Medicare drug worth negotiation is right here. The utmost truthful costs (MFP) set by Medicare result in reductions between 38% and 79%. In reality, the true reductions are bigger for the reason that figures listed within the desk under are reductions off of 2023 costs (reasonably than 2024 costs).
How did the negotiation course of work? CMS’s truth sheet described the method as follows:
CMS held three conferences with every taking part drug firm to debate the affords and counteroffers, focus on proof, and try and arrive at a mutually acceptable worth for the drug. Throughout the course of the negotiation course of, CMS revised its affords for every of the medication upward in response to those discussions. Likewise, many drug corporations revised their counteroffers for his or her medication downward, primarily based on the discussions with CMS. For 5 of the chosen medication, this strategy of exchanging revised affords and counteroffers resulted in CMS and the drug firm reaching an settlement on a negotiated worth for the drug in affiliation with a negotiation assembly. In 4 of those instances, CMS accepted a revised counteroffer proposed by the drug firm. For the remaining 5 chosen medication, CMS despatched a written ultimate provide to these drug corporations, in line with the method described in its steerage, and in every occasion, the drug firm accepted CMS’s provide on or earlier than the statutory deadline.
However how precisely did CMS arrive at these costs? This isn’t clear. In reality, CMS mentioned it received’t make public an evidence of the agreed-upon negotiated costs till March 2025.
Extra particulars on the MFP negotiation timeline is under.
What info and sources have been utilized in setting the MFP? Related info included:
…producer=submitted knowledge on analysis and growth prices, prior federal monetary assist, unit prices of manufacturing and distribution, market/income/gross sales knowledge, and knowledge on patents, FDA exclusivities, and FDA purposes and approvals. For the elements listed at part 1194(e)(2) associated to proof about different remedies (together with therapeutic advances, prescribing info, comparative effectiveness, and unmet medical want), CMS thought of info from all kinds of sources, together with: info submitted by taking part drug corporations, folks with Medicare, tutorial consultants, clinicians, caregivers, and different events…; info offered on the Affected person-Targeted Listening Classes…; info shared by taking part drug corporations throughout conferences with CMS; and knowledge CMS recognized from its personal literature searches, together with from medical pointers and revealed research.
The negotiated costs will likely be efficient January 1, 2026.