In a lawsuit against the government, Pfizer sought a legal go-ahead for a proposed program that would help cover copays for Medicare patients taking a heart drug priced at $225,000 a year.
A federal appeals court has rejected Pfizer’s claims against the government in a case with major ramifications for drug prices, Medicare spending and government anti-fraud enforcement efforts.
Programs such as the one proposed by Pfizer PFE, -0.67% can have major implications for drug pricing because they insulate patients from the actual cost of their prescriptions, removing the price sensitivity that generally helps keep prices in check, researchers say. Such programs are essentially “a marketing tool” that can help drug companies boost revenues from the Medicare program, said Ge Bai, professor of accounting and of health policy at Johns Hopkins University.
Tafamidis, sold by Pfizer as Vyndaqel and Vyndamax, is a treatment for a heart condition called transthyretin amyloid cardiomyopathy . The condition primarily affects older people, who are often covered by Medicare. Pfizer generated $612 million in worldwide revenues from the drug in the first quarter of this year, up 41% operationally from the same period a year earlier.
Federal anti-kickback law generally prohibits offering anything of value to induce the purchase of a federally reimbursable healthcare product. Pfizer’s proposed program “is specifically designed to induce Medicare beneficiaries to purchase Pfizer’s tafamidis, a federally reimbursable drug,” the appeals court wrote in its decision, adding that the program “falls squarely” within the anti-kickback statute’s prohibitions.
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