When government officials and politicians scrutinize high U.S. drug prices, the role of insurers and pharmacy benefit managers (PBMs) often commands at least some of the attention.
Tuesday, the Senate Health, Education, Labor and Pensions (HELP) Committee's hearing on Ozempic and Wegovy prices, which featured Novo Nordisk's CEO Lars Fruergaard Jørgensen as the sole witness, was no different.
In his opening remarks, committee chair Sen. Bernie Sanders, I-Vermont, angled to dismantle Jorgensen's PBM-related defense by revealing a written commitment from the nation's three largest insurers that they would not limit coverage if Novo were to cut the list prices of its massively popular GLP-1 drugs.
Cigna Group, CVS Health and UnitedHealth, which together comprise the majority of the commercial insurance market, each confirmed that lowered prices would not adversely affect patient access through their respective programs. The insurers each operate large PBM divisions.
As it stands, PBMs receive bigger rebates on drugs with higher costs, a dynamic that can result in lower-priced drugs being placed lower on formularies or dropped altogether from the coverage lists. Last year, the HELP committee proposed a bipartisan PBM reform bill that has yet to pass to the Senate floor.
At the hearing, Jorgenson expressed “a bit of concern” for how Ozempic and Wegovy price cuts could play out on the PBM side, citing prior experience with Novo’s insulin Levemir being removed from formularies after a price cut. But the CEO said he'd "be happy to” sit down with the PBMs and discuss options.
“I understand that perhaps the PBMs have changed their mind, and I'll be happy to collaborate with them on this, because anything that helps patients to get access and affordability, we are supportive of,” he added.
Jørgensen’s concern was in reference to its recent experience with the long-acting insulin Levemir, which will be discontinued by the end of this year due in part to formulary concerns, Novo has said. The move came after the insulin maker agreed to slash Levemir’s price by 65%.
“We dropped the price, yet to find that PBMs dropped access to Levemir, so much less patients have access to it,” Jørgensen said.
Still, throughout the hearing, the CEO reiterated his support of working with the PBMs. As for what happens next, Jørgensen is less certain, but he agreed that the company is open to lowering prices “if it works in a way where patients get access to a more affordable medicine, and we have certainty that it actually happens.”
"Our hope is that the conversation with the HELP Committee will result in real and tangible solutions that benefit patients and allow millions of people living with these serious and chronic diseases to be the direct beneficiaries of real change,” Novo said in an emailed statement following the hearing.