Medicare drug value negotiation is right here. The utmost truthful costs (MFP) set by Medicare result in reductions between 38% and 79%. In truth, the true reductions are bigger for the reason that figures listed within the desk under are reductions off of 2023 costs (quite than 2024 costs).
How did the negotiation course of work? CMS’s reality sheet described the method as follows:
CMS held three conferences with every taking part drug firm to debate the presents and counteroffers, talk about proof, and try to arrive at a mutually acceptable value for the drug. Throughout 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 firms revised their counteroffers for his or her medication downward, based mostly on the discussions with CMS. For 5 of the chosen medication, this means of exchanging revised presents and counteroffers resulted in CMS and the drug firm reaching an settlement on a negotiated value 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 ultimate supply to these drug firms, in step with 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 truth, CMS mentioned it gained’t make public an evidence of the agreed-upon negotiated costs till March 2025.
Extra particulars on the MFP negotiation timeline is under.
What info and sources had been utilized in setting the MFP? Related info included:
…producer=submitted knowledge on analysis and improvement 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 different therapies (together with therapeutic advances, prescribing info, comparative effectiveness, and unmet medical want), CMS thought-about info from all kinds of sources, together with: info submitted by taking part drug firms, individuals with Medicare, tutorial specialists, clinicians, caregivers, and different events…; info supplied on the Affected person-Targeted Listening Classes…; info shared by taking part drug firms throughout conferences with CMS; and knowledge CMS recognized from its personal literature searches, together with from scientific pointers and revealed research.
The negotiated costs can be efficient January 1, 2026.