Medicare will begin negotiating prices for certain drugs as part of the Inflation Reduction Act. These changesbegin rolling out in 2023, with the agency negotiating prices for 10 drugs, which are set to go into effect in 2026.
Certain criteria dictate which drugs Medicare can negotiate for — drugs must have been on the market for at least seven years, or 11 years for biologics. These drugs also must be single-source, with no generics available.
Based on these criteria, Micah Johnson, MD, Rahul Nayak, MD, and Sanjay Kishore, MD, predicted which drugs would be the first to be negotiated by Medicare, based on their use and cost to the program, for Health Affairs.
The authors note the criteria in the Inflation Reduction Act mean some of the most expensive drugs won’t be eligible for negotiation because they are too new or there are generic versions available.
These are the 10 drugs the physicians predict Medicare will choose to negotiate first:
1. Apixaban
Part D Spending (2020): $9.9 million
Number of Medicare beneficiaries (2020): 2.6 million
Use: Reduce risk of stroke and prevent blood clots
2. Rivaroxaban
Part D Spending (2020): $4.7 million
Number of Medicare beneficiaries (2020): 1.2 million
Use: Blood thinner to treat and prevent clots
3. Sitagliptin
Part D spending (2020): $3.9 million
Number of Medicare Beneficiaries (2020): 934,686
Use: Type 2 diabetes treatment
4. Ibrutinib
Part D spending (2020): $3 million
Number of Medicare beneficiaries: 26,847
Use: Treats certain kinds of cancers, including mantle cell lymphoma
5. Insulin aspart
Part D spending (2020): $2.5 million
Number of Medicare beneficiaries (2020): 869,373
Use: Treatment of Type 1 and Type 2 diabetes
6. Empagliflozin
Part D spending (2020): $2.4 million
Number of Medicare beneficiaries (2020): 594,859
Use: Type 2 diabetes treatment
7. Etanercept
Part D spending (2020): $2.2 million
Number of Medicare beneficiaries (2020): 45,991
Use: Rheumatoid arthritis treatment
8. Budesonide/Formoterol
Part D spending (2020): $2.1 million
Number of Medicare beneficiaries (2020): 1.3 million
Use: Asthma and COPD treatment
9. Palbociclib
Part D spending (2020): $2.1 million
Number of Medicare beneficiaries (2020): 21,394
Use: Treats breast cancer that is hormone receptor positive
10. Insulin detemir
Part D spending (2020): $2 million
Number of Medicare beneficiaries (2020): 590,482
Use: Type 1 and Type 2 diabetes treatment
