Let’s help patients, not PBMs

October 8, 2020
Today, we dig into the SCOTUS case addressing pharmacy benefit managers, and explain why we need to fix this system. Also, meet the winners of the Nobel Prize in Chemistry and learn why their technology is so important to human, animal, and environmental health. Here’s…
BIO

Today, we dig into the SCOTUS case addressing pharmacy benefit managers, and explain why we need to fix this system. Also, meet the winners of the Nobel Prize in Chemistry and learn why their technology is so important to human, animal, and environmental health. Here’s your Thursday news in 900 words, 4 and a half minutes.

 

Let’s help patients, not PBMs

 
 

The Supreme Court is hearing a case regarding the regulation of pharmacy benefit managers (PBMs), which BIO’s Chair Dr. Jeremy Levin says “drive up drug costs for patients through their complex system of kickbacks.” Here’s a look at the case and why it’s time to fix this system.

To start, what's a PBM? A third-party administrator of prescription drug benefits for a health plan, responsible for things like contracting with pharmacies, negotiating discounts and rebates with pharmaceutical companies, and processing and paying prescription claims.

On Tuesday, SCOTUS heard arguments in Rutledge v. Pharmaceutical Care Management Association, which examines an Arkansas law requiring PBMs “to reimburse pharmacies at or above their wholesale costs paid for generic drugs” and “prevents them from paying their own drug stores more than what is paid to other pharmacies,” says STAT News

“The law was aimed at protecting independent pharmacies from abusive pricing practices” and patient access to prescription drugs, explains Roll Call.

The PBMs won the initial lawsuit and subsequent appeals—and the Supreme Court’s decision could impact 40 states that regulate PBMs, as well as patients. 

Here’s why we need to fix the system: “[D]rug developers must offer rebates to secure a position on a PBM’s formulary, with the largest rebate winning preferred status,” explains Dr. Jeremy Levin, CEO of Ovid Therapeutics and Chair of BIO, in BioCentury. “To cover the rebates, drug developers increase the list prices of their drugs. Because patient copays are usually based on list prices, while the rebate sizes remain secret, this system of drug markups and rebates can add to out-of-pocket costs in meaningful ways—as much as 40% in many cases.”

Watch:

 
Why are patients facing higher costs at the pharmacy counter?
 

If policymakers are serious about lowering patients’ out-of-pocket medical costs, they can start by fixing the PBM system—and ensure drugmakers’ rebates are passed along to patients at the pharmacy counter instead of padding the pockets of middlemen. 

Read Dr. Levin’s op-ed for more ideas on how we can fix PBMs.  

 

More Health Care News:

Biopharma Dive: Lilly, with new data, seeks emergency clearance for COVID-19 antibody drug
“[Eli] Lilly aims to use one of its antibodies in higher-risk patients recently diagnosed with mild-to-moderate cases of COVID-19. But the drugmaker on Wednesday shared new findings suggesting a combination of two antibodies may help treat COVID-19 patients as well.”

Reuters: GSK to widen COVID-19 antibody treatment trial after safety clearance
“GlaxoSmithKline and partner Vir Biotechnology will expand their trial of an experimental antibody to treat COVID-19 after initial use by a group of volunteers did not raise any safety concerns.”

 
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CRISPR wins

 
 

Congratulations to Emmanuelle Charpentier and Jennifer Doudna, who just won a Nobel Prize in Chemistry for developing CRISPR, a tool that could help us solve some of our biggest human, animal, and environmental health challenges—if we have workable, science-based regulations. 

How they did it: “In a landmark 2012 paper in Science, the duo isolated the components of the CRISPR–Cas9 system, adapted them to function in the test tube, and showed that the system could be programmed to cut specific sites in isolated DNA,” says Nature.

In addition to its use in disease and crops, CRISPR has “tremendous promise for livestock agriculture, including improved animal care, production efficiency, and environmental impact,” said the National Pork Producers Council (NPPC) in response to the award announcement. 

As one example, gene editing could make pigs resistant to African swine fever, which is deadly for the pigs and decimates farmers’ livelihoods and rural economies. It’s now sweeping through Germany, Europe’s largest pork producer. 

But: The agriculture industry, including “academics, technology developers, farmers, and ranchers—especially livestock producers—are still waiting for some movement on regulation of animal biotechnology and gene-edited animals, currently under authority of the [Food and Drug Administration],” BIO’s Karen Batra recently explained.  

As we celebrate the scientists who developed CRISPR, we're also taking the opportunity to remind policymakers of the need for workable, science-based regulations of this technology—such as a national One Health framework and streamlined oversight of animal biotech innovation. 

Masters' Message:

 
Masters' Message on Nobel Prize in Chemistry
 
 
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I am BIO
Meet Lisa: Finding Purpose in Gene Therapy
I am BIO: Meet Lisa Carlton of REGENXBIO
 
 

Lisa Carlton got news no parent wants to hear: her daughter was diagnosed with tuberous sclerosis, a rare genetic condition that causes tumors or growths in the brain and other organs.

But it piqued her interest in rare disease—and gave her purpose in her career.

As Vice President of Regulatory Affairs at REGENXBIO, a gene therapy company that uses a virus to deliver a functioning or replacement copy of a gene to a cell, she uses her passion for biotechnology and the potential of gene therapy to advocate for patients with rare conditions.

Watch Lisa tell her story.

Visit www.bio.org/iambio to learn more and share your story!

 
 
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BIO Beltway Report
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President Trump’s Thursday: No public events scheduled. Last night, he posted a five-minute video on Twitter in which he discussed his COVID-19 treatment.

What’s Happening on Capitol Hill: If you missed the veep debate, The New York Times has a highlight reel and six takeaways. “The restrained sparring between Pence and Harris was a reminder of what politics was once like—and could be again,” says POLITICO. Meanwhile, the on-again/off-again coronavirus stimulus deal seems to be stalled, per The Hill.

 
 
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