CMS has released the negotiated prices of the 10 drugs in the Medicare Drug Price Negotiation Program in Medicare Part D, effective CY 2026, that CMS has negotiated with manufacturers. These new negotiated prices are referred to as maximum fair prices. These include, for a 30-day supply: Januvia ($113), Fiasp, Fiasp FlexTouch, Fiasp PenFill, NovoLog, NovoLog FlexPen, NovoLog PenFill ($119), Farxiga ($178.50), Enbrel ($2,355), Jardiance ($197), Stelara ($4,695), Xarelto ($197), Eliquis ($231), Entresto ($295), and Imbruvica ($9,319).
NCPA continues to advocate for pharmacy reimbursement for these drugs that will cover acquisition cost plus a commensurate professional dispensing fee in line with Medicaid fee-for-service and be paid within Medicare prompt pay requirements. For details on NCPA’s most recent comments to CMS, click here.
The selected drugs accounted for $56.2 billion in total Medicare spending, or about 20 percent of total Part D gross spending in 2023. Overall, total Part D gross spending for the 10 selected drugs more than doubled from 2018 to 2022, from about $20 billion to about $46 billion, an increase of 134 percent. Medicare enrollees paid a total of $3.4 billion in out-of-pocket costs in 2022 for these drugs.
In accordance with the Inflation Reduction Act, the negotiated price will apply to a selected drug so long as the selected drug remains in the Medicare Drug Price Negotiation Program. CMS will publish an explanation of the agreed-upon negotiated prices by March 2025.
CMS will select up to 15 more drugs covered under Part D for negotiation for 2027 by Feb. 1, 2025. CMS will select up to 15 more drugs covered by Part B or Part D for 2028 and up to 20 more Part B or Part D drugs for each year after that, as required by the Inflation Reduction Act.
For details, see the CMS fact sheet here and press release here.
