by Camalot Todd, Nevada Current
An estimated 60,000 Nevada seniors will pay less in out-of-pocket expenses for the 10 most common, high-price drugs the Biden administration identified this week for price negotiations between Medicare and pharmaceutical companies.
The 10 drugs that will be negotiated are Eliquis, Enbrel, Entresto, Farxiga, Imbruvica, Januvia, Jardiance, multiple Fiasp and NovoLog insulin products, Stelara and Xarelto. These commonly prescribed drugs are used to treat blood clots, diabetes, heart disease, and more.
The average annual out-of-pocket cost per Medicare enrollee taking these drugs, based on 2022 prices, ranges from a high of $5,247 for Imbruvica, which treats specific cancers, to a low of $121 for NovoLog, which is an insulin used to treat type 1 and type 2 diabetes, if they qualify for financial assistance through the Medicare low-income subsidy program Extra Help, according to a report by the Assistant Secretary for Planning and Evaluation (ASPE) Office of Health Policy.
For those who don’t receive financial assistance, the average annual out-of-pocket costs ranged from a high of $6,497 per enrollee for Imbruvica to a low of $261 per enrollee for NovoLog.
The report notes that enrollees’ price and use of the drugs in 2022 varies widely by state. In Nevada, 26,000 Medicare enrollees paid $438 out-of-pocket for Eliquis, a drug used to treat and prevent blood clots, totaling $11.4 million, and is the most commonly prescribed drug in the state on the list.
The report estimates 11,000 Nevadans are prescribed Xarelto, 10,000 are prescribed Jardiance, 5,000 each for Januvia and Farxiga, and 4,000 are prescribed Entresto.
The report does not track the cost of drugs that are prescribed to less than a thousand people, like Imbruvica, but the annual average out-of-pocket cost in Nevada for that drug is $6,307. For NovoLog, about 5,000 Nevadans paid an average of $122 in out-of-pocket costs.
Medicare enrollees are scheduled to see the negotiated lower prices in 2026.
The drug price negotiations are a result of the 2022 Inflation Reduction Act. Other medical expense provisions of the legislation, include allowing people to spread the out-of-cost expenses for prescription drugs in payments throughout the year instead of one large payment upfront starting in 2025, and a tax penalty on pharmaceutical companies if prices they charge for drugs outpace inflation.
The legislation also capped insulin costs for Medicare recipients at $35 a month. That provision went into effect in January.
The Centers for Medicare & Medicaid Services (CMS) is scheduled to publish the maximum fair price that the 10 drugs have been negotiated for by Sept. 1, 2024. CMS will select up to 15 additional drugs for Medicare Part D in 2027, up to 15 more drugs covered under Medicare Part B and Part D in 2028, and 20 additional drugs each year after.
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