B and Part D, but we no longer have to pay rebates and a number of other discounts disappear, manageable.  If it's Medicare Part B, Part D with the spillover into Medicaid, the spillover into 340B pricing and all of the other problems, definitely painful.”
  

• Narasimhan on 340B was eye-opening, too. It sounds like he’s banking on regulatory or legal changes rather than relying Congress, at least in the near term: “We continue to advocate for the fixing the 340B system as well. That may not happen legislatively, but we continue to pursue all avenues to ensure that there's no abuse of the 340B system.”
  

• As for Bourla, he continued to provide the optimistic view on the White House’s orientation toward pharma: “One can say that when the President issues an executive order, then you can read into what are the priorities of the administration. And I think that so far, the way I have seen it, it is the pill penalty, it is the 340B, it is the PBM reform, and it is to lower the cost for the patients because right now in the U.S., the patients, they are paying disproportionately out of pocket for their medicines compared to other medical interventions.”

REBOUND/ Super Bowl Ads, 340B, Angry Letters, and Private Jets

Some of you may remember the last Super Bowl, which feels like it was held six or seven years ago. (It has been a very long 2025.) During the telecast, a commercial for NYU Langone hospital ran. 

It was an odd commercial. The creative was, um, lacking, but it was also bizarre to have a 340B safety-net hospital blowing $8 million to advertise to an audience that mostly lived somewhere else. 

I said some mean things about the concept at the time, but my snarkiness couldn’t hold a candle to Rep. Greg Murphy, who fired off a pissy letter to the hospital’s management asking about everything from its 340B spending to its investments in the Caribbean. 

Eight days later, Murphy wrote a second letter explaining that he’d been out over his skis, that Langione was a great hospital, nothing to see here. It was all turbo-weird.

All of that is context for the next chapter in the story: the New York Times published an article yesterday that revealed that, between Murphy’s first letter and his second one, a plane registered to the investment fund of Kenneth Langone -- the guy whose name is on the hospital -- flew from Florida to Greg Murphy’s district and then turned around two hours later and went back to Florida. 

What the h*ck happened in those two hours? No one is saying. But it sure sounds juicy. 

Of course, the journalism here is fascinating, too. I assume that the NYT local hospitals reporter doesn’t spend his day mucking around on flightaware.com. Someone tipped him off about this very unusual flight. 

Who was the tipster? I’m dying to know, because I suspect this story may have even more twists to come. 

QUICK TURNS/ A Key 340B Lawsuit Sees the Inside of a Courthouse, and a New Drug Gets Priced

• There was a huge oral argument this week in a series of 340B cases seeking to force the government to back off on its opposition to manufacturer plans to move 340B reimbursement to a “rebate model.” Bloomberg Law suggested that the judge looked at the pharma arguments gimlet-eyed, but 340B Report’s take seemed to be that the judge was pretty skeptical of all sides. My completely uninformed take, for entertainment purposes only: The courts won’t decide this … the government will eventually drop its objections.

• Pharmaceutical research and manufacturing is an absolutely monster driver of economic growth, but that’s not a reality that’s discussed all that often. (The auto workers get all the attention, but …) This new study by ndp | analytics helps illustrate that reality by looking at economic performance per employee and stratifying it by IP-intensive and non-IP-Intensive industries. For those who are caffeinated and must rush, PhRMA has a nice summary.

• Mo’ drugs, mo’ prices:  Abeona Therapeutics won approval for its Zevaskyn gene therapy, used to treat a rare skin disorder. The WAC price? $3.1 million, disclosed on the conference call. Not a lot of value discussion in the presentation, but they were transparent on price. 

• I read this WSJ story like four times, and I still have no idea what the piece is trying to get at. Apparently, PhRMA is doing a good job of lobbying around PBM reform. It helps that pretty much everyone agrees that reform is needed, regardless of PBM affiliation, so I’m not sure what the thesis is.
  
  If the WSJ really wanted to impress, they’d start looking under some of the less-transparent effort underwritten by the PBM industry. Like, who is funding the Pharmaceutical Reform Alliance? And why is my go-to stop for étouffée and oxtail -- a counter-serve joint run solely by the owner -- writing letters to the FTC filled with PBM talking points?)

• This is a weird NBC News story that tries to make the case that part of the Trump administration’s effort to lower drug prices is convincing people to use less medicine. Like, I’m not sure that’s an actual strategy, but points to NBC for creativity in trying to intuit some sort of grand plan from the stew of public statements.

• Another state AG is big mad at big PBMs: Michigan is going after Express Scripts and Prime Therapeutics for allegedly damaging the state’s pharmacy market through anticompetitive actions.

• CMS has dropped a ton of new material on the “Medicare Transaction Facilitator,” which is the plumbing that will allow money linked to “maximum fair prices” to move appropriately around the system. I’m not tracking on the details, so if there’s someone with a smart take here, I’d love to amplify.

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].