The Centers for Medicare & Medicaid Services (CMS) released information today about 10 drugs that would, after negotiations with drug companies, be covered at a significant discount for Medicare drug plan enrollees, starting in 2026.
The negotiated drugs include those that are frequently dispensed as well as those that are the most expensive, and treat common conditions including cancer, diabetes, heart disease, and arthritis, according to CMS.
Right now, Americans pay two to three times more for prescription drugs than they would anywhere else.
— The White House (@WhiteHouse) August 15, 2024
But the Biden-Harris Administration beat Big Pharma. And after months of negotiations, Medicare has reached agreements to lower the price for 10 of the highest-cost drugs. pic.twitter.com/eGVtAtJsVO
“Congressional budget estimators predicted about $100 billion savings over 10 years from drug negotiations and a $3.7 billion savings in the first year alone. Today we’re announcing that in our first year of negotiations we are saving Medicare an estimated $6 billion and Americans who pay out of pocket will be saving another $1.5 billion moving forward,” said the U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra.
What drugs will be discounted?
Here is the list of drugs, the condition they treat, the 2026 pricing for a 30-day supply of each drug, and the discount off the list price:
Eliquis
- Conditions: Prevention and treatment of blood clots
- Negotiated price: $231
- Discount: 56%
Enbrel
- Conditions: Rheumatoid arthritis, psoriasis and psoriatic arthritis
- Negotiated price: $2,355
- Discount: 67%
Entresto
- Conditions: Heart failure
- Negotiated price: $295
- Discount: 53%
Farxiga
- Conditions: Diabetes, heart failure and chronic kidney disease
- Negotiated price: $178.50
- Discount: 68%
Fiasp (Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill)
- Condition: Diabetes
- Negotiated price: $119
- Discount: 76%
Imbruvica
- Conditions: Blood cancers
- Negotiated price: $9,319
- Discount: 38%
Januvia
- Condition: Diabetes
- Negotiated price: $113
- Discount: 79%
Jardiance
- Conditions: Diabetes, heart failure and chronic kidney disease
- Negotiated price: $197
- Discount: 66%
Stelara
- Conditions: Psoriasis, psoriatic arthritis, Crohn’s disease, ulcerative colitis
- Negotiated price: $4,695
- Discount: 66%
Xarelto
- Conditions: Blood clots; coronary or peripheral artery disease
- Negotiated price: $197
- Discount: 62%
Who is eligible for this pricing?
Those covered by Medicare prescription drug plans, including Part D and Medicare Advantage prescription drug plans will have access to these drugs at the reduced rate.
What prompted these lower drug prices?
The August 2022 Inflation Reduction Act’s goal was to help the environment and lower both consumer and government costs, including Medicare.
Previously, Medicare beneficiaries saw savings from the Inflation Reduction Act by receiving free vaccines and $35-a-month insulin. The Inflation Reduction Act also expanded Medicare’s Extra Help program, to provide additional funds for those who need additional help paying for Medicare Part D premiums, deductibles, and co-pays.
Another savings program will begin in 2025—a $2,000 out-of-pocket cap on prescription drug costs for Medicare Part D enrollees.
One much-anticipated provision of the Inflation Reduction Act allowed Medicare, for the first time, to negotiate directly with drug companies on the pricing of “certain high expenditure, single-source drugs without generic or biosimilar competition.”
Negotiations have been underway this year, and CMS shared that its teams met three times with each drug company to negotiate offers, listen to counteroffers, and ultimately agree on a price.
Are there plans for more prescription drug price reductions?
Yes. CMS will choose as many as 15 additional drugs covered by Part D to be negotiated for 2027, up to 15 more drugs in 2028, and as many as 20 additional Part B or Part D drugs every year after that.
Vice President Kamala Harris also released a statement saying: “Every American should be able to access the health care they need no matter their income or wealth. That is why President Biden and I fought to lower the costs of health care with our Inflation Reduction Act, transformational legislation that I was proud to cast the tie-breaking vote on in the Senate.”
Harris and President Joe Biden will be speaking this afternoon at their first joint event since Biden dropped out of the race and endorsed her Democratic nomination. The topic will be the administration’s progress on lowering costs for Americans.
More on Medicare:
- 3 big changes coming to Medicare in 2025. Here’s what they’ll mean for you
- What Medicare beneficiaries need to know about generic medications
- Medicare has a new pilot program to help people with dementia. Here’s how it works
- If you are denied coverage by Medicare, you have the right to appeal the decision. Here’s how
