An agreement has been reached with drugmakers, taking effect in 2026, to lower prices on the 10 costliest prescription drugs under Medicare.
This is part of the federal government's first-ever drug pricing negotiations, a cost reduction it claims could help ease the financial burden on the estimated 1 in 7 older adults in the U.S. struggling to pay for their medications.
Below is a list of the negotiated prices for the drugs, based on a 30-day supply:
Eliquis, a blood thinner from Bristol Myers Squibb and Pfizer: $231 negotiated price, down from $521 list price.
Xarelto, a blood thinner from Johnson & Johnson: $197 negotiated price, down from $517 list price.
Januvia, a diabetes drug from Merck: $113 negotiated price, down from $527 list price.
Jardiance, a diabetes drug from Boehringer Ingelheim and Eli Lilly: $197 negotiated price, down from $573 list price.
Enbrel, a rheumatoid arthritis drug from Amgen: $2,355 negotiated price, down from $7,106 list price.
Imbruvica, a drug for blood cancers from AbbVie and Johnson & Johnson: $9,319 negotiated price, down from $14,934 list price.
Farxiga, a drug for diabetes, heart failure and chronic kidney disease from AstraZeneca: $178 negotiated price, down from $556 list price.
Entresto, a heart failure drug from Novartis: $295 negotiated price, down from $628 list price.
Stelara, a drug for psoriasis and Crohn’s disease from J&J: $4,695 negotiated price, down from $13,836 list price.
Fiasp and NovoLog, diabetes drugs from Novo Nordisk: $119 negotiated price, down from $495 list price.
The new negotiated prices were compared to the 2023 list prices of the drugs.
Important of note is that these numbers do not represent a direct comparison between the new negotiated prices and what Medicare and enrollees would have originally paid. The list price is the full retail price of a medication and doesn't include any discounts or rebates a drug company may have offered.
The federal government will have until March 2025 to publish an explanation of how it reached the negotiated prices. If a drugmaker refused to negotiate, they faced a tax penalty, which could be lifted if the drugmaker chose to withdraw their drug from the Medicare program.
What the Opposition Says
Opposition to the price setting under the Inflation Reduction Act has indicated that the government price-setting scheme for patients means:
Reduced Options: In 2024, the number of standalone Part D plans dropped by 11%, falling to the lowest number of plans available since the Part D program’s beginning in 2006. The number of plans for low-income Part D patients dropped by 34%.
Higher Out-of-Pocket Costs: 3.5 million Part D patients taking medicines subject to government price setting are likely to see an increase in out-of-pocket costs in 2026.
Higher Premiums: Standalone Part D plan premiums jumped by 21% on average in 2024 and are projected to increase even more in 2025.
They have also indicated that these price-setting costs will lead to less innovation and alters the incentives for medicine development. That means fewer treatments for Alzheimer’s disease, ALS, cancer, mental health, rare diseases and more. In addition, they add there are no assurances patients will see lower out-of-pocket costs because the law did nothing to rein in abuses by insurance companies and PBMs who ultimately decide what medicines are covered and what patients pay at the pharmacy.
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