Trump Administration Sinks Teeth Into Paring Down Drug Prices, On 5 Key Points

Image result for Trump Administration Sinks Teeth Into Paring Down Drug Prices, On 5 Key Points imagesSource: Kaiser Health News

Three months after President Donald Trump announced his blueprint to bring down drug prices, administration officials have begun putting some teeth behind the rhetoric.

Many details have yet to be announced. But experts who pay close attention to federal drug policy and Medicare rules say the administration is preparing to incrementally roll out a multipronged plan that tasks the Centers for Medicare & Medicaid Services (CMS) and the Food and Drug Administration with promoting competition, attacking the complicated drug rebate system and introducing tactics to lower what the government pays for drugs.

Mark McClellan, director of the Duke-Margolis Center for Health Policy in Durham, N.C., and a former CMS administrator, said that although none of the initial steps has “fundamentally transformed drug prices,” there is “a lot going on inside the administration.”

Two HHS officials who are rolling out the plan, Dan Best and John O’Brien, described their efforts to Kaiser Health News not as a public relations strategy but a push to reform the system.

“This administration is trying to go after root causes” of high drug prices, said Wells Fargo analyst David Maris.

But others are not so optimistic.

Ameet Sarpatwari, an instructor in medicine at Harvard Medical School in Boston, said policies the administration has rolled out thus far “alone will not translate into meaningful cost savings for most Americans.”

Broadly, the strategy falls under a handful of steps:

1. Attacking The Rebates

Health and Human Services Secretary Alex Azar has said Americans “do not have a real market for prescription drugs” because drug middlemen and insurers get a wide range of hidden rebates from drugmakers, but those savings may not be passed on to consumers or Medicare. In July, the administration submitted a proposed rule that could change the way rebates are handled.

Details of the proposal have not been made public. But O’Brien, a deputy assistant secretary at HHS, explained during a recent conference on federal drug spending sponsored by the Pew Charitable Trust: “You don’t have to use market power to get rebates, you can use market power to obtain discounts, to actually lower the price of the drug on the front end.”

Umer Raffat, an investment analyst with EverCore ISI, said “it’s not clear [that drug prices are going down]” but the “rebate structure is changing.”

2. Bringing More Negotiation To Medicare

This week, CMS Administrator Seema Verma announced that Medicare Advantage insurers can use a step-therapy approach to negotiate better prices for Part B drugs — those administered in hospitals and doctors’ offices. These private plans will be allowed to require patients to first select the least expensive drug before stepping up to more costly drugs if the original medications aren’t working.

The administration is also looking at ways to introduce more competition into Part B drug purchasing. That idea was mentioned deep inside the annual Medicare outpatient payment rule released last month.

Peter Bach, director of Memorial Sloan Kettering’s Center for Health Policy and Outcomes in New York, pointed to the possible introduction of a competitive purchasing program in which a firm negotiates with drugmakers to buy their drugs and then sells them to the doctors and hospitals that will administer the medications. Bach said that helps ensure that hospitals and doctors can’t make more money by prescribing more expensive drugs.

Currently, Medicare pays the average sales price plus 6 percent to doctors or hospitals when they purchase drugs, a pricing mechanism that can benefit the providers if the drug costs go up. If there were a third party buying the drugs, it would “have a huge effect,” Bach said.

3. Paying For Value

Trump’s blueprint calls for CMS to encourage “value-based care” to lower drug prices, shifting from paying a set fee for drugs to basing payments on how well the patient does on them.

Louisiana’s Medicaid program could show the way. The state is working with CMS to explore a subscription-based model to pay for hepatitis C medicines. Louisiana would pay a fixed price to a drug manufacturer that would then get unlimited access to treat patients enrolled in Louisiana’s Medicaid program or in prison.

The program would move “from a big payment upfront to paying less over time based on actual outcomes,” said McClellan, who also serves on the boards of health care giant Johnson & Johnson and insurer Cigna.

CMS also approved a Medicaid waiver from Oklahoma in June. Medicaid programs are allowed to negotiate drug prices. Oklahoma’s plan would expand that to negotiate additional prescription price reductions based on value-based purchasing agreements.

Still, CMS’ recent rejection of a related Massachusetts proposal makes it difficult to believe negotiating drug prices will really happen, said Sara Rosenbaum, a professor of health law and policy at George Washington University.

That proposal would have allowed Massachusetts’ Medicaid program to choose drugs based on cost and how well the medicines work.

“They have been very good and quite careful with their [Medicaid] program and so why not let them try this?” Rosenbaum said.

4. Tackling Foreign Drug Costs

Pharmaceutical makers often sell their drugs at substantially lower prices in many foreign countries than they do in the United States. Trump emphasized in May that “it’s time to end the global freeloading once and for all,” saying U.S. consumers were paying part of the cost of the medicines that patients in other countries use.

He directed U.S. Trade Representative Robert Lighthizer to address the situation. Lighthizer’s office declined to comment.

When Sen. Todd Young (R-Ind.) asked during a Senate health committee hearing in June whether trade agreements with other countries should be used to “level the playing field,” Azar’s response was swift: “We absolutely believe we should be using our trade agreements to get them to pay more even as we have our job to pay less.”

Avalere Health President Matt Brow, who has been involved in talks with the administration, said it’s clear the focus on overseas pricing isn’t going away and the administration is “talking a lot about how to get the president what he wants.”

5. Increasing Competition

FDA Commissioner Scott Gottlieb has become the Trump administration’s lead proponent for increasing competition among drugmakers.

Competition resonates with Americans “because people see it every day in their experience in Costco and other places,” said Rena Conti, an assistant professor at the University of Chicago.

Gottlieb has announced plans to bolster the use of generic drugs and an “action plan” to encourage the development of biosimilars, which are copycat versions of expensive biologic drugs made from living organisms.

And to combat anti-competitive behavior in the market, Gottlieb said the FDA has passed along information to the Federal Trade Commission and hinted at potential action to come: “I think we’ve handed them some pretty good facts.”

Reality Check on PBMs and Drug Costs

Image result for Reality Check on PBMs and Drug Costs imagesSource: Politico

PBMs AND DRUG PRICES: A REALITY CHECK — There’s a big target on the backs of pharmacy benefits managers lately with both the drug industry and HHS drawing attention to the role they play in the pricing of medicines. Pending at OMB is a rule that could dramatically reshape PBMs by changing the practice of drug rebating — the discounts that PBMs negotiate with pharmaceutical companies — with the aim of ultimately lowering the cost of drugs.

Because the PBMs can retain a portion of the rebate as profit, they may have a perverse incentive to favor higher-cost medicines with larger rebates in their insurance plan formularies, leading drugmakers to raise prices on brand medicines, HHS Secretary Alex Azar has said.

But a new analysis sheds light into how little of U.S. drug spending might be addressed by overhauling rebates. That’s because most of the money spent on pharmaceuticals in this country goes to drug companies — not middlemen like PBMs, wholesalers, pharmacies, insurers or doctors.

The U.S. spent an estimated $480 billion on prescription medicines in 2016, including the gross profits of all intermediaries, according to an analysis last week on the Health Affairs blog. Memorial Sloan Kettering Cancer’s Nancy Yu, Preston Atteberry and Peter Bach found that $323 billion of that was drugmakers’ net revenue excluding rebates, discounts and other price concessions like copay coupons — but not accounting for manufacturing expenses.

In comparison, PBMs captured only 4 percent of the pie — or $23 billion in gross profits. That’s less than the profits taken by other players in the supply chain like pharmacies ($73 billion), providers ($35 billion) and wholesalers ($18 billion).

Put another way, as Financial Times reporter David Crow wrote last week: “Even if Mr. Azar’s reforms were to wipe [CVS and Express Scripts] profits out entirely, the savings would not cover the cost of the U.S.’s top-selling medicine, AbbVie’s anti-inflammatory drug Humira, which generated $12.36 billion in sales last year” in the U.S.

Asked whether it was fair to compare net revenue of drug makers to gross profits in the other industry, Bach, one of the authors, said that they were not looking to compare which part of the drug supply chain was more profitable. Instead they were following each drug from the time it’s manufactured and determining how much every player in the supply chain makes as the medicine passes through their hands. “So finding those dollars was the point“ Bach said.

None of this means PBMs are likely to catch a break anytime soon. And there may be legitimate reasons for concern about the industry’s practices. An article by Axios’ Bob Herman caught our eye last week. It contains a wealth of data on the difference between what pharmacies are paying for medicines and what state Medicaid programs are paying PBMs for the same drugs. For example, Indiana’s Medicaid program paid about $300 per pill for a generic version of Novartis’ Gleevec, while the drug’s pharmacy acquisition cost was $84.

Happy Monday and welcome back to Prescription PULSE, where we draw your attention to a very colorful warning letter from the FDA to BioDiagnostics. Agency inspectors found that the company used “kitchen cooking pots and household power tools” to manufacture a drug for vaginal use. It has since recalled all of its products, Fierce Pharma reports. Send your favorite drug manufacturing stories and pharma tips to Sarah Karlin-Smith ( or@sarahkarlin) and Sarah Owermohle ( or@owermohle).

A PBM PUSHES BACK  Express Scripts “will be just fine without rebates,” the PBM’s senior vice president and chief medical officer, Steve Miller, said in a media briefing Thursday. The problem, he argued, is how fast you remove what has become a mainstay in drug contracts without shocking payers’ budgets with the full price of therapies.

“Making them go away overnight is probably a windfall to pharmaceutical manufacturers and a punishment to all the plan sponsors,” said Miller. It could be particularly disastrous for Express Scripts’ Medicaid programs, which the PBM says keep 100 percent of their negotiated rebates — and therefore would feel the full brunt of the list price in a rebate-less system. Commercial plans may not fare much better — the company reports that they pocket an average 10 percent of rebates they negotiate for other payers.

The PBM is proposing a “glide path” of at least a few years to transition payers from from buying high-rebate drugs like insulin at their rebated price to buying them at their straightforward list price. The hope is that drugmakers would reduce their prices during that period until they eventually match what the companies would have taken in under the rebate system — and the result would be budget-neutral for payers. The problem is that no drug makers (that we know of) are publicly on board with cutting prices by rebate-equivalent amounts.

Express Scripts has floated the idea with state payers and talked to drugmakers that have concerns about how long such a phase-in would take, Miller said. “There’s a lot of details to work out on this, but we believe we have to be creative going forward.”

SENATE APPROPS: WHERE THE FDA MONEY WOULD GO — The Senate last week approved $159 million in new discretionary spending for FDA in fiscal year 2019 via H.R. 6147 (115) — significantly less than the $400 million requested by the administration. Medical product initiatives would get $88.5 million and new efforts to respond to the opioid crisis would get $49 million. The rest would go to food safety.

The medical product dollars in the Senate bill would go toward promoting domestic drug manufacturing and advanced medical device manufacturing, as well as helping FDA stay current with the science and tools needed to evaluate new drugs. Money is also dedicated for modernizing generic drug development and review and to FDA’s oncology center of excellence and rare disease work. For more details on these programs and how the Senate bill compares to what House appropriators have laid out for FDA, see this handy breakdown from the Alliance for a Stronger FDA.

ICYMI: HOW DRUG COMPANIES ARE BEATING TRUMP AT HIS OWN GAME — At least 10 pharmaceutical makers made pledges to roll back or freeze prices in July following a tweet from President Donald Trump. But those gestures are largely symbolic — efforts to beat Trump at his own game by giving him headlines he wants without making substantive changes to the way they do business, Sarah and Sarah report, along with colleague Andrew Restuccia.

The token concessions are “a calculated risk,” said one drug lobbyist. “Take these nothing-burger steps and give the administration things they can take credit for.”

Even the few companies that actually cut prices mostly targeted old products that no longer produce much income — such as Merck’s 60 percent discount to a hepatitis C medicine that had no U.S. revenues in the first quarter. Others volunteered to halt price increases for six months — in some cases, just weeks after announcing what is normally their last price hike for the year.

The industry’s deft response to Trump’s tweet shaming has also become a test of whether his administration is serious about following up with an aggressive crackdown on the companies — or will simply declare victory based on token measures and move on. Keep reading here.

HIGH-COST DRUGS SHIELDED BY NEARLY 40-YEAR MONOPOLIES — Hundreds of patents shielding the top-selling U.S. drugs have allowed pharmaceutical companies to extend their monopolies for years — meanwhile, those therapies’ prices have risen an average of 68 percent since 2012, according to an I-MAK report.

Four of the 12 best-selling medicines have already been on the market for 20 years, the standard exclusivity time frame for novel medicines approved by the FDA. But drugmakers have become adept at filing new patents for different indications, doses and manufacturing details, sometimes nearly doubling the duration of that monopoly.

AbbVie’s Humira, of course, tops the list for both revenue ($18 billion globally last year) and the number of patent applications (247 since it first hit the market). Though the FDA has approved two biosimilars of the autoimmune medicine, AbbVie has sued or struck deals with companies to keep competition out until at least 2022. Meanwhile, it has raised the drug’s price 144 percent since 2012. These tactics have increasingly drawn criticism — the patent system is one of the many priorities included in the Trump administration’s drug pricing blueprint, and FDA Commissioner Scott Gottlieb recently discussed the issue when launching a biosimilar action plan. But the agency can’t address IP issues itself — that could take FTC intervention.

Only one of the 12 blockbusters, the cancer treatment Herceptin, has dropped in price since 2012. But the Roche product also could potentially be the longest on the market without competition — the company is seeking to make it 48 years before rivals launch, according to the report by the nonprofit Initiative for Medicines, Access and Knowledge. Read the I-MAK report here.

UNAPPROVED ANTIDEPRESSANT COULD POSE EMERGING PUBLIC HEALTH RISK — Use of a nonapproved antidepressant that mimics some of the effects of opioids has spiked in recent years, posing a potential public health risk, researchers reported Friday in CDC’s Morbidity and Mortality Weekly Report. An analysis of calls to poison control centers related to tianeptine — marketed as Coaxil or Stablon, among others — from 2004 to 2017 found that while there were only 11 calls about the drug over the first 14 years combined, the number began rising noticeably in 2014 — reaching 81 calls in 2017 alone. Though the drug isn’t FDA approved, consumers can buy it online as a dietary supplement or research chemical. The authors recommend that misuse of tianeptine be considered when patients have opioid-like overdose or withdrawal symptoms.

“In light of the ongoing U.S. opioid epidemic, any emerging trends in drugs with opioid-like effects raise concerns about potential abuse and public health safety,” they write. Read the MMWR findings here.


Maine law eases generic development — Generic and biosimilar drug developers may soon be flocking to the Pine Tree State thanks to a new law, ME SP432 (181), that attempts to stop brand drugmakers from using FDA safety programs to prevent cheaper competition. Major pharmaceutical companies have long used the FDA safety programs, known as REMS, to prevent generic and biosimilar manufacturers from acquiring samples of their branded medicines. Samples are needed to do the necessary research for an FDA-approved copycat product. The issue has drawn attention — including bills in Congress — but no concrete action on the federal level. The Maine law, which was enacted on July 4 without Republican Gov. Paul LePage’s signature, will require brand companies to make available any drug distributed in the state to generic and biosimilar makers at a cost no greater than the wholesale price.

It will be interesting to see if brand-name drug companies try to challenge the law, said Nicholas Mitrokostas, a partner at Goodwin’s intellectual property group. They might argue that the state law is preempted by federal law, since REMS are a restriction put in place by FDA, he said.


Drug companies ramp up charity efforts in midst of opioid probes —Drug distributors and manufacturers are handing out millions of dollars in grants and donations to organizations in parts of the country that have sued the companies over their role in the opioid epidemic, Bloomberg’s Jared S. Hopkins reports. Wholesaler Cardinal Health, for example, has given at least $3 million to about 70 groups, including some with ties to plaintiffs in the opioid legislation. The efforts could pay off: Researchers at Harvard Business School who studied 20 years of lawsuits against public companies found that targeting advertising after lawsuits are filed increased the probability of a favorable outcome for companies. More here.

Clovis settles government probe over trial data — The company has agreed to pay $20 million to settle an SEC probe into whether it purposely misled investors with a false report of data on an investigational lung cancer drug. The news comes four months after the biotech revealed the SEC was preparing civil charges against current and former executives. More from Endpoints News here.

Opioid alternative may be endangering patients with back pain — The opioid epidemic appears to be spurring the use of injectable drug Depo-Medrol for back and neck conditions, with doctors administering the treatment close to the spinal cord. That’s despite known risks of administering the drug in this location and Pfizer’s own attempt to get FDA to ban that type of treatment five years ago due to risks of blindness, stroke, paralysis and death. Several other countries did so while the FDA beefed up the label warning. Neither Pfizer nor FDA made the request public. More from The New York Times here.


FDA published the user fee rates for prescription drugs, biosimilars, and medical devices for fiscal year 2019. RAPS has a handy chart comparing the rates to FY 2018.

The Institute for Clinical and Economic Review released a preliminary list of therapies that may get its cost-effectiveness assessments in 2019. ICER also released a final report on AbbVie’s endometriosis drug Orlissa and an updated report on plaque psoriasis drugs. And it announced it will review Novartis’ atherosclerosis drug Ilaris and plans to assess the comparative clinical effectiveness and value of two spinal muscular atrophy drugs.

Bipartisan leaders of the House Energy and Commerce Committee sent lettersThursday to the CEOs of three drug companies — Insys, Mallinckrodt, and Purdue Pharma — seeking information about their roles in the opioid crisis.

FDA is soliciting public comment ahead of planned work to promote development of clinical outcomes assessments and endpoints that could be used in clinical trials and support FDA decisionmaking on drug approvals.

FDA posted draft guidance for developing and submitting nicotine alternatives for regulatory approval as drugs, the latest step in the agency’s push to cut down on cigarette smoking.

Eighty-three members of the House of Representatives sent a letter to HHS Secretary Alex Azar urging him to eliminate retroactive direct and indirect (DIR) fees in Medicare Part D.

Using its authority under the 21st Century Cures Act, the FDA awarded grants to three universities working on the continuous manufacturing of drugs and biological products.

Medicare Part B spending is forecast to grow 8 percent over the next five years, outpacing the U.S. economy, according to a report from the HHS inspector general on fraud, waste and abuse in the agency’s programs. Recommendations in the OIG report include boosting oversight and changing data collection for Medicare Part D and Medicare Advantage plans.

CATCHING OUR ATTENTION: POWERFUL OPIOIDS VASTLY OVERPRESCRIBED DESPITE FDA PROGRAM TO LIMIT THEM — Off-label prescribing of a class of fast-acting fentanyl drugs — some of the strongest opioids — was widespread under a distribution oversight program that the FDA entrusted to a group of pharmaceutical companies, The New York Times reports.

TIRFs — transmucosal immediate-release fentanyl in the form of quickly absorbed sprays, tablets and lozenges — were only intended for cancer patients with severe pain who had built up a tolerance to opioids. Yet thousands of pages of documents show that patients with back pain and migraines also received the lucrative medicines, increasing the risk of overdose or addiction.

Humana Sues Dozens of Generic Drug Manufacturers for Price-Fixing Scheme

Image result for Humana Sues Dozens of Generic Drug Manufacturers for Price-Fixing Scheme images

Source: FierceHealthcare

Humana has filed a lawsuit against more than two dozen pharmaceutical companies for conspiring to fix the prices of widely used generic drugs, a scheme that forced the insurer to pay for drugs at artificially inflated prices.

The complaint, filed in the U.S. District Court for the Eastern District of Pennsylvania on Friday, adds to numerous ongoing investigations by the Department of Justice and nearly every state in the country. Humana said its allegations are “based on personal knowledge” of the price-fixing scheme as well as information made public during the state and federal investigations.

Communications between the drug manufacturers reveal that the companies schemed to obstruct competition and set, increase, or maintain the drugs’ prices, according to the 273-page complaint (PDF). It also alleges that the defendants made arrangements not to compete against each other.

The communications allegedly took place at trade association meetings and conferences, at dinners and other private outings, and via phone and text message. The lawsuit names nearly 30 manufacturers including Mylan, Novartis and Teva, nearly all of which have been subpoenaed by federal prosecutors. Heritage Pharma’s former CEO and president already cut a deal with state prosecutors last year and agreed to assist with the investigation.

Humana said it wants to “recover damages it incurred from egregious overcharges it paid for certain widely-used generic drugs, arising from a far-reaching conspiracy among Defendants and others to blatantly fix the price of such drugs.” The insurer has requested a jury trial and is seeking treble damages under the Clayton Antitrust Act.

Humana’s complaint includes a list of 16 specific generic drugs it purchased in “substantial quantities” for “grossly inflated prices” due to the conspiracy. Five of the drugs are used to treat cardiac conditions, including hypertension and high cholesterol; however, taken together, the 16 drugs treat a wide range of medical issues, from depression to arthritis to multiple sclerosis.

“For most patients prescribed one of the Subject Drugs, the drug is a necessity that must be purchased regardless of price,” Humana said.

Humana claims it spent more than $1.7 billion on the drugs listed in the complaint.

The insurer said there are also “various other persons, firms, entities, and corporations” presently unknown to the company that acted as willing co-conspirators in the scheme.

While Humana points out that the use of generic drugs saved the U.S. healthcare system $1.68 trillion between 2005 and 2014, the defendants’ collusion forced Humana to pay “artificially inflated prices at supracompetitive rates.” According to federal data, the prices of these drugs shot up as much as 8,000% over the course of years, months, or even weeks.

In November, 47 attorneys general representing 45 states, the District of Columbia, and Puerto Rico, and the Department of Justice filed suit against 18 pharmaceutical companies and two of those companies’ chief executives for conspiring to fix generic drug prices as well. Humana references the suit extensively in its own complaint.

One particular line of Humana’s complaint strikes at the heart of the drug pricing debate that has raged for decades.

“The United States is a venue ripe for illegal anticompetitive exploitation of prescription drug prices due to laws that regulate how prescription drugs are prescribed and how the prescriptions can be filled,” it said.

Drug Trade Group Quietly Spends ‘Dark Money’ To Sway Policy And Voters

Image result for Drug Trade Group Quietly Spends ‘Dark Money’ To Sway Policy And Voters images

Source: Kaiser Health News

In 2010, before the Affordable Care Act was passed by Congress, the pharmaceutical industry’s top lobbying group was a very public supporter of the measure. It even helped fund a multimillion-dollar TV ad campaign backing passage of the law.

But last year, when Republicans mounted an aggressive effort to repeal and replace the law, the group made a point of staying outside the fray.

“We’ve not taken a position,” said Stephen Ubl, head of the organization, the Pharmaceutical Research and Manufacturers of America, known as PhRMA, in a March 2017 interview.

That stance, however, was at odds with its financial support of another group, the American Action Network, which was heavily involved in that effort to put an end to the ACA, often referred to as Obamacare, spending an estimated $10 million on an ad campaign designed to build voter support for its elimination.

“Urge him to repeal and replace the Affordable Care Act now,” one ad running in early 2017 advised viewers to tell their congressman. That and similar material (including robocalls) paid for by the American Action Network ran numerous times last year in 75 congressional districts.

PhRMA was one of AAN’s biggest donors the previous year, giving it $6.1 million, federal regulatory filings show. And PhRMA had a substantial interest in the outcome of the repeal efforts. Among other actions, the GOP-backed health bill would have eliminated a federal fee paid by pharmaceutical companies, one estimated at $28 billion over a decade.

But there was no way the public could have known at the time about PhRMA’s support of AAN or the identity of other deep-pocketed financiers behind the group.

Unlike groups receiving its funds, PhRMA and similar nonprofits must report the grants in their own filings to the Internal Revenue Service. But the disclosures don’t occur until months or sometimes more than a year after the donation.

The conservative-leaning AAN has become one of the most prominent nonprofits for funneling “dark money” — difficult-to-trace funds behind TV ads, phone calls, grass-roots organizing and other investments used to influence politics. Such groups have thrived since the Supreme Court’s Citizens United decision in 2010, which loosened rules for corporate political spending, and amid what critics say is nonexistent policing of remaining rules by the IRS.

(It’s impossible to know from public records whether PhRMA donated before or after President Donald Trump’s victory, which made repealing the health law a substantial possibility. In any case, most donations to dark-money groups are not earmarked for a particular program.)

Dark-money groups are often chartered under Section 501(c)(4) of the tax law, which grants tax exemption to “social welfare organizations.” For those seeking to influence politics but stay in the background, 501(c)(4) designations offer two big advantages: tax exemption and no requirement to disclose donors.

Against the backdrop of high drug prices and its heaviest political expenditures in years, the pharmaceutical industry is directing substantial resources through AAN and other such groups that hide the identity of their donors and have few if any limits on fundraising.

“PhRMA has always been very aggressive and very effective in their influence efforts,” said Michael Beckel, research manager at Issue One, a nonprofit devoted to campaign-finance transparency. “That includes using these new, dark-money vehicles to influence policy and elections.”

PhRMA’s $6.1 million, unrestricted donation to AAN was its single-biggest grant in 2016, dwarfing its $130,000 contribution to the same group the year before. Closely associated with House Republicans — AAN has a former Republican senator and two former Republican House members on its board — the group backed the failed GOP health bill intended to replace the Affordable Care Act. It also supported the successful Tax Cuts and Jobs Act of 2017, which reduced corporate taxes by hundreds of billions of dollars over a decade.

So far in this election cycle, AAN has given more than $19 million to the Congressional Leadership Fund, a Republican super PAC with which it shares an address and staff, according to the Center for Responsive Politics. The fund recently ran ads opposing Democratic candidates in high-profile special congressional elections in Georgia and Pennsylvania.

PhRMA disputes the suggestion that it backs particular actions by the recipients of its donations. “PhRMA engages with groups and organizations that have a wide array of health care opinions and policy priorities,” said its spokesman, Robert Zirkelbach. “It is inaccurate and would be inappropriate for you to attribute those grants to a specific campaign.”

AAN declined several requests for comment.

Including AAN, PhRMA gave nearly $10 million in 2016 to politically active groups that don’t have to disclose donors, its most recent filing with the IRS shows. By contrast, PhRMA and its political action committee, or PAC, made only about $1 million in comparatively transparent political donations in 2015 and 2016 that were disclosed to regulators and reported by the Center for Responsive Politics.

PhRMA’s 2016 political activities included support for the Republican National Convention. Rather than directly support the Cleveland convention, which several companies pulled out of after it became clear that Donald Trump was going to be the presidential nominee, PhRMA routed $150,000 through limited liability companies with names like Convention Services 2016 and Friends of the House 2016.

Like 501(c)(4)s, LLCs do not have to disclose their donors. PhRMA’s support was revealed in IRS filings more than a year later. (Donations by PhRMA and other groups to Friends of the House, which financed a luxury lounge for convention dignitaries, were first reported by the Center for Public Integrity last fall.)

PhRMA’s surge in donations to AAN coincides with the arrival of Ubl, who took over as president and CEO in 2015 and has long-standing ties to Norm Coleman, a former U.S. senator from Minnesota who is now AAN’s chairman. Ubl once ran the lobby for makers of knee implants, heart stents and other medical devices, one of whose most powerful members, Medtronic, is based in Minneapolis.

Dues paid by member drug companies rose by 50 percent after he got there. PhRMA’s total revenue increased by nearly a fourth in 2016, according to IRS filings.

PhRMA’s 2016 dark-money contributions included $150,000 to Americans for Prosperity, a conservative group associated with billionaires Charles and David Koch. Their group has already signaled it will be active in November’s elections, running attack ads against Sen. Jon Tester, a vulnerable Montana Democrat, for not supporting ACA repeal.

PhRMA also gave $50,000 to Americans for Tax Reform, run by conservative anti-tax activist Grover Norquist.

PhRMA and other trade associations donate to such groups “to avoid attracting attention” amid the political fray, said Bruce Freed, president of the Center for Political Accountability, which seeks to shed light on corporate political spending. Nevertheless “they’re achieving their goals by giving money to these folks and helping elect members that are going to be in support of them.”

Mostly smaller amounts went to centrist and liberal groups. Center Forward, which claims to seek bipartisan, common ground on drug policy and other issues, got $300,000 directly from PhRMA and another $179,000 from a PhRMA-backed group called the Campaign for Medical Discovery, according to tax filings.

Zirkelbach disputed the notion that PhRMA donations to AAN and other groups were intended to achieve specific goals, saying, “We seek to work with organizations we agree with as well as those where we have disagreements on public policy issues.”

Much of the work by PhRMA-linked, dark-money groups touches health policy and harmonizes with PhRMA’s positions.

During debates over the tax overhaul, Center Forward worked to preserve a tax credit for researching rare-disease medicines known as orphan drugs. PhRMA took a similar stance, encouraging Congress “to maintain incentives” for rare-disease drugs.

AAN, which collected total contributions and grants of $14.6 million for fiscal 2016, launched a $2.6 million mass-mailing and ad campaign against letting Medicare lower drug prices through negotiations. PhRMA supported that stance, telling Healthline that such a measure could jeopardize seniors’ access to medicine and discourage companies from developing drugs.

Americans for Tax Reform ran similar ads in local markets opposing “price controls” on prescription drugs.

PhRMA’s dark-money allies push its agenda without disclosing its role, critics say.

PhRMA is “spending millions of dollars on politics every cycle, and they’re splitting it up between the state and federal level,” said Robert Maguire, political nonprofits investigator for the Center for Responsive Politics, which tracks political donations. “They’re just not running the political ads themselves,” which keeps their name off the product, he said.

A group called Caregiver Voices United, which got $720,000 from PhRMA in 2016, backed a secret effort to generate letters opposing a drug-transparency bill in Oregon. The campaign surfaced when an employee leaked phone-script documents to a lawmaker, as reported in February by The Register-Guard newspaper in Eugene.

Caregiver Voices United is “not influenced” by PhRMA or any other outside group, said John Schall, its president.

Dark-money groups received pharmaceutical industry money from individual companies as well, not just the PhRMA trade organization.

In 2016, Amgen gave $7,500 to Third Way, a center-left group that supports reimbursement for drugs and medical devices based on their results, according to the Center for Political Accountability. Johnson & Johnson gave $35,000 that year to the Republican Main Street Partnership, a 501(c)(4) that describes itself as a coalition of lawmakers committed to “conservative, pragmatic government,” the CPA data show.

But CPA’s research also reveals that many pharmaceutical companies don’t disclose donations made to 501(c)(4) organizations, nor are they legally required to.

Corporations “could dump millions into one of these (c)(4)s and nobody would ever know where it came from,” said Steven Billet, a former AT&T lobbyist who teaches PAC management at George Washington University.

CBO Underestimates Medicare Part D Savings by $4 Billion Due to Oversight Lapse

Image result for CBO Underestimates Medicare Part D Savings by $4 Billion Due to Oversight Lapse images

Source: Modern Healthcare

The Congressional Budget Office vowed it would ramp up oversight of its cost-estimate process after it underestimated the impact of a Medicare Part D change made by Congress by $4 billion.

After initially estimating that the Bipartisan Budget Act of 2018 would save Medicare $7.7 billion over a decade, the CBO discovered the law’s changes to the drug discount program would actually save $11.8 billion during that timeframe.

Drug companies will have to offer more discounts to beneficiaries in the so-called donut hole, thanks to the law. The donut hole is the period in which a Medicare enrollee’s prescription drug costs exceed coverage limits of their Part D plan. As part of the budget bill, Congress increased the discount drug that companies must offer for enrollees in the donut hole for brand-name drugs from 50% to 70%.

“(CBO) did not become aware of administrative data about the amount of the discounts provided under the coverage gap discount program until after the estimate was published,” CBO Director Keith Hall said in a letter Friday to Rep. Mark Meadows (R-N.C.). “(The agency) is redoubling its efforts to ensure that analysts’ searches for available data are as thorough as possible.”

Conservative blogs have highlighted the CBO’s mistake for weeks after the agency first revealed it made an error in a congressional document released in May.

Despite saving Medicare potentially billions of dollars, Republican think tanks, advocacy organizations and consulting firms have launched a grassroots effort to void the Part D changes now that they know their true financial impact. They argue that the increased financial burden on drugmakers could reduce the number of products they’ll offer under Part D or siphon money from research and development efforts for new drugs.

“It could endanger access to medicines, many of which actually reduce net long-term Medicare costs by preventing expensive hospital stays, surgeries and other therapies,” the Citizens Against Government Waste, the Taxpayers Protection Alliance, the Coalition to Reduce Spending and numerous others said in joint letter to House Speaker Paul Ryan last month.

Drug companies hope the savings discrepancy revelation will force Congress to change course.

“It underscores the importance of Congress acting to correct this mistake as soon as possible,” said Daniel Seaton, a spokesman for Biotechnology Innovation Organization. “Forcing companies to divert billions of dollars from the research lab to bail out insurance companies will stifle innovation while doing little to save costs for Medicare beneficiaries.”

Nonpartisan policy insiders are also expressing concern now that the CBO revealed the mistake. Billions of dollars in increased discounts may undermine the Trump administration’s efforts to lower drug prices.

“This will have the long-term effect of driving drug prices higher because manufacturers will account for the mandatory discount when they set the price for new drugs,” said James Scott, CEO of Applied Policy, a reimbursement consulting firm. “Mandatory manufacturer discounts are probably not the best way to lower patient out-of-pocket spending if lowering drug prices overall is also a policy objective.”

PhRMA Lobby Spend Grows to $15.5M in the First Half of 2018

Image result for PhRMA Lobby Spend Grows to $15.5M in the First Half of 2018 images

Source: Fierce Pharma

As the pharmaceutical industry faces potential pricing reform and continued criticism from patient advocates and members of Congress, the industry’s top trade group spent $15.5 million lobbying in the first half, an 11.5% increase compared with the same period last year.

PhRMA lobbied both chambers of Congress, plus federal agencies including the HHS, FDA, CMS and more, according to the documents. It worked on issues relating to patents, inter partes reviews, opioids, drug pricing, generics and much more, spending $1.6 million more than the same period last year, according to filings. In all, it spent $15.5 million in the first six months of 2018.

A PhRMA spokesperson said she could not discuss lobbying strategy but that issues being discussed have significant implications for patients. “We think it is vital to be engaged and a big part of what we are focused on is coming to the table with solutions to address improve patient affordability and access.”

Engaged it is. Last year in the first half, PhRMA spent $13.9 million in lobbying expenses. By the time 2017 was over, the group had boosted its spend by 30% over 2016 levels to a total of more than $25 million.

The spending comes as the industry faces close scrutiny from President Donald Trump and a range of critics over its pricing strategies. Early last year, then-president elect Trump said the industry was “getting away with murder.” He also blasted the industry’s lobbying power.

Then, early this month, the president took Pfizer to task over its second round of price hikes for the year. The drug giant ended up reversing those hikes in a move that sparked a new round of intense discussion over pricing. Pfizer have since pledged to pause price hikes for the year, pledges that critics say will provide little relief for consumers or little pain for drugmakers.

In May, the Trump administration unveiled its drug pricing blueprint, a development many industry watchers actually saw as a positive for pharma companies. The plan seeks to boost competition and price negotiations, plus take on industry tactics that have reduced competition. Wells Fargo analyst David Maris wrote after the announcement that the administration is “actually trying to address some of the root causes of price inflation and lack of affordability.”

But one consultant told FiercePharma afterward it looked like “business as usual” for industry players in the short term.

Drugmakers Cancel Price Hikes After California Law Takes Effect

Image result for Drugmakers Cancel Price Hikes After California Law Takes Effect images

Source: Bloomberg

A handful of the world’s biggest drugmakers are canceling or reducing planned price increases in the U.S., following a new California drug pricing transparency law and continued political pressure over pharmaceutical costs.

The California law, which began to take effect earlier this year, requires drugmakers to give insurers, governments and drug purchasers advance notice of large price increases, as a way of publicly pressuring pharmaceutical companies to keep prices down. In the past three weeks, Novartis AGGilead Sciences Inc.Roche Holding AG and Novo Nordisk A/Ssent notices to California health plans rescinding or reducing previously announced price hikes on at least 10 drugs.

The drugs include everything from multibillion-dollar blockbusters like Novartis’s psoriasis drug Cosentyx to smaller products, such as Entresto for heart failure and Gilead’s drugs Letairis for pulmonary hypertension and Ranexa for angina. The changes were described by a health plan official who spoke on condition of anonymity because the information isn’t yet public. Drugmakers confirmed most of the pricing decisions.

“Many factors influence our decisions to change product prices for our U.S. portfolio and it is not uncommon for us to adjust plans for price changes,” Novartis spokesman Eric Althoff said in an email. Novartis said it notified some health plans of potential price increases but later decided against implementing them.

Transparency Law

The California measure, signed in October by Governor Jerry Brown, is among the most aggressive efforts by states to peel back the secretive process of setting drug prices. The law requires pharmaceutical companies to notify insurers and government health plans at least 60 days before planned price increases of more than 16 percent during a two-year period.

It also provides a rare window into the complex U.S. pharmaceutical market, where drugmakers sometimes raise list prices multiple times a year, then negotiate discounts and rebates with insurers and drug plans.

The law is being challenged in court by the drug industry’s lobbying group Pharmaceutical Research and Manufacturers of America. Many drugmakers have been complying in the interim, sending out notices to health plans.

The law’s implementation comes as President Donald Trump, who has accused drugmakers of “getting away with murder,”promised on May 30th that drug companies will voluntarily reduce the price of drugs.


Real Moves?

What seems like transparency or falling prices forced by the new law may not actually be so, said Richard Evans, an health and pharmaceutical analyst at SSR in Montclair, New Jersey.

Pharmaceutical companies are likely “throwing up a smokescreen” to conceal the timing and magnitude of their actual price increases from competitors, or from purchasers who might then stock up in advance of an increase, said Evans. He predicted that the law won’t slow the actual rate of actual price increases.

“If what you are trying to do is limit price inflation, this is not the way to go about it,” said Evans, whose company provides drug investment research. “This is not going to change mainstream list price behavior at all.”

Other drugmakers have raised prices around the same time. Earlier this month, the Financial Times reported that Pfizer had raised prices on about 100 drugs, following a pattern of regular increases that the company takes each year.

Swiss drugmaker Roche confirmed that it was canceling a proposed 4 percent price increase for Cathflo Activase, a clot treatment.

Roche has gone ahead with price increases on some of its top-selling cancer drugs. In July it raised the price of a single-use vial of Herceptin, a breast cancer drug, by 3 percent to $1,558.42. Avastin, another cancer drug, went up 2.5 percent to $3,187.76 for a 16-milliliter vial, according to price data compiled by Bloomberg Intelligence and First Databank. The changes follow increases for both drugs in January.

The price hikes were small enough that Roche wasn’t required to send a notification, a spokeswoman for the company said.

Novo Nordisk told California drug purchasers it was also reducing a previously announced price increase, said company spokesman Ken Inchausti. Inchausti declined to name the drug or drugs, and wouldn’t provide details on the price changes.

In early July, Novo Nordisk raised the price of its Victoza diabetes injection by 7.9 percent, and its diabetes drugs Levemir and Novolog by 5 percent, according to data compiled by First Databank and Bloomberg Intelligence. The new price is $293.75 for a 10 milliliter vial of Levemir and $289.36 for a 10 milliliter vial of Novolog. Patients can use more than one vial per month.

According to the health plan official, Gilead canceled planned price increases for four drugs, none among its biggest blockbusters. The company had given notice in May that it would be increasing prices roughly 7 percent on July 1.

Gilead didn’t respond to multiple requests for comment.

Pfizer’s Bow To Trump Won’t Just Hit Its Own Prices – It’ll Put A Chill On Hikes, Period

Image result for Ian reed Pfizer CEO imagesSource: Fierce Pharma

In a little more than 24 hours, through public shaming and a phone call with Pfizer CEO Ian Read, President Donald Trump convinced the U.S. drug giant to reverse dozens of July price increases—at least temporarily. The extraordinary move signals that pharma players are willing to cede to the president, even as Pfizer and Read have previously resisted limits on their pricing power.

Pfizer announced on Tuesday that it would roll back July 1 price hikes—it raised stickers on about 40 drugs, many by more than 9%—until the administration has a chance to implement its drug pricing blueprint. The company said it will return prices to their levels before July 1 “as soon as technically possible.”

Pfizer was essentially asking for it, not only with these increases but also with its resistance to pressure previously, one analyst said. In a note to clients, Goldman Sachs’ Jami Rubin and her team wrote that Pfizer’s hikes “represented a calculated risk in our view that did not succeed.” The analysts point out that many drugmakers have committed to only raising prices once per year. Pfizer has not.

It’s important to note that the rollback is only temporary. Pfizer says it will only raise them again when that blueprint goes into effect, or at the end of the year, whichever is sooner.

The Pfizer backlash began in the media, but the president made it official on Monday, tweeting that Pfizer and other drugmakers “should be ashamed” of their price hikes. The tweet came about a week after news that the company raised stickers on dozens of drugs, including best-sellers Viagra and Lyrica.

“They are merely taking advantage of the poor & others unable to defend themselves, while at the same time giving bargain basement prices to other countries in Europe & elsewhere,” Trump wrote.

HHS Secretary Alex Azar also tweeted out an ominous message: The companies that “increased prices will be remembered for creating a tipping point in US drug pricing policy. The President’s noticed, I’ve noticed, and more importantly, the American people noticed. Change is coming to drug pricing, whether painful or not for pharmaceutical companies.”

Trump and Azar went directly to Read. And after an “extensive discussion,” Pfizer said it was backing down. In a statement, Read said the company is “encouraged that the President recognizes the value our industry brings to society and our ability to fulfill our mission to discover and bring innovative new medicines to patients.”

Pfizer’s increases may have angered the president because they belied his May 30 promise of “major” price reductions from Big Pharma in about two weeks. So when a big drugmaker like Pfizer decided to go the other way, he had an easy target.

Pfizer is among the Big Pharmas that hasn’t promised to limit its price increases as the heat on drugmakers intensified over the last few years. Some have pledged a 10%, once-a-year limit, while others, including Sanofi, have set healthcare inflation as their top bar.

Allergan CEO Brent Saunders started the pricing pledge trend back in 2015 with a manifesto on pharma’s “social contract.” He committed to once-per-year increases below 10%. Since then, many drugmakers have gotten on board with the pledge.

The Pfizer CEO has taken a different stance. Early last year, he said in a Reuters interview that the company has “always priced responsibly,” so he doesn’t “need to make that commitment.” He’s also argued that pharmaceuticals bring great value to the healthcare system, and that the industry has faced a reputation problem in the U.S. due to price hikes from Valeant, Mylan and Martin Shkreli’s Turing Pharmaceuticals.

Pfizer’s pricing reversal could represent a form of pharma price controls, according to Rubin. But she wrote that the more “realistic outcome” from the development “will be that companies will have to be even more conservative with their next round of price increases, and a 2nd round will essentially become verboten.”

Wells Fargo analyst David Maris has been writing for months that his team believes pharma is underestimating pricing and political risks. He wrote on Wednesday that Pfizer’s retreat is an “admirable step” and that pricing scrutiny is intensifying in Washington, D.C. He said the move will likely have a “chilling effect” on other drugmakers planning price hikes.

Pharma isn’t alone facing scrutiny, though. Maris pointed out that the entire supply chain is under examination from the administration and Congress.

Trump and Azar presented their drug pricing blueprint in May. The plan seeks to boost negotiations and competition, provide incentives for lower list prices and help lower patients’ out-of-pocket costs. It doesn’t propose major changes such as direct Medicare negotiations or importation. After the announcement, many experts and industry watchers said the plan won’t bring major changes to pricing right away. Maris, for his part, wrote that the administration is “actually trying to address some of the root causes of price inflation and lack of affordability.”

Drugmakers Try Evasion, Tougher Negotiations to Fight New U.S. Insurer Tactic

Image result for Drugmakers Try Evasion, Tougher Negotiations to Fight New U.S. Insurer Tactic images

Source: Reuters

In the escalating battle over U.S. prescription drug prices, major pharmaceutical companies are scrambling to limit the economic damage from a new U.S. insurer tactic that coaxes patients away from expensive drugs.

The latest move by insurers – which effectively forces drug companies to pay more to assist patients with their copays – is causing a decline in real U.S. drug prices this year, and is expected to become more widely adopted in 2019.

That reality is forcing drugmakers to devise their own response in the near term, according to interviews with pharmaceutical and insurance industry executives and consultants. Among major drugmakers, AbbVie Inc and Amgen Inc have said the most so far about the new tactic, and more drugmakers will likely face questions about it during quarterly earnings calls in July.

In recent years, insurers have tried to guide patients toward less expensive treatments by making them pay a higher portion of a drug’s costs. Drugmakers responded by dramatically raising the financial aid they offer, in the form of “copay assistance” cards – similar to a debit card – that reduce what consumers need to pay when they place their pharmacy order.

Express Scripts Holding Co and CVS Health, which manage prescription drug coverage for large U.S. employers, say these payments shield consumers from drug costs, making it easier for manufacturers to raise those prices. Insurers have to make up the difference.

This year, Express Scripts and others introduced a new “copay accumulator” approach for its corporate customers. The programs prevent copay card funds from counting toward a patient’s required out-of-pocket spending before insurance kicks in on expensive specialty drugs, such as arthritis and HIV treatments.

As an example, a patient whose medicine costs $1,000 per month might be required to pay that amount until they reach a deductible of $2,000 set by their insurer. A copay card from the drugmaker would cover most, or all, of those costs for the patient and it would count towards the deductible.  When the deductible is reached, the insurance begins to pay.

But if the insurance plan is using an accumulator, the patient could still have to pay the $2,000 out of pocket when their copay card expires or runs out of money. Some more aggressive accumulator programs will also draw more money than a drugmaker expected to pay off a copay card when the card is detected.

These tactics could force the drugmaker to keep paying the out of pocket costs. Otherwise the patient could move to an equivalent drug if one is available or abandon their prescription because it is too expensive.


Drugmakers are working on ways to counter copay accumulator programs, fearing that more employer health plans will adopt them in 2019.

They include new payment options to evade detection by the pharmacy benefits managers (PBMs) so that a patient still benefits from the financial aid, said Matthew Turner, who is working with drugmakers as director of patient affordability at TrialCard, which operates copay cards for companies. He would not provide details of how those arrangements work.

Larger drugmakers may have the financial flexibility to monitor how these accumulator programs affect revenue over time, while those reliant on a small number of drugs may not be able to wait it out, Turner said.

Drugmakers are also taking a tougher stance when negotiating prices or new discounts for payers, according to insurance industry executives and pharmaceutical consultants.

They have reason for concern. A survey by the National Business Group on Health (NBGH), which represents large corporate employers, showed that 17 percent of respondents said they were currently using a copay accumulator program. Another 18 percent of respondents are considering using one next year or in 2020.

Real U.S. drug prices, including discounts and rebates, fell 5.6 percent in the first quarter of this year, mostly due to copay accumulator programs, according to Sector and Sovereign Research.

Amgen has said that it altered copay assistance cards for arthritis drug Enbrel to work only if the funds are applied to a patient’s deductible. The company would not say how it responds when a patient is affected by an accumulator, adding the information was proprietary.

AbbVie in April said that about 4 percent of patients taking rival arthritis drug Humira were exposed to accumulators, but that they had no material effect on company profits.

Belgium’s UCB, which makes a competing drug called Cimzia, said in February that it was reaching out to patients affected by the programs to help them stay on the medication.

Savings can be substantial for employers when accumulators coax patients to switch to a drug for which they receive the highest rebate. For instance, rebates to PBMs for Humira and Enbrel can differ by as much as $1,000 per prescription, according to Michael Rea, CEO of Rx Savings Solutions.

At CVS Health, accumulator programs help reduce specialty drug spending by about 5 percent for its customers’ health plans, spokeswoman Christine Cramer said.

Express Scripts and UnitedHealth Group Inc, told Reuters they expect the programs to expand.

UnitedHealth tracks copay assistance payments at its mail order specialty pharmacy BriovaRx and wants to introduce them to other specialty pharmacies it works with, Chief Medical Officer Dr. Sam Ho said.

UnitedHealth calls patients to tell them their copay cards will no longer count towards deductibles, and suggests switching to a less pricey drug, if available, or provides information on charity assistance, he said.

When asked how drugmakers have responded to UnitedHealth’s program, Dr. Ho said the manufacturers are taking a tough stance in new price negotiations.

Kevin Cast, a partner at pharmaceutical consulting firm Archbow Consulting, said drugmakers may be better off providing greater discounts to the PBMs in exchange for ending the copay accumulator. Concocting an alternative payment method is only a temporary fix, he said.

“As soon as a copay card company makes a slight adjustment, they’ll figure it out,” he said.

Trump Slams Pfizer After July 1 Drug Price Hikes

Image result for Trump Slams Pfizer After July 1 Drug Price Hikes images

Source: New York Times

U.S. President Donald Trump on Monday took aim at Pfizer Inc and other U.S. drugmakers after they raised prices on some of their medicines on July 1, saying his administration would act in response.

“Pfizer & others should be ashamed that they have raised drug prices for no reason.” Trump wrote in a post on Twitter on Monday. “We will respond!”

Health and Human Services Secretary Alex Azar followed up with his own tweet saying that drugmakers who have raised prices have created a tipping point in U.S. drug pricing policy.

“Change is coming to drug pricing, whether painful or not for pharmaceutical companies,” Azar wrote.

Neither Trump nor Azar detailed what policy changes would be implemented to decrease prices.

Trump had said in May that some drug companies would soon announce “voluntary, massive” cuts in prices, but none have materialized yet. During his presidential campaign, he promised lower U.S. drug costs.

Pfizer raised list prices on around 40 medicines earlier this month. Those include Viagra, cholesterol drug Lipitor and arthritis treatment Xeljanz, according to Wells Fargo. List prices do not include rebates and discounts drugmakers may offer.

“The list price remains unchanged for the majority of our medicines. Our portfolio includes more than 400 medicines and vaccines. We are modifying prices for approximately 10 percent of these, including some instances where we’re decreasing the price,” Pfizer spokeswoman Sally Beatty told Reuters.

Pfizer’s stock fell after Trump’s tweet – they closed up 5 cents at $37.16, but had been trading at $37.44 just before the tweet.

Pfizer was not the only major drug company to raise prices after Trump suggested they would voluntarily slash prices. Israeli generic drugmaker Teva Pharmaceutical Industries Ltd hiked prices on 14 drugs in June and Roche Holding’s Genentech division raised prices on a number of its drugs on July 1, according to Wells Fargo.

Teva and Roche could not be immediately reached for comment.

Last Updated 08/17/2018

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