Congress Hammers PBMs Over Drug Pricing

Stat: Congress Highlighted A Chemo Drug’s Price To Blast PBMs — But It’s Not A PBM Issue
Congress blasted drug middlemen at a hearing Tuesday, with multiple lawmakers pointing to a huge discrepancy between how much a chemo drug costs at CVS and its price from Mark Cuban’s Cost Plus Drugs. There’s just one problem: PBMs don’t have anything to do with that discrepancy. (Wilkerson, 5/23)

AP: Medicaid Plans To Audit The Prices Of Costliest Drugs
The Biden administration said Tuesday it is planning to conduct a yearly audit to verify the prices drug makers charge on a handful of the costliest prescriptions covered by Medicaid. Under the proposal, the Centers for Medicare and Medicaid Services would require as many as 10 drug makers every year to furnish the government with proprietary and non-proprietary information as evidence to support the price it charges states, which administer Medicaid. Drugs that cost Medicaid the most money — some as much as $2 million per treatment — will be selected for the survey. (Seitz, 5/23)

Modern Healthcare: CMS Price Transparency Proposal Targets PBMs
Under an upcoming proposed rule, PBMs that contract with Medicaid would have to reveal the prices they pay for medicines, a provision that seeks to curb spread pricing, a practice in which PBMs charge insurance companies, employers or government programs more for medicines than it actually pays. If finalized, this would be the first time that PBMs are required to disclose actual drug prices under federal law. The regulation also would make specialty drugs administered in hospitals eligible for rebates. (Turner, 5/23)

In other pharmaceutical industry developments —

The Wall Street Journal: Your Company Doesn’t Want You To Take Ozempic For Weight Loss. Here’s Why. 
Many Americans seeking out drugs like Ozempic to shed pounds are hitting a barrier: Their employers’ health plans won’t pay for them.  The issue is an emerging fault line in U.S. workplaces, driven by the social-media and celebrity buzz around Ozempic and its sister drug, Wegovy. Prescriptions for the treatments have soared so much that the drugs’ maker has often struggled to keep pace with demand. Yet companies, already facing rising healthcare costs, are wary of footing the bill for medicines that list for $900 or more a month. (Mathews and Smith, 5/22)

The Wall Street Journal: Baby-Formula Makers Face FTC Investigation For Collusion 
The Federal Trade Commission is investigating whether baby-formula makers colluded on bids for lucrative state contracts. The agency, in documents posted to its website, said it is looking into whether Abbott Laboratories and other formula manufacturers have “engaged in collusion or coordination with any other market participant regarding the bidding” for state contracts. The FTC is also investigating whether company coordination affected sales more broadly, outside of the Women, Infants and Children formula-supply program, FTC Commissioner Alvaro Bedoya wrote. (Whyte, Newman and Peterson, 5/24)

Stat: Achieve's Drug Helps Smokers Quit But Would Face Stiff Competition If Approved
Seattle biotech Achieve Life Sciences on Tuesday announced an experimental drug meant to help people quit smoking did exactly that in a clinical trial, paving the way for the company to seek approval for a product that would face stiff competition. (Wosen, 5/23)

The Boston Globe: Blueprint Medicines Says Its Newly Approved Drug For A Rare Life-Threatening Disorder Could Be A Blockbuster
Suki Tipp had been stung by wasps before but never had a reaction like the one she experienced five years ago in a barn on her 30-acre property in Alabama. After the sting to her right arm that July day, Tipp recalled, she had a metallic taste in her mouth and felt like her body was on fire. She rushed into her house to lie on an air-conditioning grate on the floor, then texted her husband outside as she grew weak. “Something’s not right,” she wrote. “I need help.” (Saltzman, 5/23)