Redeeming Value

We're always more interested in ASCO presentations that focus on spending and prices than we are about the next great breakthrough -- we're stay-in-your-line types -- so we were excited to see new research quantifying the impact of oral oncology medicines on overall spending and out-of-pocket spending.  It turns out that both of those types of spending skyrocketed between 2011 and 2016, and we spoke with MD Anderson's Meng Li, who will present the underlying data this weekend at ASCO, about the findings.   

While Jan. 1 means sleeping off a campagne-induced hangover for many, for drug-price wonks, it means an opportunity to look at price-change behavior in the pharmaceutical market, as January is traditionally the month where most list-priceadjustments happen.   Antonio Ciaccia from 46Brooklyn and 3Axis Advisors, looks as closely at the data as anyone -- his Brand Drug Boxscore is required reading -- and has a good sense of the few times should care about list price changes, as well the many reasons why focusing too much on list price increases is ill-advised.  He joins us this month to get into the truths and the asterisks of talking about the January price-hike tradition.  

Calls for more involvement from the United States government in how medicines are priced have inevitably given rise to questions about the infrastructure required to adjudicate questions of value in medicine.   One possibility would be the establishment of a health technology assessment body -- common elsewhere in the world but historically viewed skeptically in the United States -- and Lou Garrison from the CHOICE Institute at the University of Washington spoke with us about the philosophical basis and practical realites of a U.S. HTA.  

Value-based insurance design (VBID) uses incentives to increase health care quality and to promote cost efficient health care services and consumer choices. But like all approaches to health care cost containment, VBID isn't one-size-fits-all. For VBID to be effective—that is, promote high-quality services and discourage use of low-quality care—incentives must embrace clinical nuance, using data to assess how clinical benefits vary by person, provide and site of service. Leslie shifts from our typical “supply side” perspective to talk health care demand and how VBID engages consumers in their own health decisions with Christine Juday, Vice President at Discern Health, Real Chemistry's consultancy focused on quality-based payment and delivery models. For more news about VBID and other value-based delivery models, sign up for Real Chemistry's Quality Report newsletter. LINK:  https://www.w2ogroup.com/quality-report-newsletter/

Launch prices in oncology have been rising -- a reflection, in part, of the growing clinical power of the medicines -- raising the question whether doctors, payers and others might try to push down prices of cancer medicines. Loncar Investment's Brad Loncar joins us to lend his perspective on the issue in a conversation that touches on the rise of Chinese biotech and the question of whether insurance companies are willing or able to intervene in the oncology market. 

The COVID-19 pandemic has served as a wake-up call for the healthcare ecosystem to recognize the urgencies of working together to achieve life-changing, economy-saving advancements. Leslie Isenegger interview Center for Medicine in the Public Interest President Peter Pitts about his new book, The Value Equation: A Journey Through the Innovation Ecosystem in the Time of COVID, in which he talks about the importance of failing fast, the evolving—and essential—patient voice, and why looking for health care  “good guys and bad guys” slows innovation for all.

Early legislative language from the House of Representatives on the newest COVID-19 stimulus bill includes a provision to remove the "rebate cap" in Medicaid. That has the potential to put drugmakers in a position where they are paying states every time certain medicines are prescribed. We interview West Health's Sean Dickson to understand how the program works and what the implications will be if the measure becomes law.   

Well, it's 2020, so it shouldn't be surprising that the United States awoke the morning after Election Day to uncounted ballots and unanswered questions. Fortunately, W2O Group Director Courtney Tyne joined the podcast to make sense of where things stand -- 12 hours after polls closed -- on drug pricing and access policy. The short version: expect more gridlock, no matter who is in charge.  It's likely that today is only the beginning of the unanswered questions, and if you need to pick Courtney's brain directly, please drop her a line.  

The Association for Accessible Medicines' new president and CEO, Dan Leonard, goes behind the mic to talk about the pathway to his new gig, the promise of biosimilars, what the 2020 election means for the generic drug industry, and why COVID-19 has underscored the public health impact of generic drugs.  Keep up with Dan on Twitter. 

Brian talks to Ted Slafsky, the founder and principal of Wexford Solutions and publisher and CEO of 340B Report. 340B -- the program under which certain health care entities that treat underserved populations can get reduced-price prescription drugs -- has become a flashpoint this year, with six pharmaceutical companies announcing plans to restrict how they provide medications under the program. Ted joined us to talk about how the brouhaha started, why it started now, and where things go next. 

Peter Kolchinsky, RA Capital's founder and managing partner, joins to talk about why so many of the policy ideas floated around drug-pricing are wrongheaded. Industry is going to have to give "a pound of flesh," Kolchinsky argued, and he's explicit on the business practices biopharma must abandon to get a fair system that still rewards innovation.  Peter literally wrote the book on the topic -- the Great American Drug Deal -- and it's well worth having on your bookshelf. 

PRECISIONheor Vice President Jason Shafrin pops in to talk about the Institute of Clinical and Economic Review and the broader question of where the group's influence is centered and the elements of ICER reports that stakeholders are paying attention to.  For more from Jason, check of his work at Healthcare-Economist.com.

Brian talks to Jason Buxbaum, who worked with Harvard's David Cutler and others to determine what interventions drove the 3.3-year increase in life expectancy between 1990 and 2015. 

With Donald Trump (probably) ready to give his first major address on drug pricing, W2O's Brian Reid and Ariel Gonzalez go beyond the policy proposals that might be included to look deeper at the politics of it all. 

Brian and Rita talk about whether the JPMorgan Chase/Amazon/Berkshire Hathaway collaboration can revolutionize health care (Rita is confident; Brian: no so much).  And they play a clip from last week's Health Affairs/National Pharmaceutical Council conference featuring Amitabh Chandra from Harvard explaining why all of the slam-dunk ideas for saving money in health care have failed. 

Brian Reid and Rita Glaze launch "Redeeming Value," W2O Group's bi-weekly examination of health system value, drug pricing, reimbursement, patient access and more.  In the first episode, Reid and Glaze discuss the value conversation -- and lack thereof -- at the J.P. Morgan Healthcare conference last month.