Pfizer suit could allow companies to cover patient Medicare copays, presenting 'gold rush' opportunity

Pfizer is championing a lawsuit against the federal government that would essentially legalize reimbursing Medicare members for out-of-pocket medication costs — a practice the federal government alleged amounts to paying kickbacks.

In a case settled in 2018, the Justice Department alleged that Pfizer was essentially making its drugs free for patients, incentivizing patients to choose Pfizer drugs at great cost to Medicare and Medicaid. 

The lawsuit specifically seeks to allow Pfizer to reimburse members for heart failure drugs, which would otherwise cost $13,000 in Medicare copays a year, Fortune reported on July 28. The two drugs each cost $225,000 a year before coverage and are covered by Medicare and Medicaid, presenting huge profit opportunities for pharmacies. 

Should the court rule in favor of Pfizer, federal lawyers said it would be a "gold rush" for pharmaceutical companies as they leverage the practice to capitalize on the Medicare market, according to Fortune

The judge's decision is expected to be released in the near future. 

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