Medicare drug value negotiation is right here. The utmost honest costs (MFP) set by Medicare result in reductions between 38% and 79%. The truth is, the true reductions are bigger because the figures listed within the desk under are reductions off of 2023 costs (fairly 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 collaborating drug firm to debate the presents and counteroffers, focus on proof, and try to arrive at a mutually acceptable value for the drug. Through the course of the negotiation course of, CMS revised its presents 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 strategy of exchanging revised presents 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 line 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. The truth is, CMS stated it gained’t make public an evidence 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 knowledge on analysis and improvement prices, prior federal monetary help, unit prices of manufacturing and distribution, market/income/gross sales knowledge, and knowledge on patents, FDA exclusivities, and FDA purposes and approvals. For the components 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 collaborating drug firms, folks with Medicare, educational consultants, clinicians, caregivers, and different events…; data supplied on the Affected person-Centered Listening Classes…; data shared by collaborating drug firms throughout conferences with CMS; and knowledge CMS recognized from its personal literature searches, together with from scientific tips and revealed research.
The negotiated costs will likely be efficient January 1, 2026.
