And Then There Were Two: IRA 'Selected Drugs' to Face Off Against Leqembi's Launch

We have our final two: it’ll be the CMS list of “selected drugs” under the IRA against the approval of Leqembi in the finals of Cost Curve Fight Club. You can vote on your pick here. 

This will be an interesting test: are the initial medicines selected for the IRA game-changing? Is Leqembi an intriguing one-off, or is Eisai’s approach to price -- and the government approach to reimbursement -- setting an industry-defining standard? The choice is yours. 

To look back over yesterday: the semifinal matches were fascinating. 

The first contest, between the “IRA selected drugs” (52.2%) and 340B program (47.8%) was so close that I went to sleep last night fearing that we’d have a tie. It was a hard pick, in part because the two stories were both important but different in how they’d impact the system. 

The comments reflected that. One response suggested that we may be a little early on the impact of the selected drugs and that the actual price announcement, due in September, would be the real milestone. Another said that 340B was the bigger issue, even though the selected drugs might have more resonance with the public. 

All in all, I received more comments on 340B than IRA. Read into that what you will. 

The other semifinal saw “Leqembi’s launch” (60.9%) cruise to victory against “House passage of PBM reform.” (39.1%) I can’t say that one was a huge surprise: the implications of the CMS approach to the Alzheimer’s space are going to have serious reverberations, and it sounds like the majority of you agree. 

CLICK HERE TO VOTE ON THE FIGHT CLUB CHAMPION.

• It’s a holiday tradition: Reuters publishing a pre-New Year’s story about hundreds of drug price hikes. They’re generally unilluminating clickbait, doing little to quantify which drugs are increasing in price, or why. Most of the medicines caught in the Reuters analysis have generic competition, and the big-name medicines probably aren’t taking increases above the rate of inflation. The story doesn’t spell any of that out. But it’s sure good for making pharma look bad. 

• Relatedly, Reuters did, late last week, note that some drugmakers are cutting prices, including prices on some GSK asthma products. The thinking is that the cuts are designed to respond to a new policy that amps up Medicaid rebates for drugs with big price hikes. (Also related: the coverage of brand-name Flovent being phased out in favor of an authorized generic.)

• Drug prices are too low, and that’s hurting patients. (To be specific, we’re talking about generic drug prices, but the lesson about supply and demand that underlies this is worth keeping in mind.)