The Mark Cuban-Blue Shield Tie-Up Appears to Be About Bricks, Not Clicks

Programming Note: no Curve tomorrow. Back on Wednesday.

Even though there isn’t much new today, I’m still stuck on the Blue Shield of California announcement from last week that they’re going to walk away from (part) of their PBM relationship with CVS Caremark in favor of a team-of-rivals-style effort that includes Caremark, plus Prime Therapeutics, plus Abarca, plus Amazon, plus Mark Cuban.

Blue Shield outlines, briefly, which pieces each of those partners will own, and each one of those decisions raises a thousand other interesting questions. The interesting question I’m stuck on today: what’s the Mark Cuban play?

I’ve seen some commentary that has raised red flags around the Cuban element of the plan, arguing that an online pharmacy may not be the ideal vehicle for less tech-savvy beneficiaries. But it looks like the California experiment won’t be relying on Cuban for online pharmacy services but for low prices at actual, brick-and-mortar pharmacies.

“Mark Cuban Cost Plus Drug Company will establish a simple, transparent, and more affordable pricing model, reducing surprise drug costs at the pharmacy pick-up counter,” is how the release puts it. That suggests that Blue Shield will leverage Cuban’s “Team Cuban Card” concept at retail pharmacies.

Team Cuban Card was initially framed as a partnership between Cuban and independent pharmacies, but Cuban has struck a deal with Kroger (and its brands, including -- for Californians -- Ralphs), so the ambitions appear to be greater than just independents.

There aren’t great explainers on how the Team Cuban Card works, beyond the patient-facing details on the company’s website. The back-end process here is especially mysterious (to me, anyway) so if any journalists out there are looking for a story idea, this might be one worth exploring.

I have lots of thoughts on the explosion of let’s-think-of-every-possible-obesity-angle stories out there, and it’s going to get exhausting to track them all down. Suffice it to say that the Wall Street Journal is worried about the impact on Krispy Kreme and Politico thinks that all of the attention on meds will give a boost to bariatric surgery.

I’m not saying this kind of coverage is clickbait, per se, only that the demand for weight-loss-drug journalism is starting to outstrip the supply of actual news.

Elsewhere:

• Bloomberg Law published its predictions on the first ten medicines that CMS will price-control. (At the risk of being repetitive, the official list will hit on or before Sept. 1.) At this point, there’s not much new to pick apart. My take on all of these lists is that CMS’ criteria is not especially clear, at least at the margins, and we’re probably going to learn a lot more in the next month about how CMS assesses generic competition.

• “CMS has already become a major HTA body,” declared Tufts’ Peter Neumann and former CMS official Sean Tunis in the New England of Medicine. The two suggested that, if CMS is going to get thrust into that role, the agency ought to lean into it by hiring more subject-matter experts and by strengthening its “coverage with evidence development” process.

• I have no idea why Democrat pol Howard Dean keeps writing pro-pharma op-eds -- at least three in the past four months -- but he’s back at it with this piece railing against CMS restrictions on fully approved Alzheimer’s meds. As my erstwhile colleague Gary Karr likes to say whenever Dean writes an op-ed: it’s a scream.

• This National Bureau of Economic Research publication on the GRACE value assessment framework is mostly over my head, but my layperson’s takeaway is that the GRACE model seems to assume that we’re undervaluing therapies for severe diseases … but overvaluing treatments where the health impact is more moderate. That reflects a certain challenge: I can’t see any advocacy group being OK with being told their disease is less serious (mathematically) and, therefore, that therapies are less valuable.

• BIO has a nice roundup of biopharma-related legislation in the states.

• Regeneron won approval for its Veopoz rare disease treatment. Everyone reported on the per-vial price -- $34,615 -- but far fewer did the annualized math. Judging from the kinds of patients in the clinical trials, it looks like a vial a week is a reasonable estimate, which puts the list price at $1.8 million a year. The critical context: Regeneron thinks there are about 10 patients in the United States and fewer than 100 patients worldwide.

• AARP filed an amicus brief in the Chamber of Commerce IRA lawsuit. It’s basically a PR move -- the brief doesn’t get into the legal elements -- so you should probably treat it accordingly.