It seems @icer_review’s heart is showing a little in today’s report on essential compassion & fairness of proper insurance w/ low OOP costs for medicines. But they still have a lingering attachment to math that’s been rightly criticized as racist...… 1/ patient advocate @SuePeschin in this short, incisive piece.… I wonder if it’s a bit uncomfortable for policymakers ICER claims to have influenced w/ its math. After all, #badmathkills 2/
.@icer_review says if medicines for kids w/ sickle cell disease don’t make the cut according to their math (which @SuePeschin has pointed out is deeply flawed), insurance should make those meds unaffordable to them (w/ high OOP costs) as leverage over drug companies. Harsh.
So why? B/c @icer_review thinks cutting novel but high-priced drugs is best way to lower premiums for everyone, blaming such drugs (<10% of HC costs) for why many patients can’t afford insurance. How about first eliminating $800b of waste (10 administrators for every doctor). 4/
.@icer_review doesn’t care that today’s high-priced drugs are tomorrow’s inexpensive generics and that, for all those high costs, the drug industry’s overall profit margins are ~10%, leaving little room for price cuts. ICER pushes into bone, into R&D itself. 5/
Can we hope that as @icer_review’s heart thaws, scope of its thinking might broaden? Will it open its math up to include variables it’s been leaving out (eg drugs go generic, hospitals don’t!)? If it did, that would flip many previously “overpriced” drugs to be worth it. 6/
Until then, politicians might want to pay close attention. Some may be implicated in #badmathkills as patients continue to beseech @icer_review to stop rounding down the value of their lives (making it harder to continue funding R&D into better treatments for those disease). 7/
Better still, let’s echo @SuePeschin’s call: “Congress should pass a universal ban on using QALYs for coverage and reimbursement decision-making.” @SpeakerPelosi @ChuckGrassley 8/
.@LauraArnoldFdn please pass along to John. You guys are virtuous on democracy & mass incarceration but have remained rather... lean... on healthcare reform debate. Engage please. Don’t “block” out the feedback. 9/9

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More from @PeterKolchinsky

7 May
Some think patents stand in way of making more vaccines. They don’t. Skill & money do. Just as most of us couldn’t replicate Mona Lisa (no IP there), few can make advanced vaccines. Vaccine companies have already partnered w/ all skilled producers they could find to make doses. Image
The reason they have already liberally partnered is b/c incentives were there to do so & competition among companies spurred them to get to market first. All those big contracts offered enough reward that innovators shared their knowledge & reward w/ manufacturing partners.
Anyone who didn’t partner with others to expand manufacturing knew that other companies would to sell more doses first, shrinking market for others (especially since wasn’t always evident there would be a long term booster market for laggards).
Read 18 tweets
26 Apr
This Nature paper makes strong case that any COVID, not just serious disease & hospitalization, jacks up risk of many health problems for many months thereafter (long COVID). What’s it mean for vaccines? Durably high protection matters, & boosters.…
More specifically, it means that when you hear about vaccines that protect by 70% but claim “yeah, but protects 100% against severe diseases”, know that the 30% residual risk of getting even mild-moderate COVID comes with more risk than we thought. It’s risk worth avoiding.
So right now, get whatever vaccine you can. mRNA seems better than adenoviral and inactivated vaccines. Get booster when offered, both to protect against new variants & old ones, b/c immunity wanes.
Read 14 tweets
28 Mar
Do patient groups perceive drug price controls (HR3) will end progress in treatment of many diseases? Cancer, Alzheimer’s, Parkinson’s... done. HR3 not benign. Price controls always kill investment in risky R&D. No “alternative” economics on that point.…
Some patient advocacy groups I’ve spoken with say “we don’t want to be seen defending drug industry”. And yet, as w/COVID, that’s who develops the treatments- that’s where hope comes from. What’s the point of having standing and pathos if you won’t use it to defend what’s right?
Some say “no, NIH invents drugs.”. They misunderstand. NIH builds foundation but not the product. It makes prototypes at best. But it’s takes the $160B of R&D each year to bring ~50 drugs/year to market... to patients.…
Read 11 tweets
28 Mar
Everything wrong w/ healthcare & drug pricing debate is evident in these slide. Healthcare costs in Massachusetts grew at 4.3% (slide 32). On 33, they report drug spending grew 7.2% gross of rebates. On 34, they show it’s only 3% growth net of rebates.…
Conclusion on slide 55 blames drug prices for Medicare spending growth, yet in footnote acknowledge its “not net of rebates”. Well why not? They clear know net drug spending growth is lower than almost every other aspect of healthcare. It’s clearly hospitals driving growth.
They talk about hospitals, but highlighting drugs is willful misdirection. As for patients’ costs, slide 42 & 47 shows shift towards higher out of pocket costs. So even as drug spending shrinks as a fraction of healthcare spending, Americans afford less & blaming drug costs.
Read 8 tweets
3 Mar
Last Call! Apply by Thu March 4th for Spring 2021 “Business of Biotech” discussion sessions (Wed, 3-5pm ET, March 10/17/24). If can’t make it, our virtual Thinkific materials (listed below) are available indefinitely & more discussions to come. Register at
RA Capital hosts course b/c we are inspired by all that we've seen the biotech industry accomplish for human health, have learned a lot of the past couple of decades, and want to share lessons learned so that biotech can be even better than it has been.
And now more than ever, we think it's important for everyone in biotech to understand and unite around Biotech Social Contract that governs what the public expects of innovators and insurance.
Read 25 tweets
21 Feb
Summary of Clubhouse chat (thanks @BiotechCH)... 5 injustices in a drug NPV model... 1) <100% of patients getting drug they need due to inability to afford out of pocket costs is injustice we mustn’t accept and therefore must push for insurance reforms that lower OOP costs....
2) assumptions of continued high profitability into out-years (eg >15 years) due a drug being hard or impossible to genericize (eg biologics, esp gene therapies) have a far greater cost to society than their contribution to the NPV.
That’s b/c society’s costs are net revenues discounted at 1.5-2%/year but NPV only counts out-year profits discounted at a much higher rate (~8%). So public & Congress is right to challenge drug prices but it’s not that they are too high... it’s that they are high for too long.
Read 25 tweets

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