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Medicare announcement due by Sunday
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New prices to take effect in 2027, aiming for savings
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Pharma industry opposes Medicare negotiations
(Adds graphic with U.S. net prices and average Group of Seven
prices under paragraph 6)
By Patrick Wingrove and Deena Beasley
Nov 25 (Reuters) -
The U.S. expects to announce lower prices for 15 of
Medicare's costliest drugs this week, a pivotal move for the
program's 67 million older and disabled Americans and for
President Donald Trump
's push to align costs with other wealthy nations.
The government earlier this month unveiled a deal to next
year slash to $245 a month the Medicare and Medicaid prices for
Novo Nordisk's popular GLP-1 drugs, sold as Wegovy
for weight loss and Ozempic for diabetes -- a level experts said
was unlikely to go lower under the government's negotiations.
An announcement is expected by Sunday.
Medicare's recent net price for Ozempic was $428 a month,
according to an analysis published in the Journal of Managed
Care and Specialty Pharmacy.
Other drugs up for price negotiation this year include GSK's
asthma and COPD inhaler Trelegy Ellipta and AbbVie's ( ABBV )
irritable bowel syndrome medicine Linzess. The new
prices will take effect in 2027.
Analysts said they will be looking at how the prices compare
to Medicare's recent net prices after accounting for
confidential rebates and discounts. They will also be comparing
them to prices negotiated by other high-income countries, a
concept Trump has fought for, sometimes referred to as
most-favored-nation pricing.
Medicare covers more than 67 million people age 65 and over
and those with disabilities.
"These prices are going to come down below the existing net
prices. There will be some real savings," said Sean Sullivan,
professor of pharmacy at the University of Washington, who said
the public announcement was important.
"All of the other payers can see them. What is going to stop
them from asking manufacturers for that same price?" he said.
PREVIOUS NEGOTIATIONS SAVED 22%
The Medicare agency last year unveiled maximum new prices
for the first 10 high-cost medicines negotiated under the Biden
administration's Inflation Reduction Act to take effect in 2026.
For those drugs, including medicines like the Pfizer ( PFE )
and Bristol Myers Squibb ( BMY ) blood thinner Eliquis and
Amgen's ( AMGN ) arthritis drug Enbrel, the new prices were
still on average more than double, and in some cases five times,
what drugmakers had agreed to in four other high-income
countries.
Goldman Sachs ( GS ) estimated that the new prices for those first
10 drugs resulted in a 22% discount on average relative to
Medicare's net prices at the time.
Under the IRA, Medicare is required to consider a number of
factors for pricing, including manufacturer data and
availability of alternative treatments. The law does not include
a review of international prices in the process.
Until passage of the IRA in 2022, U.S. law prevented
Medicare from negotiating drug prices, while many other
countries have long had universal prescription drug coverage
that relies on centralized price negotiation with
manufacturers.
The Trump administration has since outlined what it
considers "most-favored-nation" pricing terms: the lowest price
in any country that is part of the Organization for Economic
Cooperation and Development with a gross domestic product per
capita of at least 60% of U.S. GDP per capita.
Under a separate pilot program, Medicare has proposed a
smaller "country basket," which includes six G-7 countries: the
UK, France, Germany, Italy, Canada and Japan, plus Denmark and
Switzerland. The benchmark used to calculate the MFN price would
be the second lowest price within that basket of countries,
adjusted by GDP per capita.
The pharmaceutical industry had fought hard to block the
Medicare negotiations, with several companies suing the
government and warning that they may have to curtail some drug
development programs.
Medicare's next round of drug price talks are expected to
include 15 further prescription and hospital-administered
medicines and begin in February.