Which 10 drugs are open to price negotiation with Medicare in the USA?

The Centres for Medicare & Medicaid Services, under the Biden administration in the USA, has released a list of the 10 drugs that will be open to price negotiations as part of the new legislation under the Inflation Reduction Act (IRA). 

The aim of the negotiations is to decrease the price of prescription drugs for those living in America, who on average pay two or three times more for these drugs than people in other countries. 

The 10 medications

1.    Eliquis  – containing the active substance apixaban, from Bristol-Myers Squibb and Pfizer EEIG, is primarily used to prevent venous thromboembolism occurring in adults who have undergone a hip or knee replacement. It can also be used to treat deep vein thrombosis and pulmonary embolism, and prevent stroke and blot clots elsewhere. It’s most commonly used in patients with multiple risk factors for such conditions or who are 75 years and older. 

2.    Jardiance  – a SGLT2 inhibitor that is used to reduce the risk of cardiovascular death or hospitalisation for heart failure for adults with heart failure, and to reduce the risk of cardiovascular death in adults with Type 2 diabetes mellitus and established cardiovascular disease. Made by Boehringer Ingelheim. 

3.    Xarelto  – otherwise known as rivaroxaban, a brand from Johnson & Johnson, is an anticoagulant medication that is used to treat a range of blood clotting conditions such as stroke, thromboembolism and pulmonary embolisms as well as reducing the risk of major cardiovascular events in patients with coronary artery disease. 

4.    Januvia  – a dipeptidyl peptidase-4 (DPP-4) inhibitor from Merck to be used alongside changes to diet and exercise to improve glycemic control in adults with Type 2 diabetes mellitus. Importantly, it should not be used in patients with Type 1 diabetes or diabetic ketoacidosis. 

5.    Farxiga  – another diabetes treatment, this time from AstraZeneca, specifically for patients with Type 2 diabetes mellitus as a diet supplement, and for patients with heart failure to reduce the risk of cardiovascular death. It must not be used in patients with Type 1 diabetes mellitus or diabetic ketoacidosis. 

6.    Entresto  – made up of sacubitril and valsartan from producer Novartis, is indicated for reducing the risk of cardiovascular death and hospitalisation for heart failure in adult patients with chronic heart failure. The benefits of the medication can be most clearly seen in patients with left ventricular ejection fraction of below normal. 

7.    Enbrel  – the first on the list as a tumour necrosis factor (TNF) blocker from Pfizer. It is used to treat rheumatoid arthritis, polyarticular Juvenile Idiopathic Arthritis (JIA) in patients aged 2 years or older, psoriatic arthritis, Ankylosing Spondylitis (AS), and plaque psoriasis. The label comes with a warning of serious infections and malignancies. 

8.    Imbruvica  – from AbbVie and Janssen Biotech comes the first oncology therapy on the list, the kinase inhibitor Imbruvica. The intended treatment groups includes those with mantle cell lymphoma (MCL) who have received at least one prior therapy, adult patients with chronic lymphocytic leukemia (CLL)/Small lymphocytic lymphoma, adult patients with chronic lymphocytic leukemia (CLL)/Small lymphocytic lymphoma (SLL) with 17p deletion, adult patients with Waldenström’s macroglobulinemia (WM), adult patients with marginal zone lymphoma (MZL) who require systemic therapy and have received at least one prior anti-CD20-based therapy, and adult and paediatric patients aged 1 year and older with chronic graft versus host disease after the failure of one or more prior lines of therapy. 

9.    Stelara  – from Janssen Biotech, is a human interleukin-12 and -23 antagonist. It is used in patients with plaque psoriasis, active psoriatic arthritis, and moderate to severe Crohn’s disease who had previously failed treatment with immunomodulators or corticosteroids, or had failed treatment with one or more TNF blockers. 

10.    Insulin Aspart  – known as NovoLog® from NovoNordisk, is the final diabetes treatment on the list. It is an insulin analog, administered via a pump or intravenously, indicated to improve glycaemic control in adults and children with diabetes mellitus (type 1 and 2). 

The drugs chosen clearly reflect the intention of the price negotiation, focusing heavily on medications for chronic diseases, that should lighten the burden of cost from patients with those conditions. Just diabetes treatments in 2015–2017 in the USA were estimated to cost $57.6 billion per year. 

The new prices for the drugs will come into force in 2026 and the scheme is predicted to save $25 billion per year on drug prices by 2031.

Some of the pharmaceutical companies involved in the negotiations have expressed concerns over the impact on innovation the negotiations could have, but the knock on effects will remain to be seen. 

Sources: 

Reuters. Blood thinners, diabetes meds among first 10 drugs for US price negotiations. [Date accessed 04/09/2023] 

Taylor SI. The High Cost of Diabetes Drugs: Disparate Impact on the Most Vulnerable Patients. Diabetes Care. 2330–2332, 43(10), (2020).