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Estradiol has been around for decades, but the price of the various creams, vaginal rings and tablets that contain the drug has climbed steadily in recent years, according to an analysis by the consumer website GoodRx. And insurance coverage is spotty — many plans refuse to cover some products or require that patients pay high out-of-pocket costs. While women privately fume about the costs, drug makers have been able to raise their prices without a public outcry in part because the topic — women’s sex lives and their vaginas — is still pretty much taboo. (Thomas, 6/3)

Many consumers know of pharmacy benefit management companies through their brand names, such as Express Scripts, CVS Caremark and OptumRX. The companies, sometimes referred to as pharmacy benefit managers, manage prescription drug plans and serve as go-betweens for pharmacies and health insurance companies. The gag clauses are inserted into contracts with pharmacies by pharmacy benefit management companies, and they prohibit druggists from telling patients or caregivers about lower prices or cheaper drug options, such as generic drugs. Patients never know that there could be a less expensive way to get their medicines, because their neighborhood pharmacist can’t talk about it lest she violate those contracts. (Povich, 6/4)

A recently adopted tactic by U.S. health plans to limit the financial assistance drugmakers provide directly to consumers for prescription medicines is taking a toll on drug prices, according to a new analysis released on Tuesday. Real U.S. drug prices, including discounts and rebates, fell 5.6 percent in the first quarter of this year, compared to a 1.7 percent drop in the same period a year ago, according to Sector & Sovereign research analyst Richard Evans. (Erman and Humer, 6/5)

The growing use of copay accumulators — a new weapon against widely used but controversial copay assistance cards that drug makers distribute to consumers — is causing average net prices for medicines to fall, according to a new analysis. In the first quarter of 2018, net prices after concessions made by drug makers declined 5.6 percent, compared with a 1.7 percent drop in the corresponding quarter a year ago. This occurred even though increases in average wholesale — or list — prices more or less held steady at 6.2 percent versus 6.8 percent in the first quarter of 2017, according to Sector & Sovereign Research, which tracks the pharmaceutical industry. (Silverman, 6/5)

They are among the most promising new cancer therapies available, but they come with sky-high prices to match. And now the Trump administration is grappling with just how the federal government, through Medicare and Medicaid, will pay for them. The government’s payment policies for CAR-T treatments — which cost hundreds of thousands of dollars — are just beginning to take shape, but will likely have trickle-down effects on insurance coverage decisions throughout the country. They will also likely affect how enthusiastically doctors and hospitals start offering the therapies to patients. (Mershon, 6/5)

Allergan Plc faced a skeptical appeals court Monday as the company defended its use of an American Indian tribe’s sovereign immunity to avoid challenges to its patents from generic-drug makers. Two of three judges on the U.S. Court of Appeals for the Federal Circuit in Washington questioned whether Allergan was seeking to circumvent review by the Patent and Trademark Office. The reviews are widely used by technology companies, banks and insurers who say it offers a way to weed out bad patents. (Decker, 6/4)

Appaloosa and Senator Investment Group LP had previously telegraphed those desires to Allergan, but are turning the screws on the company by making their demands public. In a letter Tuesday to Allergan’s board of directors, released publicly, the activists call for a split of offices both held by Brent Saunders, and hire an outside candidate for either role. They also want to replace at least two additional directors on the board, and upgrade management personnel in critical operating units. (Al-Muslim, 6/5)

As Allergan stock continues to languish, two large hedge funds wrote a blistering letter to the drug maker’s board, urging them to split the roles of chairman and chief executive into separate positions, overhaul top management, and abandon an acquisition strategy. In harsh language, Appaloosa Management and Senator Investment Group criticized Allergan chief executive Brent Saunders and his board for “token measures” to revive the stock. Allergan shares are down about 33 percent in the past 12 months, although the stock was up nearly 1 percent at midday. (Silverman, 6/5)

Two of Allergan Plc's shareholders, hedge funds Appaloosa Management and Senator Investment Group, asked the drugmaker's board to split the role of chief executive officer and chairman as well as reconsider its acquisition strategy. The company has spent billions of dollars in deals in the past years, ballooning its debt to $26.6 billion, more than half of its current market value. (Mishra, 6/5)

Kaiser Health News: Price Check On Drug Ads: Would Revealing Costs Help Patients Control Spending?

President Donald Trump wants to control spending on drugs. One of his big ideas: include prices in advertisements, just like warnings about side effects. That’s not as simple as it sounds. Apart from legal questions about whether the Food and Drug Administration has the authority to require pricing in ads, other uncertainties arise. For example, what is the right number to use? (Appleby and Lupkin, 6/5)

Amid heated controversy over drug prices, Sanofi (SNY) is the latest large pharmaceutical company to release top-line numbers indicating average prices for its medicines fell last year, after accounting for rebates and discounts. Specifically, the company posted a brief summary stating the average wholesale — or list— price for its drugs increased 1.6 percent in 2017, but pricing actually declined by 8.5 percent when subtracting rebates and discounts paid to pharmacy benefit managers, or PBMs, and health plans. In 2016, the average price hike was 4 percent, but the net price fell 2.1 percent. (Silverman, 6/4)

Drug prices fell more than 5 percent in the first quarter, a new analysis found. But what caused the decrease can actually increase costs for patients in the long run. If it sounds wonky, that's because it is.List price, or the advertised amount, of drugs increased 6.2 percent, according to SSR Health. Meanwhile, real net price declined 5.6 percent, compared with 1.7 percent in the same period last year, the firm found. (LaVito, 6/5)

Investors spent the weekend chewing over cancer drug data presented at the American Society of Clinical Oncology annual meeting. It’s Monday, so time to see how the markets are reacting. Looking for ASCO Monday trading winners? Two stocks stood out early: Loxo Oncology and Merck. Loxo posted strong tumor response rates with LOXO-292 in patients with tumors containing a mutated protein known as RET. (Feuerstein, 6/4)

Vulnerable Senate Democrats have found a common villain: the pharmaceutical industry. They're highlighting both drug prices and the opioid epidemic as they try to make their cases to voters. The big picture: Democrats already think health care is a strong issue for them this year, given the unpopularity of the GOP's repeal and replace effort. Opioids and drug prices both resonate deeply with voters, and some Democratic incumbents do have long track records on one or both issues. (Owens, 6/4)

Josh Cox says that CVS will go pretty far in trying to wrest the lucrative business of filling cancer-drug prescriptions away from oncology clinics. The company, which operates a retail pharmacy chain and manages prescription-drug payments for millions of Americans, has long sent unsolicited faxes to cancer doctors, using confidential patient information, in an attempt to steer business to its own pharmacies, said Cox, pharmacy director for the Dayton Physicians Network. (Schladen, 6/3)

Insurers and their pharmacy-benefit managers like to tout mail-order operations as a convenient alternative. But in the world of expensive cancer drugs, the companies use their clout to force patients away from hospital- or clinic-based pharmacies and into their own mail-order operations. It creates another revenue stream for pharmacy benefit managers, or PBMs, the little-known middlemen in the health-care system. (Candisky and Schladen, 6/3)

The intersection of Ames and Main Streets in Cambridge's Kendall Square is perhaps the best place to stand if you want to see the biotech industry boom that has overtaken this region since the turn of the century. ... Although the San Francisco Bay Area competes with this region as the top spot for biotech, experts say the industry is much more concentrated here. (Weintraub, 6/4)

Several drug pricing scandals have grabbed headlines in recent years in cases in which companies hiked the prices of old drugs or jacked up the cost of blockbuster drugs little by little year after year. Another case hasn't garnered the same attention—and maybe that's because people just don't like to talk about vaginas. Branded versions of estradiol, a female sex hormone that treats vaginal atrophy related to menopause—a condition that can cause painful intercourse and other complications—have climbed in price for years, according to an analysis from drug pricing website GoodRx. (Sagonowsky, 6/4)

Amid a reckoning over the representation of women on the drug industry’s most prominent stages, this year’s BIO International Convention will feature a 30 percent increase in female speakers compared with last year. But in a sign of how male-dominated such events remain, the conference will also have 25 panels made up entirely of men. That’s according to a count from GenderAvenger, a group that tracks gender diversity at events. (Robbins, 6/1)