List of Medicare drug price negotiations includes Ozempic

The Biden administration on Friday unveiled the next 15 prescription drugs that will be subject to price negotiations between manufacturers and Medicare, launching the second phase of a historic process to make expensive drugs more affordable for seniors .

At the top of the list are Novo NordiskDiabetes blockbuster injection Ozempic, weight loss injection Wegovy and diabetes pill Rybelsus, which are considered to be one of the products under discussion. since they all share the same active ingredient: semaglutide. These treatments have fueled the growth of the hot obesity market and have been difficult for patients to access due to costs, insurance coverage and supply constraints.

Agreed prices for the second wave of drugs are expected to come into effect in 2027.

Here are the 15 drugs subject to initial discussions this year:

• Ozempic, Wegovy, Rybelsus, (semaglutide,) manufactured by Novo Nordisk, is used for type 2 diabetes, weight management and cardiovascular health
• Trelegy Ellipta, made by GSKis an inhaler used to treat chronic obstructive pulmonary disease and asthma.
• Xtandi, made by Pfizeris used to treat prostate cancer in men
• Pomalyst, made by Bristol Myers Squibbis used to treat a blood cancer called multiple myeloma and a cancer that develops in people living with HIV.
• Ibrance, made by Pfizer, is used to treat certain breast cancers
• Ofev, manufactured by Boehringer Ingelheim, is used to treat chronic lung diseases in adults.
• Linzess, made by AbbVie And Ironwood Pharmaceuticalsis used to treat irritable bowel syndrome and chronic constipation
• Calquence, made by AstraZenecais used to treat certain types of blood cancer
• Austedo, Austedo XR, made by Teva Pharmaceuticalsis used to treat involuntary movements caused by tardive dyskinesia or Huntington’s disease
• Bréo Ellipta, manufactured by GSK and Théravanceis an inhaler used to treat chronic obstructive pulmonary disease
• Tradjenta, made by Boehringer Ingelheim and Elie Lillyis used for the management of type 2 diabetes
• Xifaxan, manufactured by Salix Pharmaceuticals, is used to treat diarrhea caused by travel or irritable bowel syndrome
• Vraylar, manufactured by AbbVie, is used to treat schizophrenia, bipolar I disorder, and major depressive disorder
• Janumet, Janumet XR, made by Merckis used to manage type 2 diabetes
• Take it away, made by Amgenis used to treat plaque psoriasis, psoriatic arthritis, and mouth ulcers

President Joe Biden’s Inflation Reduction Act gave Medicare the power to negotiate drug prices directly with manufacturers for the first time in the federal program’s nearly 60-year history. Some congressional Democrats and consumer advocates have long called for this 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 to treat a variety of conditions, such as asthma, cancer and type 2 diabetes, between Nov. 1 2023 and October 31, 2024, according to a press release from the Ministry of Health and Social Services on Friday. The drug group also accounted for about $41 billion, or 14 percent, of the total cost of Part D prescription drugs during that period, the release added.

When combined with the 10 drugs selected for the first round of negotiations, the 25 products accounted for 36 percent of all Medicare Part D prescription drug costs during that period, the release said.

The drugs have been on the market for at least seven years without generic competitors, or 11 years in the case of biologics such as vaccines.

Medicare has already finalized negotiations for the first 10 drugs selected into the program, with the new prices expected to take effect next year. In August, the Biden administration said it expects these negotiated prices to save Medicare enrollees about $1.5 billion in out-of-pocket costs in 2026 alone. also expect these prices to generate approximately $6 billion in net savings for the Medicare program in 2026, or 22% net savings in total.

But it’s unclear whether President-elect Donald Trump might try to change or scale back some provisions of the law when he takes office next week.

The trading program has also faced a series of legal challenges – so far unsuccessful – from the pharmaceutical industry, which sees the process as a threat to its revenue growth, profits and innovation. pharmaceutical.

Medicare covers about 66 million people in the United States, and 50.5 million patients are currently enrolled in Part D plans, according to health policy research organization KFF.

Nearly 10% of Medicare enrollees aged 65 and older, and 20% of those under 65, report difficulty obtaining medications, a senior administration official told reporters last year .

“Last year we proved that negotiating lower drug prices worked. We now plan to build on that.
record by negotiating lower prices for 15 additional important medications for seniors,” HHS Secretary Xavier Becerra said in a statement. “Today’s announcement is critical: The Inflation Reduction Act lowers prices for people with Medicare. HHS will continue to negotiate in the best interests of people with Medicare for access to innovative, life-saving treatments at lower costs. »

Patient advocacy groups, such as the nonprofit AARP, applauded the announcement Friday.

“For too long, big pharmaceutical companies have increased their profits by setting exorbitant prices at the expense of American lives, forcing seniors to avoid prescriptions they could not afford,” AARP said in a press release. “The first round of Medicare drug price negotiations made it clear that this process would reduce prices for these important products and create billions of dollars in savings for Medicare and its beneficiaries.”

Drugmakers will have until February 28 to decide whether to participate in the program. If a drugmaker refuses to negotiate, it must either pay an excise tax of up to 95 percent on sales of its drugs in the United States or remove all of its products from the Medicare and Medicaid markets.

Those who participate will engage in a lengthy negotiation process involving months of price offers with Medicare. The federal program determines its initial offering for each drug using, among other information, sales volume data, the level of federal financial support for the drug’s development, and data on pending patent applications and exclusivities or approved.

Once the second round is complete, Medicare will be able to negotiate prices for 15 additional drugs that will take effect in 2028. This number will rise to 20 negotiated drugs per year starting in 2029.

The government will only select Medicare Part D drugs for the first two rounds of negotiations. It will add more specialized drugs covered by Medicare Part B, which are typically administered by doctors, in 2028.

But drugmakers will have more opportunities to negotiate with Medicare, based on final guidance released last year for the second round of price negotiations. The first optional negotiation meetings will take place after Medicare makes its initial price offers for the 15 drugs, which must be presented by June 1.