By Robin Foster HealthDay Reporter<\/b><\/p>\n
<\/b><\/p>\n
WEDNESDAY, Sept. 25, 2024 (HealthDay News) — During a tense hearing before a Senate committee on Tuesday, Novo Nordisk CEO Lars Fruergaard J\u00c3\u00b8rgensen<\/a> faced tough questions over the company’s high prices for its blockbuster drugs Ozempic and Wegovy.<\/p>\n While testifying before the Senate Committee on Health, Education, Labor and Pensions, J\u00c3\u00b8rgensen shifted the blame for those prices to pharmacy benefit managers (PBMs), explaining that Ozempic and Wegovy would likely no longer be offered by PBMs if they had a lower list price, NBC News<\/em> reported.<\/p>\n A \u00e2\u0080\u009chigh list price,\u00e2\u0080\u009d he explained, \u00e2\u0080\u009cis more likely to lead to more access to patients,\u00e2\u0080\u009d because PBMs can get larger rebates with higher-priced drugs.<\/p>\n Still, Committee Chair Sen. Bernie Sanders<\/a> did get J\u00c3\u00b8rgensen to agree to meet with PBMs to discuss lowering the cost of Ozempic and Wegovy, NBC News<\/em> reported.<\/p>\n Sanders noted that he had received commitments in writing\u00a0<\/strong>from \u00e2\u0080\u009call the major PBMs”\u00a0— UnitedHealth Group\u00e2\u0080\u0099s Optum Rx, CVS Health\u00e2\u0080\u0099s Caremark and Cigna\u00e2\u0080\u0099s Express Scripts — that if Novo Nordisk substantially reduced the list price, they wouldn\u00e2\u0080\u0099t take Ozempic and Wegovy off their formulary lists. PBMs work with insurance companies to negotiate discounts or rebates on drugs in return for coverage. PBMs have been criticized for pushing patients to higher-priced drugs, NBC News<\/em> reported.<\/p>\n For months, Sanders has railed against how much Novo Nordisk charges Americans for both Ozempic (used to treat type 2 diabetes) and Wegovy (approved for weight loss).<\/p>\n \u00e2\u0080\u009cThe result of these astronomically high prices is that Ozempic and Wegovy are out of reach for millions of Americans who need them,\u00e2\u0080\u009d Sanders said in April when the committee announced its investigation into Novo Nordisk’s pricing practices. \u00e2\u0080\u009cUnfortunately, Novo Nordisk\u00e2\u0080\u0099s pricing has turned drugs that could improve people\u00e2\u0080\u0099s lives into luxury goods, all while Novo Nordisk made over $12 billion in profits last year \u00e2\u0080\u0094 up 76 percent from 2021. That is unacceptable.\u00e2\u0080\u009d<\/p>\n That committee report<\/a>\u00a0showed the cost of Wegovy is significantly less in European countries \u00e2\u0080\u0094 from $140 a month in Germany to $92 a month in the United Kingdom. Americans pay about $1,349 a month for the exact same drug.<\/p>\n But during his opening statement on Tuesday, J\u00c3\u00b8rgensen defended the drugmaker\u00e2\u0080\u0099s pricing structure.<\/p>\n \u00e2\u0080\u009cType 2 diabetes costs the U.S. approximately $413 billion every year and obesity costs the U.S. $1.7 trillion, and we all know the physical and emotional toll these diseases have,\u00e2\u0080\u009d he said in his statement, NBC News<\/em> reported. \u00e2\u0080\u009cThat\u00e2\u0080\u0099s why we effort to secure public and private insurance coverage for patients with type 2 diabetes and obesity.\u00e2\u0080\u009d<\/p>\n J\u00c3\u00b8rgensen claimed that for every dollar Novo Nordisk makes, it gives 74 cents to PBMs and insurance companies.<\/p>\n \u00e2\u0080\u009cWhen we set a list price, we have to take into consideration what are the rebates we have to pay because, unless we pay big\u00a0<\/strong>rebates into the system, when we negotiate rebates with PBMs, we are not getting access to the formulary,\u00e2\u0080\u009d J\u00c3\u00b8rgensen said.<\/p>\n That\u00e2\u0080\u0099s why, he argued, higher prices ensure that a PBM will cover Novo Nordisk\u00e2\u0080\u0099s drugs.<\/p>\n J\u00c3\u00b8rgensen wasn\u00e2\u0080\u0099t alone in voicing his ire for pharmacy benefit managers.<\/p>\n Sen. Tim Kaine<\/a> said while he supported the focus on the pharmaceutical industry during the hearing, \u00e2\u0080\u009cwe\u00e2\u0080\u0099re letting PBMs get away scot-free.\u00e2\u0080\u009d<\/p>\n Larry Levitt<\/a>, executive vice president of health policy at KFF, a nonprofit group that researches health policy issues, told NBC News<\/em> there’s an \u00e2\u0080\u009carms race” in drug pricing: Higher list prices lead to larger rebates for PBMs, which in turn encourage higher list prices. In other words, drugmakers may be pressured to increase list prices to satisfy PBMs’ demands for higher rebates.<\/p>\n In the end, Levitt said, the uninsured and patients with so-called high deductible plans end up paying more.<\/p>\n More information<\/strong><\/p>\n The U.S. Department of Health and Human Services has more on drug pricing<\/a>.<\/p>\n