Boxes of Novo Nordisk's Ozempic and Wegovy are seen at a pharmacy in London, Britain, March 8, 2024.
Hollie Adams | Reuters
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Good day! Wegovy, the blockbuster weight loss treatment from Novo Nordiskleads the list of drugs that could soon be part of the second round of price negotiations between manufacturers and Medicare.
That's according to an article published last week in the Journal of Managed Care & Specialty Pharmacy. By February, the government will unveil the next 15 most expensive Medicare Part D drugs that will be the subject of discussions, with price changes taking effect in 2027.
The Biden administration last month announced new negotiated prices for the first 10 Medicare Part D drugs selected for talks. These prices will take effect in 2026.
Drugs that contain the same active ingredient and are manufactured by the same company are considered a single drug, according to Centers for Medicare & Medicaid Services guidelines for discussion. For that reason, researchers expect that all three of Novo Nordisk's branded drugs that contain semaglutide – Wegovy, the diabetes injection Ozempic and an older diabetes pill called Rybelsus – will be selected as a single product for the interviews.
That can be a big deal for older adults seeking these treatments, each of which costs about $1,000 per month (without insurance). But it's still unclear how much Medicare could reduce these costs — and by how 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. Lars Fruergaard Jørgensen, CEO of Novo Nordisk, faced a debate in the Senate on Tuesday over these prices.
Novo Nordisk CEO Lars Jorgensen testifies before a Senate Health, Education, Labor and Pensions Committee hearing on U.S. prices for the weight loss drugs Ozempic and Wegovy on Capitol Hill in Washington, United States, on September 24, 2024 .
Piroschka Van De Wouw | Reuters
While Jørgensen did not commit to lowering prices for Wegovy and Ozempic, he promised to work with pharmacy benefit managers “on anything that helps patients maintain access and affordability.” When asked about the possible selection of Wegovy and Ozempic, he also dismissed negotiations over Medicare pricing, calling the talks “price-fixing” that will have negative consequences for drug innovation.
Medicare Part D does not cover weight loss treatments unless they are approved and prescribed for another health condition. But Wegovy could be on the list of negotiations because it is now approved to reduce the risk of serious cardiovascular complications, which the researchers say makes it likely that some Part D plans have begun covering the treatment.
CMS guidance requires drugs to be on the market without generic competition for at least seven years before Medicare can select them for price negotiations. Semaglutide will be on the market for seven years and one month by February and there are no generic equivalents.
Other researchers and Wall Street analysts have said they expect Ozempic to be in negotiations because Medicare Part D spends so much on the treatment.
The program spent more than $5.6 billion on semaglutide drugs in 2022, which only reflects spending on Ozempic and Rybelsus because Wegovy was not covered at the time, the paper said. Researchers also predicted that Medicare Part D spent nearly $7.5 billion on Ozempic and Rybelsus in 2023, which is $3 billion more than spending on the second-highest eligible drug.
They noted that they had likely “underestimated” their projected spending figures for semaglutide
Other drugs expected to be in price discussions include: GSK's Trelegy Ellipta, a prescription inhaler used to treat asthma and chronic obstructive pulmonary disease, and Xtandi, a rheumatoid arthritis drug from Astellas Pharma.
Still, researchers said the final list of drugs chosen will depend on whether generic versions hit the market before February.
We'll be closely following the next round of Medicare drug pricing negotiations, so stay tuned for our coverage.
Feel free to send tips, suggestions, story ideas and data to Annika at annikakim.constantino@nbcuni.com.
The latest in health tech: Particle Health files antitrust lawsuit against Epic Systems
Data startup Particle Health filed an antitrust lawsuit Monday against Epic Systems, a software provider that stores medical records for about 280 million patients in the United States
Particle alleges that Epic is using its dominance in the electronic health records space to stifle competition in other markets that use this data. The lawsuit was filed in the Southern District of New York.
Oracle and Meditech are other leaders in the electronic health records segment, and patients often have their data stored with multiple providers. Still, Epic is a formidable competitor. The company has the largest acute care market share in the U.S., covering more than half of all multi-specialty acute care beds, according to a report from KLAS Research. Additionally, Epic was the only provider to see a net increase in this market share in 2023, the report said.
Particle's lawsuit comes after the two companies clashed over data sharing practices earlier this year. Epic and Particle are both part of an interoperability network called Carequality, which enables comprehensive exchange of patient information.
Epic filed a formal complaint with Carequality in March, citing concerns that Particle and its participating organizations “may be misrepresenting the purpose associated with their data retrievals.” To join the Carequality network, organizations must be approved to share patient records and adhere to “Permitted Purposes,” which are generally related to treatment.
In its 81-page complaint, Particle said Epic's dispute was “fake” and that Epic alleged that some Particle customers, not Particle itself, improperly obtained records. Particle said Epic used its “outsized influence” over Carequality to achieve a positive outcome and argued that it suffered harm as a result of Epic's conduct.
“If there are no consequences, Epic will have an incentive to apply this playbook again the next time a competitor emerges,” Particle said in a press release Monday.
Epic said it will “vigorously defend itself against Particle's baseless claims” and will continue to protect patient privacy.
“Particle’s claims are baseless. “This lawsuit attempts to divert attention from the real issue: Particle’s unlawful actions on the Carequality health information exchange network violate the HIPAA Privacy Rule,” an Epic spokesperson said in a statement to CNBC on Tuesday. “Particle’s complaint misrepresents Carequality’s decision, which effectively proposes to block Particle customers who have accessed patient data for improper purposes.”
It will likely be a while before there is a final decision, as antitrust cases often move slowly. Google, for example, lost an antitrust case last month that was originally filed in 2020. A US federal judge ruled that the company illegally held a monopoly on text advertising and search.
You can read the full particle complaint against Epic here.
Feel free to send tips, suggestions, story ideas and data to Ashley at ashley.caroot@nbcuni.com.
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