Industry and Patient Groups Agree: Time Drive Attention to 'Smoothing'

The “smoothing” provision is the most important part of the IRA that no one has heard of (I mean, you all have heard of it, but I don’t consider any of you to be average Americans, thank goodness).

The ability to take expected drug spending and apply those payments in evenly spaced chunks over the course of the year is one of those things that will have clear, tangible impacts on beneficiaries, especially in combination with the $2,000 out-of-pocket cap.

Rather than getting whomped with giant deductible/cost-sharing med bills at the beginning of the year, which harm patients by degrading adherence, patients will be able to smooth those payments. Big win for everyone.

The question is how those provisions should be implemented. CMS has asked for some feedback, and that feedback is starting to trickle in. It’s fairly aligned. PhRMA thinks that CMS needs to lean hard into promoting the benefit, which makes sense, especially in light of the fact that American seem to be only dimly aware -- if they’re aware at all -- that the IRA even exists.

Patient organizations, too, want to make sure that patients can actually use smoothing, known more formally as the “Medicare Prescription Payment Plan” (or “MPPP” for wonks who love abbreviations). That means allowing patients to register at the point of sale, and making it difficult for insurance companies to remove patients from a payment plan.

I’m hoping that more companies, advocates, wonks, policymakers, journalists, etc. start talking/writing/tweeting/shouting about this, because it seems like a classic win-win.

Some updates on the IRA-related lawsuits.

First off, the PhRMA case down in Texas has been reassigned, flipping from an Obama appointee to Judge David A. Ezra, a Reagan (!) appointee.

I’ve lamented before that I don’t know anything about the judges on these cases, and I’d be grateful for any reporting that sheds light on the legal philosophies of the six judges overseeing the suits.

Second, there are now briefing schedules in the Boehringer Ingelheim and AstraZeneca cases. You all know that I’m pretty obsessed with the AZ legal arguments, but that case is now fascinating for a second reason: the brief schedule there has a “target decision date.” It’s March 1.

So here is the combined list of briefing deadlines. I’m not 100% sure that I’ve done the math right on the PhRMA case, but this is at least a rough guide. Clip-n-save, folks!:

• September 25, 2023 (PHRMA): PhRMA’s respond to HHS’ motion to dismiss

• September 26, 2023 (AZ): AZ’s motion for summary judgment

• September 27, 2023 (BI): BI’s motion for summary judgment

• October 13, 2023 (PHRMA): HHS’ motion for summary judgment and opposition to plaintiff’s motion for summary judgment

• October 16, 2023 (BMS/JANSSEN): HHS’ combined opposition and cross-motion for summary judgment

• October 19, 2023 (MERCK): Merck’s reply to motion for summary judgment and opposition to cross-motion

• November 1, 2023 (AZ): HHS opposition to AZ’s motion for summary judgment

• November 9, 2023 (PHRMA): PhRMA’s reply and opposition to HHS’ motion

• November 10, 2023 (BMS/JNJ): BMS/JNJ combined replies in support of their motions for summary judgment

• November 21, 2023 (MERCK): HHS’ reply in support of cross-motion

• December 1, 2023 (PHRMA): HHS’ reply

• December 1, 2023 (AZ): AZ’s reply

• December 6, 2023 (BI): HHS cross-motion for summary judgment

• December 8, 2023 (BMS/JANSSEN): HHS’ reply in support of their cross-motion for summary judgment

• December 12, 2023 (BI): BI’s reply in support of its motion and in opposition to the cross-motion

• January 5, 2024 (AZ): HHS’ reply

• January 31, 2024 (AZ): Oral argument

• February 12, 2024 (BI): HHS reply in support of the cross-motion

• March 1, 2024 (AZ): Target decision date

• Insurance companies are screwing up the COVID-19 booster rollout (apparently, some are “still updating their systems,” hampering reimbursement).

• Incubate, a group of venture capitalists, sounds like they’re down with price controls, but that the government really needs to give all medicines -- not just biologics -- 13 years of freedom from government meddling with price.

• “Alternative funding programs” are such a bad idea that an OptumRx executive is on the same side of the issue as NPC’s John O’Brien, per this dispatch from the NASP 2023 Annual Meeting.

• I don’t know if I can take this Reuters piece seriously. It’s about how employer health costs are going to go up (based on conversations with benefits consultants). That, as a thesis, is reasonable enough, but it casts most of the blame on pharma, including gene therapies, which does not seem like the real problem with rising health costs.