Medicare Announces Price Negotiations on 10 Prescriptions

Medicare just announced the 10 medications they will begin negotiating the prices with the manufacturers.  Prescription pricing negotiations were part of the Inflation Reduction Act passed in 2022 and will be phased in.  Starting in 2026 10 medication’s prices will be negotiated. Medicare will then add 15 more medications for 2027 and continue adding more medication each subsequent year. 

Manufacturers of the prescriptions have filed lawsuits claiming that prescription pricing negotiations are unconstitutional, however Medicare negotiates the pricing for all other medical services and it is unlikely that claim will hold up in court.

Here’s a list of the first 10 medications. 

• Eliquis, a blood thinner
• Xarelto, a blood thinner
• Januvia, a diabetes drug
• Jardiance, a diabetes drug
• Enbrel, a rheumatoid arthritis drug
• Imbruvica, a drug for blood cancers
• Farxiga, a drug for diabetes, heart failure and chronic kidney disease
• Entresto, a heart failure drug
• Stelara, a drug for psoriasis and Crohn's disease
• Fiasp and NovoLog, for diabetes

These are all common medications and once the negotiations begin the pricing at the pharmacy will save consumers a significant amount, especially during the Coverage Gap or “Donut Hole” stage. 

Medicare prescription drug costs change throughout the year. Some plans include a deductible, which has to be reached prior to paying for medications.  After the deductible is met, the pricing at the pharmacy is based on which Tier the medication falls in and the corresponding cost share.  If the total cost of what the consumer has paid, plus the drug plan has paid combined adds up to $4,660 then the Coverage Gap phase begins, and you will pay 25% of the cost of the medication.

For example- Eliquis full price is approximately $625 per month so if you hit the coverage gap, the 25% would be $156 for one month's supply.  The negotiating of pricing will reduce these costs.


Medicare Annual Election Period begins in October!

We will be reaching out in the next week to request an updated list of your medications.  Look for a letter and email from us so that we can be prepared to assist you with your 2024 coverage options.