CMS announces 10 drugs for Medicare price negotiations

The 10 drugs selected for Medicare price negotiations are:

1.       Eliquis, used for preventing strokes and blood clots, made by Bristol Myers Squibb and Pfizer

2.       Jardiance, used for diabetes and heart failure, made by Boehringer Ingelheim and Eli Lilly

3.       Xarelto, used for preventing strokes and blood clots, made by Johnson & Johnson

4.       Januvia, used for diabetes, made by Merck

5.       Farxiga, used for chronic kidney disease, made by AstraZeneca

6.       Entresto, used for heart failure, made by Novartis

7.       Enbrel, used for arthritis and other autoimmune conditions, made by Amgen

8.       Imbruvica, used for blood cancers, made by AbbVie and Johnson & Johnson

9.       Stelara, used for Crohn's disease, made by Johnson & Johnson

10.   Fiasp and NovoLog insulin products, used for diabetes, made by Novo Nordisk

According to HHS, the selected drugs accounted for $50.5 billion in total Medicare Part D gross covered prescription drug costs, or roughly 20% of total Part D gross covered prescription drug costs, between June 1, 2022, and May 31, 2023, which is the time period designated by the IRA for price negotiations.

Drugmakers will now have roughly a month to determine whether to participate in the negotiation process or to sit out and either face an excise tax of up to 95% of their U.S. sales or withdraw their drugs from Medicare and Medicaid coverage.

CMS will publish any negotiated prices for the selected drugs by Sept. 1, 2024, and those prices will go into effect starting Jan. 1, 2026.

However, the government's ability to enact price negotiations for Medicare is currently under judicial review, as six drugmakers have sued the Biden administration in an effort to block the program.

Reaction

HHS Secretary Xavier Becerra said that pharmaceutical companies have long "made record profits while American families were saddled with record prices and unable to afford life-saving prescription drugs."

"Although drug companies are attempting to block Medicare from being able to negotiate for better drug prices, we will not be deterred," Becerra said. "The Biden-Harris Administration will continue working to ensure that Americans with Medicare have access to innovative, life-saving treatments at lower costs."

A top executive at Bristol Myers Squibb who spoke to STAT expressed concern about the company's blood thinner Eliquis being included on the list, saying the company is worried about the fairness of the decision and its potential impact on the drug industry's future decisions about research and development.

Catherine Owen, general manger for commercial at Bristol Myers Squibb, said Eliquis was included on the list not because of its high cost, but because atrial fibrillation is a common disease among Medicare beneficiaries.

"Right now, there is no requirement as written into the law that any of the savings that the government can afford from these negotiations will be passed on to patients," Owen said.

Pharmaceutical Research and Manufacturers of America (PhRMA), a lobby group, said the negotiations give the government too much power and would hurt the innovation and investment necessary to fulfill the Biden administration's push to end cancer.

"Today's announcement is the result of a rushed process focused on short-term political gain rather than what is best for patients," said PhRMA CEO Stephen Ubl. (HHS press release, 8/29; Stolberg/Robbins, New York Times, 8/29; Goldman, Axios, 8/29; Cohrs/Herper, STAT, 8/29; Simmons-Guffin et al., NPR, 8/29)