AbbVie, Gilead Sciences, Pfizer, and Roche are among the companies that must cut a check to the U.S. government. Those companies have Medicare-covered medicines whose prices rose faster than inflation and according to a new law, the drugmakers must pay back the difference.
A total of 27 drugs from 18 companies were flagged on the list released Wednesday by the Department of Health and Human Services. Under a provision of the Inflation Reduction Act, if the price of a drug covered by Medicare rises faster than the rate of inflation, the drugmaker must rebate the difference to CMS. The rebate requirement went into effect last October for drugs obtained from a pharmacy under Medicare prescription drug coverage. On Jan. 1, rebates went into effect for drugs administered by physicians.
Speaking during a conference call with journalists, Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure said her agency will send invoices to drug companies by the end of 2025. Rebates will be deposited into the Medicare Trust Fund. The list of companies that must pay rebates will be updated every quarter.
Medicare beneficiaries could start seeing lower out-of-pocket costs sooner. Starting on April 1, CMS will lower coinsurance for Medicare Part B medicines whose prices rise faster than inflation. This change affects certain drugs and biological medicines. HHS estimates that Medicare beneficiaries may save between $2 and $390 per average dose, depending on what type of supplemental coverage they have. Director for the Center for Medicare Meena Seshamani said the complexity of those details make it hard to more specifically estimate how much a person could save.
“However, overall, this provision—both because of the impact that it will have on the market to discourage manufacturers from increasing prices faster than inflation and because of this provision to lower the out-of-pocket costs in Part B for that coinsurance, this provision really does protect people with Medicare from large out-of-pocket price increases for certain Part B drugs,” she said.
The highest profile drug on the current HHS list might be Humira, the pricey immunology product that is a blockbuster seller for AbbVie. Pfizer has the most products on the list with five, but they are mostly older medicines, such as antibiotics.
The list includes some newer types of medicines, such as cell therapies for treating advanced cancers. Gilead Sciences markets two of the five FDA-approved CAR T-therapies, and both of them—Yescarta and Tecartus—are on the HHS list. Also on the list is another prominent biological medicine, Seagen’s Padcev, an antibody drug conjugate approved for bladder cancer.
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