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CMS unveils first 10 price-negotiable Medicare drugs

Today HHS announced 10 drugs that, under the Inflation Reduction Act of 2022 (IRA), will be priced for Medicare Part D purposes by direct negotiation with their manufacturers, rather than by paying the rate offered.

The drugs are blood thinners Eliquis and Xarelto; diabetes medications Jardiance, Januvia and Farxiga; chronic heart failure (CHF) drug Entresto; arthritis drug Enbrel; Imbruvica, a treatment for leukemia and other blood cancers; Crohn’s disease treatment Stelara; and the insulin delivery systems Fiasp, Fiasp FlexTouch, Fiasp PenFill, NovoLog, NovoLog FlexPen and NovoLog PenFill.

CMS normally pays for these drugs based on market prices, but under IRA authorization the agency will for the first time use its power as the nation’s largest purchaser of pharmaceuticals to get the prices down. The new prices will be announced on Sept. 1, 2024, and they will go into effect in 2026. The program will expand its list in 2027 by 15 Part D drugs, followed by 15 Part D and Part B drugs in 2028, and by 20 D and B drugs each year thereafter.

The HHS announcement says these 10 drugs represent “$50.5 billion in total Part D gross covered prescription drug costs, or about 20%, of total Part D gross covered prescription drug costs between June 1, 2022 and May 31, 2023.”

Pharmaceutical companies are currently challenging this IRA provision in court and and also applying pressure via lobbying for overriding legislation.
Blog Tags: CMS, health care reform
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