# US Prescription Drug Prices Fall the Most in 60 Years Led by Biosimilars - Drug Pricing & IRA Round 2 - Week of August 24, 2026 > Drug pricing and IRA newsletter for the week of August 24, 2026. US prescription prices posted their biggest drop in over 60 years, with Mark Cuban crediting biosimilars over the IRA, as the 340B rebate model and Medicare's $50 GLP-1 copay reshape the squeeze on branded pharma. ## Drug Pricing & IRA Round 2 ### Week of August 17–24, 2026: US Prescription Drug Prices Fall the Most in 60 Years Led by Biosimilars --- ## TL;DR - **The headline number of the week is a real one: US prescription drug prices posted their biggest year-over-year drop in more than 60 years.** On [Pivot](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOj-2BMEBK7l7kTbGjV0BwSiomPnK5xj87tjJ8t9JnCBvyfQxgLcuzL9FKPs2ocq079VBPdf6l3y91W4pk7LvmyWVzKpbp0APaOR-2FDfhHNsNkzsA-3D-3DG5GU_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnQIfiy5bT5X7MedszUpj53B9EJCGaWVAX1DUupZO4C5ayf0PsLijfkZVp-2FgZvHejZL5xR4elVL2KVpJMdYv9JGWeb61PsMOA18h8ms64mU7vpAXmQVuUPh2i-2Bugh14sxY-2B2egywujLn61L1yxjS7xvI-3D), guest host **Mark Cuban**, who runs the low-cost pharmacy Cost Plus Drugs and whose company now feeds the White House's TrumpRx site, walked through why. His answer is not the one the administration is taking a victory lap on. The biggest driver, he says, is **biosimilars**, cheap copies of expensive injectable drugs. He put hard numbers on it: the arthritis and psoriasis drug **Stelara (a Johnson & Johnson product, and one of the first drugs Medicare negotiated under the IRA) fell from $128,000 a year to $365 every couple of months** on his platform, and **Humira went from $8,000 a month to about $400**. The IRA's Medicare negotiation and the new out-of-pocket cap helped at the margin; the biosimilar wave did the heavy lifting. - **The 340B rebate model finally has an operating manual, and it is a working-capital shock aimed at exactly the drugs Medicare negotiated.** We flagged the reinstated rebate model last week; this week two industry insiders filled in the mechanics. On [Achieving Health](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOiIiim25EVTQrQiW-2BIU7rGtHLkkEuS9DAqUFN6jIvSEebFQIgxLJ9QGgBd2Uu-2B6vs4dS-2BhW-2BnZUUGaGm2C1Jd8JWtC1zqQfYFZXlpCGfRarAA-3D-3DoX7B_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnex8TKXeDDeStmCimcfh3vDcKT8Omnp-2FMAM-2FNpan6BFd6Hsq2Wcf-2Fh-2FO36W-2BSyM4xJMmTzM3izxp5njOgzWWcMMtIiG6fIGqV9Se0XVE1rU0fLR2hkZhYC9p4wD8EuLaSdb-2BKs6ss94jpYjH0yO1gz4-3D), 340B consultant **Brian Bell of Forvis Mazars** said the pilot goes live **January 1, 2027**, applies only to the drugs on Medicare's negotiated list, and could cover **"at least 30% of a covered entity's 340B drug purchasing."** Hospitals will now **pay full list price up front and wait for a rebate**, with manufacturers allowed **45 days** to accept the claim and **10 days** after that to pay or deny it. - **Congress now has three competing 340B bills on the table.** On [Monitor Mondays](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOgGy8VrkESXDy3ZeIel7n-2Bl9wWbfNYqevid2OwfckhsCNFGr6pXLCnCv9JoyQjvRMAdjvKy6iVBtCCw2E4ZKeW3r0UBemMIhupajZ6THPd69g-3D-3DgW6t_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnYV6ITqAEsqbiHZ8cJTDEP8Awza-2FBLjiLweeYykWk7-2BNp8EBgacKYMZUgF7q1zn-2FDyXxW8snIPgaX-2FpzgZKYGdpkpS7QBjTgWVOWVHhQZg13oQk1tLRYrOuxEoLQXl5EjRAvtqZge02G6orrF8pL1l4-3D), health-care attorney **Jeff Davis** laid them out side by side, Senator Cassidy's discussion draft, the House **SECURE Act**, and the bipartisan Senate **SUSTAIN Act**, and gave the blunt read: comprehensive reform is unlikely to pass this year with the midterms looming, but the momentum is real for 2027. - **A quiet but important consumer number: Medicare patients can now get GLP-1 weight-loss drugs for $50 a month.** On [Health Care Rounds](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOhJZkdAJ8yA4j3MyBmNivUtx-2FFDMVf3YMMyOMjIwvNhYRd-2FgZ6X-2BJFkj1juoIPxn7luigP4cczf-2FFjeOQQvMGgXD2qdTOLu8iIPeJesE9eBOw-3D-3DO2rp_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnVLr9QcZwXgd867g88HvH0nRZ8PKbvoyfcLU3KIdUoMHIwZ8yIcCr2LOFh0dB4O9B8vo7pl4gUQit9gibguQf59QCDqFWS4PDD5yoG4QdwKZL0F5tZy2tOHje-2BNvAmI-2BxnkttLcfbeag-2BxD24Yz5f24-3D), **Wei-Li Shao, president of Omada Health and a former Eli Lilly executive**, said that as of July 1 Medicare recipients pay **$50 out of pocket** for these drugs, down from **$1,300 a month**, while the commercial employer market still pays far more. That is the direct-to-consumer pricing pressure the administration has been leaning on Lilly and Novo Nordisk to deliver, and it reshapes the price-versus-volume math for both. - **Eli Lilly cleared an $800 million legal cloud and, in the same week, bought itself a second act.** A markets recap on [Telltales](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOhSqD6bcMBIJyseSvrebK5GZW0AJPTa7-2BVgLVDugET4iU7uYTWgrOuxp7LwfsJ-2FLcKcb5KGsLlmnLjt8VsjiqJ4BXYYE8nmcZYz1s-2BHNK5M-2Bg-3D-3DKCzF_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnQmYyj71-2BDe165OgpL49IK5RnwBVy-2ByIePMMqfLi-2BxKB3c2ARvstB-2FxMJzamdKDRyAZigVXQ8bqCGq2mM37zGlt9JSIMFi-2Fek2X56PIp15hezUIwhCFotNut6D3YRgd7K-2BChSgIuLrm-2FOLfzz8fZijA-3D) noted Lilly agreed to plead guilty to a single misdemeanor and pay **~$800 million** over old Zyprexa marketing, about **two weeks of its cash flow**, while announcing **$3.8 billion** of vaccine and infectious-disease acquisitions, a **$1.8 billion** cancer-vaccine partnership, and a **raised full-year revenue forecast of $85–87 billion**. --- ## What's new *Ranked by how much a hedge-fund book can act on it.* ### 1. Drug prices had their biggest drop in 60+ years, and the man running TrumpRx says biosimilars, not the IRA, did most of it This is the number everyone will quote, so it is worth understanding what is actually behind it. On [Pivot](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOj-2BMEBK7l7kTbGjV0BwSiomPnK5xj87tjJ8t9JnCBvyfQxgLcuzL9FKPs2ocq079VBPdf6l3y91W4pk7LvmyWVzKpbp0APaOR-2FDfhHNsNkzsA-3D-3DfIK2_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnUocJAokSQtAuTkrcD3qtLmAM5C37a-2F1jY4hyZlNETpawjfjQrJ1aJMtIkf4XVhW4M5xyk2TkN-2Bt9gnk5pW7MxGEqWiPEMofnELwAivCE59F2NTpZys52QhW1LIdQLTjoAYt4s5WrRHi3aw2q5Adang-3D), host Kara Swisher opened with it directly: *"Prescription drug prices had their biggest year-over-year drop in more than 60 years. President Trump is taking a victory lap for that."* Her guest was **Mark Cuban**, an **operator**, not a pundit, in this exact market: he co-founded Cost Plus Drugs, a pharmacy that sells generics at cost plus a flat 15% markup, and it is the company powering the White House's new **TrumpRx** price-comparison site. Cuban's honest read is that the administration is getting credit for a trend with several fathers, and the biggest one is not the IRA. It is **biosimilars**, the injectable-drug equivalent of a generic. He explained the term in plain language (*"a biosimilar is like a generic for an injectable drug"*) and then put startling numbers on what they have done to two of the most expensive, most popular drugs in America: > *"That dropped the price for Stelara from $128,000 a year to, on Cost Plus, it's $365 plus shipping every couple months. For Humira, it went from $8,000 a month to like $400 a month, $450 a month on Cost Plus. And so you saw some really, really expensive popular drugs drop in price significantly. And I think that drove it more than anything."* This matters directly for this newsletter because **Stelara is a Johnson & Johnson drug and one of the very first medicines Medicare selected for IRA negotiation.** Its collapse in price is a preview of the double-squeeze the most-exposed franchises face: negotiation on one side, biosimilar competition on the other. Cuban did give the IRA and the administration credit where it is due. On the negotiation program: *"with the IRA where you're negotiating for 10 different medications, that's a bonus… it also put a cap on the amount of out-of-pocket that comes with Medicare to $2,100"* (the statute sets the 2026 cap at $2,000; Cuban rounded). He added the important second-order effect that our "manageable-headwind-versus-structural-squeeze" debate keeps circling: *"that, in turn, increased premiums, right? Because the insurance companies had to compensate for the cap."* Lower drug costs at the counter, higher premiums to pay for them, the money moves, it does not vanish. He also credited the administration for **pressuring the makers of GLP-1 weight-loss drugs**: *"He put some pressure on the GLP-1 guys… particularly within Medicare, where in certain cases, you can get it for $50 a month."* (More on that below, a second podcast confirmed the same figure.) And Cuban says TrumpRx has been good for his own volumes: the site lets people look up prices on **600 drugs**, refers shoppers to Cost Plus when it is cheapest, and he claims that since launch *"we've dropped the price for over 200 medications."* **Why it matters for a book:** the "biggest drop in 60 years" headline is bullish for patients and politically potent, but Cuban's decomposition is the useful part. If **biosimilars** are the dominant force, the read-through is straight to the branded manufacturers whose blockbusters are losing exclusivity, J&J (Stelara), AbbVie (Humira, long since eroding), and to the biosimilar and generic makers on the other side of the trade. The IRA negotiation and the out-of-pocket cap are real but secondary, and the cap quietly pushes cost into premiums rather than eliminating it. ### 2. The 340B rebate model gets its operating manual, pay list price, chase the rebate, on 30% of your negotiated-drug spend Last week the news was that the federal health agency that runs 340B (HRSA) had **reinstated a "rebate model"** aimed at the IRA-negotiated drugs. This week, [Achieving Health](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOiIiim25EVTQrQiW-2BIU7rGtHLkkEuS9DAqUFN6jIvSEebFQIgxLJ9QGgBd2Uu-2B6vs4dS-2BhW-2BnZUUGaGm2C1Jd8JWtC1zqQfYFZXlpCGfRarAA-3D-3DK789_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnbJt8PpT4rPtqSlsmNq5cik6-2F9sCGMEtvXAXfohS8ecdmR5cL8EkUiVk7DIMaMn-2BeA28OIDLJoAQX55aPteWAbgYv5uUCXvMjZhJPQQ-2FpiqZ6qSkuoFszKpoccNi3NbpTaozUTpbzrljUQq5hZNDing-3D) turned the headline into an operating manual, with **Brian Bell, a principal at Forvis Mazars who leads the firm's 340B and pharmacy practice**, about as close to an **operator/insider** as this beat gets. First, the reminder of what 340B is, because it underpins a huge share of US hospital finances: hospitals and clinics that serve a lot of low-income patients buy outpatient drugs at a deep federal discount, bill insurers at normal rates, and keep the spread to fund care. For decades that discount happened instantly, at the point of purchase. The rebate model flips it: hospitals **buy the drug at full list price first, then file a claim and wait for the manufacturer to send the discount back.** Bell: > *"On January 1st of '27, HRSA announced a new rebate model will be effective. So under that pilot, approved drug manufacturers may use a post-dispense rebate model for selected drugs instead of providing the traditional upfront 340B discount. This is significant because covered entities would need to buy the drug first and then submit claims-level data to receive a rebate equal to [WAC] minus the 340B ceiling price."* The scope is the part that ties it straight to this newsletter's core subject. The pilot applies **only to the drugs on Medicare's negotiation list** for price-applicability years 2026 and 2027, but Bell's estimate of the footprint is bigger than you might guess: > *"The pilot is limited to… selected drugs included in CMS's Medicare drug price negotiation selected drug list for initial price applicability years '26 and '27… Based on our estimates, at least 30% of a covered entity's 340B drug purchasing may be subject to the rebate model."* Then the plumbing, which is where the working-capital pain lives. Hospitals must submit detailed claims data, dates of service, drug codes, quantities, prescriber and payer information. **Manufacturers get at least 45 days from dispensing to accept a claim, then must pay the rebate or issue a documented denial within 10 days.** Bell's own framing was that hospitals now have to *"build out a rebate cycle that functions much like their revenue cycle"*, a whole new back-office function to chase money they used to get automatically. One genuine improvement over the version a court struck down at the start of 2026: this pilot has a **denials and appeals process.** Bell: *"Under the earlier proposal, there was no formal appeals process… Under the new pilot, manufacturers must document and report every denied rebate claim, explain the reason for the denial, and track any associated disputes. HRSA intends to monitor the denial patterns and can remove manufacturers from the pilot if it finds they were improperly denying claims."* And, helpfully, at least for the first round, entities submit to **one clearinghouse**, not several. **Why it matters for a book:** this is the most concrete, dated policy action of the year, and it is a clean example of the IRA's negotiated-drug list becoming the anchor for a *second* federal price program. For hospital operators it is a real cash-flow and administrative hit on nearly a third of their 340B volume. For the drugmakers of the negotiated drugs, it hands them a new lever, the discretion to deny rebate claims, on top of the negotiated price cut itself. Watch the run-up to January 1, 2027. ### 3. Three 340B bills, one honest handicap: not this year, but 2027 is live On the same beat, [Monitor Mondays](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOgGy8VrkESXDy3ZeIel7n-2Bl9wWbfNYqevid2OwfckhsCNFGr6pXLCnCv9JoyQjvRMAdjvKy6iVBtCCw2E4ZKeW3r0UBemMIhupajZ6THPd69g-3D-3Dbzfb_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnX0onLUxFJQ7N-2BmgLoUm5q1enp-2Bk1zVbubatZ1Q6v82DP86ytjAzdHoCJXq74zK8Ytp8GQWDdC-2FPlAGQWE9PmWip3Gv-2Fk2RGRTjxS1LF3KRS-2BDmUo8CR8Z9CVyrruk7TMvuInvJ2s78ObeNrNVRZ-2F-2Fw-3D) had health-care attorney **Jeff Davis**, who represents 340B hospitals and clinics, so read him as an **operator-side insider**, lay the competing reform bills side by side. He was clear-eyed on timing up front: *"there is not much time left this Congress, and with the midterm elections coming up, it's not likely we'll see Congress enact major comprehensive 340B reform legislation this year."* But three bills are worth tracking: - **Senator Cassidy's discussion draft** (Cassidy chairs the Senate Health Committee): would let hospitals keep unlimited contract pharmacies only if they are grantees, but **limit larger "DISH" hospitals to just five contract pharmacies, none of them mail-order**, and would require physically **separate drug inventories**, which Davis flatly called *"not operationally feasible."* - **The House SECURE Act:** would **prohibit the 340B rebate model for four years** and require hospital "child sites" to meet community-needs standards. - **The bipartisan Senate SUSTAIN Act** (a "Gang of Six", three Republicans, three Democrats): would **permit rebates under an HRSA pilot for one year, then force a switch to a neutral clearinghouse** instead of manufacturer rebates, allow unlimited contract pharmacies, but impose a **three-year moratorium on new hospital child sites.** The common thread, and the real threat to hospital economics, is that **all three narrow the definition of a 340B-eligible patient**, which shrinks the program regardless of which one advances. [Health:Further](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOju-2BC6ysbsNlykq3PiHJKb61DfLYcTX6l5vhhUKQWSS68-2BuXefX0nySGCPDMQr6xnpNcZKQJkqsGrOAX1NijZwj7UIAfLmRKe5BhdNvnri7dQ-3D-3DKRVI_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnWd3haGHRyFOieUuJTt6X8ratv-2FQ8oRq203gDCVp-2FBkt2wmNJmLk6Lx-2FIZfwOL-2F0r-2BICMu-2BGorna-2FmIqoPMr1fXqQvjKmOw1BNHuv5lDanGQ6uEtTtrcKAfGhcuRQfb7LT6ZNafWDL17mZwOuzOSdRA-3D) added the political backstory: HHS's contested rebate program (nicknamed **"Noble"**) was sued by hospitals, which lost in court, so the fight has now moved to Congress. The SUSTAIN bill would **kill Noble within a year and replace it with a "National Data Clearinghouse"** to catch duplicate discounts. The hosts liked the bipartisan effort but worried about piling more complexity onto a system already absorbing too much change at once: *"I would probably be just fine with 340B being held off for at least some number of years… adding this 340B thing on top of it, it just feels like one too many headwinds."* **Why it matters for a book:** 340B reform is now a live, bipartisan legislative object with three concrete drafts, not a wish list. Low odds of passage in 2026, but the direction of travel, codified pharmacy protections traded for tighter eligibility, transparency, fees, and penalties, is a 2027 catalyst worth starting to price for hospital operators and, indirectly, for the manufacturers who sell into 340B channels. And remember the near-term deadline: **comments on the related Medicare outpatient payment rule are due August 31.** ### 4. Medicare's GLP-1 price is now $50 a month, the direct-to-consumer squeeze is landing Here is the concrete, cross-validated pricing development of the week. On [Health Care Rounds](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOhJZkdAJ8yA4j3MyBmNivUtx-2FFDMVf3YMMyOMjIwvNhYRd-2FgZ6X-2BJFkj1juoIPxn7luigP4cczf-2FFjeOQQvMGgXD2qdTOLu8iIPeJesE9eBOw-3D-3DIlwm_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQndR30zVuQUO6sMv4eFeQIrtYPXNDNT4m7qGVRIDE-2FvVBpCHHE46bKk6VmYgubm1DfgCgQxmqVB9p-2BmfZAp-2FJp2gpXzYaHZ8R-2F39YY0zq-2B5rmhyrDUu-2FH6Jl9chiv6CxQ0oOfYigbM0lrRNIh4N2XpXY-3D), **Wei-Li Shao, president of Omada Health, and before that a longtime Eli Lilly executive** (an **operator**, and a Lilly partner today), described just how far weight-loss-drug pricing has moved: > *"As of July 1st, Medicare recipients are paying $50 out of pocket. That's fantastic… And then cash pay, if you don't have coverage, you're paying maybe $250, maximum $300… From where it was $1,300 a month down to $250, $300 is great. But the commercially insured employer market is still paying a significantly higher price."* That $50 Medicare figure is exactly what Mark Cuban referenced on Pivot the same week (*"particularly within Medicare, where in certain cases, you can get it for $50 a month"*), two independent operators describing the same move. It is the fruit of the administration's pressure campaign on Novo Nordisk and Eli Lilly to cut prices directly for patients, and it is a genuine change to the economics of the category: list prices have been coming down and out-of-pocket costs have fallen dramatically, even as the branded makers keep volume. Shao's larger point is that the drugs alone are not enough, Omada now has **"well over 150,000" people on GLP-1s** in its coaching program, built around a stark clinical fact: **up to a third of the weight people lose on these drugs is muscle**, and a recent study of over 400,000 users found **one in five were short on key nutrients** because their appetite fell but their eating habits did not. That is a demand-durability story: the more the industry wraps support around these drugs, the stickier the prescriptions. **Why it matters for a book:** for **Novo Nordisk** and **Eli Lilly**, this is the price-versus-volume trade in its purest form. Headline prices are falling fast, good for access, and politically valuable, but volume keeps climbing and the addressable Medicare population is now paying a token co-pay. The question for the model is whether unit growth and the shift toward oral formulations more than offset the price give-up. For now, obesity remains the one corner of pharma where demand is strong enough to swallow big price cuts and keep growing. ### 5. Eli Lilly clears an $800 million overhang and buys a second act in one week A markets recap on [Telltales](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOhSqD6bcMBIJyseSvrebK5GZW0AJPTa7-2BVgLVDugET4iU7uYTWgrOuxp7LwfsJ-2FLcKcb5KGsLlmnLjt8VsjiqJ4BXYYE8nmcZYz1s-2BHNK5M-2Bg-3D-3DY8o6_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQncPb2d5hacp-2BEs-2BWzleGy3b72a-2FhUFP8TrLIq1wxN-2FBZavSU76fOrMMG1DWrs-2B0oR8EYVldO-2BKdqRZmvnWV7AzG3T6daOX1N76t10VhDJcG3H1GVQnX3CTRfGdWxGSpyH5m4eROfRsRZGLUskVhob-2Bk-3D), worth flagging that this show is produced with **AI-generated voices**, so treat it as synthesized commentary, not a named human's view, packed four Lilly items into one week and, usefully, ranked them: > *"Lilly agreed to plead guilty to one misdemeanor violation of the Food, Drug, and Cosmetic Act and pay roughly $800 million over how it promoted Zyprexa. That's the headline. Underneath it, in the same seven days, Lilly announced agreements to buy three vaccine and infectious disease companies for $3.8 billion, put $50 million up front into a CureVac mRNA cancer partnership worth up to $1.8 billion, and raised full-year revenue guidance to $85 to $87 billion."* The show's own analysis is the useful part. The **$800 million** settlement, it noted, *"sits against $21 billion of trailing free cash flow… That's about two weeks of production."* In other words, a closed and quantified legal problem, not a solvency one. The deals it would *"actually underwrite,"* it said, are the vaccine and infectious-disease acquisitions, *"that's Lilly buying a second act while GLP-1 is still paying for everything."* The recap has Lilly trading at a rich **58 times trailing free cash flow.** **Why it matters for a book:** none of this is a drug-pricing story per se, but it is the clearest recent picture of how the strongest name in the group is playing its hand, resolving a legal tail cheaply, raising guidance, and spending its GLP-1 cash flow to diversify away from a single blockbuster franchise. That is exactly the posture you would expect from a company that knows the IRA clock will eventually reach its best-selling drugs, and it stands in sharp contrast to the defensive, deal-driven scramble at some peers. --- ## The debate The core argument this newsletter tracks, *a bounded, well-modeled headwind* versus *a structural squeeze on US drug margins*, got a genuinely two-sided week. **The "prices are falling and the system is adjusting" case.** The headline is unambiguously in this camp: drug prices fell the most in more than 60 years. Mark Cuban, an operator with every incentive to praise cheap drugs, credits **biosimilar competition** more than any government program, a market force, not a mandate. The IRA negotiation and the out-of-pocket cap are helping at the edges, and where the cap raised costs, it flowed into premiums rather than crushing manufacturer margins. Medicare patients can now get GLP-1 drugs for **$50 a month** while the makers keep growing volume. Even the scary-sounding 340B rebate model now comes with a real appeals process and a single clearinghouse, and the reform bills in Congress trade tighter eligibility for codified protections. Nothing here looks existential. **The "the squeeze is compounding, quietly" case.** Look at what is actually being layered on. The 340B rebate model forces hospitals to front cash on nearly **a third** of their 340B purchasing and chase rebates a manufacturer can deny, a working-capital and margin hit landing on the same drugs the IRA already cut. Stelara, a negotiated J&J drug, fell **99%-plus** to a biosimilar; that is not a gentle headwind for the branded owner, it is a cliff. And the falling patient prices everyone is celebrating are, in part, a transfer: lower co-pays, higher premiums, and a middle of the supply chain (the PBMs) squeezing pharmacies on the other end (see the TRICARE read-through below). The pieces do not add up to one clean number, they add up to steady, multi-front compression on branded US pharma economics, with the strongest players (Lilly) buying their way out and the weakest exposed. **The swing factor remains January 1, 2027**, the day the 340B rebate model goes live on the negotiated drugs, with a nearer marker on **August 31**, when comments close on the Medicare outpatient payment rule that would cut what hospitals are paid for these same drugs. --- ## Stocks in play Same discipline as always: **no podcast this week attached a specific revenue-at-risk figure** to a tracked franchise. What follows is only what the week's episodes actually support. **Johnson & Johnson (JNJ)**, *the biosimilar cliff, made concrete.* - **Bull:** J&J is diversified well beyond any single drug, and the IRA negotiation on Stelara was already in the numbers. - **Bear:** Cuban's live example of the price collapse is J&J's own drug, **Stelara from $128,000 a year to $365 every couple of months** on a cash platform once biosimilars arrived. This is what "loss of exclusivity plus negotiation" looks like when it fully plays out. - **Next to watch:** the pace of Stelara biosimilar erosion and how fast J&J's newer immunology and oncology assets backfill it. ([Pivot](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOj-2BMEBK7l7kTbGjV0BwSiomPnK5xj87tjJ8t9JnCBvyfQxgLcuzL9FKPs2ocq079VBPdf6l3y91W4pk7LvmyWVzKpbp0APaOR-2FDfhHNsNkzsA-3D-3D0vAZ_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnZ12bmOPUqPiDnH4Vg48nA4s8UJI0oTt2X0py4L-2BeUYfa0dSAuhYhbVDmA5ArTsk06cmDsDBDN2k4gHAe8bsnDRWwN2yFUejoSd7Ur6rUs2pmHGg7OYKIG4udFhEsH7Z26EkS-2FxqhRxI475Iwz7qWdE-3D)) **Eli Lilly (LLY)**, *still the pricing-power outlier, now diversifying.* - **Bull:** raised full-year revenue guidance to **$85–87 billion**; obesity volume so strong it absorbs a Medicare price of $50 a month; resolved an old legal matter for ~$800 million (about two weeks of cash flow); and is spending its GLP-1 windfall on **$3.8 billion** of vaccine/infectious-disease deals and a **$1.8 billion** cancer-vaccine partnership to build a "second act." - **Bear:** trades at a demanding **~58x trailing free cash flow**, so it is priced for continued execution; the direct-to-consumer price cuts are real and ongoing. - **Next to watch:** whether oral GLP-1 volume growth outruns the falling headline price. ([Telltales](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOhSqD6bcMBIJyseSvrebK5GZW0AJPTa7-2BVgLVDugET4iU7uYTWgrOuxp7LwfsJ-2FLcKcb5KGsLlmnLjt8VsjiqJ4BXYYE8nmcZYz1s-2BHNK5M-2Bg-3D-3DR5mR_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnbhUPwftz6hdQyCc2CbAvQ4MuxzuwqiKvQt6IsATHwsCs1U1juFaOdu0dnf6dNnpvBRdcyf4inexRvVCT2ikr1uTMKyRYWzFKlJVEJjknK3b-2FNqpyF04YifJFUHROo9-2BCsqGLlhYBNSbwR8ipvsHtNw-3D); [Health Care Rounds](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOhJZkdAJ8yA4j3MyBmNivUtx-2FFDMVf3YMMyOMjIwvNhYRd-2FgZ6X-2BJFkj1juoIPxn7luigP4cczf-2FFjeOQQvMGgXD2qdTOLu8iIPeJesE9eBOw-3D-3D3j1p_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnd4-2B6pOhxPS3V2vLrWY-2B-2FYkRWkRx427HLyD9LDaXS5vfYRb1mI0MhS8g3i0V7tReuG1eZdkhYJ0Zn9ywcmURoDMfcuf1UNxT-2FUL2HbU-2BfPKpGKMjUNvZ6uPU6XkcNahHL0gDeC6iNGDfdMBg3bHNlN0-3D)) **Novo Nordisk (NVO)**, *the price-versus-volume test.* - **Bull:** the $50 Medicare co-pay dramatically widens the eligible obesity market; demand for GLP-1s remains the strongest in pharma. - **Bear:** it is the most GLP-1-concentrated of the large caps, so the very price cuts expanding access hit its mix hardest, and Lilly is out-diversifying it. - **Next to watch:** commercial (employer) pricing, which Wei-Li Shao noted is *"still paying a significantly higher price"*, the next shoe to drop on price. ([Health Care Rounds](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOhJZkdAJ8yA4j3MyBmNivUtx-2FFDMVf3YMMyOMjIwvNhYRd-2FgZ6X-2BJFkj1juoIPxn7luigP4cczf-2FFjeOQQvMGgXD2qdTOLu8iIPeJesE9eBOw-3D-3DkIBy_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnZuQFIEuCH9swF91qRbTzqNNIvpajRuqU4TxR24RetsckDFthaqs-2BhnM14MIsJzo6Xac6yAMXczt7NvqW7PVURXFOVYRHWe8SAoNlywU0vjIEyZ2BOESuHRWhCNF4JEIQZhP8rs0SjVXjyrZDU7mkDU-3D); [Pivot](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOj-2BMEBK7l7kTbGjV0BwSiomPnK5xj87tjJ8t9JnCBvyfQxgLcuzL9FKPs2ocq079VBPdf6l3y91W4pk7LvmyWVzKpbp0APaOR-2FDfhHNsNkzsA-3D-3DO1IH_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnfBi2zL7Q7dPn0quWoTp3rzRFxag4ZibNiPtkoYIyuZ7DrxntXmNuJBbi6RmMg-2FGaS9VRc-2BjI2OJJ2FsVWrx-2FTnzv42AliiqMlHj-2BWWjhrx3sAwDBqlbGy82nakDC4t-2BaC3UQsoP814W0VH-2B0skzwTQ-3D)) **AbbVie (ABBV)**, *the drug that wrote the biosimilar playbook.* - **Bull:** AbbVie has spent years replacing Humira revenue with Skyrizi and Rinvoq, so the erosion is well telegraphed. - **Bear:** Cuban's second data point is Humira, **from $8,000 a month to about $400** on a cash platform, a reminder of how completely biosimilars can hollow out a former mega-blockbuster. - **Next to watch:** the growth trajectory of the post-Humira franchise against the ongoing price decline. ([Pivot](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOj-2BMEBK7l7kTbGjV0BwSiomPnK5xj87tjJ8t9JnCBvyfQxgLcuzL9FKPs2ocq079VBPdf6l3y91W4pk7LvmyWVzKpbp0APaOR-2FDfhHNsNkzsA-3D-3DqdaU_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnUDhPel0pFfl-2Fh9sqXE1XyCm8IDprJedrpUJJHJsidjfQxu6aqMXdVzbBfO5n0j17rydogBbrG6G-2Fz8jWXeTEYiN-2BzGjib9f9n4my5lDfkZHqQELcmbFZqCqyO7UTsTcRT21gqnFSp9BisTxjYLhqM0-3D)) **CVS Health (CVS), Cigna (CI), UnitedHealth (UNH)**, *the middlemen Cuban keeps aiming at.* - **Bull:** diversified, deeply integrated giants; the underlying insurance businesses have historically been durable. - **Bear:** Cuban's sharpest attack of the week was on the PBM model, *"the middlemen are driving up the cost of everything"*, and his proposed fix, a law barring **PBMs from controlling formularies**, would strike at the core of their leverage over roughly **80 million** covered lives. The TRICARE fight (below) shows the same dynamic in miniature. - **Next to watch:** any federal or state PBM legislation that reaches formulary control or reimbursement, and 2027 plan-year bids. ([Pivot](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOj-2BMEBK7l7kTbGjV0BwSiomPnK5xj87tjJ8t9JnCBvyfQxgLcuzL9FKPs2ocq079VBPdf6l3y91W4pk7LvmyWVzKpbp0APaOR-2FDfhHNsNkzsA-3D-3D-Nq9_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnc8-2B2cOE7F2M0YpQaPYasL4F305OM5L6E0hubdYDlK5tDJbfSSJoBO1QbXdENC-2BFg3Zp-2F-2BsQn0Cfa29nZy7G55f5VFGpgA6RV1oai-2FveQe4Luyj6QkhmbAARWKKY0VzF6gNeYOu0xGl5pDzL3NENmKo-3D); [Pharmacy Podcast Network](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOiLlBc-2FGO7t133YipltHEykh4S8J9hNzayS5W-2BZ-2F3LLg5ZH3ncj-2BGG0E-2BXpUQKztetVgH5dUSAfc35Wxc0rX1rCfbfHuBTHyKCHpLp9YOy0JQ-3D-3DBlDW_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnZiHwFiRJFWi0B73Y0pcPpIWzhp1NdgXGzK-2BzYWA1XYcqvdVSpaQBVW1-2BXpBoVxOWW3vMk94k0tryle3E05EewPkj9jUw40ngM-2Fk3q-2FaJNTtKCHiDoxXxtIi8QLo-2FK3kYQ4sEUoAEQy-2Fpujsl98n-2B-2BA-3D)) **PFE, MRK, BMY, AZN**, *no company-specific podcast commentary this week.* Their negotiation- and patent-exposed franchises (Eliquis, Keytruda, Januvia, Tagrisso, and the rest) will have to be sized from filings and Street models; the podcasts did not supply the numbers, and we will not invent them. --- ## Read-throughs **Hospitals / 340B providers (and the manufacturers of the negotiated drugs).** The rebate model is a direct working-capital and margin hit, pay full list price up front, chase a rebate on **~30% of your 340B spend**, and absorb a possible payment cut on the related Medicare outpatient rule (comments due August 31). For the manufacturers whose drugs are on the list, it adds a rebate-denial lever on top of the negotiated price. And whichever reform bill eventually advances would narrow which patients and sites even qualify. ([Achieving Health](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOiIiim25EVTQrQiW-2BIU7rGtHLkkEuS9DAqUFN6jIvSEebFQIgxLJ9QGgBd2Uu-2B6vs4dS-2BhW-2BnZUUGaGm2C1Jd8JWtC1zqQfYFZXlpCGfRarAA-3D-3DYo4W_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnc5v5ktPOY7R7am1w2lXya5zMEvwHAmgwEh2TNDB5VSTvnqKtwphhXKr6mosXqeU43Y1WJ7MsxCurrbhc2wdWT6e5b0RlvsLLj9lGde3c1weHCVeX4GeX13kcsa0OsHH0wT-2FUqW8vLAbwsug0lkC0hM-3D); [Monitor Mondays](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOgGy8VrkESXDy3ZeIel7n-2Bl9wWbfNYqevid2OwfckhsCNFGr6pXLCnCv9JoyQjvRMAdjvKy6iVBtCCw2E4ZKeW3r0UBemMIhupajZ6THPd69g-3D-3DX8uP_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnWfHhBEmzo3DocoxrlMwVa3cOToAZIoaCrcQblkzy-2BFguweEtbc0ZaxoinGzlhrr4G9XUfBxcwzPhPCsAAvIZtPpTyhh9BweaUPluL8uLeIpfVbZ4S-2BM3BQd-2BoKFNHVOa6GeRhLCS8aaJBDcjvHvXnU-3D); [Health:Further](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOju-2BC6ysbsNlykq3PiHJKb61DfLYcTX6l5vhhUKQWSS68-2BuXefX0nySGCPDMQr6xnpNcZKQJkqsGrOAX1NijZwj7UIAfLmRKe5BhdNvnri7dQ-3D-3DJTux_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnYGDr8d37FtNhWDQU91hXW1GsXDz7dFriPeCqg2-2BgKReNUb-2FM06GF7bSlTs1Z3a7SaXKFFfhtSg7jmwI1ocYnWwubljrM0SbP18kcpZSq0khmTqzZCb8kcRwIoOJF-2B8FVWR9BmdflW0SJp6fYEyS7Vw-3D)) **Biosimilar and generic makers.** This is the week's cleanest positive read-through, and it is the flip side of the branded cliff. If biosimilars drove the biggest drug-price drop in 60 years, taking Stelara down 99% and Humira down roughly 95% on a cash platform, the winners are the companies making those copies (Teva and the other biosimilar/generic manufacturers) and the low-cost channels that dispense them, like Cuban's Cost Plus Drugs. ([Pivot](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOj-2BMEBK7l7kTbGjV0BwSiomPnK5xj87tjJ8t9JnCBvyfQxgLcuzL9FKPs2ocq079VBPdf6l3y91W4pk7LvmyWVzKpbp0APaOR-2FDfhHNsNkzsA-3D-3DuW60_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQncfg6zshsN59nYTiDLevVEBG8zl7ka5Lsay37YByddU4VPNpWVBL8BHNm4eB2phZiYkC8FkKpckyhNEM5xX5FMH5m8TaAMNRJhuQgDYSl-2FLpINGtZeezQq9wIs8denJWFqKNfalODPVW1EdSeTPjY1k-3D)) **PBMs / managed care (CVS, CI, UNH).** Two independent operators hammered the drug middlemen this week. Cuban described how PBMs use formulary control to extract rebates across a manufacturer's *entire* portfolio, not just one drug. And on [Pharmacy Podcast Network](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOiLlBc-2FGO7t133YipltHEykh4S8J9hNzayS5W-2BZ-2F3LLg5ZH3ncj-2BGG0E-2BXpUQKztetVgH5dUSAfc35Wxc0rX1rCfbfHuBTHyKCHpLp9YOy0JQ-3D-3Dpfrl_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnX9vSq-2F2-2Bs25-2FeuHR-2BWaW6q6-2B25NPzkpsrR8-2BvKh5cypwavAFaFg4km02qvzW7FWRiaSQAqwbn9A5BngW9yW-2BMuSht9JT9MmSRqsuKd7Jq59PrNUAfxzriuN1eb-2FYKailA3t27gDI9spdD84vah6O80-3D), Arkansas Pharmacy Association CEO **John Vinson** and **Greg Reybold** detailed how **Express Scripts (Cigna's PBM), which has held the military TRICARE contract for 23 years, used a 2022 network cull of 13,000–15,000 pharmacies** to push patients toward its own mail-order arm, even where independent retail was cheaper. A fix bill, the **Rx Access Act (S.4106)**, plus a mandatory-audit measure co-sponsored with Senator Warren, is working through Congress. Same structural pressure the IRA's Part D redesign applies from the other side. ([Pivot](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOj-2BMEBK7l7kTbGjV0BwSiomPnK5xj87tjJ8t9JnCBvyfQxgLcuzL9FKPs2ocq079VBPdf6l3y91W4pk7LvmyWVzKpbp0APaOR-2FDfhHNsNkzsA-3D-3DEYxs_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnc4f-2FzAxtrKcPVPFN473xz6Uvb3rDA0tyftAKmikJacrrMXyKtqkogB0LmwaKBOfqB5FGRN8CKpUerAci00bJ40EK2T77jq4ZAR3E-2BqcZuR9uGtgKIiIbPLq3Bjy6W4pT6fgbKswJrymVaxbfrGcNlc-3D); [Pharmacy Podcast Network](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOiLlBc-2FGO7t133YipltHEykh4S8J9hNzayS5W-2BZ-2F3LLg5ZH3ncj-2BGG0E-2BXpUQKztetVgH5dUSAfc35Wxc0rX1rCfbfHuBTHyKCHpLp9YOy0JQ-3D-3DjPRI_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnd7UUVba84tzBVJn0YYw9xNGNfAF8cPMGX8GDB-2Fad-2FjRPWsfmkcLCN84Nmo5S0RL0yJkkLCYqb6bIs1B-2Bx8AJFrUcEL9o4sz-2BJSxvp5T282UQsaDx2NUwd9fxOyivCOZKXgm8P0SrA4zMMdk41-2Ft9vs-3D)) **Small-molecule vs. biologic R&D mix, ex-US pricing strategy, and MFN/tariffs.** Quiet this week, no podcast in the window advanced the pill-penalty/EPIC Act fix, the 2028 Part B list, or new Most Favored Nation signings. One macro note worth filing: [Health:Further](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOju-2BC6ysbsNlykq3PiHJKb61DfLYcTX6l5vhhUKQWSS68-2BuXefX0nySGCPDMQr6xnpNcZKQJkqsGrOAX1NijZwj7UIAfLmRKe5BhdNvnri7dQ-3D-3D8pol_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnZCjPfUAKzJmL-2FmR1sqAMVlXanNLNZbQtsBY-2B-2Fdlixvv33JVrT-2FqTJy6rE81W1NXYWdn3ZlDZ2ezpdVafpTfXD7wkBUvh5IBsSlVmumFVSECCuO-2BjwbBBE8ProbNktRhpiamMqv1RkgQDbCfxKUFgu0-3D) cited a Kaiser Family Foundation analysis that insurers want to **raise small-business health premiums 14% next year**, roughly four times inflation, and the latest in a multi-year run, a reminder that the money squeezed out of drug prices keeps resurfacing in premiums. --- ## What changed vs. last week Last week (Aug 10–17) the story was the **340B rebate model's reinstatement, the SUSTAIN 340B Act, and the AstraZeneca–Bristol-Myers merger rumor.** This week two of those threads deepened and two genuinely new ones arrived: - **New: the biggest drug-price drop in 60 years, decomposed.** Mark Cuban's Pivot appearance put an operator's numbers on it, biosimilars, not the IRA, as the main driver, with Stelara and Humira as exhibit A and B. This is the freshest and most quotable development of the week. ([Pivot](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOj-2BMEBK7l7kTbGjV0BwSiomPnK5xj87tjJ8t9JnCBvyfQxgLcuzL9FKPs2ocq079VBPdf6l3y91W4pk7LvmyWVzKpbp0APaOR-2FDfhHNsNkzsA-3D-3DbAiq_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnX7fl65A85xueef6d5BvJCs7ANU5N3sOWz7JML1yNHiOv2lsDM2a2FKV-2BP0syuKLslVl8tCa7yGauX6n1tdxBZWL77i9K3yDLozcCKvWspl8mC29MPNU1iE0E-2BQyO8EYe-2B619h-2FFk514KaoJAVYK0a0-3D)) - **New: Medicare GLP-1 out-of-pocket is now $50/month (as of July 1)**, confirmed by two independent operators, plus Lilly's **$800 million** plea, **$3.8 billion** of M&A, and a **raised $85–87 billion** revenue guide. ([Health Care Rounds](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOhJZkdAJ8yA4j3MyBmNivUtx-2FFDMVf3YMMyOMjIwvNhYRd-2FgZ6X-2BJFkj1juoIPxn7luigP4cczf-2FFjeOQQvMGgXD2qdTOLu8iIPeJesE9eBOw-3D-3DjTO1_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnWz9xCRmFbl7QyQFiyl4kDtCwRwtaYxaaAmk0J3Q0hx2M7roxUtgKvf4KEhp4TOi68KaZ8qLsi0oEGNDWjm4biyIAnuafNvVvX7m3-2FbiOMIJeQwRRnXgezZgf7EZxpIM-2FKQZ52uS9F-2By-2BBjDvYa0BaI-3D); [Telltales](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOhSqD6bcMBIJyseSvrebK5GZW0AJPTa7-2BVgLVDugET4iU7uYTWgrOuxp7LwfsJ-2FLcKcb5KGsLlmnLjt8VsjiqJ4BXYYE8nmcZYz1s-2BHNK5M-2Bg-3D-3DdG-1_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQndfBDYmCcM-2FTEGfMvc5pu1oHITo6vKkoxKmJ-2B-2BuLHJuNBDkDHWGAgwdJJ1VMr8uNP1etX82I9chIezRPLt9lh1-2BXIcyM-2FXaJjMOnC3JN4Xw1BF4-2FHiz-2Fx0RTtgtrERTa9l0V-2FShPEWDmwruC9ZPQqCM-3D)) - **Deepened: 340B.** Last week we had the fact of the rebate model; this week we got the mechanics, **~30% of covered-entity purchasing**, the 45-day/10-day timeline, the new appeals process, and a clean three-bill comparison (Cassidy vs. SECURE vs. SUSTAIN), including that HHS's rebate program is nicknamed "Noble." ([Achieving Health](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOiIiim25EVTQrQiW-2BIU7rGtHLkkEuS9DAqUFN6jIvSEebFQIgxLJ9QGgBd2Uu-2B6vs4dS-2BhW-2BnZUUGaGm2C1Jd8JWtC1zqQfYFZXlpCGfRarAA-3D-3DlGcI_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnVTYYWYWmRzz5WOVZZiTyEBR2VIhrE1MBQD0RWbFWNlcN9r-2BmBpMh0TyLUPfNAUiU1nVMvQbdsaZmw4xru1V9LYqcTZte-2FYaTR-2BgCYtgiOPhqFogNGqhzWCRxGTK569lPQd4Yg-2BWZ8-2Bz6Srv658pwX4-3D); [Monitor Mondays](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOgGy8VrkESXDy3ZeIel7n-2Bl9wWbfNYqevid2OwfckhsCNFGr6pXLCnCv9JoyQjvRMAdjvKy6iVBtCCw2E4ZKeW3r0UBemMIhupajZ6THPd69g-3D-3DKGYZ_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbV6zStle0uSfyTPdH-2BAhnA4pdhsSqGY7CjJEFq0vIBQnVTR2b-2FLd8H9K259QubS2T3TVjetfFNlfgHbw-2FBPBQ-2FXKN0chwSL52zD1-2FJEUy5D2kRgzfFBQRJlllcfZHjw-2FV5Y8pNdnpCX73rnOr1h5TfBvOKFjSCP2qqEyEkCIHZ-2B2iiQ6jmqqCgVezsb6r1EkHA-3D)) - **Went quiet: the AstraZeneca–Bristol-Myers merger** got no fresh podcast read this week, and there was again no new coverage of IRA Round 2 specifics, the 2028 Part B list, the pill penalty/EPIC Act, or new MFN deals. --- --- ## Get the full transcripts on Matterfact This briefing was produced with Matterfact, which indexes the complete, full-text transcripts of 120M+ podcast episodes alongside SEC filings, earnings calls, and financial datasets. 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