Medicare drug value negotiations to focus on Ozempic, Wegovy and different medication

Medicare introduced Friday that it has chosen 15 medication, together with the vastly well-liked drugs Ozempic and Wegovy, used for diabetes and weight reduction, in addition to some blockbuster most cancers drugs and different medication, for its second spherical of value talks. 

Along with the primary 10 medication that the Biden administration focused for its Medicare Drug Worth Negotiation Program final yr, the drugs make up a 3rd of prescription drug spending within the authorities insurance coverage program for seniors.

Costs negotiated on this second spherical of talks are slated to take impact in 2027. The medication introduced Friday by the Biden administration are:

• Novo Nordisk’s Ozempic; Rybelsus; Wegovy 
• GSK’s Trelegy Ellipta 
• Astellas and Pfizer’s Xtandi 
• Bristol-Myers Squibb’s Pomalyst 
• Pfizer’s Ibrance 
• Boehringer Ingelheim’s Ofev 
• AbbVie and Ironwood’s Linzess
• AstraZeneca’s Calquence
• Teva’s Austedo; Austedo XR
• GSK’s Breo Ellipta
• Boehringer Ingelheim’s Tradjenta
• Salix’s Xifaxan
• AbbVie’s Vraylar
• Merck’s Janumet; Janumet XR
• Amgen’s Otezla  

Below this system’s timeline, drugmakers have till Feb. 28 to determine whether or not to both take part within the talks or face a hefty tax in the event that they wish to keep coated by Medicare and Medicaid.

Near 2.3 million seniors in Medicare are utilizing the semaglutide drugs, branded as Ozempic, Rybelsus and Wegovy by Novo Nordisk. Medicare says that the drug added as much as greater than $14 billion coated by this system over the past yr, probably the most of any treatment on this spherical. 

The subsequent costliest was GSK’s bronchial asthma and persistent obstructive pulmonary illness treatment Trelegy Ellipta, at round $5.1 billion. Round 1.25 million seniors are utilizing that drug.

The White Home says the primary spherical of negotiations lowered the value of a number of the mostly used medication in Medicare by about 40% to 80% in comparison with their record value, although researchers estimate the precise financial savings had been considerably smaller for a lot of medication. These lowered costs go into impact subsequent yr.

President Biden has touted this system, created by the Inflation Discount Act he signed into regulation in 2022, as considered one of his time period’s signature accomplishments.

Drugmakers have sought in courtroom to cease the method. Trade teams and Republicans have blasted the “price-setting scheme” as unfair and discouraging innovation. 

Dispute over protecting weight reduction medication

The brand new spherical of talks come because the Biden administration has additionally proposed increasing Medicare protection to weight reduction medication, which is at the moment not allowed. It will likely be as much as the incoming Trump administration to determine whether or not and how one can finalize the transfer. 

Medicare officers say the negotiated costs for these medication would apply for his or her use in treating weight problems too, if the incoming Trump administration decides to go ahead with the proposed rule. 

“A lot of the well being care world now sees weight problems as a illness itself. And that’s what drove our resolution making, that it’s the position of Medicare and Medicaid to cowl the well being companies that individuals want,” Facilities for Medicare and Medicaid Providers Administrator Chiquita Brooks-LaSure advised CBS Information.

A Novo Nordisk spokesperson mentioned the corporate remained against the talks, which it’s suing to overturn, and pledged to “work with the incoming administration” to deal with its issues.

“That’s the reason we’re deeply involved in regards to the price-setting course of, which may negatively influence sufferers’ capacity to entry their medicines and threatens to stifle future scientific growth of life-changing medicines,” the spokesperson mentioned in a press release.

The drugmaker additionally criticized Medicare’s grouping of Wegovy, Ozempic and Rybelsus collectively, arguing that they’d not qualify for the drug talks individually. Brooks-LaSure defended Medicare’s transfer to group the three collectively, saying the “regulation could be very clear.”

“Wegovy, Ozempic, all of them have the identical energetic ingredient. That is how the regulation was written, and that’s what we applied,” she mentioned.

Can Trump change or halt the method?

It’s unclear whether or not President-elect Donald Trump would search to vary the medication picked or cease the talks after he takes workplace. On the marketing campaign path, he usually pledged to not make cuts to Medicare after Democrats sought to tie him to a “Mission 2025” proposal to undo this system. 

Talking with reporters on Thursday, a senior Biden administration official mentioned that the method to select the medication for the negotiation program was hemmed in by the regulation Congress handed.

That regulation requires Medicare to primarily make a listing of eligible medication for this system, after which choose the medication that make up the 15 highest in spending from Half D.

“That course of, once more, is clearly outlined in statute. There isn’t any capacity for a coverage official to say, I favor this drug over that drug. Your complete course of relies on these information,” the official mentioned.

A spokesperson for the president-elect didn’t reply to a request for remark.

The majority of workers engaged on the negotiation program are profession workers operating the talks, Brooks-Lasure mentioned, not political appointees who will go away in the course of the transition.

“There’s a lot technical info that’s handed forwards and backwards throughout that negotiation and that’s largely completed by individuals who will keep right here,” mentioned Brooks-Lasure.

“We’ve got obtained to get a deal with on prescription drug prices on this nation, and it is essential that Medicare, the CMS workers are negotiating decrease costs. It is necessary for the individuals taking the medication. It is also necessary for your entire Medicare program. We wish to be sure this program is right here for us and our youngsters,” she mentioned.

Which medication had been chosen for the primary spherical?

The Biden administration introduced the ten medication chosen for the primary spherical of the Medicare Drug Worth Negotiation Program in August 2023, and reached an settlement in August 2024. 

The negotiated costs will take impact in 2026. These medication are:

• Merck Sharp Dohme’s Januvia
• Novo Nordisk’s Fiasp and NovoLog
• AstraZeneca’s Farxiga
• Immunex’s Enbrel
• Boehringer Ingelheim’s Jardiance
• Janssen’s Stelara 
• Janssen’s Xarelto
• Bristol Meyers Squibb’s Eliquis
• Novartis’ Entresto
• Pharmacyclics’ Imbruvica

CMS estimated final yr that the financial savings they negotiated from this system would save round $1.5 billion for beneficiaries and $6 billion for the Medicare program.