There's a Lot to Unpack Today, Starting With Some Political Theater from Bernie and Biden

With apologies to Inigo Montoya: Let me explain. No, there is too much. Let me sum up:

• President Biden and Bernie Sanders gave a joint press conference to tout all the good things they’ve done around drug pricing. It was kind of a greatest-hits thing: pure politics, with no actual policy next steps. But if the goal was to get attention, well: mission accomplished, with WaPo and CNN coverage (for starters). 

• Of note: Biden repeated his plan to expand the IRA “negotiations” to 50 drugs a year, which -- as we’ve discussed before -- is meaningless. (Why not go all-in and pledge to price control 2,000 medicines a year? It would be equally meaningless but sound even more impressive.) He also repeated his plan to bring a $2,000 out-of-pocket cap to the commercial market, another piece of pure politics that, if implemented, would just prompt insurers to jack premiums. But this is campaign season, so there’s no need to think hard on any of this. 

• The patient who introduced Biden has $800 in drug bills a month, making me wonder what his insurance benefit design looks like. He’s also a spokesperson for Patients for Affordable Drugs, which has had a lot of success in creating the patient stories that have undergirded Biden’s IRA push. 

• Donald Trump is getting back into the price-control game, too. His proxies told Politico that he’s going to have another go at “most favored nation” pricing. Trump tried that during his time in office, and it took like 15 seconds to get vaporized by the legal system. Apparently, there’s a plan to keep that from happening a second time. I’ll believe it when I see it. 

• Bernie may have Vader-kidded his way to lower insulin and inhaler prices, but he doens’t have the Force and can’t compel GLP-1 price drops, according to a quite good Bloomberg Law story on the dynamics of price cuts. 

• Not every well-intentioned GLP-1 story turns out well. This Vox story has trouble dealing with the duality of the GLP-1 narrative: compelling cost-effectiveness data, huge budget impact. Instead, it has policy wonks analyzing clinical data and low-context information about pricing. 

• The Cleveland Clinic, which has 340B policies that were put through the ringer about a year ago by the Wall Street Journal, is still generating the wrong kind of attention. An Ohio public media group, Ideastream, flagged ongoing abuses of 340B at the Cleveland Clinic, sourced to a solid BRG report on how “rural referral centers” are allowing big hospitals to sneak into the 340B program. But it’s not just Cleveland … the report documents the phenomenon in Boston, Chicago, and Detroit, too. 

• This Washington Post op-ed suggests that the IRA won’t hurt innovation because the big company targeted by the IRA are not the drivers of approvable new drugs, which largely come from small, unprofitable startups. The piece doesn’t really grapple with the fact that the “drug industry” isn’t just a set of discrete actors, but rather a hugely interconnected ecosystem, but the argument laid out is an important one to understand.

• The Alliance for Aging Research cast another vote in support of the EPIC Act, which would fix the IRA’s “9 vs 13” issue, via a Real Clear op-ed. 

• This sponsored content in Fortune from the head of CVS’ PBM is, um, brave. He goes after Mark Cuban for implementing “a generic sourcing business that is 10 years too late.” The piece then pivots to talk about branded medicines, but -- free PR advice -- I wouldn’t provoke Cuban if you can avoid it. If you come for the king, you best not miss. 

If I can manage, Cost Curve will be off tomorrow. Let’s hope everyone behaves.