Senate tackles drug pricing

This is funny: There’s a fight brewing in the Senate over drug-pricing legislation. What’s funny about that? The two political sides are handling it like adults^* — disagreeing while remaining civil — while the PBMs and pharmaceutical companies are bickering, sniping at each other, and predicting the end of the world as we know it if they don’t get what they want.

The main provisions of the bill would try to prevent pharmaceutical companies from making minor tweaks to a drugs’ chemistry in order to extend the patents, and to cap the price of insulin at $35 a month for private insurance the way it is for Medicare and Medicaid.

^* Kids, ask your parents about the Long, Long Ago when the major parties disagreed on issues, but didn’t think the Other Side was actually evil.

ICYMI: Alzheimer’s drug

An FDA advisory panel voted unanimously to recommend full approval of Eisai’s lecanemab Alzheimer’s treatment. If approved, it stands a good chance of being covered by Medicare and Medicaid, so expect costs and premiums to shoot up for both Medicare/caid and private insurance.

Eisai is charging $26,500 per year per patient for the drug, which means it would cost Medicare $17.8 billion per year if only 10% of older Alzheimer’s patients take lecanemab. Perspective: NASA’s entire budget is only $23 billion.

Twist: CMS said it would cover the drug, but only for patients whose “physician and clinical team participate in the collection of evidence about how these drugs work in the real world.” That would mean using a trial registry of some sort, which as you might imagine has caused some consternation.

This was just a committee vote; a decision from the FDA is expected by July 6.

More Part B rebates a-comin’

Drug manufacturers will have to pay rebates on 25 more drugs if they raise prices faster than the rate of inflation. That brings the total to 43 drugs covered under that section of the Inflation Reduction Act, which allows the federal government to levy fines against drug manufacturers who raise the cost of Part B drugs higher than the rate of inflation.

That means, explained HHS, that Part B patients could see lower co-pays, co-pay rebates, or both.

Alcohol cuts stress

Moderate drinking, good or bad? It’s time to spin the ol’ wheel of destiny!

[whirrrrrr click click clack]

Today’s answer, courtesy of Mass General researchers, is that, “Alcohol in moderation may lower stress-related risk of heart disease.” How? By reducing the amount of stress signalling the brain does.

Brain: Aieeeeeee!!!

Alcohol: Yo, chill.

Brain: Oh, right. Mmmmmmm.

Cardiovascular system: Whew!

That said, they’re quick to point out that no, alcohol isn’t a good method of protecting your heart because it has plenty of detrimental effects that probably outweigh any stress reduction. Instead, they hope they can mimic the calming effect through non-alcoholic chemistry.

Drug shortages at 10-year high

The latest data from the American Society of Health-System Pharmacists shows that, as the headline says, drug shortages in the US have hit a 10-year high thanks to a combination of … well, we don’t know the reason for more than half the shortages. But of the ones we do know about, demand outstripping supply is the biggest issue, followed closely by manufacturing issues (e.g., a plant in India with, shall we say, contamination problems).

The FDA has said it will relax some of its rules to allow probably-just-fine meds into the country to help ease the shortages, but there’s not much else it can do. Cheap, safe, plentiful — pick any two.

The Long Read: Joy to the World? edition

How do you measure when a medication or treatment plan is working? There are obvious signs — the infection clears, the pain stops, the bone heals — but what about patients’ happiness?

The idea of measuring not just physical recovery but the overall effect on quality of life is gaining traction, as are ways to objectively measure that.

Experts are finding that a critical missing ingredient of modern health research is the ability to objectively measure changes in happiness over the long term, including throughout peoples’ experiences with illness, diagnosis and recovery.

Non-pharma interesting medical story of the day

You don’t often find a major discovery in the world of dentistry and yet Penn researchers have done just that.

A bacteria called Streptococcus mutans causes cavities — we’ve known that forever. (Technically it’s not S. mutans, but its acidic excretions.) But now it seems it has a partner in crime: Streptococcus sputigena.

S. sputigena is no saint — it can cause gum disease — but the Penn folks found that it also “can work as a key partner of S. mutans, greatly enhancing its cavity-making power.”

So what does this mean?

The findings […] show a more complex microbial interaction than was thought to occur, and provide a better understanding of how childhood cavities develop—an understanding that could lead to better ways of preventing cavities.