Even though the ten top-selling Medicare Half D medicine solely accounted for 0.3% of complete coated medicine in 2021, they represented 22% of complete gross Medicare drug spending, a brand new KFF evaluation discovered.
Beneath the Medicare Drug Worth Negotiation Program created by the Inflation Discount Act, the federal authorities will have the ability to negotiate the value of some high-spending medicine coated by Medicare Half D and Medicare Half B. The Facilities for Medicare and Medicaid Companies will begin by choosing 10 Half D medicine for 2026 (although the medicine can be introduced September 1, 2023). After that, CMS will progressively add extra medicine.
The KFF evaluation, revealed Wednesday, gives “context for understanding the potential affect of negotiating costs for a restricted variety of Medicare-covered medicine.” It relied on CMS’ information on Medicare Half D spending by drug. Nevertheless, the researchers famous that “this evaluation shouldn’t be designed to establish which medicine are more likely to be topic to cost negotiation for 2026, since we don’t bear in mind all the components that decide whether or not a drug is negotiation-eligible and we wouldn’t have entry to the extra present spending information that CMS will use in choosing medicine for value negotiation.”
KFF discovered that the ten top-selling Half D medicine represented $47.7 billion of the $215.7 billion complete gross Medicare Half D drug spending in 2021 (this didn’t embrace rebates paid by drug producers to PBMs). Eliquis, a blood thinner by Bristol Myers Squibb, accounted for essentially the most spending out of those 10 medicine at $12.6 billion.
One other 5 of those medicine had been diabetes medicine: Trulicity ($4.7 billion of gross spending), Januvia ($4.1 billion), Jardiance ($3.7 billion), Lantus Solostar ($2.8 billion) and Ozempic ($2.6 billion). The latter has gained consideration just lately because of its effectiveness in supporting weight reduction.
The remaining top-selling medicine had been a number of myeloma remedy Revlimid ($5.9 billion), blood thinner Xarelto ($5.2 billion), most cancers remedy Imbruvica ($3.2 billion), and rheumatoid arthritis remedy Humira Citrate-free pen ($2.9 billion).
KFF additionally found that gross Medicare spending for the ten top-selling Half D medicine greater than doubled between 2018 and 2021, from $22 billion to $48 billion. In complete, gross Half D spending elevated from $166 billion in 2018 to $216 billion in 2021.
“The rise in gross spending on these 10 medicine alone accounted for greater than half of the rise in gross Medicare spending throughout all coated Half D medicine over these years,” the report acknowledged.
To be eligible for the value negotiation program, small-molecule medicine should have acquired FDA approval no less than seven years previous to when the chosen medicine are introduced. For biologics, it’s 11 years. In addition they can’t have therapeutically-equivalent generic or biosimilar options. For these causes Trulicity, Ozempic, Revlimid, Humira and Lantus can be excluded.
“Whereas all the 10 top-selling Half D medicine in 2021 won’t be included on the checklist of 10 medicine chosen for value negotiation this yr, this evaluation means that concentrating on negotiation on a small variety of high-spending medicine may have an effect on a disproportionate share of Medicare drug spending sooner or later,” KFF mentioned.
Photograph: cagkansayin, Getty Photos
