🥊 Axios Vitals: The next matchup

Plus: You're paying too much for generics | Wednesday, June 01, 2022

Open in app View in browser   Presented By PhRMA   Axios Vitals By Tina Reed · Jun 01, 2022 Happy Wednesday, Vitals readers. It's June already. How did that happen? 🚨 Situational awareness: President Biden will convene a roundtable today on the U.S. baby formula supply with HHS Secretary Xavier Becerra, Surgeon General Vivek Murthy, and manufacturers including Gerber, Perrigo Company, Reckitt, Bubs Australia and ByHeart. Today's newsletter is 827 words or a 3-minute read.     1 big thing: America's latest "vaccine versus variants" matchup Illustration: Aïda Amer/Axios   Efforts to update COVID vaccines can't seem to keep up with changes in the virus itself, Axios' Caitlin Owens reports. State of play: Emerging variants appear to be even more immune-resistant than the original Omicron strain, raising the question of whether even retooled vaccines will be outdated once they come to market this fall. Driving the news: Preliminary data suggests the most recent Omicron subvariants to emerge are significantly different than the original version that began spreading late last year. Between the lines: Although drugmakers have said they can quickly adapt to produce new vaccine versions, collecting data on those vaccines' effectiveness through real-world clinical trials ultimately takes time. "It takes six months for the omicron BA.1 vaccines to be properly tested and then longer to produce them. That's inevitable," said Cornell virologist John Moore. What they're saying: "It's unclear what the mix will be in the vaccine that's used in the fall, but there's a very good chance that it'll be against the original Omicron," said Celine Gounder, an infectious disease specialist and Kaiser Health News editor-at-large. "It's pretty challenging. We're very much behind the virus given the speed at which it's moving," Gounder added. Yes, but: The jury is still out as to whether an Omicron-specific vaccine has significant benefits compared to the original version. The bottom line: Keeping up with a virus that is evolving this quickly is inherently in tension with collecting the data traditionally required to make big regulatory decisions. In this case, the implications are likely relatively minor. But if a more dangerous variant that requires new vaccines emerges, some very tough choices will have to be made. Go deeper.     2. Americans overpay for generics Illustration: Aïda Amer/Axios   U.S. consumers overpay for generic drug prescriptions by as much as 20% and it's largely because of the industry middlemen known as pharmacy benefit managers, according to a white paper from the USC Leonard D. Schaeffer Center for Health Policy & Economics. Why it matters: As we've previously written, PBMs are powerful, secretive and heavily consolidated, and have a big impact on drug prices in America. This report focuses specifically on generics, which account for more than 90% of U.S. prescriptions and 18% of drug spending. The big picture: PBMs are facing increasing scrutiny from both Congress and the Federal Trade Commission — as well as the now customary wrath of drugmakers, pharmacies, hospitals and patient groups. Among the strategies driving up costs for generics, the researchers said, are copay clawbacks where overpayments for drugs are pocketed by PBMs, as well as spread pricing where a PBM charges a health insurer a higher price for a drug than the amount it reimburses a pharmacy for — and pockets the difference. What they're saying: "Generics are overlooked when we talk about drug pricing issues in this country," said Erin Trish, co-director of the USC Schaeffer Center. "But the same lack of transparency that is causing outrage over high and rising spending on branded drugs is also creating issues in the generic drug space."     3. Insurers often opt out of paying for obesity drugs Illustration: Aïda Amer/Axios   A new crop of drugs received FDA approval to help fight obesity, but often insurers are refusing to cover the prescription medications, the New York Times reports. Why it matters: Obesity affects more than 40% of Americans and is linked to a larger number of chronic diseases that erode individuals' quality of life and drive up health care costs. The problem took on more urgency during the pandemic as COVID, on top of pre-existing conditions, made many Americans more vulnerable serious illness and death. What's happening: Insurers often categorize evidence-based obesity care such as obesity drugs and behavioral therapy as "vanity" care that falls beyond their coverage rules. But studies have shown that drugs can help a person with obesity lose up to 15% of their body weight compared to 5% seen with diet and exercise changes alone. The intrigue: Doctors sometimes prescribe the drugs for diabetes in an attempt to get coverage, per the Times. What they're saying: "Access to medicines for the treatment of obesity is dismal in this country," said Fatima Cody Stanford, an obesity medicine specialist at Massachusetts General Hospital and Harvard Medical School.     A message from PhRMA Voters want Congress to address health insurance     Many Americans reject so-called government "negotiation" once they learn it could sacrifice access, choice and innovation. The story: Respondents find health care coverage costs unreasonable and a top priority health care issue for policymakers to address today. Read more in the new survey.     4. What they're saying "It can't be the case that people come away from this thinking there's a certain level of fraud that's just OK..." — Michael Horowitz, head of the Pandemic Response Accountability Committee and inspector general of the Department of Justice in an interview with the Associated Press. He's pushing for more authority to go after fraud in the COVID-19 relief programs.     5. Catch up quick 🎙 Slate launches its four-part podcast series today called "Slow Burn: Roe v. Wade," examining the story of how we got Roe in the first place. (Slate) 💻 The VA is now required to report the performance and costs of its troubled EHR system rollout as Congress steps up its oversight of the project. (Fierce Healthcare) 🌳 HHS just announced a new Office of Environmental Justice within the department to address climate-related health issues particularly affecting poor and marginalized Americans. (The Hill)     A message from PhRMA Insured Americans face barriers to care     Nearly half of insured Americans who take prescription medicines encounter barriers that delay or limit their access to medicines. Learn more about the abusive insurance practices that can stand between patients and the care they need in PhRMA's new report.   Like this email style and format? It's called Smart Brevity®. Over 200 orgs use it — in a tool called Axios HQ — to drive productivity with clearer workplace communications.   Axios thanks our partners for supporting our newsletters. If you're interested in advertising, learn more here. Sponsorship has no influence on editorial content. Axios, 3100 Clarendon B‌lvd, Suite 1300, Arlington VA 22201   You received this email because you signed up for newsletters from Axios. Change your preferences or unsubscribe here.   Was this email forwarded to you? Sign up now to get Axios in your inbox.   Follow Axios on social media: