What Happens When A State’s Medicaid Program Decides A Drug Isn’t Worth The Cost?

The New York Times: A Drug Costs $272,000 A Year. Not So Fast, Says New York State.
A wave of breakthrough drugs is transforming the medical world, offering hope for people with deadly diseases despite their dizzying price tags. But what if it turns out that some of these expensive new drugs don’t work that well? That’s the quandary over Orkambi, a drug that was approved in 2015 for cystic fibrosis and was only the second ever to address the underlying cause of the genetic disease. Orkambi, which is sold by Vertex Pharmaceuticals, costs $272,000 a year, but has been shown to only modestly help patients. (Thomas, 6/24)

ProPublica: FDA Repays Industry By Rushing Risky Drugs To Market
The FDA is increasingly green-lighting expensive drugs despite dangerous or little-known side effects and inconclusive evidence that they curb or cure disease. Once widely assailed for moving slowly, today the FDA reviews and approves drugs faster than any other regulatory agency in the world. (Chen, 6/26)

Modern Healthcare: Senate Pushes For Stronger Drug-Pricing Policy Than Trump Proposal
Members of the Senate Finance Committee on Tuesday called on the Trump administration to use stronger tactics to curb high drug prices than its tempered strategy unveiled last month. In its first hearing on the White House's drug pricing blueprint, lawmakers on both sides of the aisle pushed for price controls and broad-strokes negotiation. The central focus of the White House's proposal is moving Medicare Part B drug purchasing to the Medicare Part D model, in which prices are negotiated by pharmacy benefit managers. (Luthi, 6/26)

Stat: Most Americans Buy Trump's Idea To Force Pharma To Advertise Drug Prices
When the Trump administration released its blueprint for coping with high drug costs last month, one particular idea was widely derided — requiring drug makers to include list prices in consumer advertising. That’s because drug pricing is highly confusing and few people actually pay list prices. Nonetheless, the White House seems to believe that such transparency could force companies to compete on price. Whether or not this is correct remains to be seen, but for the moment, most Americans like the idea. (Silverman, 6/27)

Stat: As Pharma Eyes The Biosimilar Market, Its United Front Is Starting To Crack
The pharmaceutical industry’s massive lobbying operation has a well-earned reputation for maintaining a united front on most of the major policy proposals that could affect drug makers and their bottom lines. But as the industry eyes the burgeoning biosimilar market, that united front is starting to crack. For years, branded pharmaceutical and biotech manufacturers — largely represented by PhRMA and BIO — have clashed most often with generic manufacturers, largely represented by their own Association for Accessible Medicines. (Mershon, 6/25)

The New York Times: Diabetes Patients At Risk From Rising Insulin Prices
A surprisingly large number of people with diabetes are using less insulin than prescribed because of the rising cost of the drug, putting themselves in danger of serious complications. Those are the findings of a small new study by researchers at Yale University, who found that at one clinic in New Haven, Conn., one in four patients admitted to cutting back on insulin use because of cost. Everyone with Type 1 diabetes needs to take insulin, while about a third of those with Type 2 diabetes do. Not getting enough insulin can have severe consequences for someone with diabetes who does not produce enough of the hormone, which regulates levels of glucose in the blood. Within a week or so without insulin, people with Type 1 diabetes die. (Epstein and Strodel, 6/22)

Stat: Maine May Not Wait For Congress To Boost Generic Drug Development
As Congress considers a bill that would prevent brand-name drug makers from thwarting generic competition, Maine lawmakers are refusing to wait. The legislature recently passed a bill of its own and is now hoping the governor will sign the legislation into law. The bill attempts to address an issue that has frustrated generic drug makers for years — tactics by brand-name companies that make it difficult, if not impossible for generic companies to obtain needed samples for developing equivalent versions. (Silverman, 6/25)

The Washington Post: In May, Trump Predicted The Pharmaceutical Industry Would Cut Prices In Two Weeks. It Hasn’t Happened Yet.
President Trump said at the end of May that drug companies were about to make “voluntary, massive drops in prices” in two weeks. Two weeks later, Health and Human Services Secretary Alex Azar backed down from that timeline, testifying to Congress that drug companies “want to execute substantial material reductions in their drug prices” but were facing hurdles. Nearly four weeks out, the White House has not explained why nothing has happened on that front, but it continues to hint that news could be imminent. “We’re not going to get ahead of any forthcoming announcements,” deputy White House press secretary Hogan Gidley said in an email last week. (Johnson, 6/26)

Bloomberg: Finding Cancer Patients Is The Pharma Industry’s Unlikely Challenge
The world’s biggest pharmaceutical companies, looking to sell a new type of cancer drug that could transform treatment, are grappling with an unusual challenge: finding patients. The new medicines aim to shrink tumors by targeting a rare genetic anomaly -- appearing in 1,500 to 5,000 patients’ tumors in the U.S. annually -- that can spur cancer’s growth. Bayer AG is out in front with a drug that could go on sale by the end of the year. Roche Holding AG is pursuing the same target. (Kresge and Cortez, 6/20)

Stat: Scientists, Drug Makers Reach For 'Holy Grail' Of Diabetes Treatment
For decades, Americans living with diabetes have been relying on injections of insulin to manage their illness. Those injections can be painful — and inconvenient. Two new developments — one a newly released study and the other the publication of new clinical trial data — describe advances toward an alternative approach: the delivery of blood-sugar-regulating hormones in a pill, long regarded as the “holy grail” of diabetes treatment. (Chen, 6/25)

The Wall Street Journal: What Is Ailing The Drug Industry?
It’s a golden age for drug development, but the major pharmaceutical companies aren’t enjoying the good times. U.S. health-care spending regularly grows faster than inflation and has reached about 18% of gross domestic product. Prescription drugs are a major component of that sum. The Centers for Medicare and Medicaid Services projects that total U.S. drug spending will rise by 68% to $600 billion by 2026. Meanwhile, the Food and Drug Administration is approving new medicines at a brisk rate and venture capitalists have poured billions into biotech startups. (Grant, 6/22)

Stat: Ohio Peels Back The Curtain On A Lucrative PBM Profit Center 
As the debate over prescription drug costs accelerates, a new report shows two pharmacy benefit managers reaped more than $223 million by working on behalf of Ohio Medicaid plans during a recent 12-month period. And the findings are likely to intensify scrutiny of the roles these companies play in shaping pharmaceutical costs nationwide. From April 2017 through March 2018, CVS Caremark (CVS) and OptumRx billed $2.55 billion to a handful of managed care plans that administer Medicaid plans for Ohio residents. At the same time, the pharmacy benefit managers spent $2.3 billion for prescription medicines and services performed by pharmacies. This amounted to an 8.8 percent gain, or spread, of $223 million from a key profit center, according to the report. (Silverman, 6/22)

FiercePharma: Pfizer Doubles Price Of Smoking-Cessation Drug Chantix In Just 5 Years: Report
Pfizer’s smoking-cessation drug Chantix nudged closer to blockbuster status last year, bringing in $997 million in sales—up 18% from 2016. But some portion of that may have come from price hikes, judging from a new report released by GoodRx, an aggregator of pricing and discount information on prescription drugs. The price of a 30-day supply of Chantix has more than doubled to $485 since 2013, according to GoodRx. Sure, a big proportion of patients do get help paying for the drug from their health plans, but that assistance may not be so generous: Many insurers have relegated the drug to tier 3 status on their formularies, putting patients on the hook for high out-of-pocket costs, GoodRx reports. (Weintraub, 6/26)

Stat: Lawmakers Ask FTC To See If Pay-To-Delay Deals Are Thwarting Biosimilars
Two Washington lawmakers want the Federal Trade Commission to examine whether so-called pay-to-delay deals are preventing biosimilars from reaching Americans sooner than the drugs would otherwise and, consequently, are increasing costs for the health care system. In a letter to the FTC, Sen. Amy Klobuchar (D-Minn.) and Sen. Chuck Grassley (R-Iowa) argued there is reason for concern that the same controversial tactic used to thwart the arrival of lower-cost generics is being extended to biosimilars. (Silverman, 6/22)

Boston Globe: Roche Will Pay $2.4 Billion To Complete Its Takeover Of Foundation Medicine
The giant Swiss drug maker Roche is ponying up $2.4 billion for the rest of Cambridge-based Foundation Medicine, a cancer-focused gene-sequencing company that recently won approval for a diagnostic test aimed at personalizing cancer care. ...In November, federal regulators approved a diagnostic test by Foundation called FoundationOne CDx that can detect all four classes of alterations in 324 cancer-related genes that cause solid tumors. (Saltzman, 6/20)