Axios Vitals: Dem drug bill's bite

Plus: A boost for updated Covid boosters | Wednesday, July 27, 2022

Open in app View in browser   Presented By Pharmaceutical Care Management Association   Axios Vitals By Adriel Bettelheim · Jul 27, 2022 We're halfway to the weekend, Vitals fans. Today's newsletter is 897 words, or a 3-minute read. Join me and Axios' Caitlin Owens today at 12:30pm ET for a virtual event examining the path forward for health care in a post-pandemic world. Guests include Centers for Medicare and Medicaid Services administrator Chiquita Brooks-LaSure and Rep. Fred Upton (R-Mich.). Register here.     1 big thing: Dem drug bill targets old blockbusters Illustration: Aïda Amer/Axios   Democrats' push to allow Medicare to negotiate prescription drug prices has been limited to older drugs without generic competition, but even so, many of the program's costliest medicines would still be eligible, Axios' Caitlin Owens writes. Why it matters: Direct government negotiations would plug some holes in a system that's now dependent on market competition to contain prices. But there are a lot of holes, and even older drugs with generic competition can cost the federal government billions of dollars each year. State of play: The scaled-back plan that Democrats landed on limits the number and type of drugs subject to negotiations yet has plenty of bite, because nearly all of the drugs that cost Medicare the most money — at least in 2019 — are older, according to a Kaiser Family Foundation analysis from January. By the numbers: Of the 20 Part B drugs and the 20 Part D drugs that cost Medicare the most money in 2019, more than half would still qualify for negotiations, unless new generics or biosimilars come to market, per KFF. Yes, but: Drug companies can recoup whatever money they lose from lower negotiated prices on old blockbusters by raising the launch prices of new drugs, some analysts say. The bottom line: For all of the consternation about exempting new drugs from negotiations, excluding drugs with generic competition would be costlier. Go deeper.     2. Updated COVID boosters could be fast-tracked Illustration: Sarah Grillo/Axios   The Biden administration is trying to speed up development of updated COVID-19 vaccines that better protect against the BA.5 subvariant, and could scrap plans to expand the availability of existing shots this summer, NPR reported. Why it matters: Immunity from earlier vaccinations or infections is wearing off, and a potential fall surge could result in a peak of around 1,500 deaths per day, according to a Commonwealth Fund analysis. The intrigue: Federal officials are weighing whether to broaden eligibility for existing boosters to all adults or to focus on a fall vaccination campaign built around reformulated vaccines. State of play: The FDA is trying to get Moderna and Pfizer-BioNTech to make more potent "bivalent" boosters available as early as September, instead of October or November, NPR reported, citing sources familiar with the situation. If that can be achieved, the FDA would drop plans to make fourth shots of the original vaccines more widely available this summer. But there's concern in some public health circles about waiting, partly because it's unclear if BA.5 will be the prevalent strain by fall and winter. Look ahead: A robust early fall vaccination campaign could prevent as many as 160,000 more deaths and avert between $63 billion and $109 billion in direct medical costs, depending on vaccine uptake, the Commonwealth analysis found. In one scenario, a campaign could run in tandem with seasonal flu shots. The analysis didn't address the specific variety of vaccine.     3. Wuhan market pinpointed as COVID Ground Zero Illustration: Aïda Amer/Axios   A market in Wuhan, China, was the epicenter of the COVID-19 pandemic, and the virus emerged from activities connected with the live animal trade, according to research published in Science on Tuesday. Why it matters: The case-mapping and genetic studies offer some of the strongest evidence yet that the coronavirus jumped from an animal host to humans and didn't escape from a laboratory. What they found: There were two lineages of the virus introduced in humans as early as November 2019. The variants over time spread into the neighborhoods surrounding the market and beyond, challenging the idea the market was the source of a single superspreader event. Early cases linked to the part of the market where wildlife sales took place resemble cross-species transmissions later observed on mink farms and from infected hamsters to humans in the pet trade. Flashback: A World Health Organization-backed team of scientists said in June that available data suggests SARS-CoV-2 had a zoonotic origin and that the lab-leak theory needs "further investigations," per the Washington Post. The bottom line: Accurately determining the causes of COVID-19 will go a long way toward informing what can and should be done to prevent the next pandemic. Go deeper.     A message from Pharmaceutical Care Management Association PBMs support lower insulin costs for patients     Drug manufacturers alone set insulin prices. The INSULIN Act is a windfall for Big Pharma and will inflate insulin costs by $23 billion for the federal government and billions more for state governments and the health care system. Learn more about PBM's efforts to lower patients' insulin costs.     4. Challenge to ACA puts cloud over HIV coverage A legal challenge to the way the Affordable Care Act requires coverage of preventive services is putting a focus on medication that prevents HIV and whether it should be fully paid for by insurance, Axios' Oriana Gonzalez writes. Driving the news: Jonathan Mitchell, Texas' former solicitor general, argues that mandatory pre-exposure prophylaxis, known as HIV PrEP, violates the Religious Freedom Restoration Act. Under the ACA, most health insurers have to cover recommended preventive services, including HIV testing for people aged 15-65 and HIV PrEP for adults who are at high risk of getting HIV. What we're watching: If Mitchell and his clients prevail, HIV PrEP — which can cost upward of $20,000 a year and is prescribed to tens of thousands of people — would become harder to access. Go deeper.     5. Catch up quick The Biden administration estimated that it may need nearly $7 billion to mount a response to the monkeypox outbreak. (Washington Post) President Biden completed his five-day course of the antiviral Paxlovid, and his COVID-19 symptoms are "almost completely resolved," his physician reported. (Axios) Teva, one of the biggest makers of generic opioids, reached a tentative $4.25 billion settlement with states and localities over its role in the addiction crisis. (New York Times) Health providers sued to challenge Georgia's six-week abortion ban on privacy grounds, saying it could give district attorneys authority to access medical files without a subpoena. (Axios)     A message from Pharmaceutical Care Management Association PBMs support lower insulin costs for patients     Drug manufacturers alone set insulin prices. The INSULIN Act is a windfall for Big Pharma and will inflate insulin costs by $23 billion for the federal government and billions more for state governments and the health care system. Learn more about PBM's efforts to lower patients' insulin costs.   Why stop here? Let's go Pro. 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