FTC deal over insulin prices forces Express Scripts to overhaul policies
Elizabeth Casolo / beckershospitalreview - The Federal Trade Commission reached a settlement with Cigna’s Express Scripts in a case over alleged inflation of insulin prices, according to a Feb. 4 agency news release. Under the settlement, Express Scripts must keep drug manufacturer compensation de…
AI Summary: Federal regulators reached a settlement with Express Scripts amid long‐standing allegations that the pharmacy benefit manager overcharged for insulin. The deal forces sweeping policy revisions to curb price inflation and protect patients from rising costs, following years of regulatory scrutiny over insulin rebate practices.
‘Vertical integration is destroying people’s ability to access care’: Payer CEOs face bipartisan congressional grilling
Jakob Emerson / beckershospitalreview - The CEOs of the nation’s largest health insurers drew the ire of lawmakers on both sides of the aisle during congressional hearings Jan. 22 over industry consolidation, prior authorization practices and executive pay, with members pressing executives to e…
AI Summary: Lawmakers grilled top health insurance executives in a high‐profile congressional hearing over rising healthcare costs, vertical integration and shifting of cost burdens to hospitals and drug makers. The grilling highlighted deep concerns over patient access and systemic inefficiencies in American healthcare.
Compounding pharmacy sues Eli Lilly, Novo Nordisk over GLP-1 access
Ella Jeffries / beckershospitalreview - Strive Compounding Pharmacy filed a federal antitrust lawsuit Jan. 14 against Eli Lilly and Novo Nordisk, alleging the two drugmakers used their market power to restrict access to compounded GLP-1 medications and suppress competition. The lawsuit, filed i…
AI Summary: A compounding pharmacy has taken legal aim at industry giants Eli Lilly and Novo Nordisk, alleging an anti‑competitive scheme designed to restrict access to their blockbuster GLP‑1 therapies. The lawsuit puts the pharmaceutical titans on the defensive as antitrust concerns mix with therapeutic access debates.
Judge blocks 340B rebate pilot program
Ella Jeffries / beckershospitalreview - A federal judge granted a temporary restraining order blocking the Department of Health and Human Services from launching its 340B Rebate Model Pilot Program, which was scheduled to begin Jan. 1, 2026. U.S. District Judge Lance Walker of the District of M…
AI Summary: A federal judge has temporarily halted the rollout of a 340B rebate pilot program designed to reshape drug pricing ahead of its January start. The ruling challenges the current administration’s approach to reforming pricing models, casting uncertainty on the initiative’s future.
House floats new healthcare bill after Senate proposals fail
Andrew Cass / beckershospitalreview - House Republicans have unveiled new healthcare legislation in the wake of votes in the Senate that failed to pass bills addressing expiring ACA enhanced subsidies. Seven things to know: 1. The House Republicans’ proposal does not extend the subsidies that…
AI Summary: House Republicans have introduced new legislation aimed at containing rising healthcare costs after recent Senate proposals failed. Notably, the bill deliberately excludes any extension of ACA subsidies or changes to health savings accounts, signaling a distinctly partisan approach that is already stirring debate on its future impact.
Optum Rx: 100% of network community pharmacies shift to cost-based model
fiercehealthcare - Earlier this year, Optum Rx announced that it would shift to a cost-based model, which would boost reimbursements for brand-name drugs at community pharmacies.
AI Summary: In a significant payment model overhaul, Optum Rx has moved 100% of its community and independent pharmacies to a cost‐based model, a change aimed at aligning reimbursements with actual expenses and enhancing pharmacy viability in a challenging market.
ACA approval hits new high as subsidies set to expire: 7 things to know
Alan Condon / beckershospitalreview - Approval of the ACA recently climbed to a new high of 57% — driven largely by a surge in support among independents — even as pandemic‑era enhanced subsidies are set to expire Dec. 31 unless Congress acts, according to a survey published Dec. 8 by the Wes…
AI Summary: Multiple reports point to growing concerns that the impending expiration of expanded Affordable Care Act subsidies could leave millions facing steep premium hikes or loss of coverage. Survey findings and policy analyses underscore the potential financial strain on vulnerable populations as the deadline nears.
CVS Health agrees to pay $37.8M to settle fraud allegations over insulin pens
fiercehealthcare - CVS Health agreed to pay $37.76 million to settle allegations that it dispensed too many insulin pens to patients and improperly billed federal healthcare programs for those prescriptions.
AI Summary: CVS Health has agreed to pay approximately $38 million to settle allegations that it improperly dispensed insulin pens and misbilled federal health programs, resolving accusations of fraudulent practices and restoring trust in its operations.
UK and US agree zero-tariff deal on pharmaceuticals
go - Officials say the U.K. has sealed a deal securing a 0% tariff rate for all U.K. medicines exported to the U.S. for at least 3 years, in return for the U.K. spending more on new medicines
AI Summary: In a twist worthy of a Hollywood trade drama, officials announced that the UK and US have struck a deal to impose zero tariffs on UK‐made medicines destined for the US. As part of the arrangement, the UK must shell out considerably more for drug pricing—a move set to avoid tariffs that could soar as high as 100%—with the agreement effective for at least three years.
Novo Nordisk rolls out lower prices for Ozempic and Wegovy
medicalxpress - People paying out of pocket for Ozempic or Wegovy may soon see lower costs, as Novo Nordisk rolls out new price discounts for its popular GLP-1 medications.
AI Summary: In a bid to ease the financial burden on self‐pay patients, Novo Nordisk has unveiled deep price cuts for its flagship GLP-1 drugs, Ozempic and Wegovy. The new pricing strategy comes amid intensifying market pressures and aims to broaden access to these critical therapies for weight management and type 2 diabetes.
CMS unveils new Medicaid drug payment model
Max Bayer / endpoints - CMS plans to launch a new drug payment model for state Medicaid programs, the first of potentially multiple pricing models under President Donald Trump's "most favored nation" push that the pharma industry has been closely ...
AI Summary: The Centers for Medicare and Medicaid Services has introduced a novel Medicaid drug payment model that employs a most-favored nation pricing strategy, aiming to rein in healthcare spending. This bold move signals a shift toward competitive pricing that, while promising cost efficiencies, also raises eyebrows over its unorthodox approach.
What Trump’s New Drug Pricing Deal Means for People With Obesity
Rebecca Robbins, Dani Blum and Margot Sanger-Katz / nytimes - The president’s agreement with drug companies involves a range of prices, depending on dose, product and how you’re paying.
AI Summary: In a bold move to tackle the obesity crisis, the Trump administration has brokered agreements with industry giants such as Eli Lilly and Novo Nordisk to slash weight-loss drug prices. The deals, promising reductions as steep as $149 a month, have sparked both applause and debate over the future of drug pricing in America.