Choosing the most expensive drugs

CMS is beginning the process of choosing Medicare’s 10 most expensive drugs — the medications it now has the power to negotiate the prices of*.

It’s not entirely simple; the agency first has to decide whether it will use gross or net spending (the latter considers discounts). Then it will look at total spending over a year and determine the top 10.

CMS said in January it would announce the list of 10 drugs in September. The agency will make its initial offers in February 2024 and the negotiation period will end that Aug. 1.

Capitalism at work: The buyer and seller will come to an agreement on pricing, which will take effect on January 1, 2026, saving taxpayers billions.

^* “… the prices of which it now has the power to negotiate” if you’re a Latin speaker

So many bad-pun headlines to choose from

Who would have thought that taking laxatives regularly could raise your risk of dementia? Yet here we are. In fact, found researchers in China and Boston, using them “most days of the week” increased dementia risk by 50 percent.

And those who used multiple types of laxative had an even greater risk — 90% higher than non-users.

The big disclaimer: “The study does not prove that laxatives cause dementia. It only shows an association.”

So what can you do?

Afraid of the Ex-Lax now? No worries — gastroenterologists at the Medical College of Georgia have the solution.

CMS rejects paying for Aduhelm or Leqembi — again

CMS said no, it’s not changing its stance on Alzheimer’s drugs. Medicare will only pay for drugs that have been approved through the FDA’s standard process, not the accelerated process. Specifically, it’s not going to pay for Aduhelm or Leqembi.

The Alzheimer’s Association immediately made it political, of course, but the reason behind the decision is simple: Neither drug has shown it makes a huge difference in the real world, which CMS said it requires to determine that a medication is “reasonable and necessary.”

Per the agency:

CMS will expeditiously review any new evidence that becomes available that could lead to a reconsideration and change in the [national coverage determination].

When remdesivir works

In the beginning, remdesivir was the go-to treatment for Covid-19, but it didn’t always work, and now we’ve got better stuff. (“Stuff” being nirmatrelvir/ritonavir, aka Paxlovid.)

But we never figured out why it only worked part of the time.

Enter the Swiss. University of Basel researchers wanted to know when remdesivir worked and when it didn’t. What they found was that “a specific group of patients benefits the most from the drug.”

What group? People who got, at most, conventional oxygen therapy. If they needed intensive ventilation support, it didn’t seem to help because the infection was too serious.

Will this make a difference? Probably not, with Paxlovid the go-to these days, but it does mean that remdesivir is worthwhile in milder cases.

FDA on the attack (kinda)

The FDA warned vape makers not to sell illegal products because, you know, they’re illegal. Most of the time the industry just ignores the law, but now the agency is showing how tough it is … by fining four smaller companies (of the 120 it warned more than a year ago) for ignoring the rules.

Non-pharma interesting medical story of the week

It kinda makes sense when you think about it: Wearable fitness devices like smartwatches that use electrical impedance (i.e., tiny electrical currents) to measure things like heart rate can interfere with pacemakers and other implanted cardiac devices.

“Bioimpedance sensing generated an electrical interference that exceeded Food and Drug Administration-accepted guidelines and interfered with proper CIED [cardiac implantable electronic devices] functioning.”