Medicare negotiated drug prices for the first time. Here’s what it got (2024)

Medicare negotiated drug prices for the first time. Here’s what it got (1)

The first price negotiations between Medicare and drugmakers could save billions of dollars a year for taxpayers and beneficiaries. Nam Y. Huh/AP hide caption

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Nam Y. Huh/AP

The White House unveiled the fruits of months of negotiations between the government and pharmaceutical companies: new, lower Medicare prices for 10 blockbuster drugs.

The discounts range from 79% for diabetes drug Januvia to 38% for blood cancer drug Imbruvica.

Politics

Here are the first 10 drugs that Medicare will target for price cuts

Health and Human Services Secretary Xavier Becerra played up the savings Wednesday evening.

In a press call ahead of the announcement, Becerra said if the negotiated prices were in effect in 2023, Medicare would have saved $6 billion and beneficiaries would have saved $1.5 billion in out-of-pocket costs, such as copays at the pharmacy counter.

“I had the privilege to work closely with our HHS team and oversee the negotiations,” which took nearly a year, Becerra said. “The negotiations were comprehensive. They were intense. It took both sides to reach a good deal.”

The program selected the first 10 medicines for negotiation last year based on several conditions laid out in the Inflation Reduction Act, which ended Medicare’s 20-year ban on negotiating drug prices. The drugs included blockbuster blood thinners, like Eliquis and Xarelto, as well as drugs for arthritis, cancer, diabetes and heart failure.

The negotiated prices will go into effect in January 2026.

After all these years, why negotiate now?

Medicare Part D covers outpatient drugs for about 50 million seniors. The federal program was able to negotiate these prices for the first time in the program’s history as a result of the Inflation Reduction Act. Negotiations began in February and progressed through the summer, coming to a close on Aug. 1.

NPR asked Administrator for the Centers for Medicare and Medicaid Services Chiquita Brooks-LaSure on Thursday if there was ever a moment when she thought the negotiations would fall apart. “Until it’s signed on the dotted line, you always have a chance that things won’t work out, but i believe so strongly the arc of righteousness was on our side,” she said.

While individual plans have previously been able to negotiate to drive prices down, this is the first time that Medicare was able to use its leverage and negotiate for the program as a whole.

Sen. Amy Klobuchar, a Democrat from Minnesota, says she fought for years to get Congress to pass a law lifting the ban on Medicare drug price negotiation.

She joined advocates on Wednesday to discuss the significance of the upcoming negotiated price announcements, calling out the various tactics pharmaceutical companies have used to hang onto their monopoly power and keep prices high over the years.

“It is fine to make profits, but not to the extent that you're actually hurting Americans' health in the United States of America,” she said. “No one should be forced to choose between filling their prescriptions or filling their grocery carts.”

In all, these 10 drugs alone cost Medicare $50.5 billion in 2022, or about 20% of the program’s gross total drug spending that year, according to HHS. They also cost beneficiaries $3.4 billion in out-of-pocket expenses.

The politics of prescription drugs

President Biden and Vice President Harris are expected to trumpet the announcement at an event on Thursday in Maryland, where they will each give remarks about lowering health care costs for Americans.

It’s the first formal joint speaking appearance for Biden and Harris since he stepped aside from his bid for a second term and endorsed Harris last month. She has been campaigning furiously and is under some pressure to lay out her policy priorities in what is an unusually short campaign season.

The high cost of living is a key issue for voters. Polls have shown Biden has struggled to get credit for his efforts to lower prices and many voters continue to trust GOP presidential nominee Donald Trump more on the economy — but polls also show that voters are less critical of Harris on economic issues.

Harris is expected to give more details about her economic priorities in a campaign speech in North Carolina on Friday.

Looking ahead at Medicare drug price negotiation

It’s expected Medicare drug price negotiations will save the government $98.5 billion over a decade, according to the Congressional Budget Office, which scored the Inflation Reduction Act.

The pharmaceutical industry has pushed back against the negotiations, filing several lawsuits to keep the negotiated prices from going into effect and saying the move will be bad for drug innovation. However, the CBO estimates that the Inflation Reduction Act will prevent 13 new drugs from coming to market over the next 30 years out of the 1,300 of them that are expected to come to market over that time.

Over the past few weeks, several drug companies involved in this round of negotiations told their investors they are able to manage the losses from lower Medicare prices.

Medicare will begin negotiating prices for the next batch of medicines early next year. The process will continue annually with the government negotiating the prices of up to 20 drugs by the end of the decade.

Medicare negotiated drug prices for the first time. Here’s what it got (2024)

FAQs

What does it mean that Medicare can negotiate drug prices? ›

Medicare will negotiate to get you lower drug prices

For the first time, Medicare will be able to negotiate directly with manufacturers for the price of certain high-spending brand-name Medicare Part B and Part D drugs that don't have competition.

Can providers negotiate prices with Medicare? ›

For the first time, the law provides Medicare the ability to directly negotiate the prices of certain high expenditure, single source drugs without generic or biosimilar competition.

What is the Medicare drug cap for 2024? ›

The IRA's two main drug pricing provisions aim to lower the Medicare beneficiaries' out-of-pocket cost burden by reducing the net prices of certain top-selling products through government-led negotiations and redesigning the outpatient pharmacy benefit called Part D, capping recipient annual out-of-pocket expenses, ...

Are Medicare drug plans worth it? ›

While the lower tier drugs may be manageable to pay for without Part D coverage, the higher tiers may give you sticker shock. So, while you may have to pay a premium, deductible, copay or coinsurance, your overall Medicare Part D costs will likely be significantly less than if you don't have coverage.

Is the donut hole going away in 2025? ›

The Inflation Reduction Act (IRA) signed by President Biden in 2022 will eliminate the Prescription Drugs Coverage Gap (known as the donut hole) for Seniors in 2025.

What drug does Medicare spend the most on? ›

In the aggregate, gross Medicare drug spending on the top 10 Part D drugs in 2021 was $48 billion. Eliquis, a blood thinner manufactured by Bristol Myers Squibb, was the top-selling drug, accounting for a quarter of this total, or $12.6 billion (Figure 2).

What is the best Part D drug plan for 2024? ›

"Based on my research, I found two top Medicare Part D companies in 2024. First, Wellcare's Value Script plan makes a splash as the lowest-cost Part D plan on the market while also offering good star ratings. Second, AARP plans from UnitedHealthcare have a solid track record for quality.

Why can't Medicare patients get discounts on drugs? ›

It's illegal for pharmaceutical companies to offer discounts for medications that you purchase through Medicare due to the Social Security Amendments of 1972. Included in those amendments is the Anti-Kickback Statute (AKS).

How can seniors afford Eliquis? ›

Patients who have prescription insurance through Medicare pay, on average, $44 per month. And 5 out of 10 ELIQUIS patients pay $30 or less. Low-Income Subsidy patients may pay $0 to $11.20 per month through the Social Security Administration's Extra Help4 program. Use this link to learn about Extra Help.

Why can't Medicare negotiate drug prices? ›

Why couldn't Medicare negotiate drug prices? The act that created Medicare Part D also prohibited Medicare from negotiating lower prescription drug prices. 108th Congress. House Bill 1.

Why is Eliquis so expensive on Medicare? ›

What makes Eliquis so expensive? Eliquis is a brand-name oral tablet that doctors prescribe to treat or prevent certain blood clots in adults. The cost of Eliquis is high due to the current patent laws and limited drug cost regulations.

What is the donut hole in Medicare Part D 2024? ›

This means there's a temporary limit on what the drug plan will cover for drugs. Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. Once you and your plan have spent $5,030 on covered drugs in 2024, you're in the coverage gap.

Will Medicare's negotiations with drug makers succeed in controlling prices? ›

Medicare is set to negotiate prices for 10 different drugs with manufacturers in a bid to make those costly treatments more affordable for older Americans. But analysts say the drug price talks will likely have a muted financial impact on manufacturers, at least in the near term.

Can insurance companies negotiate drug prices? ›

Working on behalf of health insurance companies or employers, PBMs negotiate upfront discounts on the prices of prescription drugs with pharmaceutical companies, as well as rebates, which reward favorable coverage of a particular drug (and the resulting increase in utilization by a health plan's patients).

Does Medicare pay full price for drugs? ›

California law enables Medicare recipients to obtain their prescription drugs at a cost no higher than the Medi-Cal price for those drugs. Here's how it works: You must have a Medicare card, and show it to the pharmacy staff.

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