Deeper Dive On 2025 Medicare Drug Price Negotiations
The Trump administration announced the results of the second round of Medicare drug price negotiations, taking credit for the 2025 process that it says led to much deeper price reductions than in 2024’s process. The 2025 set prices will go into effect in 2027.
The administration said $12 billion in federal savings would occur due to the negotiations in 15 drugs. That is computed at 44% off of net (after rebates) costs, compared with 22% or $6 billion under Biden’s negotiations in 2024 for ten drugs. Under another calculation, the 2025 savings is $8 billion or 36%. Consumers would save an estimated $685 million in out-of-pocket costs. The medications are used by about 5.3 million Medicare beneficiaries. The negotiated savings range from 38% to 85% off the drugs’ list prices. Total spending on the drugs is about $42.5 billion.
The administration reached agreement with brand drug makers on all 15 drugs, which include treatment for cancer and a number of disease states such as diabetes and asthma.
It appears that the prices obtained on some GLP-1s, Ozempic and Wegovy, are not as low as what President Trump struck with Novo Nordisk earlier.
All this said, it must be remembered that drug prices will remain markedly above other developed countries even with these negotiations. Right now, Americans pay over three times more generally and over four times more for brand drugs than those in other countries. Our per capita spending is well more than double those nations. Despite the year-over-year drug price reduction progress, I believe most-favored-nation pricing must come quickly and cover all drugs in all lines of business. The savings from Medicare drug price negotiations or even Trump’s direct discussions is simply not enough.
Additional articles: https://www.politico.com/news/2025/11/25/trumps-cms-touts-12b-savings-from-medicare-drug-price-negotiations-00669231 and https://www.healthcaredive.com/news/medicare-price-negotiation-wegovy-ozempic-trelegy-2027/806578/ and https://www.cms.gov/files/document/fact-sheet-negotiated-prices-ipay-2027.pdf and https://www.medpagetoday.com/publichealthpolicy/medicare/118727 and https://www.kff.org/quick-take/understanding-the-trump-administrations-negotiated-drug-prices-for-medicare/ and https://thehill.com/policy/healthcare/5623364-trump-medicare-drug-price-negotiation/
#drugpricing #ira #branddrugmakers #cms #medicare #partd
Health Insurer M&A Picking Up
Health insurance mergers and acquisitions (M&A) picked up in Q3 as companies sought to gain scale, modernize operations, and stay competitive. Ten M&A deals were announced, up from seven in Q3 2024. More have emerged during Q4. MVP Health Care and Independent Health announced a deal a merger. Medica proposed buying UCare’s exchange and Medicaid operations. Cambia Health Solutions and Arkansas Blue and Cross and Blue Shield will affiliate.
(Article may require a subscription.)
#healthplans #manda #mergers #acquisitions
https://www.modernhealthcare.com/insurance/mh-medica-arkansas-blue-cross-mvp-health-care
Trump May Not Propose Healthcare Changes
The White House was on the verge of announcing an Exchange subsidy extension proposal with some conservative reform elements in it. But the proposal could be dead or delayed over conservative GOP lawmakers’ objections. But a door was left opened.
On Air Force One, President Trump said Tuesday he would prefer not to extend the enhanced subsidies set to expire at the end of the year. At the same time he said it may be necessary to reach an agreement on healthcare legislation. He said it was his preference to give money directly to Americans to allow them to purchase their own healthcare plan.
#exchanges #healthcare #coverage
https://thehill.com/homenews/administration/5622869-trump-opposes-aca-subsidy-extension
Medicare IP-Only List To Be Eliminated
A Modern Healthcare article discusses the elimination of the Inpatient-only list in Medicare and related expansion of Ambulatory Surgery Center procedures. It is about time. Quality and clinical concerns are boogeymen manufactured by greedy hospitals defending their bloated turf and empires. Small site neutral reforms were included in a Medicare outpatient finalized rule as well.
(Article may require a subscription.)
#medicare #hospitals #siteneutral
https://www.modernhealthcare.com/politics-regulation/mh-cms-medicare-inpatient-only-list-end
— Marc S. Ryan
