May 7, 2018

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning ... Congratulations to Justify, the first horse since 1882 to win the Kentucky Derby (which is limited to 3-year-olds) without having raced as a 2-year-old.

Bonus Derby content: Watch the track announcer call Saturday's race.

1 big thing: PBM industry makes a change

Photo: Mike Kemp/In Pictures via Getty Images

The Pharmaceutical Care Management Association — the trade organization for pharmacy benefit managers — is announcing a leadership change this morning. CEO and President Mark Merritt will announce his plans to step down at the end of the year, according to people familiar with the change.

Why it matters: Individual PBMs have grown frustrated with PCMA. It's “not able to get out ahead of the debate” over the industry’s role in setting the price of prescription drugs, a person familiar with the situation told me.

  • Bringing in a new leader for PCMA is part of a broader effort to hit back harder against the pharmaceutical industry and defend the industry more proactively.

What they’re saying: “When [Merritt] came aboard in 2003, he started from scratch and built PCMA into one of the most effective advocacy and lobbying groups in American health care,” Express Scripts’ Tim Wentworth, PCMA’s board chairman, said in a statement.

What’s next: Member companies are looking for a replacement who will guide PCMA toward a more aggressive public posture. I’m told the decision should happen before Merritt steps down at the end of the year, but hasn’t yet been made.

Flashback: PBMs against the world.

2. Charlie Munger’s health care stunners

Warren Buffett held his widely watched annual shareholder meeting over the weekend. Buffett’s right-hand man, Charlie Munger, caught Bob Herman’s attention after he made two interesting health care comments, both coming in response to questions about pharmacy benefit managers that were flagged by Chip Cutter, an editor at LinkedIn.

Key quotes:

  • “I suspect when Democrats control both houses of Congress and the White House, we will get single payer.” 
  • “I don’t think it’s going to be very friendly to the PBMs, and I won’t miss them."
3. Big week on opioids

There's a lot going on this week in the House Energy and Commerce Committee's response to the opioid crisis.

What's happening:

  • The panel's health subcommittee will meet Wednesday and Thursday to mark up opioid bills. (The list of specific bills hasn't yet been released.) The subcommittee has already advanced more than 50 bills related to the epidemic.
  • Meanwhile, the committee's oversight panel is dragging a who's-who of drug distributors in on Tuesday, for a hearing about their role in the crisis. It's one of the few punitive elements of Congress' response so far.

More: The DEA on Friday suspended a wholesaler in Louisiana over its handling of opioids, the first such move since 2012, per the Washington Post.

4. Say hello to more calorie counts

A menu board at Chipotle. Photo: Chris Hondros/Getty Images

Today is the deadline by which large chain restaurants — those with more than 20 locations — must display calorie counts on their menus or menu boards.

Context: It's a product of the Affordable Care Act, but the Trump administration has had to handle some of the implementation, thanks to lawsuits from the food industry.

  • Many large restaurant chains have already made this change, but a few have held out.
  • "Surveys show consumers overwhelmingly want this information. And many use it to improve their diets and health," Food and Drug Administration Commissioner Scott Gottlieb said in a statement last week.

Yes, but: "Menu labeling may be taking our eye off the ball. By offering us what seems to be a solution, it may prevent us from trying other things that might work better," Indiana University professor Aaron Carroll wrote in the New York Times in 2015.

5. While you were weekending ...
  • "60 Minutes" had a good piece on the role that both pharmaceutical companies and PBMs play in high drug costs.
  • Dr. Oz will be a science adviser to President Trump despite his track record of embracing weak evidence, Vox notes.
  • Former HHS Secretary Donna Shalala, who's running for Congress in Florida, says the ACA needs "deeper subsidies" to function better, per WPLG.
  • Maine's attorney general won't represent Gov. Paul LePage in litigation over LePage's refusal to expand Medicaid, AP reports.
Caitlin Owens

What we're watching this week: Trump's speech on drug prices, which has been delayed until later in the week.

What else are you watching? I'll be watching my inbox for your answers: