CMS selects 10 drugs for price negotiation – Healthcare Economist

CMS selects 10 drugs for price negotiation

As of my last knowledge update in September 2021, I do not have access to real-time information, including specific updates on actions taken by government agencies. However, I can provide you with some general information about how drug price negotiation might work in the context of government programs like Medicare.

The Centers for Medicare & Medicaid Services (CMS) in the United States may select specific drugs for price negotiation through various initiatives and programs. One of the key programs related to drug price negotiation is the Medicare Part D program. Here’s a general outline of how it may work:

  1. Medicare Part D: Medicare Part D is a federal program that provides prescription drug coverage for eligible Medicare beneficiaries. Private insurance companies approved by Medicare offer these prescription drug plans (PDPs) to beneficiaries. The government negotiates with these insurance companies to set the terms and conditions of the program.
  2. Negotiation of Drug Prices: Under Medicare Part D, the government, through CMS, has the authority to negotiate drug prices with pharmaceutical manufacturers. This negotiation typically occurs for drugs that are offered through Medicare Part D plans.
  3. Formularies: Each Medicare Part D plan has a formulary, which is a list of covered drugs. CMS and the private insurance companies work together to determine which drugs are included on these formularies and at what cost-sharing levels (e.g., copayments or coinsurance) they will be available to beneficiaries.
  4. Benchmark Plans: CMS establishes benchmark plans each year, which serve as a reference for determining the subsidy amount that beneficiaries receive to help cover their drug costs. The benchmark plans are typically based on negotiated prices for drugs.
  5. Annual Review: The list of drugs selected for price negotiation and the terms of these negotiations can change annually based on factors like drug prices, utilization, and therapeutic advances.
  6. Beneficiary Access: CMS and the insurance companies strive to ensure that beneficiaries have access to a broad range of medications while keeping costs in check. They must balance cost savings with access to essential medications.

It’s important to note that the specifics of which drugs are selected for price negotiation can vary from year to year and may depend on various factors, including the drugs’ costs and utilization patterns. Additionally, legislative changes or new government initiatives can impact drug price negotiation within the Medicare program.

For the most up-to-date information on CMS’s selection of drugs for price negotiation, I recommend checking the official CMS website or consulting recent news sources for any announcements or developments related to drug pricing and negotiation in the Medicare program.

Here is the CMS Factsheet and news coverage from NY Times.

The companies that make each of these drugs is listed below.

  1. Eliquis – Bristol Myers Squibb and Pfizer
  2. Jardiance- Boehringer Ingelheim and Eli Lilly
  3. Xarelto – Johnson & Johnson
  4. Januvia – Merck
  5. Farxiga – AstraZeneca
  6. Entresto – Novartis
  7. Enbrel – Amgen
  8. Imbruvica,- AbbVie and Johnson & Johnson
  9. Stelara, – Johnson & Johnson
  10. Fiasp and NovoLog – Novo Nordisk

One Comment

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