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They are group purchasing organizations, which broker drug purchases for hospitals and other health-care providers, and drug wholesalers, which buy medicines from manufacturers and distribute them to providers. But the Biden administration is zeroing in on other players in the drug supply chain to uncover the "root causes and potential solutions" to ongoing shortages. The Federal Trade Commission on Wednesday said it is examining the role that drug wholesalers and companies that purchase medicines for U.S. health-care providers play in shortages of generic drugs, which account for the majority of Americans' prescriptions. Group purchasing organizations and wholesalers have gotten limited attention on Capitol Hill, even as reining in high drug costs has become a key priority among lawmakers in both chambers. PBMs contend that manufacturers are responsible for high drug prices, while drugmakers say rebates and fees collected by those middlemen force them to increase list prices for products.
Persons: Biden, Doug Farrar, Cencora Organizations: FTC, Department of Health, Human Services, Federal Trade Commission, Public Affairs, CNBC, HHS, Cardinal Health, Group, Capitol, CNBC PRO Locations: U.S
As a multi-stage VC fund, Lightspeed has an advantage in its exposure to both early-stage and later-stage healthcare markets, Imanbayev said. And many later-stage healthcare startups still have plenty of room to grow, he said. The first one to three years are often slow-moving for a healthcare startup, too, as it works to get its first partnerships with payers or providers, he said. But they also tend to be less risky, since later-stage startups should have revenue streams or partnerships that demonstrate their value. Lightspeed led value-based care startup Aledade's $260 million Series F in June 2023, an unusually large deal as other investors cut much smaller checks.
Persons: , Galym, Imanbayev, I'm, There's, Farzad Mostashari, Aledade Tom Sandner, VCs, Abridge, he's, Chris Severn Organizations: Business, Lightspeed Venture Partners, Lightspeed, CVS, Health, Turquoise Health, Pharma, FDA, pharma
Anderson Cancer Center in Houston, Dr. Jason Westin regularly witnesses the power of lifesaving cancer drugs. But because generic cancer drugs are often in shortage in the United States, he says, he and his patients have been put in a terrible position. Makers of generic drugs don’t have to share information about the supply chain, so buyers currently choose based only on price. Hernandez told the Senate committee that of the top 50 generic drugs paid for by Medicare Part D, 16 were marked up 1,000% or higher. Until there is some kind of legislation that addresses drug shortages, Wosińska and the other experts agreed, they will continue.
Persons: Jason Westin, ” Westin, that’s, they’d, Sen, Marsha Blackburn, Mike Crapo, Generics, ” Crapo, , , Crapo, Inmaculada Hernandez, ” Hernandez, Dr, Marta E, it’s, ” Wosińska, Ron Wyden, ” Wyden, Hernandez, Sanjay Gupta Organizations: CNN, Anderson Cancer Center, US, Finance, Vanderbilt, Tennessee Republican, Food and Drug Administration, Westin, Skaggs School of Pharmacy, Pharmaceutical Sciences, University of California, Centers, Medicare, Medicaid Services, Brookings Institution, CNN Health Locations: M.D, Houston, United States, Nashville, Idaho, China, India, San Diego, Oregon, generics
Dec 5 (Reuters) - Eli Lilly (LLY.N) on Tuesday said its recently approved obesity treatment Zepbound is now available in U.S. pharmacies and could cost $550 a month for customers whose health insurance does not cover the drug, or half the list price. Wall Street analysts expect sales of Zepbound to reach about $2 billion in 2024, and for sales of Novo Nordisk's (NOVOb.CO) rival obesity drug Wegovy to hit around $7.5 billion. An Eli Lilly and Company pharmaceutical manufacturing plant is pictured at 50 ImClone Drive in Branchburg, New Jersey, March 5, 2021. When the U.S. Food and Drug Administration approved Zepbound in November, Lilly said it would launch after the U.S. Thanksgiving holiday. Lilly's obesity drug has the same active ingredient, tirzepatide, as its previously approved diabetes drug Mounjaro, which has been used off-label for weight loss since its 2022 launch.
Persons: Eli Lilly, Wegovy, danuglipron, Zepbound, Lilly, Mike Segar, Eli Lilly's, Patrick Wingrove, Manas Mishra, Khushi, Arun Koyyur, Alexander Smith, Bill Berkrot Organizations: Wall Street, Novo, Pfizer, Company, REUTERS, CVS, U.S . Food, Drug Administration, U.S, Thomson Locations: U.S, Branchburg , New Jersey, Indianapolis, New York, Bengaluru
CVS Health on Tuesday said it will revamp how it prices prescription drugs and scrap a complex model that typically sets how much pharmacies get reimbursed and what patients pay for those medications. CVS' new model could change the cost of prescription drugs for some patients, but it will not necessarily make all medicine cost less, company executives said. Lynch told CNBC: "It's a cost plus markup, plus a fee. Billionaire Mark Cuban last year launched an online pharmacy that takes a similar approach to CVS' new reimbursement model. The company, called Cost Plus Drugs, aims to drive down the price of medicines broadly by selling them at a set 15% markup over their cost, plus pharmacy fees.
Persons: Karen Lynch, Lynch, Prem Shah, markups, Billionaire Mark Cuban, Cuban Organizations: CVS Health, CVS, CNBC, Billionaire
The new program includes a set markup for medication costs, a step toward drug pricing transparency. The retailer has been facing pressure from new models like Mark Cuban Cost Plus Drugs. They've been especially focused on pharmacy-benefit managers and the lack of transparency around how much drugs cost. How Mark Cuban changed drug pricingCuban's pharmacy buys drugs directly from manufacturers and sells them to consumers at a 15% markup, plus pharmacy fees. AdvertisementBut the announcement looks to be a step in the right direction for drug pricing transparency.
Persons: , Mark, Prem Shah, Mark Cuban, GoodRx, PBMs, Kroger, it's Organizations: CVS, Cuban, Plus, Service, Mark Cuban, Federal, US Federal Trade Commission, CVS Health, Kroger, Walgreens, Drug, Wall Street Locations: California
The giant health insurers Cigna and Humana are reportedly considering a merger. While they offer different kinds of health insurance, the deal is likely to face antitrust scrutiny. Still, Cigna and Humana did toy with a deal way back in 2014 before they pursued deals with other partners. Later, to sidestep antitrust scrutiny, health insurers eyed mergers with other pieces of the healthcare system outside of insurance. Cigna and Humana would face a more skeptical Justice DepartmentAny deal between health insurers the size of Cigna and Humana would have to get past the Justice Department's antitrust enforcers.
Persons: Biden, , Justice that's, BofA, David Balto, Cigna, That's, Balto, Barak Richman, there's, Matthew Cantor, Constantine Cannon, divestitures aren't, Molina wouldn't, Cantor Organizations: Humana, Service, Reuters, Bloomberg, Street, Department, Justice, Cigna, UnitedHealth Group, Equity, Federal Trade Commission, Justice Department, Express, CVS Health, Aetna, Kindred, Biden Administration, FTC, Duke University Locations: Cigna, Aetna, Delaware
REUTERS/Andrew Kelly/File Photo Acquire Licensing RightsNov 29 (Reuters) - Cigna (CI.N) and Humana (HUM.N), two of the biggest U.S. health insurers, are in talks for what could be the largest merger announced in 2023, according to a source familiar with the matter. A Humana and Cigna combination would give the merged company the scale to rival UnitedHealth Group (UNH.N) and CVS Health (CVS.N). In July 2016, the Justice Department filed lawsuits against two health insurance mergers on the same day, saying they would lead to less competition and higher prices for Americans. Health insurers have been facing higher medical costs as people return for procedures they had put off during the pandemic. Humana in February said that it would sell its commercial business but keep its Medicare Advantage products.
Persons: Andrew Kelly, Cigna, Cigna's, Aetna, Bill Baer, Andre Barlow of Doyle, Barlow, Mazard, Bernstein, Lance Wilkes, Craig Garthwaite, Manas Mishra, Diane Bartz, Deena Beasley, Caroline Humer, Bill Berkrot Organizations: Humana Inc, REUTERS, Street Journal, UnitedHealth, CVS Health, Humana’s, Medicare, Affordable, Justice Department, Humana, U.S ., Reuters, Northwestern University, Thomson Locations: Queens , New York City, U.S, Cigna, Bengaluru, Washington, Los Angeles
Pharmacy closures have been a problem for years. “You had a routine: You would go to a pharmacy that was geographically accessible — ideally affordable — was probably preferred for your health insurance plan. Thompson, who himself lives close to a pharmacy in the South Side, said there is now more pressure on remaining locations. But chain closures aren’t likely to lead to more business for independents, which face challenges apart from competition from national chains. Recently, pharmacy workers have been staging walkouts over working conditions they say put patients at risk.
Persons: drugstores, Jenny Guadamuz, , , Guadamuz, Melvin Thompson, Thompson, We’re, Angus Mordant, Omolola Adepoju, University of Houston’s Tilman J, Douglas Hoey, PBMs, Hoey, JC Scott, ” Hoey Organizations: New, New York CNN, CVS, Walgreens, Aid, UC Berkeley School of Public Health, Health Policy, Management, Endelo Institute, Bloomberg, Getty, National Community Pharmacists Association, USC, University of, Fertitta Family College of Medicine, Rite, Walmart, Target, Pharmacy, Pharmaceutical Care Management Association Locations: New York, Chicago, United States
People walk by a CVS pharmacy store in Manhattan, New York City, New York, U.S., November 17, 2021. REUTERS/Andrew Kelly/File Photo Acquire Licensing RightsCompanies CVS Health Corp FollowNov 1 (Reuters) - CVS Health Corp (CVS.N) beat Wall Street estimates for quarterly profit on Wednesday as strength in its drugstores and pharmacy benefit management business offset higher-than-expected medical costs at its insurance unit. CVS' medical benefit ratio, or the percentage of claims paid compared to premiums collected, was 85.7% in the third quarter, compared with analysts' estimates of 85.1%. CVS' pharmacy and consumer wellness segment recorded 6% revenue growth to $28.87 billion, boosted by higher drug prices and prescription volume. The company reported an adjusted profit of $2.21 per share, beating estimates of $2.13 per share, according to LSEG data.
Persons: Andrew Kelly, Julie Utterback, Mariam Sunny, Leroy Leo, Saumyadeb Chakrabarty, Vinay Dwivedi Organizations: REUTERS, CVS Health, CVS Health Corp, CVS, Morningstar, PBMs, Revenue, Walgreens, Thomson Locations: Manhattan , New York City , New York, U.S, United States, Bengaluru
Insurers and the drug-industry middlemen they own stand to earn more as healthcare spending increases. AdvertisementAdvertisementFor US health insurers, explosive demand for new weight-loss drugs likely means bigger profits. Insurers and the drug-industry middlemen they own stand to earn more as weight-loss drugs drive up healthcare spending, BofA analysts wrote. Meanwhile, if the drugs help people live longer, insurers could earn more from higher enrollment in their health plans. As weight-loss drugs drive up healthcare spending, insurers will make more moneyWeight-loss drugs, which can cost around $1,000 a month, are driving up healthcare spending.
Persons: Li Ran, Brian Evanko, Evernorth Organizations: Trilliant Health, Bank of America Global Research, Getty, Cigna, CVS Health, UnitedHealth Group, CVS, Kaiser Family Foundation Locations: Xinhua, GLP
Shares of CVS Health plunged 9% on Thursday after Blue Shield of California said it will drop the company's pharmacy benefit management services and instead partner with Mark Cuban's Cost Plus Drug Company and Amazon Pharmacy to save on drug costs for its nearly 5 million members. Blue Shield will now work with five different companies to provide "convenient, transparent access to medications while lowering costs." Blue Shield CEO Paul Markovich said the plan, which is scheduled to fully launch in 2025, could save the company up to $500 million annually. Cuban's Cost Plus Drug Company will provide access to low-cost medications through retail pharmacies. Blue Shield will retain CVS Caremark for its specialty pharmacy services, which provide specialized therapies and counseling to patients suffering from complex disorders.
Persons: Mark Cuban's, Caremark, Paul Markovich, Michael DeAngelis, Centene Organizations: CVS Health, Drug Company, Amazon Pharmacy, UnitedHealth, CVS, Abarca, Blue, CNBC Locations: New York, California
Seven drugmakers this month launched their own versions, known as biosimilars, of AbbVie's (ABBV.N) flagship arthritis drug Humira, once the world's top-selling prescription medicine. Three have kept their list price within 5%-7% of AbbVie's, two priced at an 85% discount and two have offered both types of prices. For insured patients who are often on the hook for co-pays of 10% to 25% of the list price, the savings have been minimal. Reuters GraphicsThe Biden administration has made lowering drug prices a priority. Amgen offered 5% and 55% discounts to AbbVie's $6,922 per month Humira price tag, and both were included on drug coverage lists at two large PBMs.
Persons: Dado Ruvic, Humira, Ameet Sarpatwari, Biden, PBMs, Cigna, UnitedHealth, Amgen, Robin Feldman, Ron Wyden, Wyden, Chuck Grassley, Grassley, Patrick Wingrove, Moira Warburton, Josephine Walker, Caroline Humer, Bill Berkrot Organizations: REUTERS, Association for Accessible Medicines, Harvard Medical School, Reuters, Lawmakers, Federal Trade Commission, FTC, CVS, Biosimilars, Healthcare, Novartis, Sandoz, Reuters Graphics Reuters, University California College of the, Democratic, Republican, Thomson Locations: U.S, Humira, San Francisco, New York, Washington
The annual cost of overall care for patients prior to taking Wegovy or a similar drug was $12,371, on average, according to the analysis. The costs for a similar control group of patients not taking the drugs decreased by 4% over the same period. The analysis by Prime Therapeutics, a pharmacy benefits manager (PBM), reviewed pharmacy and medical claims data for 4,255 people with commercial health plans. For the analysis, Prime Therapeutics excluded patients with type 2 diabetes to focus on obesity treatment. In trials with adults, Novo found that 6.8% of patients taking Wegovy discontinued treatment due to gastrointestinal problems and other adverse events.
Persons: Wegovy, Khrysta Baig, Patrick Gleason, Novo, aren't, Gleason, David Lassen, Lassen, Chad Terhune, Michele Gershberg, Bill Berkrot Organizations: Reuters, Vanderbilt University, Novo Nordisk, Prime Therapeutics, Therapeutics, U.S, Blue, Thomson Locations: Danish
July 5 (Reuters) - Mark Cuban Cost Plus Drugs, an online pharmacy launched by the billionaire to sell drugs directly to customers at low prices, should soon begin selling Coherus BioSciences's (CHRS.O) biosimilar version of AbbVie Inc's (ABBV.N) blockbuster rheumatoid arthritis drug Humira, Cuban said on Wednesday. Cost Plus Drugs will sell Yusimry for $569.27 plus dispensing and shipping fees. Coherus introduced its Humira biosimilar in the U.S. market this month alongside offerings from other drugmakers such as Boehringer Ingelheim, Sandoz and Organon (OGN.N). Cuban's Cost Plus Drugs aims to drive down the cost of drugs broadly by selling them at a 15% markup over its cost, plus pharmacy fees. Cuban said the company hopes to provide other biosimilar drugs as well.
Persons: Humira, Cuban, Coherus, AbbVie, Michael Erman, David Holmes Organizations: Cuban, Plus, Sandoz, Cuban's, Thomson Locations: U.S, Organon, Cuban
US FTC expands probe into pharmacy benefit managers
  + stars: | 2023-05-17 | by ( ) www.reuters.com   time to read: +1 min
May 17 (Reuters) - The U.S. Federal Trade Commission said it had sought information from two privately held companies that negotiate drug rebates on behalf of pharmacy benefit managers (PBMs) as part of its probe into how PBMs affect pricing of prescription drugs. The two companies, Zinc Health Services and Ascent Health Services, are group purchasing organizations, that negotiate after-market discounts or rebates with drug manufacturers on behalf of PBMs and hold the contracts that govern those rebates. Zinc Health negotiates rebates for CVS Health Corp (CVS.N) and Ascent Health for Cigna Group's (CI.N) Express Scripts unit and Prime Therapeutics, which is a privately held PBM, the FTC said on Wednesday. PBMs act as middlemen and negotiate rebates and fees with drug manufacturers, create lists of medications that are covered by insurance, and reimburse pharmacies for patients' prescriptions. Reporting by Manas Mishra in Bengaluru Editing by Vinay DwivediOur Standards: The Thomson Reuters Trust Principles.
Both sides blame each other for high drug prices. Senator Bernie Sanders, who chairs the Senate Health, Education, Labor, and Pensions (HELP) Committee, is a fierce critic of both industries and will likely grill the executives. Optum Rx CEO Heather Cianfrocco will say manufacturers alone set the drug prices and abuse patent protections to stifle competition, her written testimony shows. Lilly, Novo Nordisk, and Sanofi all said in March they were cutting list prices by more than 70% for some insulin products. Uninsured people often have to pay full list prices, an average of $900 a month, forcing many to ration or skip doses.
In this photo illustration, an insulin pen manufactured by the Novo Nordisk company is displayed on March 14, 2023 in Miami, Florida. Those companies — Eli Lilly, Novo Nordisk and Sanofi — had announced in March that they will slash prices of their most widely used insulin products by 70% or more. The companies' versions of insulin cost at least $275 before the announced price slashes, Sanders noted. Novo Nordisk said its CEO looks forward to "a productive and collaborative discussion about this important issue." PBMs have come under criticism for inflating drug prices and not passing on all the discounts they negotiate to consumers.
Investors Are Too Spooked by Washington’s PBM Crackdown
  + stars: | 2023-04-03 | by ( David Wainer | ) www.wsj.com   time to read: 1 min
Pressure from Washington on pharmacy-benefit managers is having a chilling effect on Cigna stock. Middlemen known as pharmacy-benefit managers have been facing scrutiny in Washington for years, but the complexity of their system means substantial reforms continue to fail. While bipartisan momentum is once again building in Congress, a material financial impact on PBMs looks doubtful. One doesn’t have to look very far back for examples of efforts that came close but flamed out. President Donald Trump nearly hit PBMs where it would have hurt the most—by eliminating the rebates they negotiate with pharma companies—but he dropped the plan when it became clear that doing so would increase health insurance premiums, with political consequences for Republicans.
Eli Lilly’s Insulin Decision Puts Others in Hot Seat
  + stars: | 2023-03-08 | by ( David Wainer | ) www.wsj.com   time to read: +1 min
High list prices for insulin add to the profits of pharmacy-benefit managers. But when a little-known nonprofit named Civica Rx announced plans last year to make low-cost insulin, the move didn’t spook the companies that profit from high insulin prices. Pharmacy-benefit managers, which control 80% of the prescription-drug market, profit from high list prices. Keeping Civica Rx at bay is one thing. That is exactly what happened last week when Eli Lilly decided to drastically cut the list price of some of its insulin products.
The lawsuit, filed in California Superior Court in Los Angeles, targets Eli Lilly and Co , Novo Nordisk A/S (NOVOb.CO) and Sanofi SA (SASY.PA), which together make more than 90% of the insulin drugs sold globally. Insulin drugs are used to control blood sugar in patients with diabetes. Eli Lilly and Sanofi both previously announced that they would cap the cost of a 30-day supply of insulin at $35 for uninsured patients. California said that the companies' dominance in the market has allowed them to hike insulin prices at patients' expense, violating the state's Unfair Competition Law. Prices of top-selling insulin drugs have soared in recent years.
Mark Cuban's pharmaceuticals startup ties up with RxPreferred
  + stars: | 2023-01-11 | by ( ) www.reuters.com   time to read: +1 min
Jan 11 (Reuters) - Billionaire entrepreneur Mark Cuban's pharmaceuticals startup has tied up with pharmacy benefits manager RxPreferred Benefits, the companies said on Wednesday, in a move to offer lower priced drugs through some employer-backed health insurance plans. Mark Cuban Cost Plus Drugs provides generic drugs through direct contracts with manufacturers and charges a standard markup on every drug it sells. Under the partnership, RxPreferred Benefits' customers will have the option to use Mark Cuban Cost Plus Drugs as part of their health insurance plans. Mark Cuban Cost Plus Drugs in December partnered with EmsanaRx, a nonprofit coalition of nearly 40 companies including U.S. retailers Walmart (WMT.N) and Costco (COST.O), that operates a PBM service for employers. PBMs serve as intermediaries between drug manufacturers, health insurance plans and pharmacies to negotiate prescription drug prices.
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The Mark Cuban Cost Plus Drug Company negotiates directly with drugmakers. So far, that's been the strategy for the Mark Cuban Cost Plus Drug Company. In October, Cost Plus Drug Company announced a partnership with Capital Blue Cross. Cuban said he wanted Cost Plus Drug Company to be as transparent as possible on pricing. Cost Plus Drug Company is considering a test program for insulin that would offer a 90-day supply of insulin, or a total of 12 vials, for $170.
Hux has owned Pickerington Pharmacy, which takes nearly every kind of insurance, since 2016. For some drugs, especially name-brand medications without generic alternatives, the insurance pharmacy, Pickerington, will most likely be the better bet. For other drugs, particularly those that have recently gone generic, it will be the all-cash pharmacy, Freedom. Or is it the noninsurance world?”For Kitchen, a retired registered nurse with arthritis and fibromyalgia, it was the noninsurance world of Freedom Pharmacy. By cutting out the middlemen, Freedom Pharmacy is far cheaper to operate.
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