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FTC lawsuit against PBMs; Ozempic price cuts; salary increase for outpatients

FTC lawsuit against PBMs; Ozempic price cuts; salary increase for outpatients
FTC lawsuit against PBMs; Ozempic price cuts; salary increase for outpatients

FTC prepares lawsuit against PBMs over insulin discounts

According to the Los Angeles Times, the Federal Trade Commission (FTC) is preparing a lawsuit against the three largest drug brokers over their use of rebates for insulin and other drugs. The FTC is investigating whether the rebate practices of insulin manufacturers and three pharmacy benefit managers (PBMs), namely units of CVS Health Corp., UnitedHealth Group Inc. and Cigna Group, violate federal law. The complaint is still being drafted but could be filed as early as this month. However, the FTC’s five commissioners would have to vote on the lawsuit before it can be filed. In a statement, CVS Caremark blamed pharmaceutical companies for raising list prices, as its members pay less than $25 on average for insulin. Similarly, Cigna’s Express Scripts unit claimed that members paid less out-of-pocket for drugs in 2023 even though drugmakers raised prices. Previously, states and municipalities filed lawsuits against drugmakers and PBMs, claiming they raised insulin costs for public health insurance plans.

Senator Bernie Sanders optimistic that Novo Nordisk will reduce costs for Ozempic and Wegovy in the US

Sen. Bernie Sanders (I, Vermont), chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, is optimistic that drugmaker Novo Nordisk will lower the cost of Ozempic and Wegovy after being publicly pilloried for how much it charges in the U.S. compared to other countries, according to Reuters. Novo Nordisk CEO Lars Jorgensen will testify before the HELP committee in a hearing in September on U.S. pricing for Ozempic and Wegovy. Novo Nordisk said the net price of both drugs has dropped 40% since they were launched, but blames PBMs for those savings not getting through to consumers. But Sanders said the price reduction is not enough. Using the public shaming strategy, Sanders was able to convince Novo Nordisk, Eli Lilly and Sanofi to lower high insulin prices last year, so he thinks it will work for Ozempic and Wegovy prices, too.

Medicare proposes a 2.6% pay raise for outpatients next year

CMS on Wednesday proposed a payment rule that would increase Medicare reimbursements for hospital outpatient departments by 2.6% next year, resulting in $5.2 billion more to providers, according to Healthcare Dive. If passed, the rule would also see a 2.6% payment increase for ambulatory surgery centers that meet quality standards, resulting in about $202 million in higher reimbursement next year. In addition, the rule would require states to provide children ages 18 or younger with one year of continuous eligibility for the Children’s Health Insurance Plan and Medicaid. And for the first time, the rule would establish basic safety requirements for hospitals’ obstetric services. CMS regulators said their goal is to improve maternal health outcomes in the U.S., so hospitals that fail to meet obstetric standards would be kicked out of Medicare.

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