Medicare to Negotiate Prices for Botox, 14 Other Drugs in 2021
TL/DR –
The Trump administration has announced the next round of prescription drugs, including Botox and the GLP-1 drug Trulicity, to be negotiated for Medicare pricing under the Inflation Reduction Act of 2022. Drugmakers have until Feb. 28 to decide if they will participate in negotiations, with non-participants ostensibly removing their drugs from Medicare. The drugs selected for negotiation accounted for about $27 billion in total prescription drug spending under Medicare Part B and Part D, with the negotiated prices set to take effect in 2028.
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Medicare Price Negotiations Round to Include Botox and Trulicity
The Trump administration has made the announcement that key prescription drugs like Botox and the GLP-1 drug Trulicity will be included in the next round of Medicare price negotiations.
Background and Details
These price negotiations are part of President Joe Biden’s Inflation Reduction Act of 2022, which offers the Centers for Medicare and Medicaid Services the authority to negotiate prices for the most expensive prescription drugs annually. The first round of these price negotiations has already been implemented this year.
Significance of the Selected Drugs
The drugs chosen for this negotiation round account for approximately $27 billion in overall prescription drug spending under Medicare Part B and Part D, as per CMS.
Medicare Part B generally includes drugs administered in a healthcare facility, such as intravenous chemotherapy, while Medicare Part D focuses on prescription drugs.
Consequences of Non-Negotiation
Pharmaceutical manufacturers have the option to refuse negotiations. However, this could potentially result in the removal of their drugs from Medicare, a significant market in the nation. These businesses have a deadline of February 28 to decide whether or not they will participate in the negotiations. (In the previous two negotiation rounds, no manufacturers decided to opt out.)
The prices agreed upon in this negotiation will become effective in 2028.
Medicare does not cover Botox for cosmetic uses, but the drug has numerous other applications, such as treating chronic migraines, overactive bladder, muscle stiffness, and lazy eye.
In November, CMS announced price reductions for prescription medications like Ozempic and Wegovy, which will become effective in 2027.
Drugs Included for Negotiations
The prescription drugs that will be a part of this year’s Medicare price negotiation process are:
- Anoro Ellipta, used for COPD.
- Biktarvy, for HIV treatment.
- Botox and Botox Cosmetic, used for migraines, bladder dysfunction, and muscle spasms.
- Cimzia, used for Crohn’s disease, rheumatoid arthritis, and other autoimmune diseases.
- Cosentyx, a psoriasis medication.
- Entyvio, for Crohn’s disease and ulcerative colitis.
- Erleada, for prostate cancer.
- Kisqali, for breast cancer.
- Lenvima, for various types of cancer.
- Orencia, for rheumatoid arthritis.
- Rexulti, an antipsychotic drug.
- Trulicity, for diabetes.
- Verzenio, for breast cancer.
- Xeljanz and Xeljanz XR, for autoimmune conditions.
- Xolair, for allergies and asthma.
The administration also stated that it has decided to renegotiate the price of one drug, Tradjenta, used for Type 2 diabetes, which had previously been selected for negotiation under Medicare’s second round.
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