Latest News | Feb 23, 2024

The Week in Review in Prescription Drug Pricing

Welcome to the Week in Review.

1. “The Inflation Reduction Act is a great, wonderful thing”

2. High Cost Of Cell And Gene Therapies

BONUS: On March 7th from 10 a.m. – 2:30 p.m., combined oral arguments will be heard in New Jersey for all four lawsuits aimed at stopping Medicare negotiations —filed by Bristol Myers Squibb (BMS), Novo Nordisk, Novartis, and Johnson & Johnson (J&J). These four companies each have a drug up for negotiation: Eliquis (BMS), Entresto (Novartis), Novolog (Novo Nordisk), and Imbruvica (J&J). While Big Pharma fights tooth and nail to undermine the widely supported provision in the Inflation Reduction Act, we’re advocating alongside patients for the successful implementation of the law that will deliver long-sought relief from high prices.

Welcome to the Week in Review.

1. Medicare Negotiation Will Deliver Relief To Millions

2. Drug Price Reforms Drive Big Cost Savings

BONUS: Patients For Affordable Drugs Now (P4ADNow) began running a series of TV ads this week to inform constituents in Congressman Don Davis’ district (D-NC1) that he has reneged on his campaign promise to “stand up to drug companies.” Instead, Davis has become the only Democrat in the House of Representatives to sponsor a bill that would undermine Medicare’s ability to negotiate lower drug prices, a wildly popular provision in the Inflation Reduction Act that is supported by more than 80 percent of voters. (PoliticoAxiosYouTubeYouTubeNC NewslineP4ADNowYouTubeSTAT NewsP4ADNow)

The Ads Tell Constituents That After Vowing “To Stand Up To Drug Companies,” Don Davis Is “the Lone Democrat Willing To Weaken Medicare’s Power To Negotiate Drug Prices”

Washington, D.C. – Patients For Affordable Drugs Now (P4ADNow) today began running a series of TV ads to inform constituents in Congressman Don Davis’ district (D-NC1) that he has reneged on his campaign promise regarding prescription drug pricing. Congressman Davis pledged he would “stand up to drug companies.” Instead, Davis has become the only Democrat in the House of Representatives to sponsor legislation that would undermine Medicare’s ability to negotiate lower drug prices, a wildly popular provision in the Inflation Reduction Act that is supported by more than 80 percent of voters and would lower drug prices for millions of people on Medicare. 

His betrayal of his promise to patients comes after he accepted tens of thousands of dollars from drug companies including Gilead, Astellas, Genentech, Bayer, Pfizer, Novo Nordisk, GSK, Bristol Myers Squibb, Amgen, Boehringer Ingelheim, Merck, AbbVie, and Eli Lilly. 

“Voters overwhelmingly support Medicare negotiation to lower prescription drug prices,” said David Mitchell, a cancer patient and founder of Patients For Affordable Drugs Now.  “The voters in Congressman Davis’s district need to know that he reneged on his campaign promise to stand up to drug companies and is sponsoring legislation that, if enacted, would weaken Medicare’s ability to negotiate and lead to higher prices for roughly 90 percent of the drugs Americans need. 

P4ADNow has heard from dozens of patients within Congressman Davis’s district who are struggling under the weight of high drug prices. One constituent revealed the heartbreaking reality of having to forego essential medications despite being insured, simply due to financial strain. Another shared the daily struggle of managing a chronic disease while grappling with the prohibitive cost of medications, often relying on the goodwill of friends for assistance. Additionally, a third constituent’s plea for affordable access to life-saving heart medications for her husband underscores the urgent need for Congressman Davis to honor his campaign promises and prioritize the well-being of his constituents over corporate interests. 

These personal stories serve as an important reminder of the human toll of high drug prices and the critical importance of Medicare negotiation to alleviate the burden for millions of Americans.

The ads–which can be viewed here and here–will be broadcast across local television and digital platforms starting February 13th. 


Welcome to the Week in Review.

1. Panel Discussion On Bipartisan Push For Competition 

2. Senate HELP Committee Examines High Drug Prices

BONUS: This past Sunday’s New York Times featured a story from Mark Miller about the profound impact of the Inflation Reduction Act on prescription drug costs for millions of seniors. The piece focused on P4AD founder and cancer patient, David Mitchell, whose story illustrates how individuals like him are for the first time paying less out-of-pocket as a result of the new drug price law.

Welcome to the Week in Review.

1. “Fewer people will have to make these tough choices”

2. Legal Battle For Drug Pricing

3. Bipartisan Solutions To Increase Competition 

BONUS: The announcement by the Centers for Medicare and Medicaid Services regarding the focus on sickle cell disease (SCD) as the inaugural target of the Cell and Gene Therapy Access Model marks a significant step towards addressing the unmet needs of patients on Medicaid living with rare diseases and increasing the reach of potentially curative treatments in the future. The agency announced plans to negotiate with drugmakers over the prices of these gene therapies to ensure they’re accessible for the thousands of patients on Medicaid living with SCD. By facilitating access to potentially life-changing treatments and supporting outcomes-based agreements with manufacturers, this model has the potential to not only improve health outcomes for patients on Medicaid living with SCD but also alleviate financial burdens on communities facing systemic barriers to access essential medications.

CMS Takes On Big Pharma And Makes First Offers To Manufacturers Of The First Ten Drugs Selected For Drug Price Negotiation To Lower Prices For Prescription Drugs

Patients For Affordable Drugs Now, applauds the Centers for Medicare & Medicaid Services (CMS) as it takes the huge next step towards negotiating fair prices for essential medications. Today, CMS sent out its initial fair pricing offers to pharmaceutical manufacturers for the first 10 drugs selected for Medicare negotiations.
The 10 drugs chosen were identified as the top spending drugs covered under Medicare Part D without generic or biosimilar equivalents that have been on the market for at least seven years and also meet other selection criteria. These essential medications include cancer treatments, blood thinners, autoimmune disease treatments, and some diabetes drugs. Between June 2022 and May 2023, 8.3 million Medicare Part D enrollees used one or more of these medications. With 84 percent of voters backing Medicare negotiations, it’s clear CMS is doing work that is urgently demanded by the American public. 
Merith Basey, Executive Director of Patients For Affordable Drugs Now, released the following statement:
“Patients For Affordable Drugs Now stands firmly in support of Medicare negotiation and efforts to curb the unjustified costs of prescription medications. We hear from patients everyday who are grappling with the crushing weight of exorbitant drug prices, forced to make impossible decisions between their health and financial well-being. We’ve listened to stories of people rationing insulin or other life-sustaining medications just to make ends meet. By advancing this process of direct negotiation with drug companies, CMS is helping ensure that fewer people will have to make these tough choices. Drugs don’t work if people can’t afford them, and today marks a historic milestone in the fight to lower drug prices for everyone.”

Background in Medicare negotiations:


Welcome to the Week in Review.

1. Fighting Against Lawsuits To Stop Negotiations

On Wednesday, January 31st, oral arguments will be heard in AstraZeneca’s legal challenge against Medicare’s ability to negotiate the price of the company’s diabetes and heart failure drug, Farxiga. Amidst this legal battle, Patients For Affordable Drugs Now (P4ADNow) has thus far signed onto seven amicus briefs led by Public Citizen and supported by AARP, Protect Our Care, Doctors for America, and Families USA to support the government’s opposition and explain the harm high drug prices have on people on Medicare. Meanwhile, by February 1st, the Centers for Medicare & Medicaid Services (CMS) are set to dispatch initial offers to the manufacturers of the first 10 drugs selected for negotiation. Drugmakers will then have 30 days to agree on the maximum fair price or provide a counteroffer. This next step marks a historic stride towards lower negotiated prices for millions of people on Medicare in 2026 and increased access to medications at prices they can afford.  — (O’Neill InstitutePublic CitizenALM BenefitsPro)

2. Big Pharma Greed: Wheeling and Dealing

New figures show that drug corporations are pulling in record profits and have been cashing out on billion-dollar biotech deals. Johnson & Johnson, manufacturer of three of the drugs selected for Medicare negotiation, announced $4.8 billion in Q4 earnings which is nearly double their earnings from the previous year, according to Accountable.US. Sanofi, one of the big three insulin makers that monopolize the industry, announced a multi-billion dollar acquisition of a biotech company, making it the sixth drugmaker buyout valued at $50 million or more this year. Despite all the huffing and puffing from drug industry CEOs about recent drug price reforms slowing down investment, Big Pharma is making huge returns on drug sales and new drug development is doing just fine! In fact, a report published by S&P Global Ratings projects that the global pharmaceutical industry will have “healthy revenue growth through 2027.” It’s clear that drug corporations put profit over the well-being of patients and we’ll continue to expose their shady behavior until everyone can access medications at prices they can afford.  — (Accountable.USBiopharma DiveS&P Global)

3. Push For Competition

Big drug companies exploit our patent and regulatory systems to extend their monopolies and keep prices high, at the expense of patients. Big Pharma wields anti-competitive tactics like patent thickets and pay-for-delay deals to extend their timed monopolies and block competition from the market. Right now, there is a critical window of opportunity to pass legislation to curb these patent abuses and bolster competition to lower drug prices for all patients. These competition bills have critical bipartisan support from influential legislators: “Some of the most liberal Democrats in Congress and the House GOP’s lead budget writer are backing a plan to keep drugmakers from gaming the patent system,” wrote Axios reporter Peter Sullivan. Patients urgently need legislators to pass these reforms to curb anti-competitive practices and strengthen market forces to drive down steadily increasing drug prices. — (Chicago TribuneReutersEndpointsAxios)

Welcome to the Week in Review.

1. Pushing for Transparency

In the health care policy arena, the focus centers around the passage of the Lower Costs, More Transparency Act (HR 5378). With bipartisan backing, this legislation seeks to increase transparency and affordability in healthcare pricing practices. One important provision of the bill requires the Food and Drug Administration (FDA) to streamline the approval process for generic drugs by mandating that the FDA explain to generic drug companies why their applications were not approved and therefore better enable them to address issues that might stand in the way of their future approval. If passed, this provision would not only help increase competition but is also projected to result in over $800 million in cost savings. Facilitating generic entry is a key step toward reshaping the pharmaceutical landscape to lower costs for patients. Ironically, current negotiations between the House and Senate underscore the lack of transparency in the dynamics themselves that are shaping healthcare policies for patients. (MoneyTalks News, STAT News)

2. Easing the Burden for People on Medicare

In a significant development for many people on Medicare, the 2022 Inflation Reduction Act cap on out-of-pocket expenses for Part D drugs has gone into effect. This year, many individuals on Part D plans and who only take brand-name drugs will pay no more than $3,300 out of pocket annually for their medications, eliminating the 5 percent coinsurance after reaching the catastrophic spending threshold. The cap is expected to bring relief to approximately 1.5 million people, leading to substantial savings for patients. By 2025, the cap will further decrease to $2,000. In a piece from the Wall Street Journal, Patients For Affordable Drugs patient advocate Judy Aiken, who faced over $9,000 in out-of-pocket costs last year for her medication, Enbrel, expressed relief, emphasizing the positive financial impact of the cap on her well-being. David Mitchell, founder and president of P4AD, highlighted the remarkable savings this change brings and the crucial protection it offers to people on Medicare. These savings come at the same time as a notable escalation in list prices for a range of widely prescribed medications, including those by pharmaceutical giants like Novo Nordisk and Eli Lilly. This is despite the outlier in some of the older and competing insulins which saw a January 1 price drop for some of their older competing insulins timed to avoid paying additional rebates and following years of patient advocacy to lower the price of insulin. (KFF, WSJ, P4ADNow, NPR, Forbes, WSJ, CNN)

BONUS: Public Citizen and AARP, both prominent advocates for lowering drug prices, have released reports this week. Public Citizen’s report emphasizes the pharmaceutical industry’s disingenuous opposition to drug pricing regulations, revealing that major drug manufacturers spent billions more on activities such as stock buybacks and executive compensation than on research and development. Meanwhile, AARP’s Rx Price Watch series provides a comprehensive analysis of prescription drug pricing trends, highlighting the staggering annual costs faced by Americans, particularly older adults, and the disproportionate impact on people on Medicare. These reports are important tools for the ongoing conversation on drug costs and the need for comprehensive reforms. (Public Citizen, AARP)