What we don’t know about new Medicare drug prices

For many people, Thursday was Well being-Coverage-Wonk Festivus.  The Facilities for Medicare & Medicaid Companies launched the Most Honest Costs (MFPs) for the primary 10 medication topic to negotiation beneath the Inflation Discount Act. This is a crucial second in prescription drug pricing coverage. For the primary time, CMS had the chance to research present medical proof, unmet wants, and different associated issues as they negotiated the costs of those 10 medication. And for the primary time, now we have transparency across the precise web costs to be paid by the only largest purchasers of medicine within the U.S. Most significantly, this can be a milestone in CMS’ efforts to ship financial savings to seniors and taxpayers for medication that lack generic competitors.

And what do the costs really inform us? Nicely, there’s CMS’ estimate for the way a lot would have been saved by the Medicare program had the MFPs been in impact in 2023 ($6 billion), and the estimate for the way a lot seniors will save out-of-pocket simply from the decrease costs ($1.5 billion) in 2026.

Nevertheless, understanding what to make of reductions from checklist costs starting from 38% for Imbruvica for blood cancers to 79% for Januvia for diabetes is trickier. These of us who work in drug pricing each day are carefully inspecting and evaluating the strategies used to find out these costs. Which of the numerous elements outlined within the laws most affected CMS’ dedication of preliminary worth provides? How did producers leverage the information they have been entitled to offer to show the case of the worth of their medicines?  The quick reply: We don’t know. A minimum of not but.