A Nailbiting House Vote Is Coming Today on PBMs

It continues to be boom time for news. I’m going to go as quickly as I can today …

It looks like we’re going to get a House vote on PBM reform (among other things). The big health care transparency bill -- which includes provisions that would bar spread pricing by PBMs and hike some disclosure requirements -- is on the calendar for a vote tonight. So that could be exciting.

Or maybe not.

The list of caveats is long: For procedural reasons, a two-thirds vote is needed, and some key Democrats are not on board (for reasons having to do with private equity, not PBMs). This is only the House, and there’s no assurance the Senate will follow suit. Timing of next steps is probably weird, especially with a looming government shutdown. The provisions in the House bill are more limited than other legislation. And so on.

Still, we live in an age where an up-or-down vote in any chamber is unusual, which makes today -- grading on that curve -- a big deal. So …

There’s a ton of polling data that hit at the end of last week/early this week, and it all suggests that the White House is going to have to go all-in on talking about Medicare negotiations.

First, there’s an illuminating AP/NORC poll that confirmed the Medicare negotiations are popular on a bipartisan basis: 76% of Americans are on board.

(I’m going to leave aside, for right now, the fundamental criticism of polls that ask this question, which is that no one understands what “negotiation” means, and, as soon as you introduce the idea of tradeoffs, support plummets.)

The AP poll also documented an ironic twist: Joe Biden isn’t really benefiting from the fact that most Americans support one of his landmark achievements. Fewer than half of those polled approve of the job he’s doing on drug prices. The story seems to suggest it’s because Biden isn’t doing enough.

The AP poll should be paired with this CBS/YouGov poll, which looked at a lot of super-dull (to me, anyway) horse-race stuff on Biden and Trump.

But buried in the results (slide 66 and 67) are an interesting finding: only 54% of Americans even know that Biden delivered Medicare “negotiations.” This reinforces a KFF poll from last month that showed that most Americans have zero idea what’s in the IRA.

All of this adds up to an environment where:

1. Americans are mad about drug prices

2. Americans want Medicare “negotiations”

3. Joe Biden delivered a hugely popular (at least, in broad strokes) policy win with the IRA

4. A huge number of Americans are utterly unaware of the IRA

5. Joe Biden’s approval numbers are underwater

So it is super-logical -- even to someone who lives 1,200 miles from DC -- that every speech Joe Biden makes for the next 14 months will include mention of Medicare negotiations.

Buckle up.

I’m going to make these Quick Turns as quick as possible … only one line each!

Except … I need to rant for a hot second about this Financial Times piece. It’s lengthy and generally OK, but there are some elements that rub me the wrong way.

For starters, it repeats gross sales numbers, which I just find irritating. Eliquis did not “cost Medicare $16.4bn last year,” because billions in rebates flowed back into the system. Context here would help.

It’s also weird, I think, that the one patient that this global news powerhouse was able to identify was Steven Hatfield, the guy who appeared at Biden’s press conference for the CMS “selected drugs” two weeks ago. I think some of the quotes in the paper are the clearly-scripted-by-the-White-House comments from that presser. But the paper doesn’t mention that the guy is the administration’s official poster child. That’s hardly a journalistic felony, but I expected better.

And I don’t want to make light of Hatfield’s situation. It sure sounds like he’s on the hook for way too much in drug costs. Which is why the $2,000 cap on out-of-pocket costs is probably the most important part of this story. Instead, it’s buried in paragraph 18.

Anyway …

• There was a not-particularly-enlightening hearing on Friday in the Chamber of Commerce’s IRA-related lawsuit in which the judge didn’t offer any insight on his thinking or timing.

• The ICER report on how CMS should set prices for Eliquis and Xarelto has been pushed back to Oct. 2.

• The FTC wants to go after pharma -- mostly inhaler makers -- for abusing the Orange Book, a patent registry that can block generic competition.

• I liked how the Wall Street Journal frames up a other-countries-are-freeloading-on-drug-prices counter argument in its editorial today.

• PBMs are the reason we can’t have cheap, biosimilar Humira, KFF Health News concluded.

• I’m being brief, so please know that Massachusetts Health Policy Commission has a big annual spending report out, and Exhibits 2.10 and 3.10 are the pieces I found most interesting.

• CMS should make sure that “limited supply agreements” aren’t used to game the IRA, according to a JAMA “Viewpoint” funded by Arnold Ventures.

• Great stat here from EveryLife: delayed diagnosis of rare diseases can cost as much as $517,000 per patient in health costs and productivity losses.

• OTC coverage of birth control is going to be complicated.