The Biden administration released the next list of prescription drugs that will be negotiated with Medicare on Friday. These drugs include Ozempic and Wegovy, which are popular diabetes and weight loss drugs. People don’t like how expensive the drugs are, which has made people look for cheaper options.
The list has 15 drugs on it, up from 10 last year. It is the first step in a process that Medicare and drug companies plan to negotiate over the next few months. The new prices that were agreed upon won’t start until 2027.
The Inflation Reduction Act of 2022 requires the discussions to happen, but it’s not clear what will happen with them now that Trump is in office. The new administration hasn’t said whether it supports the government program or not.
The drugs that have been chosen to be negotiated are
Wegovy, Ozempic, and Rybelsus are all medicines for Type 2 diabetes and weight loss.
Ellipta Trelegy, a medicine for asthma.
Xtandi, for cancer of the prostate.
Pomalyst is a drug used in treatment.
Ibrance is a drug for breast cancer.
Ofev, for lung fibrosis that has no known cause.
Linzess, a drug for long-term diarrhea.
Calquence is a drug for cancer.
For Huntington’s disease, Austedo and Austedo XR are used.
Breo Ellipta is a drug for COPD.
TRADJENTA is a drug for diabetes.
It is used to treat diarrhea and irritable bowel syndrome.
The drug Vraylar is an antidepressant.
Janumet and Janumet XR are diabetes medicines.
Otezla is a drug for psoriatic arthritis.
KFF is a non-profit that studies health policy problems. Juliette Cubanski is the deputy director of the Medicare policy program there. She said that this year, getting a good deal for the government is very important.
A KFF poll released on Friday found that more than half of people, including almost half of Republicans, say it should be a “top priority” to negotiate more prescription drugs.
A lot of people want drugs like Ozempic. As Medicare starts to cover these drugs for other FDA-approved uses, like lowering the risk of heart disease, the cost to taxpayers is likely to go up. Medicare is not allowed to pay for weight loss drugs right now. Cubanski said, “Being tough at the negotiating table could save Medicare billions of dollars over the next few years.”
The drug companies have a little more than a month to agree to talk, or they could be hit with tax fines. To get around the tax, they would have to take the drug out of the Medicare program, which would leave them with very little of the market.
On a call, a representative from the Centers for Medicare and Medicaid Services said that the government will start calling drug companies later today to give them information about the discussion process.
When asked if the new Trump administration could stop the talks or make changes, the official said, “If they were to make changes in the future, it would require more program guidance, possibly new rules, and possibly new requests for information.”
Novo Nordisk, the company that makes Ozempic and Wegovy, said in a statement that the company is still against the price talks. The spokesperson did say that the group would work with the new administration to “deliver meaningful solutions for patients.”
The CMS says that between November 1, 2023, and October 1, 2024, about 5.3 million Medicare recipients used the drugs.
Altogether, the 15 chosen drugs cost $41 billion, or 14% of all Medicare Part D spending. CMS says that these drugs, along with the first 10 drugs that Medicare already agreed to pay for, make up a third of all Part D spending. Part D of Medicare pays for prescription drugs that people take on their own, not ones that are given in a facility, like chemotherapy.
“We have a chance to negotiate a better deal for the American people,” Xavier Becerra, who is leaving his job as secretary of the Department of Health and Human Services, told reporters on a call. “This is very important. Some people have to skip a dose or cut their pills in half to make their medication last longer.
Last year, Medicare agreed to lower the prices of the 10 most expensive drugs. These drugs included the blood thinner Eliquis, the blood cancer treatment Imbruvica, and the diabetes drug NovoLog.
In 2026, those drugs will cost more than they do now.
Stacie Dusetzina, a professor of health policy at Vanderbilt University in Nashville, Tennessee, said that the fact that the Olympics are back this year is “a big deal.”
“This could lead to a lot more Medicare recipients using these drugs over time, which has big budget effects for their Part D plans, taxpayers, and Medicare recipients,” Dusetzina said. This could cause premiums to go up if a lot of qualified beneficiaries started using these weight loss products, since they need to be used regularly.
The drug business has sued the program many times to fight it, but so far they have not been successful.
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