The Biden administration this week is expected to announce the first 10 prescription drugs the federal government will negotiate under a new federal law that aims to reduce the cost of Medicare’s most expensive medicines.

For the first time, the federal government is allowed to negotiate drug prices for older Americans because of the Inflation Reduction Act, the sweeping climate and health legislation passed by Congress last year. The Centers for Medicare & Medicaid Services must publish the list of 10 drugs by Friday, but administration officials have signaled the announcement could come earlier in the week.

Consumer and senior advocates long have sought efforts to rein in drug prices for Medicare enrollees and taxpayers.

The federal health program for adults 65 and older and disabled people sets reimbursement amounts for medical care from doctors and hospitals, but until now, Medicare has been prohibited from negotiating drug prices under 2003 legislation that expanded Medicare’s prescription drug coverage.

Analysts say some expensive and widely used drugs for arthritis, cancer, diabetes or heart disease could be targeted for negotiation. Price changes for the first batch of 10 drugs won’t take effect until 2026. Over the next two years, another 30 drugs will be selected for negotiated prices beginning in 2027 and 2028.

“The negotiation process is going to meet its goal of capturing those drugs that are either used by a lot of people, are very expensive, or both,” said Leigh Purvis, a prescription drug policy principal with AARP Public Policy Institute.

Big Pharma takes the fight to court

But the pharmaceutical industry is challenging the drug negotiations. Big Pharma and industry allies have filed eight lawsuits seeking to derail drug negotiations. AstraZeneca, Astellas Pharma, Bristol Myers Squibb, Johnson & Johnson, Merck and the drug industry’s trade group, PhRMA, have filed legal challenges, as has the U.S., Michigan and Ohio chambers of commerce.

The lawsuits use unique legal theories on why drug negotiations should be halted. In a lawsuit filed Friday at U.S. District Court in Delaware, AstraZeneca said the Inflation Reduction Act’s drug negotiation provisions conflict with another federal law, the Orphan Drug Act, which seeks to promote drug industry investment in new therapies for rare diseases.

If the drug negotiations are allowed to continue, U.S. patients "will get delayed access to scientific breakthroughs relative to other parts of the world,” said Dave Fredrickson, AstraZeneca’s executive vice president of oncology.

The growing list of lawsuits filed in different courts likely represents a strategy to get a case before the U.S. Supreme Court, said Kelly Bagby, vice president of litigation for the AARP Foundation.

“What they’re trying to do is create as much momentum to get to the Supreme Court as quickly as possible,” Bagby said.

Patient on Xarelto looks for negotiated discount

Seniors who rely on expensive prescription drugs are anxiously awaiting which drugs could be discounted through negotiation.

Massachusetts resident Ellen Farmer, 64, takes Xarelto to manage a type of abnormal heartbeat called atrial fibrillation. Her doctor told her she needed to take the blood thinner or she could be at risk for blood clots, heart attack or stroke.

“I was shocked and terrified when the pharmacist told me the monthly copay for Xarelto, after insurance, would be $1,000,” Farmer said. “There was no way I could afford that.”

Farmer is enrolled in Medicare because of a disability caused by her heart condition. And subsidies available to some low-income Medicare recipients − another provision of the IRA − means her monthly copayment has for the drug has been sharply reduced.

She said it “gives me hope” the price of her medication might be cut even more through drug negotiations.

“There are far too many in this country who cannot afford the price of countless medications they need to survive,” Farmer said. “No one should ever have to choose between financial security and their health.”

Insulin costs, vaccines among other benefits

The law does not give Medicare unlimited authority to select which drugs to negotiate. Retail drugs are eligible only after they have been on the market for nine years without a competing generic version. Physician-administered drugs will have 13 years before being subject to negotiation.

While consumers won’t see discounts from negotiated prices until 2026, other provisions promise more immediate savings. In 2025, Enrollees in Medicare’s Part D drug plans will have their out-of-pocket expenses for prescriptions capped at $2,000 per year.

'Making it as simple as possible:'Amazon Pharmacy offers insulin discounts amid price hikes

The law also capped Medicare recipients’ out-of-pocket insulin costs at $35 per dose beginning this year. While that provision did not extend to Americans covered by private insurance plans, three major insulin makers said they would slashed prices by 70% or more on their respective products.

Medicare recipients also won’t pay out-of-pocket costs for recommended vaccines such as shingles, whooping cough or tetanus.

The federal law also requires drugmakers to pay federal rebates if they increase prices above inflation levels. In June, Medicare said it would target 43 drugs with price hikes that exceeded this threshold. Officials said the rebates could save consumers money through lower costs, as well as trim Medicare’s spending.

Purvis, of AARP Public Policy Institute, said even consumers who don’t take expensive prescriptions will see benefits. The health-related provisions of the federal law are expected to save taxpayers $173 billion over the next decade, according to a Committee for a Responsible Federal Budget analysis.

“They are going to see savings as a result of negotiation," Purvis said.

  • reddig33@lemmy.world
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    1 year ago

    Medicare should threaten to produce their own generic drugs at the federal level to compete in the marketplace.

    • WagesOf@artemis.camp
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      1 year ago

      Every single politician in congress and the president require $100s of millions of dollars to pay the media conglomerates for their elections.

      Big pharma’s extortion (literally pay or die) funds much of it.

      There will never be a federal level generic drug production.

        • ME5SENGER_24@lemm.ee
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          1 year ago

          Fair, but do you really expect big pharma to allow that to happen? They will throw cash at every politician needed to crush it. The US should’ve stepped in years ago and slapped regulation upon regulation on these companies but politicians won’t bite the hand that feeds them

  • TheaoneAndOnly27@kbin.social
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    1 year ago

    My local pharmacy canceled providing me with the heart medication I need to live because it didn’t generate enough profit for them. So now I have to drive 30 minutes away to get my prescription. Fuck all levels of this Bs system.

      • TheaoneAndOnly27@kbin.social
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        1 year ago

        I’ve been really hesitant to do the order by mail, because it’s something that if it got delayed in the mail would really mess me up.

          • halcyoncmdr@lemmy.world
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            1 year ago

            Their insurance would just deny covering it, because it was already filled by the mail order pharmacy, meaning they’d be paying retail price for it.

            People already have insurance issues with prepared prescriptions being transferred to different locations within the same pharmacy chain. Bringing a second company into it just adds more complexity to a situation the insurance company couldn’t care any less about to start with.

        • SmashingSquid@notyour.rodeo
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          1 year ago

          I’ve done mail order, one of my meds can only be gotten via my insurance’s mail order pharmacy because it cost them over $12,000 per month. Usually the insurance let’s mail order prescriptions be refilled earlier than retail pharmacies to make up for shipping time, at least that’s how it was when I was getting my meds from Amazon.

    • SmashingSquid@notyour.rodeo
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      1 year ago

      Why can’t they order it from their distributor? Unless you need it same day there’s no reason they need to keep it in stock in store.

      • TheaoneAndOnly27@kbin.social
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        1 year ago

        They said after insurance reimbursements they were losing 75 dollars filling my prescription? It was very confusing, the owner of the pharmacy called me. Unfortunately it’s a drug that is time sensitive and there’s no generic of it.

        • SmashingSquid@notyour.rodeo
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          1 year ago

          That really sucks. That’s one of the reasons I won’t use a non chain pharmacy, as much as I’d like to support small businesses the big chains are unlikely to pull that crap.

  • xenoc@lemmy.world
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    1 year ago

    Typical bought-Congress bill that sounds better in the headlines than it actually is.

    Passed last year 2022 but doesn’t take effect until 4 years later, 2026. And only for just 10 drugs that year. Only 30 more total for 2026 to 2027. And these negotiated price drugs cannot be newer drugs - they are only negotiable if they’ve been marketed 9 whole years first without any generic competition.

    Yeah, the already-effective $35 insulin cap, and the 2025 $2000 max out-of-pocket are legit improvements for USA but still are laughably bad compared to most of the developed world and an increasing amount of the highly developing world.

    This bill was just enough to make the Democrats (for whom I vote, given the alternative), AARP, and other rich players crow about how much good they’ve done in this issue, fundraise on it, ignore fixing it further, and leave us seniors in a still-unaffordable situation. Just slightly less unaffordable.

    • NoneOfUrBusiness@kbin.social
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      1 year ago

      Climate change isn’t the only problem out there, and like it or not the government can’t just dedicate itself to one problem at the cost of all others. Also, the bill does have climate change measures. They’re just not what the article is about.

      • TokenBoomer@lemmy.world
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        1 year ago

        Why not? We do it in wartime. Go to war with climate change. Let’s have this discussion after we get rid of capitalism so you can be right.

          • TokenBoomer@lemmy.world
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            1 year ago

            I’m talking about the mobilization. I’m sorry. I just got stressed about climate change and took it out on this post. Lower drug prices are great and are needed. But when climate change gets worse, they’ll just go back up to offset the cost. I didn’t mean to minimize health issues.