FTC Finds Top Three PBMs Took In Billions From Inflated Drug Costs

NBC News: Top Three Insurers Reaped $7.3 Billion Through Their Drug Middlemen's Markups, FTC Says
The three largest drug middlemen inflated the costs of numerous life-saving medications by billions of dollars over the past few years, the Federal Trade Commission said in a report Tuesday. The top pharmacy benefit managers (PBMs) — CVS Health’s Caremark Rx, Cigna’s Express Scripts and UnitedHealth Group’s OptumRx — generated roughly $7.3 billion through price hikes over about five years starting in 2017, the FTC said. (Kopack and Kaplan, 1/14)

More on the high cost of health care and prescription drugs —

The Hill: Trump's Greenland Demands May Impact Ozempic Costs
President-elect Trump’s threat to tariff Denmark if it resists his acquisition plans for the island territory of Greenland could disrupt one export that is wildly popular in America: Ozempic. ... Danish multinational pharmaceutical giant Novo Nordisk is the sole owner of semaglutide, the active ingredient in both Ozempic and Wegovy. A month’s supply of Ozempic is close to $1,000 without insurance, though manufacturer coupons and patient assistance programs are available. Novo Nordisk was estimated to be responsible for half of Denmark’s gross domestic product growth in 2024. (Choi, 1/14)

The Hill: Nearly Half Of Americans Skeptical Trump Admin Will Lower Health Costs: Poll
Nearly half of Americans don’t believe that the incoming Trump administration will lower health costs, according to a new Gallup poll. The research, conducted after the presidential election, found 48 percent of Americans are pessimistic about the new administration’s ability to lower healthcare costs, while 45 percent feel the same about prescription drug costs. But much of the public’s opinion is colored by partisanship. The poll found 84 percent of Democrats said they think any future policy from the Trump administration on health costs is headed in the wrong direction, along with nearly half of independents. (Weixel, 1/15)

The Baltimore Sun: Baltimore Schools Suing Over Allegedly Inflated Price Of Insulin
The Baltimore City Board of School Commissioners is suing Eli Lilly and Co., UnitedHealth Group, CVS and several other drug manufacturers for allegedly colluding to inflate the cost of insulin. Baltimore City Schools offers health insurance to more than 9,000 employees and their dependents, and one of the benefits is paying a “substantial share of the purchase price of their pharmaceutical drugs, including the diabetes medication,” according to the complaint. (Karpovich, 1/15)

North Carolina Health News and The Charlotte Ledger: Refill Requests Are Supposed To Be Free - But Not For This Dad
Novant Health billed a Huntersville dad $41 for a MyChart message exchange about a medication refill, despite a published policy that says prescription refill requests are free. (Crouch, 1/15) 

The New York Times: How A Company Makes Millions Off A Hospital Program Meant To Help The Poor
Soon after being diagnosed with metastatic breast cancer, Virginia King sat in an outpatient clinic in Santa Fe, N.M, while a nurse injected her with a powerful drug to slow damage to her spine, where the disease had spread. Even though the drug had a list price of about $2,700, the hospital that owned the cancer center billed Mrs. King’s insurance company $22,700. Her insurer paid $10,000, but the hospital wanted more. She got a bill for over $2,500 — “more than half my take-home salary for a month,” said Mrs. King, 65. (Gabler, 1/15)

KFF Health News: Listen To The Latest 'KFF Health News Minute'
This week on the KFF Health News Minute: Small interventions at the doctor’s office, such as removing a splinter, can be billed as surgeries, and billing problems with the Indian Health Service are leaving Native American communities with significantly higher medical debt than the national average. (1/14)

Also —

The New York Times: Online Therapy Boom Has Mainly Benefited Privileged Groups, Studies Find
The number of Americans receiving psychotherapy increased by 30 percent during the pandemic, as virtual sessions replaced in-person appointments — but new research dampens the hope that technology will make mental health care more available to the neediest populations. In fact, the researchers found, the shift to teletherapy has exacerbated existing disparities. (Barry, 1/15)

Modern Healthcare: How Medical Device Reprocessing Can Save Hospitals Millions
Beth Israel Lahey Health has found a way to save millions of dollars while being a good corporate citizen. The Boston health system reprocesses some devices used in its in-patient settings, operating rooms and labs, sending them off to be reprocessed, made like-new again and then buying back some to use. In 2023, the reprocessing program at its 14 hospitals saved Beth Israel $1.7 million, and supported its goal of keeping 80% of its waste out of landfill or incinerators by 2030. (Dubinsky, 1/14)

Bloomberg: Prospect Medical Faces Landlord Brawl, Cash Burn In Bankruptcy
Bankrupt hospital chain Prospect Medical Holdings Inc. won court permission to start drawing from its $100 million Chapter 11 financing despite a challenge from landlord Medical Properties Trust Inc. Judge Stacey G.C. Jernigan said late Tuesday she’d authorized Prospect’s request after company advisers testified that the hospital operator’s cash dwindled to about $3 million before filing for protection on Jan. 11. MPT challenged the financing, saying it improperly puts the new debt ahead of its liens. (Ma and Randles, 1/15)