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Morning Briefing

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Wednesday, May 24 2023

Full Issue

Congress Hammers PBMs Over Drug Pricing

And sometimes Congress misses the mark. Meanwhile, CMS announces that it will audit annually the prices of drugs covered by Medicaid. And among news from the pharmaceutical industry, an explainer on why employer insurance plans discourage the use of Ozempic.

Congress blasted drug middlemen at a hearing Tuesday, with multiple lawmakers pointing to a huge discrepancy between how much a chemo drug costs at CVS and its price from Mark Cuban鈥檚 Cost Plus Drugs. There鈥檚 just one problem: PBMs don鈥檛 have anything to do with that discrepancy. (Wilkerson, 5/23)

The Biden administration said Tuesday it is planning to conduct a yearly audit to verify the prices drug makers charge on a handful of the costliest prescriptions covered by Medicaid. Under the proposal, the Centers for Medicare and Medicaid Services would require as many as 10 drug makers every year to furnish the government with proprietary and non-proprietary information as evidence to support the price it charges states, which administer Medicaid. Drugs that cost Medicaid the most money 鈥 some as much as $2 million per treatment 鈥 will be selected for the survey. (Seitz, 5/23)

Under an upcoming proposed rule, PBMs that contract with Medicaid would have to reveal the prices they pay for medicines, a provision that seeks to curb spread pricing, a practice in which PBMs charge insurance companies, employers or government programs more for medicines than it actually pays. If finalized, this would be the first time that PBMs are required to disclose actual drug prices under federal law. The regulation also would make specialty drugs administered in hospitals eligible for rebates. (Turner, 5/23)

In other pharmaceutical industry developments 鈥

Many Americans seeking out drugs like Ozempic to shed pounds are hitting a barrier: Their employers鈥 health plans won鈥檛 pay for them.聽聽The issue is an emerging fault line in U.S. workplaces, driven by the social-media and celebrity buzz around Ozempic and its sister drug, Wegovy. Prescriptions for the treatments have soared so much that the drugs鈥 maker has often struggled to keep pace with demand. Yet companies, already facing rising healthcare costs, are wary of footing the bill for medicines that list for $900 or more a month.聽(Mathews and Smith, 5/22)

The Federal Trade Commission is investigating whether baby-formula makers colluded on bids for lucrative state contracts. The agency, in documents posted to its website, said it is looking into whether Abbott Laboratories and other formula manufacturers have 鈥渆ngaged in collusion or coordination with any other market participant regarding the bidding鈥 for state contracts. The FTC is also investigating whether company coordination affected sales more broadly, outside of the Women, Infants and Children formula-supply program, FTC Commissioner Alvaro Bedoya wrote. (Whyte, Newman and Peterson, 5/24)

Seattle biotech Achieve Life Sciences on Tuesday announced an experimental drug meant to help people quit smoking did exactly that in a clinical trial, paving the way for the company to seek approval for a product that would face stiff competition. (Wosen, 5/23)

Suki Tipp had been stung by wasps before but never had a reaction like the one she experienced five years ago in a barn on her 30-acre property in Alabama. After the sting to her right arm that July day, Tipp recalled, she had a metallic taste in her mouth and felt like her body was on fire. She rushed into her house to lie on an air-conditioning grate on the floor, then texted her husband outside as she grew weak. 鈥淪omething鈥檚 not right,鈥 she wrote. 鈥淚 need help.鈥 (Saltzman, 5/23)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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