CMS recently announced 10 drugs covered under Medicare Part D that it will negotiate with manufacturers on price under the Inflation Reduction Act (IRA) to establish a “maximum fair price” (MFP) of these drugs, effective in 2026. The list of the ten drugs includes: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill.
Under the IRA, pharmacies will be reimbursed the difference between the acquisition cost of the drugs and the MFP.
NCPA continues to advocate for reasonable reimbursement of these drugs for pharmacy, including reasonable acquisition cost, ingredient cost, margin and a commensurate dispensing fee under this model and in Medicare Part D generally. Medicare enrollees taking the 10 drugs covered under Part D selected for negotiation paid a total of $3.4 billion in out-of-pocket costs in 2022 for these drugs. These selected drugs accounted for $50.5 billion in total Part D gross covered prescription drug costs, or about 20 percent, of total Part D gross covered prescription drug costs between June 1, 2022 and May 31, 2023, which is the time period used to determine which drugs were eligible for negotiation.
CMS will hold negotiations with manufacturers in 2023 and 2024 to establish the MFP for these 10 drugs. For more details, see CMS’ fact sheet here, as well as a fact sheet from the Office of the Assistant Secretary for Planning and Evaluation here.
