Medicare Part D Sponsors Grapple With Unknowns as Drug Price Negotiations Begin

CMS on Aug. 29 unveiled the long-awaited list of 10 drugs for which Medicare will negotiate prices and included drugs to treat common diseases like diabetes, high blood pressure and certain cancers. Industry experts tell AIS Health, a division of MMIT, that while the list provides Part D stakeholders with some new clarity, a host of uncertainties remain, such as how the negotiation process itself will unfold and how plan sponsors will respond to mandated benefit design changes in 2025. But if CMS prevails in implementing drug price negotiation with no delays from manufacturer lawsuits, sources are hopeful that the new process will ultimately provide more insight and fewer uncertainties for subsequent rounds of negotiation.

Based on criteria outlined in the Inflation Reduction Act (IRA), CMS is tasked with selecting drugs for price negotiation, beginning with 10 Part D drugs in 2026, an additional 15 Part D drugs for 2027, and another 15 Part D and Part B drugs in 2028. Starting in 2029, the agency will add another 20 Part D and Part B medications each year to the list. The Congressional Budget Office (CBO) has projected that Medicare will save $3.7 billion in 2026, $8.3 billion in 2027 and $17.5 billion in 2028.