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Yahoo
a day ago
- Business
- Yahoo
Senate panel votes to tighten rules on big pharmacy firms
BATON ROUGE, La. (LSU Manship School News Service) — A bill aimed at increasing transparency in how pharmacy benefit managers operate advanced out of the Senate Insurance Committee Wednesday, signaling a push to regulate an industry that critics say drives up drug prices and puts local pharmacies at risk. House Bill 264, authored by Rep. Michael Echols, R-Monroe, cleared the committee with amendments that would ban pricing schemes, strengthen oversight and increase transparency in the often-confusing world of drug benefits. PBMs are third-party companies that manage prescription drug benefits for health insurers, large employers and government programs like Medicaid. They negotiate with drugmakers and reimburse pharmacies, all while claiming to lower costs for patients. In practice, critics say they frequently do the opposite. A 2023 New York Times investigation found that the three largest PBMs–CVS Caremark, Express Scripts, and OptumRx–frequently steer patients toward higher-priced drugs, inflate prices and pocket billions in hidden fees. Owned by major healthcare conglomerates like CVS Health, Cigna, and UnitedHealth Group, PBMs operate largely behind the scenes but have significant control over drug costs for more than 200 million Americans. These layers of secrecy are what Louisiana lawmakers are now trying to peel back. But the Louisiana bill does not go as far as a law that took effect in Arkansas last year, which has led to concerns that CVS could close its stores in that state. Echols' bill would prohibit PBMs in Louisiana from engaging in spread pricing, a practice where they charge insurers more than they reimburse pharmacies and keep the difference. It would also require PBMs to pass 100% of manufacturer rebates to insurers or employers. It also would mandate annual certification under oath that they followed state transparency rules and give the Louisiana Department of Insurance power to audit their contracts and compensation programs. 'It creates a broader model nationally for transparent, fair BPM operations,' Echols said. 'It provides robust transparency, prohibits some of the spread pricing games that have been played in the past, and creates a local pharmacy reimbursement that has national standards.' Trump signs executive order aimed at slashing prescription drug costs To some extent, the debate in Louisiana echoes the turmoil in Arkansas, though Echols' bill is not as far-reaching. Arkansas passed a law in the spring of 2024 banning PBMs from owning or operating pharmacies. Last month, a year after the law was enacted, CVS Health sued to block it, warning that the policy would force the company to close 23 CVS Pharmacy locations in the state, eliminate more than 500 jobs and reduce patient access to life-saving medications. CVS Caremark, the PBM arm of CVS Health, manages prescription drug benefits for millions of Americans. Don Caffery, who represented the Louisiana Independent Pharmacies Association, called some of the changes in the Louisiana bill essential. 'Moving to a model prohibiting steering and prohibiting spread pricing, these are things that are going to keep independent community doors open ,' he said. 'This is simply about allowing the pharmacy to recoup the price of the drug and keep their doors open.' The bill drew wide support from local pharmacies, many of whom did not wish to speak publicly. Sen. Rick Edmonds, R-Baton Rouge, said he has heard from constituents struggling to get prescriptions filled. 'We are obligated to take up this issue and not let this happen to our local pharmacies or our constituents,' Edmonds said. 'I just want a fair dollar for dollar for our constituents, for our local pharmacies and our providers.' Sen. Regina Barrow, D-Baton Rouge, pressed Echols on whether the bill would truly benefit independent pharmacies and patients. 'I think 'scheme' is such an accurate word,' she said, referring to current PBM pricing practices. 'This has been one of the biggest schemes I've seen in a long time.' But she questioned whether the bill would keep money in the pockets of consumers and union workers. A representative from a Baton Rouge-based union testified against the bill, raising concerns that parts of the bill might conflict with a federal law that regulates employer-sponsored health plans, but there was testimony that the bill aligns with a 2020 U.S. Supreme Court decision that gave states limited authority to regulate PBMs, particularly on reimbursement rates. Still, the amendments added to Echols' bill focus less on rate-setting and more on tightening the appeals process for pharmacies and shielding certain proprietary PBM information from public disclosure. Echols said the bill began as a transparency measure in the House but has 'broadened' through its amendments in the Senate. 'At the end of the day, if the money isn't going to the patient, it has to go somewhere,' he said. 'This is an opportunity to lower premiums for our people and help our independent pharmacies.' Louisiana bill inspired by Make America Healthy Again movement heads to governor Musk calls for killing House's 'big, beautiful bill' Trump calls for scrapping debt limit US Education Department to determine funding EBR Schools gets for diversity program California teen stripped of track title after imitating iconic celebration Judge blocks deportation of family of man charged in Boulder attack Copyright 2025 Nexstar Media, Inc. All rights reserved. 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Yahoo
28-05-2025
- Business
- Yahoo
Litigation, legislation, collaboration: Neronha outlines fix for R.I.'s broken health care system
Rhode Island Attorney General Peter Neronha answers reporters' questions on his new health care reform strategy during a press conference at his Providence office on Wednesday, May 28, 2025. (Photo by Alexander Castro/Rhode Island Current) Rhode Island Attorney General Peter Neronha took a break Wednesday from his breathless legal pursuit of President Donald Trump's administration to chase a different foe: pharmacy benefit managers, or PBMs. 'The cost of drugs is astounding,' Neronha told reporters gathered at his South Main Street office in Providence. 'Pharmacy benefit managers…operate in a very secretive and shrouded way…Because they have 80% of the market, they're able to use that market power to drive drug prices sky high and keep that difference.' A lawsuit filed Tuesday in Rhode Island Superior Court against three of the nation's biggest PBMs — CVS Caremark, Express Scripts, and OptumRx — is perhaps the sharpest prong among many in a sweeping plan to restructure the way Rhode Island funds health care unveiled Wednesday morning. All of the initiatives in Neronha's heavy slate of proposals are meant to remedy what Neronha called a 'spectacular failure' that has been years in the making. 'It was looming then,' Neronha said Wednesday of the state's health care crisis when he took office in 2019. 'It's here now.' In about 34 minutes of opening remarks, Neronha detailed his office's new list of efforts to effect major change, from boosting mediocre Medicaid reimbursement rates to filling absences in primary care practices. The entire plan is available on a new website, titled 'A Way Forward,' which went live during the press conference. The health care system in Rhode Island is so bad, Neronha offered, that even the state's largest hospital corporation doesn't want to buy hospitals here but instead shops for prospects in Massachusetts. Neronha cited Brown University Health's 2024 purchase of Saint Anne's Hospital in Fall River and Morton Hospital in Taunton. 'There are struggling hospitals right here in Rhode Island,' Neronha said. 'Why are they buying them in Massachusetts? Because the reimbursement rates are higher. It's always about the money. Don't let anyone convince you that it's not about the money.' The rollout of initiatives came a week after Neronha announced he secured an $11 million settlement with Barletta Heavy Division Inc., the Massachusetts contractor accused of dumping contaminated soil during construction of the Route 6/10 Interchange in Providence. Neronha steered most of the money toward dental care for children in low-income neighborhoods near the construction site. Unlike with multistate lawsuits where proceeds go directly to the state's general fund, the term-limited Neronha said his office had the authority to decide where the money goes. 'We really started rolling out what we're doing last week with the Barletta settlement,' Neronha said. 'The question was, 'What do we do with that money and how do we solve a problem?'…It became very clear to me that if we had this pot of money and we could use it to drive it back into those neighborhoods, to at least address that community problem and hope to solve it, then that action would make a difference.' After Neronha's monologue, seven of his staff attorneys came up to the podium one by one to describe the details of the AG's plan, including the PBM lawsuit, which targets the three companies who make up around 80% of the national market for managing insurers' prescription drug benefits for patients. 'The cost of drugs is benefit managers…operate in a very secretive and shrouded way…Because they have 80% of the market, they're able to use that market power to drive drug prices sky high and keep that difference. – Rhode Island Attorney General Peter Neronha The lengthy complaint alleges that PBMs extract billions in rebates while reimbursing pharmacies below cost. These shadowy maneuvers, the lawsuit claims, threaten the survival of independent pharmacies, deceive consumers, and inflate drug costs via intricate manipulation of pricing schemes. Sarah Rice, deputy chief of the office's civil division, told reporters that PBMs will demand manufacturers offer rebates on certain drugs if they wish to be distributed through PBMs' networks. That leads manufacturers to increase prices, and PBMs then shave a little off the top by taking a portion of the rebate, according to Rice. 'The health plans pay more, and consumers pay more,' Rice said. 'All of this is set out in much better detail in the complaint, if you are ready to read over 200 paragraphs of allegations.' The complaint was filed under state laws on deceptive trade practices, Rice said, 'Because this behavior is harmful to consumers. It has a direct pocketbook effect to any consumer that has a deductible or co-insurance when they go to the pharmacy, which is most of us.' The suit also identifies three group purchasing organizations (GPOs) — Zinc Health Services, Ascent Health Services, and Emisar Pharma Services — as defendants. PBMs use their organizations to aggregate their purchasing power for pharmaceuticals — a more recent development as benefit managers usually had 'enormous bargaining power on their own,' the lawsuit explains. 'It appears PBMs use GPOs to recategorize existing income streams and generate new income streams,' the lawsuit reads. 'GPOs also serve as an additional, non-transparent layer in an already opaque system, making it even more difficult for health benefit plans to determine whether they received their fair share of rebates.' Neronha's office is seeking injunctive relief, civil penalties, and full restitution for affected patients and pharmacies. The complaint aligns Rhode Island with a growing cohort of states, including Ohio, Arkansas, and Mississippi, that have started legal battles with PBMs for pricing tactics or rebate sleights-of-hand. CVS spokesperson Amy Thibault defended the Woonsocket-based company against the lawsuit's claims in a statement Wednesday. 'It's surprising and unfortunate that Rhode Island's attorney general would use biased and incorrect assertions about our industry to needlessly attack a hometown company,' Thibault wrote. 'CVS Health contributes nearly $3 billion of positive economic activity in Rhode Island each year, and we employ more than 7,000 colleagues across the state.' Thibault said CVS saved customers nationwide over $40 billion last year, with members paying under $8 on average for a 30-day prescription. She also cited an increase in independent pharmacies over the past six years, which the company says are reimbursed at higher rates than CVS stores, including its 62 Rhode Island locations. Neronha's plans include support in three major areas of legislation, including some bills he hopes will pass before the legislative session ends next month. Most prominent in the AG's machinations is a reevaluation of Medicaid rates, illustrated by a presentation slide at the press conference. A hypothetical Medicare reimbursement may pay a provider $100, the slide showed. A commercial insurer might reimburse the provider at $200 for the same service, but Medicaid might only pay $37 — a problem in a state where Medicaid factors heavily into the payer mix, or makeup of different insurance types among the population. About 70% of Rhode Islanders are on public insurance, either Medicare or Medicaid, according to a report accompanying Neronha's action plan. That's why Neronha is supporting H6373, sponsored by Exeter Democratic Rep. Megan Cotter, which would immediately increase Medicaid payment rates to be on par with Medicare payments. The bill was introduced and referred to the House Committee on Finance on Wednesday. Retooling the reimbursement rates would conservatively cost $50 million, Neronha said. 'We can find it in our state government, a $14.2 billion budget,' Neronha said. A year to the day ago, Neronha argued passionately to save the state's safety net hospitals to a who's who of lawmakers and health care leaders at a Rhode Island State House health care summit. On Wednesday, Neronha reiterated several of the same points, and said that the lamentable case of Rhode Island's two safety net hospitals — Our Lady of Fatima and Roger Williams Medical Center — taught him valuable lessons in how reimbursement rates work. It's surprising and unfortunate that Rhode Island's attorney general would use biased and incorrect assertions about our industry to needlessly attack a hometown company. – CVS spokesperson Amy Thibault 'That's where I learned that there's a problem in health care, a structural problem that's going on here,' Neronha said. 'And what is it? Our reimbursements are too low. They're too low in Medicare, they're too low in Medicaid, they're too low in commercial.' The hospitals remain in a purgatory of ownership, with the finalization of the two properties' transfer from Prospect Medical Holdings to new owner Centurion Foundation still incomplete as of Wednesday. Also on Wednesday, Gov. Dan McKee submitted a budget amendment that would infuse $4.3 million in state money for a 21-bed long-term behavioral health care inpatient unit at Fatima. Hoping to preempt similar situations, one of Neronha's more assertive proposals would let his office petition Superior Court to place financially distressed or poorly run hospitals, especially those under private ownership, into receivership. The corresponding bill is H6369, sponsored by Rep. Susan Donovan, a Bristol Democrat. On Wednesday, it was introduced and referred to the House Committee on Judiciary. 'This is something, frankly, that we talked about with Prospect before we got to where we are today,' Neronha said. To complement that legislation, Neronha is proposing a regulation that would require Rhode Island-based medical groups to notify the AG's office of any acquisition or restructuring involving private equity or the consolidation of large practices. A public hearing on the proposed rule is scheduled for July 8. 'One thing that we know we don't know is the level of private equity intrusion into the health care market outside of hospital systems,' Neronha said. 'We have great insight into hospital systems because of our regulatory authority over hospital systems, but not into health care practices, and we believe that we need to know so we can head off any problems.' Neronha wants to almost universally eliminate prior authorization processes for primary care providers, except for certain controlled substances or in documented cases of physician fraud, via bill H6317 sponsored by Rep. Mia Ackerman, a Cumberland Democrat. The bill was introduced and referred to the House Committee on Health and Human Services on May 9, and is still waiting for a hearing date. Prior authorization acts as a lever on insurance claims and is meant to help insurers contain unnecessary costs, but it has also been criticized as an example of payer overreach and a seriously demanding time constraint on already overworked physicians. Jordan Broadbent, the office's insurance advocate, told reporters the move to abolish prior authorization is 'bold legislation' and would make Rhode Island a national leader should it pass. Backing Neronha's claims are two reports — one focused on the past, the other on the future. The Statewide Health Care Capacity Assessment features the retrospective data and was compiled by the consulting firm Health Management Associates, who found deep gaps in primary care access and coverage, wobbly long-term financing across different kinds of providers, and understaffed and overworked emergency departments. According to the report, there are roughly 100,000 Rhode Island adults without a primary care provider, an ongoing issue recently exacerbated by the impending closure of Anchor Medical Associates' remaining offices. The report also found poor outcomes for nursing homes, which boast a closure rate twice the national average. An additional nursing home closed shortly after the report was being prepared last summer, said Dorothea Lindquist, health care senior litigation attorney at the AG's office. Lindquist also noted that four providers of Medicare Advantage plans in Rhode Island — which account for over 56% of Medicare enrollees statewide — have not raised their post-acute care reimbursement rates in a decade. 'This finding should be terrifying to everyone in Rhode Island who plans to find themselves aging here,' said Lindquist. Another policy brief included in the AG's package comes from the Collaborative for Health Policy and Reform Analysis (CAHPR) at the Brown University School of Public Health. The dossier reinforces load-bearing planks in Neronha's plans, including enhanced regulatory authority over health care transactions and expansion of primary care access. 'The proposals vary in scope, legal complexity, and political feasibility, but each offers a potential pathway for meaningful reform,' according to the brief, which discusses a state-based, single-payer plan, a comprehensive public option, pricing parity for Medicaid reimbursements and widening the state's drug purchasing pool beyond state employee coverage. The Brown collaborative's recommendations and Neronha's stratagems differ from those outlined in a primary care stabilization strategy recently announced by Gov. Dan McKee, which emphasized more gradual reform via existing regulatory mechanisms and a future review of Medicaid rates. Neronha called McKee's April 29 announcement of a long-term primary care strategy 'slapdash,' and the attorney general's plan is contrastingly nimble, in his own evaluation. 'Everything we're gonna roll out today is action we believe will make a difference,' Neronha said. The complete set of initiatives included in Neronha's wishlist, as listed in a press release from his office: File suit against the three largest Pharmacy Benefit Managers (PBMs) in the country to protect Rhode Island consumers from unfair and deceptive conduct that has caused drug prices to skyrocket; Introduce legislation to immediately raise Medicaid reimbursement rates to 100% of Medicare rates for primary care providers; Introduce legislation to immediately eliminate nearly 100% of prior authorization requirements for primary care providers; Introduce legislation authorizing the Attorney General to petition the Superior Court to place a hospital into receivership if the facility becomes financially unstable; Issue proposed regulations to require pre-merger notification of certain material corporate transactions involving medical practice groups, including transactions involving private equity firms; Issue an advanced notice of proposed rulemaking regarding market oversight of artificial intelligence (AI); Collaborate with the Brown University School of Public Health Center for Advancing Health Policy Through Research (CAHPR) to examine potential policy options for state-based health system reform; and Plan for a new state health care agency to obtain and analyze healthcare data, and inform innovative and effective governmental health care decision-making. 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Boston Globe
21-05-2025
- Health
- Boston Globe
State health plan shortfall points to challenge of expensive weight loss drugs
Get The Gavel A weekly SCOTUS explainer newsletter by columnist Kimberly Atkins Stohr. Enter Email Sign Up Injectable GLP-1 drugs were initially developed to treat diabetes, then approved for obesity. Their popularity has risen among consumers eager to lose weight, and the drugs carry enormous potential health benefits in mitigating the risks of obesity-related disease. But they are expensive, with annual list prices as high as $16,000 and net prices, after discounts, of $7,000 to $9,000, according to Advertisement Increased use of GLP-1 drugs was not the only factor in GIC's shortfall, but these medications have been causing GIC's costs to rise for years. Advertisement According to In the long term, drug prices may come down as more drugs enter the market and competition increases. Medicare will negotiate prices for some of these drugs to take effect in 2027. US consumers already pay more than Europeans for the same medication, and the ultimate solution will need to involve finding some way to lower prices for American consumers. In the short-term, GIC is right to consider what solutions best balance cost and access. The main change announced so far is that beginning in July, CVS Caremark will 'prefer' the GLP-1 drug Wegovy. That means patients will no longer receive insurance coverage for another GLP-1 drug, Zepbound, unless they obtain an exception and pay a higher copay. The decision encouraged competition that enabled CVS Caremark to negotiate a lower price. CVS Caremark says its clients, including GIC, are expected to save 10 percent to 15 percent on their anti-obesity medicine costs. It's a strategy similar to one used by MassHealth. In January, Advertisement More changes for state employees' coverage may be forthcoming. GIC executive director Matthew Veno said at Thursday's meeting that GIC continues to be 'actively evaluating steps that we can take to strike the right balance between cost and access.' At a prior Some other public plans are going further. North Carolina's state employee health plan last year On the commercial market, Blue Cross Blue Shield Massachusetts There is a benefit to giving employers choice in how much they want to pay for what coverage. The downside is when employees aren't covered, it creates inequality where only the wealthy can get drugs. Drugmakers now offer products directly to cash-paying consumers, with a year's supply of Advertisement Compounded versions of the drugs also became available when these drugs were deemed to be in shortage in 2023 and 2024, and Another important way to contain costs is to make sure patients who seek insurance coverage for GLP-1 drugs actually need them. But there isn't consensus on how to do this. Some insurers require step therapy, first forcing patients to try a different drug or engage in a lifestyle management program. MassHealth requires members to try an oral appetite suppressant. But step therapy can potentially harm a patient — and make treatment longer and more expensive — if an insurer first requires a treatment not recommended by the patient's physician. There is a need for clinical guidelines to determine when someone qualifies as obese. But the main clinical measure used is body mass index, which Connecticut's state health insurance plan is experimenting with outsourcing obesity treatment to a third-party organization, FlyteHealth, which employs experts who prescribe GLP-1 and other drugs and use lifestyle management approaches. That model deserves more study to determine impacts on cost, care quality, and health outcomes. There's no easy answer, but Massachusetts state officials deserve credit for trying to find ways to maintain coverage while cutting costs. Advertisement Editorials represent the views of the Boston Globe Editorial Board. Follow us
Boston Globe
12-05-2025
- Health
- Boston Globe
Mass. residents who take GLP-1 drugs for obesity tend to be white and affluent. But who needs them most?
Obesity, which White people account for about 68 percent of Massachusetts residents with obesity but make up 82 percent of patients taking the drugs, according to the analysis, which relied on tens of thousands of insurance claims and data on assets. Advertisement Women make up 51 percent of the state's obese residents but about 71 percent of GLP-1 users. And nearly one-third of people taking the medicines have household incomes of $200,000 or more. Meanwhile, Black, Hispanic, Asian, and low-income residents are underrepresented among people taking GLP-1s, based on their obesity rates. (In Massachusetts, Advertisement A variety of factors appear to contribute to the disparities, not the least of which is the cost of the self-injected drugs. GLP-1s have list prices of $1,000 or more a month, and insurance coverage of the medications varies widely. The disparities worry health experts, who say the medicines have the potential to narrow differences in obesity rates among demographic groups, but may in fact be widening them. 'These drugs are very important for everyone to have access to,' said Jonathan Rossman, a senior analyst for Real Chemistry, 'not just the ones who have the means to pay for it.' Related : Among those who have struggled to afford GLP-1 drugs is Jordan, a 37-year-old Cambridge resident and manager of a nonprofit that mentors high school students. Jordan is Black, uses they/them pronouns, and only wanted to be identified by their first name because of privacy concerns. Weighing 285 pounds at their peak, Jordan first tried the daily drug Saxenda in mid-2022. They shed 40 pounds but then plateaued. In January of last year, they switched to the weekly drug Wegovy. In both cases, Jordan had a modest monthly co-pay of $20 through their insurance. 'It's been extremely meaningful,' Jordan said of losing weight. It helped to relieve asthma and back pain, they said, and had 'mental effects, like being on the subway and not worrying about whether I can squeeze into the seat.' But when Jordan began working for the nonprofit last July, they said, their new insurance plan at CVS Caremark wouldn't cover Wegovy. It would cost $1,500 a month out of pocket, which was unaffordable. Advertisement So Jordan switched to a copycat version of the drug available online from a compounding pharmacy for $500 a month. However, the Food and Drug Administration has cracked down on copycat GLP-1s, saying in March that they 'can be risky for patients' because they haven't been approved by regulators. Jordan isn't sure what to do if the drug becomes unavailable; they have lost a total of 92 pounds since they began taking GLP-1s. Related : Experts say some demographic groups aren't as aware of the medications as others. Some patients of color are more skeptical of medical care than white patients because of harm they historically suffered during such episodes as the infamous Tuskegee syphilis study. Black and brown patients may also face greater challenges in finding a primary care physician to prescribe GLP-1s, or have difficulty getting time off from work to see a doctor. Cultural ideals about appearance may also play a role in the disparities between groups. 'That's basically the demographic that faces the most societal pressure for fitness, so they'd be the ones seeking the prescriptions most urgently,' she said. Anekwe sees about 20 patients a week with obesity, she said, and roughly 70 percent are white women. To qualify for the medications, private and public insurers have generally required patients to have a body mass index of at least 30, or 27 if individuals have a weight-related medical condition such as cardiovascular disease or high blood pressure. (Someone who is 5 feet 7 inches tall and weighs 192 pounds has a BMI of 30.) Advertisement Traci Haddock, who works for a biotech in the Fenway area, said she first began taking GLP-1s about 18 months ago after her primary care doctor said her blood sugar levels indicated she was prediabetic. She weighed 330 pounds at the time. Haddock, who is white, said she had struggled to lose weight all her life but didn't feel societal pressure to take a GLP-1 – just the opposite. Related : 'I feel like there's a bit of stigma against taking the medication, like it's the easy way out,' said Haddock. She first used Saxenda, which her husband, Chris Angelli, a Somerville High School science teacher, takes for obesity. Haddock lost 25 pounds but then regained it. In December, she switched to Zepbound. She has lost 25 pounds again and says her cravings, or 'food noise,' have disappeared. Haddock, whose annual household income exceeds $200,000, said she has a co-pay of $60 a month under her insurance plan from Harvard Pilgrim Health Care and can easily afford the treatment. 'We're very fortunate,' she said. 'I will pay $15 a week to lose one to two pounds a week, no problem.' Traci Haddock and her husband, Chris Angelli. Haddock said she has a co-pay of $60 a month under her insurance plan from Harvard Pilgrim Health Care and can easily afford Zepbound. John Tlumacki/Globe Staff A new study by researchers from the Yale School of Medicine found similar disparities in prescriptions for GLP-1s written nationwide that the Globe analysis identified for prescriptions written in Massachusetts. The Yale researchers examined electronic health records of 277 million patients from more than 280 US health care systems between July 2020 and October 2024. The team found more than 39 million adults qualified for GLP-1s to treat obesity, but only 2.3 percent of them obtained prescriptions for semaglutide (the active ingredient in Ozempic and Wegovy) or tirzepatide (the active ingredient in Mounjaro and Zepbound). Related : Advertisement Again, male patients were less likely than female patients to obtain prescriptions, and Black, Hispanic, and Asian patients were underrepresented, based on their obesity rates, according to the study published late last month in JAMA Network. 'We want to make sure these powerful drugs can reach the patients who need them most, but when we look at the obesity prevalence, there's a disparity there,' Yuan Lu, an assistant professor of medicine and the senior author of the study, said in an interview. Although affordability appears to be fueling disparities in Massachusetts, the state actually has one of the more generous public insurance programs for lower-income residents seeking GLP-1s. Massachusetts is one of 15 states that cover the cost of GLP-1s to treat obesity in patients on Medicaid, the federal health care program for people with low incomes, according to former Massachusetts Public Health Commissioner Christine Ferguson. Her firm, Leverage Global Consulting, tracks coverage of GLP-1s by public and private insurers. MassHealth, Related : 'At least in Massachusetts, our Medicaid program works against disparity,' said Dr. James Morrill, a primary care physician and medical director at the MGH Charlestown HealthCare Center who prescribes GLP-1s several times a week. In addition to treating diabetes and obesity, GLP-1s are being studied by scientists as potential treatments for disorders ranging from Scientists have known for years that the drugs lessen the rewarding effects of addictive drugs, including alcohol, nicotine, and opioids, in laboratory rodents. Advertisement 'There are, like, 60 different disease states that GLP-1s are being studied for in various clinical trials,' said Rossman, of Real Chemistry. 'It's an amazing class of drugs.' Jonathan Saltzman can be reached at
Business of Fashion
01-05-2025
- Business
- Business of Fashion
CVS Drops Lilly's Zepbound as Preferred Drug in Novo Win
CVS Health Corp.'s drug-benefits unit negotiated a deal to make Novo Nordisk A/S's Wegovy more widely available to its members, a blow to rival Eli Lilly & Co.'s Zepbound that was moved off the company's list of preferred drugs. Starting July 1, Zepbound will no longer be preferred on CVS Caremark's standard formulary, while Wegovy and other anti-obesity medicines will be, according to the company. The change means that Lilly's drug may cost more to insurers or employers that opt to pay for weight-loss drugs and who use CVS Caremark to manage their prescription drug plans. Under the new deal, 'Zepbound will be excluded' in health plans using CVS's standard drug list, CVS spokesperson David Whitrap said in an email. People in those plans on Zepbound will be able switch to Wegovy, with exceptions made for medical need on a case-by-case basis, he said. CVS shares rose as much as 10 percent before markets opened in New York on Thursday. Novo shares were up as much as 6.5 percent in Copenhagen while Lilly fell as much as 6.7 percent in premarket trading. Novo and Lilly have been locked in a fierce competition to dominate the obesity market, which is expected to reach $130 billion by the end of the decade. CVS Caremark's decision to place Wegovy over Zepbound could give Novo an edge as the companies fight to convince insurance companies to pay for their treatments, which cost more than $1,000 a month before rebates. The behind-the-scenes negotiating the resulted in the change shows that competition is heating up, especially as more supply hits the market and drug plans can pit one roughly equal treatment against another. Novo is also allowing CVS to sell the drug for $499 to cash-paying customers, less than half its list price, to patients at its more than 9,000 pharmacies nationwide. There's likely to be more haggling for similar favourable treatment in the future. 'Now that both of these GLP-1s are available in adequate supply, Caremark was able to do what PBMs do best: compete clinically similar products against one another, and choose the option that delivers the lowest net cost for our clients who choose our standard formulary,' CVS chief executive officer David Joyner said in a statement to Bloomberg News. Health plans have complained that the popularity of drugs like Wegovy and Zepbound has led to higher costs from covering them. The agreement between CVS and Novo provides bigger discounts on Wegovy, ultimately saving the plans money, the company said. A CVS spokesperson declined to say how much the company was saving on Wegovy. 'The cost of this therapeutic category is one of the biggest pain points for Caremark clients, and I'm proud we could be first to market with a solution that drives greater affordability.' It is Novo's responsibility to work with players in the US health care system to connect patients with authentic Wegovy in 'a convenient and affordable way,' said Dave Moore, Novo's executive vice president of US operations, in a statement. CVS Caremark is one of the largest pharmacy benefit managers, an industry that negotiates drug prices between insurers, pharmacies, and manufacturers. They have faced mounting criticism in Washington from lawmakers and the pharmaceutical industry for allegedly driving up prescription drug prices, a charge the industry denies. President Donald Trump, who's said he's going to 'knock out' such intermediaries, has spoken to Lilly chief executive officer Dave Ricks about the issue. 'Every time I talk to him about drug prices, he sweet talks me,' Trump said, referring to Ricks, during a White House event they both attended on Wednesday. 'He tells me about the middlemen. By the time I leave the meetings, I say, gee, he's giving us a great bargain.' Trump, however, has also complained about the high prices of weight-loss drugs. CVS is the first retail pharmacy chain to sell Wegovy at a $499 cash price under a program the drugmaker announced earlier this week. Novo is also teaming up with telehealth companies including Hims & Hers Health Inc. Hims & Hers Health Inc. to sell Wegovy at the discounted rate. Additionally, Lilly has made efforts to lower the price of Zepbound for patients whose health plans don't cover weight-loss drugs. The company is working with telehealth partners to provide broader access to the lower-cost option. By Ike Swetlitz, Madison Muller, and Robert Langreth Learn more: Novo Nordisk to Sell Wegovy Through Telehealth Firms The drug manufacturer will partner with companies like Hims & Hers and Ro amid a larger crackdown on compounded forms of its GLP-1 drugs.
