The Week in Review in Prescription Drug Pricing: P4AD Joint ETHIC Letter, MFN Deals Put to the Test, New AARP Report, and more
Welcome to the Week in Review.
The ETHIC Act & P4AD Joint Letter with AARP & ERISA Industry Committee
This week, Patients For Affordable Drugs Now, AARP, and the ERISA Industry Committee (ERIC) sent a joint letter to congressional leadership urging Congress to pass the ETHIC Act. The bipartisan bill would curb patent thickets by allowing generic drugmakers to challenge one patent per patent family – lowering barriers to entry for lower-cost competition while preserving protections for true innovation. The letter comes as the House Judiciary Subcommittee on Courts, Intellectual Property, Artificial Intelligence and the Internet will hold a hearing on June 4th on how intellectual property policy impacts prescription drug competition and patient access. A new article from the Epoch Times, featuring three P4AD patient advocates, highlights how brand-name drugmakers build these dense patent thickets, forcing generic competitors to challenge dozens of patents to enter the market. — [P4AD, POLITICO, Congress, House, Epoch Times]
MFN Deals Put to the Test
The administration’s most-favored-nation deals are about to face their first real test, as several new drugs from AstraZeneca, Novo Nordisk, and Pfizer, prepare to launch in the U.S. While the agreements touted requirements for new drugs to be launched in the U.S. at prices aligned with other peer nations, none of the companies would confirm to STAT News whether these drugs would be subject to the MFN deal terms. The lack of clarity and secrecy around these agreements makes it difficult to assess scope, enforceability, and real-world impact. There may be significant gaps in how broadly the agreements apply, raising questions about whether patients will truly see the lower-cost drugs they’ve been promised. — [STAT News]
New AARP Report: U.S. Drug Prices Continue to Rise, Despite Falling Abroad
Prices for the 25 top-selling brand-name prescription drugs have increased by an average of 81% in the U.S., while falling by 13% in other high-income countries. That’s according to a new report from AARP this week. The gap is stark: Eli Lilly’s Trulicity rose 106% in the U.S. while falling 16% abroad, Merck’s Januvia rose 126% in the U.S. while dropping 40% elsewhere, and Amgen’s Enbrel surged 873% despite declining 27% internationally. The findings highlight a key driver of America’s high drug costs: unlike peer nations, drugmakers face few constraints on raising prices over time — leaving patients exposed to unchecked price increases. — [AARP]
ICYMI: With more than 130 patents and a yearly cost of $77,000, AbbVie’s Humira remains a leading example of how patent thickets delay competition. In a new STAT News op-ed, I-MAK founder and CEO Tahir Amin details how overlapping patents and aggressive tactics have extended exclusivity and kept prices high — reinforcing the need for reforms like the ETHIC Act. You can read the full piece here.
The Supreme Court denied petitions from six major drugmakers — AstraZeneca, Bristol Myers Squibb, Janssen, Novartis, Novo Nordisk, and Boehringer Ingelheim— leaving in place lower court rulings that rejected their challenges to the Medicare Drug Price Negotiation Program. After 16 losses for the industry in court, these pharmaceutical companies asked the Supreme Court to step in, and it declined. It’s the end of the line for these six drugmakers, and Medicare can continue delivering lower drug prices for patients without interruption, exactly what patients fought for. P4AD has been in this fight from the beginning, advocating for the program’s protection through amicus briefs, and this ruling vindicates that work. Four cases remain in the lower courts, from AbbVie, Merck, Teva, and PhRMA, but they rest on many of the same arguments courts have now repeatedly rejected. Pharma is running out of legal options. We’ll keep watching and keep pushing for the full implementation and expansion of Medicare negotiation. — [POLITICO, Epoch Times, AP, Endpoints News, STAT News, The Hill, CNN, Axios]
P4AD and Social Security Works’ joint mobile billboard traveled around D.C. on Monday, celebrating the news: Patients won, and Big Pharma lost.
TrumpRx Expansion: What It Is and Isn’t
President Trump announced this week that over 600 generic drugs are being added to TrumpRx, the administration’s direct-to-consumer discount website. The rollout is being billed by the administration as a major new affordability initiative, but in practice the platform aggregates and links to existing cash-discount programs available to patients through GoodRx, Amazon Pharmacy, and Mark Cuban’s Cost Plus Drugs. From what we’ve seen thus far, many of the coupon prices — including many from the original set of discounts — can only be fulfilled at large chain pharmacies like CVS and Walgreens that have the infrastructure to honor them. Patients who rely on independent pharmacies (including the nearly 20% of Americans reliant on rural pharmacies) or have insurance plan restrictions may not be able to access these prices at all. While TrumpRx may help some patients navigate existing options, it does nothing to address list prices, manufacturer pricing power, or the structural conditions that allow drug companies to price-gouge Americans for their essential medicines. — [New York Times, Rural Health Medicine, Washington Post, Reuters, USA Today]
Takeda Pharmaceutical Sued for Pay-For-Delay
A U.S. judge found Takeda Pharmaceutical liable for $885 million in damages this week after the company paid competitor Par Pharmaceutical to delay launching a generic version of the constipation drug Amitiza. The deal, struck in 2014, kept the generic off the market for seven years — leaving patients with no lower-cost alternative until 2021. Pay-for-delay deals let drug companies pay off competitors to stay out of the market, abusing the patent system to protect profits at patients’ expense. Takeda’s case is a win, but one verdict doesn’t fix a systemic problem. Congress needs to pass the bipartisan Preserve Access to Affordable Generics and Biosimilars Act to rein in these types of deals. The stakes are real: when one generic alternative enters the market prices can drop by 39%, and multiple can lead to a 95% reduction in price. — [Reuters, Fierce Pharma, Congress, FDA]
ICYMI: Virginia Governor Spanberger vetoed the state’s Prescription Drug Affordability Board (PDAB) this week — in a win for industry. Colorado became the first state to cap a prescription drug price through its PDAB last October, using it to lower the cost of the blockbuster drug Enbrel. — [VA Governor, Denver 7, Virginia Mercury, Virginia Scope]
Over the last two weeks, P4AD patient advocates from across the country traveled to Washington, D.C., to share what high drug prices mean in real terms — skipped doses, delayed care, and impossible financial tradeoffs. They met directly with lawmakers on both sides of the aisle to urge action on reforms like the ETHIC Act, a bipartisan bill that would curb pharma patent abuses and help bring lower-cost generic and biosimilar alternatives to market faster. During meetings with lawmakers, patient advocates also described how the Medicare Negotiation Program is already improving their lives and how bills like EPIC would undermine hard-won progress. With nine in ten Americans calling on Congress to do more, theirstories make clear what’s at stake — and why action can’t wait.
Regeneron is the latest drugmaker to reach a most-favored-nation (MFN) pricing agreement with the Trump administration, part of a broader set of voluntary deals aimed at bringing U.S. drug prices in line with those in other high-income countries. The company was the last of the 17 corporations that received letters in July 2025. The White House announced the agreement alongside the expedited approval of Regeneron’s new gene therapy, Otarmeni, to treat a rare genetic form of hearing loss. The treatment was expedited through the FDA’s National Priority Voucher program. According to Regeneron, it will be available in the United States at no direct cost to patients. While we are thrilled for the families able to access this treatment for free, voluntary, company-by-company agreements do not change the fundamental dynamic that gives Big Pharma the power to set and raise prices at will. — [White House, White House]
Pharma Tops Q1 Healthcare Lobbying
New disclosures show the pharmaceutical industry continuing to outpace the rest of the health sector in lobbying spending. PhRMA reported $12.2 million in Q1 — more than $4 million higher than any other health care organization — already putting it on track to approach its record $38 million spend in 2025. Several major drugmakers, including Pfizer, Merck, Novartis, Genentech (Roche), and Eli Lilly also ranked among the top 10 highest spenders on health care lobbying. Collectively, these five companies reported a staggering $323.5 billion in 2025 revenue. The spending comes as Congress continues to weigh drug pricing policies, highlighting the scale of industry influence aimed at shaping, and in many cases slowing, efforts to lower prices. — [OpenSecrets, Washington Post, Fierce Pharma]
Bipartisan Hill Pharma Probe
Sens. Maggie Hassan (D-NH) and Chuck Grassley (R-IA) this week called on the Government Accountability Office to investigate how pharmaceutical companies use coupons, including whether they steer patients toward higher-cost brand-name drugs instead of lower-cost generics. Drugmakers deploy these coupons to maintain market share and blunt competition from generics, offering short-term discounts that can obscure true costs and keep patients on more expensive medications. When those coupons expire, patients can face sudden spikes in out-of-pocket costs. The probe reflects growing bipartisan scrutiny of industry practices that drive up costs and limit competition. — [Sen. Hassan, POLITICO]
BALANCE Model Delayed As Insurers Decline To Participate
The Trump administration has indefinitely delayed the Part D component of the BALANCE model, a pilot designed to test Medicare coverage of GLP-1 drugs like Ozempic for weight loss, after failing to secure sufficient participation from insurers. CMS will still launch a smaller, temporary program to run from July 2026 through 2027 to provide the treatment to some Medicare patients at $50 per month. This initiative will exist outside of the Part D coverage benefits, with the government absorbing the cost of expanded coverage. While Medicare patients may still access these medications in the near term, the path forward remains uncertain and costly. When drug prices are set at such high levels, they create pressure throughout the system — shaping coverage decisions and ultimately determining who can access treatment. — [Axios, Washington Post]
ICYMI: Senate Democrats are introducing legislation to require HHS to disclose the terms of its most-favored-nation drug-pricing deals, which remain largely confidential. Public Citizen is also seeking information through FOIA requests. — [Axios, Public Citizen]
Patient Advocate Spotlight: Don Kreis and his daughter Rose
Condition: Cystic Fibrosis
Drugs: Trikafta (Over $300,000 / year)
In His Words: “My daughter Rose is living and thriving with cystic fibrosis. Last year, the more routine set of drugs Rose currently takes to treat her CF costs upwards of $160,000. Fortunately, my employer has a good health insurance plan, so our family paid very little of that out-of-pocket.
Vertex has a real-life monopoly on expensive CF drugs, and the next iteration could keep my daughter out of the hospital. These drugs could save her life. When she no longer has dad’s insurance plan, in the not so distant future, will she be able to weather hundreds of thousands of dollars in medication costs? We must do more as a society to make sure that my daughter and others like her can always afford the prescription drugs they need.”
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.”
WASHINGTON, D.C. — Yesterday, the Federal Trade Commission (FTC) announced a settlement with Cigna’s Express Scripts, resolving claims that the pharmacy benefit manager engaged in practices that artificially inflated insulin prices and harmed patients.
In response to the settlement, Merith Basey, CEO of Patients For Affordable Drugs, released the following statement:
“Patients have been price-gouged for decades by shady PBMs whose business models have been intentionally structured to push patients toward higher-priced drugs. This settlement includes welcome reforms that aim to prevent Express Scripts from favoring higher-priced drugs, delink PBM compensation from list prices, allow patient cost-sharing to be based on a drug’s net price, and ensure fairer reimbursement to community pharmacies — long-overdue steps that move the system in the right direction. Ultimately, patients will judge progress by what they pay at the pharmacy counter.While PBM reform remains a top priority, Big Pharma should not be let off the hook. We will continue pressing for systemic reforms that hold drug manufacturers and PBMs accountable and deliver lower drug prices for patients.”
The public now has 30 days to submit comments on the proposed settlement, followed by a final FTC approval vote. The FTC’s cases against the other two dominant pharmacy benefit managers — CVS Caremark and OptumRx — remain ongoing. In September 2024, the FTC sued the nation’s three largest PBMs following a bipartisan report exposing secret agreements with drug manufacturers that incentivized higher list prices and restricted access to cheaper generics and biosimilars. Together, CVS Caremark, Express Scripts, and OptumRx control roughly 80% of prescriptions filled in the U.S. A subsequent FTC report found PBMs generated $7.4 billion by inflating the prices of 51 lifesaving drugs between 2017 and 2022, driving up patient costs across conditions including cancer, HIV, and heart disease.
This settlement follows bipartisan action by Congress earlier this week, when lawmakers passed a government funding package that included new restrictions on PBM business practices, including changes to how PBMs are compensated in Medicare. Together, legislative and enforcement efforts signal growing momentum to rein in middleman practices that have contributed to unaffordable drug costs, while underscoring the need for continued oversight to ensure reforms deliver real savings for patients.
PBMs, however, are not the only bad actors in this system. Insulin manufacturers, led by the Big Three: Eli Lilly, Novo Nordisk, and Sanofi, have repeatedly raised list prices in lock-step, knowing those increases would be rewarded through rebate-driven arrangements. Any serious effort to lower drug costs must address both the practices of PBMs that profited from inflated prices and the manufacturers that set those prices.
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Patients For Affordable Drugs Now is the only national, patient advocacy organization focused exclusively on policies to lower drug prices. We empower and mobilize patients and allies, hold accountable those in power, and fight to shape and achieve system-changing policies that make prescription drugs affordable for all people in the United States. P4ADNow is bipartisan and does not accept funding from organizations that profit from the development or distribution of prescription drugs. To learn more, visit: PatientsForAffordableDrugsNOW.org
Welcome to the Week in Review.
Uncertainty Around MFPs with Recent Trump GLP-1 Deal
With President Trump’s GLP-1 pricing deals dominating headlines, the ongoing Medicare negotiation program appears to have taken a backseat — despite the fact that the second round of maximum fair prices (MFPs) is required to be announced by the end of November. The new prices, which cover 15 drugs including Ozempic and Wegovy, are expected to take effect in 2027 and should deliver significant savings for millions of patients on Medicare. Despite broad support from Americans on both sides of the aisle, the president has said little about the program in recent months. Instead, the administration has leaned on voluntary agreements with drugmakers. And while those deals are highly visible and offer potentially quick wins, the Medicare Negotiation Program remains the nation’s most consequential and durable tool for lowering prescription drug prices. Patients are eagerly awaiting the new, lower negotiated prices. — [White House, AV, NBC News, P4AD]
Congress Is Back — Here’s What We’re Watching
There are only a few weeks of session left this year, and we’re closely monitoring any movement on drug pricing legislation and keeping the pressure up for lawmakers to stand behind patients. In addition, the newly-enacted Continuing Resolution (CR) runs through January 30, which creates an opportunity for a health extenders package come January. Here’s what our community is pushing for
✅ The Affordable Prescriptions for Patients Act: Passed the Senate unanimously last year, and would limit the number of patents a drug company can assert on a biologic drug. It’s a key reform to stop Big Pharma from blocking biosimilar competition through patent thickets and keeping prices high.
✅ The ETHIC Act: Bipartisan measure that would streamline the patent process and limit drug companies to one patent at a time, making the harmful practice of patent thicketing significantly harder.
✅ The Biosimilar Red Tape Elimination Act and Q1/Q2, a provision of the Lower Costs, More Transparency Act: Policies that would streamline approvals processes by deeming biosimilars interchangeable with FDA approval and simplifying rejections — making it easier for generic alternatives and biosimilars to come to market and saving taxpayers millions.
And here’s what patients are focused on stopping:
🛑 The EPIC Act and The MINI Act: Industry-backed proposals that would delay Medicare negotiation for small-molecule drugs and genetically targeted technologies (GTTs) for an additional four years. Both would drive up costs for patients and taxpayers — echoing the same pharma giveaways seen in the recently passed $8.8 billion ORPHAN Cures Act.
Patient Advocate Spotlight: Emmabella Rudd Background: Florida State University student, documentary producer, and insulin accessibility advocate since her diagnosis at 5 years old. Condition: Type 1 Diabetes Drug: Insulin ($3,000 per year)
In her words: “It’s frustrating to see pharmaceutical companies bask in the protection of numerous patents around their insulin products. They’re interested in appearing concerned about drug affordability, but their efforts are always superficial and short-lived. Drug companies need to remember that their actions affect real human lives, and at the end of the day, the people will have the power.”
Amgen Follows Pfizer — What That Means For Patients
Nearly two weeks after President Trump’s TrumpRxannouncement, Amgen unveiled its own direct-to-consumer (DTC) program, announcing a discounted price for its cholesterol drug, Repatha, at $239 per month, which the company says is “nearly 60% lower than the current U.S. list price.” This is the latest move as drug manufacturers race to align with the administration’s pressure campaign. But while framed as progress, these piecemeal discounts underscore the limits of voluntary action: $239 a month remains impossible for many patients, and Repatha is only one of the dozens of drugs Amgen sells at high prices. Real affordability will require systemic reforms – not temporary, corporate-driven programs that leave patients dependent on goodwill. — [White House, Amgen, STAT News, POLITICO, Endpoints News, Reuters]
Big Pharma’s Legal Campaign Continues
Pharma’s courtroom losing streak continued this week, marking the industry’s 15th defeat. On Monday, the U.S. Court of Appeals For The Third Circuit unanimously rejected Novo Nordisk’s challenge to the Medicare Negotiation Program, dismissing claims that the law violates the First and Fifth amendments. The next day, the Fifth Circuit heard oral arguments in PhRMA’s lawsuit, where the government’s lawyer faced sharp questioning from one judge who appeared sympathetic to PhRMA’s position. The panel’s other two judges were more measured, one even noting the absence of any amicus briefs supporting PhRMA, compared to several backing the government. The court may wait for related filings in the upcoming Supreme Court case before ruling, but the trend remains clear: Pharma continues to challenge Medicare’s authority to negotiate, and patients’ advocates continue to defend it. — [P4AD, U.S. Court of Appeals, U.S. Court of Appeals]
Colorado Becomes First State to Cap the Price of a Prescription Drug
Colorado patients and advocates scored a major victory this week as the state’s Prescription Drug Affordability Review Board (PDAB) set the nation’s first price cap on a prescription drug, limiting the cost of Enbrel to $600 per weekly dose. This milestone was years in the making — and it happened because patients spoke up. P4AD patient advocates in Colorado supported the effort, sending letters and sharing their stories to illustrate the need for reform. Enbrel, approved more than 25 years ago, has seen its price rise by more than 1,500% and is protected by at least 57 separate patents that block generic competition. As expected, manufacturer Amgen and the broader industry are threatening lawsuits and reviving familiar claims about “innovation.” But with $3.2 billion in annual sales, Amgen has long recouped its investment — this fight is about protecting profits, not progress. — [Denver 7, Washington Post, Colorado Sun]
P4AD Defends Patients’ Voices at GW Law’s IRA Conference
Executive Director Merith Basey joined GW Law’s Inflation Reduction Act conference for a panel focused on the law’s most pressing questions, threats, and challenges around drug pricing. In a room dominated by industry representatives and economists, Merith made sure patients’ voices were heard – pushing back when affordability was dismissed and reminding the audience that these policies aren’t theoretical, but affect real people. While much of the discussion rehashed the same tired industry arguments about innovation and investment, Merith cut through the noise – emphasizing that it’s about balance and patients need both. As she noted, our founder, David Mitchell’s story (who lives with a rare blood cancer) shows that innovation is essential, but it means nothing if patients can’t afford it. — [GWU]
In Case You Missed It
Senators Grassley (R-IA) and Hassan (D-NH) reintroduced the bipartisan Open Payments Expansion Act, which would reveal the financial ties between drug companies and the tax-exempt patient advocacy groups they fund. As P4AD’s Hidden Hand reports have shown, these front groups often claim to represent patients while defending drug industry interests. The bill would bring long-overdue transparency to those relationships — ensuring lawmakers and the public can see who’s really behind campaigns that seek to undermine drug pricing reform. — [Sen. Grassley, P4AD]
Patient Advocate Spotlight: Janet Kerrigan Background: Retired critical care nurse living in Myrtle Beach, SC
Condition: Multiple Myeloma, an incurable blood cancer
Drug: Revlimid ($800 per daily capsule, or $24,000 in monthly copays)
In her words: “I relied on grants to help cover these astronomical expenses, and the uncertainty of their availability meant living in a constant state of worry, wondering if the drugs that were keeping me alive would be covered… No one should have to face bankruptcy or fear losing access to life-saving medications.”
This week, Janet spoke with the New York Post about her struggles with high drug prices and President Trump’s recent DTC announcements. You can read the full article here.
Another Patient Victory: Federal Court Rejects BMS and Janssen’s Case Against Medicare Negotiation
Yesterday morning, the U.S. Court of Appeals For The Third Circuit rejected Bristol Myers Squibb (BMS) and Janssen’s challenge to the Medicare Drug Price Negotiation Program. This latest decision marks the 13th ruling in favor of the program, following pharma’s three legal defeats over just 48 hours in August. Once again, a federal court has found that the program is constitutional, that drugmakers are not being coerced, and that participation in Medicare is voluntary. P4AD submitted an amicus brief on behalf of patients in this case as part of our ongoing work to stand against pharma’s multi-pronged legal campaign and to ensure patients are represented inside and outside the courtroom. — [P4AD, IP Watchdog, P4AD, P4AD, POLITICO, Bloomberg Law, Endpoints News]
Pharma Continues to Shatter Lobbying Records
In 2024, the pharmaceutical industry spent a record $388 million on lobbying. This year, they’re on track to shatter that record again — already pouring $227 million into federal lobbying in just the first half of 2025, and the spending isn’t slowing down. Just two weeks ago, four major drug manufacturers joined together to launch a brand new lobbying group aimed squarely at undermining Medicare negotiation. As the year goes on, we anticipate even more spending from the industry on their never-ending influence campaign as they work to claw back patient progress. — [Sludge, Open Secrets, STAT News]
For PBMs, Government Scrutiny Continues
PBMs remain under scrutiny this week with the House Oversight Committee expanding its inquiry and Chair James Comer sending letters to Cigna and UnitedHealth’s OptumRX about efforts “to evade transparency and oversight” in the U.S. At the same time the FTC is advancing a complaint against Cigna, OptumRX, and CVS’ Caremark, alleging anticompetitive practices related to inflated list prices for insulin drugs. PBMs profit from opaque “rebate” deals while offering little in the way of benefits to patients. Congress came close to enacting bipartisan PBM reform at the end of 2024, and there is still solid interest in getting those reforms signed into law. P4AD welcomed the FTC’s initial findings on PBMs’ harmful practices last July, and we’ll be watching closely to ensure that real transparency is brought to the PBM black box and that reforms will help lower drug prices for patients. — [House Oversight, Endpoints News, Roll Call, P4AD, FTC, Axios, Becker’s Hospital Review, Healthcare Finance]
ICYMI
Health Affairs published two new articles dissecting the harmfulORPHAN Cures Act and the impact of rare disease exemptions on the Medicare Negotiation Program: “Exemptions and delays to the negotiation of orphan drugs are poised to erode [Medicare negotiation] savings by more than previous analyses suggested,” and “the impact of exemptions and delays will grow.” — [Health Affairs, Health Affairs]
Patient Advocate Spotlight: Aarolyn McCullough
Condition: Diabetes
Drugs: Everolimus, Zortress, and Ozempic ($100, but would be $2,000 per month without coverage)
Background: Michigan resident and liver transplant survivor
In her words:
“I can thankfully afford [my prescriptions] due to manufacturer assistance and health coverage benefits I receive through my former employer: the United States Postal Service. But without such assistance, a situation which I have faced before in the past, I would be paying about $2,000 per month for all of my medications.”
“In these circumstances, I’ve either had to change prescriptions or cope with the fact that I may die, and that is a fact that runs constantly in my thoughts.”
“As a retired individual, this should not be my reality. As an American citizen, I believe we deserve lower cost prescription drugs because we are simply overpaying compared to the rate other countries pay for the same or equivalent medications.”
