Axios contributor Steve Brill says the apparent push from the administration and PhRMA for value-based drug pricing needs to be looked at carefully — because it could be PhRMA's Trojan horse to get traction on two long-sought agenda items.
First: The need to negotiate value-based contracts with insurers could result in the FDA waiving rules on marketing or promoting drugs off label. After all, Brill notes, how can a company talk about getting a bonus or paying a penalty for a drug's effectiveness in treating a wide range of illnesses, if it can't talk about how the drug might be used to attack that wide range of illnesses?
Second: The bonus and penalty regime could be a way for PhRMA to get Medicaid's "best price" rules thrown out — because in some instances the "best price" could be a deep discount, or zero, if the drug doesn't work for a particular patient or group of patients.
PhRMA's response: Spokeswoman Holly Campbell says there's broad agreement that "outdated regulations need to be modernized to keep pace with the shift to value in health care." To do that, she said, "biopharmaceutical companies need to be able to communicate with insurance companies about the potential benefits and risks of their medicines."
- But on Medicaid, Campbell said, "we need to modify – but not eliminate" the best price rules.