Looking for a Bit of Sunlight to Illuminate PDAB Efforts in Colorado and Maryland

I plan to move once more in my life, next summer. If, after that, I ever talk about maybe wanting to move again, I deputize you all to knock some sense into me.

I’m on the record on the need to have a serious conversation about how we’re going to pay for diabetes/obesity meds over the next 10 years. Hand-waving about a lack of outcomes data is just punting on that conversation because that data is coming and is (almost certainty) going to support broad use of these new tools.

So, that said, the UK’s NICE said “nah” on coverage of Lilly’s Mounjaro for diabetes, citing a lack of outcomes data. To be clear: this is all just part of the negotiation, not a final decision, but it’s still interesting to see the punt happening in real time. (Meanwhile, Lilly looks like it has an even more powerful obesity drug coming down the pike. So yeah: punting is only going to work for so long.)

Two states -- Maryland and Colorado -- are moving full-steam ahead with plans to set upper payment limits on certain prescription drugs. The process to be used to determine how to assess medicines is being hashed out in both states, and that’s not a process that has had a lot of attention or transparency.

In Maryland, a meeting of the PDAB’s “stakeholder council” was held yesterday -- Maryland Matters has coverage here, and it included a presentation by the Harvard PORTAL folks here -- but my attention went to the slides presented at the meeting, which link to the 12 comments that the PDAB has received on its efforts.

To save you a click, here is the 19-page PhRMA letter, here is BIO’s take, and this is the one from Boehringer Ingelheim, the only biopharma company to submit a comment (BI’s concerns are narrow). PIPC is on the record, and three payers submitted comments, though the payer feedback, too, was very specific.

To boil down the industry feedback into a single line, there is a “lack of clear and meaningful standards.” So addressing that should be interesting. There is another comment period open right now that runs through the end of the month.

Colorado’s PDAB has a meeting on Friday. You can watch the video here if you have four hours to spare, but I haven’t seen any coverage of that meeting that would summarize the state of play succinctly. Colorado seems to be grappling with the same issues that Maryland is dealing with, which makes keeping an eye on that important, too.

I’ll keep linking to what meager info I can dig up.

• Not sure what to make of this NEJM “Perspective” that celebrates some legal losses that the pharma industry has suffered around reducing cost-sharing for Medicare patients. It’s the usual anti-pharma cheerleading, without a real clear proposal on how to address the out-of-pocket burden.

• Always read Ed Yong. Even if you need to cancel an entire afternoon to do it. (He’s on the cancer-drug shortage story.)

• AAM’s interim CEO, David Gaugh, throws everything into this Real Clear op-ed, trying to tackle PBMs, drug shortages, high drug prices and the business model of the generics industry all in about 800 words. High marks for ambition.