Diabetes Dialogue: What Medicare Drug Price Negotiations Mean for Diabetes

On August 29, 2023, the US Department of Health and Human Services (HHS) debuted a list of 10 drugs that will be part of the first-ever Medicare drug price negotiation.¹

As part of the Inflation Reduction Act, the HHS, through the Centers for Medicare & Medicaid Services (CMS), announced the first 10 drugs covered under Medicare Part D selected for negotiation. The list, which includes the 10 drugs with the highest gross annual spending total, accounts for $50.5 billion in total Part D gross covered prescription costs per year and more than $3.4 billion in out-of-pocket costs.¹

Among the 10 agents chosen for negotiation were 4 with specific indications for patient populations with diabetes: empagliflozin, sitagliptin, dapagliflozin, and Novo Nordisk-specific insulin aspart products. According to CMS statistics, these 4 agents accounted for more than $16 billion in total Part D spending from June 1, 2022 through May 31, 2023, which served as the evaluation period for the decision-making process.²

According to the HHS, the CMS will publish any agreed-upon negotiated prices for the selected drugs by September 1, 2024 and those prices will come into effect starting January 1, 2026. As part of the Inflation Reduction Act, CMS will select up to 15 more drugs covered under Part D for negotiation in 2027, up to 15 more drugs for negotiation in 2028, including drugs covered under Part B and Part D, and up to 20 more drugs for each year after.¹

With nearly half of the list sporting indications for people with diabetes, hosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, convened to record a special edition episode of Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives.

Relevant disclosures for Dr. Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Dr. Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others.

References:

1. Assistant Secretary for Public Affairs (ASPA). HHS selects the first drugs for Medicare Drug Price Negotiation. HHS.gov. August 29, 2023. Accessed August 29, 2023. https://www.hhs.gov/about/news/2023/08/29/hhs-selects-the-first-drugs-for-medicare-drug-price-negotiation.html.
2. Centers for Medicare and Medicaid Services. Medicare Drug Price Negotiation Program: Selected Drugs for Initial Price Applicability Year 2026. August 29, 2023. Accessed August 29, 2023. https://www.cms.gov/files/document/fact-sheet-medicare-selected-drug-negotiation-list-ipay-2026.pdf.