The Latest on the Drugs Selected for Medicare Price Negotiation

October 30, 2023

CMS today hosted the first of its virtual listening sessions for the drugs selected to participate in Medicare’s new drug price negotiation program.

This afternoon, the agency took feedback from patients, caregivers, and others in the medical community about Eliquis, a common drug from Bristol Myers Squibb used in the prevention and treatment of blood clots.

Since its announcement as part of the Inflation Reduction Act, the drug price negotiation program has faced legal scrutiny from the pharmaceutical and business community. Amid the legal concerns, all 10 drug manufacturers last month agreed to take part in the first round of negotiations.

“Our priority in negotiating with participating drug companies is to come to an agreement on a fair price for Medicare,” said Dr. Meena Seshamani, deputy administrator and director of the Center for Medicare.

Here’s what you need to know:

• Usage:  Eliquis is Medicare’s top-selling drug, accounting for $16,482,621,000 from June 2022–May 2023.
  • More than 3.7 million Medicare Part D enrollees used the drug during that timeframe.
• In Pennsylvania:  For calendar year 2022, 187,000 Pennsylvania Part D enrollees used the drug, with a mean out-of-pocket cost of $431.
• Top feedback:  The testifiers at today’s hearing emphasized concerns about access to care (fail-first requirements, formulary changes, etc.) and wanted to ensure that CMS built in safeguards against any unintended consequences from participation in the negotiation program.
  • Some stakeholders said they wanted to ensure patients weren’t removed from successful therapies solely due to the cost of the drug.
  • Others discussed concerns related to drug development, especially for cardiovascular disease.
• Common trend:  Five of the 10 drugs selected for negotiations are used in treating heart patients. Other products are used in the treatment of diabetes, cancer, and Crohn’s disease, among others. All the drugs are single-source products with no generic alternatives.
  • About one in 10 Medicare enrollees have heart conditions that put them at risk for blood clots, federal figures show.
• Up next:  The virtual listening session for Enbrel (rheumatoid arthritis, psoriasis, and psoriatic arthritis) is slated for tomorrow. The total part D costs for the drug were $2,791,105,000 from June 2022–May 2023.

Following negotiations, CMS will publish agreed-upon negotiated prices for the selected drugs by September 1, 2024, with those prices effective January 1, 2026.

Additional information about the program is available online.