Feds name 10 prescription drugs for Medicare negotiations

Ten common prescription medicines that treat health conditions ranging from diabetes and heart failure to arthritis have been selected as the first to undergo price negotiations between Medicare and pharmaceutical firms, federal health officials announced Tuesday.

The aim is to eventually reduce out-of-pocket expenses for consumers, including almost 600,000 Long Islanders on Medicare, and slow the growth of drug spending.

“Any reduction in pharmaceutical costs is a win-win when you are a senior on a limited income,” said Karen Boorshtein, president and CEO of the Huntington-based nonprofit Family Service League. “This is a good start that will go a long way to helping people.”

But drug company representatives, who have sued to stop the plan, argue the provision will have “significant negative consequences,” including limiting their ability to invest in research and development.

A list released by the Centers for Medicare and Medicaid Services showed Medicare spent more than $50 billion on the 10 drugs, which were used by almost 10 million enrollees between June 2022 and May 2023.

Tuesday’s announcement was the next step in the Biden administration’s plan to slash the cost of prescription drugs, outlined in the Inflation Reduction Act approved last year. Negotiations over the first 10 drugs are expected to start in the coming months with more drugs being added to the list over time.

Medicare recipients who take these medications are expected to see a drop in prices — and the amount they pay toward them — by 2026, officials said.

“It’s almost one of the most significant laws ever enacted, especially when it comes to reducing the cost of prescription drugs,” Biden told the lawmakers and advocates of lower drug costs in the East Room of the White House on Tuesday.

“Big Pharma has been charging America more than three times what they charge other countries simply because they could. I think it’s outrageous. That’s why these negotiations matter,” Biden said.

House Republicans responded with a statement calling Biden’s plan “an unworkable, legally dubious scheme that will lead to higher prices for new drugs coming to market, stifle the development of new cures, and destroy jobs.”

Rep. Nick LaLota (R-Amityville), however, said in a statement: “I strongly support allowing Medicare to negotiate drug prices.”

The Pharmaceutical Research and Manufacturers of America, a trade group for the industry, said in a statement it was a “rushed process focused on short-term political gain.”

“Many of the medicines selected for price setting already have significant rebates and discounts due to the robust private market negotiation that occurs in the Part D program today,” said president and CEO Stephen J. Ubi. “Giving a single government agency the power to arbitrarily set the price of medicines with little accountability, oversight or input from patients and their doctors will have significant negative consequences long after this administration is gone.”

More than 63 million people in the United States are enrolled in Medicare, including 3.7 million New Yorkers, according to 2021 statistics from the Center for Medicare and Medicaid Services. There were 309,819 Medicare enrollees in Suffolk and 281,892 in Nassau as of April.

The overall purpose of the prescription drug provisions in the Inflation Reduction Act is to both provide help for seniors with their drug costs and to constrain the growth of Medicare drug spending, said Tricia Neuman, senior vice president at KFF, a nonprofit focused on health policy.

When the law governing Medicare was changed to include a drug benefit in 2003, it stated the federal government could not interfere in prices from drug companies, she said. The public since then has been pressuring lawmakers to do something about high drug prices.

“The negotiations provision is one that has been debated for many, many years,” Neuman said. “This change is a long time coming and it responds to concerns among people on Medicare about their drug costs.”

New Yorkers over the age of 50 struggle with the high cost of prescription drugs, said Bill Ferris, AARP New York legislative representative. The advocacy group has spent years lobbying for lower Medicare drug prices.

“We know from our surveys in New York that the number one reason people don’t fill a prescription is because of cost,” he said. “People on Medicare take between four and five prescription drugs.”

Neuman pointed to data showing one of the drugs on the list, Enbrel, used to treat arthritis, can cost Medicare recipients as much as $2,000 a year in out-of-pocket expenses if they don’t qualify for help geared to those with low incomes.

“If you think about someone on Medicare with a median income of about $31,000 per person, you can see how $2,000 or so out of pocket would be pretty tough to afford given all other expenditures,” she said.

Another drug on the list, Imbruvica, which is used to treat some blood cancers, can cost some Medicare recipients more than $6,400 a year.

“For people living on the median income, that’s a big chunk of their income,” she said.

Making prescription drugs more affordable will lead to better health for seniors, said Onisis Stefas, CEO of VIVO Health, Northwell Health’s outpatient pharmacy network. Patients who can’t afford medications are connected with assistance, he said.

“The more they adhere to their medications and take what’s prescribed to them, the healthier they’re going to be,” Stefas said. “We’ve seen cases where patients can’t afford their medications, so they have to make choices. They may not take them every single day.”

With Arielle Martinez