Pictures Are Worth a Thousand Words ... So Here Are 3,000 Words on IRA, UM, and Formulary Design

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Today is a great day for visual learners. 

There’s been a ton of illuminating data on a handful of subjects that has dropped in the past few days, and it’s worth highlighting that work. 

So because pictures are worth a thousand words … here are some pictures: 

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Endpoints just dropped some data from its semi-regular survey of executives, and it found that more than one in three expect the IRA to have an impact. My guess is that the 63% who are “nos” here don’t have the kind of portfolio where they have to make these decisions. 

The verbatims really drive home some of these points, including the anonymous exec who said, “We routinely kill small oncology indications. Heartbreaking. Lung, breast, colon; everyone else gets nothing.” 

It’s heartbreaking because this is explicitly (if unknowingly) what members of Congress incentivized. 

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BIO and Morning Consult have data out on utilization management. One-third of Americans have run into issues with prior auths, formulary exclusions, and the like, providing further evidence that this is a core part of the health care experience for most Americans. 

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Avalere just updated its annual look at how generic drugs are covered in Medicare Part D, illustrating a dispiriting point: most generic medicines are not on “generic” cost-sharing tiers. That’s a figure that dropped below 50% give years ago and continues to fall. 

The upshot is that a lot of patients, then, are paying brand-level copayments/coinsurance for generic meds. Not cool. 

The data is underwritten by the Association for Accessible Medicines.

The University of Michigan’s Mark Fendrick has a piece in AJMC suggesting a path toward a health care system that doesn’t produce overwhelming consumer anger as one of its byproducts. 

Mark’s solution isn’t surprising to those who know his work, but it bears repeating: “This shift must start with an honest and rigorous assessment of which clinical services are high value (producing more health for the money spent) and which are low value (offering little to no benefit, potentially causing unnecessary costs and harm).”

ELSEWHERE:

• Oh, this will be one to watch: there is a bipartisan effort afoot to force PBMs to divest their pharmacies, per a WSJ scoop. I have no idea how likely it is that such an idea can move forward, but I’m pretty sure this moves the Overton Window around payer reform.

• I appreciate that Bloomberg Law tried to figure out what Mehmet Oz will do with price controls under the IRA, but they ran into the fundamental truth of predicting health policy under Trump 2.0: Nobody knows anything. 

• It feels like there has been a lot of silence out of Washington on PBM reform in the lame duck, which I assume is a bad sign. Modern Healthcare has an overview of where those efforts stand, but a lot of its reporting seems to be a week old. 

• About a year ago, GSK replaced Flovent with an authorized generic of Flovent. A year later, there are still access challenges, as this Boston Globe piece illustrates, as well as continued congressional pressure (e.g. this letter from Liz Warren to the company). And I still haven’t seen a clear accounting of what’s happening with net prices, which seems like the most important element here.

Cost Curve is produced by Reid Strategic, a consultancy that helps companies and organizations in life sciences communicate more clearly and more loudly about issues of value, access, and pricing. We offer a range of services, from strategic planning to tactical execution, designed to shatter the complexity that hampers constructive conversations. 

To learn more about how Reid Strategic can help you, email Brian Reid at [email protected].