Day: November 23, 2021

Blog article

Cap on drug price hikes for privately insured sparks battle

Workers and families with private health insurance would reap savings on prescription drugs from a little-noticed provision in President Joe Biden’s sweeping social agenda bill. It’s meant to break the cycle of annual price increases for widely used medicines.

That provision would require drug companies to pay rebates to Medicare if they increase prices above the rate of inflation. Drugs sold to private plans would count in calculating the penalty, like a tax on price increases. The issue is dividing business groups in a fierce lobbying battle.

Corporate groups focused on affordable employee benefits want to keep the language as is so it would provide price-increase protection for companies and their workers and not just Medicare enrollees. Other groups such as the influential U.S. Chamber of Commerce are backing the pharmaceutical industry’s drive to block restraints on pricing, including inflation caps, saying they would stifle innovation.

House Democrats passed the

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Health News

Insurers balk at paying for Biogen’s $56,000-a-year Alzheimer’s treatment

Credit: CC0 Public Domain

U.S. health insurers say they want more proof before paying for Biogen Inc.’s Aduhelm, stalling sales of the costly new Alzheimer’s therapy that the company hailed as a breakthrough for patients.

None of the 25 large insurers that responded to a Bloomberg News survey judged the $56,000-a-year drug “medically necessary,” a term used to describe treatments that are needed for specific ailments and meet medical standards. Most have deemed Aduhelm experimental, while some say they’re still evaluating it.

Insurers cited uncertainty about benefits and side effects for their denials. Still, Humana Inc., the nation’s second-largest Medicare insurer, is covering the drug for members who resemble those it helped in .

Health insurers and will play an outsize role as gatekeepers for Aduhelm, which the Food and Drug Administration approved despite objections from its scientific advisers and contradictory clinical trial results. Some patients

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