Axios Vitals

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June 08, 2022

🐪 Good morning, Vitals readers. Today's newsletter is 975 words or a 4-minute read.

Situational awareness: South Dakota voters rejected a measure during yesterday's primaries to make it harder for ballot initiatives that raise taxes or certain fees to pass, requiring 60% support rather than a simple majority.

  • What does that have to do with health care? The rule was aimed at a forthcoming Medicaid expansion ballot measure on November's ballot.

1 big thing: Exponential drug price growth

Illustration of a turn over pill bottle the pills forming an upward trending arrow
Illustration: Sarah Grillo/Axios

Nearly half of all drugs launched in the last two years initially cost above $150,000 a year, according to new research that's landing as Congress renews discussions about drug price controls.

Why it matters: The "exponential" growth during the pandemic offers more stark evidence of how pharmaceutical companies raised costs in the face of lawmakers' vows to enact price controls and even add them to COVID relief packages.

By the numbers: From 2008 to 2021, launch prices for new drugs increased by 20% per year, according to the research letter published in JAMA yesterday.

  • Prices rose 11% per year in 2020–2021, even after adjusting for manufacturer discounts and a shift toward more oncology and specialty drugs, said the researchers from the Program on Regulation, Therapeutics, and Law Brigham and Women's Hospital.
  • In contrast, overall health care spending typically increases around 5% annually.
  • Earlier this year, drug companies raised the prices on hundreds of existing medications, with most prices up 5% to 6% on average.

Between the lines: The researchers argue for the kind of prospective Medicare drug-price negotiations that are back in play as Democrats in Congress struggle to craft a slimmed-down Build Back Better package.

That's been a non-starter for the GOP, as well as the pharmaceutical industry, which says it could have a chilling effect on innovation.

The big picture: Key centrist Democratic Sen. Joe Manchin signaled he is ready to come to the table on a prescription drug price deal during an AARP event.

  • "By allowing Medicare to negotiate drug prices, capping the cost of insulin at $35 per month and allowing the importation of drugs from Canada, we can lower prescription drug prices in America," Manchin told AARP West Virginia members last week.
  • Manchin and Senate Majority Leader Chuck Schumer are discussing a revised bill that would, among other things, include drug pricing provisions from a House-passed BBB and make the 50 drugs with the highest spending in Medicare subject to negotiation. The drugs would have to be single-sourced, lacking a generic equivalent.

Yes, but: We've heard this kind of talk many times before. Even with Democrats eager for a win heading into the mid-term elections — and with compelling data charting rising drug costs — little has changed for months and the outcome is far from certain, per Cowen analyst Rick Weissenstein.

2. FTC launches PBM probe

Illustration of a pill with the dividing line in the shape of a dollar bill sign.
Illustration: Aïda Amer/Axios

After deadlocking on the issue earlier this year, the Federal Trade Commission is launching an inquiry into the business practices of pharmacy benefit managers and how they influence drug prices and the pharmacy business, Axios' Adriel Bettelheim writes.

The big picture: The prescription drug middlemen have been an increasingly prominent target of finger-pointing as players up and down the drug supply chain try to pass off blame for rising drug costs.

Driving the news: The FTC unanimously voted Tuesday to require the six biggest PBMs — CVS Caremark, Express Scripts, OptumRx, Humana, Prime Therapeutics and MedImpact Healthcare Systems — to turn over information and records.

  • There are no specific allegations of wrongdoing, but practices to be scrutinized include familiar points of contention like how PBMs negotiate drug prices on behalf of health plans and decide which medicines get preferential treatment, according to an analyst note from Evercore ISI.
  • "This study will shine a light on these companies' practices and their impact on pharmacies, payers, doctors and patients," said FTC chair Lina Khan in a statement.
  • The FTC in February deadlocked on a motion to study the highly concentrated PBM sector, but the recent confirmation of a fifth commissioner created a Democratic majority and changed the outlook for an investigation.

The other side: Some say the FTC should focus on the entire drug supply chain and not just on the middlemen to get at the root causes of price hikes.

  • The Pharmaceutical Care Management Association, which represents PBMs, says its members are doing what health plans ask and aren't pocketing what they extract from drugmakers.

3. Most hospitals failing price transparency rule

Six months after a federal price transparency rule went into effect in 2021, adherence to the rule by hospitals was low, according to new research published in JAMA on Tuesday.

Zoom in: Starting Jan. 1, 2021, the rule required hospitals to disclose five types of standard charges for all services in an accessible file, and have a consumer-friendly display for at least 300 shoppable services.

Yes, but: Only 6% of facilities covered by the rule were totally compliant.

  • Looking across roughly 5,000 hospitals, 14% of hospitals had had an adherent machine-readable file but no shoppable display.
  • About 30% had a shoppable display but no machine-readable file.
  • And more than half of hospitals had neither.

The intrigue: Acute care hospitals with less revenue per patient per day located in unconcentrated health care markets and in urban areas were more likely to be transparent.

  • "Greater scrutiny of hospitals without these characteristics may be needed to ensure hospital price transparency," the authors said.

4. Quote of the day

Peter Marks, FDA
Photo: Susan Walsh/Pool/AFP via Getty Images
"Anything we can do to make people more comfortable to accept these potentially lifesaving products is something we are compelled to do.”
— Peter Marks, the FDA's top vaccine regulator

Marks was discussing a key FDA advisory panel's recommendation Tuesday for emergency authorization of Novavax's COVID vaccine for use in adults 18 and older. Some members of the committee questioned whether the current situation constituted an "emergency."

5. Catch up quick

💰 Believing they were buying health insurance plans under the Affordable Care Act, a number of Texas-based consumers inadvertently bought into health care sharing ministries memberships, finding they had a lack of insurance the hard way. (KHN)

💉 California is getting into the drug business, announcing its new initiative called CalRx that it will produce its own brand of generic insulin and sell it at below-market prices. (Los Angeles Times)

💻 Massachusetts-based Shields Health Care Group had a health care cyberattack that may have exposed the public health information of at least two million people. (Health IT Security)