HHS will begin negotiating 10 Part D drug prices this year
COVID-19 vaccines are moving towards commercial prices set by Moderna and Pfizer.
Photo: Alex Wong/Getty Images
Starting this year, the Department of Health and Human Services will begin negotiations with drug companies to lower the price of Part D drugs in Medicare, according to HHS Secretary Xavier Becerra.
The 10 Part D drugs that will be negotiated will be published on September 1, according to Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure. On September 1, 2024, CMS will publish the fair prices for these drugs, she said.
Starting on January 1, 2026, Medicare beneficiaries can expect to buy the drugs at the negotiated lower prices. If a drug company tries to set its drug price beyond the cost of living for Medicare beneficiaries, the manufacturer will be required to reimburse the extra charge beyond the cost of living, Becerra said.
"On average Americans are paying two-to-three times more than drugs sold in other parts of the world for no reason whatsoever," Becerra said during a press call Wednesday morning.
In future years, CMS will select for negotiation 15 more 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 each year after that, as outlined in the Inflation Reduction Act.
WHY THIS MATTERS
The ability for Medicare to negotiate drug prices is part of the Inflation Reduction Act.
Because of the law, as of January 1 every American in Medicare who needs insulin should be paying $35 a month, Becerra said. Shingles vaccines are available without cost. However, COVID-19 vaccines are moving towards commercial prices set by Moderna and Pfizer.
Moderna's pricing for COVID-19 vaccines is potentially $110 to $130 per dose in the United States, according to The Wall Street Journal. Pfizer is reportedly considering similar pricing.
Becerra said the United States is moving towards commercialization of the vaccine, because federal funding has been exhausted. HHS last year said that unless Congress released more funds, there would be a move towards commercialization.
"This conversation has been ongoing," he said.
The pricing is now in the hands of drug manufacturers and distributors. HHS is in conversations with drug manufacturers to make the vaccines affordable, he said.
THE LARGER TREND
Becerra and Brooks-LaSure also said the Inflation Reduction Act has kept the cost low for health insurance through the Affordable Care Act.
The tenth year of the ACA implementation is showing record-breaking enrollment of over 15 million people. Of that, 3.1 million are new enrollees. Four out of five people can get a plan for $10 a month or less after tax credits.
Open enrollment ends on January 15.
Twitter: @SusanJMorse
Email the writer: SMorse@himss.org
