CMS recently announced the maximum fair prices (MFPs) for 15 Medicare Part D drugs selected for the second cycle of Medicare negotiations, which will take effect on Jan. 1, 2027. CMS noted that approximately 5.3 million people with Medicare Part D coverage used these 15 drugs between Jan. 1, 2024, and Dec. 31, 2024, accounting for $42.5 billion in total gross covered prescription drug costs under Medicare Part D and $1.7 billion in beneficiaries' out-of-pocket spending. Medicare Part D beneficiaries are expected to save "an estimated $685 million in out-of-pocket costs" under the defined standard benefit design when these negotiated prices take effect on Jan. 1, 2027.
The most noticeable drug on the list, Novo Nordisk's Ozempic, Rybelsus, and Wegovy will have an MFP of $274, higher than the $245 Medicare price announced weeks earlier under the administration's most-favored-nation (MFN) deal. According to news reports, CMS has confirmed that due to the terms and timelines of the negotiated deals, the MFN prices for covered GLP-1 drugs are expected to supersede the IRA prices.
The CMS press release is available here, and the fact sheet on the initial price applicability year (IPAY) 2027 MFP is available here. Additionally, a plain language infographic on the IPAY 2027 MFP can be found here. Further information on the Medicare Drug Price Negotiation Program can be found here.
We're telling you this twice in today's newsletter, we know, because it's that important: The Medicare Drug Price Negotiation Program kicks off in one short month for the first 10 drugs. Make sure you are prepared and enrolled in the Medicare Transaction Facilitator! For more information on how to enroll and other helpful details, click here.
