A Viral Exchange at a Hill Hearing Makes Clear the Stakes Around IRA Communications

Programming Note: No Curve tomorrow. Back Monday. And I’ll have a weekend LinkedIn newsletter live at some point on Saturday or Sunday.

It didn’t make the mainstream media, but the progressive internet lit up with this exchange between Rep. Ro Khanna and Aviva Weis, J&J assistant general counsel.

The short summary is that, during a hearing that was nominally about tort reform, Khanna hit Weis with a series of questions about J&J’s IRA lawsuit, essentially asking Weis why J&J felt that the IRA was an unconstitutional taking when the company negotiates with the VA and Medicaid without objection.

Weis tried to punt on the question, which provided the foundation for Khanna’s social-media victory lap (“We need to rein in Big Pharma’s greed,” etc.).

My intention here is not to call out Weis. She was testifying about an entirely different subject and the GC’s office at J&J has a lot of balls in the air. Detailed answers on every piece of litigation that J&J touches is beyond the capabilities of any human.

Instead, it’s worth pointing out that there are good responses to this line of questioning, which (given the aforementioned social-media victory lap) we’ll no doubt see again. PhRMA has a good wrapup of how the IRA differs from VA negotiation, which every industry comms person should probably print out. And Khanna’s reference to Medicaid negotiation suggests a fundamental misunderstanding of how Medicaid works. (There isn’t a central, nationwide “negotiation” in Medicare.)

The broader takeaway is that any pharma exec, anywhere in public, is probably at risk of having this kind of exchange, so comms folks should have their IRA resources accessible broadly. And if you work for a company that doesn’t have IRA resources or isn’t applying them consistently, well … I know a guy who can help.

Lots of interesting bits today, but nothing that really felt big enough for the daily “Inflection Point.” For instance, there is a ton of IRA-lawsuit chatter, but nothing that really changes the understanding of the state of play for those who have been paying attention.

That said, this Bloomberg Law piece about the AstraZeneca strategy -- essentially, going after the IRA procedures rather than the constitutional underpinning of the law -- deserves a click. Axios had a broad look at the way that the lawsuits might intersect the 2024 presidential race, and Fierce and The Hill both covered the HHS filing in the Merck case.

Elsewhere:

• We’re going to have hearings out the wazoo next week, most notably this House Oversight meeting, where PBMs will get smacked around. PCMA, PhRMA and AAM will all testify.

• I’ve already noted last Friday’s deal between HHS and Regeneron over a new COVID treatment, a deal that includes a provision that will ensure that the price in the United States is no higher than the price in any high-income country. STAT’s coverage includes a noteworthy response from Regeneron: because the government chipped in for development costs, “we support the idea that they should not pay more than other comparable high-income countries in the future.”

• Thirty-four Medicare Part B medicines have violated the IRA’s price-hike “speed limit,” though the violations -- and the corresponding impact -- generally seem to be minor.

• I don’t think there is anything new in this WaPo wrapup of how different parts of the health care system are covering obesity drugs, but if you’re not paying close attention to where Medicare is on this vs. Medicaid or commercial insurance, it’s a nice catch-up-quick piece.

• My enthusiasm for op-eds waxes and wanes, and today it’s waning. So know that Sens. Bob Menendez and Marsha Blackburn are pumping their PBM reform bill in The Hill and that the WaPo’s Megan McArdle thinks that price controls will harm innovation.

• Researchers at Vital Transformation have a post-mortem on where they went wrong in their predictions on CMS’ “selected drugs” list.

Finally, I’m super-sad that Akili, which makes an FDA-cleared video game for ADHD, is laying off staff and pivoting away from the by-prescription approach to its product. I’m sad partly because it’s a company run by good, smart people. And I’m sad partly because Akili reflects a failure in the health care system.

They have a fully approved, well-validated, cost-effective clinical intervention, but they couldn’t succeed because they couldn’t get reimbursement. Payer resistance here is going to have a chilling effect on innovation, and we’re all worse off in the long run.