Wegovy could face Medicare drug price negotiations next

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Good afternoon! Wegovy, the blockbuster weight reduction treatment from Novo Nordisk, tops the list of medicine that would soon turn out to be a part of the second round of price negotiations between manufacturers and Medicare. 

That is in line with a paper published last week within the Journal of Managed Care & Specialty Pharmacy. By February, the federal government will unveil the subsequent 15 costliest Medicare Part D drugs that will probably be subject to the talks, for price changes that can go into effect in 2027. 

The Biden administration last month announced recent negotiated prices for the primary 10 Medicare Part D drugs chosen for the talks. Those prices will take effect in 2026. 

Medications containing the identical energetic ingredient and manufactured by the identical company will probably be considered a single drug for the talks, in line with guidance from the Centers for Medicare & Medicaid Services. The researchers said that is why they expect all of Novo Nordisk’s three branded drugs containing semaglutide – Wegovy, the diabetes injection Ozempic and an older diabetes pill called Rybelsus – to be chosen for the talks as a single product.

Which may be an enormous deal for older adults who use those treatments, which each carry price tags of around $1,000 monthly before insurance. Nevertheless, it’s still unclear how much Medicare could negotiate down those costs — and the way much patient costs would fall after insurance and rebates. 

The Biden administration, lawmakers and patient advocates have long criticized the Danish drugmaker for the high list prices of its obesity and diabetes drugs. Novo Nordisk’s CEO Lars Fruergaard Jørgensen faced a Senate grilling on Tuesday over those prices. 

While Jørgensen didn’t commit to lowering prices of Wegovy and Ozempic, he vowed to “collaborate” with pharmacy profit managers “on anything that helps patients get access and affordability.” He also pushed back on Medicare price negotiations when asked in regards to the potential number of Wegovy and Ozempic, calling the talks “price-setting” that may have negative consequences for drug innovation.

Medicare Part D doesn’t cover weight reduction treatments unless they’re approved and prescribed for one more health condition. But Wegovy could make the list for negotiations since it is now approved to cut back the chance of major cardiovascular complications, making it likely that some Part D plans have began covering the treatment, in line with the researchers. 

Under CMS guidance, drugs have to be available on the market for at the very least seven years without generic competitors before Medicare can select them for price talks. Semaglutide may have been available on the market for seven years and one month by February and doesn’t have any generic equivalents.

Other researchers and Wall Street analysts have said they expect Ozempic to be subject to negotiations due to how much Medicare Part D spends on the treatment. 

This system spent greater than $5.6 billion on semaglutide drugs in 2022, which only reflects spending on Ozempic and Rybelsus since Wegovy was not covered on the time, the paper said. Researchers also projected that Medicare Part D spent nearly $7.5 billion on Ozempic and Rybelsus in 2023, which is $3 billion higher than spending for the second-highest eligible drug. 

They noted they likely “underestimated” their projected spending figures for semaglutide

The opposite drugs expected to be subject to cost talks include GSK‘s Trelegy Ellipta, a prescription inhaler used to treat asthma and chronic obstructive pulmonary disease, and Xtandi, a rheumatoid arthritis medication from Astellas Pharma. 

Still, researchers said the ultimate list of medicine chosen will rely on whether generic versions launch before February. 

We’ll be following the subsequent round of Medicare drug price negotiations closely, so stay tuned for our coverage. 

Be at liberty to send any suggestions, suggestions, story ideas and data to Annika at annikakim.constantino@nbcuni.com.

Data startup Particle Health on Monday filed an antitrust lawsuit against Epic Systems, a software vendor that houses medical records for around 280 million patients within the U.S.

Particle alleges that Epic is using its dominance within the electronic health records space to stifle competition in other markets that use this data. The suit was filed within the Southern District of Latest York. 

Oracle and Meditech are other outstanding firms within the electronic health records segment, and patients often have data stored across multiple vendors. Even so, Epic is a formidable competitor. The corporate commands essentially the most acute care market share within the U.S., covering greater than half all acute care multispecialty beds, in line with a report from KLAS Research. Moreover, Epic was the one vendor that saw a net increase on this market share in 2023, the report said.  

Particle’s lawsuit comes after the 2 firms clashed over data-sharing practices earlier this 12 months. Epic and Particle each belong to an interoperability network called Carequality, which helps facilitate a large-scale exchange of patient information.

Epic filed a proper dispute with Carequality in March, citing concerns that Particle and its participant organizations “is perhaps inaccurately representing the aim related to their record retrievals.” To hitch the Carequality network, organizations have to be approved and abide by “Permitted Purposes,” generally having to do with treatment, for the exchange of patient records.

In its 81-page criticism, Particle said Epic’s dispute was “manufactured” and that Epic asserted some Particle customers, not Particle itself, were obtaining records improperly. Particle said Epic used its “outsized influence” over Carequality to get a good end result, and argues that it has suffered damages due to Epic’s conduct.

“Absent repercussions, Epic will probably be incentivized to run this playbook again the subsequent time a competitor emerges,” Particle said in a release Monday.

Epic said it can “vigorously defend itself against Particle’s meritless claims,” and that it can proceed to guard patients’ privacy.

“Particle’s claims are baseless. This lawsuit attempts to divert attention from the actual issue: Particle’s illegal actions on the Carequality health information exchange network violated HIPAA privacy regulations,” an Epic spokesperson told CNBC in a press release Tuesday. “Particle’s criticism mischaracterizes Carequality’s decision, which in reality proposes banning Particle customers that were accessing patient data for impermissible purposes.” 

It can likely be some time before there is a definitive ruling, as antitrust cases often crawl. Google, as an illustration, lost an antitrust case last month that was originally filed in 2020. A federal U.S. judge ruled that the corporate illegally held a monopoly over text promoting and search.

You may read the total Particle criticism against Epic here.

Be at liberty to send any suggestions, suggestions, story ideas and data to Ashley at ashley.capoot@nbcuni.com.