Relatively Unknown Secret Committees Have Been Influencing Insurers’ Drug Coverage Decisions For Decades

News outlets report on stories related to pharmaceutical pricing.

Reuters: The Obscure Advisory Committees At The Heart Of The U.S. Drug Pricing Debate

Expectations were high last year for three new migraine drugs hitting the market from Amgen Inc, Eli Lilly and Co and Teva Pharmaceutical Industries. Priced around $7,000 each, the drugmakers called them "breakthrough" treatments designed to prevent migraines when taken year-round, and estimated that millions of patients could benefit. The U.S. Food & Drug Administration said Amgen's Aimovig – the first of the three drugs approved – was an "important addition" to available treatments. But a small group of external medical experts who quietly advise U.S. health insurers on new drugs was not impressed, according to a private meeting held at UnitedHealth Group's OptumRx offices in Chicago that was attended by Reuters. (Humer, 4/29)

The Wall Street Journal: Maryland Takes Step Toward Capping Drug Prices

Maryland is poised to become the first state to create a panel to review expensive prescription drugs and cap what public agencies will pay for them. The legislation, which cleared the state legislature in the waning moments of its session earlier this month, would be the first of its kind to allow prices for certain drugs to potentially be capped. The effort already has encouraged other states to take action, and lawmakers in Nevada, Maine and Massachusetts are considering legislation to create similar boards. The bill’s backers say they are confident the measure can survive court challenges that have stalled other efforts in Maryland and elsewhere on drug-price reform. (Hopkins, 4/30)

Politico Pro: Gottlieb Appears To Take Aim At Trump Part B Drug Idea

President Donald Trump's former FDA commissioner today appeared critical of the administration's plan to overhaul how Medicare pays for physician-administered drugs in his first speech since leaving his government post. While Scott Gottlieb didn't directly reference HHS's proposal to test tying payments for Medicare Part B drugs to the lower cost paid in others countries, he was critical of any government-controlled pricing system and alluded to newly proposed changes for Part B. (Karlin-Smith, 4/29)

Bloomberg: Pharma’s Charity Allies Help Its Fight To Keep Drug Prices High

The U.S. Rural Health Network has a slogan on its website that seems obvious: “We’re fighting for rural health.” But it’s not that simple. The two-year-old nonprofit hasn’t had much impact in rural health circles, where experts say they’ve never heard of it. It’s also active in a different area: fighting proposals that would cut the cost of prescription drugs. This year, it joined scores of other groups to oppose letting Medicare negotiate prices with drugmakers. (Elgin, 4/25)

The Wall Street Journal: Should Drug Prices Be Disclosed In Ads Targeted Directly To Consumers?

The Centers for Medicare and Medicaid Services is working on a proposed rule that would require drug companies to disclose the list prices of prescription medications when advertising them directly to consumers on television. The move, part of the Trump administration’s blueprint for reducing drug prices, aims to increase transparency around prices in the hope consumers will make more informed decisions about their medications and pressure manufacturers to rein in the cost of their products. (4/29)

Tampa Bay Times: PolitiFact Florida: TV Ad Misleads On Florida Plan To Import Drugs From Canada

Supporters say that the bill will lead to lower prices for consumers who struggle to pay for medicines. Opponents cast doubt about whether it will truly save money, and a conservative group, Americans for Tax Reform, called the bill “socialist price controls.”SB 1528 would require the Florida Agency for Health Care Administration to establish a program to allow a vendor to import wholesale drugs into Florida pharmacies. (Sherman, 4/29)

Columbus Dispatch: Could Michigan's High Drug Prices Flow South To Ohio?

The analysis of spending on more than 2 million prescriptions for generic drugs found that pharmacy benefit managers, or PBMs, charged Michigan taxpayers far more than they paid pharmacies to dispense the medications to Medicaid beneficiaries. The practice, known as spread pricing, allowed PBMs to increase their profits, pushing Medicaid’s drug spending higher despite declining drug costs, researchers found. (Candisky, 4/29)

Columbus Dispatch: Movement To Reform Pharmacy Middlemen Reaches A Boiling Point Nationwide

PBMs, such as CVS Caremark, OptumRx and Express Scripts, act as the middlemen between health insurers, drug manufacturers and pharmacies. Their contracts typically keep pricing and rebate data secret, leading many people to conclude that they’re partly to blame for the rising price of drugs, which itself is the fastest-rising part of the health-care sector. Following a Dispatch analysis last year of confidential pharmacy-reimbursement data, the Ohio Department of Medicaid released its own analysis showing that in 2017, CVS Caremark and OptumRx charged taxpayers $224 million more for drugs than they reimbursed pharmacists. (Candsiky and Schladen, 4/29)

The CT Mirror: PBMs Driving Up Drug And Insurance Prices, Critics Say

Pharmacy benefit managers – the middlemen who negotiate drug purchases for insurers and large buyers – are coming under growing scrutiny and criticism both in Connecticut and nationwide for their role in the sharp rise of prescription drugs. The third-party companies, called PBMs for short, originally processed claims for pharmacies, but now are hired by Medicare, Medicaid and commercial health plans to manage pharmaceutical benefits. (Hoffman, 4/27)

The Wall Street Journal: Government To File Complaint After Mallinckrodt Unit Is Accused Of Bribery To Drive Drug Sales

Shares of drugmaker Mallinckrodt Plc fell 16% Tuesday after news reports that the federal government is intervening in a pair of lawsuits that allege its subsidiary bribed doctors to drive sales of a pricey multiple-sclerosis drug. The U.S. Department of Justice said in recent court filings that it would file its own complaint within 90 days in relation to lawsuits brought by whistleblowers alleging that Questcor, which Mallinckrodt acquired in 2014 for $5.9 billion, defrauded government health-care plans by illegally marketing H.P. Acthar Gel. (Hopkins, 4/30)

Stat: U.K. Reaches 'First-Of-Its-Kind' Deal With Drug Makers For Hepatitis C

n the latest attempt to bring drug spending under control, the U.K.’s National Health Service reached what it calls a “first-of-its-kind” agreement with three drug makers to provide hepatitis C medicines at “best prices” in hopes of eradicating the disease. Five-year agreements were reached with Gilead Sciences (GILD), AbbVie (ABBV), and Merck (MRK), which will also work with local health services and voluntary groups to find patients —including homeless people and those with mental health problems — test for infection, and provide treatment. (Silverman, 4/30)

Kaiser Health News: Is Insulin’s High Cost Keeping Diabetes Patients From Taking Their Medicine?

High prescription drug prices are fast becoming a leading political topic, with medications like insulin emerging as a poster child for the issue. Nearly doubling in price from 2012 to 2016, the diabetes medication has commanded bipartisan attention on Capitol Hill and even a shoutout in a recent Netflix comedy special. Voters say curbing such prices should be a top priority for lawmakers — and Democratic presidential candidates are paying attention. (Luthra, 4/29)

Stat: Sun Pharma's Insider-Trading Policy Raises Question Of Double Standard

Earlier this month, a senior executive at Sun Pharmaceuticals, one of the world’s largest purveyors of generic drugs, and his wife settled insider trading allegations brought by Indian regulators. The case stemmed from an episode five years ago, when Abhay Gandhi traded in Ranbaxy Laboratories stock soon after Sun Pharma agreed to buy the company from another drug maker. Despite the infraction, Gandhi remains with the company as both head of its North American operations and as a director of Taro Pharmaceuticals, in which Sun Pharma owns a controlling stake. (Silverman, 4/29)

The Associated Press: Pfizer 1Q Profit Jumps 9% On Higher Drug Sales, Lower Costs

Higher prescription drugs sales and restrained spending together gave drugmaker Pfizer a 9% jump in first quarter profit as it easily topped analysts' profit expectations. Investors drove up Pfizer shares $1.20, or 3%, to $40.79 in early afternoon trading. Sales of breast cancer drug Ibrance and blood thinner Eliquis both jumped over 20% to more than $1 billion each in the quarter, and Xeljanz for rheumatoid arthritis saw sales soar 30%, lifting prescription drug sales by 3%. (4/30)

Reuters: Eli Lilly Misses Estimates For Top-Selling Diabetes Drug Trulicity, Shares Slip

Eli Lilly and Co on Tuesday reported lower-than-expected first-quarter sales for its top-selling diabetes drug Trulicity, and the U.S. drugmaker said the need to offer rebates and discounts were taking a toll and likely to weigh on revenue growth for the year. Lilly has been banking on newer drugs such as psoriasis treatment Taltz and migraine treatment Emgality to grow revenue and help offset pricing pressures and sales declines for other products. However, sales of both fell short of Wall Street estimates in the quarter. (Joseph and Steenhuysen, 4/30)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription