Medicare May Group Drugs With Same Ingredients For Price Talks, Court Rules
Novo Nordisk argued in a lawsuit that each of its medications should be considered separately. By lumping together meds, Medicare is able to negotiate lower prices for more than the Inflation Reduction Act cap allows. In Novo Nordisk's case, six insulin drugs were counted as one.
Stat:
Court Rules Against Novo Nordisk On Medicare Price Negotiations
A federal appeals court unanimously rejected a Novo Nordisk challenge to Medicare’s drug price negotiation program, a ruling that will allow the government to lump together products with the same ingredient for the purpose of choosing drugs for negotiation. (Wilkerson, 10/7)
The Wall Street Journal:
Trump Wants To Overhaul Drug Sales. A Company Tied To His Son Stands To Benefit.
The country’s top drugmakers are set to meet in early December at the Four Seasons hotel in Georgetown with Donald Trump Jr. and senior Trump administration officials that regulate the pharmaceutical industry. The host: BlinkRx, an online prescription drug delivery company that this year installed Trump Jr. as a board member. The summit will conclude with a dinner at the Executive Branch, the exclusive new club founded by Trump Jr. and his close friends, according to people with knowledge of the event and a copy of the invitation viewed by The Wall Street Journal. (Linskey and Dawsey, 10/7)
Stat:
Pharma Companies Scramble To Strike Deals With Trump After Pfizer
The agreement between Pfizer and the Trump administration to lower drug prices has sent other companies scrambling to make a deal. Several major pharmaceutical firms that received letters from President Trump demanding lower prices have been hustling to show progress, with some hoping to announce a deal with the White House as soon as this week, according to five Washington representatives and lobbyists for the companies, granted anonymity to speak about private deliberations. (Payne, 10/7)
More on Medicare costs and billing disputes —
Medscape:
Medicare Proposal Would Boost Primary Care Doc Pay
Medicare has announced plans to change the way it calculates fees for doctors, signaling that it will rely less on American Medical Association recommendations. (Szabo, 10/7)
Fierce Healthcare:
Stable Premiums, Plan Exits: The State Of Medicare Part D
The current state of the Medicare Part D market is a mixed bag, with premiums declining but many payers scaling back options, according to a new analysis from KFF. The report noted that the Centers for Medicare & Medicaid Services put an emphasis on "stability" in Part D when it announced premium estimates in late September, but KFF found that the total number of stand-alone Part D plans available will decrease in 2026, marking the third straight year of shrinking plan options. (Minemyer, 10/7)
Modern Healthcare:
IDR Process Sees Backlog Drop, But Providers Want Other Fixes
Federal regulators say they have made inroads into speeding up the process to resolve out-of-network billing disputes. It’s not enough for frustrated providers and health insurance companies. The No Surprises Act’s Independent Dispute Resolution, or IDR, process has been a punching bag for both camps since it launched in 2022, and a backlog of cases had piled up by the beginning of this year. (Early, 10/7)
KFF Health News:
Listen To The Latest 'KFF Health News Minute'
Oct. 2: Sam Whitehead reads the week’s news: Hospital charity care programs can still leave patients who qualify with big bills, and the Trump administration is rolling out a pilot program to use AI to deny care for Medicare patients in six states. Sept. 25: Arielle Zionts reads this week’s news: Asking AI tools to interpret your lab results can have downsides, and more Americans are choosing environmentally friendly “green burials.” (10/7)
On disability fraud at the VA —
The Washington Post:
These Veterans Are Defrauding VA's 'Honor System' Disability Program
Kinsley Kilpatrick put on a convincing show. During visits to Atlanta VA Medical Center, the Iraq War veteran arrived in a wheelchair, claiming multiple sclerosis had paralyzed his arms and legs. By the time he turned 35, the onetime athlete said he could barely move from the neck down, leaving him dependent on others to eat, dress and bathe, according to court records. ... The hoax lasted for three years and might have continued indefinitely, if not for a whistleblower who sent VA proof that Kilpatrick was lying: videos of the Army veteran backflipping on a trampoline, prancing around a sports field like a ballerina and swan diving into a playground ball pit. ... The Kilpatricks pleaded guilty in 2019 to defrauding taxpayers of more than $200,000. (Whitlock, Rein and Jones, 10/8)
