This Week in Drug Pricing: DOJ Defends Medicare Negotiations, Push For Competition Bills & Defending Medicare Negotiations, Drugmakers Meet With President Trump — Patients Excluded, and ICYMI
Welcome to the Week in Review.
DOJ Defends Medicare Negotiations
The Trump Department of Justice (DOJ) took the first step in defending Medicare negotiation in court. On Wednesday, the DOJ filed a brief in the Third Circuit Court of Appeals in the Novartis case, maintaining the government’s legal defense of the Medicare negotiation program – for now. Notably, this is the first DOJ brief under the Trump Administration, and it remains largely unchanged from previous filings, signaling that the government is standing with the program against Big Pharma’s multi-million dollar legal assault. This is an encouraging sign for the nine million patients on Medicare who are expected to save at least $1.5 billion out-of-pocket in the first year. However, this fight is far from over. Several industry-backed lawsuits still threaten the program, and with a critical February 28th deadline approaching for drugmakers to agree to negotiate in the next round, PhRMA’s pressure campaign is in full force. Patients fought hard for this law – and we will continue to hold the administration accountable to ensure it delivers the savings millions of Americans are counting on. — (Politico, O’Neill Institute, Inside Health Policy, STAT, Axios, FightPharma.org, P4AD)
Push For Competition Bills & Defending Medicare Negotiations
With a new Congress in session, there is a critical opportunity to continue to advance reforms that lower drug prices. Last Congress, P4AD championed a slate of bipartisan bills to curb anti-competitive practices by drug companies and pharmacy benefit managers (PBMs), including:
Millions of patients are counting on lawmakers to revive these reforms and pass them into law to rein in the skyrocketing cost of prescription drugs and reduce taxpayer spending. At the same time, Big Pharma and its allies are aggressively pushing legislation to undermine Medicare negotiations. The recently re-introduced Orphan CURES Act would expand the Medicare negotiation exemption beyond drugs with a single orphan disease designation to those with multiple indications, giving drugmakers more power to inflate prices. Meanwhile, the EPIC Act, which is expected to be re-introduced, would extend the negotiation exemption period for small-molecule drugs from nine to 13 years – keeping prices high for longer. Pharma is framing both bills as pro-innovation, but in reality, they are blatant attempts to protect monopoly pricing at the expense of patients. Lawmakers must reject these industry-backed measures and instead deliver the bold reforms that Americans overwhelmingly support. — (Congress.gov, CBO, Congress.gov, CBO, Congress.gov, P4ADNow, Congress.gov, STAT, P4ADNow)
Drugmakers Meet With President Trump — Patients Excluded
Big Pharma is cozying up to President Trump while patients are shut out. Yesterday, drug industry executives from PhRMA sat down with President Trump for a third time to push their agenda to weaken the 2022 prescription drug law and keep drug prices high. Meanwhile, patients who are most harmed by drug pricing policy have yet to be granted a seat at the table. Make no mistake: PhRMA’s so-called commitment to “innovation and affordability” is nothing more than a smokescreen for their all-out assault on the drug price provisions in the IRA which they’ve openly declared is their top priority, The drug industry has spent millions buying access to the administration, but patients won’t stop fighting to protect the reforms they fought for — and we’re watching to see whether Trump follows through on his promise to lower drug prices or caves to Big Pharma’s influence. — (Reuters, Fierce Healthcare, The Wall Street Journal, MedPage Today)
In Case You Missed It At a White House event yesterday, following President Trump’s meeting with PhRMA executives, Pfizer CEO Albert Bourla was met with loud boos from the audience as he was introduced. One can safely assume this reaction underscores the deep frustration Americans feel toward Big Pharma’s greed, as drug companies continue to prioritize profits over patients while millions struggle to afford their medications.
This week, P4AD released a report dismantling Big Pharma’s false claims about the 2022 prescription drug law, highlighting how the law is already lowering costs for patients and taxpayers. The report reveals PhRMA, the drug industry’s largest lobbying arm, spent more than $235,800 on social media ads over a four month period spreading misinformation about the law’s “unintended consequences” as it relates to patient costs, access, and future innovation. The report rebutted each of PhRMA’s claims with data and evidence – proving that the industry’s assertions are misleading at best and outright false at worst. At a press briefing on Wednesday, P4AD’s president and founder David Mitchell, and AARP’s prescription drug policy principal Leigh Purvis, debunked these claims, calling out the industry’s desperate attempt to regain its complete monopoly pricing power. They underscored how the law is delivering tangible savings to millions of Americans while ensuring fair profits for the industry and safeguarding future innovation. After decades of Big Pharma’s unchecked pricing power, the 2022 prescription drug law is reining in drug costs, and patients remain committed to defending this progress. — (P4AD, Youtube)
RFK Jr. Selected As HHS Secretary
Robert F. Kennedy Jr. was confirmed yesterday as the Secretary of the Department of Health and Human Services (HHS), but after two Senate hearings last week, he offered little clarity on how he plans to lower prescription drug prices – raising concern for patients who urgently need access to affordable medications. With bipartisan interest in reducing skyrocketing drug costs and nine in 10 voters – on both sides of the aisle – demanding action, all eyes are on Secretary Kennedy. Will he champion reforms that put patients first or side with Big Pharma? — (Fierce Healthcare, P4ADNow, P4ADNow)
Rising Cost of Cell And Gene Therapies
New gene therapies are hitting the market with staggering price tags based on what the market can bear – not development costs. An investigation by ProPublica focused on one such treatment, Zolgensma, a $2.1 million gene therapy for children born with spinal muscular atrophy (SMA), which has become a prime example of how Big Pharma sets drug prices. Despite critical early grassroots fundraising and taxpayer-funded grants from the National Institute of Health (NIH), Zolgensma’s price was driven by Wall Street projections and a calculated pricing strategy. Novartis leveraged value-based pricing studies that floated prices as high as $5 million, helping to condition the market toward accepting an astronomical price tag. The final $2.1 million price was framed as a “compromise,” even though it had little to do with actual R&D costs and everything to do with maximizing profits for investors. This approach has set a dangerous precedent: new gene therapies can now leverage these prior launch prices as justification for setting even higher ones. Since Zolgensma’s debut, cell and gene therapies like Hemgenix ($3.5M) and Lenmeldy ($4.25M) have pushed the ceiling higher, straining public programs like Medicaid and Medicare. As P4AD’s David Mitchell told ProPublica, “every time the benchmark moves up, they think, ‘Well, we can get away with more.” Without reforms to rein in high launch prices, patients and taxpayers will continue to pay the price for Pharma’s unchecked greed. — (Drug Discovery Trends, ProPublica)
In Case You Missed It Payouts to shareholders of major drug companies like Merck, Johnson & Johnson, and Pfizer more than tripled over the past two decades, according to a new study published in JAMA. Meanwhile, patients continue to struggle to afford their essential medicines as a result of Big Pharma’s anti-competitive tactics.
WASHINGTON, D.C. — Following a narrow Senate vote, Robert F. Kennedy Jr., was confirmed today as Secretary of the Department of Health and Human Services (HHS).
P4ADNow Executive Director, Merith Basey, released the following statement:
“Secretary Kennedy has a critical opportunity – and responsibility – to build on existing measures to rein in Big Pharma’s price-gouging and lower drug costs for patients. We are ready to work with him to ensure Medicare drug price negotiations continue, out-of-pocket costs are reduced, and competition in the marketplace is increased through reforms to end abusive pharmaceutical monopolies that harm patients.
“But make no mistake: patients fought hard to secure the 2022 prescription drug law, and we will fiercely oppose any efforts to weaken it. We stand ready to help make America healthy again by making prescription drugs affordable. Nine out of ten Americans think lowering prescription drug costs should be a top priority – and they are counting on Secretary Kennedy to deliver.”
Background
—During back-to-back confirmation hearings, RFK Jr. provided limited details on plans to lower drug prices and defend Medicare negotiations — a critical issue for millions of American families.
—Americans pay three to eight times more than people in other wealthy nations pay for the exact same brand-name drugs.
—In 2023, about three in 10 adults reported not taking their prescription medicines due to the high cost.
—84% of voters on both sides of the aisle support allowing Medicare to negotiate directly with big drug companies over the prices of some drugs to bring down costs.
### Patients For Affordable Drugs Now, is the only national, patient advocacy organization focused exclusively on policies to lower drug prices. We empower and mobilize patients and allies, hold accountable those in power, and fight to shape and achieve system-changing policies that make prescription drugs affordable for all people in the United States. P4ADNow is bipartisan and does not accept funding from organizations that profit from the development or distribution of prescription drugs. To learn more visit; PatientsForAffordableDrugsNOW.org.
Welcome to the Week in Review.
New Bills Attempt To Weaken The IRA
P4AD sent a letter to all members of the House of Representatives yesterday, opposing two bills that would weaken the Medicare Drug Price Negotiation Program – a critical lever that will lower drug prices for millions of Americans on Medicare. The letter makes it clear: the 2022 prescription drug law was designed to balance innovation with fairer pricing, ensuring drug companies can profit while preventing unnecessary price hikes that leave patients struggling to afford their medications. One bill, the ORPHAN Cures Act, would expand Medicare’s negotiation exemption beyond drugs approved for a single orphan disease to those with multiple indications—providing a loophole for drugmakers to extend unwarranted monopolies and inflate prices indefinitely. Orphan drugs with multiple indications already generate significant revenue from expanded patient populations, in both public and private markets, and don’t need additional exemptions to remain profitable. The second bill, the Ensuring Pathways to Innovative Cures (EPIC) Act, which is expected to be reintroduced, would extend the negotiation exemption for small molecule drugs from nine to thirteen years, forcing patients to pay higher prices for longer. This change is unnecessary, as the current law gives drugmakers ample time to recover R&D costs. Companies can still set launch prices and raise them in subsequent years – Medicare negotiation simply ensures they can’t keep hiking prices unchecked. These bills aren’t about innovation – they’re about protecting pharma’s profits and undermining the law at the expense of patients. Any members who are committed to lowering drug prices should oppose these harmful bills and reject industry-backed efforts to weaken the law. — (P4ADNow, KFF, STAT, BIO)
Price Hikes On 15 Drugs Selected For Medicare Negotiation
The drugmakers behind the 15 drugs selected for the second round of Medicare negotiation have spent years rapidly hiking prices. Cancer drugs on the list lead the pack: Pomalyst, a multiple myeloma treatment, has soared in price by 130% since its launch in 2013, while Ibrance, a breast cancer medication, has increased by 62% over the 10 years its been on the market. Novo Nordisk has hiked prices on expensive GLP-1 treatments Ozempic and Rybelsus every single year since 2021. Meanwhile, GlaxoSmithKline’s (GSK) inhaler Trelegy is up 24% since 2017 and Breo Ellipta has jumped 52% since 2013. Many of these drugs have also been shielded from competition by layers of patents, extending Pharma’s monopolies long past the dates they should have faced lower-cost alternatives. Austedo, a drug used to treat movement disorders like Huntington’s disease, has 28 active patents, while Ozempic and Trelegy eachhold 20 active patents—ensuring prices stay high while patients foot the bill. — (NBC, AARP, Pharsight, Pharsight, Pharsight)
Americans Demand Health Care Affordability
A new Gallup and Emory University poll found that more than half of Americans ranked improving access and lowering costs as one of their top three concerns – cutting across party lines and underscoring the mounting frustration over soaring prices. Big Pharma has rigged the system to put excessive profits over patients, driving up prices and leaving one in three Americans struggling to afford their medicines. With public demand for reform at an all-time high and nine out of 10 Americans in agreement that Congress needs to do more to lower drug costs, the question is no longer whether drug prices need to come down—it’s whether lawmakers will stand with patients or protect Pharma’s bottom line. — (Gallup/Emory University, Axios, KFF)
Big Pharma’s Big Earnings
Quarterly earning reports from 2024 are rolling in and unsurprisingly, Big Pharma has once again come out on top. Pfizer beat expectations and raked in $17.76 billion in fourth-quarter revenue, a 22% increase from the same period last year. Novo Nordisk reported revenue of $12.26 billion in the period, largely driven by skyrocketing sales of its pricey GLP-1 drug Wegovy. Meanwhile, GSK pulled in $10.4 billion in revenue, as it continues to charge more than $11,000 for its endometrial cancer treatment, Jemperli, among other medications. These earnings are a blunt reminder: Big Pharma is swimming in cash and can afford to lower prices. Instead, they continue to hike drug costs while lobbying to block reforms—putting profits over patients at every turn. — (CNBC, The Washington Post, Fierce Pharma, The Washington Post)
In Case You Missed It Ranking Members of the House Committee on Energy and Commerce, the House Education and Workforce Committee, and the House Ways and Means Committee wrote a letter to the Government Accountability Office requesting that they monitor the Medicare Drug Price Negotiation Program to ensure the new Trump administration upholds its promise to lower prescription drug prices and drive down taxpayer spending.
In a promising sign for patients, the Centers for Medicare and Medicaid Services (CMS) confirmed that the Medicare Drug Price Negotiation Program remains on track, marking a critical moment for the new administration and for patients. P4AD welcomed the announcement, and in a statement released on Wednesday, founder and president David Mitchell reiterated that this was a positive step forward, but that the real test will be in the execution. Patients need negotiations that deliver price cuts similar or better than those secured in the first round – where list prices were reduced by more than 60 percent on average. P4AD is fiercely committed to protecting the historic negotiation program and ensuring its successful implementation. — (CMS, P4AD, AARP)
US v. Pharma: Patient-Led Petition Delivery
Standing outside the headquarters of The Pharmaceutical Research and Manufacturers of America (PhRMA), the powerful lobbying arm of the pharmaceutical industry, P4AD and allied organizations delivered a clear message to drug company CEOs: Drop your lawsuits and let Medicare negotiate lower prices for patients. Backed by more than 202,000 petition signatures, patients demanded an end to Big Pharma’s legal assault on the program as they urged the CEO of PhRMA, among others, to uphold the law and not interfere with the popular program supported by more than 80% of Americans on both sides of the aisle. At the demonstration, Judy Aiken, a P4AD patient advocate, who paid over $9,000 for Enbrel in 2023, shared how Medicare negotiation will provide long-overdue relief when the new lowered prices come into effect next year. As drug companies and their allies continue to threaten the 2022 prescription drug law in court, patients aren’t backing down. — (Inside Health Policy, P4AD, P4AD)
HHS Secretary Confirmation Hearings
During heated, back-to-back confirmationhearings, Health and Human Services (HHS) Secretary nominee Robert F. Kennedy Jr. provided limited details on how he plans to lower drug prices for patients — a pressing issuefor a majority of American families. If confirmed as HHS Secretary, he would shape the future of programs and policies to make prescriptions more affordable — including the historic Medicare Negotiation Program. When asked about the program, RFK Jr. vaguely committed to continuing the initiative but offered no clarity about his plans or vision for implementation. His positions could determine whether it delivers real savings or is weakened to protect Big Pharma’s profits. Additionally, when facing questions about legislation that nearly passed during the 118th Congress and would have targeted pharmacy benefit managers, RFK Jr. replied that he had not read the specific bill. In closing remarks, Senator Bernie Sanders called out the lack of clear answers from RFK Jr. on why Americans pay some of the highest prices in the world. Nine in ten Americans want more to be done to lower drug prices – but whether RFK Jr. will stand with patients or protect Pharma’s profits is becoming increasingly uncertain despite his apparent dislike of the industry. — (STAT, Politico, West Health, P4AD)
In Case You Missed It Senators Dick Durbin and Chuck Grassley re-introduced the Drug-price Transparency for Consumers (DTC) Act, a bipartisan bill, endorsed by P4AD, that would require drug manufacturers to disclose prices on advertisements for prescription drugs.
Patients For Affordable Drugs filed a patient-focused amicus brief in the Second Circuit Court of Appeals, opposing Boehringer Ingelheim’s lawsuit to block Medicare negotiation. The amicus brief, P4AD’s third as part of our US v. Pharma campaign, highlights the transformative relief that lower negotiated prices will deliver to millions of patients and dismantles Big Pharma’s claims that the widely-supported program will stifle future innovation and limit patient access to essential medicines. It also recounts how drug industry lobbying resulted in a two-decades-long prohibition on Medicare’s negotiation authority, leaving patients to bear the burden of exorbitantly high prices dictated by the industry. Patient stories are central to the argument against Boehringer’s claims, including Oluyomi Amoye who shared his difficulty affording Jardiance, which is used to treat his type 2 diabetes, and one of the first 10 drugs selected for negotiation. As ten lawsuits have threatened this hard-fought victory, patients continue to defend lower drug prices in the courtroom and beyond. — (P4AD, Fierce Pharma, KFF, Action Network)
Trump Administration’s First Drug Pricing Action
On his first day in office, President Trump rescinded President Biden’s Executive Order that directed the Centers for Medicare and Medicaid Innovation (CMMI) to develop and test innovative payment and delivery models to reduce drug costs and promote access to drug therapies. These models include the voluntary Medicare $2 Drug List Model to standardize cost-sharing for over a hundred generic drugs at $2 per month, and the Cell and Gene Therapy (CGT) Access Model to help Medicaid patients, starting with those living with sickle cell disease, afford cutting-edge treatments. While the move doesn’t immediately end the models, it raises serious concerns about their future. Experts have called the decision “perplexing,” noting it signals a troubling start for an administration that has pledged to address high drug costs. In a conversation with Inside Health Policy, P4AD President and Founder David Mitchell emphasized the importance of these models as creative solutions consistent with bipartisan goals, urging the administration to move forward with bold initiatives to deliver meaningful relief to patients. P4AD remains committed to working with lawmakers across the political spectrum to advance reforms that make medications affordable for all. — (Politico, Pink Sheet, NBC, Inside Health Policy)
$2k OOP Cap Brings Transformative Relief
Just weeks into the new year, patients are already sharing how the $2,000 annual cap on out-of-pocket costs for people on Medicare is transforming their lives. The cap, which came into effect this month, will provide long-awaited financial relief for 11.3 million Americans struggling with high prescription drug costs. P4AD patient advocate Judy Aiken shared with NPR how she expects to save $7,000 this year on her psoriatic arthritis medication Enbrel – meaning she can consistently take her prescribed medications and finally address much-needed home repairs. Pamela of Rockford, MI, shared with P4AD that she will save $6,000 after years of paying the maximum out-of-pocket costs. “This year I can finally begin to pay down some debt rather than incurring more.” Maureen of Bridgewater, NJ, said she’s already met the cap, saving $4,000 this year. These stories represent just a fraction of the 420,000 patients on Medicare who are projected to save more than $3,000 this year thanks to this critical provision in the 2022 prescription drug law. — (Commonwealth Fund, NPR, AARP)
In Case You Missed It This week on Capitol Hill, David Mitchell shared his story as a patient living with multiple myeloma, an incurable blood cancer. David highlighted the staggering costs of his treatments, which carry an annual list price of $1 million. Holding up a bottle of his Pomalyst – one of the drugs selected in the second round of Medicare negotiation – David emphasized the urgent need for the successful implementation of the Medicare Negotiation Program. In 2023, Pomalyst cost David over $16,000 for a year’s supply.
Photo by Rod Lamkey, freelance reporter, for The Associated Press Center
Marking another historic step for patients, the Centers for Medicare & Medicaid Services (CMS) announced the next 15 drugs selected for Medicare negotiation. The selected medications were used by 5.3 million people on Medicare between November 2023 and October 2024 and accounted for $41 billion in Medicare spending within that period. In January this year, 12 of the 15 drugs selected for negotiation saw new list price increases, 11 of which were higher than the rate of inflation. Given the successful negotiations for the first 10 drugs, which saw an average list price reduction of more than 62%, lower negotiated prices for these additional 15 drugs will mean substantial relief to millions more patients. A lower negotiated price for Ofev, one of the selected drugs, could ensure Carole from Michigan can consistently take her treatment for chronic lung disease for which is unaffordable at $14,000 per month. A lower negotiated price for the inhaler Breo Ellipta would mean Teresa from North Carolina could finally treat her asthma with the only inhaler on that market that works for her. We remain steadfast in our commitment to supporting the successful implementation of the Medicare negotiation program, ensuring patients and taxpayers get a better deal on their life-sustaining medicines. — (P4AD, NBC News, HHS, AARP, BioPharma Dive)
Teva Joins Big Pharma’s Assault On Medicare Negotiation
Teva Pharmaceuticals has filed the 10th lawsuit representing Big Pharma and its allies aimed at blocking the drug price negotiation program. The lawsuit came just one day before Austedo and Austedo XR, Teva’s treatments for movement disorders, were officially selected for the next round of Medicare negotiations. These drugs cost patients up to $14,642 per month and generated $435 million in revenue for Teva in just three months last year. Teva’s legal argument – that Medicare shouldn’t negotiate prices for two drugs with the same active ingredient – is a new and desperate attempt to undermine negotiations. After seeing their earlier legal challenges repeatedly rejected by federal courts, the pharmaceutical industry is testing fresh claims to see if any will stick. This latest tactic is part of a broader, coordinated campaign to protect exorbitant profits at all costs, even as Americans struggle with high drug prices. Now that the next drugs up for negotiation have been announced, more lawsuits are expected. P4AD will continue to fight back, defending Medicare negotiation through amicus briefs filed in the courts, with campaigns like “US vs. Pharma,” and by mobilizing patients to protect these critical reforms. – (Bloomberg Law, FightPharma.org, Austedo, Teva Pharmaceuticals, HHS)
FTC Report Exposes PBM Price Gouging Scheme
The Federal Trade Commission’s (FTC) latest report shines a spotlight on the greed of pharmacy benefit managers (PBMs), revealing how CVS Caremark, Express Scripts, and OptumRx raked in $7.4 billion in revenue by inflating the prices of 51 lifesaving drugs between 2017 and 2022. The Big Three PBMs marked up specialty generics used to treat cancer, HIV, and heart disease, by hundreds – and in some cases thousands of dollars – at the expense of patients. For example, a month’s supply of Tadalafil, a pulmonary hypertension treatment, was acquired by pharmacies for $27 and marked up to $2,106, an increase of over 7,700%, and Tecfidera, a multiple sclerosis drug, was acquired for $177 and hiked to $3,930, a markup of more than 2,100%. The report, which expands on the FTC’s initial probe from July 2024, confirms what patients have long suspected: PBMs exploit their shadowy role in the drug supply chain to hike prices and pocket enormous profits, leaving patients to foot the bill. The findings underscore the urgent need for Congress to pass meaningful reforms to bring transparency and accountability to the PBM industry. — (FTC, Fierce Healthcare, Axios)
Debunking Pharma Misinformation About IRA The Federal Trade Commission’s (FTC) latest report shines a spotlight on the greed of pharmacy benefit managers (PBMs), revealing how CVS Caremark, Express Scripts, and OptumRx raked in $7.4 billion in revenue by inflating the prices of 51 lifesaving drugs between 2017 and 2022. The Big Three PBMs marked up specialty generics used to treat cancer, HIV, and heart disease, by hundreds – and in some cases thousands of dollars – at the expense of patients. For example, a month’s supply of Tadalafil, a pulmonary hypertension treatment, was acquired by pharmacies for $27 and marked up to $2,106, an increase of over 7,700%, and Tecfidera, a multiple sclerosis drug, was acquired for $177 and hiked to $3,930, a markup of more than 2,100%. The report, which expands on the FTC’s initial probe from July 2024, confirms what patients have long suspected: PBMs exploit their shadowy role in the drug supply chain to hike prices and pocket enormous profits, leaving patients to foot the bill. The findings underscore the urgent need for Congress to pass meaningful reforms to bring transparency and accountability to the PBM industry. — (FTC, Fierce Healthcare, Axios)
ICYMI
As the Biden-Harris administration comes to an end, never-before-seen photos were recently published in People, of P4AD’s Judy Aiken sharing her experience with the high cost of prescription drugs with President Biden and how the relief being delivered through the historic drug pricing law is truly life-changing.
Big Pharma is ringing in the New Year with more than 250 planned price hikes on essential medicines with median increases of 4.5% – well above the 2.7% inflation rate. Pfizer leads the charge with hikes on nearly 60 drugs, including a 3% increase on already expensive breast cancer medication Ibrance which was hiked from $15,982 in 2024 to $16,462 in 2025 – a nearly $500 increase monthly. Bristol Myers Squibb (BMS) is raising prices on its costly cancer cell therapies Abecma and Breyanzi by $29,904 and $43,872 respectively, per infusion – treatments that already cost patients nearly half a million dollars. Big Pharma continues to raise prices at will despite the introduction of the Inflation Rebate Program which requires manufacturers to pay Medicare back for price hikes that outpace the rate of inflation, a safeguard that currently only applies to Medicare-covered drugs. These relentless increases highlight the need for reforms to curb unchecked price gouging throughout the entire system, prevent patent abuses that stifle competition, and tackle high launch prices for new therapies coming to market. As more price hikes roll out this month, we’ll continue exposing how Big Pharma puts excessive profits over patients. Stay tuned. — (Reuters, Fierce Pharma, MM+M)
The Next 15 Drugs
The Centers for Medicare & Medicaid Services (CMS) is expected to announce the next 15 drugs selected for Medicare negotiation ahead of the February 1st deadline, offering more patients renewed hope for more affordable medicines beginning in 2027. Among the drugs likely to be included is Novo Nordisk’s blockbuster GLP-1 treatment Ozempic. Medicare spending on this treatment has skyrocketed due to its outrageous monthly list price of $969. Unsurprisingly, 54% of patients using GLP-1 treatments report difficulty affording them. A lower negotiated price for Ozempic could help to more closely align the list price of this expensive treatment with countries like Germany, where it is sold for a fraction of the U.S. price. The results of the first round of negotiations were announced in August 2024 and will lower the list price of 10 widely-used medicines by 39% to 79% in 2026. These lower prices will benefit nine million patients on Medicare who are prescribed these first 10 selected drugs, with millions more patients to benefit in 2027 and beyond. — (Axios, STAT, KFF, Reuters)
$2,000 Cap On OOP Costs In Effect
Beginning January 1, 2025, patients with Medicare Part D plans will have their annual out-of-pocket drug costs capped at $2,000. This provision, which is part of the historic 2022 prescription drug law, is estimated to save approximately 3.2 million people — who don’t receive a low-income subsidy — thousands of dollars within the first year. For patients with cancer, the cap could mean an average savings of over $7,500 per year, with some saving as much as $19,296. Patients across the country have called the cap “life-changing” and shared that it could allow them to finally retire, after decades in the workforce. — (USA Today, AARP, NBC News, P4AD, The Charlotte Observer, Bangor Daily News)
ICYMI
A new RAND study published in JAMA found that a few ultra-expensive therapies significantly inflate the average cost of developing a new drug. Researchers analyzed 38 FDA-approved drugs and found estimated median research and development costs of $150 million, compared to an average of $369 million. When just two expensive drugs were excluded, the average cost dropped by 26%.
