What Are the 10 Drugs to be Negotiated by Medicare?
For the first time, the White House has unveiled 10 drugs up for price negotiation with pharmaceutical companies on behalf of more than 53 million Medicare beneficiaries.
Brokered as part of the Inflation Reduction Act that President Joe Biden signed into law last August, experts say this move could save the United States billions annually and help make life-saving medications more affordable and accessible. New prices would not go into effect until 2026, and first must survive legal challenges from the pharmaceutical industry.
“There is no reason why Americans should be forced to pay more than any developed nation for life-saving prescriptions just to pad Big Pharma’s pockets,” Biden said in a statement. “For many Americans, the cost of one drug is the difference between life and death, dignity and dependence, hope and fear.”
Older Americans pay nearly $6,500 in out-of-pocket expenses for prescription drugs each year, the statement noted. For many with limited means, the cost of medications can consume a significant portion of their budgets. In 2019, nearly half of all Medicare recipients had an estimated annual income of less than $30,000.
The 10 drugs prioritized in the first round of negotiations are often prescribed by doctors to treat patients with heart disease, diabetes, blood clots, certain cancers and arthritis, according to the Centers for Medicare and Medicaid Services (CMS). While they are not the most expensive drugs for some Medicare patients, health policy expert Stacie Dusetzina said that “they’re used by so many Medicare beneficiaries that they end up being the top-selling drugs.”
The first 10 drugs include:
- Eliquis: prevents and treats blood clots
- Jardiance: treats diabetes and heart failure
- Xarelto: prevents and treats blood clots; reduces risk for patients with heart disease
- Januvia: treats diabetes, heart failure and chronic kidney disease
- Farxiga: treats diabetes, heart failure and chronic kidney disease
- Entresto: treats heart failure
- Enbrel: treats rheumatoid arthritis, psoriasis and psoriatic arthritis
- Imbruvica: treats blood cancers
- Stelara: treats psoriasis, psoriatic arthritis, Crohn’s disease, ulcerative colitis
- Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill: treats diabetes
- For the drugs on this list, 9 million older Americans spend $3.4 billion out-of-pocket each year, according to senior officials in the Biden-Harris administration. If negotiations are able to lower the prices and they withstand challenges, savings would be put back into the program to further expand access to medications, said Dusetzina, who is a professor of health policy and cancer research at Vanderbilt University Medical Center.
Over the next year, CMS is expected to release another 35 additional drugs for negotiation, she added.
Patients, lawmakers and policy experts have long debated how to lower the nation’s prescription drug prices, which are among the highest in the world. Some critics have said these negotiations could prompt the pharmaceutical industry to raise prices on other drugs to make up for lost profits, but Dusetzina said it is too soon to know for certain.
Research has suggested that nearly a third of Medicare beneficiaries diagnosed with cancer never take their medication, in part because they simply cannot afford it, she said. Because these drug prices would now be more affordable for more people, Dusetzina said, “we’ll see more people being able to start their medication and stay on it.”
By Laura Santhanam | Aug 29, 2023