Trump heads back to the White House

President Trump is back home at the White House after spending the weekend at Walter Reed Medical Center, where he was treated for Covid-19. We still don’t know much about Trump’s condition: His doctor, Sean Conley has repeatedly declined to say how high Trump’s fever reached, how low his oxygen levels dropped, or what his lung scans looked like. Trump, however, is insisting he feels better than he did 20 years ago.

In a new story, Liz Cooney, Lev Facher and I unpack how doctors decide when to discharge a Covid-19 patient and the care he’s likely to receive at the White House. Our reporting reveals that Trump’s speedy discharge isn’t altogether incongruous with the guidelines doctors use for normal patients, and his discharge is likely to be coupled with follow up medical care that’s virtually unparalleled — because the White House has a pretty extensive medical unit already on its campus.

The biggest question mark, however, is whether Trump will obey public health guidelines, which recommend he stay isolated at least until Oct. 10.

So far, the signs don’t look good: After being discharged Monday night Trump posed, maskless, for a brief photoshoot. He was also paraded around by Secret Service agents on Sunday, whilst still hospitalized and contagious.

Trump is also already planning to participate in the next presidential debate, which is scheduled for Oct. 15th, and he has already tweeted that people shouldn’t be afraid of Covid-19, despite public health officials’ insistence that everyone should take extra precautions to prevent the spread of the pandemic.

Read more here.

SCOTUS, Meet PBMs

The Supreme Court will hear oral arguments this morning in Rutledge v. PCMA, a years-long dispute between the drug middlemen trade association and the state of Arkansas. It will be the first time ever that the Supreme Court will hear a case about pharmacy benefit mangers, the much-maligned and oft-misunderstood middlemen who are hailed by supporters as a key part of keeping drug prices down, and characterized by critics as grifters who make massive profits off the backs of patients. Who else is excited to see where Justice Breyer comes out on that debate?

The case concerns a 2015 Arkansas law meant to make sure middlemen don’t reimburse pharmacies less than they pay to acquire generic drugs, and that middlemen don’t treat independent pharmacies worse than they treat the pharmacies they own. Middlemen argue that the state law is invalid because only the federal government has the power to regulate issues like pharmacy reimbursement.

But the court’s decision could impact more than just Arkansas. In an amicus brief, 45 state attorneys general said that the case could have a lasting impact on the more than 40 states that have already passed some form of PBM regulation. The United States solicitor general also urged the Supreme Court to take up the case, and argued that an appeals court had erred when it found the Arkansas law invalid.

For more on the case, check out my colleague Ed Silverman’s new story for STAT.

How to prevent another Covid-19 dumpster fire

Trust for America’s Health, a nonprofit closely allied with the CDC and local health departments, is out with its annual blueprint for “Transforming Public Health in America.” The report paints a grim picture of the country’s public health infrastructure as the nation struggles to contain Covid-19. It notes, for example, that public health departments lost 26,000 jobs over the last decade and that the economic downturn created by Covid-19 “is already leading to additional reductions in federal, state and local public health budgets.” States that are gearing up to vaccinate against Covid-19 are also relying on antiquated computer systems to track vaccine administration in local communities, the report explains.

TFAH’s recommendations for transforming the U.S. public health system includes:

Appropriating $4.5 billion per year to a new “Public Health Infrastructure Fund”
Creating a “health security directorate” to oversee a national biodefense strategy
Immediately appropriating $450 million to modernize public health surveillance systems, coupled with $100 million in follow-up annual funding
Exempting health security funding from the Budget Control Act's annual spending caps
Establishing an external regulatory body to set standards for health care facility readiness, and to provide payment incentives for hospitals to keep disaster care facilities

Biosimilars are finally starting to save the U.S. health care system some serious cash

That’s the takeaway from a new report from the IQVIA Institute for Human Data Science, Ed Silverman reports. IQVIA found that there are now 22 biosimilars available in the United States, and some are rapidly gaining market share. The first biosimilar for Avastin gained more than 40% of the market within the first year of launching, IQVIA reports. That’s a huge advance from just a year ago, when biosimilars were such a minimal part of the drug market that experts were urging federal regulators to give up on them altogether.

IQVIA predicts that biosimilars could rack up $80 billion in aggregate sales over the next five years. More from Ed, here.

STAT stories you may have missed

The FDA gave an emergency authorization to an algorithm used to inform Covid-19 care.

Congressional lawmakers grilled drug makers in two days worth of hearings. STAT’s dispatches can be found here and here.

An appeals court might have just saved Abbvie over $400 million.

How is Covid-19 burnishing pharma’s reputation? Click here for Ed Silverman’s conversation with one drug industry veteran.

A bipartisan duo of lawmakers introduced a new bill meant to spur antibiotic drug development.