Drug Middlemen Who Have Drawn Increasing Scrutiny In Pricing Blame Game Found To Have Marked Up Generics For Medicaid
The findings in the report suggest “hundreds of millions of dollars” that should have been allocated toward patient care may have been “shifted elsewhere," said the Pharmacists Society of the State of New York, which hired a firm to conduct the analysis of pharmacy benefit managers. In other pharmaceutical news: whistleblower lawsuits, cancer drugs, a setback for Bristol, and the 2020 election.
Drug Middlemen Got Big Markup In New York, Pharmacists Say
Pharmacy-benefit managers are taking increasingly large markups on generic drugs in New York, according to an analysis of Medicaid prescriptions at independent pharmacies in the state. In Medicaid, private insurers are paid by the state to cover low-income citizens. The insurers in turn usually contract with pharmacy-benefit managers, or PBMs, paying them to provide drug coverage. PBMs run by CVS Health Corp., Cigna Corp. and UnitedHealth Group Inc. then bill insurers for coverage, and reimburse pharmacies for drugs. (Langreth, 1/24)
PBMs Marked Up Generics For Medicaid, But Where'd The Money Go?
Amid intensifying scrutiny of medicine costs, an analysis of the New York Medicaid and pharmacy data suggests that pharmacy benefit managers are increasingly marking up generic drugs, raising questions about the extent to which the profits are passed back to the state health care program. In 2017, the pharmacy benefit managers that were contracted with managed care plans working on behalf of the state Medicaid program paid independent pharmacies an average of $10.85 for each generic prescription. But the managed care plans reported their average costs were $14.34 per prescription, which was a 32 percent markup. This was up from 11 percent in 2016. (Silverman, 1/24)
Whistleblower Hits Justice Department Move To Dismiss Nurse Educator Lawsuits
The company that filed nearly a dozen lawsuits alleging drug makers devised schemes in which nurses were used illegally to promote medicines and boost prescriptions has filed blistering responses to a federal government effort to dismiss the cases. In court filings, the National Health Care Analysis Group took the U.S. Department of Justice to task for misunderstanding the issues raised in its whistleblower lawsuits, maintained the government never fully investigated the allegations, and suggested a conflict of interest in the Executive Branch may have influenced the decision to have the cases tossed. (Silverman, 1/24)
Lilly Cancer Drug Shouldn't Be Started In New Patients, FDA Says
Eli Lilly & Co.’s cancer drug Lartruvo shouldn’t be started in new patients and those already taking it should ask their doctors if they should continue, U.S. regulators said, following a key study that failed to show the medicine prolonged lives. The drug for soft tissue sarcoma, a relatively rare and hard-to-treat type of tumor, was given accelerated approval by the U.S. Food and Drug Administration in 2016 based on promising data from an early-stage study. The company was required to complete a larger trial to confirm the benefits. (Cortez and Edney, 1/24)
In Disappointment, Bristol Pulls Application For Opdivo Combo In Lung Cancer
In another setback in the lucrative lung cancer market, Bristol-Myers Squibb (BMY) said Thursday that it is withdrawing its application with the Food and Drug Administration to use its cancer immunotherapy blockbuster, Opdivo, in combination with Yervoy, a second Bristol drug, for some patients with previously untreated non-small cell lung cancer. The news comes as Bristol is announcing strong fourth-quarter earnings, with sales up 10 percent from last year to $6 billion and earnings per share excluding items of 94 cents, 10 cents ahead of the expectations of analysts polled by FirstCall. (Herper, 1/24)
Kaiser Health News:
Drug-Pricing Policies Find New Momentum As ‘A 2020 Thing’
The next presidential primary contests are more than a year away. But presumed candidates are already trying to stake a claim to one of health care’s hot-button concerns: surging prescription drug prices. “This is a 2020 thing,” said Dr. Peter Bach, who directs the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center in New York and tracks drug-pricing policy. (Luthra, 1/25)