IRA, 340B, Leqembi and House PBM Reform Advance to the Fight Club Final Four

Yesterday, we saw three blowouts and one nail-biter. The details are below, but if you’re caffeinated and must rush, here’s today’s ballot.

I’m not particularly surprised that “IRA’s 10 selected drugs” (69.9%) TORCHED “IRA lawsuits,” (30.4%) though one contrarian voice, in a comment, suggested that the “first 10 isn’t the event, it’s a milestone along the path. The lawsuits could pivot the path set up.”

“340B growth” (81.8%) was an EVEN BIGGER WINNER against “FTC intervention in Amgen/Horizon.” (18.2%) But that doesn’t mean it’s an open-and-shut case. As one commenter put it: “FTC falsely extrapolating antitrust issues in Big Tech to biopharma industry is a terrible harbinger that narrows liquidation opportunities.”

“Leqembi’s launch” (81.8%)  FLEW THE W against the “Zepbound launch.” (18.2%) In some ways, both of these launches were about bigger issues than a single medicine. One commenter suggested that the decision of CMS to intervene in questions of safety and efficacy in Alzheimer’s was a sea change. But so is the possibility of a price war in the hottest therapeutic area of the next five years. 

The nailbiter came in the PBM regional, where the “House PBM vote” (52.2%) EDGED OUT “Blue Cross of California walks away from its PBM” (47.8%). It’s the closest vote so far. Viewed broadly, both of these are game-changers. But the devils are in the details, and in both of these cases, the damage done to PBMs is less than what it appears.

So that sets up a penultimate vote. Things get tricky now with some apples-to-oranges matchups. LET YOUR THOUGHTS BE KNOWN HERE. 

(1) The selection of the first 10 medicines for Medicare price controls
(4) The growth of the 340B program to record size

(1) Leqembi's launch in Alzheimer's, along with its four-page pricing explanation
(1) House passes the Lower Price, More Transparency Act

• CNBC has a basic primer on what’s ahead on the IRA in 2024. Fair warning: if you read it, you’re not going to learn anything new. It quotes exactly two people, both of whom are AARP employees, so there’s not a lot of balance or nuance. (If you’re a health journalist and need independent sources over this “dead week,” I’d be happy to connect you.) 

• STAT has a worthwhile wrapup on what to watch in state health policy next year. And -- yup -- prescription drug affordability boards are front-and-center. I just wish they’d mentioned the big win that patients scored in avoiding price controls for Trikafta.