If best of biopharma industry were incarnated, would be as my friend Paul Hastings @phastings14, CEO of Nkarta, now Chair of BIO @IAmBiotech, & a good soul. Here’s his story & call for reforms: Lower OOP & make drugs go generic w/o undue delays. @NPLB_org vimeo.com/octo8er/review…
What Paul speaks to is very much aligned with the reforms supported by No Patient Left Behind (nopatientleftbehind.org), an organization I helped start and of which Paul is a personal supporter (see Life Science Builder page), as my firm and I support BIO. 2/8
Paul’s comments will make rent-seekers in our industry uncomfortable (companies that have gotten good at milking old drugs for high profits as if they still merit more reward for having been recently invented). Still, I know many within those companies who agree with Paul. 3/8
Our industry will evolve. We Builders (those who see that rewards for what we create/build should be finite, like mortgages) will eventually win over the Landlords who enjoy the easy street of collecting rents b/c we share the cause of winning insurance reform for patients. 4/8
Nothing in healthcare, not most drugs nor hospitals, is affordable to Americans w/o proper insurance. Out of pocket costs imposed by insurance/employers are just way of making insurance inaccessible, like a broken promise, even when one’s own plan agrees you need that treatment.
Paul has personal experience w/ inadequate insurance. He suffers from a chronic condition. He also knows what it’s like to wish for invention of a better medicine (& then make them). He’s speaking for best of our industry. Hopefully you’ll agree he’s speaking for you. 6/8
And personal addendum. Paul and I are both supporters of the Biotech Social Contract (what I discussed in my book thegreatamericandrugdeal.com & what he describes in the video above). However, we have different terms for it. 7/8
He refers to it as the Biotech Social Compact. If he can bring it about as Chair of BIO, we’ll makeup and I’ll switch to calling it that. Should be an open and shut case. (#dadjoke). 8/8

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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.
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. nature.com/articles/s4158…
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. timmermanreport.com/2021/03/a-glim…
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. nopatientleftbehind.docsend.com/view/mxht62ee3…
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. mass.gov/doc/presentati…
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 racap.com/courses
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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