Medicare is paying wildly different prices for the same drug, even for people insured under the same plan. As a result, people covered by Medicare can be on the hook for thousands of dollars in additional out-of-pocket costs depending on where they live and which drug plan they choose. Take commonly used generic versions of prostate-cancer treatment Zytiga. They have more than 2,200 prices in Medicare drug plans. The generics ring in at roughly $815 a month in northern Michigan, about half of what they cost in suburban Detroit, while jumping to $3,356 in a county along Lake Michigan, according to a recent analysis of Medicare data.
The Biden administration plans to require Medicare and Medicaid to offer coverage of weight loss medications for patients seeking to treat obesity. The new rule, which was proposed by the administration on Tuesday, would dramatically expand access to anti-obesity medications like Wegovy, Ozempic and Mounjaro. Until now, Medicare and Medicaid have only provided insurance coverage for these drugs when they are used to treat conditions such as diabetes.
Robert F. Kennedy Jr. and his advisers are considering an overhaul of Medicare's decades-old payment formula, a bid to shift the health system's incentives toward primary care and prevention, say four people who spoke on the condition of anonymity to discuss private deliberations. The discussions are in their early stages, the people say, and have involved a plan to review the thousands of billing codes that determine how much physicians get paid for performing procedures and services.
Mehmet Oz, MD, has sown misinformation about COVID treatments, weight loss hacks and unproven supplements. He has invested in drug companies, even as he has publicly taken aim at Big Pharma, and has profited from a medical device that he helped invent but that has been subject to several recalls. Over roughly two decades in the public eye, Oz has drawn the ire of medical experts, members of Congress and even his own peers, including a group of 10 doctors who called for him to be fired from a faculty position at Columbia University, arguing he had shown a “disdain for science." The university quietly cut its public ties with Oz in 2022.
CVS Health, UnitedHealth Group and Cigna are suing the FTC, claiming that the agency's case against drug supply chain middlemen over high insulin prices in the U.S. is unconstitutional. The complaint is the latest move in a bitter legal fight between the three largest PBMs in the U.S. and the FTC. The FTC in September sued CVS's Caremark, Cigna's Express Scripts and UnitedHealth's Optum Rx in the agency's administrative court, accusing those PBMs and other drug middlemen of using a "perverse" rebate system to boost their profits while inflating insulin costs for Americans.
Lilly and Novo Nordisk are hoping to win over employers on the idea that obesity and its complications are already a huge cost in terms of healthcare, workers' compensation and disability. By offering employees coverage for the weight-loss drugs Zepbound and Wegovy, companies can save money in the long run, the messaging goes. Whether these efforts succeed will help shape the size of the anti-obesity drug market, which some analysts predict could top $100 billion in annual sales. It is an unconventional approach for pharmaceutical companies. They have long used tried-and-true methods to boost sales, including running TV ads aimed at consumers, and sending tenacious representatives to persuade doctors to prescribe drugs to patients and health insurers to pay for them.