Health Insurance in the U.S. Is Broken. Like Really Broken.

The U.S. health care system is broken. That may be the only statement that everyone in the industry agrees on. Why it’s broken, or how to fix it … those are more difficult questions.

Still, quantifying the broken-ness helps, because it does guide toward why the system is broken and adds urgency to the efforts to find the right solution.

That’s the prologue to me saying: you should really read the new Patient Experience Survey from PhRMA (for those who are caffeinated and must rush, this PhRMA blog post gets to the heart of things).

It’s a 5,000-person poll, performed by Ipsos, so the data here is the real deal. The underlying narrative that emerges from this dataset is that insurance doesn’t work for a huge number of Americans.

The survey found 34% of Americans agree with the statement “Insurance currently provides everyone with affordable access to health care, when it’s needed.” About one in every five Americans with insurance said that having an illness or injury would be unaffordable. Which raises the question: if insurance isn’t there to cushion the blow from an unexpected illness, is it really insurance.

There are a lot more nuggets in the report (or, if you want a more comprehensive visual take, the Ipsos deck is pretty good). Anyway: if you need to pull together any stats for how the U.S. health system works, this is absolutely a clip-n-save.

I’ve written a few times about how interested I am in TheracosBio, the private company that is trying an unprecedented experiment: launching a new, branded medicine at a cash-pay price ($50, in conjunction with Mark Cuban Cost Plus Drug Co.).

So I was fortunate to get some time with TheracosBio CEO Albert Collinson, who is at the helm of a grand experiment to determine whether, in today’s rebate-happy, PBM-first world, there is room for a new model.

This is an excerpt of that interview, and I’ll have a fuller version of the conversation on LinkedIn, probably this weekend. You can follow me over there.

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Brian: Can you describe what the TheracosBio model is here?

Al: The harsh reality is this is a novel approach to the market and I can't tell you yet how successful this will be. But we are very eager to run the experiment. We're all a bunch of stupid scientists, you know, so we like to do experiments like this one here.

We think that there's a lot of elements that have aligned to make this model something that's pretty interesting. And the formation of Mark Cuban Company, with transparent pricing, is one of the things that was requisite to this type of product launch.

We're providing an important drug at a price point that is lower than the typical copay in the market right now. Even if you have good insurance. If you have bad insurance, it's way better than to do. At the same time, let's face it, we're competing against some reasonable sized companies that are somewhat well known.

Brian: You've initially linked yourself to Mark Cuban and those who are partnering with him. Where do you go from here?

Al: Here’s what made the Cuban Company attracted to us. They're handling all of the logistics. We ship to Mark Cuban Company, Mark Cuban Company distributes to their systems. We don't need the infrastructure to do that.

I can think of a number of other groups that are analogous to that and I can't go into details right now because we don't have signed contracts. … Those single buyers typically are very, very cost conscious. And they would rather not play the big rebate games that gets played in the world right now. All they really care about at the end of the day is “what's the price that I'm paying for this drug?” and “can I get it to my patients?”

Brian: Do you believe that there is a portion of prescribers that would opt for this simply because they're simply price sensitive, that they believe that this is the way the system should work?

Al: We see a lot of writings by endocrinologists and primary care docs that point out that the cost of medicines are preventing … access to those medicines. … So we believe that the current $10 billion SGLT2 to market is actually under-prescribed. It should be a lot bigger than that.

I think there is a market demand for this. More than that. I'm counting on the fact that there is a market demand.

Lord, this is dumb.

Patients for Affordable Drugs David Mitchell looked at Novartis’ earnings and tweeted this:

It’s a terrible, bad-faith argument, and David is a smart guy who knows that a law that isn’t even taking effect for a couple of years will not impact earnings today. (There is a more nuanced argument that the Novartis earnings are actually a huge, flashing IRA-related warning sign, but I’ll get into that maybe next week.) He’s doing it for the clicks and the lolz, and it undermines his seriousness.

I’m hoping that his funders and the journalists who quote him take notice, because we really do need to have an honest and informed conversation, and we don’t need anyone intentionally making that discussion any more difficult than it already is.

Anyway, needed that off my chest … here’s some news:

• The PBM legislation keeps piling up. The most interesting bit is probably the new bill from Sen. Chuck Grassley that focused on formularies (and the committees that help assemble them). I assume that will be one of the bills that gets marked up next Wednesday. There’s also a bill from Sens. Manchin and Blackburn, but given the number of competing PBM bills, I have no idea how to handicap that.

• Speaking of PBMs, I mentioned yesterday that the FTC was going to consider walking back all of the nice things they said about PBMs in the aughts. They actually did pull that trigger yesterday.

• Former NPC and AAM chief Dan Leonard is writing up a storm. His latest -- looking at the connection between drug prices and shortables -- is up at Real Clear.

• I need to talk more about the ever-growing goat rodeo that is the drug market in the U.K., where government clawbacks linked to drug spending levels is getting absurd at the exact moment the whole program is being renegotiated.

• No idea what to make of this study showing the “cost wastage” of having extra oral cancer meds after discontinuation or dose reduction. Not saying it’s not a thing, but it certainly doesn’t feel like a huge program. Anyway: it’s a JAMA Oncology study, so flagging it. It’s also a study out of the lab of Vinay Prasad, who has spent the last three years shitposting on Twitter and playing footsie with the anti-vaxx crowd, which is probably worthwhile context.

• Sen. Bernie Sanders’ quest to replace the entire U.S. drug patent system with a system of prices moved one (small) step closer to reality, as his committee passed a bill allowing for a study of the prize idea.

• J&J’s CFO gave a predictably anti-IRA interview to Yahoo Finance.