- Medicare has removed seven drugs from a list of medicines it said earlier this month will be subject to penalties under a provision of the Inflation Reduction Act, after recalculating average sales prices.
- The Centers for Medicare and Medicaid Services, which administers the program, pared down the list to 20 drugs on Thursday, removing Gilead’s cancer cell therapies Yescarta and Tecartus and five others from an initial set of 27 drugs announced March 15.
- The other drugs taken off the list were made by Menarini, Shionogi, Aurobindo Pharma, Kamada and Bausch + Lomb. The companies still on the list won’t have to pay a rebate to Medicare until 2025, but some of the program’s enrollees will pay less out of pocket for their drugs starting April 1.
The Inflation Reduction Act, passed last year, requires drugmakers to pay back to Medicare a rebate for price hikes they took that were greater than inflation, beginning with certain self-administered Part D drugs under a limit that took effect in October. The limits on Part B drugs were applied in January.
On Thursday, CMS updated its calculations for the copayments that enrollees will pay for Part B rebatable drugs, CMS communications director Bruce Alexander said in a statement to BioPharma Dive. CMS releases its average sales price public files several weeks before each quarter they take effect to take feedback on any potential discrepancies.
“We have updated the files and supplemental materials to reflect the accurate calculations and updated the list of now 20 drugs for which reduced coinsurance applies,” he said.
Pfizer remains the drugmaker with the most on the list at five, although they are older, lower revenue products. The list also includes AbbVie’s top-selling inflammatory disease drug Humira and Seagen’s bladder cancer drug Padcev.
Depending on their coverage, enrollees will pay less than the inflation-adjusted coinsurance payment of 20%. For example, the Humira copay will be set to 19.644%. The estimated range of savings for enrollees was revised slightly to between $1 and $372 per average dose starting April 1, Alexander said.
The published list of affected drugs come months before CMS will announce the first drugs subject to Medicare price negotiations. The IRA allows Medicare to negotiate prices for top-selling, single-source drugs, starting with 2026 prices for 10 drugs that CMS will publish by Sept. 1.