Introducing a New Holiday Tradition: Fight Club

Cost Curve Fight Club starts on Tuesday as a way of making the break a little more entertaining for those of you who love this stuff too much to stay off of email. 

Here’s how it will work: I’ve set up a bracket of 16 news items broken down into four subject-area regions. Each day, I’ll ask you to vote on the most important one. The winner advances. That means eight votes on Tuesday, four on Wednesday, two on Thursday, and the finals will be Friday. 

I’ll let you know who wins after the new year. 

I’ve done the seeding based, roughly, on the amount of attention each item received, but I hope there are some contrarians out there. Certainly, I don’t think that the biggest news of the year is necessarily the most important. (But I won’t tip my hands on which choices feel like Cinderellas.)

So you have the weekend to think, here are the brackets. And I’d love an angry note from anyone who thinks I’ve made an egregious omission. This is Fight Club, after all: 

The Price Control Regional: 

(1) The selection of the first 10 medicines for Medicare price controls
(4) The patient-focused listening sessions
(3) The explosion of state prescription drug affordability boards
(2) Lawsuits seeking to toss the IRA

The Regulatory Regional 

(1) Guidelines around using march-in rights around drug prices
(4) The growth of the 340B program to record size
(3) The FTC's intervention in the Sanofi-Maze deal
(2) The FTC's intervention in the Amgen-Horizon deal

The Launch Regional 

(1) Leqembi's launch in Alzheimer's, along with its four-page pricing explanation
(4) Brenzavvy's entry into the type 2 diabetes market as a cash-pay-only launch brand
(3) Sickle cell pricing: $2.2 million for Casgevy, $3.1 for Lyfgenia
(2) Zepbound hitting the market at a discount to Wegovy

The PBM Regional

(1) House passes the Lower Price, More Transparency Act
(4) Senate Finance Committee recommends reform
(3) Mark Cuban calls the PBM model "absolutely freaking insane"
(2) Blue Shield of California drops its PBM for a home-grown solution

Bloomberg has a piece looking at companies that have said they might alter development or regulatory strategy in response to the IRA. It’s kind of a weird piece because none of the four examples flagged (Roche, Alnylam, Seagen, and Relay) are new. 

Indeed, the big story here might be the way the way that industry has clammed up on the subject, given the amount of crap companies receive when they talk about the subject. The Bloomberg piece underscores this point by quoting an AARP exec painting industry decisions as ““frankly reprehensible behavior.”

Shaming companies for making decisions in response to clear incentives baked into the law by policymakers is a lousy way to have a constructive dialogue. 

Elsewhere: 

• The Congressional Budget Office is looking for research and advice on how to weigh the impact of policy changes on drug development, including items like small-vs-large molecule decisions and how policies impact development of drugs for certain populations. It feels like there are increasingly good sources for that kind of data. Let’s hope CBO is listening. 

• Bloomberg has a well-researched story about the current state of the priority review voucher program, though the piece is larded with heavy doses of skepticism about whether the benefits of the program are accruing to those that need the help the most. But the best summary of the article might be the quote from the founder of Kids v Cancer: “Did we draw the line exactly right? No. Is it possible to? I don't think so.”