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A new KFF analysis unearths that the ten top-selling prescribed drugs beneath Medicare Phase D comprised not up to 1 p.c of all lined medicine in 2021, however accounted for 22 p.c, or $48 billion, of gross Medicare Phase D drug spending that yr.
The research supplies context for figuring out the government’s new authority beneath the Inflation Aid Act to barter costs for some high-spending medicine lined through Phase D, Medicare’s outpatient prescription drug get advantages program, and Phase B, which covers doctor and outpatient products and services, together with medicine administered through physicians and different suppliers.
The entire 10 top-selling Medicare Phase D medicine in 2021 had been brand-name medicine. 5 of them had been diabetes medicine, together with Ozempic, which belongs to a category of medicines that in recent times have won consideration as a result of they’re additionally efficient for weight reduction. Different medicine within the peak 10 integrated Eliquis, a blood thinner that was once the No. 1 promoting drug in 2021, adopted through Revlimid, a remedy for more than one myeloma, and Xarelto, a blood thinner.
Whilst the drug value negotiations start modestly with 10 medicine within the first yr, KFF’s analysis displays that even a quite small choice of medicine can command a considerable proportion of spending in Medicare. The choice of medicine matter to value negotiation will develop in next years and might come with medicine lined beneath Phase B starting in 2028. Medicine will likely be decided on for negotiation from amongst the ones with the absolute best gross prescription drug prices beneath Medicare.
You will need to notice that this research, in accordance with 2021 information from the Facilities for Medicare and Medicaid Services and products (CMS), isn’t designed to spot which medicine usually are matter to value negotiation for 2026. CMS will use extra present spending information and believe a number of components, together with FDA approval date and generic availability, in making that choice. CMS will put up the names of the primary 10 Phase D medicine decided on for value negotiation through September 1, 2023.
In 2021, Phase D lined greater than 3,500 prescription drug merchandise, with general gross spending of $216 billion, no longer accounting for rebates paid through drug producers to pharmacy get advantages managers. General Phase B drug spending was once $40 billion on greater than 600 lined medicine in 2021, however Phase B medicine might not be matter to value negotiation till 2028.
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