What's Scarier: Halloween or Open Enrollment?

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It’s Halloween, which is a top-three holiday here at Cost Curve HQ. A whole day devoted to goofy costumes and fun-size candy bars? Yes, please!

This year, we’ve been gifted with some great Halloween-inflected drug-policy content. Those of you reading online have already seen the header image for today, which is some very scary pumpkins courtesy of J&J’s Sean Clements.

And then there is this article in BIO.news, which observes that open enrollment and spooky season overlap, and that the former can be a lot more frightening than the latter. It’s a house of horrors, the piece suggests, highlighting four “monsters” that should really turn our hair white: formulary changes, prior auths, step therapy, and OOP costs. 

I dig the graphic:

And KFF Health News did its usual seasonal haiku contest, which has some clever twists of phrase. There is one about pharma price-gouging, but -- and this is fascinating -- the cartoon used to illustrate it depicts a vampiric PBM exec. Horrifying indeed.

I’m not sure that I’ve ever heard 340B come up during quarterly earnings calls. That’s not a blanket statement -- I don’t listen to every call, and my mind isn’t exactly a steel trap -- but I feel confident that 340B hasn’t been a major theme of earnings season. 

Until this week. 

The program has come up at least three times in the past 48 hours, each time in response to a question about the IRA (i.e. analysts didn’t ask directly about 340B). In other words, 340B is having a moment. 

Here’s Pfizer:

Here’s GSK: 

And Novartis:

I’m not going to vet the messaging here. My view is that what 340B needs most is name recognition. A sense that this is a topic of discussion. That it’s on everyone’s tongue and everyone’s mind. 

Repeated mentions on earnings calls help that process. 

The goal is to get to a point where enough people have a vague idea of what 340B is, and they start asking questions and the point of the program and the size of the program and whether it’s delivering. Because once those questions get asked, reform isn’t too far behind. 

I didn’t get a chance to listen to the oral arguments in the three IRA cases yesterday, and the audio isn’t yet available. From the reporting, it’s not clear that hearing the back-and-forth would have made the case any easier to handicap. Reuters has a pretty good take. 

To the extent there was interest, it was around a comment made by one of the jurists, Judge Thomas M. Hardiman: “Those words to me—maximum fair price—it’s a normative judgment. It might be oxymoronic in some regards. Maximum and fair, they seem to be working against each other.” 

It’s not clear what that might mean, legally, but he ain’t wrong, semantically.

ELSEWHERE: 

• There are partisan politics in 340B, but I don’t think I’ve ever seen the issue itself presented as a red state vs. blue state thing. Until today, with this RedState.com commentary that frames the debate as rural hospitals vs. big pharma. That’s not a helpful framing, but it’s a reminder of where the debate could go. 

• If you want an accounting of the ways that the Biden administration has threatened innovation (IRA, march-in rights, etc.), here’s a STAT op-ed for you. 

• This is kind of a weird Modern Healthcare piece that looks at why large insurers are getting into the specialty pharmacy business without paying any attention to the controversies around vertical integration. 

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