Letter to President Biden, Secretary Becerra, Speaker Pelosi, Minority Leader McCarthy, Senate Majority Leader Schumer, and Senate Minority Leader McConnell opposing HR 3

Members of the VC community voice concerns over HR 3 to policymakers

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09.08.2021

Dear President Biden, Secretary Becerra, Speaker Pelosi, Majority Leader Schumer, Leader McCarthy, Leader McConnell, America’s Lawmakers, Patient Advocates, and Fellow Americans:

We lead, fund, and count on the many small biotechnology companies that develop medicines for diseases* that lack sufficient treatments and cause considerable suffering. The companies led by the executives among us employ 22,411 people in the US and collectively invest over $16.9 billion/year in search of breakthroughs. We are currently testing 373 new and potentially life changing drug candidates in clinical trials, some of which build upon foundational NIH-funded research led by the academic researchers among us. The investors among us work at firms managing over $183 billion of life science-focused capital that comes primarily from pension funds, families, universities, non-profits, and others who invest in drug development. Many of us are also patients and patient advocates, with loved ones who suffer from difficult diseases in need of better treatment options. We have dedicated ourselves to that effort. Collectively we come together to defeat disease. Each drug in development is a complex, time consuming, and expensive scientific and medical undertaking. Most of the time we lose the battle. But we persist because the few projects that succeed will forever improve human health. Our industry invests over $160 billion in R&D each year. In the past decade it has created vaccines and treatments for Covid-19, treatments for cystic fibrosis and sickle cell disease, and cures for several cancers and hepatitis C. These successes are just a few examples of the many significant advances we are driving. Our efforts are reducing the burden and threat of diseases across the USA and around the globe. It has become clear that we must also help our lawmakers understand the basic economic framework that inspires companies and investors to take the financial risk required to create new medicines. Called to action by the justifiable outrage of patients who cannot afford their out-of-pocket costs, some lawmakers have misdiagnosed the problem. They believe drug companies charge too much for their products. In response, they are proposing to enact laws that not only fall short of making drugs affordable to all patients but also defund our efforts to create better ones.

The Right Goal

To be clear, we are concerned about the high and rising out-of-pocket costs that have made our medicines increasingly unaffordable to many patients. We, too, call for a solution to affordability. We don’t invent drugs to have them placed out of the reach of people who need them. Insurance makes it possible for Americans to afford today’s medicines and collectively invest in tomorrow’s, as is captured in this short video. To solve the problem of affordability for patients, we must lower the amount that insurance plans can make patients pay out-of-pocket, redefining proper insurance by law, just as policymakers have appropriately outlawed discrimination on the basis of preexisting conditions.

The Wrong Policy

Instead, Congress is considering allowing the government to dictate the price that a company may charge for a novel drug with the threat of ruining the company financially with a 95% tax should the company refuse to accept the government’s price. Such draconian measures would immediately halt private funding of drug discovery and development. As an industry, we would no longer be able to infer what insurance plans might value and pay tomorrow from what they value and pay today, which is the premise of a market economy. Unpredictable government-dictated prices would supplant the current market-based framework that inspires biomedical R&D investment. The investors among us would have to shift our investments toward areas still governed by markets, such as technology and consumer goods. Those companies with drug candidates in development would fail to raise more capital, making it pointless for them to spend existing dollars on ongoing research. The loss of hundreds of thousands of well-paying jobs would be swift, though it may take longer for the public to sense the loss of future treatments and cures. Some may think NIH funding will be sufficient to fund continued R&D. The NIH is a crucial funder of the basic research that provides the ideas for what kinds of drugs might be possible. Translating those ideas into actual medicines is almost entirely driven by the private sector and makes all that basic research worth funding in the first place. Some of us signing this letter are NIH funded academic researchers whose discoveries have had significant patient impact, and we affirm that the private sector has been and will continue to be essential for turning our ideas into medicines. The NIH and industry are parts of one whole ecosystem, not a replacement for one another.

What’s in a Word?

Successful negotiations result in market-based prices based on competing alternatives – this negotiation already takes place between drug manufacturers and insurance companies, resulting in an average 50% reduction from drugs’ list prices to their net prices. True negotiation requires that both parties can walk away from the table. True negotiation is acceptable to all of us and spurs us to compete. True negotiation means that even if we don’t get to the market first, our second and third place drugs can still secure some market share by competing on price. The proposed introduction of a 95% tax penalty would allow The Center for Medicare and Medicaid Services (CMS) to simply dictate any drug’s price. This is not true negotiation. As proposed, the government would be able to keep a company from walking away from an unacceptably low price. This gives the American public the impression that they can have any drug that’s been invented for any price, however low. Overlooked in that bargain is that investors and companies will stop investing in new programs, and we’ll give up the medicines that haven’t been invented yet. Congress may not intend to dictate the price for every drug. But dictating the price of drugs covered by Medicare would defund R&D for diseases of aging, including Alzheimer’s, osteoporosis, and cancer. Dictating prices for medicines priced above a certain threshold would defund R&D for rare diseases. Dictating prices for medicines that generate the most total revenue would defund R&D for our most difficult diseases, since those are the ones that require greater expected revenues to incentivize substantial R&D investment. Dictating prices for drugs deemed less “valuable” to society sounds tempting, until one realizes that the math for estimating a drug’s value is so nascent, imprecise, and controversial that it’s easily biased to reflect the preferences of the practitioner. For example, a recent business plan competition demonstrated that not a single project would be fundable if future products could only be priced in accordance with the over-simplified math used in the UK and Canada. Furthermore, there is mounting evidence from health economics research that medicines offer greater societal value than is reflected by their prices.

Better Solutions

We already have a functioning mechanism to drive down drug prices: drugs go generic. Because drugs go generic, what America spends on drugs has remained at roughly 10% of healthcare spending for decades, yet we have so many more effective and safer medicines today than in the 1970s. Hospitals, long-term care facilities, and medical procedures do not go generic; those costs have only
been climbing. We can keep ourselves from having to rely as much on hospitals in the future by inventing better medicines, which will then go generic. Society saves money, and we all lead healthier
lives. Preserving market-based incentives for drug R&D is how we get the medicines to achieve this goal. Heart transplants were first performed in 1967 and climbed in price by over 2,000% to cost $1.4 million today. The heart failure drug amiloride helps avert the need for transplants and was approved in 1967; today it costs 26 cents/pill. We haven’t solved heart failure, but we’re working on it. So, there’s hope for the people who need better heart failure medicines, but that hope requires continued investment in
R&D. America, and specifically CMS, can still save on drugs without sacrificing future treatments, cures, and vaccines. Certain drugs do not go generic even after their patents have expired, and CMS could save money by solving that particular market failure. Doing so would not reduce R&D incentives. Members of industry and others have proposed a specific, actionable framework for how this could work.

Averting A Costly Error

It’s true that replacing market-based pricing with non-market government-dictated prices will reduce healthcare spending in the short run (the Congressional Budget Office, which helps lawmakers determine what legislation may cost or save the government, uses a 10-year timeframe). But without new medicines, this policy will condemn America to spend far more on managing diseases in hospitals and long-term care facilities for decades to come. The worst part is that it will take a long time to realize that we’re not making progress like we used to. For example, antibiotic R&D has historically suffered from low investment incentives because the prices of antibiotics are so low. Today, we urgently need new antibiotics to combat the rise of resistant bacterial infections, but it will take years to remedy this gap in R&D even with proper incentives and funding. It’s hard to appreciate what we don’t have until we need it. The advocates among us know this acutely, having worked with so many patients struggling to make it to the next breakthrough. Where there are market failures, we should fix them. All drugs should go generic without undue delay. Americans should not suffer because their insurance burdens them with unaffordable out-of-pocket costs, whether they get their drugs through Medicare, their employer insurance, or on the public exchanges. Patients and policyholders should benefit from the savings insurers negotiate with drug companies, and drugs covered under Medicare Part B should be subject to the same competitive market forces as those covered by Part D. Lawmakers should focus on these important, achievable,
and bipartisan reforms for the benefit of all Americans.

In the meantime, the term “negotiation” must not be redefined to encompass the government dictating a price under threat of financial ruin. Were such a law to pass, capital would be immediately redirected away from biomedical R&D, with an immediate effect on biotechnology jobs and longer-term harm to patients and our national budget and security. Some observers of the drug development ecosystem who propose different theories and models of how it works might contradict us. But the executives and investors among us write not as observers of biotech’s economic framework but as its actual elements and conductors; capital and incentives flow through our funds and our companies like electricity through a circuit. It is evident to us that replacing true negotiation with dictated prices would defund R&D, like flipping off a light switch.

Sincerely,
Peter Kolchinsky, Aoife Brennan, Alex Karnal, Jeremy Levin, Laura Shawver, Daphne Zohar, and Signatories to this Statement, listed below**:

Peter Kolchinsky, PhD RA Capital Management, LP Boston, MA Aoife Brennan, MB, BCh, BAO, MRCPI Synlogic Therapeutics Cambridge, MA Alex Karnal Braidwell Management New York City, NY Jeremy Levin, D.Phil, MB BChir Ovid Therapeutics New York City, NY Laura Shawver, PhD Silverback Therapeutics Seattle, WA Daphne Zohar PureTech Health Boston, MA Robert Langer, ScD MIT Cambridge, MA Paul Hastings Nkarta Therapeutics South San Francisco, CA Bob Nelsen ARCH Venture Seattle, WA Jean Francois Formela, MD Atlas Venture Boston, MA John Maraganore, PhD Alnylam Pharmaceuticals Cambridge, MA Gunnar Esiason, MBA Boomer Esiason Foundation New York, New York Ted W. Love, MD Global Blood Therapeutics South San Francisco, CA Brook Byers Kleiner Perkins Menlo Park, CA Siddhartha Mukherjee, MD Dphil Columbia University New York, NY Arjun Goyal, MD Vida Ventures Boston, MA Wendye Robbins Blade Therapeutics South San Francisco, CA Ron Cohen, MD Acorda Therapeutics Ardsley, NY Corey S. Goodman, PhD venBio Partners San Francisco, CA Mark Murcko, PhD Dewpoint Therapeutics Boston, MA Kush M Parmar, MD, PhD 5AM Ventures Boston, MA Akiko Iwasaki Yale University New Haven, CT Nina Kjellson Canaan Partners San Francisco, CA Rajeev Shah RA Capital Management, LP Boston, MA J. Tyler Martin, MD Adjuvance Technologies Lincoln, NE Robert Ang Vor BioPharma Cambridge, MA D.A. Wallach Time BioVentures Los Angeles, CA Jeffrey L Cleland, PhD Ashvattha Therapeutics Redwood City, CA Jake Becraft, PhD Strand Therapeutics Inc Cambridge, MA Peter A. Thompson, MD OrbiMed Advisors New York, NY James McArthur, PhD PepGen Inc Cambridge, MA Robert D. Schultz Satsuma Pharmaceuticals, Inc. Durham, NC Jeffrey Bird, MD, PhD Bluebird Ventures Palo Alto, California Troy Wilson, PhD, JD Kura Oncology San Diego, CA Peter Bisgaard Pivotal Life Sciences San Francisco, CA John A. Scarlett, MD Geron Corporation Foster City, CA Todd Harris Tyra Biosciences Carlsbad, CA Paul Bolno, MD Wave Life Sciences Cambridge, MA Cedric Francois, MD, PhD Apellis Pharmaceuticals, Inc. Waltham, MA Marc de Garidel CinCor Boston, MA Andreas Wicki HBM Healthcare Investments AG Zug, Switzerland Jill C. Milne, PhD Catabasis Pharmaceuticals Boston, MA Jeffrey A. Leerink SVB Leerink Boston, MA Jay Venkatesan, MD Angion Uniondale, NY Nicholas Oo Invus New York, NY Stephen J. Hoffman, PhD, MD Apic-Bio, Inc. Cambridge, MA David A. Katz, PhD Sparrow Pharmaceuticals Portland, OR Joseph Healey HealthCor Management New York, NY Joshua Resnick, MD RA Capital Boston, MA Jeff Albers Blueprint Medicines Cambridge, MA Agustin Mohedas, PhD Janus Henderson Investors Denver, CO Blake Wise Novome Biotechnologies South San Francisco, CA David-Alexandre C. Gros, MD Eledon Pharmaceuticals Irvine, CA Larry Feinberg Oracle Partners L.P. Greenwich, CT Ashley Dombkowski, PhD Alladapt Immunotherapeutics, Inc Menlo Park, CA Alain D. Baron, MD Escient Pharmaceuticals San Diego, CA Andrew N. Schiff, MD Aisling Capital New York, NY Michael R. Hayden, MBChB, PhD Prilenia Therapeutics Herzaliya, Israel Amit D. Munshi Arena Pharmaceuticals Inc San Diego, CA Melinssa McCracken, PhD Nextech Invest Boston, MA Timothy M Shannon, MD Canaan Partners Westport, CT John Kollins Satsuma Pharmaceuticals, Inc. South San Francisco, CA Ed Mascioli EMMD LLC Boston, MA Nancy A. Thornberry Kallyope New York, NY Amy Burroughs Cleave Therapeutics San Francisco, CA Alex Virgilio Asymmetry Capital Management San Francisco, CA Frank Watanabe Arcutis Biotherapeutics Westlake Village, CA Sarah Boyce Avidity Bioscience San Diego, CA Brian Halak, PhD Domain Associates Princeton, NJ Ken Drazan Arsenal Biosciences South San Francisco, CA David Sable, MD Special Situations Life Sciences Fund New York, NY Nassim Usman, PhD Catalyst Biosciences South San Francisco, CA Jon Edwards, PhD Red Tree Venture Capital Menlo Park, CA Sean Jeffries, PhD Design Therapeutics Carlsbad, CA Jak Knowles Affini-T Therapeutics Boston, MA Yishai Zohar Gelesis Inc Boston, MA Dr. Vipin Garg Altimmune, Inc. Gaithersburg, MD Dan Becker, MD, PhD Access Biotechnology New York, NY Sadik H. Kassim, PhD Vor Bio Cambridge, MA James A. Geraghty Fulcrum Therapeutics Cambridge, MA Doug Crawford Mission BioCapital San Francisco, CA Eric Dube, PhD Travere Therapeutics San Diego, CA Gregory J. Flesher Reneo Pharmaceuticals, Inc. Irvine, CA Matt Eckler Arrowmark Partners Denver, CO Scott Clarke Ambagon Therapeutics San Francisco, CA Andy Schwab 5AM Ventures San Francisco, CA Vikram Khanna Ikarian Capital Dallas, TX Stephen Dilly M.B.B.S., Ph.D Sierra Oncology San Francisco, CA Cris Montero, PhD RA Capital Management, LP Boston, MA Todd Foley MPM Capital Cambridge, MA Kenneth I. Moch Euclidean Life Science Advisors Chapel Hill, NC Marina Udier Nouscom AG Basel, Switzerland Ali Behbahani New Enterprise Associates Washington DC Michael Broxson Q32 Bio Cambridge, MA JP Sommandossi Atea Pharmaceuticals Boston, MA Branden B. Muhl B Group Capital Dallas, TX Arthur Tzianabos, PhD Homology Medicines Bedford, MA Fredrik Wiklund Bright Peak Therapeutics San Diego, CA Paul Sekhri eGenesis, Inc. New York, NY Bernat Olle Vedanta Biosciences Cambridge, MA Tomer Kariv Pontifax Israel/UK Adi Hoess Affimed NV Heidelberg, Germany Stephen J. Farr PhD Zogenix, Inc. Emeryville, CA Laurie Halloran, BSN, MS Halloran Consulting Group, Inc. Boston, MA Peter Greenleaf Aurinia Pharmaceuticals Rockville, MD Pieter Boelhouwer JD RA Capital Management, LP Boston, MA Adam Rosenberg Ambagon Therapeutics San Francisco, CA Michael Kauffman MD, PhD Verastem Newton, MA Harith Rajagoplan MD, PhD Fractyl Health Lexington, MA Bob Ward OncoSec Immunotherapies Princeton, NJ Rosana Kapeller ROME Therapeutics Cambridge, MA Patrick Heron Frazier Life Sciences Menlo Park, CA Andrew Levin, MD, PhD RA Capital Management, LP Boston, MA Zach Collins Mission Biocapital San Francisco, CA Zach Scheiner, PhD RA Capital Management, LP Boston, MA Maria Koehler MD, PhD Repare Therapeutics Cambridge, MA Llew Keltner, MD, PhD Light Sciences Oncology Portland, OR Michael D. Clayman, MD Flexion Therapeutics, Inc. Burlington, MA Mark Corrigan MD Exacis Biotherapeutics Boston, MA Christoph Westphal Longwood Fund Boston, MA Jeffrey M. Solomon Cowen Inc. New York, NY Laura Tadvalkar, PhD RA Capital Management, LP Boston, MA Roger J Pomerantz MD, FACP ContraFect New York, NY Jyoti Chauhan Landos Biopharma Inc. Blacksburg, VA James Mackay Aristea Therapeutics San Diego, CA Francesco Draetta Omega Funds Boston, MA Anurag Kondapalli RA Capital Management, LP Boston, MA Zachary Hornby Boundless Bio, Inc. San Diego, CA Bob Linke Osmol Therapeutics, Inc. New Haven, CT Jake Simson, PhD RA Capital Management, LP Boston, MA Matthew Hammond, PhD RA Capital Management, LP Boston, MA Taylor Schreiber MD, PhD Shattuck Labs, Inc. Durham, NC H. Stewart Parker Parker BioConsulting Chapel Hill NC John P. Butler Akebia Therapeutics Cambridge, MA James N. Campbell, MD, FAANS Centrexion Therapeutics Baltimore, MD Russell Cox Epirium Bio San Diego, CA Erich Scheller, PhD RA Capital Management, LP Boston, MA Joseph Edelman Perceptive Advisors New York, NY Derek DiRocco, PhD RA Capital Management, LP Boston, MA David H. Crean Coast BioVentures San Diego, CA Matt Cohen, PhD Osage University Partners, LP Bala Cynwyd, PA Jeremy P. Springhorn, PhD Nido Biosciences Cambridge, MA Peter Strumph Parvus Therapeutics San Francisco, CA Jon Soderstrom, PhD Yale University New Haven, CT Tess Cameron RA Capital Management, LP Boston, MA Scott M. Rocklage 5AM Ventures Boston, MA Kevin Kimberlin Spencer Trask & Co Greenwich, CT Laura Stoppel, PhD RA Capital Management, LP Boston, MA Scott Kellen DiaMedica Therapeutics Inc. Minneapolis, MN Bassil Dahiyat Xencor Monrovia, CA Pratik Shah, PhD Design Therapeutics San Diego, CA Jason Gardner Magenta Therapeutics Cambridge, MA John F. Crowley Amicus Therapeutics, Inc. Philadelphia, PA Brad Loncar Loncar Investments Lenexa, KS Armando Anido Zynerba Pharmaceuticals Devon, PA Joshua T. Brumm Dyne Therapeutics Waltham, MA Dennis Purcell Aisling Capital New York City, NY Walter H. Moos Pandect Bioventures South San Francisco, CA Sandip Agarwala Longitude Capital Greenwich, CT Reza Halse, PhD RA Capital Management, LP Boston, MA John Tucker scPharma Burlington, MA Randy Mitchell Alyeska Investment Group Chicago, IL Adam Keeney NodThera Lexington, MA Nancy Simonian Syros Pharmaceuticals Cambridge, MA Ronald C Renaud Jr. Translate Bio Lexington, MA Jeremy Bender, PhD Day One Biopharmaceuticals, Inc. South San Francisco, CA Kate Moreau, PhD RA Capital Management, LP Boston, MA Travis Wilson Gurnet Point Cambridge MA Jeffrey H. Knapp DNAtrix, Inc. Houston, TX Mike Derkacz Braeburn Plymouth Meeting, PA Jeff Kindler Centrexion Therapeutics Boston, MA Richard W. Pascoe Histogen Inc. San Diego, CA Douglas Ingram Sarepta Therapeutics Cambridge, MA Jason Lin TwoThree Capital Toronto, ON Jason Bhardwaj Follica, Inc. Boston, MA David de Graaf, PhD Abcuro, Inc. Newton, MA John Neis Venture Investors Madison, WI Wesley M. Jackson Valitor Berkeley, CA Rich Aldrich Longwood Fund Boston, MA Peter Rubin No Patient Left Behind (NPLB) Washington, DC Adam Simpson Icosavax, Inc. Seattle, WA Douglas M Fambrough Dicerna Pharmaceuticals, Inc. Lexington, MA Shuo Zhang AuGC Partners Belmont, CA Keith Murphy Viscient Biosciences San Diego, CA Neil Warma I-Mab Biopharma U.S. San Diego, CA Steve Elms Aisling Capital New York, NY Jeffrey Herz, PhD Algomedix, Inc. Mill Creek, WA Jeb Keiper Nimbus Therapeutics Cambridge, MA Brent Ahrens Canaan Partners Menlo Park, CA Wendell Wierenga, PhD Chairman, Crinetics San Diego, CA Ken Takanashi SNBL Ltd. Tokyo, Japan Misha Petkevich, DPhil V2M Capital LLC West Palm Beach, FL Josh Mandel-Brehm CAMP4 Therapeutics Cambridge, MA Chen Yu, MD, MBA TCG Crossover Palo Alto, CA Jason Bonadio, MD Alera Partners Greenwich, CT David Socks HilleVax, Inc. Boston, MA Aaron Royston venBio Partners San Francisco, CA Dillon Hoover CASTLEARK MANAGEMENT, LLC Chicago, IL Art Pappas Pappas Capital, LLC Research Triangle Park, NC Carmine Stengone Pipeline Therapeutics San Diego, CA Laura A Brege Acadia Pharmaceuticals San Diego, CA Jonathan Rourke MitraSpan Belmont, MA Joseph Leveque, MD Mirati Therapeutics San Diego, CA Evan Markegard AuGC Partners LLC Belmont, CA David J. Woodhouse, PhD NGM Biopharmaceuticals, Inc. South San Francisco, CA Rachael Nokes scPharmaceuticals Inc. Burlington, MA Joseph Sarret CohBar, Inc. Menlo Park, CA Bharat Chowrira, PhD, JD PureTech Health Boston, MA Scott Harris Cleave Therapeutics, Inc. San Francisco, CA Pearl Freier Cambridge BioPartners, Inc. Cambridge, MA Joao Siffert Design Therapeutics San Diego, CA Rick Pauls DiaMedica Therapeutics Minneapolis, MN Catherine Stehman-Breen, MD Chroma Medicine Cambridge, MA Michael Hassman scPharmaceuticals Inc. Burlington, MA Joseph Bolen, PhD PureTech Health Boston, MA Jacob Chacko, MD ORIC Pharmaceuticals South San Francisco, CA Catherine Pearce, DHSc, MBA CinCor Pharma Inc. Cincinnati, OH Emily Drabant Conley, PhD Federation Bio South San Francisco, CA Timothy P. Walbert Horizon Therapeutics Deerfield, IL Justin R. Thompson CinCor Pharma, Inc. Cincinnati, OH Steven Burke, MD Akebia Therapeutics Cambridge, MA Stan Wang, MD, PhD Thymmune Therapeutics Cambridge, MA Albert Seymour, PhD Homology Medicines, Inc. Bedford, MA Richard Gaster, MD, PhD venBio Partners San Francisco, CA Rohan Palekar 89bio Inc. San Francisco, CA Alyssa Larson, PhD RA Capital Management, LP Boston, MA Daniel Bensen Tyra Biosciences, Inc. Carlsbad, CA Nancy Lurker EyePoint Pharmaceuticals Watertown, MA Neil Exter Third Rock Ventures Boston, MA John L. LaMattina PureTech Hrealth Stonington, CT Ron Hunt New Leaf Venture Partners New York, NY Chip Clark Genocea Biosciences, Inc. Cambridge, MA Nathaniel Brooks Horwitz RA Capital Management, LP Boston, MA Ivor Royston, MD Viracta Therapeutics Cardiff, CA William E. Rote, PhD Travere Therapeutics San Diego, CA Jason Rhodes Atlas Venture Boston, MA Peter Parker Mission BioCapital Cambridge, MA June H. Lee, MD Esker Therapeutics San Francisco, CA Lee D. Cooper Leaps by Bayer Cambridge, MA Todd Krueger AOBiome Therapeutics Cambridge, MA Jonathan Piazza Silverback Therapeutics Seattle, WA Otello Stampacchia Omega Funds Boston, MA Paulina Hill Omega Funds Boston, MA Cristina Ghenoiu, PhD RA Capital Management, LP Boston, MA Ankit Mahadevia, MD Spero Therapeutics Cambridge, MA Ari Zweiman 683 Capital Management LLC New York, NY Adrian Gottschalk Foghorn Therapeutics Cambridge, MA Brian Rosenberger Zynerba Pharmaceuticals Devon, PA Mark Leuchtenberger Aleta Biotherapeutics Natick, MA Will Brown Altimmune, Inc. Gaithersburg, Maryland Kristina Burow ARCH Venture Partners Chicago, IL Mike Sherman Chimerix Durham, North Carolina Daniel E. Rosan Synlogic Therapeutics Cambridge, MA Philip Astley-Sparke Replimune Inc Boston, MA CJ Sylvester Manulife Boston, MA Adrian (Ad) Rawcliffe Adaptimmune Philadelphia, PA Faheem Hasnain Gossamer Bio San Diego, CA Ephraim Heller SynAgile Corporation Wilson, WY Rebecca Lucia, CFA 5AM Ventures San Francisco, CA Paul Johnson Braeburn Plymouth Meeting, PA Valerie Daggett, PhD AltPep Seattle, WA W. Eddie Martucci, PhD Akili Interactive Labs Boston, MA Mike Powell Omega Funds Boston, MA Steve Dickman CBT Advisors Cambridge, MA Fouad Azzam, PhD Life Sciences Partners Waltham, MA Fred Aslan, MD Artiva Biosciences San Diego, CA Ray Debbane Invus New York, NY Habib Dable Acceleron Pharma Cambridge, MA Michael A. Schrader Vaxess Technologies, Inc. Cambridge, MA Philippe Amouyal Invus Miami, FL David V. Goeddel, PhD Tenaya Therapeutics San Francisco, CA David Grayzel, MD Atlas Venture Boston, MA Khalil Barrage Invus New York, NY Steven Gillis ARCH Venture Partners Seattle, WA Kris Jenner Rock Springs Capital Baltimore, MD Bertrand Georges Altimmune Inc. Gaithersburg, MD Carl L. Hansen, PhD AbCellera Vancouver, BC Canada David Kroin Deep Track Capital Greenwich, CT Thomas E Darcy Viracta Therapeutics, Inc. Cardiff, CA Adam M. Koppel Bain Capital Life Sciences Boston, MA Vicente Anido, PhD Aerie Pharmaceuticals, Inc Durham, NC Sen Sundaram Terns Pharmaceuticals Foster City, CA Raju Kucherlapati Harvard Medical School Boston, MA Aaron Davis Boxer Capital San Diego, CA Greg Mayes Antios Therapeutics Mendham, NJ Jonathan Kipnis Washington University in St. Louis St. Louis, MO Evan Loh, MD Paratek Pharmaceuticals Boston, MA Barry Quart, PharmD Heron Therapeutics San Diego, CA Brian S. Kim, MD, MTR, FAAD Washington University School of Medicine; St. Louis, MO Stephen Hurly LAVA Therapeutics Philadelphia, PA Clay B. Thorp Hatteras Venture Partners Durham, NC Norbert Bischofberger Kronos Bio San Mateo, CA Jerry Cahill Boomer Esiason Foundation New York, NY David Hirsch Longitude Capital Boston, MA Angie YouPhD Amunix Pharmaceuticals South San Francisco, CA Dave Madden River 2 and 3 Renal Corps New York, NY Evan Greif Bain Capital Life Sciences Boston, MA Kevin Bitterman Atlas Venture Cambridge, MA Robert L. Hudkins Tyra Bioscience Carlsbad, CA Jeffrey Bluestone, PhD Sonoma Biotherapeutics South San Francisco, CA Adam Muzikant, PhD Flexion Therapeutics Burlington, MA Jose Ochoa Altimmune Gaithersburg, MD Josh Richardson Longitude Capital Boston, MA Emily Schaller Rock CF Foundation Detroit, MI Lloyd M. Segal Repare Therapeutics Inc. Cambridge, MA Kevin Pyun Dellora Investments LP Greenwich, CT William S. Slattery Deerfield Management New York, NY Ansbert Gadicke MPM Capital Cambridge, MA Pascal Touchon Atara Biotherapeutics San Francisco, CA Daniel Vitt Immunic Therapeutics New York City, NY Robert Adelman, MD venBio San Francisco Robert Blazej, PhD MBC Biolabs San Francisco, CA Khrystal K Davis, JD Texas Rare Alliance Austin, TX Michael Nolan Freenome South San Francisco, CA Samuel L Murphy, PhD Salubris Biotherapeutics Cambridge, MA Jim Sullivan, PhD Vanqua Bio Chicago, IL Peter Wirth Quan Capital Management Boston, MA Aaron Hakim, MD Deep Track Capital Boston, MA Hillary Theakston Clearity San Diego, CA Michelle Ho 5AM Ventures San Francisco, CA Mark Simon Torreya Partners New York, NY Noah L. Rosenberg, MD Travere Therapeutics San Diego, CA Bong Koh, MD Venrock New York, NY James Brush, MD Frazier Healthcare Partners Menlo Park, CA Galya Blachman 5AM Ventures San Francisco, CA Bruce Booth Atlas Venture Boston MA Thomas Malley Mossrock Capital, LLC Englewood, CO Deborah Palestrant 5AM Ventures Boston, MA Albert Gianchetti XyloCor Therapeutics Malvern, PA Douglas Fisher, MD InterWest Partners Menlo Park, CA Barry Labinger Checkmate Pharmaceuticals Cambridge, MA Peter Smith Remix Therapeutics Cambridge, MA Daniel Koller BB Biotech AG Schaffhausen, Switzerland Roderick Wong, MD RTW Investments New York, NY John E. Osborn BioVentures Investors Wellesley, MA Sanjiv Patel Relay Therapeutics Boston, MA Vasudev Bailey, PhD Artis Ventures San Francisco Sean McCarthy CytomX Therapeutics South San Francisco, CA Ryan Lane Empery Asset Management LP New York, NY Chris Garabedian Perceptive Advisors Boston, MA Jonathan Lim, MD Erasca San Diego, CA Sandy Mong MD Atlas Venture Boston, MA James Blair Domain Associates LLC Princeton, NJ Joanne Kotz, PhD Jnana Therapeutics Boston, MA Allen Conger NeuroMedica Mt. Pleasant, SC Michael Keyoung, MD, PhD CBC Group New York, NY Seth Rotberg, MNM Our Odyssey Chicago, IL Michael S. Weiss TG Therapeutics Boca Raton, FL Bala Venkataraman Avego Management Alpharetta, GA Stan Erck Novavax Gaithersburg, MD Harris Weber Bain Capital Boston, MA Gerard Smith Deep Track Capital Greenwich, CT Michael Gladstone Atlas Venture Cambridge, MA Axel Hoos Scorpion Therapeutics Boston, MA Vincent S. Mosca Ditch Plains Capital Management Manhasset, NY Colin Wang 6 Dimensions Capital Cambridge, MA Patrick Nosker, PhD Affinity Asset Advisors, LLC New York, NY Fred Dotzler De Novo Ventures Saratoga, CA Dan Janney Alta Partners San Francisco, CA Michael J. Hearle Clough Capital Partners Boston, MA Doug Roeder Delphi Ventures San Mateo, CA David Allison 5AM Ventures San Francisco, CA Wende Hutton Canaan Partners Menlo Park CA Robert F. Johnston Johnston Associates, Inc. South Hamilton, MA Albert Cha Frazier Healthcare Partners Menlo Park, CA Marc W. Elia M28 Capital Management Stamford, CT Thomas A. Romero Capital Research Partners & Co. Norwalk, CT Laurence Blumberg, MD Arch Oncology Brisbane, Ca Bryan Roberts Venrock Palo Alto, CA Jonathan Root, MD U.S. Venture Partners Menlo Park, CA Gary Stern Eagle Health Investments Greenwich, CT Lazar Dimitrov, PhD Day One Biopharmaceuticals South San Francisco, CA Andrew Oberwager MD Machaon Capital Managemnt LP Stamford, CT Benjamin Young Gray’s Creek Capital Partners Westport, CT Julie Papanek Grant Canaan Menlo Park, CA Owen Smith, MSc, CPFA 4BIO Capital London, UK Dr. Michael Fischer Medical Strategy – Investmentmanager Munich, Germany Dmitry A. Kuzmin, PhD ,FRSB 4BIO Capital LLP London, U.K. Matt Renna Westfield Capital Management Boston, MA Thilo Schroeder Nextech Invest Zurich, CH Torbjorn Bjerke, MD Arctic Asset Management Stockholm, Sweden Nicole Vitullo Domain Associates, LLC Princeton, NJ Chris Varma, PhD Frontier Medicines South San Francisco, CA Francis Parnell, MD Parnell Pharmaceuticals Inc San Rafael, CA James Sapirstein AzurRx BioPharma Boca Raton, FL Jay M. Short, PhD BioAtla, Inc. San Diego, CA Jeff Livingstone Igia Pharmaceuticals Franklin, MA Laurie Stelzer Arena Pharmaceuticals San Diego, CA Thomas P. Mathers Allievex Corporation Marblehead, MA Charles M. Baum, MD, PhD Mirati Therapeutics Inc San Diego, CA Bill Newell Sutro Biopharma, Inc. South San Francisco, CA Rami Levin Saniona Waltham, MA Rick E. Winningham Theravance Biopharma South San Francisco, CA Barry Simon, M.D. ImmunityBio San Diego, CA Jigar Raythatha Constellation Pharmaceuticals, Inc. Cambridge, MADiseases that companies affiliated with signatories are working to prevent, treat, or cure:
ADHD, ALS, Alzheimer’s, Amyloid diseases, Anemia, ARDS, Autism, Autoimmune Disorders, Benign
Prostatic Hyperplasia, Blindness, Breast Cancer, Chemotherapy Induced Peripheral Neuropathy and
Chemotherapy Induced Cognitive Impairment, Chronic Hepatitis B, Chronic Lymphocytic Leukemia,
Chronic Pain, Cognitive Injuries, Colorectal Cancer, Complement Disorders, COVID, Dementia, DM1,
DMD, Enteric Hyperoxaluria, Fragile X syndrome, FSGS, FSHD, Gout, Heart Failure, Huntington’s
Diseases, Idiopathic Pulmonary Fibrosis, IgA nephropathy, Infectious Disease, Inflammatory Bowel
Disease, Influenza, Long COVID, Lung Cancer, Lupus, Major Depressive Disorder, Melanoma, MLD,
MPS2, Multiple Sclerosis, NASH, NMOSD, Non-Hodgkin Lymphoma, Obesity, Opioid Use Disorder,
Osteoarthritis, Ovarian Cancer, Pancreatic Cancer, Parkinson’s Disease, Parkinson’s Psychosis,
Pediatric Leukemias, Pediatric low grade glioma, PKU, Post-surgical Pain, Primary Biliary Cholangitis,
Prostate Cancer, Pulmonary Arterial Hypertension, Rare Epilepsies, Renal Cancer, Retinal eye
diseases, Rhett’s Syndrome, Stroke, Type 1 Diabetes, Type 2 Diabetes, Uterine Cancer, and many
other diseases.

**The appended signatures do not necessarily reflect the policy or position of any agency,
organization, employer, or company with which the signatories are affiliated.

CC: House Energy and Commerce Committee Chair Pallone and Ranking Member McMorris Rodgers House Ways and Means Committee Chair Neal and Ranking Member Brady Senate Finance Chair Wyden and Ranking Member Crapo Senate Health, Education, Labor, and Pensions Chair Murray and Ranking Member Burr