Jul 30, 2018

Axios Vitals

Sam Baker

Good morning ... A vending machine in the San Francisco airport makes $10,000 per month selling vests. The clothing item. About 200 of them per month, apparently.

Get it together, San Francisco.

1 big thing: Reinsurance is so hot right now

President Trump and Wisconsin Gov. Scott Walker. Photo: Chip Somodevilla/Getty Images

It's not quite fair to say reinsurance is fully bipartisan or non-controversial — it couldn't get through Congress, after all. But it's about the closest thing to a consensus idea that exists in the world of insurance, and it's continuing to move forward.

Driving the news: The Centers for Medicare & Medicaid Services announced yesterday that it has approved Wisconsin's proposal for a reinsurance program — the fourth state to win such a waiver. (The others are Alaska, Minnesota and Oregon.)

How it works: Reinsurance is pretty straightforward: The government simply gives insurers money to help offset the costs of their most expensive patients. That lowers premiums overall, which in turn lowers the federal government's costs to subsidize those premiums.

Why it matters: Reinsurance works. Insurers in Minnesota are actually looking to reduce their premiums next year — which almost never happens — and they say the state's reinsurance program is part of the reason.

2. "Anarchists" promote "DIY" drugs

Well here's a new one: Vice profiles a "volunteer network of anarchists and hackers" that says it's able to reproduce prescription drugs using off-the-shelf ingredients, casting itself as a renegade alternative to the profitable (and regulated) pharmaceutical industry.

They call themselves Four Thieves Vinegar Company, and the company's founder "has no formal training in medicine and he’ll be the first to tell you he’s not a doctor," Vice reports.

  • They company says it has made five drugs, including "DIY" versions of naloxone, two abortion drugs, and Daraprim, the HIV drug whose price Martin Shkreli famously raised.

You don't say: "In the last decade," Vice reports, "Four Thieves has run afoul of the Food and Drug Administration, billionaire pharma executives, doctors, and chemists at some of the United States’ most prestigious universities."

3. Be wary of Alzheimer’s breakthroughs

“Hey there’s a new Alzheimer’s treatment that looks really promising and ugh never mind.” It’s happened so many times the stories run together, and now Bloomberg has a good look at how it might be happening again with a drug that was getting a lot of attention last week.

  • The drug, BAN2401, is being developed by Biogen Inc. and Eisai Co. It generated a lot of excitement after a clinical trial found that it slowed the progression of Alzheimer’s by 30%.
  • But stock analysts were unimpressed: high doses seemed to get results, but lower doses didn’t show any benefit.
  • And then it turned out that people with a gene mutation that’s associated with Alzheimer’s were kept out of the high-dose group, at the request of regulators. That made it harder to tell whether the results for the high-dose group actually meant anything.

The bottom line: Whenever you hear about a promising new Alzheimer’s treatment, make a mental note to check back in a few months — or even a few days — to see if it’s still worth your attention.

4. Between the lines: AbbVie’s earnings call

Even though pharmaceutical company AbbVie posted giant profit numbers for the second quarter on Friday, Wall Street investors were frantic about how the company will react to imminent changes to rebates and competition from biosimilars.

Axios' Bob Herman offers a translation of what he heard from AbbVie CEO Richard Gonzalez on the earnings call:

“It’s not my objective to telegraph to all of our competitors what our defense strategies are,” Gonzalez said when asked about biosimilar competition for its cornerstone drug, Humira.

  • Translation: AbbVie’s short-term defense strategy for Humira, which makes up 63% of company revenue, has been patents. And those 100+ patents serve as a moat around Humira, keeping biosimilars at bay until at least 2023 for U.S. patients.

“Some of it is driven by people who want to elicit fear for their own person gain,” Gonzalez said as he addressed concerns over cheaper biosimilars and drug rebates.

  • Translation: This seems like a clear jab at short seller Citron Research, which labeled AbbVie as “the next great drug short” because it is reliant on sales of a drug that faces cheaper alternatives. 

“We compete in every socialized health care system in the world. None of those systems have U.S.-style rebates," Gonzalez said.

  • Translation: The Trump administration is targeting the rebates that pharma companies pay to middlemen to get favorable placement on drug lists. Gonzalez is trying to convince investors that changes in rebate structure won’t dissuade intermediaries from excluding Humira because doctors and patients still value the drug. It's not an easy sell.

Flashback: AbbVie executives thought the political risks of drug pricing were “waning” last September.

5. While you were weekending ...
  • Medicare reduced the star ratings for one out of every 11 nursing homes due to inadequate staffing, the New York Times reports.
  • CNBC's Christina Farr tried out the "physical of the future," which honestly seems to have a lot in common with the physical of the present.
  • Some doctors tell Crain's Detroit Business that new, well-intentioned limits on opioids are having unintended side effects.
Sam Baker

What we're watching this week: Senate health committee hearing Tuesday on reducing administrative costs in health care.

Got tips? Feedback? Movie recommendations? Send them to baker@axios.com.