IRA Leading to Better Medicare Coverage of Negotiated Drugs

A new analysis from KFF shows that the Inflation Reduction Act (IRA) has helped Medicare Part D enrollees gain access to important medications. The IRA established a new drug price negotiation program to help bring down drug costs, and the program also generally requires Part D plans to cover the negotiated drugs.

How the Negotiation Process Works

The drugs chosen for negotiation must be single source drugs—meaning they have no generic or biosimilar competition. Some drugs are excluded because they are orphan drugs, plasma products, or drugs subject to a small biotech exception. The 15 (originally 10) eligible drugs with the highest total Medicare expenditures due to a combination of cost and the number of beneficiaries who take the medication are selected for negotiation.

Negotiated Prices Are Currently in Effect for 10 Drugs

Starting this year, negotiated prices are in effect for

• Eliquis
• Jardiance
• Xarelto
• Januvia
• Farxiga
• Entresto
• Enbrel
• Imbruvica
• Stelara
• NovoLog/Fiasp

The Negotiation Program Is Working

KFF analysis shows that being included in the negotiation has increased beneficiary access to these drugs. While some of the drugs, like some formulations of Xarelto, were already widely available, others have shown sharp increases. For example, Fiasp has climbed from being available to only one-quarter of enrollees to coverage for all enrollees.

Fiasp has climbed from being available to only one-quarter of enrollees to coverage for all enrollees.

The money saved is also significant. This first set of negotiated drug prices is expected to save $1.5 billion in annual out-of-pocket costs for Medicare beneficiaries while saving the Medicare program $6 billion per year. The negotiated prices are a minimum of 38% off the 2023 list price.

Congress Should Build on These Successes

The IRA’s Medicare changes are improving access to prescription drugs. But more must be done to bring down drug prices to ensure older adults and people with disabilities can get the treatments they need while protecting their pocketbooks.

At Medicare Rights, we call on policymakers to expand and deepen these negotiations. Especially in these high-cost times, the health and financial security of people with Medicare is at stake.

If You Need Assistance

Those who are struggling to afford their prescription drug or other health care costs may be eligible for help. For example, Medicare Savings Programs and the Low-Income Subsidy (also known as “Extra Help”) can bring down costs for people with few resources. Other programs, or choosing a different plan, may also help.

For assistance, contact your local State Health Insurance Assistance Program (SHIP) or our free, national helpline (800-333-4114).

Read the KFF analysis.

Read more about the IRA.