How Not to Talk About the Costs and Benefits of Obesity Drugs

Programming note: Cost Curve is off Monday for Juneteenth.

I also wanted to thank Adam Fein for saying nice things about Cost Curve on social media yesterday. I’d return the favor (here is his Twitter and his LinkedIn), but it’s probably a safe bet that you’re already following him.

Lord, this is dumb:

The implication here is that the rising rate of hep C is proof that the promise of Solvaldi -- and the wave of better, faster, cheaper hep C meds that followed-- was somehow an illusion, and that the continued rise in hep C rates is proof that the drugs don’t work. I guess? Maybe? Like I said: dumb.

The actual reason that hep C rates are through the roof is that we have a crisis-level problem with injectable opioids, and trying to somehow pin that on Sovaldi is some serious through-the-looking-glass stuff.

Anyway: that line comes in an op-ed published by STAT on how difficult it is for employers to decide whether to cover obesity drugs. The op-ed spends a lot of time making the point that there isn’t robust outcomes or cost-savings data, and blowing up employer budgets -- boosting spend by 25% -- isn’t worth it for the speculative benefit of obesity control.

And that may be a legit rationale now, but outcomes and cost-savings data are coming. That data, if positive, is going to complicate things: the benefits of weight loss are likely to accrue over the long term, and employers and insurers have a hard time paying lots in the short term for benefits years down the road that are likely to recognized by some othe payer.

All of this means we should probably start having an serious, honest conversation about how we handle that mismatch. And the best way to start a serious, honest conversation is not by suggesting that hep C cures are driving up the hep C death rate.

None of the below really qualifies as fun beach reading, but this has been quite a week for reports, white papers and other PDF-ish kind of content. Here’s what you might want to peek at:

• Vital Transformation has a new analysis of legislative proposals that would make the IRA even tougher. Their conclusion: we’d see massive losses in new drugs. The work was done with the advocates at We Work for Health, and it’s built on roughly the same framework used for an estimate of the IRA’s impact published last month with BIO.

• In the know-thy-enemy department, Patients for Affordable Drugs has a new report out. Credit where credit is due: it gives a nice sense of what the $2,000 out-of-pocket cap will mean for patients using oral cancer meds. And then P4AD surrounded that analysis with the usual low-context pharma-bashing.

• Pfizer and the Alliance for Regenerative Medicine have a deep dive out on how health systems should think about gene therapy. It’s a useful primer, but there’s not a lot of details on how to get from point A to point B when it comes to policy change.

• On the other side of the spectrum, Sandoz has done some thinking on the kinds of policy changes needed to ensure broad, global biosimilars uptake.

Also Notable: 

• Genentech’s Columvi received the green light from the FDA for diffuse large B-cell lymphoma. It’s a fixed duration cancer drug -- when patients are done, they’re done -- that will run about $350,000 for the full course of treatment. It’ll enter a market with the similarly priced Epkinly, approved last month, and compete with CAR-T treatments.

• The Atlantic has a piece of “pay for delay” deals, but the story -- which focuses on one case involving Gilead and Teva -- never really has a payoff. There’s no call to action or drum-beating on policy change.

• There are apparently only like four or five law professors in the country capable of commenting on the IRA litigation, and Vox quotes three of them -- University of California-Hastings’ Robin Feldman and Georgetown’s Zachary Baron and Andrew Twinamatsiko -- in a new story. You’ve probably already heard what those three think. If you haven’t, the Vox piece isn’t a bad way to catch up.