
Pharma industry loses on Medicare price negotiations
A federal judge dismissed the U.S. Chamber of Commerce's lawsuit challenging Medicare negotiations a year ago, and this ruling was upheld Wednesday by the Sixth Circuit Court of Appeals.
The suit was dismissed on the basis that some of the plaintiffs — the Dayton Area Chamber of Commerce, the Ohio Chamber of Commerce, and the Michigan Chamber of Commerce — lacked standing to sue.
While the appeals court clarified that local and state organizations can sue over federal laws that impact them, it still found that the case was improperly filed. The court agreed that the U.S. Chamber of Commerce had standing to sue, but it would need to file a new lawsuit in a separate venue.
On Thursday, Medicare negotiation lawsuits challenging the constitutionality of the program were both ruled against.
PhRMA, another trade group, saw its lawsuit dismissed by a Texas federal judge who found that the organization had failed to demonstrate irreparable harm or constitutional violations stemming from Medicare negotiations.
In Connecticut, the U.S. 2nd Circuit Court of Appeals upheld a decision from last year against the pharmaceutical company Boehringer Ingelheim. Three of the company's products have been selected for Medicare negotiation.
As has been the case in other rulings, such as the one in Texas, the court relied on the fact that participation in Medicare is entirely voluntary, meaning companies are not being deprived of certain rights because of the negotiation program.
When reached for comment by The Hill, PhRMA spokesperson Sarah Ryan said, 'We disagree with the district court's legal assessment. We continue to believe the IRA's price-setting provisions are unconstitutional.'
With compounding losses in appellate courts, the pharmaceutical industry may be gearing up to take Medicare negotiations before the Supreme Court.

Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles

Epoch Times
an hour ago
- Epoch Times
These Drug Prices Won't Soon Go Down—Here's Why
Pharmaceutical companies can continue to charge the federal government—and Medicare beneficiaries—full price for a handful of drugs that might have seen price reductions as soon as next year. That's because Congress changed the law to outright exempt or delay consideration of more than 300 medications for the Medicare Drug Price Negotiation Program.
Yahoo
2 hours ago
- Yahoo
Tandem, Insulet monitoring CMS payment proposal for diabetes tech
This story was originally published on MedTech Dive. To receive daily news and insights, subscribe to our free daily MedTech Dive newsletter. Medtech executives discussed planned changes to how the Centers for Medicare and Medicaid Services could pay for diabetes technology in earnings calls this week. Insulin pump makers Insulet and Tandem Diabetes Care don't expect much of an impact on their business from the proposed changes, but said they would be monitoring the policy. In June, CMS issued a proposed rule that would seek to include insulin pumps and continuous glucose monitors in a competitive bidding program. The rule would also change payments to a monthly rental schedule instead of a contract where the devices are paid for upfront. RBC Capital Markets analyst Shagun Singh expects Tandem and Medtronic to be impacted the most, 'as the new proposal would allow for competitive switching,' she wrote in a July 1 research note. Singh expects Insulet to see less of an impact as the company already uses a 'pay-as-you-go' model, and Dexcom's and Abbott's CGMs are already sold on a monthly bundle basis. Tandem CFO Leigh Vosseller said on an earnings call Wednesday that the company does not expect the changes to have a material impact on the company's business, and 'we anticipate it could help drive more people to pump therapy.' Currently, traditional Medicare makes up less than 10% of Tandem's sales. Vosseller said the payment change would shift pump reimbursement from a 13-month rental to a pay-as-you-go model. Tandem, which currently sells most of its pumps through a durable medical equipment model, plans to begin selling supplies for its t:slim X2 pump through the pharmacy channel starting in the fourth quarter. 'Transitioning to a pay-as-you-go model is something that we've contemplated anyway from a commercial perspective as we've pursued the pharmacy channel,' Vosseller said. She added that Tandem will be participating in the comment period and anticipates final rulings in November. Tandem lowered its earnings forecast for U.S. sales in 2025 to $700 million for the year, down from a previous range of $725 million to $730 million. CEO John Sheridan said the change was due to a new market entrant that has built a larger-than-expected sales team, and initiatives that are still in progress to modernize Tandem's systems and grow its salesforce. The company also disclosed a recall related to a speaker problem with its devices, which has been associated with 59 injuries. Tandem's stock price was down roughly 20% to $11.52 at market close Thursday. Insulet, Dexcom expect little impact Insulet expects little impact from the CMS changes. CEO Ashley McEvoy told investors Thursday that the company's devices are already sold on a pay-as-you-go basis, as the company does almost all of its sales through the pharmacy channel. Insulet's patch pumps are covered under Medicare Part D, which covers prescription drugs, and McEvoy doesn't think they will be eligible for competitive bidding under Part B, which covers durable medical equipment. 'We are going to continue to engage with CMS to really talk about the benefits of our differentiated Omnipod 5 technology and how we improve care for people with diabetes,' McEvoy said. Insulet raised its sales expectations for 2025, now anticipating growth of 24% to 27%, from a previous range of 19% to 22% Dexcom Chief Operating Officer Jake Leach also addressed the CMS competitive bidding proposal, saying about 15% of the company's business is fee-for-service Medicare. Leach, who will become CEO of Dexcom in January, said on an earnings call in July that 'we feel very comfortable about the value that we bring for the price of our product.' He added that Dexcom also wants to ensure there's not an interruption to care for people on Medicare as has happened in previous versions of competitive bidding. CFO Jereme Sylvain said he expects the bidding process to start no earlier than 2027, based on historical precedent. Recommended Reading Tandem insulin pump malfunction linked to 59 injuries Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data


The Hill
14 hours ago
- The Hill
Pharma industry loses on Medicare price negotiations
Three separate federal courts ruled against the pharmaceutical industry this week, with some cases having previously been dismissed. A federal judge dismissed the U.S. Chamber of Commerce's lawsuit challenging Medicare negotiations a year ago, and this ruling was upheld Wednesday by the Sixth Circuit Court of Appeals. The suit was dismissed on the basis that some of the plaintiffs — the Dayton Area Chamber of Commerce, the Ohio Chamber of Commerce, and the Michigan Chamber of Commerce — lacked standing to sue. While the appeals court clarified that local and state organizations can sue over federal laws that impact them, it still found that the case was improperly filed. The court agreed that the U.S. Chamber of Commerce had standing to sue, but it would need to file a new lawsuit in a separate venue. On Thursday, Medicare negotiation lawsuits challenging the constitutionality of the program were both ruled against. PhRMA, another trade group, saw its lawsuit dismissed by a Texas federal judge who found that the organization had failed to demonstrate irreparable harm or constitutional violations stemming from Medicare negotiations. In Connecticut, the U.S. 2nd Circuit Court of Appeals upheld a decision from last year against the pharmaceutical company Boehringer Ingelheim. Three of the company's products have been selected for Medicare negotiation. As has been the case in other rulings, such as the one in Texas, the court relied on the fact that participation in Medicare is entirely voluntary, meaning companies are not being deprived of certain rights because of the negotiation program. When reached for comment by The Hill, PhRMA spokesperson Sarah Ryan said, 'We disagree with the district court's legal assessment. We continue to believe the IRA's price-setting provisions are unconstitutional.' With compounding losses in appellate courts, the pharmaceutical industry may be gearing up to take Medicare negotiations before the Supreme Court.