Weight-loss drug Wegovy could be next in line for Medicare pricing negotiations – NBC Connecticut

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Good day! Wegovy, Novo Nordisk's blockbuster weight-loss drug, is at the top of the list of drugs that could soon be part of the second round of price negotiations between manufacturers and Medicare.

This is according to an article published last week in the Journal of Managed Care & Specialty Pharmacy. By February, the government will announce the next 15 most expensive Medicare Part D drugs that will be the subject of discussions, with price changes set to take effect in 2027.

The Biden administration last month announced new negotiated prices for the first 10 Medicare Part D drugs selected for talks. Those prices will take effect in 2026.

Drugs that contain the same active ingredient and are made by the same company are considered a single drug for the talks, according to guidelines from the Centers for Medicare & Medicaid Services. For that reason, researchers expect all three of Novo Nordisk's brand-name drugs that contain semaglutide — Wegovy, the diabetes injection Ozempic and an older diabetes pill called Rybelsus — to be selected as a single product for the talks.

That can be a big problem for older people who seek these treatments, since each of these treatments costs about $1,000 a month before insurance coverage. But it's still unclear how much Medicare could reduce those costs — and how much patient costs would drop after coverage and reimbursements.

The Biden administration, lawmakers and patient advocates have long criticized the Danish pharmaceutical company for the high list prices of its obesity and diabetes drugs. Novo Nordisk's CEO Lars Fruergaard Jørgensen faced a Senate hearing on Tuesday about those prices.

While Jørgensen did not commit to lowering prices for Wegovy and Ozempic, he vowed to work with pharmacy benefit managers “on anything that provides access and affordability for patients.” He also dismissed price negotiations with Medicare when asked about the potential selection of Wegovy and Ozempic, 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 condition. But Wegovy could make the list for negotiations because it is now approved to reduce the risk of serious cardiovascular complications, making it likely that some Part D plans have begun to cover the treatment, the researchers said.

Under CMS guidelines, drugs must be on the market for at least seven years without generic competitors before Medicare can select them for price negotiations. Semaglutide will have been on the market for seven years and one month in February and has no generic equivalents.

Other researchers and Wall Street analysts believe Ozempic will be subject to negotiations due to the high cost of Medicare Part D for the treatment.

The program spent more than $5.6 billion on semaglutide drugs in 2022, reflecting only spending on Ozempic and Rybelsus because Wegovy was not covered at the time, the paper said. The researchers also projected that Medicare Part D would spend nearly $7.5 billion on Ozempic and Rybelsus in 2023, $3 billion more than spending on the second-highest reimbursable drug.

They pointed out that they had probably “underestimated” their projected spending on semaglutide.

Other drugs expected to be subject to price negotiations include GSK's Trelegy Ellipta, a prescription inhaler used to treat asthma and chronic obstructive pulmonary disease, and Astellas Pharma's Xtandi, a rheumatoid arthritis drug.

However, researchers said the final list of drugs selected will depend on whether generics come to market before February.

We will be closely following the next round of Medicare drug price negotiations, so stay tuned for our coverage.

Feel free to send tips, suggestions, story ideas and data to Annika at [email protected].

Healthtech News: Particle Health Files Antitrust Lawsuit Against Epic Systems

Data startup Particle Health filed an antitrust lawsuit on Monday against Epic Systems, a software provider that manages medical records of around 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 that data. The suit was filed in the Southern District of New York.

Oracle and Meditech are other notable companies in the electronic health record space, and patient data is often stored with multiple vendors. Still, Epic is a serious contender. According to a report by KLAS Research, the company has the largest market share in the acute care space in the U.S., covering more than half of all multi-specialty acute care beds. In addition, Epic was the only vendor to see a net increase in that market share in 2023, the report said.

Particle's lawsuit comes after the two companies clashed earlier this year over their data-sharing practices. Epic and Particle are both part of an interoperability network called Carequality that enables large-scale sharing of patient information.

Epic filed a formal objection to Carequality in March, saying it was concerned that Particle and its participating organizations “may misrepresent the purpose of their data requests.” To join the Carequality network, organizations must be approved to share patient data and adhere to “permissible purposes,” which generally relate to treatment.

In its 81-page complaint, Particle claimed Epic's dispute was “constructed” and that Epic had claimed some Particle customers, not Particle itself, had improperly obtained data. Particle said Epic had used its “outsized influence” over Carequality to obtain a favorable outcome and argued it was harmed by Epic's conduct.

“Unless there are consequences, Epic will have an incentive to reapply this playbook the next time a competitor emerges,” Particle said in a press release on Monday.

Epic said it would “vigorously defend itself against Particle's baseless claims” and continue to protect patient privacy.

“Particle's claims are without merit. This lawsuit seeks to divert attention from the real issue: Particle's unlawful actions on the Carequality health information exchange network violated HIPAA privacy protections,” an Epic spokesperson said in a statement to CNBC on Tuesday. “Particle's complaint misrepresents Carequality's decision, which in reality proposes to suspend Particle customers who accessed patient data for improper purposes.”

It will likely be a while before there is a final ruling, as antitrust cases often move slowly. Google, for example, lost an antitrust case last month that was originally brought in 2020. A U.S. federal judge ruled that the company illegally held a monopoly on text advertising and search.

You can read Particle’s full complaint against Epic here.

Feel free to send tips, suggestions, story ideas and data to Ashley at [email protected].