Top Pharmacy News Story #1: Medicare kicks off first price review
The federal government is set to begin price negotiations on the ten costliest prescription drugs covered by Medicare this week. The negotiations, as mandated by the Inflation Reduction Act, are scheduled to run through Aug. 1 before final prices are announced on Sept. 1. It’s uncharted territory for Medicare, which has never before been able to directly haggle with drugmakers over prices.
The ten drugs under negotiation are Eliquis, Jardiance, Xarelto, Januvia, Enbrel, Imbruvica, Farxiga, Entresto, Stelara, Fiasp and Novolog. Together, these ten drugs accounted for $50.5 billion, or 20%, of Medicare Part D spending from June 1, 2022, to May 31, 2023 according to the CMS.
Top Pharmacy News Story #2: A third class-action lawsuit has been filed against PBMs by independent pharmacies
Another class action lawsuit has been filed against Express Scripts alleging that the massive pharmacy benefit manager, one of the largest in the world, colluded with several smaller PBMs to rig reimbursement rates and shake down pharmacies for higher fees.
The lawsuit claims that Express Scripts used its dominant market position to push rival PBMs to impose excessive back-end fees on pharmacies and then share the revenue with Express Scripts. Express Scripts announced one such arrangement in 2019 with Prime Therapeutics, a smaller PBM.
The other two lawsuits were filed against UnitedHealth Group and its PBM, OptumRx and CVS Health, Caremark and Aetna.
Independent pharmacies do not need to sign up to benefit from the potential class action. The plaintiffs involved will ask the Court to allow it to pursue its claims on behalf of other pharmacies. If the Court permits that, pharmacies across the U.S. will be able to share in any money or other legal relief that is obtained.
Top Pharmacy News Story #3: City of Boston Sues Major PBMs Over Role in Opioid Crisis
The City of Boston, the Boston Public Health Commission and the Boston Housing Authority filed a lawsuit in Suffolk County Superior Court and names some of the largest PBMs in the US, including Express Scripts and OptumRx.
Boston’s lawsuit accuses the pharmacy benefit managers of colluding with drug makers to maximize profits by prioritizing the prescribing of addictive opioids despite the risks. The companies, the lawsuit alleges, profited from deals with drug makers that made it easier to prescribe opioids in exchange for financial incentives.
The defendants deny the allegations.