Earlier this year (January Voice) we reported on the status of the Medicare Drug Price Negotiation Program that is administered by the federal CMS (Centers for Medicare & Medicaid Services). Briefly we highlighted CMS’s final implementation of the 1st cycle drug prices, that took effect this past January, and its announcement of the negotiated maximum fair price (MFP) for the 15 drugs included in the 2nd cycle that will be effective this coming January (2027). Please refer to our January Voice for a complete listing of the 25 drugs in the 1st and 2nd cycles.
Since then the CMS has implemented the program’s 3rd cycle of 15 drugs, with a 4th cycle also planned. Among the factors for selecting a drug in the program is determining whether no generic or biosimilar competition exists. Also, CMS ranks negotiation-eligible drugs according to the highest total expenditure for drugs payable under Medicare Part B and/or Part D.
Listed here are the 15 drugs whose MFP are now being negotiated between CMS and the participating drug manufacturers, along with the commonly treated conditions for which the drug is prescribed and the drug’s manufacturer. Some have familiar names such as Trulicity, Botox and Rexulti.
It must be noted that CMS lists a 16th drug, Tradjenta, that was originally negotiated as part of the program’s 2nd cycle. It is now being renegotiated in the 3rd cycle.
As done in the 1st and 2nd cycles, CMS has conducted extensive data and information gathering from the public as well as the participating drug companies. This included multiple patient-focused and clinical- focused public engagement sessions, as well as optional meetings between CMS and participating drug companies.
As we went to press, CMS will be sending an initial offer of the MFP for each drug to the participating drug manufacturer who will then have to accept CMS’ initial offer or propose a counteroffer. If a counteroffer is made, negotiations continue through the summer, with CMS issuing its final MFP offer by September 30th.
For updates, please look to our weekly emails, hotline messages and other media outlets.
