Joe Biden (Carolyn Kaster, AP Images)

What about the Ger­man ne­go­ti­a­tion mod­el? Biden steers drug pric­ing de­bate to a show­down

From an ill-fat­ed pro­pos­al to ban re­bates for phar­ma­cy ben­e­fit man­agers to an ex­ec­u­tive or­der de­mand­ing a “most-fa­vored-na­tion price” for Medicare, if noth­ing else Pres­i­dent Don­ald Trump has in­tro­duced Amer­i­cans to a flur­ry of ideas to rein in phar­ma, an in­dus­try he once ac­cused of “get­ting away with mur­der.” And now we’re get­ting the first glimpse of what a Joe Biden pres­i­den­cy might mean for pre­scrip­tion drug pric­ing.

Speak­ing to a press pool last week, Biden sug­gest­ed he is in fa­vor of a vari­a­tion of the Ger­man mod­el — where drug­mak­ers must un­der­go na­tion­al lev­el ne­go­ti­a­tion for both gov­ern­ment and com­mer­cial in­sur­ance.

The ap­proach would give an in­de­pen­dent group the pow­er to es­ti­mate the “fair val­ue” for any giv­en ther­a­py, Bern­stein an­a­lyst Ron­ny Gal not­ed, and would cov­er both new­ly in­tro­duced and ex­ist­ing drugs.

While crit­i­cal de­tails are still miss­ing, Gal reck­oned that un­der this pro­pos­al, phar­ma com­pa­nies can like­ly still charge high­er prices than they could un­der the in­ter­na­tion­al pric­ing in­dex, a yet-to-be-im­ple­ment­ed Trump pol­i­cy that in­dus­try ex­ecs have blast­ed as “rad­i­cal” and “hor­ri­ble.”

Gal wrote:

It would be fair to point out that once this mech­a­nism is es­tab­lished, it be­comes rel­a­tive­ly easy for Con­gress to re­set drug prices by chang­ing the dol­lar val­ue as­signed to QALY. Thus, this would be in ef­fect, mov­ing away from free mar­ket price set­ting for drugs. How­ev­er, it is much bet­ter than bench­mark­ing in­ter­na­tion­al prices (IPI) and if this is the start­ing po­si­tion of the de­mo­c­ra­t­ic front run­ner ahead of the elec­tion ahead of ne­go­ti­a­tions in Con­gress… it cer­tain­ly could have been worse

QALY, or qual­i­ty ad­just­ed life year, will be the key vari­able. If a Biden ad­min­is­tra­tion fol­lows ICER, the in­de­pen­dent drug price watch­dog, and sets the val­ue of a QALY as $100,000 to $150,000, which would in ef­fect keep the same gap in US and Eu­ro­pean pric­ing. At least the­o­ret­i­cal­ly.

“Some drugs will do bet­ter, oth­ers worse,” he rea­soned. “How­ev­er, there will not be a whole­sale rat­ing of US prices low­er.”

Bernie Sanders and Eliz­a­beth War­ren, Biden’s top ri­vals on the pri­ma­ry cam­paign trail, had promised to uti­lize the fed­er­al gov­ern­ment’s com­pul­so­ry li­cens­ing pow­ers to break patents on block­buster drugs to sub­due un­co­op­er­a­tive play­ers. But Biden stood out as one of the on­ly De­mo­c­ra­t­ic can­di­dates whose plat­form didn’t fea­ture this pol­i­cy.

No­tably, though, De­moc­rats in Con­gress do seem to sup­port more ag­gres­sive reg­u­la­tions. Nan­cy Pelosi’s sig­na­ture health­care bill in­clud­ed a pro­vi­sion that echoes the in­ter­na­tion­al pric­ing in­dex and passed the House, where she had a ma­jor­i­ty, be­fore get­ting shot down in the Sen­ate. It is un­clear if Con­gress would play a role in set­ting pric­ing or ap­peal mech­a­nisms un­der Biden’s pro­pos­al.

Oth­er ques­tions — or “dev­il is in the de­tails” is­sues as Gal put it — that are still un­re­solved in­clude whether there will be a set price or a sug­gest­ed ceil­ing; and when it would be im­ple­ment­ed.

Im­ple­ment­ing re­silience in the clin­i­cal tri­al sup­ply chain

Since January 2020, the clinical trials ecosystem has quickly evolved to manage roadblocks impeding clinical trial integrity, and patient care and safety amid a global pandemic. Closed borders, reduced air traffic and delayed or canceled flights disrupted global distribution, revealing how flexible logistics and supply chains can secure the timely delivery of clinical drug products and therapies to sites and patients.

In fi­nal days at Mer­ck, Roger Perl­mut­ter bets big on a lit­tle-known Covid-19 treat­ment

Roger Perlmutter is spending his last days at Merck, well, spending.

Two weeks after snapping up the antibody-drug conjugate biotech VelosBio for $2.75 billion, Merck announced today that it had purchased OncoImmune and its experimental Covid-19 drug for $425 million. The drug, known as CD24Fc, appeared to reduce the risk of respiratory failure or death in severe Covid-19 patients by 50% in a 203-person Phase III trial, OncoImmune said in September.

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Pascal Soriot (AP Images)

UP­DAT­ED: As­traZeneca, Ox­ford on the de­fen­sive as skep­tics dis­miss 70% av­er­age ef­fi­ca­cy for Covid-19 vac­cine

On the third straight Monday that the world wakes up to positive vaccine news, AstraZeneca and Oxford are declaring a new Phase III milestone in the fight against the pandemic. Not everyone is convinced they will play a big part, though.

With an average efficacy of 70%, the headline number struck analysts as less impressive than the 95% and 94.5% protection that Pfizer/BioNTech and Moderna have boasted in the past two weeks, respectively. But the British partners say they have several other bright spots going for their candidate. One of the two dosing regimens tested in Phase III showed a better profile, bringing efficacy up to 90%; the adenovirus vector-based vaccine requires minimal refrigeration, which may mean easier distribution; and AstraZeneca has pledged to sell it at a fraction of the price that the other two vaccine developers are charging.

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Bob Nelsen (Photo by Michael Kovac/Getty Images)

Bob Nelsen rais­es $800M and re­cruits a star-stud­ded board to build the 'Fox­con­n' of biotech

Bob Nelsen spent his pandemic spring in his Seattle home, talking on the phone with Luciana Borio, the scientist who used to run pandemic preparedness on the National Security Council, and fuming with her about the dire state of American manufacturing.

Companies were rushing to develop vaccines and antibodies for the new virus, but even if they succeeded, there was no immediate supply chain or infrastructure to mass-produce them in a way that could make a dent in the outbreak.

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Carl Hansen, AbCellera CEO (University of British Columbia)

From a pair of Air Jor­dans to a $200M-plus IPO, Carl Hansen is craft­ing an overnight R&D for­tune fu­eled by Covid-19

Back in the summer of 2019, Carl Hansen left his post as a professor at the University of British Columbia to go full time as the CEO at a low-profile antibody shop he had founded called AbCellera.

As biotech CEOs go, even after a fundraise Hansen wasn’t paid a whole heck of a lot. He ended up earning right at $250,000 for the year. His compensation package included a loan — which he later paid back — and a pair of Air Jordan tennis shoes. His newly-hired CFO, Andrew Booth, got a sweeter pay packet than that — which included his own pair of Air Jordans.

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Leonard Schleifer, Regeneron CEO (Andrew Harnik/AP)

Trail­ing Eli Lil­ly by 12 days, Re­gen­eron gets the FDA OK for their Covid-19 an­ti­body cock­tail

A month and a half after becoming the experimental treatment of choice for a newly diagnosed president, Regeneron’s antibody cocktail has received emergency use authorization from the FDA. It will be used to treat non-hospitalized Covid-19 patients who are at high-risk of progressing.

Although the Rgeneron drug is not the first antibody treatment authorized by the FDA, the news comes as a significant milestone for a company and a treatment scientists have watched closely since the outbreak began.

Bahija Jallal (file photo)

TCR pi­o­neer Im­muno­core scores a first with a land­mark PhI­II snap­shot on over­all sur­vival for a rare melanoma

Bahija Jallal’s crew at TCR pioneer Immunocore says they have nailed down a promising set of pivotal data for their lead drug in a frontline setting for a solid tumor. And they are framing this early interim readout as the convincing snapshot they need to prove that their platform can deliver on a string of breakthrough therapies now in the clinic or planned for it.

In advance of the Monday announcement, Jallal and R&D chief David Berman took some time to walk me through the first round of Phase III data for their lead TCR designed to treat rare, frontline cases of metastatic uveal melanoma that come with a grim set of survival expectations.

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Am­gen sev­ers 14-year Cy­to­ki­net­ics part­ner­ship, bail­ing on ome­cam­tiv af­ter mixed PhI­II re­sults

Amgen is shrugging off a 14-year development alliance and the tens of millions of dollars spent to develop a new heart drug at Cytokinetics after a Phase III trial turned up weak data — leaving Cytokinetics to soldier on alone.

Omecamtiv mecarbil technically worked, meeting the primary composite endpoint in the Phase III GALACTIC-HF study. But it missed a key secondary endpoint, which analysts had been following as a key marker for success — reduction of cardiovascular (CV) death. While Cytokinetics celebrated the results, its stock tanked 43% upon the news, and analysts warned of an uncertain path ahead. Now, Amgen wants out.

News brief­ing: Ab­b­Vie part­ner Teneo­bio ex­pands tech li­cense with CAR-T play­er Po­sei­da; Ar­genx buys PRV from Bay­er for $98M

Teneobio may be best known for its pact with AbbVie and Gilead, but before its big break the bispecific player had licensed its antibodies for a different use: as binders in CAR-T therapies being developed by Poseida.

Now, the biotechs are expanding their partnership, with Poseida exercising four options to deploy Teneobio’s heavy chain only domain antibodies commercially.

The commercial licensing fees remained under wraps, but Teneobio is eligible for $250 million in milestones for these CAR-Ts against undisclosed targets.