Medicare negotiated drug prices for the first time. Here’s what it got (2024)

Medicare negotiated drug prices for the first time. Here’s what it got (1)

The first price negotiations between Medicare and drugmakers could save billions of dollars a year for taxpayers and beneficiaries. Nam Y. Huh/AP hide caption

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Nam Y. Huh/AP

The White House unveiled the fruits of months of negotiations between the government and pharmaceutical companies: new, lower Medicare prices for 10 blockbuster drugs.

The discounts range from 79% for diabetes drug Januvia to 38% for blood cancer drug Imbruvica.

Politics

Here are the first 10 drugs that Medicare will target for price cuts

Health and Human Services Secretary Xavier Becerra played up the savings Wednesday evening.

In a press call ahead of the announcement, Becerra said if the negotiated prices were in effect in 2023, Medicare would have saved $6 billion and beneficiaries would have saved $1.5 billion in out-of-pocket costs, such as copays at the pharmacy counter.

“I had the privilege to work closely with our HHS team and oversee the negotiations,” which took nearly a year, Becerra said. “The negotiations were comprehensive. They were intense. It took both sides to reach a good deal.”

The program selected the first 10 medicines for negotiation last year based on several conditions laid out in the Inflation Reduction Act, which ended Medicare’s 20-year ban on negotiating drug prices. The drugs included blockbuster blood thinners, like Eliquis and Xarelto, as well as drugs for arthritis, cancer, diabetes and heart failure.

The negotiated prices will go into effect in January 2026.

After all these years, why negotiate now?

Medicare Part D covers outpatient drugs for about 50 million seniors. The federal program was able to negotiate these prices for the first time in the program’s history as a result of the Inflation Reduction Act. Negotiations began in February and progressed through the summer, coming to a close on Aug. 1.

NPR asked Administrator for the Centers for Medicare and Medicaid Services Chiquita Brooks-LaSure on Thursday if there was ever a moment when she thought the negotiations would fall apart. “Until it’s signed on the dotted line, you always have a chance that things won’t work out, but i believe so strongly the arc of righteousness was on our side,” she said.

While individual plans have previously been able to negotiate to drive prices down, this is the first time that Medicare was able to use its leverage and negotiate for the program as a whole.

Sen. Amy Klobuchar, a Democrat from Minnesota, says she fought for years to get Congress to pass a law lifting the ban on Medicare drug price negotiation.

She joined advocates on Wednesday to discuss the significance of the upcoming negotiated price announcements, calling out the various tactics pharmaceutical companies have used to hang onto their monopoly power and keep prices high over the years.

“It is fine to make profits, but not to the extent that you're actually hurting Americans' health in the United States of America,” she said. “No one should be forced to choose between filling their prescriptions or filling their grocery carts.”

In all, these 10 drugs alone cost Medicare $50.5 billion in 2022, or about 20% of the program’s gross total drug spending that year, according to HHS. They also cost beneficiaries $3.4 billion in out-of-pocket expenses.

The politics of prescription drugs

President Biden and Vice President Harris are expected to trumpet the announcement at an event on Thursday in Maryland, where they will each give remarks about lowering health care costs for Americans.

It’s the first formal joint speaking appearance for Biden and Harris since he stepped aside from his bid for a second term and endorsed Harris last month. She has been campaigning furiously and is under some pressure to lay out her policy priorities in what is an unusually short campaign season.

The high cost of living is a key issue for voters. Polls have shown Biden has struggled to get credit for his efforts to lower prices and many voters continue to trust GOP presidential nominee Donald Trump more on the economy — but polls also show that voters are less critical of Harris on economic issues.

Harris is expected to give more details about her economic priorities in a campaign speech in North Carolina on Friday.

Looking ahead at Medicare drug price negotiation

It’s expected Medicare drug price negotiations will save the government $98.5 billion over a decade, according to the Congressional Budget Office, which scored the Inflation Reduction Act.

The pharmaceutical industry has pushed back against the negotiations, filing several lawsuits to keep the negotiated prices from going into effect and saying the move will be bad for drug innovation. However, the CBO estimates that the Inflation Reduction Act will prevent 13 new drugs from coming to market over the next 30 years out of the 1,300 of them that are expected to come to market over that time.

Over the past few weeks, several drug companies involved in this round of negotiations told their investors they are able to manage the losses from lower Medicare prices.

Medicare will begin negotiating prices for the next batch of medicines early next year. The process will continue annually with the government negotiating the prices of up to 20 drugs by the end of the decade.

Medicare negotiated drug prices for the first time. Here’s what it got (2024)

FAQs

Medicare negotiated drug prices for the first time. Here’s what it got? ›

The 10 drugs selected for the first round of negotiations include treatments for several medical conditions, including diabetes (Farxiga, Fiasp/NovoLog, Januvia, Jardiance), blood clots (Eliquis, Xarelto), heart failure (Entresto, Farxiga), psoriasis (Stelara, Enbrel), rheumatoid arthritis (Enbrel), Crohn's disease ( ...

What drugs are selected for IRA negotiation? ›

The 10 drugs selected for the first round of negotiations include treatments for several medical conditions, including diabetes (Farxiga, Fiasp/NovoLog, Januvia, Jardiance), blood clots (Eliquis, Xarelto), heart failure (Entresto, Farxiga), psoriasis (Stelara, Enbrel), rheumatoid arthritis (Enbrel), Crohn's disease ( ...

What law prevents Medicare from negotiating drug prices? ›

Specifically, the 2003 Medicare Prescription Drug, Improvement, and Modernization Act (MMA)(P.L. 108-173) noninterference provision prohibits the Secretary of Health and Human Services (HHS) from negotiating Medicare drug prices or establishing a preferred drug list.

Do insurance companies negotiate drug prices? ›

Working on behalf of health insurance companies or employers, PBMs negotiate upfront discounts on the prices of prescription drugs with pharmaceutical companies, as well as rebates, which reward favorable coverage of a particular drug (and the resulting increase in utilization by a health plan's patients).

Does Medicare pay full price for drugs? ›

California law enables Medicare recipients to obtain their prescription drugs at a cost no higher than the Medi-Cal price for those drugs. Here's how it works: You must have a Medicare card, and show it to the pharmacy staff.

What drugs are being negotiated by Medicare? ›

On August 29, 2023, CMS published the list of 10 drugs covered under Medicare Part D selected for the first cycle of negotiation. The drugs selected are Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog/Fiasp.

What are the 10 IRA drugs? ›

As shown in Table 2, the conditions treated by the 10 drugs include blood clots (treated by Eliquis and Xarelto), diabetes (treated by Jardiance, Januvia, Farxiga, and NovoLog/Fiasp), heart failure (treated by Jardiance, Farxiga, and Entresto), coronary or peripheral artery disease (treated by Xarelto), chronic kidney ...

Is Eliquis going to be cheaper in 2024? ›

The Inflation Reduction Act was passed into law in 2022 and includes changes to Medicare Part D, or prescription drug coverage. In 2026, Medicare will use a new government-set price for ELIQUIS, called the “Maximum Fair Price” (MFP). This is what the government will pay for ELIQUIS.

Did the Lower drug Costs Now Act pass? ›

Passed House (12/12/2019) This bill establishes several programs and requirements relating to the prices of prescription drugs, health care coverage and costs, and public health. The bill requires the Department of Health and Human Services (HHS) to negotiate prices for certain drugs.

How do insurance providers negotiate rates? ›

Insurance Contract Negotiation Tips
  1. Research comparable contracts: Research what other healthcare providers have successfully negotiated in terms of reimbursem*nt rates and contract terms. ...
  2. Focus on the fee schedule: Take a closer look at the billing codes that generate the most revenue for your organization.
Jan 24, 2024

Are Medicare drug plans worth it? ›

While the lower tier drugs may be manageable to pay for without Part D coverage, the higher tiers may give you sticker shock. So, while you may have to pay a premium, deductible, copay or coinsurance, your overall Medicare Part D costs will likely be significantly less than if you don't have coverage.

What is the best prescription card for seniors? ›

Here Are the Best Prescription Discount Cards in 2024
  • SingleCare - Best Prescription Drug Price Comparison.
  • America's Pharmacy - Most Versatile Prescription Discount Card.
  • WellRx - Best Prescription Discount Card App.
  • GoodRx Gold - Best Paid Prescription Discount Card.
Jul 26, 2024

Why do people say not to get a Medicare Advantage plan? ›

Restrictive networks

In some cases, you'll have a higher share of costs when you see an out-of-network doctor. In other cases, you're not covered at all if you go out of network. This is particularly important if you travel a lot because Medicare Advantage plans generally don't provide out-of-state coverage.

Which drugs will be impacted by IRA? ›

CMS Releases List of 10 Drugs Subject to Price Negotiation Under IRA
  • Apixaban (Eliquis)
  • Empagliflozin (Jardiance)
  • Rivaroxaban (Xarelto)
  • Sitagliptin (Januvia)
  • Dapagliflozin (Farxiga)
  • Sacubitril/valsartan (Entresto)
  • Etanercept (Enbrel)
  • Ibrutinib (Imbruvica)
Aug 29, 2023

What is the prescription drug pricing reduction act? ›

The Inflation Reduction Act, also known as the lower cost prescription drug law, created the first ever annual cap on out-of-pocket drug costs for people with Medicare, capped the cost of each covered insulin at $35 per month, granted Medicare the power to directly negotiate drug prices, and made Affordable Care Act ( ...

What are part B drugs on Medicare? ›

Usually, Part B covers drugs that typically aren't self-administered. These drugs can be given in a doctor's office as part of their service. In a hospital outpatient department, coverage generally is limited to drugs that are given by infusion or injection.

What is the Inflation Reduction Act pharmaceuticals? ›

President Biden's prescription drug law, the Inflation Reduction Act, was signed into law on August 16, 2022. This new law provides meaningful financial relief for millions of people with Medicare by expanding benefits, lowering drug costs, and strengthening Medicare for the future.

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