Massachusetts Asks To Be Able To Limit Which Drugs Medicaid Has To Cover
The somewhat controversial move would shift the state toward what is known in the insurance world as a closed formulary. This allows an insurer to provide coverage for only certain drugs that are made available on favorable terms. Meanwhile, Rep. Elijah Cummings (D-Md.) takes to Twitter to demand President Donald Trump take action on high prices, and a new study finds a promising drug's costs is limiting the number of people who can take it.
Stat:
To Lower Costs, Massachusetts Seeks To Limit Medicaid Drug Coverage
Alarmed by rising prescription drug prices, Massachusetts officials are seeking permission from the federal government to limit the number of medicines that would be covered by the state Medicaid program, which is currently required to provide coverage for all treatments. In making their request, state officials argue they should be able to use some of the same tools that commercial insurers employ to contain costs. And they insist such a move is needed in order to preserve the larger mission of providing adequate health coverage. (Silverman, 9/28)
Stat:
Demanding Action From Trump On MS Drug Prices, Elijah Cummings Takes To Twitter
Rep. Elijah Cummings (D-Md.) has always been outspoken on the issue of drug pricing, even wrangling a meeting with President Trump in March to discuss how to reduce costs for Americans struggling with the cost of their prescriptions. Cummings, who recently returned to Capitol Hill after recuperating from heart surgery, used a decidedly different medium — one preferred by the President — on Thursday in resurfacing the issue. (Facher, 9/28)
Kaiser Health News:
Out-Of-Pocket Costs Often Keep Pricey New Cholesterol Drugs Out Of Reach, Study Finds
Access to powerful new cholesterol-lowering drugs is so tightly controlled and patients’ out-of-pocket costs are so high that fewer than a third of people whose doctors prescribe the drugs get them, a new study found. While highly effective, the new drugs cost as much as $14,000 annually, leading some insurers and pharmacy benefit managers to require doctors to get preapproval for them. For example, only 47.2 percent of people who were prescribed the drugs, Praluent and Repatha, received that insurance green light, and just under two-thirds of those patients filled their prescriptions. (Andrews, 9/29)
In other pharmaceutical news —
The Wall Street Journal:
AbbVie, Amgen Reach Settlement In Humira Patent Dispute
Drugmakers AbbVie Inc. and Amgen reached a patent-dispute settlement requiring Amgen to wait until 2023 to start selling a lower-price copy of the world’s top-selling drug, AbbVie’s arthritis treatment Humira, in the U.S. The deal could give AbbVie an unusually long 20-year U.S. monopoly on sales of the expensive biotech drug that went on sale in early 2003, assuming no other rivals manage to bring copies to market before 2023. Humira costs more than $57,000 annually a patient and had U.S. and global sales last year of $10.4 billion and $16 billion, respectively. (Loftus, 9/28)
Chicago Tribune:
AbbVie Protects Blockbuster Drug Humira For 5 Years Through Settlement
AbbVie’s top-selling drug Humira won’t have to compete in the U.S. against a similar medication made by rival Amgen for five years, thanks to a settlement between the two companies. The settlement is good news for North Chicago-based AbbVie and its shareholders, but it could mean higher prices over the next few years for consumers, says at least one expert. (Schencker, 9/28)