Tuesday, April 16, 2024

All 10 Pharma Companies Respond to Medicare Pricing Negotiations Offers, Progressing Under Inflation Reduction Act

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The US Department of Health and Human Services (HHS), operating under the Centers for Medicare and Medicaid Services (CMS) umbrella, has declared that all ten pharmaceutical manufacturers engaged in Medicare pricing negotiations have provided counteroffers. This development follows the issuance of initial offers by the HHS on February 1, as part of ongoing endeavors to curtail drug prices in the United States under the Inflation Reduction Act (IRA). Negotiations are slated to persist over the ensuing months.

The ten medications earmarked for the inaugural round of Medicare pricing negotiations were carefully selected last August to encompass a diverse array of therapeutic categories addressing prevalent health conditions. These encompass therapies vital for managing diabetes, heart failure, immunological disorders, cancer, and anticoagulants, catering to a broad spectrum of patient needs and medical requirements.

Among the selected drugs are Bristol Myers Squibb/Pfizer’s Eliquis (apixaban), acknowledged for its efficacy in preventing blood clots and reducing the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation, Novartis’ Entresto (valsartan/sacubitril), recognized for its role in reducing the risk of cardiovascular death and hospitalization for heart failure, and AstraZeneca’s Farxiga (dapagliflozin), renowned for its efficacy in managing type 2 diabetes by lowering blood sugar levels.

The selected drugs encompass AbbVie/Johnson & Johnson’s Imbruvica (ibrutinib), celebrated for its effectiveness in treating certain types of leukemia, Eli Lilly/Boehringer Ingelheim’s Jardiance (empagliflozin), recognized for its cardiovascular benefits and efficacy in managing type 2 diabetes, and Johnson & Johnson’s Stelara (ustekinumab) and Xarelto (rivaroxaban), acknowledged for their roles in managing psoriasis and preventing blood clots and strokes, respectively. Each of these medications represents a cornerstone in contemporary healthcare, addressing critical medical needs and improving patient outcomes across various therapeutic domains.

By including a diverse range of medications spanning different therapeutic classes, the Medicare pricing negotiations aim to address the multifaceted healthcare needs of the population and ensure equitable access to vital medications for all beneficiaries. The selection process underscores the meticulous attention to detail and comprehensive evaluation of clinical evidence and patient outcomes to identify medications with the greatest potential to enhance healthcare quality and affordability within the Medicare program.

According to HHS data, these medications collectively accounted for up to $50 billion in Medicare expenditures between June 2022 and May 2023, while incurring $3.4 billion in out-of-pocket expenses for patients in 2022.

Medicare Pricing Negotiations

Biden Administration Advances Medicare Pricing Negotiations, Aiming for Lower Costs by 2026

The Biden-Harris Administration has affirmed that all ten designated drugs will persist in Medicare pricing negotiations, with updated prices slated for announcement by September 1, 2024, and implementation scheduled for the onset of 2026.

CMS administrator Chiquita Brooks-LaSure emphasized, “Receiving counteroffers marks another negotiation milestone met in the continued implementation of the landmark IRA, which is already lowering drug prices for people with Medicare.”

President Biden conveyed in a statement his intent to address his administration’s endeavors to mitigate healthcare costs and continue confronting ‘big pharma’ to enhance the affordability of prescription drugs for all Americans.

Since expanding eligibility for full benefits, nearly 300,000 individuals with low and modest incomes have enrolled and commenced reaping the benefits of the IRA. Moreover, the HHS Office of the Assistant Secretary for Planning and Evaluation released an IRA-related fact sheet. It underscored that the IRA’s $35 cap on cost-sharing for each Medicare-covered insulin product would have benefitted approximately 281,000 rural enrollees if implemented in 2020.


Resource: PM Live, March 06, 2024

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