Enbrel, Stelara to be discounted nearly 70% through Medicare price negotiations
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Key takeaways:
- In 2026, Stelara will be discounted 66% from its list price for Medicare users, while Enbrel will be discounted 67%.
- Medicare discounts negotiated for 10 drugs will save $1.5 billion in out-of-pocket costs overall.
The list prices of Stelara and Enbrel for Medicare users will be discounted nearly 70% come 2026 as a result of the first round CMS price negotiations with drugmakers, the White House has announced.
Beginning Jan. 1, 2026, a 30-day supply of Stelara (ustekinumab, Janssen) will be discounted 66% from its 2023 list price, from $13, 836 to $4,695. Meanwhile, a 30-day supply of Enbrel (etanercept, Amgen) will be discounted 67%, from $7,106 to $2,355.
The American College of Rheumatology praised the negotiated discounts.
“This administration’s effort to make care more affordable and improve patient access to necessary medications is commendable,” Deborah Dyett Desir, MD, president of the ACR, said in a statement. “The financial burden caused by skyrocketing drug prices all too often forces patients to skip or forgo treatments altogether, leading to further disease progression and permanent harm that impacts their quality of life. Lowering out-of-pocket medication expenses for Medicare beneficiaries will help to alleviate this risk. Although there is still more to be done to reduce prescription drug costs, we are greatly encouraged by the important step this initiative takes in helping seniors afford the medications they need to manage their rheumatic conditions.”
Ustekinumab is an interleukin-12/23 inhibitor used to treat psoriasis, psoriatic arthritis, Crohn’s disease and ulcerative colitis. Etanercept, a TNF inhibitor, is used to treat rheumatoid arthritis, psoriasis and PsA.
CMS negotiated the discounts of the drugs, along with several other drugs, earlier this year through a provision of the Inflation Reduction Act of 2022, which allows direct negotiation between Medicare officials and pharmaceutical companies. The first round of negotiations involved 10 drugs covered under Medicare Part D.
“When these lower prices go into effect, people on Medicare will save $1.5 billion in out-of-pocket costs for their prescription drugs, and Medicare will save $6 billion in the first year alone,” President Joe Biden said in a statement. “It’s a relief for the millions of seniors that take these drugs ... and it’s a relief for American taxpayers.”
According to a White House fact sheet, if the negotiated prices for all 10 included drugs had been in effect in 2023, it would have resulted in an estimated $6 billion in net prescription drug cost savings and a 22% decline in aggregate net spending for Medicare. Individuals enrolled in Medicare prescription drug coverage are expected to save an estimated $1.5 billion when the negotiated prices take effect.
The savings are in addition to Inflation Reduction Act provisions, such as the cap on out-of-pocket drug costs for people with Medicare and a monthly $35 cap on out-of-pocket insulin costs for people with diabetes.
Each year following 2026, CMS will publish an updated negotiated price for each medication. The new price will be increased by the annual percentage increase in the Consumer Price Index for all urban consumers. The price could also be updated if CMS and the pharmaceutical company renegotiate it.
Further Medicare drug price negotiations are in the works. CMS on May 3 published draft guidance for the second round of drug price negotiations, which will take place in 2025. Any prices negotiated next year would take effect in 2027.
“Additional prescription drugs will be selected each year as part of our Medicare drug price negotiation program,” Vice President Kamala Harris said in a statement. “This includes up to 15 additional drugs covered under Medicare Part D for negotiation in 2025, up to an additional 15 Part B and Part D drugs in 2026, and up to 20 drugs every year after that.”
References:
Statement from President Joe Biden on lower prescription drug prices. https://www.whitehouse.gov/briefing-room/statements-releases/2024/08/15/statement-from-president-joe-biden-on-lower-prescription-drug-prices/. Published Aug. 15, 2024. Accessed Aug. 15, 2024.
Statement from Vice President Kamala Harris on lower prescription drug prices. https://www.whitehouse.gov/briefing-room/statements-releases/2024/08/15/statement-from-vice-president-kamala-harris-on-lower-prescription-drug-prices/. Published Aug. 15, 2024. Accessed Aug. 15, 2024.
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