Wegovy could face Medicare drug price negotiations next | Wilnesh News

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Good afternoon! Wegovy, the blockbuster weight loss treatment Novo Nordiskthe drug that topped the list may soon be part of a second round of price negotiations between manufacturers and Medicare.

This is based on piece of paper Published last week in the Journal of Managed Care and Professional Pharmacy. By February, the government will reveal the next 15 most expensive Medicare Part D drugs, which will be subject to negotiations and price adjustments that will take effect in 2027.

The Biden administration last month announced new negotiated prices for the first 10 Medicare Part D drugs selected for negotiations. These prices will take effect in 2026.

According to guidance from the Centers for Medicare and Medicaid Services, drugs that contain the same active ingredient and are manufactured by the same company will be considered a single drug in the conversation. Researchers say that’s why they expect all three of Novo Nordisk’s brand-name drugs containing semaglutide – Wegovy, the diabetes shot Ozempic and an older diabetes drug called Rybelsus – to be selected as a single product talks.

This can be a big deal for seniors using these treatments, each with a price tag of approximately $1,000 per month Before insurance. However, it’s unclear how much Medicare can negotiate down costs and how much patient costs will fall after insurance and rebates.

The Biden administration, lawmakers and patient advocates have long criticized the Danish drugmaker for overpricing its obesity and diabetes drugs. Novo Nordisk Chief Executive Lars Fruergaard Jørgensen faced a Senate question on Tuesday over the prices.

While Jørgensen stopped short of committing to lowering the prices of Wegovy and Ozempic, he vowed to “collaborate” with pharmacy benefit managers “on anything that helps patients access and afford the medicines.” When asked about potential options for Wegovy and Ozempic, he also rejected Medicare price negotiations, calling the negotiations “price fixing” that would have a negative impact on drug innovation.

Medicare Part D does not cover weight loss treatments unless they are approved and used to treat other health conditions. But researchers say Wegovy may be on the negotiating table now that it’s approved to reduce the risk of major cardiovascular complications, making it possible that some Part D plans may already begin to cover the treatment.

Under CMS guidance, drugs must be on the market without generic competitors for at least seven years before Medicare can select them for price negotiations. As of February, semaglutide had been on the market for seven years and one month and did not have any generic versions.

Other researchers and Wall Street analysts said they expected Ozempic to be open to negotiations because of how much Medicare Part D spends on treatment.

The newspaper said the plan spent more than $5.6 billion on the drug semaglutide in 2022, which only reflects spending on Ozempic and Rybelsus because Wegovy was not covered at the time. The researchers also project that Medicare Part D spending on Ozempic and Rybelsus will be nearly $7.5 billion in 2023, $3 billion more than spending on the next-highest eligible drug.

They noted that they may have “underestimated” the projected spending figures for semaglutide

Other drugs expected to undergo price negotiations include GSKTrelegy Ellipta is a prescription inhaler used to treat asthma and COPD, while Xtandi is a rheumatoid arthritis drug from Astellas Pharmaceuticals.

However, the researchers said the final list of selected drugs will depend on whether generic versions become available by February.

We’ll be keeping a close eye on the next round of Medicare drug price negotiations, so stay tuned for our coverage.

Please feel free to send Annika any tips, suggestions, story ideas and data: annikakim.constantino@nbcuni.com.

Data startup Particle Health filed a report on Monday antitrust litigation For Epic Systems, a software provider that maintains the medical records of some 280 million patients in the United States

Particle claims that Epic is using its dominance in electronic health records to stifle competition in other markets that use that data. The lawsuit was filed in the Southern District of New York.

Oracle and Meditech are other big names in electronic health records, where patient data is often stored across multiple vendors. Even so, Epic remains a formidable competitor. The company holds the largest acute care market share in the United States, covering more than half of all emergency multispecialty beds, according to a report. Klass Research. In addition, the report stated that Epic is the only vendor to achieve net growth in market share in 2023.

Particle’s lawsuit comes after the two companies clashed over their data-sharing practices earlier this year. Epic and Particle both belong to an interoperability network called Carequality, which helps facilitate the large-scale exchange of patient information.

Epic filed a formal dispute with Carequality in March, citing concerns that Particle and its participating organizations “may have inaccurately stated their purposes related to their records searches.” To join the Care Quality Network, an organization must be approved and comply with “permitted purposes,” typically related to treatment and exchange of patient records.

Particle said in its 81-page complaint that Epic’s dispute was “fabricated,” with Epic alleging that certain Particle customers, not Particle itself, improperly obtained records. Particle said Epic used its “significant influence” over Carequality to obtain a favorable outcome and argued it suffered losses as a result of Epic’s actions.

“If there’s no impact, Epic will be incentivized to run this strategy again the next time a competitor emerges,” Particle said in a press release on Monday.

Epic said it will “vigorously defend against Particle’s baseless allegations” and will continue to protect patient privacy.

“Particle’s claims are baseless,” an Epic spokesperson told CNBC in a statement on Tuesday. “This lawsuit attempts to distract from the real issue: Particle’s unlawful conduct on the Carequality Health Information Exchange Network violated HIPAA privacy regulations. “Particle’s complaint mischaracterizes Carequality’s decision, which actually recommended that Particle customers who access patient data for impermissible purposes be banned. ”

Because antitrust cases move slowly, a final ruling may take some time. For example, Google last month lost an antitrust lawsuit originally filed in 2020.

You can read the full Particle complaint against Epic here.

Please feel free to send any tips, suggestions, story ideas and data to Ashley at ashley.capoot@nbcuni.com.