SOTU address promises cap on OOP drug cost
President Joe Biden’s State of the Union Address Thursday included some sweeping proposals, including extending a $2,000 cap on out-of-pocket drug costs to all Americans. Other proposals included expanding the number of drugs that can be negotiated by Medicare, capping the cost of insulin at $35 a month for all patients, and launching a $12 billion women’s healthcare initiative. (Modern Healthcare)
Practice Transformation
“All of Us” releases trove of genetic data
The NIH’s All of Us project recently released its first batch of results. The $3.1 billion research initiative, aimed at diminishing racial disparities in genetic research, has collected genetic sequences from 245,000 volunteers—nearly half of whom are from diverse racial or ethnic backgrounds. It covered over a billion genetic variations, including 275 million previously unidentified variants. “The sheer quantity of genetic data in a really diverse population for the first time creates a powerful foundation for researchers to make discoveries that will be relevant to everyone,” says Dr. Joshua Denny, who runs the program. (NPR)
Prescription prices higher than other nations
US prescription drug prices are, on average, 2.78 times higher than in 33 other nations studied, according to a RAND report released last month. US insulin prices range from 457% to 3,799% higher than other countries. Despite the US accounting for just 24% of drug volume sold, it represents 62% of total drug spending among the nations studied. In related news. Pharmaceutical companies have raised prices on hundreds of name-brand drugs this year, but the median increase of 4.7% is the lowest in over a decade. (USA Today; UPI)
Evidence & Innovation
PBMs take more money out of the supply chain than do drug makers
Researchers looked at the 45 most used generic medications taken by patients enrolled in a Medicare Part D pharmacy plan in 2021. They found that for every $100 spent by the Part D plans, $41 went to the PBMs, $30 to the manufacturers, $17 to the pharmacies that dispense the drugs, and $12 to the wholesalers. As Johns Hopkins’ Ge Bai, PhD, CPA, explained in a recent episode of the Relentless Health Value podcast, PBMs take far more money out of the supply chain than any other entity, including the drug makers. (HEALTH CARE un-covered; Relentless Health Value podcast)
Congress may have punted on PBMs, but AGs want action
Congress has punted on PBM reform –at least in the most recent short-term funding agreement—STAT reports. Meanwhile, a bipartisan group of 39 state attorneys general sent a letter urging lawmakers to take “decisive action” to reform pharmacy benefit managers. The letter from the National Association of Attorneys General accuses PBMs of raising the cost of drug prices and contributing to opaque pharmaceutical pricing. It asks them to address drug costs by passing legislation requiring PBMs to disclose more about their prescription drug price negotiations. (STAT; Healthcare Dive)
Policy Solutions
FTC to probe role of GPOs
The Federal Trade Commission is launching a probe into the extent group purchasing organizations (GPO) and wholesalers may contribute to ongoing shortages of key medicines at hospitals and other facilities. The FTC will explore how these companies — which are responsible for brokering and distributing countless medicines — might misuse their market power to influence pricing and availability. Three GPOs buy drugs on behalf of most hospitals in the US, while three leading wholesalers supply about 90% of medicines to hospitals, clinics, and nursing homes, among others. (STAT)
