Hello! Wegovy, the blockbuster weight reduction treatment from Novo Nordiskis at the highest of the list of medicine that would soon be a part of the second round of price negotiations between manufacturers and Medicare.
That is loud a paper published last week within the Journal of Managed Care & Specialty Pharmacy. By February, the federal government will announce the subsequent 15 most costly Medicare Part D drugs that will probably be the topic of discussions for price changes that may take effect in 2027.
The Biden administration last month announced recent negotiated prices for the primary 10 Medicare Part D drugs chosen for talks. Those prices will take effect in 2026.
Drugs that contain the identical lively ingredient and are made by the identical company are considered a single drug for the talks, based on guidelines from the Centers for Medicare & Medicaid Services. For that reason, researchers expect all three of Novo Nordisk's brand-name drugs that contain semaglutide — Wegovy, the diabetes injection Ozempic and an older diabetes pill called Rybelsus — to be chosen as a single product for the talks.
This could be a big deal for older adults who use these treatments, each of which carries a price tag of about $1,000 monthly before insurance. However, it remains to be unclear how much Medicare could reduce these costs – and the way much patient costs would decrease after insurance and reimbursements are deducted.
The Biden administration, lawmakers and patient advocates have long criticized the Danish pharmaceutical company for the high list prices of its obesity and diabetes drugs. Novo Nordisk's CEO Lars Fruergaard Jørgensen faced a Senate hearing on Tuesday about those prices.
While Jørgensen didn’t commit to lowering prices for Wegovy and Ozempic, he vowed to work with pharmacy profit managers “on anything that provides access and affordability for patients.” He also dismissed price negotiations with Medicare when asked concerning the potential choice of Wegovy and Ozempic, calling the talks “price fixing” that can have negative consequences for drug innovation.
Medicare Part D doesn’t cover weight-loss treatments unless they’re approved and prescribed for an additional condition. But Wegovy could make the list for negotiations since it is now approved to cut back the chance of significant cardiovascular complications, making it likely that some Part D plans have begun to cover the treatment, the researchers said.
Under CMS guidelines, drugs should be in the marketplace for at the very least seven years without generic competitors before Medicare can select them for price negotiations. Semaglutide can have been in the marketplace for seven years and one month in February and has no generic equivalents.
Other researchers and Wall Street analysts consider Ozempic will probably be subject to negotiations because of the high cost of Medicare Part D for the treatment.
The program spent greater than $5.6 billion on semaglutide drugs in 2022, reflecting only spending on Ozempic and Rybelsus because Wegovy was not covered on the time, the paper said. The researchers also projected that Medicare Part D would spend nearly $7.5 billion on Ozempic and Rybelsus in 2023, $3 billion greater than spending on the second-highest reimbursable drug.
They identified that they’d probably “underestimated” their projected spending on semaglutide.
Other drugs which might be expected to be subject to cost negotiations include GSKTrelegy Ellipta, a prescription inhaler used to treat asthma and chronic obstructive pulmonary disease, and Xtandi, a rheumatoid arthritis drug from Astellas Pharma.
However, researchers said the ultimate list of medicine chosen will rely on whether generics come to market before February.
We will probably be closely following the subsequent round of Medicare drug price negotiations, so stay tuned for our coverage.
Please send suggestions, suggestions, story ideas and data to Annika at annikakim.constantino@nbcuni.com.
Healthtech News: Particle Health Files Antitrust Lawsuit Against Epic Systems
The data startup Particle Health filed a Antitrust lawsuit against Epic Systems, a software provider that manages medical records of around 280 million patients within the United States
Particle alleges that Epic is using its dominance within the electronic health records space to stifle competition in other markets that use that data. The suit was filed within the Southern District of New York.
Oracle and Meditech are other major players within the electronic health record space, and patient data is usually stored with multiple providers. Still, Epic is a serious competitor. The company has the most important market share within the acute care space within the U.S., covering greater than half of all acute care beds in multiple specialties, based on a report by KLAS ResearchIn addition, Epic is the one provider to see a net increase on this market share in 2023, the report said.
Particle's lawsuit comes after the 2 firms clashed earlier this yr over their data-sharing practices. Epic and Particle are each a part of an interoperability network called Carequality that allows large-scale sharing of patient information.
Epic filed a proper objection to Carequality in March, saying it was concerned that Particle and its participating organizations “may misrepresent the purpose of their data requests.” To join the Carequality network, organizations should be approved to share patient data and cling to “permissible purposes,” which generally relate to treatment.
In its 81-page criticism, Particle claimed Epic's dispute was “constructed” and that Epic had claimed some Particle customers, not Particle itself, had improperly obtained data. Particle said Epic had used its “outsized influence” over Carequality to acquire a positive end result and argued it was harmed by Epic's conduct.
“Unless there are consequences, Epic will have an incentive to reapply this playbook the next time a competitor emerges,” Particle said in a press release on Monday.
Epic said it will “vigorously defend itself against Particle's baseless claims” and proceed to guard patient privacy.
“Particle's claims are without merit. This lawsuit seeks to divert attention from the real issue: Particle's unlawful actions on the Carequality health information exchange network violated HIPAA privacy protections,” an Epic spokesperson said in an announcement to CNBC on Tuesday. “Particle's complaint misrepresents Carequality's decision, which in reality proposes to suspend Particle customers who accessed patient data for improper purposes.”
It will likely be some time before there may be a final ruling, as antitrust cases often crawl. Google, for instance, lost an antitrust case last month that was originally brought in 2020. A U.S. federal judge ruled that the corporate illegally held a monopoly on text promoting and search.
You can read the complete Particle criticism against Epic Here.
Feel free to send suggestions, suggestions, story ideas and data to Ashley at ashley.capoot@nbcuni.com.
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