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They are the secret middlemen in the chain of rising prescription drug costs. Now there’s a substantial body of evidence that pharmacy benefit managers are costing public and private health insurance policies — and consumers — untold millions.A new report from the state’s Health Policy Commission, the office charged with riding herd on health care costs, documents part of the problem. Its title, “Cracking Open the Black Box of Pharmacy Benefit Managers,” tells us much of what we know — or, frankly, what we don’t know — about the role these middlemen play and the pressing need to shine some light on that dark corner. (6/11)

We have arrived at a special moment in health care. Innovative, life-changing gene therapies are here that will cure or ease debilitating diseases. Yet these expensive treatments are entering a market structure that was not built to price them. Congress will likely need to play a part in developing a new paradigm for financing such treatments. As a senator and a physician, I have been following this issue closely, and see several possible paths forward. There are multiple issues to address. (Bill Cassidy, 6/12)

n an effort to force reductions in prescription drug prices, the Trump administration risks sending those prices through the roof. Thankfully, the Department of Health and Human Services late last month delayed the expected finalization of a new rule that would radically upend the pharmaceutical market for Medicare Part D. Good. Sometimes it is better, as the criminal Fagin sang in "Oliver," to “think [we]’d better think it out again.” (Quin Hillyer, 6/7)

In his four years as chief executive officer of Sanofi, the French pharma giant, Olivier Brandicourt has been unable to convince investors that he can overcome the company’s challenges, and its stock has declined 17.9%. Come September, it will be Paul Hudson’s turn. The Novartis Holding AG pharma head seems like a solid choice for a tough turnaround job. Investors have already received Hudson positively, sending shares up 5% in Europe. There’s reason for optimism. While Sanofi’s issues aren’t entirely of Brandicourt’s making, it’s past time for new blood. (Max Nisen, 6/7)

Harnessing the power of the immune system to destroy cancer has dominated the biotech industry over the past decade. And for good reason: CAR-T therapies, checkpoint inhibitors, oncolytic viruses, and other next-generation immunotherapies can be incredibly effective at treating cancer — in some patients. That last phrase is the big caveat of immuno-oncology therapies: They don’t work in everyone, but only in very specific subsets of patients. While a promising way to make these therapies work in broader patient populations is to combine different immuno-oncology therapies, we first need to understand which patients will respond to treatment and why. (Grey Wilkinson, 6/7)

Pushing to cut prescription drug prices, Florida Republican U.S. Sen. Rick Scott is drawing fierce opposition from groups that usually are allies – those on the political right, who are condemning his proposal as “socialism.” Scott rarely hears criticism from solid conservatives. But Scott, himself, may be an unusual advocate for lowering drug prices.The multi-millionaire former governor and his wife, Ann, have been longtime investors in Gilead Sciences, the controversial manufacturer of Hepatitis C medication that cost U.S. and Florida taxpayers millions of dollars when used to treat Medicaid patients and prison inmates. (John Kennedy, 6/11)

Merck & Co. seems to have it in for investment bankers, at least when it comes to potential IPO fees. The drug giant announced Monday that it was buying closely held cancer-treatment developer Tilos Therapeutics for up to $773 million, a few weeks after shelling out $1.05 billion for another oncology startup, Peloton Therapeutics, on the eve of its IPO. Buying private and relatively early-stage biotech firms has a lot to recommend it. (Max Nisen, 6/10)

Medicare’s prescription drug benefit is known as the one federal entitlement program that routinely comes in under budget. Now, a new push is on in Congress to make changes to the program that could increase costs. (Avik Roy, 6/11)