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What We’re Reading: FTC Lawsuit Against PBMs; Ozempic Price Cuts; Hospital Outpatient Pay Bump

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The Federal Trade Commission (FTC) is preparing a lawsuit against the 3 largest drug middlemen over their use of rebates for insulin and other drugs; Sen Bernie Sanders (I, Vermont) feels confident that Novo Nordisk will cut Ozempic and Wegovy costs after hearing; CMS proposed a payment rule that would increase Medicare reimbursement for hospital outpatient departments by 2.6% next year.

FTC Preparing Lawsuit Against PBMs Over Insulin Rebates

The Federal Trade Commission (FTC) is preparing a lawsuit against the 3 largest drug intermediaries over their use of rebates for insulin and other drugs, according to the Los Angeles Times. The FTC has been investigating whether the rebate practices of insulin manufacturers and 3 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 it could be filed this month. However, the FTC’s 5 commissioners would need to vote on the lawsuit before it can be filed. In a statement, CVS Caremark blamed drug companies for raising list prices as its members pay less than $25 for insulin on average. Similarly, Cigna’s Express Scripts unit claimed that members paid less out of pocket for medicines in 2023 despite drugmakers raising prices. Previously, states and municipalities filed suits against drugmakers and PBMs, alleging that they raised insulin costs for public-sector health plans.

Sen Bernie Sanders Optimistic Novo Nordisk Will Cut US Ozempic, Wegovy Costs

Sen Bernie Sanders (I, Vermont), chair of the Senate Committee on Health, Education, Labor, and Pensions (HELP), is optimistic that drug manufacturer Novo Nordisk will cut Ozempic and Wegovy costs after being publicly shamed over how much it charges in the US compared with other countries, according to Reuters. Novo Nordisk CEO Lars Jorgensen will testify before the HELP committee in a September hearing on US prices for Ozempic and Wegovy. Novo Nordisk stated that the net price of both drugs dropped 40% since the drugs’ launch, but it blames PBMs for these savings not making their way to consumers. However, Sanders said that price drop is not enough. The public shaming strategy worked for Sanders last year to convince Novo Nordisk, Eli Lilly, and Sanofi to cut high insulin prices, so he feels that it will work to slash Ozempic and Wegovy prices.

Medicare Proposes 2.6% Hospital Outpatient Pay Bump Next Year

CMS proposed a payment rule on Wednesday that would increase Medicare reimbursement for hospital outpatient departments by 2.6% next year, resulting in $5.2 billion more being paid to providers, according to Healthcare Dive. If the rule is finalized, ambulatory surgery centers that meet quality standards would also receive a 2.6% payment increase, equating to about $202 million more in reimbursement next year. Additionally, the rule would require states to provide 1 year of continuous eligibility for children aged 18 or younger for the Children’s Health Insurance Plan and Medicaid. And for the first time, the rule would establish baseline safety requirements for hospitals’ obstetrics services. CMS regulators said their goal is to improve US maternal health outcomes, so hospitals that do not meet the obstetric standards would be removed from Medicare.

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