What’s next in Medicare price negotiation

The medications announced on Tuesday target highly common diseases in the U.S., such as heart disease, heart failure, rheumatoid arthritis and diabetes.


The selection included insulin drug NovoLog, blood thinner Eliquis, antidiabetic Jardiance and leukemia drug Imbruvica, as well as a more unanticipated pick: Stelara, which is used to treat Crohn’s disease.


The drugs chosen for initial Medicare price negotiation were picked based on a very specific set of guidelines.


They couldn’t be “orphan drugs” (medications for diseases so rare that manufacturers have little incentive to develop them without government assistance), couldn’t be on the market for less than a certain number of years and couldn’t already have competition from the generic or biosimilar market.


According to the Centers for Medicare and Medicaid, the 10 drugs that were chosen account for $50.5 billion in total gross Part D spending, or about 20 percent of total expenses.


The pharmaceutical industry, which is waging a legal battle against the program, will likely play ball when it comes to negotiations despite its protests. The penalties for opting out of talks are potentially steep, and there’s always the possibility their wave of lawsuits are ultimately unsuccessful.


Amid all the noise, the White House still celebrated the milestone on Tuesday, with President Biden standing resolute.


“Big Pharma charging Americans more than three times what they charge other countries simply because they could and I think it’s outrageous. That’s why these negotiations matter,” he said in a speech.


“We’re going to keep standing up to Big Pharma, and we’re not gonna back down,” he added.


Manufacturers now have until Oct. 1 to sign an agreement to negotiate.


Read more here on what happens next.


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