About health insurance/insurers
Feds sue Cigna over alleged Medicare Advantage overpayments linked to home assessments ”The federal government has filed suit against Cigna, alleging that the insurer submitted false and inaccurate Medicare Advantage diagnostic codes in a bid to boost its reimbursement.
The Department of Justice (DOJ) will intervene in a suit initially filed by a whistleblower, the agency said Monday. The suit claims that the diagnostic codes in question were based on forms submitted by contracted vendors who conducted in-home assessments of Cigna members.”
Apple Will Launch Health Insurance In 2024, Says Analyst “Apple will start to offer health insurance in 2024 as it looks to build on the health data it has acquired from the Apple Watch, an analyst has predicted.
CCS Insight believes that Apple will take its tentative first steps into the U.S. health insurance market in partnership with a major insurer, using the health data it’s already collecting to give it a competitive edge over rivals.
Apple already collects data such as blood pressure, blood oxygen levels, ECG readings and body temperature from the Watch, as well as helping people regulate their medication. With accompanying devices, the Watch and iPhone can also be used to monitor conditions such as diabetes.”
About pharma
J&J sets sights on $60B in pharma sales by 2025, targets 8 brands to deliver growth “During an investor call Tuesday, J&J execs said the company aims to generate $60 billion in pharmaceutical sales by 2025. The unit pulled down $13.2 billion in the third quarter, which would annualize at nearly $53 billion.
J&J is targeting the $60 billion goal for 2025 despite next's year's loss of exclusivity for Stelara, currently the company's top drug by sales. The immunology blockbuster generated $7.33 billion in the first 9 months of 2022, a 12% increase from the same period last year operationally.”
HRSA: AbbVie, Amgen violating 340B program “The HRSA, an HHS subagency, said the companies are surpassing the ceiling prices for drugs dictated by the 340B statute, a federal program that aims to cut certain outpatient drug costs for some hospitals and specialized clinics.”
Pfizer Appeals Anti-Kickback Decision to the Supreme Court “Pfizer is appealing a decision by the Second U.S. Circuit Court of Appeals in August that its proposed copay assistance program for its $225,000-a-year heart treatment, tafamidis, would violate the federal anti-kickback statute (AKS).
In its appeal to the Supreme Court, Pfizer stated that it manufactures the only FDA-approved drug for a rare, and fatal cardiac condition, transthyretin amyloid cardiomyopathy, and that it “seeks to provide financial assistance to needy Medicare patients to help them access this breakthrough treatment.”
Pfizer’s plan was to grant patients $13,000 a year to cover all Medicare copays for the drug, while Medicare would have to pay the rest of the cost. Before launching the program, the company asked the HHS Office of the Inspector General (OIG) for a regulatory opinion on whether its assistance program would be legal.”
Post Dobbs fallout tracker—HHS investigating Walgreens, CVS over reports of withheld prescriptions “The Department of Health and Human Services (HHS)' Office for Civil Rights (OCR) has opened an investigation into chain pharmacies including Walgreens and CVS over complaints that some pharmacists are refusing to fill prescriptions for medications that could threaten a patient's pregnancy.”
Roche’s sales of Covid drugs fall by $1bn “Roche chief executive Severin Schwan said health authorities are holding back from ordering more coronavirus tests and treatments despite a rise in cases, after sales of the company’s Covid-19 drugs fell SFr1.12bn ($1bn) in the first nine months of the year. The Swiss pharmaceutical company sells the antibody treatment ronapreve and the anti-inflammatory actemra, originally developed for arthritis, for Covid.”
About the public’s health
1.3 million Americans with diabetes rationed insulin in the past year, study finds “ According to research published Monday in the journal Annals of Internal Medicine, over a million people with diabetes in the US rationed their insulin in the past year.
’The main takeaway is that 1.3 million people rationed insulin the United States, one of the richest countries in the world,’ Dr. Adam Gaffney, the lead author of the study and a pulmonologist and critical care doctor at Harvard Medical School and Cambridge Health Alliance, told CNN. ‘This is a lifesaving drug. Rationing insulin can have life-threatening consequences.’”