In an unexpected move, Johnson & Johnson, the multinational pharmaceutical giant, has informed certain US hospitals about a change in their pricing strategy for two drugs sold under the drug-savings program. Previously, these drugs were sold at discounted prices, but hospitals will now have to purchase them at full cost, following which they can claim a rebate.
The Wall Street Journal reported this unprecedented move, which is seen as part of the pharmaceutical industry’s ongoing battle against profitable drug discounts for healthcare institutions. Despite the move, the US government agency has expressed reservations, describing the plan as ‘inconsistent’ with Federal law and stipulating that it requires approval before Johnson & Johnson can proceed.
Furthermore, the healthcare sector saw more significant moves with Nestle expressing intent to retain its Health Science unit – even after announcing a change of guard in its senior leadership. The unit, which was under the speculation of being sold in the near future, was officially declared safe by Chairman Paul Bulcke in an interview.
In a related finding, private equity-backed physician practices seemingly benefitted from the Federal process for resolving billing disputes for out-of-network care. An analysis of 2023 data underlines that these groups saw significantly higher payouts than what insurers would have paid in-network.
Shifting our attention towards the Medicare drug negotiations, Wall Street analysts are predicting that by 2027, a list including Novo Nordisk’s blockbuster Ozempic for diabetes will have negotiated prices. Interestingly, leading players such as Pfizer and GSK are also on the list with their specialties – cancer and chronic respiratory disease drugs respectively.
Concerning mental healthcare, insurance companies have been caught repeatedly, undermining Federal law by restricting coverage and delaying or denying treatment. ProPublica reports this sector as ‘bad for business’, as treating customers with mental illness, especially chronic disorders, can be costly.
Meanwhile, a government audit has exposed that several for-profit nursing homes might not be abiding by Federal rules that mandate having designated infection control workers. The Inspector General Office of the Health and Human Services Department has uncovered that these institutions either failed to nominate an infection control personnel or the appointed person lacked the necessary training.
Finally, as healthcare services evolve, complex patients who find it challenging to leave their homes to seek care are noticing promising signs in home-based primary care. Several home-based primary care practices are now negotiating value-based contracts with Medicare Advantage carriers. This is led by Medically Home, a hospital-at-home technology company, aiming to reduce the cost of in-home care and making it accessible to more health systems.