Medicare price negotiation list includes rheumatology drugs ustekinumab, etanercept
Click Here to Manage Email Alerts
Key takeaways:
- The total list accounted for 20% of prescription drug costs paid by Medicare part D plans in 2022 through 2023.
- Negotiations will take place through 2024, and the newly negotiated prices are expected to take effect in 2026.
The first 10 drugs eligible for price negotiation through Medicare includes etanercept and ustekinumab, biologic therapies commonly used to treat patients with rheumatic diseases, the Biden administration announced.
The ability to negotiate drug prices was included in the Inflation Reduction Act passed in 2022 and allows Medicare officials to negotiate prices directly with pharmaceutical companies. The program includes etanercept (Enbrel, Amgen) and ustekinumab (Stelara, Janssen). Etanercept is used to treat patients with rheumatoid arthritis, psoriasis, or psoriatic arthritis, while ustekinumab is often prescribed for the treatment of psoriasis, PsA, Crohn’s disease and ulcerative Colitis.
“It’s clear that lower costs are needed to improve rheumatology patients’ access to necessary drug therapies and treatments,” Douglas White, MD, PhD, president of the American College of Rheumatology, said in a statement responding to the announcement. “High drug costs create an enormous financial burden for too many Americans living with rheumatic disease.”
However, the ACR president also warned that access may remain limited due to other budgetary reasons, and called on legislators to “address the root causes of drug pricing increases.”
“Even with anticipated lower costs from negotiations, there is concern that patient access will remain limited if Congress fails to exempt Medicare Part B reimbursements from the sequestration reductions included in the Budget Control Act of 2011,” White said in the release. “On behalf of rheumatology providers, we are optimistic that these negotiations will yield savings for our patients. However, we ask that policymakers address the root causes of drug pricing increases throughout the drug supply chain to truly help patients afford their medications.”
The Budget Control Act of 2011 — the product of a compromise between then-President Barack Obama and Congressional Republicans — triggered budget sequestration across the federal government, including Medicare. The resulting 2% Medicare cut has been in place since 2013, but had been held off until July 2022.
According to a statement from HHS, negotiation processes will take place during the remainder of 2023 and throughout 2024. The newly negotiated prices are expected to take effect in 2026, the statement said.
“This is a huge step to lower drug costs for Americans, but it’s also just the beginning,” Sen. Bob Casey, D, Pa., chairman of the U.S. Senate committee on aging, said in a statement. “More drugs will be added to the list in the years to come, and Democrats are going to keep fighting to lower everyday costs for Americans and ensure that families don’t have to choose between their health and their bank account.”
According to the statement from HHS, the drugs included in the initiative accounted for $50.5 billion in total Medicare part D prescription drug coverage costs between June 1, 2022, and May 31. That sum accounted for about 20% of total Medicare part D prescription costs. The full list of drugs to be negotiated includes:
- Eliquis (apixaban, Bristol Myers Squibb and Pfizer), which prevents and treats blood clots;
- Enbrel (etanercept, Amgen), which treats psoriasis, psoriatic arthritis and rheumatoid arthritis;
- Entresto (sacubitril/valsartan, Novartis), which treats heart failure;
- Farxiga (dapagliflozin, AstraZeneca), which treats chronic kidney disease, diabetes and heart failure;
- Imbruvica (ibrutinib, Janssen), which treats blood cancers;
- Januvia (sitagliptin, Merck), which treats diabetes;
- Jardiance (empagliflozin, Boehringer Ingelheim), which treats diabetes and heart failure;
- Stelara (ustekinumab, Janssen), which treats Crohn’s disease, psoriasis, psoriatic arthritis and ulcerative colitis;
- Xarelto (rivaroxaban, Janssen), which prevents and treats blood clots and reduces risk for patients with coronary or peripheral artery disease; and
- Several types of insulin treatments, including Fiasp, Fiasp FlexTouch and Fiasp PenFill (all manufactured by novoMEDLINK), as well as NovoLog, NovoLog FlexPen and NovoLog PenFill (all manufactured by Novo Nordisk).Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill
References:
- HHS selects the first drugs for Medicare drug price negotiation. https://www.hhs.gov/about/news/2023/08/29/hhs-selects-the-first-drugs-for-medicare-drug-price-negotiation.html. Aug. 29, 2023. Accessed Aug. 29, 2023.
- Medicare drug pricing negotiations set to begin, with first set of drugs announced. https://www.casey.senate.gov/news/releases/medicare-drug-pricing-negotiations-set-to-begin-with-first-set-of-drugs-announced. Aug. 29, 2023. Accessed Aug. 29, 2023.
Collapse
ACR press release
Read more about
Click Here to Manage Email Alerts