Medicare drug worth negotiation is right here. The utmost truthful costs (MFP) set by Medicare result in reductions between 38% and 79%. In actual fact, the actual reductions are bigger for the reason that figures listed within the desk under are reductions off of 2023 costs (fairly 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 collaborating drug firm to debate the presents and counteroffers, focus on proof, and try and arrive at a mutually acceptable worth for the drug. In the course of the course of the negotiation course of, CMS revised its presents for every of the medication upward in response to those discussions. Likewise, many drug corporations revised their counteroffers for his or her medication downward, based mostly on the discussions with CMS. For 5 of the chosen medication, this strategy of exchanging revised presents 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 remaining supply to these drug corporations, per the method described in its steerage, and in every occasion, the drug firm accepted CMS’s supply on or earlier than the statutory deadline.
However how precisely did CMS arrive at these costs? This isn’t clear. In actual fact, CMS stated it gained’t make public a proof of the agreed-upon negotiated costs till March 2025.
Extra particulars on the MFP negotiation timeline is under.
What data and sources had been utilized in setting the MFP? Related data included:
…producer=submitted knowledge on analysis and growth prices, prior federal monetary help, unit prices of manufacturing and distribution, market/income/gross sales knowledge, and knowledge on patents, FDA exclusivities, and FDA purposes and approvals. For the components listed at part 1194(e)(2) associated to proof about various remedies (together with therapeutic advances, prescribing data, comparative effectiveness, and unmet medical want), CMS thought of data from all kinds of sources, together with: data submitted by collaborating drug corporations, individuals with Medicare, educational specialists, clinicians, caregivers, and different events…; data offered on the Affected person-Targeted Listening Periods…; data shared by collaborating drug corporations throughout conferences with CMS; and knowledge CMS recognized from its personal literature searches, together with from scientific tips and printed research.
The negotiated costs might be efficient January 1, 2026.
