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 Sen. Bernie Sanders (I-Vt.), chair of the Senate Committee on Well being, Schooling, Labor and Pensions (HELP).
Novo Nordisk chief Lars Fruergaard Jørgensen advised senators Tuesday that pharmacy profit managers (PBMs), the business middlemen that negotiate the phrases and circumstances for entry to pharmaceuticals, are the explanation Wegovy and Ozempic value a lot.
Jørgensen mentioned his firm must pay excessive rebates to the PBMs with a purpose to get favorable insurance coverage protection. In his written testimony, he mentioned the online worth for Ozempic, which displays the quantity his firm is paid per prescription, is down 40 % 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 most important drug middlemen confirmed that decreasing the checklist worth alone wouldn’t negatively influence their choices to cowl the medicine in query.
“I’m delighted to announce right this moment that I’ve acquired commitments in writing from the entire main PBMs that if Novo Nordisk considerably decreased the checklist worth for Ozempic and Wegovy, they’d not restrict protection,” Sanders mentioned. “In actual fact, all of them advised me they’d be capable of develop protection for these medicine if the checklist worth was decreased.”
Sanders repeatedly requested Jørgensen whether or not, in mild of that data, he would decide to working with the PBMs to decrease the medicine’ costs.
“Something that may assist sufferers get entry, I’m supportive of. And that features collaborating and negotiating with anybody who might help that,” Jørgensen mentioned.
However he added a wholesome dose of skepticism concerning the specifics of what the PBMs dedicated to doing.
“Once I hear statements that PBMs would entry a low checklist worth product, it must go to sufferers,” Jørgensen mentioned. “If it really works in a manner that sufferers get entry to extra reasonably priced drugs and now we have certainty that it truly occurs … we will likely be optimistic in the direction of it.”
Jørgensen identified that chopping checklist costs doesn’t at all times result in expanded protection, as a result of PBMs make extra rebates from merchandise with larger costs.
For instance, he cited the corporate’s insulin product Levemir. After Novo Nordisk decreased its checklist worth, insurers started dropping protection to the purpose the place solely 36 % of sufferers had entry to it, and the corporate finally stopped making it, he mentioned.
Through the listening to, Sanders and different Democratic senators questioned Jørgensen about why the blockbuster weight reduction and diabetes medicine Wegovy and Ozempic value a lot extra within the U.S. in comparison with different nations.
“Deal with the American folks the identical manner that you just deal with folks all around the world,” Sanders mentioned. “Cease ripping us off.”
Sanders mentioned 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 checklist worth for Wegovy within the U.S. is $1,349 monthly, whereas Sanders mentioned the identical product could be bought for simply $186 in Denmark, $140 in Germany and $92 in the UK.
Novo Nordisk has made almost $50 billion in gross sales from these two medicine alone, Sanders famous.
Jørgensen countered that People with insurance coverage pay far lower than the checklist worth. Ozempic for diabetes is roofed by 99 % of business plans, he mentioned, in addition to Medicare and Medicaid.
However protection of Wegovy for weight reduction is way much less constant, which means sufferers usually tend to be on the hook for the complete value of the drug.
Jørgensen mentioned Wegovy is roofed by half of all business plans, and the vast majority of sufferers with insurance coverage protection pay $25 or much less for a 28-day provide.
“It isn’t our intention that anybody ought to pay the checklist worth,” Jørgensen mentioned, 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 advanced system rewards each events. Sanders mentioned even given the rebates, Novo Nordisk’s web costs are nonetheless far larger than what folks pay in different nations.
“You make large quantities of cash on this nation, and also you’re charging us much more. And also you haven’t given me a solution as to why,” Sanders mentioned.
Regardless of the hassle by Sanders to maintain the give attention to Novo Nordisk’s pricing choices, the PBM business confronted its share of criticism from lawmakers.
“Novo Nordisk will not be the villain on this story. They’re a hero,” Sen. Roger Marshall (R-Kan.) mentioned. “The PBMs are making the financial institution right here.”
Sen. Tim Kaine (D-Va.) mentioned the brand new means for Medicare to barter drug costs will assist maintain drug firms liable for excessive costs, however there hasn’t but been an effort by Congress to reform the PBM business.
“I’ve come to conclude, together with plenty of my colleagues … we’re letting PBMs get away scot-free,” Kaine mentioned. “One business is underneath pretty intense scrutiny by this committee in Congress and one isn’t, and it’s the one which’s super-duper worthwhile and never researching and never producing merchandise.”
Bipartisan payments to alter sure PBM enterprise practices have cleared two Senate committees, together with the HELP Committee, however by no means made it to the ground.
Main coverage disagreements between Home and Senate Republicans when it comes to 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 truly chorus from limiting protection of Wegovy and Ozempic if Novo Nordisk lowered the costs.
“Colour me skeptical that an business that’s now giving us pie-in-the-sky statements about what they’re keen to do … that they’re going to come back to the desk and instantly have a conversion expertise and begin doing the proper factor,” he mentioned.
