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This small town of 20,000 might seem an unlikely place for the world’s largest maker of insulin to build a stockpile of drugs needed to fight a chronic disease affecting 30 million Americans. Yet Novo Nordisk is constructing a $1.8 billion plant here, to make the active pharmaceutical ingredients for an array of diabetes medicines. The largest project in Novo Nordisk’s history, the plant is rising across the street from a building where the Danish company has assembled and packaged its product for the past quarter century. It sits on the edge of a region known as the “diabetes belt” — a wide swath stretching from Louisiana up to West Virginia and over to North Carolina, where people are more likely to have type 2 diabetes. (Blau, 5/15)

Pharmacy benefit managers (PBM) — the “middlemen” in drug price negotiations — are under attack, and, for the past 15 years, Mark Merritt has been the point man in charge of defending them. Merritt, who recently underwent open-heart surgery, is stepping down as president and chief executive officer of the trade group Pharmaceutical Care Management Association (PCMA) at the end of the year, even as the PBM industry is smack in the middle of a drug pricing war involving drug companies, insurers and the Trump administration. (Weixel, 5/15)

Last week, two drug companies that jointly sell a blood-cancer drug made a rare decision: to not move forward with changes that would have effectively tripled the cost of a lifesaving medicine for some patients. Most patients take three capsules of Imbruvica a day, at an annual price of $148,000 — most of which is picked up by insurance. But just as early evidence began to suggest a lower dose might be effective, Janssen and Pharmacyclics announced they were discontinuing the old capsule and introducing once-a-day tablets in four different dosages. (Johnson, 5/15)

In his speech on Monday on ways to combat high drug costs, Health and Human Services Secretary Alex Azar was careful not to mention any one company by name when talking about some medicines that Medicare Part D must automatically cover. But it certainly appears that he was pointing a finger at Celgene. (Silverman, 5/15)

The Centers for Medicare & Medicaid Services spent $174 billion on prescription medications in 2016, or 23% of its total budget, the agency reported Tuesday. That's up from $109 billion, or 17% of the budget, in 2012. The agency released the data in conjunction with its newly redesigned Drug Spending Dashboard, which contains a wide array of information on drug usage and costs in Medicare and Medicaid for 2016. (Luhby, 5/15)

Medicare spending on each dose of Sanofi Genzyme’s Renvela has been ratcheting up by an annual growth rate of 21.6 percent for roughly the last five years. Nearly the same is true for Sanofi’s Lantus, Merck’s Zetia, and Amgen’s Enbrel — Medicare spending on all of them climbed by an annual rate of more than 18 percent between 2012 and 2016. Now the Trump administration is calling out the companies behind those increases as part of an effort to tout its updates to the Centers for Medicare and Medicaid Services “drug pricing dashboard” and the data available there. It updated the dashboard Tuesday as part of its broader effort to put forth policies and changes that will help lower drug prices. (Mershon, 5/15)

The Trump administration may not support importing medicines from Canada, but that’s not stopping lawmakers in Vermont, who endorsed a bill that would make the state the first in the nation to designate wholesalers to buy drugs from across the border. The bill, which was passed last week by both the Vermont House and Senate, is now before Gov. Phil Scott, who has so far not indicated whether he will sign the legislation into law but has until this week to decide. We asked his office for comment and will pass along any reply. (Silverman, 5/15)

A former Valeant Pharmaceuticals International Inc. executive told a jury how he became concerned that one of his senior directors had a secret financial interest in a mail-order pharmacy that did business with the drug company. Laizer Kornwasser, one the government’s star witnesses in the fraud and money-laundering trial of Gary Tanner and Andrew Davenport, the former head of Philidor Rx Services LLC, took the witness stand Monday in Manhattan federal court. He said Tanner wasn’t following through on his responsibility to find additional mail-order pharmacies with which Valeant could do business, suggesting he wanted to keep all of the business at Philidor. (Larson, 5/14)

Independent pharmacist Ira Katz has been serving the eclectic community of Little Five Points in Atlanta for 37 years. But it wasn't until Georgia passed a law last year banning "gag rules" that Katz could legally tell his patients they might save big bucks on their prescriptions if they paid cash or used a lower-priced generic. The gag rule was a clause in his contract with one of the pharmaceutical benefit managers, also known as PBMs, that manage most of our nation's prescription drug programs. (LaMotte, 5/11)

After a group of doctors raised a public fuss last month about a complicated change in pricing and dosing for a cancer medication, the manufacturers late last week suddenly scrapped plans to greatly increase the cost, according to a statement issued by one of the companies. The about-face is an unusual instance in which a drug maker — in this case, two drug makers — rolled back plans to boost pricing in the face of notable criticism. Typically, pharmaceutical companies try to ride out bad publicity, but the outcry came just as the White House made a push to lower drug prices. (Silverman, 5/14)

It’s one of 300 community specialty pharmacies Walgreens has opened in just a few U.S. cities, including Dallas, Austin and San Antonio. There are no rows of toilet paper. No aisles of Maybelline and L’Oreal. ...Unlike the company’s larger stores, these pharmacies dispense medications only to people suffering from complicated medical conditions that are hard to manage and costly to treat. Specialty pharmacies have traditionally been the realm of pharmacy benefit managers, the third-party administrators of prescription drug programs for health insurers. (Rice, 5/15)

When Alec Smith turned 26 last May and aged out of his parents’ health insurance, he discovered that he couldn’t afford coverage of his own. Within weeks, he was trying to ration his diabetes medication because he couldn’t afford a $1,300 refill. A month later, the young restaurant manager was dead. An autopsy found he suffered a critical shortage of insulin, a hormone that regulates blood sugar and energy in the body. Now, Smith’s mother is speaking out against the high and rising prices of prescription drugs and calling for legislation to prevent excessive price increases for essential medications. (Olson, 5/10)