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Major U.S. health insurers, including CVS Health, Elevance Health, and Kaiser Permanente, have agreed to cover the anti-obesity drug Wegovy for certain Medicare beneficiaries with heart-related conditions. This decision comes after new guidance from the Centers for Medicare and Medicaid Services, which allows Part D plans to cover anti-obesity medications if they receive approval for an additional use. The coverage change will alleviate the financial burden on individuals who were previously paying out of pocket for the drug, but it may also result in billions of dollars in additional drug spending for insurers. [Extracted from the article]

A Johnson & Johnson employee has filed a lawsuit accusing the company of mismanaging its workers' prescription-drug benefits. The lawsuit alleges that J&J did not make enough effort to secure good deals for its employees on prescription drugs, resulting in overpayment for some generic drugs. The lawsuit seeks compensation for the alleged losses to the employees' health plan but does not specify an amount. This lawsuit is part of a larger battle over transparency and cost in the management of employers' health and drug benefits, and it is one of the first of its kind to be filed. [Extracted from the article]

CVS, the largest drugstore chain in the US, plans to change how pharmacies are paid for prescription drugs. Currently, pharmacies are paid using complex measures that are not directly based on the cost of the drugs. Under CVS's new plan, pharmacies will be reimbursed based on the amount CVS paid for the drugs, plus a small markup and a fee for services. This move aims to bring transparency and accountability to drug pricing, but the effects on consumers, employers, and health insurers may vary. Some drugs may become cheaper, while others may increase in price. CVS's new payment model, called CostVantage, will be phased in starting in 2024. [Extracted from the article]

Keywords: gfx-contrib; photo-commission; wsjhealth; North America; United States; Midwest U.S.; Indiana; Corporate/Industrial News; SYND; WSJ-PRO-WSJ.com EN gfx-contrib photo-commission wsjhealth North America United States Midwest U.S. Indiana Corporate/Industrial News SYND WSJ-PRO-WSJ.com N.PAG N.PAG 1 10/03/23 20230929 NES 230929 Indiana group's bruising battle for legislation to limit hospital fees is spurring employer groups in other states to follow suit A bruising battle over hospital costs in Indiana previews a growing trend: Employers are sick of the ever-rising price of healthcare, and they are ready to do something about it. Gloria Sachdev, who is chief executive officer of the Employers' Forum of Indiana, launched research that produced a stunning takeaway: They paid the most out of all the states studied. [Extracted from the article]

The company has raised its own prices to cover mounting costs including healthcare, he said, but if it isn't able to do so in the future, he might be forced to increase workers' out-of-pocket costs for care. Keywords: wsjhealth; kwexclusive; Insurance; Non-life Insurance; Health/Medical Insurance; Financial Services; Labor/Personnel; Corporate/Industrial News; Workers Pay; Political/General News EN wsjhealth kwexclusive Insurance Non-life Insurance Health/Medical Insurance Financial Services Labor/Personnel Corporate/Industrial News Workers Pay Political/General News N.PAG N.PAG 1 09/11/23 20230908 NES 230908 Employers and workers are expected to see an increase of about 6.5% or higher in health-plan costs next year Health-insurance costs are climbing at the steepest rate in years, with some projecting the biggest increase in more than a decade will wallop businesses and their workers in 2024. [Extracted from the article]

German pharmaceutical firm Bayer AG has been requested to withdraw Trasylol, a coagulant drug, from the market until more data becomes available regarding the drug's safety. One clinical study has indicated Trasylol could be linked to a 50% increased risk of death than rival medications. Trasylol had worldwide sales totaling $223.5 mil in 2006.

Swiss pharmaceutical firm Novartis AG received approval by the European Union to market a generic version of epoetin alfa, an anti-anemia drug, in Europe. The non-generic version, Eprex, is marketed in Europe by Johnson and Johnson.

U.K.-based pharmaceutical company GlaxoSmithKline PLC shares dropped by 7% after analysis by Cleveland Clinic cardiologist Steven Nissen suggested a potential cardiovascular risk in patients taking Glaxo's antidiabetic drug Avandia. Avandia sales totaled $3 bil in 2006.

Sanofi S.A. has obtained approval from the US Food and Drug Administration for its viral vaccine to prevent avian influenza in humans. The vaccine will not be marketed to the general public, but is expected to provide a measure of protection for workers who have a higher risk of contracting the disease.

At the request of the U.S. Food and Drug Administration, pharmaceutical companies are putting warning labels on their sleeping medications. Adverse effects include severe allergic reactions and unconscious behaviors like driving while asleep.

Pharmaceutical companies in the United Kingdom, Switzerland, Japan, and the United States are researching existing diabetes drugs to see if they can be used in diabetes prevention. The potential market for a diabetes prevention drug could be as high as $15 billion per year.

Watchdogs that work for Medicaid Programs, insurers and nonprofit organizations are studying the advertising of pharmaceutical companies, debunking advertising spin on new medications. By studying the clinical trials closely they are able to help the consumer understand what the research is really saying.

Health Canada has pulled Adderall XR, a popular treatment for attention deficit hyperactivity disorder, off the market because of safety concerns, but the U.S. Food and Drug Administration refuses to follow suit because it cites mitigating factors.

The U.S. system for drug approval and the Food and Drug Administration's procedures for responding to drug safety issues after drugs are approved is discussed in light of the recent recall of several high-profile medications in the United States. Drug approval and monitoring procedures in such countries as France, Britain, and Sweden are also examined.

Pfizer Inc.'s new antiarthritic drug, Celebrex has been recalled due to increased risks of cardiovascular problems. United States Food and Drug Administration faces the challenge of detecting and responding to long term adverse side effects that emerge after the agency has approved them.

Pfizer Inc. plans to continue to market its painkiller Celebrex after reports of adverse side effects in the drug, but will scrap its advertising for the drug. This is in contrast to Merck and Company Inc., which withdrew its painkiller Vioxx after numerous reports of potentially fatal side effects.

The U.S. Food and Drug Administration has been criticized for its monitoring of risks by David Graham, and official in the FDA's drug-safety office, during a hearing which focused on Vioxx, the Merck and Company Inc. painkiller which was withdrawn for reasons of health risk.

The recent recall of Vioxx is highlighting concerns about how regulators deal with evidence of risks once a drug has been approved. There are also questions about whether the FDA is striking the proper balance between the potential benefits and risks of drugs.

Merck and Company Inc. has had to recall its painkiller Vioxx, after evidence was shown that the medication raises the risk of heart attack two-fold. About two million people will be affected, who will have to take other medications instead which also have adverse side-effects. The company's future is in doubt, with the loss of billions of dollars in sales.

A House Energy and Commerce subcommittee will hold a hearing to sort out a growing controversy in the pharmaceutical industry regarding labeling; the FDA's attempts to balance informing the public with preventing unnecessary fear have created confusion with products such as Wyeth Pharma's Effexor.

Recent Food and Drug Administration analysis indicates that antidepressants increase the chances of suicide in young patients. The agency will likely recommend label changes and other regulatory improvements.

Guidelines for medicines covered by the new Medicare drug benefit are expected to increase the already heavy lobbying by the pharmaceutical industry and the insurance industry.