Even though the ten top-selling Medicare Section D medication simplest accounted for 0.3% of general coated medication in 2021, they represented 22% of general gross Medicare drug spending, a brand new KFF research discovered.

Underneath the Medicare Drug Worth Negotiation Program created through the Inflation Aid Act, the government will be capable of negotiate the cost of some high-spending medication coated through Medicare Section D and Medicare Section B. The Facilities for Medicare and Medicaid Services and products will get started through settling on 10 Section D medication for 2026 (although the medicine will probably be introduced September 1, 2023). After that, CMS will steadily upload further medication.

The KFF research, printed Wednesday, gives “context for working out the possible have an effect on of negotiating costs for a restricted collection of Medicare-covered medication.” It depended on CMS’ knowledge on Medicare Section D spending through drug. Alternatively, the researchers famous that “this research isn’t designed to spot which medication usually are matter to value negotiation for 2026, since we don’t keep in mind all the components that resolve whether or not a drug is negotiation-eligible and we don’t have get entry to to the extra present spending knowledge that CMS will use in settling on medication for value negotiation.”

KFF discovered that the ten top-selling Section D medication represented $47.7 billion of the $215.7 billion general gross Medicare Section D drug spending in 2021 (this didn’t come with rebates paid through drug producers to PBMs). Eliquis, a blood thinner through Bristol Myers Squibb, accounted for probably the most spending out of those 10 medication at $12.6 billion. 

Every other 5 of those medication have been diabetes medication: Trulicity ($4.7 billion of gross spending), Januvia ($4.1 billion), Jardiance ($3.7 billion), Lantus Solostar ($2.8 billion) and Ozempic ($2.6 billion). The latter has won consideration just lately because of its effectiveness in supporting weight reduction.

The remainder top-selling medication have been a couple of myeloma remedy Revlimid ($5.9 billion), blood thinner Xarelto ($5.2 billion), most cancers remedy Imbruvica ($3.2 billion), and rheumatoid arthritis remedy Humira Citrate-free pen ($2.9 billion).

KFF additionally found out that gross Medicare spending for the ten top-selling Section D medication greater than doubled between 2018 and 2021, from $22 billion to $48 billion. In general, gross Section D spending larger from $166 billion in 2018 to $216 billion in 2021.

“The rise in gross spending on those 10 medication on my own accounted for greater than part of the rise in gross Medicare spending throughout all coated Section D medication over those years,” the record mentioned.

To be eligible for the associated fee negotiation program, small-molecule medication should have won FDA approval a minimum of seven years previous to when the chosen medication are introduced. For biologics, it’s 11 years. Additionally they can’t have therapeutically-equivalent generic or biosimilar choices. For those causes Trulicity, Ozempic, Revlimid, Humira and Lantus will probably be excluded.

“Whilst all the 10 top-selling Section D medication in 2021 might not be incorporated at the record of 10 medication decided on for value negotiation this 12 months, this research means that concentrated on negotiation on a small collection of high-spending medication may just have an effect on a disproportionate proportion of Medicare drug spending at some point,” KFF mentioned.

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