U.S. prescription drug prices will be on the menu again Tuesday, as Congress continues to serve up a steady diet of outrage over what some biopharma companies are charging.

While six CEOs and an executive vice president from major drug companies have been invited to the sit-down, Sanofi SA's CEO, Olivier Brandicourt, could be in for the hottest grilling. The Paris-based company is the only insulin producer to be seated at the table.

Other companies on the guest list for the second course of the committee's hearings on drug prices are Abbvie Inc., Astrazeneca plc, Bristol-Myers Squibb Co., Johnson & Johnson, Merck & Co. Inc. and Pfizer Inc.

Several biopharma CEOs declined an invitation last month to the committee's first sitting, which proved to be a productive, even-handed discussion of the drivers of prescription drug prices and ways to realign government reimbursement schemes and do away with perverse incentives. (See BioWorld, Jan. 30, 2019.)

In opening that hearing, committee Chair Chuck Grassley (R-Iowa) was noticeably irked that the biopharma executives had rejected the invite, with a few saying they would only testify privately. Grassley promised that he and Ranking Member Ron Wyden (D-Ore.) would be more insistent that they accept the next invitation to dish on drug prices.

Insulin prices are sure to be on the platter Tuesday, especially since Grassley and Wyden sent letters Friday to Brandicourt and the CEOs of the other two U.S. insulin makers, Eli Lilly and Co. and Novo Nordisk A/S, demanding answers to 11 detailed questions about how they price their insulin products.

The letters referenced the testimony Kathy Sego provided at the first hearing, in which she gave the senators a taste of the hardships her son, who has type 1 diabetes, faces because of the inexplicable price hikes for the drug he needs to live.

"These hardships can lead to serious medical complications that are entirely preventable and completely unacceptable for the world's wealthiest country," Grassley and Wyden wrote to the insulin producers.

Noting that in 2016, Medicare Part D spending on just one insulin product more than doubled to $1.2 billion, the senators said, "We are concerned that the substantial increases in the price of insulin over the past several years will continue their upward drive and pose increasingly severe hardships not only on patients . . . but also on the taxpayer."

The senators' letters are not the first congressional inquiry into insulin pricing. Democratic leaders of the House Energy and Commerce Committee sent similar queries to the three insulin producers last month. Those letters, signed by Reps. Frank Pallone (D-N.J.) and Diana DeGette (D-Colo.), asked the Lilly, Novo Nordisk and Sanofi CEOs to explain the root causes of rising insulin prices and obstacles to making the drugs more affordable. (See BioWorld, Feb. 1, 2019.)

Both the House and Senate letters requested details about the pricing of each insulin product, price increases and the justification for those hikes, arrangements with pharmacy benefit managers (PBMs), and patient assistance programs. In addition, the senators asked how the pricing of insulin products would be impacted if the Department of Health and Human Services implemented a proposed Part D rule that would remove the anti-kickback safe harbor for the rebates drug companies pay to PBMs in exchange for favorable formulary placement. (See BioWorld, Feb. 22, 2019.)

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