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- Poll Shows Docs (And, Probably, the Rest of Us) Could Use Some 340B Education
Poll Shows Docs (And, Probably, the Rest of Us) Could Use Some 340B Education
And a nice STAT explainer on 'bridge programs'
Brian Reid
April 02, 2024
Another reminder that the quarterly extravaganza of analysis that is Adam Fein’s Drug Channels webinar is kicking off on Friday and focused on the IRA.
The full text of this doesn’t seem to be available, but I find the poll numbers on 340B in this American Journal of Health-System Pharmacy piece to be fascinating and revealing.
About 200 docs were polled on 340B, and a huge number -- 95% -- said “patients benefited from access to the organization’s 340B pharmacies.” I don’t think that’s a surprise, and it really quantifies the halo effect around 340B. And these were physicians at a multisite federally qualified health center, where, frankly, it’s much easier to see where the program is helping the underserved.
But, in the really telling bit, it appears that even physicians working at a FQHC don’t really understand 340B. Of those polled, 54% we able to answer at least four of seven questions about 340B correctly. (Because I can’t see the paper, I don’t know what was on the quiz.)
Still, that illustrates the educational gulf that still exists … even in a care environment where 340B is front and center, barely a majority of docs seem to really understand the program. That suggests that we’re a few steps away from having a fully informed debate about where to go next.
We covered last week the topline numbers in this STAT story about the record drop in net prices in the fourth quarter, but the piece is well worth the read for some of the more detailed nuggets. It has the net price of Humira down 38%, the overall net price of the rheumatoid arthritis segment down 30%, and psoriasis down 10%.
The most important element, though, might have been author Ed Silverman’s efforts to dig into “bridge programs.” Most of you all know what he’s talking about -- patient assistance designed to drive speedy, affordable access ahead of insurance coverage -- but I don’t think it’s a concept most people are tracking on.
As it turns out, the end of bridge programs drove up the net price of GLP-1 drugs, which is a phenomenon worth tracking on.
Here’s how Ed explains bridge programs:
One is a so-called bridge program that Lilly sponsored to help patients gain access to its Mounjaro medication after it was approved to treat diabetes in 2022 by the U.S. Food and Drug Administration. Lilly offered the program to win over insurers that were reluctant to extend coverage because the drug was also widely prescribed to combat obesity, even though weight loss was not an approved use.
Here’s how these programs work: An insured patient whose insurer does not cover a medicine can receive it at a greatly reduced cost from the manufacturer. This discount is typically much larger than what would be paid later by the insurer, if the drug is placed on its formulary, according to Richard Evans, general manager at SSR Health.
In the first 11 months in which Mounjaro was on the market, this type of patient assistance program accounted for more than one-quarter of all new prescriptions written for the drug, according to a recent report by IQVIA, a research firm that studies pharmaceutical pricing. And as these patients rolled off the program onto insurance coverage, the discounts fell and net prices rose. But SSR expects this to slow.
This Biden administration is out with a new release on how much the IRA helps women, looking the $35 insulin cost-sharing cap and the free-vaccine part of the law. I don’t think any of the numbers are particularly interesting or important, but the fact that HHS took the time to knit all of this into a release shows exactly how committed the White House is to promote the IRA. Act accordingly.
This piece in the JAMA Health Forum that tracks out-of-pocket spending around biosimilar is somewhat useful, documenting how savings from biosimilars don’t really make it to patients. It’s a phenomenon that’s probably somewhat muted by the economics of the physician-administered cancer drugs that dominated the analysis (which looked at biosims between 2009 and 2022). The issue is likely to become even more relevant as patient-administred biosimilars begin arriving. The work is from the Harvard PORTAL team.
Increased GLP-1 use in Medicare is probably going to drive premiums up, per this NBC News article. I don’t have a hot take here. I think this is probably impactful but almost certainly obvious to everyone looking at the issue. It’s another reminder that there is a reckoning coming here: these are good, cost-effective interventions that will nonetheless consume a lot of budget, and we need to accept both of those realities and a hard think about how to handle it. (We’re just real bad at “hard thinks” about tradeoffs in the United States.)