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FTC Lawsuit Against PBMs; Ozempic Price Cuts; Hospital Outpatient Pay Raise

FTC Lawsuit Against PBMs; Ozempic Price Cuts; Hospital Outpatient Pay Raise

FTC Prepares Lawsuit Against PBMs Over Insulin Rebates

The Federal Trade Commission (FTC) is preparing a lawsuit against the three largest drug brokers over their use of discounting on insulin and other drugs, the Los Angeles Times reported. The FTC has been investigating whether the discounting 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 in preparation but could be filed this month. However, the FTC’s five commissioners must 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 an average of less than $25 for insulin. Likewise, Cigna’s Express Scripts unit alleged that members paid less out of pocket for medications in 2023, despite drugmakers raising prices. Previously, states and localities have filed lawsuits against pharmaceutical companies and PBMs, alleging that they raised insulin costs for public health plans.

Senator Bernie Sanders is optimistic that Novo Nordisk will lower the cost of 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 shamed over how much it charges in the U.S. compared to other countries, Reuters reports. Novo Nordisk CEO Lars Jorgensen is scheduled to testify before the HELP committee at a September hearing on U.S. prices for Ozempic and Wegovy. Novo Nordisk has said the net price of both drugs has dropped 40% since the drugs were launched, but it blames PBMs for not passing those savings on to consumers. Sanders, however, said the price drop isn’t enough. The public shaming strategy worked for Sanders last year to convince Novo Nordisk, Eli Lilly and Sanofi to lower their high insulin prices, so he thinks it will work to lower prices for Ozempic and Wegovy.

Medicare proposes 2.6% pay raise for hospital outpatient care next year

CMS proposed a payment rule Wednesday that would increase Medicare reimbursements for hospital outpatient surgeries by 2.6% next year, resulting in an additional $5.2 billion paid to providers, according to Healthcare Dive. If the rule is finalized, outpatient surgery centers that meet quality standards would also receive a 2.6% payment increase, which would equate to about $202 million more in reimbursements next year. Additionally, the rule would require states to maintain 1 year of continuous eligibility for the Children’s Health Insurance Plan and Medicaid for children 18 or younger. And for the first time, the rule would establish basic safety requirements for hospital obstetric services. CMS regulators said their goal is to improve U.S. maternal health outcomes, so hospitals that don’t meet obstetric standards would be removed from Medicare.