It's All About March-In Rights, Isn't It?

Today is proof that you can have busy days in Drug Pricing Land without nessarily having big news.

It’s all about march-in, isn’t it?

Yesterday, the news out of DC was that Bernie Sanders was going to hold up confirmation of a new head of the NIH until the Biden administration delivered a “comprehensive” plan on how to control drug prices.

This felt a little bizarre. I mean, Biden delivered price controls last year. His 2024 budget wants to make the Inflation Reduction Act even more aggressive. HHS has its own plan, which includes reimbursement reforms tied to accelerated approval. It’s not like drug pricing is some sort of forgotten issue over at the White House.

But there is one tool that Biden and HHS have not used or, really, talked about. And it’s one that’s near and dear to Bernie: march-in rights. That’s the idea that the government has the option to step in and break patents if high prices are hindering access.

That’s a theory that has been rejected over and over through the years, but if the last decade has taught us anything, it’s that precedent is for chumps.

So is Bernie just asking for the administration to lean in on march-in? The report out of Bernie’s committee this week basically gives a road map to compounds where the government has a stake (through licensing).

Add that to this pointed letter to HHS from Sen. Elizabeth Warren and colleagues asking for details on the agency’s working group on march-in right, and it starts to feel like the ask from Senate progressives is not for a “comprehensive plan,” but rather a very specific one that would whack pharma in the kneecaps by breaking patents.

So SmithRx, a tiny PBM, is going to partner with Mark Cuban’s drug company to make Coherus’ Humira biosimilar available to its members. As you might remember, the Coherus product is listed a lot, lot lower than Humira, and Cuban is getting an additional discount, so we’re talking a med coming in 90%+ below Humira.

Even though neither SmithRx or Mark Cuban have a meaningful footprint, it feels like a really interesting experiment.

The model is upside-down compared to what we’re used to. It’s the pharmacy negotiating the price here, not the PBM, suggesting a radically different approach to PBMing that relies on technology and nimble shopping, not negotiating heft. I have no idea if it will work, but I’ve seen worse strategies than just repeating “Mark Cuban” over and over.

Also:

• Man, the annual Trends in Drug Benefit Design Report from Pharmaceutical Strategies group is a treasure trove of data. Fierce has a bit on what employers/plans think about obesity drugs, but that might be the least interesting piece. The report has some pretty good evidence that there is no end to increasing cost-sharing, and there’s more ignorance than I would have expected about the coming war over copay assistance.

• The Boston Globe runs a “plague o' both your houses” editorial about drug prices, decrying finger-pointing between pharma and PBMs. But most of the op-ed is about PBMs, which is a nice change of pace.

• Do you care about congressional grandstanding on PBMs? I’m not sure that I do, but here is STAT’s coverage of Rep. James Comers’ rant yesterday. As far as I’m concerned, this is all fun and games until legislation starts moving or investigations start concluding.

• Lilly CEO David Ricks went on CNBC and talked smack about the IRA, leaning into the issues with the “pill penalty” (the four-year disparity between protection for biologics and small molecules). Ricks is also talking about the economics of obesity medicines in a way that I think can (or should!) really shift the conversation about spending in that category.

• This is real wonky, but there is a Health Affairs piece warning, essentially, that the growing interest in Medicare Advantage plans could have all kinds of weird and not entirely anticipated impacts on drug prices (and vice versa).

• The Canadians are still trying to get aligned on a nationwide approach to paying for prescription drugs.