Gallup Data Underscores How Far Underwater Pharma's Rep Is ... Especially with the GOP

Gallup’s industry reputation data is out, and -- hoo boy -- the pharmaceutical industry looks bad.

I mean, there really is no positive spin: pharma is dead last among all the industries assessed, dropping below oil and the federal government. It’s the worst favorability score in the 22 years of the survey. And even though pharma was near the bottom of the list a year ago, the industry still had the second largest drop of any group.

In other words, there’s no assurance that the industry has hit some sort of bottom.

The underlying reason is fairly clear: Republicans used to view the industry more positively than Democrats, and that’s no longer the case. Only 13% of GOP-leaning Americans have a positive view. (Other skeptical groups, per the detailed findings: 16% of college-educated Americans view pharma favorably, and the same percentage of those making $100,000+ are in the industry’s camp.)

The Gallup poll is a blunt tool, though, which makes specific prescriptions hard to make confidently. Clearly, shoring up support for science and public health would help, but that’s a tall order.

But this should be a wake-up call that the industry probably ought to be weighing the reputational impact of just about every decision more carefully. An industry where only 13% of Republicans and 24% of Dems like you is one that is in grave danger of being indiscriminately regulated.

It didn’t get much attention, but last week, ICER pushed out its evidence report for Orchard’s Libmeldy, a gene therapy for metachromatic leukodystrophy.

The metachromatic leukodystrophy effort has always been kind of a weird review: ICER’s own calculus assumes that 34 patients will be treated each year, which means that there is no budget impact at almost any price and no real policy issues, because a patient population that small is not going to set any precedents. It’s not clear to me what point ICER is trying to drive home by picking this treatment.

Still, the new report is noteworthy because it showed an example of a flexible ICER. The draft report generated a lot of concerns from the company and from patient advocates over the way that the impact of the disease is calculated. It’s tough to think about, but there are diseases where the impact is so great that, statistically, the burden is worse than death (the academic euphemism is “negative utilities”). And metachromatic leukodystrophy can lead to negative utility values.

ICER didn’t account for that in its original analysis, but changed course after hearing about the patient experience. And that tweak more than tripled measures of cost-effectiveness of the treatment. ICER’s math now suggests that Libmeldy would be cost-effective at a price between $2.3 million and $3.9 million.

I’m not confident that traditional cost-effectiveness measures (especially at a willingness-to-pay threshold of $150,000/QALY) are the right way to assess the price of a treatment that will be given to 34 patients a year, but it’s still good to celebrate instances where the patient experience can make an impact in on the mathematics.

I’m not sure any of the hearings yesterday really moved the needle as much as they defined everyone’s position on things.

Two elements that I found interesting from the PBM session:

One, the discussions of the PSG research on health plan satisfaction with PBMs. Endpoints played it straight here, but Adam Fein had the more sophisticated take that suggested that the “not horrible” satisfaction ratings said more about the naivete of health plans than it did the PBM industry.

Two, the framing of the STAT story on the hearing, which focused on skepticism of the pharmaceutical industry as much as it did PBMs. From what I saw, I don’t think that is, even remotely, the correct perspective or a fair takeaway from the hearing, but it’s a reminder that anything can be spun in a way that paints the industry as on the defensive.

Elsewhere:

• This Biopharma Dive story about the ease (or difficulty) of shopping for health care services, based on this JAMA IM study, misses the coolest part: Mark Cuban is a co-author. He’s credited with coming up with the research concept. Does that dude sleep?

• While we’re talking Mark Cuban, here is another journal article that outlines how using Mark Cuban prices, rather than PBM-set prices, would save Medicare money. (This one looks at generic heart drugs.)

• SSR Health continues to document an inconvenient truth for pharma industry skeptics: drug prices are falling. The visuals on this LinkedIn post make that trend super-clear.

• Six small PBMs are joining forces to lobby for PBM reforms, including ensuring rebate pass-throughs and banning spread pricing. Godspeed, little guys.

• STAT ran a Q-and-A with Knowledge Ecology International’s Jamie Love on the subject of using prizes, rather than patents, to stimulate innovation. Prizes are an interesting approach, especially if applied narrowly, but they probably fundamentally misunderstand the way that innovation works more broadly. But the sticky nuances are largely ignored, and Love’s interview is a good and cogent review … of one side of the story.