As President Donald Trump touts new offers to chop the price of blockbuster medication like Wegovy and Zepbound, he’s barely talked about Medicare’s drug value negotiation program — despite the fact that the federal government is anticipated to announce decrease costs earlier than the top of the month.
This system, created beneath President Joe Biden’s Inflation Discount Act of 2022, gave Medicare the authority to barter straight with drugmakers on a few of the costliest drugs.
A Facilities for Medicare and Medicaid Companies (CMS) spokesperson stated the company is making ready to launch the second spherical of negotiated costs by Nov. 30 — overlaying 15 medication, up from 10 final yr, and including Ozempic and Wegovy to the checklist. The newly negotiated costs received’t take impact till 2027.
The shortage of consideration has puzzled well being coverage specialists, who say this system may play an vital position in decreasing prescription drug prices for tens of millions of older adults within the U.S.
About 1-in-5 adults say they’ve not stuffed a prescription due to price, in accordance with a ballot from the nonpartisan well being coverage analysis group KFF.
“Actually, the flurry of bulletins and lack of particulars [on negotiations] make issues complicated,” stated Dr. Benjamin Rome, a major care doctor and well being coverage researcher at Harvard Medical Faculty.
Trump’s strategy to decreasing drug costs has leaned closely on government orders and voluntary offers with drugmakers, somewhat than laws. Final week, he introduced agreements with Novo Nordisk and Eli Lilly — the makers of Wegovy and Zepbound, respectively — to decrease costs for some doses in trade for tariff aid and accelerated Meals and Drug Administration overview of recent medication. A number of specialists described the main points as murky and questioned whether or not the agreements would translate into actual financial savings for Individuals. Trump has struck related offers with Pfizer and Astrazenca.
Rome stated the Medicare negotiation program is seen because the steadier, extra dependable path to decreasing prices for Individuals.
Drugmakers can decline to take part — however doing so would probably require pulling their medication from Medicare totally, chopping them off from one of many nation’s largest markets. A number of firms have challenged the negotiation program in court docket, however these lawsuits have thus far been unsuccessful.
“Though it’s nice that the Trump administration needs to aggressively negotiate decrease costs with pharmaceutical firms, these advert hoc negotiations appear to be extra about saying short-term political victories,” Rome stated.
“I might be very skeptical of relying solely on voluntary offers with drug producers as a most important coverage for making drugs extra reasonably priced to Individuals,” Rome added. “In contrast, the IRA completely will get monetary savings for taxpayers by means of the negotiation course of.”
Regardless of the looming announcement, the White Home has stated little publicly in regards to the negotiation program or the way it matches into Trump’s broader push to decrease drug costs.
In an emailed assertion, White Home spokesperson Kush Desai stated: “Democrats endlessly touted the Inflation Discount Act, which mockingly beneath Biden’s watch did little however improve Medicare premiums. The Trump administration is concentrated on outcomes, and our historic drug pricing offers with international pharmaceutical giants are proof that we’ll proceed to ship significant change for the American folks.”
Final yr, the Biden administration introduced agreements to decrease costs on 10 pharmaceuticals beneath Medicare, with these cuts set to take impact in 2026. The medication included the blockbuster blood thinner Eliquis, together with a number of most cancers and diabetes remedies. On the time, administration officers projected the negotiations would save Medicare enrollees $1.5 billion in out-of-pocket prices within the first yr.
Consultants say the second spherical could have an excellent bigger influence than final yr’s since a few of the medication on the checklist — significantly Ozempic and Wegovy — have gotten essentially the most extensively used and costliest in Medicare.
The Congressional Finances Workplace, a nonpartisan authorities group that gives funds and financial info to Congress, initiatives that, due to negotiations, the web value of Ozempic and Wegovy will “fall considerably” starting in 2027 — chopping Medicare’s spending on every affected person who makes use of the medication by one third. The CBO additionally expects that these decrease costs are prone to put strain on different GLP-1 medication, together with Mounjaro and Zepbound.
Stacie Dusetzina, a well being coverage professor at Vanderbilt College in Nashville, Tennessee, stated it’s doable the negotiations could have factored into Trump’s deal on Wegovy and Zepbound final week.
When requested on a name with reporters whether or not Trump’s deal was associated to the negotiations, senior administration officers insisted it was not.
“We’re all eagerly awaiting the announcement of what costs have been negotiated,” Dusetzina stated. “It may very effectively be that that is the place the negotiations landed.”
Different specialists raised questions on how Trump’s deal matches with the negotiations — or whether or not the 2 efforts are even aligned in any respect.
Tricia Neuman, government director of this system on Medicare coverage at KFF, stated it’s “not clear how the current White Home announcement dovetails with the Inflation Discount Act in the case of negotiated costs for GLP-1s.”
Rome stated Trump’s offers are unlikely to intervene or undermine the negotiation course of.
“That course of could be very clearly spelled out by CMS and has been ongoing all year long and can repeat for one more 20 medication early subsequent yr,” he stated. “I don’t assume these facet offers with Lilly and Novo will change that.”
Neuman added that whereas the voluntary offers could also be drawing extra consideration from the White Home, they don’t exchange the long run impacts of Medicare negotiations.
“The IRA’s Medicare negotiations program is baked into the regulation, and is up and working, and will finally result in decrease costs for a lot extra medication over time,” she stated.
