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Illustration: Sarah Grillo/Axios
There's a scientific and economic revolution happening in medicine, and the political debate over drug prices isn’t keeping up, my colleague Caitlin Owens writes.
The big picture: "We haven't really contemplated how we're going to absorb some of these things," Food and Drug Administration commissioner Scott Gottlieb said. "These are good problems to have … but they are policy challenges."
Where it stands: Congress is mainly squabbling over proposals to reduce prices by boosting competition. And with the exception of some very preliminary talk about the length of patent exclusivity period for biologics, they're mostly focused on traditional small-molecule generics.
But those regulatory tools were designed for a world in which pharmaceutical companies develop relatively simple drugs and try to market them to a big group of people. And science is rapidly moving away from that world.
The old dichotomy of a brand-name pill followed by a generic version of that pill doesn't just hold up for custom-made drugs. And even when new drugs aren't entirely individualized, many will still be targeted at smaller numbers of patients.
The bottom line: For now, Congress is focused mainly on areas where it can build consensus — and that means solving a lot of yesterday's problems, even as a new and wildly expensive future is already arriving.
I wrote yesterday that President Trump's health care agenda was hitting brick walls in the courts — and the hits keep coming.
Driving the news: A federal judge in Washington yesterday struck down the administration's expansion of association health plans, which allow similarly situated individuals to band together and buy insurance as if they were a company.
Context: Trump expanded association health plans alongside the expansion of bare-bones "short-term" plans, and both moves were cast as alternatives to the ACA.
Screenshot of the price disclosure in a new Xarelto ad.
Xarelto will be the first drug to include pricing information in its TV ads, even before the Trump administration finalizes rules that will require those disclosures.
Why it matters: There's been plenty of uncertainty about how this would work and what it will look like. The administration wants drugmakers to include list prices, which most people don't pay, and critics say that could give patients an unrealistically inflated view of their costs.
How it works: The Xarelto ad, which begins running today, shows the drug's $448 per month list price, then adds that most patients pay between $0 and $47, depending on their insurance.
A Florida man is capitalizing on the Trump administration's sudden legal reversal in an attempt to get off the hook for accusations of Medicare fraud.
Philip Esformes, who operated about 20 nursing homes in the Miami area, was arrested in 2016 and charged with committing $1 billion in Medicare fraud through a complex kickback scheme.
How it works: Some of the specific charges against Esformes stem from parts of the Affordable Care Act. They are, his lawyers say, among the specific sections of law that Judge Reed O'Connor invalidated when he threw out the entire ACA.
My thought bubble: This seems like the kind of thing a good prosecutor will probably find a way to wriggle out of. It also seems like the kind of thing career lawyers at DOJ would have caught, if they had been allowed to shape DOJ's position in the ACA case.
New data from the Health Care Cost Institute tries to pin down just how often patients end up with the most common form of a surprise hospital bill — the kind that arises when patients go to a hospital that's in their insurance network, but are seen by a doctor who's out-of-network.
By the numbers: Nationwide, about 14% of in-network hospital admissions included a bill for out-of-network care, per HCCI.
Go deeper: How to crack down on surprise medical bills
Brand-name EpiPen barely has any share of the epinephrine injection market these days — a swift change from 2015, when EpiPens controlled 89% of the market and Mylan earned congressional scrutiny for jacking up prices.
Yes, but: Mylan still owns the market through its "authorized" generic, Axios' Bob Herman notes.
Where it stands: The price for a pack of Mylan's generic EpiPens is $300, or about half the price of regular EpiPen.
What we're watching: Eli Lilly is mirroring Mylan's EpiPen strategy with its most popular insulin.
The bottom line: Drug companies can retain most or all of their turf by competing with themselves through their own generics.
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