Medicare beneficiaries will see lower prices but not for about a year and a half.
The Biden administration announced that it has negotiated agreements for lower prices on 10 popular medications that are among the “most expensive and most frequently dispensed drugs in the Medicare program,” the Department of Health and Human Services Department said.
The medications treat heart disease, diabetes and cancer and the HHS said that people on Medicare use at least one of the drugs on the list.
“The selected drugs accounted for $56.2 billion in total Medicare spending, or about 20 percent of total Part D gross spending in 2023,” HHS said in a news release.
“Medicare enrollees paid a total of $3.4 billion in out-of-pocket costs in 2022 for these drugs.”
One of the medications, Imbruvica, cost $14,934 in 2023. The new, negotiated price is $9,319. Stelara was $13.836 in 2023 but will be $4,695 under the plan.
The price of the medications has been increasing steadily over the years. Some went up as much as 55% from 2019 to 2023.
Right now, Americans pay two to three times more for prescription drugs than they would anywhere else.
— The White House (@WhiteHouse) August 15, 2024
But the Biden-Harris Administration beat Big Pharma. And after months of negotiations, Medicare has reached agreements to lower the price for 10 of the highest-cost drugs. pic.twitter.com/eGVtAtJsVO
The medications have been available for years and do not have competition, The New York Times reported.
HHS shared a hypothetical example of a person on Medicare who takes Stelara. They currently pay 25% co-insurance or about $3,400 for a 30-day supply now. Once the new pricing goes into effect, they still pay 25% coinsurance, but it would be $1,100 before they hit the catastrophic cap. Once they reach the level, they pay no more out-of-pocket costs on prescriptions. The actual amounts will vary depending on the benefits a person has.
The new pricing structure goes into effect in 2026.
Fifteen additional medications will be added to the list to be covered in 2027 with another 15 drugs added in 2028 and finally 20 more added in 2029. The Biden administration wants Medicare to negotiate prices for 500 drugs over the next 10 years.
A $35 monthly cap for insulin is already in effect and a $2,000 annual cap for medications taken at home goes into effect in 2025, The New York Times reported.
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