The Drug Prices Medicare Can Directly Negotiate
When the Inflation Reduction Act of 2022 was signed into law, it gave Medicare the novel ability to negotiate directly with manufacturers on certain drugs’ costs. Medicare will negotiate 10 Part D drugs for 2026, 15 Part D drugs for 2027, 15 more Part B or Part D drugs for 2028, and 20 more Part B or Part D drugs for 2029 and every year thereafter.
As of 2023, the criteria that drugs must meet to be eligible for negotiation are:
- Brand-name drugs or biologics
- Part of the 50 negotiation-eligible drugs with the highest total Medicare Part D spending
- Part of the 50 negotiation-eligible drugs with the highest total Medicare Part B spending
- Aren’t in one of the disqualifying categories:
- Drugs that have generic or biosimilar versions available
- Drugs less than nine years (small-molecular drugs) or 13 years (biologics) from FDA approval or licensure date
- Certain “small biotech drugs” (from 2026 to 2028)
- Drugs that amount to less than $200 million of Medicare spending in 2021
- Drugs with an orphan designation as their only FDA approval
On August 29, 2023, the first 10 drugs that will be part of the Medicare Drug Price Negotiation Program were announced. We’ll continue to keep this list updated as more drugs are announced in the future so you can be aware which drugs Medicare can negotiate for directly.
Generic Name: Apixaban
Eliquis is an anticoagulant that is prescribed to help prevent serious blood clots (primarily deep vein thrombosis (DVT) and pulmonary embolus (PE) clots) and may prevent them from reforming. It can also lower your risk of having a stroke.
Generic Name: Empagliflozin
Jardiance can help treat type 2 diabetes by improving blood sugar levels, reducing the risk of cardiovascular death in adults with cardiovascular disease alongside type 2 diabetes, and reducing the risk of hospitalization and death in some adults with heart failure.
Generic Name: Rivaroxaban
Xarelto is an anticoagulant that can treat and prevent DVT and PE blood clots due to certain atrial fibrillation or hip or knee replacement surgery. It’s also used for limited-mobility, high-risk patients during or after inpatient care.
Generic Name: Sitagliptin Phosphate
Januvia is used to help control high blood sugar in people with type 2 diabetes. It both increases the number of incretins in your body, a natural substance that helps control blood sugar, and decreases the amount of sugar your liver makes.
Generic Name: Dapagliflozin Propanediol
Farxiga is used to help control high blood sugar in people with type 2 diabetes. It’s also used to lower your risk of developing, and in the treatment of, chronic kidney disease and heart failure.
Generic Name: Sacubitril-Valsartan
Entresto can help treat certain types of heart failure by relaxing the blood vessels, allowing the blood to flow more easily. This lessens the strain on your heart as it pumps blood through your body.
Generic Name: Etanercept
Enbrel is an injectable medicine that is used to treat certain types of autoimmune diseases like rheumatoid arthritis, psoriasis, and psoriatic arthritis.
Generic Name: Ibrutinib
Ibrutinib is a class of drug called a kinase inhibitor that is used to treat certain types of cancers, specifically blood cancers. It slows the growth of cancer cells, sometimes even stopping the growth.
Generic Name: Ustekinumab
Stelara is an injectable medicine that blocks proteins (interleukin-12 and interleukin-23) that can cause inflammation in certain conditions. It’s used to help treat psoriatic arthritis, Crohn’s disease, ulcerative colitis, and plaque psoriasis.
NovoLog and Fiasp (2026)
Generic Name: Insulin Aspart
Both NovoLog and Fiasp are injectable insulin used to help control high blood pressure in people with diabetes by replacing the insulin your body would normally create. Medicare can also negotiate for NovoLog FlexPen, NovoLog PenFill, Fiasp FlexTouch, and Fiasp PenFill.
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As this list continues to grow, we’ll continue to add to it. Be sure to check back each year to see which medicines Medicare will be able to negotiate pricing on next!
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