The First 10 Drugs Included in Medicare’s Price Negotiation Program

Medications account for $3.4 billion in out-of-pocket costs, White House officials say

August 29, 2023

The Biden administration today unveiled the first 10 drugs selected in the Medicare prescription drug price negotiation program.

The announcement is the next step for the program, which was created as part of the Inflation Reduction Act to help make the most expensive Medicare prescription drugs more affordable.

The medications include products for diabetes, blood clotting, heart failure, Crohn's disease, and arthritis. They were selected because they “have high total spending and are high expenditure, single source drugs without generic or biosimilar competition,” federal officials said. The implementation of the program would affect the costs for 53 million Americans who are enrolled in the Part D prescription drug program.

“The Biden-Harris Administration will continue working to ensure that Americans with Medicare have access to innovative, life-saving treatments at lower costs,” said Xavier Becerra, secretary of the U.S. Department of Health and Human Services.

Here’s what you need to know:

• Selected products:  The first selected products are Eliquis (blood clotting), Jardiance (diabetes), Xarelto (blood clotting), Januvia (diabetes), Farxiga (diabetes), Entresto (heart failure), Enbrel (autoimmune diseases), Imbruvica (blood cancers), Stelara (Crohn’s disease), and NovoLog (diabetes).
• Rationale:  The selected drugs accounted for $50.5 billion in total Part D gross covered prescription drug costs, or about 20 percent, of total Part D gross covered prescription drug costs between June 1, 2022 and May 31, 2023.
• Out-of-pocket costs:  Medicare enrollees paid $3.4 billion in out-of-pocket costs, with average annual out-of-pocket costs ranging from $5,247 per enrollee for Imbruvica to a low of $121 per enrollee for NovoLog.
• Timeline:  The manufacturers have until October to sign agreements to participate in program. Following negotiations, CMS would publish agreed-upon negotiated prices for the selected drugs by September 1, 2024, with those prices effective January 1, 2026.
• Legal considerations:  The program faces litigation from the U.S. Chamber of Commerce’s and other pharmaceutical companies that want to prevent the program from moving forward.

“Our goal with these negotiations is to improve access to some of the costliest drugs for millions of people with Medicare while driving competition and innovation,” said CMS Administrator Chiquita Brooks-LaSure.

The government plans to roll out additional medications to be included in upcoming years.

A fact sheet and news release about the program are available online.