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FTC is looking at GPOs Zinc and Ascent, PD-1 stimulation (not inhibition) for rheumatoid arthritis and a wide-angled view of the behavioral health workforce | May 18 News Round-Up


The Federal Trade Commission is casting a wider net in its ongoing inquiry of pharmacy benefit managers (PBMs).

FTC’s PBM inquiry broadened to include GPOs Zinc and Ascent | FTC

The Federal Trade Commission (FTC) announced yesterday that it was broadening its inquiry into the pharmacy benefit manager (PBM) industry to take in Zinc Health Services LLC and Ascent Health Services LLC.

Zinc was founded in 2020 and operates as the group purchasing organization (GPO) for CVS Caremark, according to the FTC newsrelease. Ascent Health was founded in 2019 and operates as a GPO for Express Scripts, Prime Therapeutics, Envolve Pharmacy Solutions and Humana Pharmacy Solutions.

The FTC launched its inquiry, or “study,” of the PBM industry in June 2022. The agency has the power to conduct such studies of without specific violations of law in mind. As part of those inquiries, the agency can ask businesses to answer questions about their business practices (“compulsory orders”) and the businesses can file a petition to quash the request in the same way that there can be request to quash subpoenas, although the FTC can go to court to enforce the requests for information.

The FTC press release says that the GPOs are also called “rebate aggregators, which negotiate rebates with drug manufacturers on behalf of the PBMs and hold the contracts that govern those rebates.”

Positive results from PD-1 stimulation for rheumatoid arthritis | New England Journal of Medicine

Immune checkpoint inhibitors that act on the PD-1, PD-L1 pathway have become an important part of cancer treatment. They unleash T cells and the immune system so it recognizes cancer cells and attack them. The checkpoint inhibitors include Keytruda (pembrolizumab), Opdivo (nivolumab), Tecentriq (atezolizumab) and Imfinzi (durvalumab).

But when it comes to autoimmune diseases, stimulating rather than inhibiting the PD-1, PD-L1 pathway could make sense. Rather than checking the checkpoints, activating them might quiet and estore order to the dysregulated immune response that underlines autoimmune disease.

Positive results from an Eli Lilly-sponsored phase 2a trial of a PD-1 stimulator called peresolimab were reported in today’s New England Journal of Medicine (aside from the abstract, the write-up of the study is behind a paywall). At 12 weeks, the rheumatoid arthritis patients assigned to receive peresolimab fared better on the primary endpoint of the trial (a measure of disease activity) than those in the placebo group.

It is only a phase 2a trial, so the usual caveats about mid-stage clinical trials apply.

In accompanying editorial, Ellen Gravallese, M.D., and Ranjeny Thomas, M.D., pose a series of cautionary questions about peresolimab that further research needs to answer, but they sound an optimistic note: “This trial opens a refreshing chapter in the treatment of rheumatoid arthritis and introduces an approach that might also be applied to the treatment of other autoimmune diseases that are driven by antigen-activated lymphocytes.”

Understanding the behavioral health workforce | The Commonwealth Fund

There is so much attention on mental aka behavioral health these days. The Commonwealth Fund joined the crowd this morning with an useful explainer piece about the behavioral health workforce. Framing it as workforce is an eye opener that expands the view of those who deal with behavorial health issues and problems beyond just psychiatrists, psychologists and other licensed providers.

Other categories listed in writer Nathaniel Count’s exposition are clinical supporters (social workers, occupational therapists, certified addiction counselors, nurses, certified peer specialists, recovery coaches), community care workers (peer support specialists, community health workers and participants in voluntary programs, such as barbers who have been recruited to participate in behavioral health programs) and frontline workers (police, social service workers, teachers and others who deal with people with behavioral health problems as part of their jobs).

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