Medicare drug value negotiation is right here. The utmost honest costs (MFP) set by Medicare result in reductions between 38% and 79%. In actual fact, the true reductions are bigger for the reason that figures listed within the desk under are reductions off of 2023 costs (reasonably than 2024 costs).
How did the negotiation course of work? CMS’s truth sheet described the method as follows:
CMS held three conferences with every taking part drug firm to debate the affords and counteroffers, focus on proof, and try and arrive at a mutually acceptable value for the drug. Throughout the course of the negotiation course of, CMS revised its affords for every of the medicine upward in response to those discussions. Likewise, many drug corporations revised their counteroffers for his or her medicine downward, based mostly on the discussions with CMS. For 5 of the chosen medicine, this means of exchanging revised affords 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 circumstances, CMS accepted a revised counteroffer proposed by the drug firm. For the remaining 5 chosen medicine, CMS despatched a written ultimate provide to these drug corporations, in keeping with the method described in its steering, and in every occasion, the drug firm accepted CMS’s provide on or earlier than the statutory deadline.
However how precisely did CMS arrive at these costs? This isn’t clear. In actual fact, CMS mentioned it gained’t make public a proof of the agreed-upon negotiated costs till March 2025.
Extra particulars on the MFP negotiation timeline is under.
What data and sources have been utilized in setting the MFP? Related data included:
…producer=submitted knowledge on analysis and improvement prices, prior federal monetary assist, unit prices of manufacturing and distribution, market/income/gross sales knowledge, and data on patents, FDA exclusivities, and FDA purposes and approvals. For the elements listed at part 1194(e)(2) associated to proof about different remedies (together with therapeutic advances, prescribing data, comparative effectiveness, and unmet medical want), CMS thought-about data from all kinds of sources, together with: data submitted by taking part drug corporations, folks with Medicare, tutorial consultants, clinicians, caregivers, and different events…; data supplied on the Affected person-Targeted Listening Periods…; data shared by taking part drug corporations throughout conferences with CMS; and data CMS recognized from its personal literature searches, together with from scientific tips and revealed research.
The negotiated costs might be efficient January 1, 2026.