The Centers for Medicare and Medicaid announced lower CMS prices for 15 prescription medications, as part of the Medicare Drug Price Negotiation Program created under the Inflation Reduction Act of 2022.
The maximum fair prices for a 30-day supply of the following 15 drugs for Medicare Part D enrollees will become effective January 1, 2027, and are estimated to generate a net savings of 44% or $12 billion:
- The semaglutide drugs Ozempic®, Rybselus®, and Wegovy®, used for the treatment of obesity and diabetes will drop to $274, down from $959
- Trelegy Ellipta (fluticasone furoate, umeclidinium, and vilanterol inhalation powder), used for the treatment of COPD and asthma, will drop to $175, down from $654
- Xtandi® (enzalumatide), used for the treatment of prostate cancer, will drop to $7,004, down from $13,480
- Pomalyst® (pomalidomide), used for the treatment of multiple myeloma and Kaposi sarcoma, will drop to $8,650 from $21,744
- Ofev® (nintedanib), used for the treatment of interstitial lung diseases, will drop to $6,350, down from $12,622
- Ibrance® (palbociclib), used for the treatment of metastatic breast cancer, will drop to $7,871, down from $15,471
- Linzess® (linaclotide), used for the treatment of IBS or chronic idiopathic constipation (CIC) will drop to $136, down from $539
- Calquence® (acalabrutinib), used for the treatment of mantle cell lymphoma, chronic lyphomic leukemia, or small lymphocytic lymphoma, will drop to $8,600, down from $14,228
- Austedo®/Austedo XR® (deutetrabenazine), used for the treatment of Huntington’s disease and involuntary movements caused by tardive dyskinesia will drop to $4,093, down from $6,623
- Breo Ellipta (fluticasone furoate/vilanterol), used for the treatment of asthma and COPD, will drop to $67, down from $397
- Xifaxan® (rifaximin), used for the treatment of IBS and other conditions, will drop to $1,000, down from $2,696
- Vraylar® (cariprazine), used for the treatment of major depressive disorder, bipolar I disorder, and schizophrenia, will drop to $770, down from $1,376
- Tradjenta® (linagliptin), used for the treatment of type 2 diabetes, will drop to $78, down from $488
- Janumet®/Janumet XR® (sitagliptin/metformin), used for the treatment of type 2 diabetes, will drop to $80, down from $526
- Otezla®/Otezla XR® (apremilast), used for the treatment of psoriatic arthritis, plaque psoriasis, and Bechet’s disorder, will drop to $1,650, down from $4,722
A significant amount of workers’ comp fee schedules is tied to Medicare-based fee schedules, meaning CMS changes can eventually impact workers’ comp drug prices. Additionally, it is very likely that CMS coverage and policy changes could spill over into employer health plans and other commercial coverage.
For ongoing coverage of the latest drug approvals and alerts impacting workers’ comp, visit Med Monitor online.
