The CEO of Novo Nordisk wouldn’t decide to decreasing the costs of Ozempic and Wegovy throughout a Senate listening to Tuesday, regardless of repeatedly being pressed by Senate Well being Committee Chair Bernie Sanders (I-Vt.).
Novo Nordisk chief Lars Fruergaard Jørgensen advised senators Tuesday that pharmacy profit managers (PBMs), the trade middlemen that negotiate the phrases and circumstances for entry to pharmaceuticals, are the rationale Wegovy and Ozempic value a lot.
Jørgensen stated his firm must pay excessive rebates to the PBMs as a way to get favorable insurance coverage protection. In his written testimony, he stated the online value for Ozempic, which displays the quantity his firm is paid per prescription, is down 40 p.c since 2018 due to rebates paid to PBMs.
However in an effort to preemptively cease the blame-shifting, Sanders introduced on the high of the listening to that three of the largest drug middlemen confirmed that decreasing the record value alone wouldn’t negatively affect their selections to cowl the medication in query.
“I am delighted to announce today that I have received commitments in writing from all of the major PBMs that if Novo Nordisk substantially reduced the list price for Ozempic and Wegovy, they would not limit coverage,” Sanders stated. “In fact, all of them told me they would be able to expand coverage for these drugs if the list price was reduced.”
Sanders repeatedly requested Jørgensen whether or not, in mild of that data, he would decide to working with the PBMs to decrease the medication’ costs.
“Anything that can help patients get access, I am supportive of. And that includes collaborating and negotiating with anyone who can help that,” Jørgensen stated.
However he added a wholesome dose of skepticism concerning the specifics of what the PBMs dedicated to doing.
“When I hear statements that PBMs would access a low list price product, it needs to go to patients,” Jørgensen stated. “If it works in a way that patients get access to more affordable medicine and we have certainty that it actually happens … we will be positive towards it.”
Jørgensen identified that slicing record costs doesn’t at all times result in expanded protection, as a result of PBMs make extra rebates from merchandise with greater costs.
For instance, he cited the corporate’s insulin product Levemir. After Novo Nordisk diminished its record value, insurers started dropping protection to the purpose the place solely 36 p.c of sufferers had entry to it, and the corporate finally stopped making it, he stated.
Throughout the listening to, Sanders and different Democratic senators questioned Jørgensen about why the blockbuster weight reduction and diabetes medication Wegovy and Ozempic value a lot extra within the U.S. in comparison with different international locations.
“Treat the American people the same way that you treat people all over the world,” Sanders stated. “Stop ripping us off.”
Sanders stated People with diabetes pay as a lot as $969 monthly for Ozempic, whereas the identical drug could be bought for $155 in Canada, $122 in Denmark and $59 in Germany.
The record value for Wegovy within the U.S. is $1,349 monthly, whereas Sanders stated the identical product could be bought for simply $186 in Denmark, $140 in Germany and $92 in the UK.
Novo Nordisk has made practically $50 billion in gross sales from these two medication alone, Sanders famous.
Jørgensen countered that People with insurance coverage pay far lower than the record value. Ozempic for diabetes is roofed by 99 p.c of economic plans, he stated, in addition to Medicare and Medicaid.
However protection of Wegovy for weight reduction is far much less constant, which means sufferers usually tend to be on the hook for the complete value of the drug.
Jørgensen stated Wegovy is roofed by half of all business plans, and nearly all of sufferers with insurance coverage protection pay $25 or much less for a 28-day provide.
“It is not our intention that anyone should pay the list price,” Jørgensen stated, as a result of it’s meant to be the place to begin for negotiations between the drug firm and PBMs.
Drug firms and PBMs routinely blame one another for why pharmaceuticals value a lot. However the complicated system rewards each events. Sanders stated even given the rebates, Novo Nordisk’s web costs are nonetheless far greater than what folks pay in different international locations.
“You’re making huge amounts of money in this country, and you’re charging us far more. And you haven’t given me an answer as to why,” Sanders stated.
Regardless of the hassle by Sanders to maintain the give attention to Novo Nordisk’s pricing selections, the PBM trade confronted its share of criticism from lawmakers.
“Novo Nordisk is not the villain in this story. They’re a hero,” Sen. Roger Marshall (R-Kan.) stated. “The PBMs are making the bank here.”
Sen. Tim Kaine (D-Va.) stated the brand new skill for Medicare to barter drug costs will assist maintain drug firms answerable for excessive costs, however there hasn’t but been an effort by Congress to reform the PBM trade.
“I have come to conclude, along with a number of my colleagues … we’re letting PBMs get away scot-free,” Kaine stated. “One industry is under fairly intense scrutiny by this committee in Congress and one isn’t, and it’s the one that’s super-duper profitable and not researching and not producing products.”
Bipartisan payments to alter sure PBM enterprise practices have cleared two Senate committees, together with the Well being Committee, however by no means made it to the ground.
Main coverage disagreements between Home and Senate Republicans by way of the scope of the modifications led to the payments being sidelined this previous spring, probably till the lame-duck session after the November elections.
Kaine additionally expressed skepticism that the PBMs would really chorus from limiting protection of Wegovy and Ozempic if Novo Nordisk lowered the costs.
“Color me skeptical that an industry that is now giving us pie-in-the-sky statements about what they’re willing to do … that they’re going to come to the table and suddenly have a conversion experience and start doing the right thing,” he stated.
