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The Drug Prices the Medicare Program Can Directly Negotiate

Posted on January 16, 2024 By Jeff Snyder

When the Inflation Reduction Act of 2022 was signed into law, it gave the Medicare program the novel ability to negotiate directly with manufacturers on certain drugs’ costs. The Medicare program will negotiate 10 Part D drugs for 2026, 15 Part D drugs for 2027, 15 more Part B or Part D drugs for 2028, and 20 more Part B or Part D drugs for 2029 and every year thereafter.

As of 2023, the criteria that drugs must meet to be eligible for negotiation are:

  • Brand-name drugs or biologics
  • Part of the 50 negotiation-eligible drugs with the highest total Medicare Part D spending
  • Part of the 50 negotiation-eligible drugs with the highest total Medicare Part B spending
  • Aren’t in one of the disqualifying categories:
    • Drugs that have generic or biosimilar versions available
    • Drugs less than nine years (small-molecular drugs) or 13 years (biologics) from FDA approval or licensure date
    • Certain “small biotech drugs” (from 2026 to 2028)
    • Drugs that amount to less than $200 million of the Medicare program spending in 2021
    • Drugs with an orphan designation as their only FDA approval

On August 29, 2023, the first 10 drugs that will be part of the Medicare Drug Price Negotiation Program were announced. We’ll continue to keep this list updated as more drugs are announced in the future so you can be aware which drugs the Medicare program can negotiate for directly.

Eliquis (2026)

Generic Name: Apixaban

Uses

Eliquis is an anticoagulant that is prescribed to help prevent serious blood clots (primarily deep vein thrombosis (DVT) and pulmonary embolus (PE) clots) and may prevent them from reforming. It can also lower your risk of having a stroke.

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Jardiance (2026)

Generic Name: Empagliflozin

Uses

Jardiance can help treat type 2 diabetes by improving blood sugar levels, reducing the risk of cardiovascular death in adults with cardiovascular disease alongside type 2 diabetes, and reducing the risk of hospitalization and death in some adults with heart failure.

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Xarelto (2026)

Generic Name: Rivaroxaban

Uses

Xarelto is an anticoagulant that can treat and prevent DVT and PE blood clots due to certain atrial fibrillation or hip or knee replacement surgery. It’s also used for limited-mobility, high-risk patients during or after inpatient care.

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Januvia (2026)

Generic Name: Sitagliptin Phosphate

Uses

Januvia is used to help control high blood sugar in people with type 2 diabetes. It both increases the number of incretins in your body, a natural substance that helps control blood sugar, and decreases the amount of sugar your liver makes.

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Farxiga (2026)

Generic Name: Dapagliflozin Propanediol

Uses

Farxiga is used to help control high blood sugar in people with type 2 diabetes. It’s also used to lower your risk of developing, and in the treatment of, chronic kidney disease and heart failure.

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Entresto (2026)

Generic Name: Sacubitril-Valsartan

Uses

Entresto can help treat certain types of heart failure by relaxing the blood vessels, allowing the blood to flow more easily. This lessens the strain on your heart as it pumps blood through your body.

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Enbrel (2026)

Generic Name: Etanercept

Uses

Enbrel is an injectable medicine that is used to treat certain types of autoimmune diseases like rheumatoid arthritis, psoriasis, and psoriatic arthritis.

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Imbruvica (2026)

Generic Name: Ibrutinib

Uses

Ibrutinib is a class of drug called a kinase inhibitor that is used to treat certain types of cancers, specifically blood cancers. It slows the growth of cancer cells, sometimes even stopping the growth.

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Stelara (2026)

Generic Name: Ustekinumab

Uses

Stelara is an injectable medicine that blocks proteins (interleukin-12 and interleukin-23) that can cause inflammation in certain conditions. It’s used to help treat psoriatic arthritis, Crohn’s disease, ulcerative colitis, and plaque psoriasis.

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NovoLog and Fiasp (2026)

Generic Name: Insulin Aspart

Uses

Both NovoLog and Fiasp are injectable insulin used to help control high blood pressure in people with diabetes by replacing the insulin your body would normally create. The Medicare program can also negotiate for NovoLog FlexPen, NovoLog PenFill, Fiasp FlexTouch, and Fiasp PenFill.

Learn More - Novolog

Learn More - Fiasp

This entry was posted in Medicare Insurance and Tagged Chastain Agency LLC, Gainesville GA

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