May 17, 2018
'Naming and shaming' among the Trump administration drug price tactics

The initial reactions to the president's speech on drug prices last Friday ranged from negative to meh. The headline on the  Health Affairs blog post by Rachel Sachs was typical: "Trump's Drug Pricing Speech Breaks Little New Ground, Largely Spares Industry."
But this week, attitudes started to shift as the Azar-Verma-Gottlieb troika swung into action. 
The administration's efforts to lower drug prices depend on market dynamics, freer flow of information, and calling out bad behavior. How effective that will be is up for debate, but at least we are not stuck in the nihilistic status quo. 
HHS Secretary Alex Azar's speech on Monday ( full text is available here) had some colorful passages ("I've been a drug company executive--I know the tired talking points: the idea that if one penny disappears from pharma profit margins, American innovation will grind to a halt. I'm not interested in hearing those talking points anymore, and neither is the President") and some concrete proposals, including shifting Part B drugs to Part D and changing the rules for protected classes in the Part D program. 
On Tuesday, it was CMS Administrator Seema Verma's turn. She unveiled a new-and-improved drug spending dashboard for Parts B, D, and Medicaid. It includes many more drugs than the previous version and shows price changes over the past several years. The press release about the dashboard even went as far as singling out some of the drugs with double-digit annual price increases (Orencia among the Part B drugs, for example, and Renvela among the Part D drugs).
And today, the FDA posted a list of brand-name drugmakers who have purportedly fended off competition by not complying with requests to share samples of their products so potential generic or biosimilar makers can make copies. The New York Times quipped that while FDA Commissioner Scott Gottlieb calls it transparency, this approach is known among ethicists as "naming and shaming." 
Among the named companies on the FDA list and products they are protecting are Celgene (Pomalyst, Revlimid, and Thalomid), Actelion, which part of Johnson and Johnson, (Opsumit, Tracleer, Veletri, and Zavesca), and Gilead (Letairis, Truvada).
A dashboard for social determinants of health

Speaking of dashboards, the Department of Population Health at NYU's School of Medicine has developed a nifty dashboard for social determinants of health and other health-related measures. 
For some of the 36 metrics, you can drill down to the level of census tract. Tis amazing. 
Is it just us or does it seem like the world has woken up to the importance of the social determinants of health this year? 
Not-for-profit drugmakers could be the answer

Dan Liljenquist, a vice president at Intermountain, and two colleagues from Johns Hopkins make a case in a New England Journal of Medicine perspective piece this week that not-for-profit generic drugmakers could be the tamers of runaway drug prices. Of course, Intermountain and several other hospitals have set about to do just that with their Project Rx. 
Without stockholders to please, and even with a 10-fold markup to cover administrative and sundry other expenses, Liljenquist and his coauthors calculate that a nonprofit manufacturer could sell Daraprim at $3.50 per pill instead of Turing's price of $750. 
Keep an eye on Project Rx and whether it will be the remedy that Liljenquist and company envision.
Choosing Wisely relatively mum on cost 

In an opinion piece in this week's  JAMA about low-value care, Harvard's Ankur Pandya says that of the 435 health services included in the Choosing Wisely campaign, only 2% cite cost-effectiveness research to support the recommendation and less than a third (29%) of the rationales mention the word  cost or a term related to money or expense. 
Pandya is right: It's time to start baking financial considerations into the definition of low-value care. We're long past the time when cost (and price) was something that only insurers needed to fret about.
Check out Vinay Prasad's tweetorial on RCTs 

Prasad is not boring and good at Twitter. That can take you a long way in politics these days. And it doesn't hurt in health care. 
His clever, well-illustrated tweetorial this week on RCTs argues that we need them because most "biomedicine" has "putative benefits with modest or marginal effect size." 
Modest or marginal effect size? Is that all? "We should celebate that fact," Prasad tweetured, "that in contrast with most of human medicine over millennia that probably had no benefit or net harm we at last have many interventions with REAL modest or marginal effects." 
Envision, pilloried, fights back

Ellie Kincaid at Forbes  painted a pretty unflattering picture of Envision Healthcare, an outsourcing company for hospitals. Her article this week talks about the company facing a "barrage of criticism" from academic researchers, UnitedHealthcare (in the middle of legal battle with the company, the giant insurer "created a website for the express purpose of explaining to the world how bad Envision is"), and the U.S. Department of Justice. 
Envision pushed back with longish statement that said the academic research is flawed and payer-funded, that it has long-standing relationship with UnitedHealthcare and is negotiating a continuation of the contract, and that short seller John Chanos is on a "misguided crusade against Envision."
Dubious doctors still getting paid by Medicare

The Milwaukee Journal Sentinel and  MedPage Today have teamed up several times to do some important investigative health care reporting. 
This week they are at it again with a well-documented story about 216 doctors who are still getting paid by Medicare despite having lost their medical license in at least one state or after being excluded from a state-level program. 
If not shocking (what is anymore?) it's definitely disgraceful. And good work by the newspaper and the online medical news outlet to expose it. 
Why wasn't Azar invited to this party?

David Feinberg, Judy Faulkner, Scott Gottlieb, A. Marc Harrison, Seema Verma, Bernard Tyson-- Becker's Hospital Review list of 100 "great leaders" in health care includes many of usual boldface name suspects. Was Alex Azar deliberately left off the list?  
Profile of Eric Lander's critic

Michael Eisen's unsparing tweetstorm over the weekend forced MIT's Eric Lander to apologize for toasting James Watson. 
Stat profiled Eisen, a University of California-Berkley biologist, this week. The targets of his emotional, unbridled blog posts and tweets (39,000 of them) include not only Lander, but Francis Collins, scientific publishers, and universities and their pursuit of patents.

Peter Wehrwein
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