The New York Times Puts the IRA on A1

For those who missed it, I published the full interview with TheracosBio CEO Albert Collinson -- the guy launching the new, branded cash-only diabetes med -- on LinkedIn over the weekend.

The New York Times had a front-page piece about the lawsuits around the Inflation Reduction Act. Maybe 90 to 95% of the story should be familiar to you all, because you’ve been keeping up with the story. But I had two flags:

1. This was A1 in the Sunday New York Times, which means that the New York Times-reading public is now a lot more familiar with this issue than they were 48 hours ago. I don’t know if that’s good or bad, but it does shift the communications landscape somewhat.

2. The legal frame put around this (largely via one source, Georgetown’s Lawrence Gostin) suggests that maybe this isn’t the swing-for-the-fences longshot that others have implied. To wit, via Gostin: “It would not surprise me at all to see these cases go up to the Supreme Court and have them strike it down.”

I’m hugely appreciative to the American Society for Preventive Cardiology for having me out to their annual congress to take part in their drug-pricing town hall series on Friday, along with Amanda Conschafter, Dharmesh Patel and Bill Smith.

The mark of any good town hall is that the education flows both ways, and — by that measure — it was a great conversation. I learned that the number one issue for this group of providers is access. These are folks loaded for bear around prior auths, who are living every stat you’ve ever read about the paperwork burden of utilization management.

They’re ticked at PBMs, and they’re worried about what the IRA will do to access. So these are all areas to watch. If you listen to these docs, there is a reckoning coming, and it’s not in response to high prices.

For my part, I suggested that physicians have three ways they can exert influence: through straight-up advocacy at the state and local level; through education (both of themselves and of their patients), because, unfortunately, providers are on the front lines when it comes to explaining the system; and through experimentation. There are novel approaches out there (see Brenzavvy, above), and whether they succeed will depend an awful lot on feedback from docs.

• Utilization management for oral oncology medicines got really out of control between 2010 and 2020, per JAMA Oncology. At the risk of piling on, it’s possible that its access, not prices, that will really drive health advocacy over the next decade.

• The NYT takes a look at Gilead’s decision to delay development of an HIV medicine, going deep on a lawsuit that alleges that the company “slow-walked” a follow-on compound to boost profits. The company denied the allegation.

• I need to go into this in more depth, but there is another GoFundMe study, this one showing the expenses that prompted campaigns focused on neurological diseases (mostly ALS and cancer). The takeaway: housing costs and medical debt were the biggest driver. Meds were not.

• Employers are restricting use of obesity drugs, previewing the great debate of the next decade. Ascension and the University of Texas both pulled reimbursement for the meds, according to this Business Insider story.

• Pharma-funded patient advocates were engaged in 138 of 173 NICE assessments that the Guardian analyzed.

• I feel like AHIP has been especially disingenuous lately, so I shouldn’t be surprised that it put out a release blaming drug prices for increasing premiums. That’s despite the fact that there is zero evidence that drug prices -- which are, remember, going down on a net price basis -- are driving premiums.