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Medicare

Medicare’s New Drug Price Negotiations to Save Billions

By September 9, 2024No Comments
Prescription bottle and pills laying over cash with a calculator next to it.

Medicare drug price negotiations for 2026 address the issue that Americans have long paid more for prescription drugs than other developed nations. Due to the Inflation Reduction Act, the Centers for Medicare & Medicaid Services (CMS) can negotiate drug prices for the first time. This historic change is projected to save American taxpayers $6 billion and Medicare beneficiaries $1.5 billion in 2026 alone.

Negotiated Prices for Medicare Drugs in 2026

The US Department of Health and Human Services (HHS) has finalized agreements on lower prices for the first 10 drugs selected for negotiation, reducing their list prices by 38-79%. These new negotiated prices will take effect for Medicare Part D in 2026.

To view these prices and the full press release from the White House, click here.

These reductions will benefit millions of Medicare Part D enrollees treating conditions like diabetes, heart failure, and cancer. For example, a Medicare enrollee using Stelara for arthritis will see costs drop from $3,459 to $1,174 per month. Additionally, the Inflation Reduction Act’s $2,000 cap on out-of-pocket spending in 2025 will save 19 million beneficiaries an average of $400 annually.

Drug NameCommonly Treated ConditionsNumber of Medicare Enrollees Who Used the Drug in 2023Drug List Price in 2023 for 30-day SupplyNegotiated Price for 2026 for 30-day SupplySavings (%)
EliquisPrevention and treatment of blood clots3,928,000$521$231$290 (-56%)
JardianceDiabetes; Heart failure; Chronic kidney disease1,883,000$573$197$376 (-66%)
XareltoPrevention and treatment of blood clots; Reduction of risk for patients with coronary or peripheral artery disease1,324,000$517$197$320 (-62%)
JanuviaDiabetes843,000$527$113$414 (-79%)
FarxigaDiabetes; Heart failure; Chronic kidney disease994,000$556$178.50$377.50 (-68%)
EntrestoHeart failure664,000$628$295$333 (-53%)
EnbrelRheumatoid arthritis; Psoriasis; Psoriatic arthritis48,000$7,106$2,355$4,751 (-67%)
ImbruvicaBlood cancers17,000$14,934$9,319$5,615 (-38%)
StelaraPsoriasis; Psoriatic arthritis; Crohn’s disease; Ulcerative colitis23,000$13,836$4,695$9,141 (-66%)
Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFillDiabetes785,000$495$119$376 (-76%)

SOURCE: CMS, https://www.cms.gov/files/document/fact-sheet-negotiated-prices-initial-price-applicability-year-2026.pdf

Continuing to Lower Healthcare Costs

Other actions have taken place to save Americans money, such as:

  • Vaccines: Medicare enrollees save $70 on average for vaccines, with 10.3 million receiving free vaccines in 2023.
  • Insulin: Costs capped at $35 per month for 3.4 million Medicare Part D enrollees in 2023.
  • Inflation Rebates: Savings up to $4,593 for drugs with prices rising faster than inflation.
  • Out-of-Pocket Cap: Over 260,000 people benefited from a $3,500 cap in the first quarter of 2024.
  • Health Insurance Premiums: Savings of about $800 per year on premiums under the American Rescue Plan.

Medicare will continue to expand its negotiation program, selecting more drugs each year. The FY 2025 budget aims to accelerate negotiations, expand the $2,000 out-of-pocket cap beyond Medicare, and address inflation in drug prices. It also proposes extending the $35 insulin cost-sharing cap to the commercial market