April 19, 2018
Increases in specialty drug costs to slack off a wee bit

Magellan has come out with its 2018 employer market report today. The full text is available here. If you're like us and enjoy feasting on drug spending numbers, you're in for a tasty banquet.
To absolutely no one's surprise, specialty drugs are in the pharmacy benefit driver's seat, according to Magellan. The report projects that specialty drugs will account for nearly half (48%) of drug costs by 2020, up from 39% in 2017. And in 2020, two thirds (65%) of that specialty drug cost will be for medications for autoimmune diseases, cancer, and HIV/AIDS, says the report. 
Yet Magellan's crystal ball also shows the increases in specialty drugs costs easing off a bit from 17.8% this year to 10.6% in 2019 and to 11% in 2020. Contributing factors, says the report, include the number and amount of price increases for specialty drugs and the contraction of the market for the hepatitis C drugs.
Steve Miller is OK with this drug price

Speaking of specialty drugs, the FDA announced on Tuesday that it had approved   Crysvita (burosumab-twza), a monoclonal antibody used to treat x-linked hypophosphatemia, a rare inherited form of rickets. The disease, according to the FDA, affects about 3,000 children and 12,000 adults in the United States. The agency gave Crysvita the red carpet treatment: breakthrough and orphan drug designations and a rare pediatric disease priority review voucher
Ellie Kincaid at Forbes reported that the Crysvita will have a net price of $160,000 for children and $200,000 for adults and that Steve Miller, the chief medical officer for Express Scripts who has railed against high prices set by pharma, is fine with that. 
"It's not inexpensive, but I do believe the right word is responsible," Miller told Kincaid.
A third of MIPS/QPP measures deemed 'invalid'  

Those MIPS/QPP performance measures, they don't measure up, according to the American College of Physicians' Performance Measurement Committee. 
In a perspective piece in this week's New England Journal of Medicine (full text available), committee members Catherine H. MacLean and Eve A. Kerr (and a third author, Amir Qaseem, ACP's vice president of clinical policy) applied ACP criteria for assessing performance measures to 86 MIPS/QPP measures related to ambulatory general internal medicine. By their reckoning and the ACP criteria, 30 (35%) of those measures are invalid and 24 (28%) are of uncertain validity. 
Screening elders for abuse is one of the invalid measures MacLean, Kerr, and Qaseem discuss in  NEJM. It's a serious problem, they say, but they also point to  USPSTF rating the evidence for routine screening as insufficient. They also mention the requirement that  all [emphasis added] patients have a blood pressure of 140/90 or lower. In keeping with ACP's 2017 revision of its blood pressure guidelines, they say that "forcing blood pressure down to this threshold could harm frail elderly adult and patients with certain coexisting conditions." 
Alexa, tell me about Amazon and health care 

CNBC and its health-meets-tech correspondent, Christina Farr, reported this week that Amazon was giving up on plans to sell pharmaceuticals to hospitals and clinics. Instead, Amazon Business, which sells bulk items to business customers, is going to concentrate on "less sensitive" items. 

Stat  revisited the rise and fall of Qliance, the now-defunct direct primary care practice in Seattle that Jeff Bezos invested in. The Stat article is behind a paywall but not the piece about direct primary care that Charlotte Huff wrote for our September 2017 issue.

Bezos's letter to shareholders this week included a Ted-talky sermonette about setting and reaching high standards, news that Amazon Prime members has over 100 million members, and a shout out to good writing ("clarity of angels singing") that editors and English teachers will save on their desktops.

Conspicuous by its absence was any mention of that Amazon/Berkshire Hathaway/JP Morgan heath care slay-the-tapeworm thingamajig.  
Cigna's purchase of Express Scripts merger is not a done deal 

Cigna confirmed this week that the Justice Department is reviewing its proposed $54 billion acquisition of Express Scripts. It remains to be seen whether department is just sniffing around or will make a move to block the deal. 
It has been previously reported that the Justice Department has sought information from both CVS Health and Aetna about their proposed merger. 
A web search today didn't turn up news about government scrutiny of the proposed Walmart-Humana deal, but maybe there has been and it hasn't been reported yet.  
In any event, many legal experts think this batch of mixed-marriage health care mergers is less likely to prompt antitrust objections than the mergers of Cigna and Anthem and Aetna and Humana. The Justice Department moved to block those deals, and federal judges eventually made rulings that kept them from happening. 
Pass-through status could have a perverse effect on biosimilar prices

Our colleague, Mimi Chen, posted an explanation of biosimilar pricing on our website yesterday 
One of her takeaways is that pass-through status for biosimilars might make them more expensive for patients than reference products. 
Yes, more expensive. 

Mimi explains it well.
'King Keytruda' rules at Merck

Results presented at the meeting of the American Association for Cancer Research this week and published at the same time in the  New England Journal of Medicine showed that adding to Keytruda (pembrolizumab) to the standard chemotherapy for metastatic non-small-cell lung cancer had marked effect on overall survival (69.2% in the treatment group at 12 months vs. 49.4% in the placebo group) and on other endpoints. Matthew Herper at  Forbes calculated that at the end of 21 months, an extra two patients out of every 10 were still alive because of the addition of Keytruda.
The  Wall Street Journal reported this week that Merck has dumped other drugs so now more than half of its budget for clinical trial studies are devoted to trials involving Keytruda. The  Journal called it "one of the biggest bets on a single drug in the pharmaceutical industry. "
Politico takes a tough look at Patrick Kennedy

Kennedy's mental health and substance use disorder not-for-profit organization is supported by drug markers and addiction treatment companies, reported  Politico, and his total compensation from the organization from 2014 to 2016 was more than $1 million. 
We interviewed Kennedy for our January issue. He made good points about parity issues. It was moving when he spoke about his and his family's struggles with mental health illnesses and substance use disorders. But  Politico's tough-minded reporting puts Kennedy and his organization in a new, and unflattering, light. 
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