Medicare drug value negotiation is right here. The utmost honest costs (MFP) set by Medicare result in reductions between 38% and 79%. In reality, the actual reductions are bigger for the reason that figures listed within the desk under are reductions off of 2023 costs (moderately 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 provides and counteroffers, focus on proof, and try and arrive at a mutually acceptable value for the drug. In the course of the course of the negotiation course of, CMS revised its provides for every of the medicine upward in response to those discussions. Likewise, many drug firms revised their counteroffers for his or her medicine downward, primarily based on the discussions with CMS. For 5 of the chosen medicine, this means of exchanging revised provides 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 remaining provide to these drug firms, in step 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 reality, CMS mentioned it received’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 had been utilized in setting the MFP? Related data included:
…producer=submitted information on analysis and improvement prices, prior federal monetary help, unit prices of manufacturing and distribution, market/income/gross sales information, and knowledge on patents, FDA exclusivities, and FDA purposes and approvals. For the elements listed at part 1194(e)(2) associated to proof about different therapies (together with therapeutic advances, prescribing data, comparative effectiveness, and unmet medical want), CMS thought of data from all kinds of sources, together with: data submitted by taking part drug firms, individuals with Medicare, tutorial consultants, clinicians, caregivers, and different events…; data offered on the Affected person-Centered Listening Periods…; data shared by taking part drug firms throughout conferences with CMS; and knowledge CMS recognized from its personal literature searches, together with from medical tips and printed research.
The negotiated costs shall be efficient January 1, 2026.
