There is an assault on the foundation of U.S. science. Recent actions—including arbitrarily restricting scientists' ability to speak and travel and stalling the dispersal of previously awarded NIH and NSF funds—are more than bureaucratic disruptions. They are an assault on the foundation of biomedical and technological progress.

No Patient Left Behind (NPLB) wrote to the Centers for Medicare and Medicaid services (CMS) urging the agency to allow Medicare to cover anti-obesity medications (AOMs) and to strengthen patient protection “guardrails” through better oversight of Medicare Advantage Part D (MAPD) plans.

No Patient Left Behind wrote to the Centers for Medicare & Medicaid Services (CMS) asking the agency to adopt rules that ensure that patients—not health plans or PBMs—see savings from the implementation of Medicare price setting.

When assessing the viability of an investment, investors attempt to calculate the business’s or product’s net-present value (NPV). The NPV combines a project’s likelihood of success with an estimate of the money it may make over time to determine its present value to investors. The price-setting provisions of the IRA reduce the NPV of any drug candidate at launch by 40%. If investors aren’t confident they will earn a return on their investment, they won’t invest in new drug candidates, and most ideas will never leave the laboratory.

CBO’s ability to correctly model investor decision-making is vital to our country’s ability to establish policies that achieve lasting biomedical affordability and continued innovation. In support of CBO’s efforts to improve its model, this letter emphasizes a number of economic and financial first principles, notably that investment is incentivized by expected returns based on discounted profits, not revenue, and adjusted for expected dilution from financings.