An Eye-Opening ASCO Study Suggests Costs Are Falling for Many Cancers

Grad Szn is almost done, but I need to celebrate my oldest, who is graduating from McGill on Monday. Montreal in June is pretty spectacular, so Curve will be off Monday (and probably Tuesday). Bon week-end!

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If you’re still working when this newsletter hits your inbox, chances are you’re thinking about ASCO. This is a pricing newsletter, so you won’t find strong opinions here on the future of TIGIT or how to handicap ADC results. 

There used to be more to say about ASCO when it came to pricing. The organization used to elevate one or two pieces of research every year that put pricing or costs in focus, but those days are further and further in the rear-view mirror. 

That doesn’t mean there’s not any ASCO pricing news to talk about.

I was flipping through abstracts, and I came across this fascinating research. It’s only a poster, so it probably won’t get any attention or eyeballs, but it illustrates a forgotten part of the price discussion: because more and more generics show up every year, medicine costs often go down. 

That’s a reality that gets lost when we focus too heavily on brand-name drugs, price increases, and launches. Don’t get me wrong: those are absolutely drivers of spending. But at the other end of the tunnel is an equal number of new generics hitting the market. 

So the research that caught my eye looked at the standards of care for 20 prevalent cancer types by assessing 83 clinical indications across 16 solid tumor cancer types, comparing costs in 2021 to costs in 2017. Turns out the median SOC cost fell by about half during that period, with 69% of indications seeing lower prices. Nice. 

As the abstract puts it: “Although introduction of newly approved drugs can cause large price increases for some indications, more commonly the financial cost of delivering the standard-of-care treatment for a given cancer trended down due to slower-than-inflation price increases and new generic entrants.”

Because it’s the abstract of a poster, I don’t have details, and I don’t want to imply that there’s no possibility of a dark cloud within this silver lining. I could be that looking at a longer time period with more introductions may have shown a different trend. The outliers here are probably large and meaningful. Less-prevalent cancers may lead to less rosy conclusions.

But -- broadly -- this study is a useful corrective against the idea that everything everywhere is getting more expansive. Unlike every other part of medicines, drugs get cheaper -- way cheaper -- over the long run. And this study elegantly shows one way that shows up.

I was kind of unfair in calling out Mark Cuban -- the owner of the Western Conference champion Dallas Mavericks -- yesterday as the only guy who can set employers straight about PBMs.

But Mark was nice enough to respond on LinkedIn that while “we need to educate [employers],” he didn’t want to give oxygen to the PCMA campaign. “I don’t want to give any visibility to these videos. They are so bad they will be ignored and forgotten quickly.”

Gotta respect that.

• Novartis is taking Maryland to court over the state’s effort to restrict how manufacturers can treat 340B contract pharmacies. Industry has had some trouble in the states, as the STAT coverage makes clear, but it’s worth noting that Maryland is in a different appeals court circuit, so the the slate is clear here. One to watch, especially in light of the recent decision that suggests that the federal government can’t meddle in pharma 340B restrictions. 

• This Reuters story about Liz Warren and Lloyd Doggett’s efforts to push the administration on march-in rights is probably safe to ignore, except for two small-but-important nuggets. First, there is an unnamed source suggesting that the administration will make a decision on finalizing the march-in rules “within days,” which is kind of a big deal. And, second, the headline labels the issue a “patent seizure policy,” which is the kind of semantics that make the stakes here a lot clearer.