Litigation Against Medicare Price Negotiation Gains Four Potential New Plaintiffs
Abbvie, Amgen, Novartis and Novo Nordisk have drugs on the list but haven’t sued yet. While they could add to the ranks of legal opposition, the Court Battle for the IRA is more about philosophy than numbers.
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CMS will monitor Medicare plans’ use of utilization management, and they are required to have the negotiated drugs on formulary, but the ‘ultimate question’ is how the plans will cover these negotiated drugs.
Some drugs recorded significant increases in Medicare gross spending between the periods covered by publicly available data and what CMS had access to internally, which contributed to their unexpected presence on the list.
Amgen asked the FTC to accept its pledge not to bundle Horizon’s Tepezza or Krystexxa, while an FTC administrative law judge urged a settlement between the agency and Amgen.