Today Is the Biggest Day Ever for PBM News, No?

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It’s (almost) all PBMs, all the time, today. The only question is where to start. 

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I suppose the best place to jump in is the place where the impact is most immediate. It looks like we will get a PBM reform bill passed as a part of the year-end package. 

No one has actually seen the legislative text yet, but STAT has the best description of what’s in the package. Per STAT, we’ll get delinkage in Medicare, some Medicaid-focused provisions, and some transparency. Punchbowl said there’s 100% rebate passthrough, too. 

So that feels like a bill with some teeth. The short-term question is when we get the actual bill and when (or maybe if) it passes, given the upcoming fund-the-government deadline. The long-term question is exactly how toothy the bill is. Can PBMs squirm around it? 

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Donald Trump’s comments on PBMs yesterday were eyebrow-raising (or, if you’re a PBM, hair-raising), and it’s worth excerpting them in full: 

I can come up with a half-dozen reasons to be skeptical of the idea that Trump will try to whomp PBMs as a major health priority, but it’s worth noting that the market is taking him at his word, driving down the share prices of United, CVS, and Cigna. 

And former FTC staffer David Balto has a STAT op-ed out today suggesting that Trump is going to be hard on the industry. 

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Two months ago, Barron’s published an absolute jaw-dropper of an article that meticulously detailed the intersection between PBM rebates and the explosion of the opioid epidemic. 

I covered it here, and I was flabbergasted that it didn’t get more attention. “Seriously,” I wrote. “Can anyone point me to a newsletter or other media source that cites to the Barron’s piece? This tree is way too big to fall in a forest without anyone hearing it.”

It turns out my news judgment was right: the news was so big that the New York Times just published a 3,000-word investigation on exactly the same topic. 

The NYT is well worth your time, even at 3,000 words. But credit to Barron’s Catherine Dunn for getting there first. 

(If I had to guess, there would be one or two more big PBM pieces from the NYT to drop in the next two weeks. It feels like the Times is gunning for a Pulitzer submission here, which means that the articles need to run before we flip the calendar.)

My newsletter platform sent me the equivalent Spotify Wrapped last week, letting me know that I’ve published somewhere around 185,000 words this year, and I should hit 200 posts this week. 

That’s a lot of content. Word-wise, that’s more than Great Expectations but just a tad shy of Dune. 

On the flip side, I haven’t had quite the impact of a Dickens, and I don’t expect Timothée Chalamet to be cast in the film adaptation of Cost Curve. 

Still, looking back does get me thinking about the kind of impact that the newsletter has had, and whether there are things I can do to add value to the broader health policy community. My goal for 2025 is to define what the next generation of Cost Curve looks like. 

And for that, I need your help. 

I have a brief survey set up here, and I’d be grateful for your input. 

To be clear: I plan on continuing Cost Curve in its current iteration, though I’m open for suggestions on how I can talk about the issues that are most important to you all. The broader question is whether the demand is there for an expanded Cost Curve universe. 

Finally: thanks to everyone who has read, clicked, shared, emailed, and engaged with Cost Curve this year. Readership has nearly tripled, and I’m hugely appreciative of each one of you. 

Here’s to a wild 2025.

• That didn’t take long: Last week, HRSA threatened mammoth retaliation if Sanofi moved forward with its 340B rebate approach. This week, Sanofi sued HRSA to allow it to move forward. There are now four pending suits. 

• If all of the PBM stuff above is a little much, and you need a good, solid foundation, this “What journalists need to know” effort by Kerry Dooley Young is a masterwork. 

• There’s a MedPage Today article on how newer diabetes meds, including SGLT-2s, are still massively underused. Any time I see something on SGLT-2s being underused, I think about Brenzavvy, which remains the most interesting drug launch of the 2020s. Brenzavvy is sold entirely outside of the insurance system for a low cash price. Given the underuse issues, there should be a healthy market for it, but awareness is always an issue. Anyway: consider this a very small signal boost. 

• The idea that the government can own drug development, from research all the way through manufacturing and distribution, is a fairly radical concept. But this Journal of Law, Medicine & Ethics piece on “Public Research and Manufacturing Enterprises” outlines what that could look like. I don’t exact to see PRMEs anytime soon, but the concept is certainly thought-provoking. 

• I’m still wrapping my brain around the sheer amount of information captured by 46Brooklyn’s new dashboards for analyzing prices in Medicare -- particularly the variations in price seen in the program -- but if you’re looking for a way to keep your mind engaged through the holiday season, this is an effort well worth your time.

• Here’s a deep dive on 2025 Medicare formularies from Brooks Conway.

Header image via Flickr user Peter Harmer.

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].