Something weird is going on with the rebate rule

HHS has already received 18,000 comments on its proposal to end the system of rebates insurers and middlemen use to negotiate drug prices. That is not normal. That’s six times more comments than HHS received on the entire drug pricing plan it released last May. And I’m even more suspicious because almost all the big groups in town — the trade associations, the individual drug companies, the PBMs, and the consumer advocacy groups told me they haven’t yet submitted their comments, which aren’t due until next month.

So who are these mysterious 18,000 people? The comments themselves aren’t publicly available yet — only the number received is — but I suspect it’s a write-in campaign organized by a group that has some stake in the regulation. These groups often mobilize their members (think pharmacists or doctors or just everyday people) to fill out prewritten letters to the government pushing their message.

While there’s nothing nefarious about mobilizing people to write the government about an issue they care about, it’s often less than clear to everyday folks that there’s an industry group with a financial stake behind the initiative.

I asked the two most obvious suspects, AHIP and PCMA, which lobby for insurers and PBMs, respectively, whether they were behind the initiative. AHIP denied any connection, but PCMA did not respond to multiple requests for comment. Both groups are also pushing back against the idea in other ways: AHIP’s Coalition for Medicare Choices has collected more than 2,900 letters to Congress opposing the rule. It’s also running Facebook ads. So was PCMA, up until last week, under the name "Affordable Pharmacy Action Network." Like AHIP, it argues the rule is a windfall for pharma and would raise insurance premiums.

Wondering whether any of those comments are having any impact on HHS’ thinking? HHS drug pricing wonk John O’Brien is slated to give a talk about “a world without rebates” Thursday at the Newseum. He will be joined by Drug Channels Institute CEO Adam Fein, who has put together one of the most thorough explanations of what a world without rebates might actually look like, among others.