Axios Vitals: Insurers weigh Aduhelm's value

Plus: Pandemic is still very real in some states | Wednesday, June 23, 2021

Open in app View in browser   Presented By PhRMA   Axios Vitals By Tina Reed ·Jun 23, 2021 ☀️ Good morning. Today's newsletter is 677 words, or a 2½-minute read. But first: The Delta variant was top of mind when Axios' Dan Primack sat down to chat this week with former CDC director Tom Frieden for the Axios "Re:Cap" podcast. "It's a symptom that the virus is continuing to evolve. The virus is not done with us yet," Frieden said. Listen to the interview.     1 big thing: Health insurers leery of Aduhelm Photo illustration: Axios Visuals. Photo: Bill Clark/CQ Roll Call via Getty Images   The head of the health insurance industry's main lobbying group doesn't think the $56,000 annual price tag for Biogen's unproven Alzheimer's treatment, Aduhelm, is justified. But he won't call on insurance companies to deny coverage of it, Axios' Bob Herman reports. Instead, insurers are relying heavily on Medicare and an independent drug pricing group for their coverage decisions, Bob writes today in a Q&A with Matt Eyles, CEO of America's Health Insurance Plans. What he's saying: "This is not a cure, unlike what we had seen with the hepatitis C treatments. There are significant questions about efficacy, and I think that's why so many people are scratching their heads and figuring out what's the best path forward," Eyles tells Bob. Eyles points to the Institute for Clinical and Economic Review, which estimated a fair price is in the $2,500–$8,300 range. He adds that health insurers should make their own clinical and business decisions about future coverage of the drug. Go deeper: Top FDA officials thought scant evidence was enough to approve Alzheimer's drug     2. A window into Democrats' drug price plans Illustration: Rebecca Zisser/Axios   A senator with a key role in Democrats' efforts to lower drug prices yesterday released a list of high-level "principles" that will serve as a foundation going forward, Axios' Caitlin Owens reports. The document, published by Sen. Ron Wyden, chairman of the Finance Committee, outlines aggressive goals while leaving plenty of room for negotiating specifics. The principles include calling for Medicare to be able to negotiate drug prices, finding ways to extend savings to drugs covered by commercial and employer-sponsored plans, and ensuring drug prices reflect new innovation rather than "gaming of the patent system." Democrats have no margin for error in the Senate, and legislation lives or dies in the details.  "There are many details that can be dialed up or down to try to thread the political needle," said KFF's Larry Levitt. Of note: 👀 Wyden calls out Aduhelm by name.  "For some drugs, prices may be justified based on the remarkable clinical benefits they offer," the document states. "But many, like the recently-approved Alzheimer's drug Aduhelm, launch at prices far beyond any reasonable justification of the clinical value to patients, caregivers, or society."     3. Where COVID is still spreading the most Data: Centers for Disease Control and Prevention; Chart: Axios Visuals The coronavirus pandemic has essentially ended in some states, while others are still experiencing outbreaks, Caitlin writes. Why it matters: Stark disparities in case rates could be America's norm for a while. State of play: Some states saw an average of seven or fewer new cases per 100,000 people over the last week. On the other end of the spectrum, Missouri had 76 new cases per 100,000 people. For context, at its peak, South Dakota saw more than 160 new cases per 100,000 people a day. It's now logging four new cases per capita over the last week. Go deeper: White House acknowledges U.S. will miss July 4 vaccination goal     A message from PhRMA Out-of-pocket costs don't have to be out-of-this-world confusing     The way insurance covers your medicine is too complicated. What you pay out of pocket for medicines should be more transparent, more predictable and more affordable. Because the system should work for patients. Not the other way around. Get the facts.     4. 🛫 Nonprofit hospitals head abroad Illustration: Eniola Odetunde/Axios   In a bid to boost their bottom lines, a growing number of nonprofit hospitals are taking their business overseas. The big picture: With stagnant or declining revenues, about three dozen U.S. hospitals and health systems are searching outside the U.S. for patients and insurers willing to pay higher prices, Kaiser Health News reports. In one example, KHN points to Cleveland Clinic's planned outpost across the street from the Buckingham Palace Garden in London. It prompts questions about why nonprofits in the U.S., which are largely tax-exempt, would be able to pursue "such nakedly commercial ventures overseas," KHN writes.     5. Uneven uptick in pandemic traffic deaths Data: NHTSA; Chart: Danielle Alberti/Axios Americans drove fewer miles during the pandemic, but traffic deaths were up 7.2% last year, preliminary data from the National Highway Traffic Safety Administration shows. About 38,680 people died in motor vehicle traffic crashes last year, the highest projection of fatalities since 2007. Driving the news: Black people suffered the greatest increase in traffic fatalities (23%) last year, the Washington Post reported yesterday. Predominantly Black neighborhoods are less likely to have crosswalks, warning signs and other safety mechanisms — and more likely to have high-speed highways, Calvin Gladney, president of Smart Growth America, told NBC.     A message from PhRMA Out-of-pocket costs don't have to be out-of-this-world confusing     The way insurance covers your medicine is too complicated. What you pay out of pocket for medicines should be more transparent, more predictable and more affordable. Because the system should work for patients. Not the other way around. Get the facts.   Thanks for reading! Please invite your friends, family, colleagues to sign up here for Axios Vitals. Like this style and format? Request access to Axios HQ The tool and templates you need for more engaging team updates.   Axios thanks our partners for supporting our newsletters. If you're interested in advertising, learn more here. Sponsorship has no influence on editorial content. 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