Medicare costs significantly lowered on popular prescription drugs for cancer, diabetes, heart disease and arthritis
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.
The savings are significant.
Right now, Americans pay two to three times more for prescription drugs than they would anywhere else.
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
— The White House (@WhiteHouse) August 15, 2024
“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 for a 30-day supply
- Discount: 56%
Enbrel
- Conditions: Rheumatoid arthritis, psoriasis and psoriatic arthritis
- Negotiated price: $2,355 for a 30-day supply
- Discount: 67%
Entresto
- Conditions: Heart failure
- Negotiated price: $295 for a 30-day supply
- Discount: 53%
Farxiga
- Conditions: Diabetes, heart failure and chronic kidney disease
- Negotiated price: $178.50 for a 30-day supply
- Discount: 68%
Fiasp (Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill)
- Condition: Diabetes
- Negotiated price: $119 for a 30- day supply
- Discount: 76%
Imbruvica
- Conditions: Blood cancers
- Negotiated price: $9,319 for a 30-day supply
- Discount: 38%
Januvia
- Condition: Diabetes
- Negotiated price: $113
- Discount: 79%
Jardiance
- Conditions: Diabetes, heart failure and chronic kidney disease
- Negotiated price: $197 for a 30-day supply
- Discount: 66%
Stelara
- Conditions: Psoriasis, psoriatic arthritis, Crohn’s disease, ulcerative colitis
- Negotiated price: $4,695 for a 30-day supply
- Discount: 66%
Xarelto
- Conditions: Blood clots; coronary or peripheral artery disease
- Negotiated price: $197 for a 30-day supply
- 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.
