麻豆传媒

Physician and consumer groups expressed positive responses to Medicare's release Thursday of its price list for the first 10 negotiated drugs under its Drug Price Negotiation program, but the pharmaceutical industry was not so pleased.

"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 American College of Rheumatology, 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."

The price negotiation program was passed in 2022 as part of the Inflation Reduction Act (IRA). The measure lowers prescription drug costs for seniors by empowering Medicare to negotiate the cost of prescription drugs. The 10 drugs on the list and their price reductions for a 30-day supply were:

• Sitagliptin (Januvia): for type 2 diabetes; original price $527, negotiated price $113 (79% decrease)
• Insulin aspart injection (NovoLog, among others): for diabetes mellitus; original price $495, negotiated price $119 (76% decrease)
• Dapagliflozin (Farxiga): for type 2 diabetes, heart failure, and chronic kidney disease; original list price $556, negotiated price $179 (68% decrease)
• Etanercept (Enbrel): for rheumatoid arthritis; original list price $7,106 ($1,777 per weekly dose), negotiated price $2,355 (67% decrease)
• Empagliflozin (Jardiance): for type 2 diabetes and heart failure; original list price $573, negotiated price $197 (66% decrease)
• Ustekinumab (Stelara): for Crohn's disease, ulcerative colitis, psoriasis, and psoriatic arthritis; original list price $13,836, negotiated price $4,695 (66% decrease)
• Rivaroxaban (Xarelto): to prevent blood clots and reduce risks for patients with coronary or peripheral artery disease; original list price $517, negotiated price $197 (62% decrease)
• Apixaban (Eliquis): to prevent stroke and blood clots; original list price $521, negotiated price $231 (56% decrease)
• Sacubitril/valsartan (Entresto): for chronic heart failure; original list price $628, negotiated price $295 (53% decrease)
• Ibrutinib (Imbruvica): for chronic lymphocytic leukemia/small lymphocytic lymphoma and other blood cancers; original list price $14,934, negotiated price $9,319 (38% decrease)

"For years, the powerful drug lobby had prevented any negotiation for drug prices by the largest purchaser of medications, our Medicare program," , senior director of healthcare campaigns at U.S. PIRG, a public interest consumer group. "But Congress and the president heard the pleas of patients saying that they can't just pay whatever the industry wants to charge -- drug prices are out of control. Now, we can celebrate the first set of new lower prices for common pricey medications that patients rely on to live productive, healthy lives."

The Endocrine Society was also pleased. "There are significant savings for the diabetes drugs on this list," the society said in an email to 麻豆传媒. "This is a significant victory for Medicare beneficiaries living with diabetes who rely on these medications."

Asked about whether the drop in insulin prices would have any effect on Medicare beneficiaries since their insulin out-of-pocket costs are already capped at $35 per month, a spokesperson responded, "The $35 cap for Medicare beneficiaries stays the same regardless of the negotiated price. However, the negotiated price could help drive down the overall price of these insulins since Medicare often sets the standard for the price of medications in the private market -- so this is a win for people with diabetes who need insulin."

Not surprisingly, things looked different on the pharmaceutical side of the ledger. "The administration is using the IRA's price-setting scheme to drive political headlines, but patients will be disappointed when they find out what it means for them," Steve Ubl, president and CEO of the Pharmaceutical Research and Manufacturers of America, . "There are no assurances patients will see lower out-of-pocket costs because the law did nothing to rein in abuses by insurance companies and PBMs [pharmacy benefit managers] who ultimately decide what medicines are covered and what patients pay at the pharmacy."

"As a result of the IRA, there are fewer Part D plans to choose from and premiums are going up," he continued. "Meanwhile, insurers and PBMs are covering fewer medicines and say they intend to impose further coverage restrictions as the price-setting scheme is implemented."

The Biosimilars Forum, which represents biosimilar manufacturers, had a beef about one of the drugs in particular. "The Biosimilars Forum is greatly concerned that the CMS is misinterpreting the Biosimilar Special Rule of the IRA," said Juliana Reed, the forum's executive director, . "Congress's intent was to omit products from negotiation that will have imminent biosimilar competition, which would ultimately provide more choice to patients and lower prescription drug prices."

However, she continued, "Several biosimilars for Stelara are to launch in 2025 and should be able to meaningfully compete in a free market system. CMS should follow the intent of the IRA and immediately remove Stelara from the list."

Over on Capitol Hill, divided opinions on the program were in evidence. "The Biden-Harris administration's Inflation Reduction Act is already backfiring -- leading to higher list prices for the prescription drugs that seniors rely upon to stay healthy," Rep. Cathy McMorris Rodgers (R-Wash.) chair of the House Energy & Commerce Committee, said . "This scheme is also hampering the research and development of the next treatment or cure for Americans battling diseases, such as cancer. Furthermore, the IRA has driven up Medicare Part D premiums, which the administration is desperately trying to hide by giving away taxpayer dollars to big insurance companies."

But Rep. Frank Pallone (D-N.J.), the committee's ranking member, disagreed. "This is a historic day," Pallone said in a statement released Thursday. "Democrats fought for over 20 years to empower Medicare to negotiate lower prescription drug prices for seniors. Today we have finally achieved that goal."

"As a result of these negotiations, Americans are expected to save $1.5 billion in the first year alone," he said. "And this is just the beginning. Now that Medicare has the authority to negotiate, it will continue to negotiate lower prices on more drugs each year going forward. It is a game changer that will save American seniors' hard-earned money for years to come."

The negotiated prices will take effect beginning Jan. 1, 2026. Looking ahead, CMS will choose up to 15 additional drugs for price negotiation for 2027, up to 15 more drugs (to include drugs covered under Medicare Part B) for 2028, and up to 20 more drugs for price negotiation each year after that, as stated in the IRA.

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