As JP­Mor­gan mad­ness sub­sides, De­moc­rats will un­veil a leg­isla­tive pack­age to ad­dress drug price hikes

On the night be­fore the start of JP Mor­gan — a con­fer­ence where bio­phar­ma ex­ec­u­tives big and small waxed lyri­cal about in­no­va­tion, adorned with name badges fea­tur­ing a gold DNA cap­sule — Pres­i­dent Don­ald Trump tweet­ed his dis­plea­sure that drug­mak­ers were not hon­or­ing their promis­es to rein in prices. He wasn’t wrong. Da­ta sug­gest drug­mak­ers have re­turned to busi­ness as usu­al. And now, af­ter De­moc­rats clawed back con­trol of the House, they’re ex­pect­ed to un­veil a leg­isla­tive pack­age to­day to ad­dress what the White House has so far at­tempt­ed in vain to do: cut prices for pre­scrip­tion drugs.

At least three bills are be­ing tout­ed in the pack­age — in­clud­ing one re­vealed last No­vem­ber from Sen­a­tor Bernie Sanders and Rep­re­sen­ta­tive Ro Khan­na that as­serts Amer­i­cans should not pay more for pre­scrip­tion drugs than the me­di­an price in five ma­jor coun­tries, re­sem­bling a Trump ad­min­is­tra­tion pro­pos­al pre­sent­ed the pre­ced­ing month. Oth­er parts of the leg­is­la­tion pro­pos­es al­low­ing HHS to ne­go­ti­ate prices for Medicare Part D di­rect­ly with drug­mak­ers, in­stead of mid­dle­men like phar­ma­cy ben­e­fit man­agers — as well as im­port­ing med­i­cines at a low­er price from coun­tries such as Cana­da.

Last year, un­der pres­sure from the Trump ad­min­is­tra­tion and in re­sponse to pub­lic out­rage, a num­ber of high pro­file drug­mak­ers made pledges to freeze prices. Since then, the Trump ad­min­is­tra­tion has al­so in­tro­duced two pro­pos­als to tem­per prices. But de­spite in­ten­si­fy­ing po­lit­i­cal and me­dia scruti­ny, drug­mak­ers have re­turned to hikes on at least a por­tion of their port­fo­lio. That in turn has trig­gered an in­tense pub­lic back­lash, which is dri­ving this new leg­isla­tive on­slaught.

The phar­ma­ceu­ti­cal in­dus­try, along with its well con­nect­ed lob­by, has ve­he­ment­ly fought against pro­pos­als to im­port over­seas prices, sug­gest­ing such schemes will sti­fle in­no­va­tion and po­ten­tial­ly ush­er un­safe med­i­cines in­to the coun­try.

Stephen Ubl, CEO of PhRMA, at an End­points News event at the 2019 JP Mor­gan con­fer­ence Jeff Ru­mans for End­points News

Click on the im­age to see the full-sized ver­sion

How­ev­er, da­ta show that de­spite the high cost of health­care, the Unit­ed States ac­tu­al­ly per­forms worse across var­i­ous health mea­sures ver­sus a num­ber of oth­er high-in­come na­tions. And Amer­i­cans them­selves are des­per­ate­ly seek­ing change: at­tack­ing drug price goug­ing is one of the few sub­jects that has wide­spread bi­par­ti­san sup­port. Ac­cord­ing to a re­cent Politi­co/Har­vard poll, an over­whelm­ing ma­jor­i­ty of Amer­i­cans ranked ad­dress­ing the cost of med­i­cines as a top pri­or­i­ty for the new Con­gress.

On Wednes­day, for­mer Lil­ly ex­ec­u­tive and HHS sec­re­tary Alex Azar tweet­ed: “For those lis­ten­ing in the phar­ma­ceu­ti­cal in­dus­try: The list price in­creas­es must stop. Prices must start com­ing down.”

But an­a­lysts are not as con­vinced po­lit­i­cal pres­sure will have the im­pact some an­tic­i­pate. Bern­stein’s Ron­ny Gal in a note in No­vem­ber 2018 wrote: “phar­ma does not have to be as nice to PO­TUS now that CMS has pol­i­cy ideas that are an­ti­thet­i­cal to in­dus­try in­ter­est…At the very least, threat­en­ing to raise prices gives in­dus­try a bar­gain­ing chip to ne­go­ti­ate some of these poli­cies away.” More re­cent­ly in Jan­u­ary, Cowen an­a­lysts pub­lished a sur­vey of US drug buy­ers — in­clud­ing HMOs, PBMs and hos­pi­tals who col­lec­tive­ly bought more than $42 bil­lion in drugs in 2017 — to as­cer­tain the mo­men­tum of US drug prices over the next 3 years.

“Re­spon­dents ex­pect U.S. brand drug prices will con­tin­ue to rise over the next 3 years, at a rate sim­i­lar to the past,” the an­a­lysts found.

When asked about the flur­ry of de­bate sur­round­ing the is­sue of pric­ing, Bio­Marin chief Jean-Jacques Bi­en­aime said “It’s not a re­al prob­lem; it’s all pol­i­tics” in an in­ter­view with Bloomberg on the eve of JP Mor­gan.

Con­quer­ing a silent killer: HDV and Eiger Bio­Phar­ma­ceu­ti­cals

Hepatitis delta, also known as hepatitis D, is a liver infection caused by the hepatitis delta virus (HDV) that results in the most severe form of human viral hepatitis for which there is no approved therapy.

HDV is a single-stranded, circular RNA virus that requires the envelope protein (HBsAg) of the hepatitis B virus (HBV) for its own assembly. As a result, hepatitis delta virus (HDV) infection occurs only as a co-infection in individuals infected with HBV. However, HDV/HBV co-infections lead to more serious liver disease than HBV infection alone. HDV is associated with faster progression to liver fibrosis (progressing to cirrhosis in about 80% of individuals in 5-10 years), increased risk of liver cancer, and early decompensated cirrhosis and liver failure.
HDV is the most severe form of viral hepatitis with no approved treatment.
Approved nucleos(t)ide treatments for HBV only suppress HBV DNA, do not appreciably impact HBsAg and have no impact on HDV. Investigational agents in development for HBV target multiple new mechanisms. Aspirations are high, but a functional cure for HBV has not been achieved nor is one anticipated in the forseeable future. Without clearance of HBsAg, anti-HBV investigational treatments are not expected to impact the deadly course of HDV infection anytime soon.

No­var­tis is ax­ing 150 ear­ly dis­cov­ery jobs as CNI­BR shifts fo­cus to the de­vel­op­ment side of R&D

Novartis is axing some 150 early discover jobs in Shanghai as it swells its staff on the drug development side of the equation in China. And the company is concurrently beefing up its investment in China’s fast-growing biotech sector with a plan to add to its investments in local VCs.

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Democratic presidential candidate, U.S. Sen. Elizabeth Warren (D-MA) speaks during the Nevada Democrats' "First in the West" event at Bellagio Resort & Casino on November 17, 2019 in Las Vegas, Nevada (Getty Images)

Eliz­a­beth War­ren pro­pos­es us­ing com­pul­so­ry li­cens­ing, an­titrust ac­tions to break bio­phar­ma’s con­trol of drug pric­ing — and here are the block­busters she’s tar­get­ing first

Nancy Pelosi’s drug pricing bill may have sparked some industrial strength headaches on the money side of biopharma, but Elizabeth Warren seems determined to become biopharma’s Nightmare on Pennsylvania Avenue.
Warren, one of the top-ranked candidates for the Democratic presidential nomination backing Medicare for all, is circulating a new plan that promises to break the industry’s grip on drug prices — and she has some very specific examples of how she would do it.
The Warren plan would rely on the federal government’s compulsory licensing powers to seize the IP of blockbuster drugs like Truvada and Harvoni to provide them at a fraction of what Gilead sells them for in the US. And she would throw some antitrust actions in as needed to rein in the price of Humira, AbbVie’s cash cow that continues to dominate the list of the most profitable therapeutics on the market.
Notably, she plans to rely on the powers already vested in the federal government, rather than suggest remedies that would require the assent of a deeply divided Congress.
In addition to the blockbusters on the list, Warren sends a clear signal that the same tactics would be used to beef up the supply of cheap antibiotics, as needed. And the same action could befall any other therapy patients can’t afford.

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Mer­ck’s $1B cash gam­ble pays off with a sur­pris­ing PhI­II car­dio suc­cess for Bay­er’s heart drug veri­ciguat

More than 3 years after Merck stepped up and paid $1 billion in cold, hard cash to gain the US commercial rights to Bayer’s high-risk heart drug vericiguat in a broad-ranging cardio alliance, the partners say their Phase III study has come through with promising data and a date with regulators.
We don’t have the data, and won’t until they put it out at an upcoming scientific session, but Merck touted the results, saying that their big Phase III VICTORIA study hit the primary endpoint  — with vericiguat combined with available therapies reducing “the risk of the composite endpoint of heart failure hospitalization or cardiovascular death in patients with worsening chronic heart failure with reduced ejection fraction (HFrEF) compared to placebo when given in combination with available heart failure therapies.”
Depending on the hard data, and how it breaks out with the combinations used, this drug could pose a threat to Novartis’ blockbuster drug Entresto, currently at $1.6 billion while analysts expect peak sales to hit $4 billion.
The drug is a soluble guanylate cyclase (sGC) stimulator, which Bayer and Merck have had high hopes for. Evidently, so did cardiologists. Cowen’s last analysis set potential sales at $400 million in 2024, but that number could go up significantly now.
Cowen’s Steve Scala noted this morning:
Vericiguat could be a lucrative product for Merck, and one with potentially under-appreciated value. At Cowen’s Therapeutics Conference in September 2019, 80% of specialists anticipated a positive result from VICTORIA whereas only 51% of investors shared this optimism.
Investigators recruited more than 5,000 patients at more than 600 centers in 42 countries for this study — one of the most expensive propositions in R&D. Millions of people in the US suffer from heart failure with reduced ejection fraction when the failing heart fails to contract properly to eject blood into the system. Bayer holds ex-US rights to the drug and also stands to earn cash from the $1.1 billion in milestones Merck agreed on for their collaboration.
Remarkably, the drug was pushed into Phase III despite failing the mid-stage trial — though investigators flagged a success at the high dose of 10 mg. In VICTORIA, researchers started patients at 2.5 mg and then titrated up to 5 and then 10 mg.

Alk­er­mes forges $950M biotech buy­out deal in a bold bet on an ear­ly-stage CNS drug plat­form

Alkermes $ALKS is investing $100 million cash and committing up to $850 million more in milestones in a big wager on a very early-stage CNS discovery platform. And the biotech is adding $20 million more to fund next year’s new research work on the platform it’s acquiring in today’s buyout with an eye to expanding the research work in oncology.

The biotech, helmed by Richard Pops, is buying Rodin Therapeutics, which had focused early on Alzheimer’s disease. Pops’ buyout, though, isn’t focused solely on the most troublesome sector in pharma R&D.

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Left to right: Arthur Pappas, Robert Nelsen, Peter Kolchinsky Doug Cole and David Beier

In rare po­lit­i­cal for­ay, top biotech in­vestors urge Con­gress to re­ject drug pric­ing bill

Thirteen of the top biotech venture capitalists in the country wrote a letter last week warning lawmakers that if Congress passes a drug pricing bill House Speaker Nancy Pelosi has put before lawmakers, they won’t be able to invest in biomedical research at their current rate, and patients will suffer.

“If policies such as those included within H.R. 3, the Lower Drug Costs Now Act, are passed, our ability to continue to invest in future biomedical innovation will be severely constrained, thus crushing the hopes of millions of patient waiting for the next breakthroughs to treat or cure their cancers, rare genetic diseases, Alzheimer’s, or other serious and life-threatening conditions,” they wrote in a letter addressed to the highest-ranking Democrats and Republicans in the House and Senate and acquired by Endpoints News. 

Dicer­na scores broad, 'rest of liv­er' deal with No­vo Nordisk, bag­ging $225M in cash to hit some 30 tar­gets with RNAi plat­form

Turns out Dicerna wasn’t done with deals yet after locking in $200 million upfront from Roche for a hepatitis B cocktail two weeks ago.

Novo Nordisk has signed on as the latest partner to its GalXC RNAi platform, handing over $175 million in cash to claim any and all targets of interest in liver-related cardio-metabolic diseases that are not already reserved in previous pacts. The Danish drugmaker — which has signaled its interest to expand considerably beyond its core diabetes franchise into areas like NASH — is also purchasing $50 million worth of Dicerna’s equity at a 25% premium of $21.93 per share. More research payments and milestones extending to the billions are on the line.

Gene ther­a­py wins the in­side track at EMA; PPD files for IPO

→ Gene therapy maker Orchard Therapeutics has been granted an accelerated assessment for OTL-200 by the EMA’s Committee for Medicinal Products for Human Use (CHMP). The gene therapy — in development in partnership with the San Raffaele-Telethon Institute for Gene Therapy (SR-Tiget) in Milan, Italy — being used towards the treatment of metachromatic leukodystrophy.

→ Pharmaceutical Product Development has announced that its parent company, PPD, Inc has submitted a draft to the SEC relating to the proposal of an IPO of the parent company’s common stock. Number of shares and price range have not yet been determined.

Pfiz­er gets biosim­i­lar ap­proved for Hu­mi­ra, set­ting up com­pe­ti­tion — in 2023

In the story lawmakers and drug pricing reform advocates have told about the drug industry, there are perhaps few greater villains than Humira and its maker AbbVie.

Between 2012 and 2018, AbbVie upped the drug’s annual after-rebates cost from $19,000 to $38,000 in the US, with sticker prices now over $60,000 per year — increases that led to accusations of price gouging, most recently from Democratic presidential frontrunner Elizabeth Warren.