Welcome to the Week in Review.

High Cost of GLP-1 Drugs Forces Some States to Scale Back Coverage

The high cost of GLP-1 drugs are increasing pressure on state Medicaid programs — and in response, some cities and states are beginning to restrict or eliminate coverage. In the U.S., drugs like Ozempic cost more than eight times what they do in peer countries such as the U.K., France, and Australia. Despite those elevated prices, manufacturer Novo Nordisk hiked the price of both Ozempic and Rybelsus above the inflation rate at the start of the year. The downstream impact is clear: when manufacturers set and raise prices at these levels, payers limit coverage, and for patients who rely on these medications to manage diabetes and related conditions, that can mean losing access to essential treatment. — [The Guardian, Healthline]

Expanding Access to Cash-Pay Drugs, Not Lower Prices 

New legislation introduced this week by Rep. Greg Murphy (a champion of the pharma-backed EPIC Act) would require insurers to count drug purchases made through direct-to-consumer platforms like TrumpRx towards a patient’s deductible and out-of-pocket maximum — a change that could make these programs more usable for insured patients. The proposal reflects a recognition that cash-pay models, while sometimes cheaper, have limited reach and appeal when they exist outside the insurance system. The change could benefit patients in cases where cash prices undercut insurance costs, particularly for those enrolled in high-deductible plans. But it has tradeoffs: requiring plans to integrate these purchases could lead to higher premiums, and the TrumpRx model still depends on a narrow set of drugs and voluntary, time-limited pricing arrangements that have yet to deliver savings across the board. While some policymakers are looking for ways to expand access to lower-cost options within the current system, these approaches do not replace the need for reforms that address high list prices and drugmakers’ pricing power directly. — [Axios, Inside Health Policy]

LTE: High Medication Costs Harm Latinos

In a new letter to the editor published in the Washington Times, P4AD advocate Sonia Vega pushed back on industry claims that lowering drug prices would harm innovation, highlighting instead how high costs are already affecting patients. The letter was in response to a March op-ed claiming that reforms to bring U.S. prices in line with those of other high-income countries would lessen R&D investment from the pharmaceutical industry, ultimately harming Hispanic patients. In response, Sonia points out that presenting efforts to lower drug prices as a threat to innovation and new-drug development ignores the real patient experience. The Hispanic community is disproportionately burdened by chronic disease, meaning they’re also disproportionately burdened by the high cost of prescription drugs — nearly 70% of Hispanic adults report being worried about affording their medications. As she writes, “for Hispanic patients like me, the real risk isn’t reform; it’s a system where lifesaving medications remain out of reach because of the cost.” — [Washington Times]

ICYMI: Senate Democrats released a report this week finding that drugmakers with Most Favored Nation deals have continued to raise prices on drugs, raising questions about the impact of the arrangements. The report points to drugs like Keytruda, Kesimpta, and Opdivo that continue to see price hikes despite their manufacturers signing MFN agreements. The long-term viability of these deals is also in question, as at least 16 are set to expire after three years — and the exact terms of the agreements are not public. — [Senate HELP, NBC News, STAT News]

Patient Advocate Spotlight: Gail DeVore

Condition: Type 1 Diabetes

Drugs: Insulin

In Her Words: “For the last 45 years, I have seen the invention of home glucose meters, insulin pumps, better insulin, continuous glucose monitors (CGM), and many other new and advancing treatment options for type 1 diabetics. These are not “special devices” or extraordinary treatment options. The ability to constantly monitor our blood sugar levels is critical to saving our lives.

However, it all comes with a very high price. A single bottle of insulin costs about $350. Many diabetics need multiple bottles per month to simply stay alive. Supplies can also cost about $1,000 per month on top of that, despite insurance coverage and prescription benefits. These costs are exorbitant. Considering the risks diabetics like myself face, the costs are absolutely unacceptable.”

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