Axios Vitals

A briefcase with a red cross on the front.

June 28, 2021

🇺🇸 Welcome back from the weekend!

Situational awareness: I'm preparing for some serious FOMO from all the vacation bounce-back emails coming my way as we approach the Fourth of July.

  • I'd love to hear from those of you who are working this week! Send your tips, story ideas and feedback to me at [email protected].

Today's newsletter is 772 words, or a 3-minute read.

1 big thing: Alzheimer's drug presents Democrats' new policy dilemma

Illustration of a folder with a dollar bill sign cut out of it. 
Illustration: Aïda Amer/Axios

With a $56,000-a-year price tag, Biogen's newly approved Alzheimer's drug Aduhelm is dovetailing into the debate on Capitol Hill over how to lower prescription drug prices.

Why it matters: Democrats may be positioning themselves to push policy measures that assign value to drugs and then price them accordingly — a huge potential blow to the pharmaceutical industry.

To truly address its launch price, policymakers have to grapple with big questions the U.S. system currently avoids: How should we determine the value of a drug, and who gets to make that decision?

  • President Biden proposed giving an independent review board the power to determine the Medicare rate for new drugs that don't have any competition.
  • Democrats' most prominent drug legislation is a House bill that gives Medicare the power to negotiate drug prices.
  • Sen. Ron Wyden, the chairman of the Senate Finance Committee, recently called out Aduhelm by name in a document outlining the principles that will guide the Senate's drug pricing bill, a hint that the Senate's legislation will take a different direction than the House's.

The bottom line: "Any kind of process for valuing new drugs like Aduhelm take you immediately into the controversial quagmire of how to quantify improvements in quality of life for people," said KFF's Larry Levitt.

2. The broader impact of Aduhelm's approval

An illustration of a checkmark that looks broken.
Illustration: Aïda Amer/Axios

The FDA's approval of Aduhelm should have been cause for celebration. Instead, it's become a scientific and financial mess, Axios' Bob Herman and Sam Baker report.

Why it matters: Aduhelm, an unproven drug, might not only bring massive costs to Medicare. It has broader implications for patients and future drug approvals.

Between the lines: Millions of Alzheimer's patients and families are desperate for signs of a promising treatment. Empathy for that pain may have motivated the FDA to ease up on Aduhelm, some critics say.

  • Medicare will likely spend tens of billions of dollars per year just on Aduhelm. Patients who receive it will also need additional care, like imaging scans.
  • Many also fear Aduhelm's approval will only make the long and painful search for treatment longer and more painful for patients.

What next: Medicare could save some money by putting limits on its coverage of the drug, or reject coverage completely. If ongoing trials don't yield more evidence that Aduhelm works, the FDA can pull it from the market.

The bottom line: If the FDA is going to start greenlighting more drugs simply because they might work, that could unleash a flood of expensive and unproven products.

Go deeper.

3. Medicare spending on advertised drugs

Data: U.S. Government Accountability Office; Chart: Connor Rothschild/Axios

Prescription drugs with some of the highest Medicare spending also had the highest level of direct-to-consumer advertising, a recently-released GAO report found.

By the numbers: The GAO found the Medicare program and its beneficiaries spent nearly $324 billion on prescription drugs advertised to beneficiaries and other consumers between 2016 and 2018.

This amount is more than half (58%) of total Medicare Parts B and D spending on drugs during that time, the most recent data available.

  • Seven of the top 25 drugs in Part D and two of the top 25 drugs in Part B with the highest spending were also among the top 25 drugs with the highest consumer advertising spending that year.
  • For example, Trulicity, as well as Lyrica, Eliquis and Humira were among the top 25 drugs in Part D and direct-to-consumer advertising spending.
  • Keytruda and Botox were among the top 24 drugs in Part B and direct-to-consumer advertising spending.

4. Public health workers harassed

A person in clinical scrubs sits with their head in their hands, appearing distressed.
Illustration: Eniola Odetunde/Axios

Nearly a quarter of public health workers said they felt bullied, threatened, or harassed because of their work since the pandemic began, new CDC data shows.

  • By the numbers: Out of 26,174 public health workers surveyed across the U.S., 23.4% said they'd been threatened or harassed.

Why it matters: The data corroborates the anecdotal evidence of how politically charged public responses and work burnout wreaked havoc on the mental health of public health workers this past year, Axios' Marisa Fernandez reports.

5. While you were weekending

Illustration of a desk on a beach under a palm tree.
Illustration: Aïda Amer/Axios
  • During an appearance Sunday on CBS' "Face of the Nation," Arkansas Gov. Asa Hutchinson said that hospitalizations are up among the unvaccinated and that he's working to reverse drops in vaccination rates in his state, Axios' Yacob Reyes reports.
  • The Biden administration is sending their A-list officials — and actual celebrities — across the country, devising ads for niche markets and enlisting community organizers in a major vaccine push, Yacob writes.
  • A newly-released book excerpt says CDC director Robert Redfield "prayed" then-President Trump would understand how serious COVID-19 was after contracting it, Business Insider reported.
  • Doximity's CEO told CNBC he ignored Silicon Valley wisdom in order to build what became a $10 billion health-tech company.