Drug Makers Slash Prices to Look Good, MA Plans Slash Benefits to Stay Profitable, and One Insurer Slashes Access to Life-Saving Care

Hey all,

Happy Tuesday! As patients head into another open enrollment season, the same old tension plays out: access to care on one side, profit motives on the other. Drugmakers test direct-to-patient sales, insurers trim Medicare Advantage benefits, and lawsuits pile up over denied treatments. The pattern is consistent, if not particularly inspiring.

Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(Fierce Pharma) Novartis, Boehringer Slash Drug Prices via DTP Platforms

Novartis and Boehringer Ingelheim are launching new direct-to-patient platforms that cut U.S. drug prices in response to pressure from President Trump’s “Most Favored Nation” pricing demands. Novartis will debut a program on Nov. 1 offering Cosentyx at 55% off its $7,936 list price, while Boehringer’s live Access platform offers Spiriva Respimat for $35 per month compared to a $600 list price, with broader portfolios planned. These moves highlight Big Pharma’s growing shift toward direct-selling models to improve affordability, bypass middlemen, and align U.S. drug costs with other developed nations—because why split rebates with a PBM when you can just go straight from pharm to table? Full Article

(Health Care Un-covered) Medicare Advantage Benefits Cuts

Insurance companies are reducing Medicare Advantage (MA) benefits, exiting markets, and repricing products to protect profits rather than prioritizing patient care. Despite receiving higher payments than traditional Medicare—costing taxpayers and beneficiaries billions—insurers like UnitedHealthcare, Humana, and CVS/Aetna are cutting supplemental benefits and shrinking service areas to reassure investors, leaving hundreds of thousands of enrollees at risk of losing coverage. After all, trimming gym memberships and hearing aid benefits is a whole lot easier than trimming profit margins or executive bonuses. Full Article

(BenefitsPro) Anthem faces California suit over stem cell transplant benefits

A California woman with multiple sclerosis and her mother are suing Anthem Blue Cross, alleging the insurer not only denied coverage for a potentially life-changing stem cell transplant but also blocked her from accessing prerequisite treatments, such as natalizumab, that she needed to qualify for the procedure. The case highlights growing concerns over how insurers manage access to high-cost, experimental therapies, and its outcome could influence future coverage disputes in California. After all, the most “effective” step therapy for controlling costs might just be to deny the prerequisites so the expensive treatment never has to be covered. Full Article