US President Joe Biden speaks about prescription drug costs during an event at NHTI Concord Community College in Concord, New Hampshire, US, October 22, 2024. REUTERS/Elizabeth Frantz
Elizabeth Frantz | Reuters
On Friday, the Biden administration revealed the next 15 medications that will be subject to the price Negotiations Between manufacturers and Medicare, to begin Phase 2 of A Historical process It aims to make expensive medicines more accessible to the elderly.
Topping the list is Novo NordiskPopular diabetes injection Ozempic, weight loss injection Wegovy and diabetes pill Rybelsus are one product in talks Because they all share the same active ingredient: semaglutide. These treatments have fueled the emergence of the morbid obesity market, and have been difficult for patients to access due to cost, insurance coverage, and supply constraints.
The agreed prices for the second wave of medicines are scheduled to enter into force in 2027.
Here are the 15 drugs that will be subject to preliminary talks this year:
- Semaglutide (Ozempic, Wegovy, Rybelsus,) made by Novo Nordisk, is used to treat type 2 diabetes, weight management, and cardiovascular health.
- Trelegy Ellipta, manufactured by GSK, is an inhaler used to treat chronic obstructive pulmonary disease and asthma.
- Xtandi, produced by Pfizer, is used to treat prostate cancer in men
- The drug, made by Bristol-Myers Squibb, is used to treat a blood cancer called multiple myeloma, a cancer that develops in people with HIV.
- Ibrance, which is manufactured by Pfizer, is used to treat some types of breast cancer
- Ovive, manufactured by Boehringer Ingelheim, is used to treat chronic lung diseases in adults.
- Linzess, produced by AbbVie and Ironwood Pharmaceuticals, is used to treat irritable bowel syndrome and chronic constipation.
- Calquines, manufactured by AstraZeneca, is used to treat certain types of leukemia
- Austedo XR, made by Teva Pharmaceuticals, is used to treat involuntary movements caused by tardive dyskinesia or Huntington's disease.
- Breo Ellipta, made by GSK and Theravance, is an inhaler used to treat chronic obstructive pulmonary disease.
- Tradjenta, made by Boehringer Ingelheim and Eli Lilly, is used to treat type 2 diabetes.
- Zifaxan, manufactured by Salix Pharmaceuticals, is used to treat travel-related diarrhea or irritable bowel syndrome.
- Vraylar, made by AbbVie, is used to treat schizophrenia, bipolar disorder, and major depressive disorder.
- Janumet XR, manufactured by Merck, is used to treat type 2 diabetes
- Otezla, made by Amgen, is used to treat plaque psoriasis, psoriatic arthritis, and mouth ulcers.
President Joe Biden's inflation-reducing law gave Medicare the ability to discuss drug prices directly with manufacturers for the first time in the federal program's nearly 60-year history. Some Democrats in Congress and consumer advocates have long pushed for change, as many seniors across the country struggle to afford care.
About 5.3 million people with Medicare Part D coverage used the 15 drugs in the second round of talks to treat various conditions, such as asthma, cancer and type 2 diabetes, between November 1, 2023 and October 31, 2024, according to a statement from Department of Health and Human Services on Friday. The drug group also accounted for approximately $41 billion, or 14%, of total Part D prescription drug costs during that time period, the statement added.
When combined with the 10 drugs selected for the first round of negotiations, the 25 products account for 36% of all Medicare Part D prescription drug costs during that time period, the statement said.
Drugs have been on the market for at least seven years without generic competitors, or 11 years in the case of biological products such as vaccines.
Medicare has already completed negotiations for the first 10 drugs selected into the program, and the new prices are scheduled to take effect next year. In August, the Biden administration said it expected these negotiated prices to bail out Medicare enrollees $1.5 billion in out-of-pocket costs in 2026 alone. The government also expects the rates to generate about $6 billion in net savings for Medicare In 2026Or 22% net savings overall.
But it is unclear whether President-elect Donald Trump may try to change or reduce some provisions of the law when he takes office next week.
The negotiating program has also faced a wave of legal challenges – so far unsuccessful – from the pharmaceutical industry, which views the process as a threat to its revenue and profit growth and drug innovation.
Medicare covers approximately 66 million people in the United States 50.5 million Patients are currently enrolled in Part D plans, according to the health policy research organization KFF.
A senior administration official told reporters last year that roughly 10% of Medicare enrollees ages 65 and older, and 20% of those under 65, reported challenges purchasing medications.
“Last year we demonstrated that negotiating lower drug prices works. Now we plan to build on that
“Today’s announcement is pivotal — the Inflation Control Act lowers prices for people receiving Medicare,” Health and Human Services Secretary Innovative and life-saving at lower costs.”
Patient advocacy groups, such as the nonprofit AARP, applauded the announcement Friday.
“For too long, Big Pharma has cornered their profits by setting exorbitant prices at the expense of Americans’ lives, forcing seniors to skip prescriptions they cannot afford,” AARP said in a statement. “The first round of Medicare drug price negotiations has made clear that this process will lower prices for these important products and create billions of dollars in savings for Medicare and its beneficiaries.”
What's next in Medicare pricing talks?
Drugmakers will have until February 28 to decide whether to participate in the program. If a drug manufacturer refuses to negotiate, it must either pay an excise tax on up to 95% of its drug sales in the United States or withdraw all of its products from the Medicare and Medicaid markets.
Those who participate will engage in a lengthy negotiation process that involves months of back-and-forth quotes with Medicare. The federal program determines its initial offering for each drug using sales volume data, the level of federal financial support for drug development and data on pending or approved patent applications and exclusivity, among other information.
After the end of the second round, the Medicare program can negotiate the prices of 15 other medicines that will take effect in 2028. The number increases to 20 medicines to be negotiated annually starting in 2029.
The government will select only Medicare Part D drugs in the first two rounds of negotiations. It will add more specialty drugs covered by Medicare Part B, typically administered by doctors, in 2028.
But drug makers will have more opportunities to negotiate with Medicare, based on… Final guidance It was issued last year for the second round of price talks. The first discretionary negotiation meetings will be held after Medicare submits initial quotes for the 15 drugs it must provide June 1.
