What's Important Enough to Prompt Senators to Work This Week? Copay Accumulators, Natch

Scheduling Note: Cost Curve isn’t exactly taking a holiday break. Instead, tomorrow, I’ll unveil the end-of-the-year “Cost Curve Fight Club” in which we can vote on (and, hopefully, argue about) the top stories of the year in drug pricing and policy over the next week. If you’re down to participate, please play along. If you’d rather take the week off, I’ll provide a news summary of the “off week” on Jan. 2.

I do not normally think of members of Congress as individuals who are going to stay at work right up until they hear reindeer hooves on the roof, and yet 17 senators took the time to write a letter to HHS telling them to knock it off around copay accumulators. (h/t to STAT) 

As you’ll recall, in September, a judge ruled that HHS needed to unwind a Trump-era rule that allowed health plans to disallow patient assistance from counting toward deductibles or out-of-pocket maximums. That practice, a countermeasure against drug coupons, mostly has the effect of enriching insurance companies at the literal expense of patients. 

Last month, the Biden administration said they were going to fight the ruling by both appealing it and refusing to enforce it, which did not make advocates happy. Subsequent comments from the government suggested they might be willing to walk things back. Maybe. 

So it’s noteworthy that a bipartisan group of senators took time away the week before Christmas to sign on to a letter pushing back on that policy, and worthwhile to flag that the letter teases some federal legislation that would ban accumulators. 

I’m not saying that this issue is going to rocket to the top of anyone’s list. Only that there seems to be a growing consensus … and that HHS is on the wrong side of the consensus.

• Other people still working: government lawyers, who filed their first brief in the Boehringer Ingelheim IRA lawsuit. They have another brief due tomorrow in the J&J/BMS case. Fortunately for those lawyers, the government filings are now following a pretty familiar pattern. I didn’t see anything new in the BI document, and I doubt there will be much new tomorrow. 

• The FTC’s deadline for eight companies to delist patents from the Orange Book, an FDA compendium of critical patents, has come and gone, and only two companies (GSK and Amneal) removed any patents, per Bloomberg. So the game of legal chicken continues. If you’re into the topic, PhRMA has a blog post well worth reading that puts this dispute into context: industry has been asking for clarity on what belongs in the Orange Book for the better part of a decade, to no avail. That’s good perspective when thinking about whether the FTC is taking the most constructive approach to the issue.

• Speaking of the FTC (and the Department of Justice), they released a final version of their revised guidelines around merger and acquisition enforcement. No one is particularly happy, especially not industry, because the new approach is both tougher and more vague than the guidelines put in place in 2010. For the reaction of an industry coalition, check out PULSE’s statement. 

• Policy wonk Zeke Emanuel posits that the reason that health costs are growing slower than inflation is “spillover” effects of Affordable Care Act policies that encouraged doctors to be more cost-conscious. I’m not sure that Emanuel brings the data to prove his point, and if you want to look at other possible explanations, this NYT piece is a good place to start. 

• It’s not drug-related, but the Camden Coalition research is maybe the most interesting health policy endeavor of the past decade, rigorously testing whether improved care coordination lowers total costs for frequent users of health care services. The landmark 2020 paper carried a landmark conclusion (“No, it doesn’t”), and the team has continued to look at where care coordination succeeds and where it falls short. There’s a new Health Affairs paper from the Camden folks out now that goes deeper, and it’s worth a read if you’re a fan of their approach. 

• That patent paper on “terminal disclosures” that I wrote about last week got covered in STAT today.