Thread.

"[Prasad] and Høeg have also seized control from career scientists who run the FDA’s vaccine surveillance programs... Prasad and Høeg are changing procedures rapidly and with little input from career staff. They have not discussed their ideas in a public forum..."

As the ~discourse~ seems to bend interminably towards Republicans trying to figure out how they can (further) HDHP-ify ACA coverage, it's worth revisiting what is probably our best (most rigorous) study on the effect of deductibles in health insurance. academic.oup.com/qje/article-...

I don't think that Trump has any specific health care plan to point to — he never has — but Cassidy is a different story. He was advocating for "Roth HSAs" back in 2017 and 2017, in the lead up to the ACA's near-repeal. From Tim Jost in 2017:

Glad to join the @healthaffairs.bsky.social This Week podcast to discuss my recent Forefront article with Kristi Martin about the 2028 Medicare Drug Price Negotiation final guidance. It's timely, as we await the announcement of the 2027 negotiated prices. www.healthaffairs.org/do/10.1377/h...

Lots of thoughts regarding today's White House announcements on drug pricing policies for GLP-1s and the Medicaid drug pricing model. But clouding all of this are the 4 patients I saw today in clinic who asked me about food pantries due to their SNAP benefits being cut and... #MedSky

There are a lot of very interesting design choices in this model. A brief thread. 1/4

1: "In return for dropping prices, Novo and Lilly each received a priority review voucher, which guarantees a regulatory decision within one to two months." Also 2: "agency watchdogs have worried that the program may primarily be a way to hand out political favors rather than advance public health."

Drug pricing law/policy experts have many questions going into this announcement. For those watching, here are just a few important ones. 1. What's the form of the "deal"? Is it a model through CMMI (as suggested in @ddiamond.bsky.social's reporting)? How enforceable is the deal (and by whom)? 1/6

Important new analysis from @matthewherper.bsky.social and @lizzylawrence.bsky.social about the ongoing situation at FDA. This quote from an agency staffer sums up the potential concerns. www.statnews.com/2025/11/04/f...

Tidmarsh posted on LinkedIn w/ fair concerns abt how FDA uses surrogate endpts. But the drug example he named didn't make sense, except maybe for Tidmarsh's personal connection to that drugmaker's board chair...who has now filed a complaint w/ FDA, after the post caused the co's stock to drop 16%.

CDER Director Tidmarsh said "he believed the new [voucher] program injected politics into the drug review program, superseding decisions based on science" and "raised concerns about [its] legal basis." www.nytimes.com/2025/11/02/h... 1/3

"CBER employees are concerned that the exodus of employees and the worsening morale problems will affect the functioning of the center, which ensures the safety and efficacy of vaccines and helps speed potentially lifesaving therapies to rare disease patients."

New: As open enrollment is about to begin, we estimate ACA insurers are raising premiums by an average of 26%. But if enhanced tax credits expire, 22 million enrollees will see their payments increase by way more than that, more than doubling. www.kff.org/quick-take/a...

Important reporting from @lizzylawrence.bsky.social, finding that "[f]ive companies actively applied, while the other four were surprised to learn they were selected after being nominated by reviewers inside the agency." This is another important way the program has changed without public input. 1/4

Excited to see this published as part of @jhppl.bsky.social's 50th anniversary edition! The balance between the role of the government and the private sector even in traditionally public programs has continued to evolve in ways which may become even more important in the future.

CBO has now revised its estimate of the reconciliation law's expansion of the orphan drug exemption to the Medicare Drug Price Negotiation Program, increasing its estimated cost from $4.9 billion to $8.8 billion. A few thoughts. 1/4 www.cbo.gov/publication/...

FDA has updated their CBER/CDER net hiring data for FY 2025. Although both Centers grew in FY2023 and FY2024, in FY2025 they've lost ~16-18% (respectively) of staff, over a thousand people at CDER alone. www.fda.gov/industry/fda...

FYI to other FDA National Priority Voucher watchers: yes, the July version of the website did say that "no more than 5" vouchers would be given out "during the initial year." (Screenshot below.) That language is not present in the current version of the website. www.fda.gov/industry/com...

Great reporting by @lizzylawrence.bsky.social. Great, insightful quotes from @reshmagar.bsky.social, @nathancortez.bsky.social & @rachelsachs.bsky.social. Not great news, to say the least, for public health, innovation, or any of us.

Useful new analysis from @mattafiedler.bsky.social: A specific — and arguably particularly consequential — effect of allowing enhanced ACA subsidies to lapse is that net-$0 plans would become far less available. Matt estimates this change, alone, would cause over 400,000 people to lose coverage.

Now up at Health Affairs Forefront, Kristi Martin and I analyze CMS's final guidance for the 2028 cycle of the Medicare drug price negotiation program, including key provisions that CMS both did and did not change from the draft guidance. www.healthaffairs.org/content/fore...

Zero-claim enrollees would be risk-pool-improving and premium-reducing. Reasonable people can debate whether/to what extent the increase in zero-claim enrollees might reflect increased broker-driven fraudulent enrollment, but not whether that enrollment increases (individual) premiums.

Glad to see my piece with Hayden Rooke-Ley on consolidation in the pharmaceutical wholesaler market out now in @nejm.org. Back in April, @bobjherman.bsky.social called this an "under the radar" issue - hopefully that's beginning to change. www.nejm.org/doi/full/10.... 1/2

Narrator: It is not a reasonable cash price.

On May 12, the White House issued an MFN EO in the morning and CMS issued the IPAY 2028 draft guidance in the afternoon. There was another MFN announcement today, and now CMS has issued the final guidance for IPAY 2028 this afternoon. Looking forward to reading. www.cms.gov/priorities/m...

"[I]t all happened without it being clear to the outside world exactly what Pfizer had given up or what the United States has gained. (Much will depend on the details of the agreements laid out Tuesday.)" Pfizer described the agreement as "voluntary" and "confidential," exacerbating this challenge.

Today's White House fact sheet doesn't clearly address this issue. It states that it "guarantee[s] MFN prices on all new innovative medicines" but does not state whether those are list prices or net prices. It would've been easy to clarify if it meant net prices. www.whitehouse.gov/fact-sheets/...

Now we have a fact sheet released by the White House. It does not provide clear answers to most of the Qs below. www.whitehouse.gov/fact-sheets/...

Drug pricing is complex, and the answers to Qs like these are critical for understanding the impact of any announcement. Which drugs are going DTC? Which patients are eligible? Can they afford $100s/1000s per month out of pocket? When companies tout "lower prices," list or net? In which programs? /1

ICYMI last week, reposting this @kff.org analysis from @jcubanski.bsky.social and @tricia-neuman.bsky.social about the reconciliation law's changes to the Medicare negotiation program that are expected to keep prices higher for longer for both Medicare and beneficiaries. www.kff.org/medicare/peo...

While we wait for more info on what, exactly, the pharma tariff announcement applies to, reupping this March piece from @martawosinska.bsky.social on pharma tariffs, including how Medicare/Medicaid inflation rebates may limit companies' ability to pass them through. www.brookings.edu/articles/pha...

Those who don't subscribe to the Federal Register might be missing some very unusual developments today on the leucovorin front. There's a notice that FDA is approving a previously withdrawn NDA for leucovorin tablets. That in itself is unusual. /1

Yes! Exactly the types of affordability/access divides that VFC was created in ‘94 to address. (And it’s done so!) The immediate issue here is a pretty niche one—15% of families who opted for a non-preferred option for 1 dose of 1 vaccine—but likely a harbinger of more consequential changes to come.

Thread. ACIP's reversal this morning imposes new financial barriers to accessing the MMRV vaccine for VFC-eligible families, while AHIP's public statements mean that privately insured families will continue to have access with no cost-sharing, at least for now.

True. (And even though not all insurers are part of AHIP—UnitedHealth, most notably—I suspect they’ll all just ignore the ACIP chaos and stay the course.) Bigger complication of this outcome is probably for CHIP, as someone mentioned in the replies

As others have noted, this vote would end the ACA requirement for private insurers to cover these vaccines. BUT recall that AHIP just announced health plans "will continue to cover all ACIP-recommended immunizations... recommended as of September 1, 2025" through 2026. www.ahip.org/news/press-r...

Thread (with context regarding the kinds of questions ACIP members were asking, for further support for Jason's conclusion).

Many new ACIP members claim to want people to be able to choose whether to receive certain vaccines. But some of their votes would remove certain vaccines from VFC purchasing, significantly limiting people's ability to afford them. Stunning that some members appear to not understand this point.

Thread. As @adrianna.bsky.social notes, the scoring system for these funds is confusing. Some elements are scored anywhere from 0-100 based on the "quality of details" in an application. Others are binary - either 0 or 100 (below). Others are tiered - 0, 25, 50, 75, or 100 points. /1

Deeply researched article detailing the Trump admin’s “deliberate and targeted attack” on cancer research. Attacks on NIH are compounded by efforts to undermine FDA (causing many cancer drug reviewers to depart) and to patients’ ability to get and retain insurance. www.nytimes.com/2025/09/14/m...

Thread. Super interesting new article with implications for a wide range of important topics in health policy, including hospital finances, patient outcomes, hospital capacity, insurance design, and more.

As some states move to make COVID vaccines broadly accessible and require insurers to cover them, keep in mind one thing: States do not have authority over self-insured employers, which provide coverage to 63% of employees with employer health benefits.

One important issue here is administrative preparation/capacity and its potential to create errors that cause eligible people to lose coverage. The piece notes that CMS spent three years preparing for unwinding, while work requirements will be imposed on a much shorter timeline.

New: 14.2 million more people are expected to be uninsured due Republican Medicaid and ACA cuts, and if enhanced ACA tax credits expire at the end of this year. Here's how the coverage losses break down by state. www.kff.org/uninsured/ho...

It's important to get behind the headlines of Lilly raising the price of Mounjaro in the UK in response to President Trump's most favored nation pricing push. The UK price increase is for the list price, not what the National Health Service pays. www.reuters.com/business/hea...

This is an example of why I find most of the administration's bluster over drug prices coming down to be non-credible. The goal is not to help people who are really struggling to obtain their medications.

The net effect of the changes President Trump and Republicans in Congress are making to health care is a partial repeal of the Affordable Care Act.

Important story. Although Trump claims to want to lower drug prices, the reconciliation bill includes a provision that "delay[s] Medicare price negotiations for some of the biggest-selling drugs in the world," including Keytruda, with $17.9B in US sales alone in 2024. /1 www.wsj.com/health/pharm...