‘We applaud CMS’: Two more rheumatology drugs bound for Medicare price negotiation
The second round of Medicare Part D price negotiations will feature two drugs familiar to rheumatologists — Ofev and Otezla — a move applauded by experts as they await the impact of the first round of discounts anticipated next year.
Ofev (nintedanib, Boehringer Ingelheim) and Otezla (apremilast, Amgen) were selected for the CMS program’s new round of negotiations along with 13 other medications, including semaglutide (Ozempic/Rybelsus/Wegovy, Novo Nordisk), covered under Medicare Part D. New prices negotiated this year between CMS and drug companies will be applicable in 2027. The announcement follows the first round of negotiations in 2024, which resulted in a 66% discount for Stelara (ustekinumab, Janssen) and a 67% discount for Enbrel (etanercept, Amgen). Those price reductions are set to take effect in 2026.
Madelaine Feldman, MD, FACR, vice president of advocacy and government affairs for the Coalition of State Rheumatology Organizations, applauded the pending negotiations but told Healio another provision of the Inflation Reduction Act may have a “more immediate benefit” for patients — a $2,000 annual cap on what Medicare Part D beneficiaries pay for prescription drugs, effective this year.
“We hope to have a better idea by the end of this year of the true impact of negotiated prices on patients, as well as government spending, for these medications,” she said.
Meanwhile, American College of Rheumatology President Carol Langford, MD, MHS, released a statement describing the price negotiations as “an important advancement toward expanding access to care and improving management of rheumatic diseases.”
“Excessive drug costs often create a financial burden for patients, forcing some to choose to delay treatment or abandon care if they can’t cover the expenses,” Langford said in the statement. “Skipping medication doses or forgoing treatment can worsen their conditions and cause irreversible harm. Given these risks, we applaud CMS’ initiative to make essential medications more affordable and accessible.”
Nintedanib is approved for the treatment of idiopathic pulmonary fibrosis, a complication of rheumatic diseases such as rheumatoid arthritis and systemic sclerosis. Apremilast is approved for plaque psoriasis, psoriatic arthritis and oral ulcers in Behçet’s disease.
The drug price negotiation program was launched as part of the Inflation Reduction Act, passed in 2022. To be selected for the program, drugs must have no generic or biosimilar competition and rank among the highest total gross prescription costs covered under Medicare Part D.
The full list of drugs selected for the second round of negotiations also includes:
- acalabrutinib (Calquence, AstraZeneca);
- cariprazine (Vraylar, AbbVie);
- deutetrabenazine (Austedo/Austedo XR, Teva Pharmaceuticals);
- enzalutamide (Xtandi; Astellas, Pfizer);
- fluticasone furoate; umeclidinium bromide; vilanterol trifenatate (Trelegy Ellipta, (GlaxoSmithKline);
- fluticasone furoate; vilanterol trifenatate (Breo Ellipta, GlaxoSmithKline);
- linaclotide (Linzess, AbbVie/Ironwood);
- linagliptin (Tradjenta, Boehringer Ingelheim);
- metformin hydrochloride; sitagliptin phosphate (Janumet/Janumet XR, Merck);
- palbociclib (Ibrance, Pfizer);
- pomalidomide (Pomalyst, Bristol Myers Squibb);
- rifaximin (Xifaxan, Salix Pharmaceuticals); and
- semaglutide.
“The drugs treat conditions such as diabetes and cancer, and seniors across the country rely on them,” former President Joe Biden said in a statement announcing the new round of negotiations prior to the inauguration of President Donald Trump. “These 15 drugs, together with the 10 drugs that Medicare already negotiated, represent about a third of Medicare Part D spending on prescription drugs.”
References:
Medicare Drug Price Negotiation Program: Selected Drugs for Initial Price Applicability Year 2027. https://www.cms.gov/files/document/factsheet-medicare-negotiation-selected-drug-list-ipay-2027.pdf. Accessed Jan. 24, 2025.
Statement from President Joe Biden on the next fifteen drugs selected for Medicare drug price negotiation. https://web.archive.org/web/20250118080258/https://www.whitehouse.gov/briefing-room/statements-releases/2025/01/17/statement-from-president-joe-biden-on-the-next-fifteen-drugs-selected-for-medicare-drug-price-negotiation/. Published Jan. 17, 2025. Accessed Jan. 24, 2025.
American College of Rheumatology applauds additional drugs included in second round of Medicare drug price negotiations. Published Jan. 24, 2025. Accessed Jan. 24, 2025.