Here’s What You Need To Know About the Medicare Drug Price Negotiation Program

Here’s What You Need To Know About the Medicare Drug Price Negotiation Program

Prescription drug prices are a burden for many Americans. Negotiating with Medicare aims to help — but you may not have to wait for relief
Cost of health care

It’s a well-known problem in the United States: prescription medications are just too expensive. Almost a third of Americans who are taking prescription medications say they put a strain on their finances, and have even skipped filling a prescription to spare their wallet.

To try and ease the financial burden, the U.S. government paved the way for Medicare to negotiate the prices of the costliest prescription drugs with their manufacturers. Should they go through, these negotiations promise steep savings for the Americans most affected by high prescription prices.

How does the Medicare drug price negotiation program work?

Thanks to the Inflation Reduction Act of 2022, Medicare is now allowed to negotiate the price of brand-name drugs that don’t have a generic alternative. The drugs chosen for negotiation must be among the 50 that account for the highest proportion of Medicare spending under Part D, which covers prescriptions.

While the new prices wouldn’t go into effect until 2026, Centers for Medicare & Medicaid Services (CMS) recently released their list of the first 10 drugs that will be subject to negotiation. They are:

  • Apixaban (Eliquis, a blood clot treatment)
  • Empagliflozin (Jardiance, a treatment for diabetes and heart failure)
  • Rivaroxaban (Xarelto, a blood clot treatment)
  • Sitagliptin (Januvia, a treatment for diabetes)
  • Dapagliflozin (Farxiga, a treatment for diabetes, kidney disease and heart failure)
  • Sacubitril/valsartan (Entresto, a treatment for heart failure)
  • Etanercept (Enbrel, a treatment for arthritis and psoriasis)
  • Ibrutinib (Imbruvica, a treatment for blood cancers)
  • Ustekinumab (Stelara, a treatment for Crohn's disease, psoriasis and ulcerative colitis)
  • Insulin aspart (Fiasp, Fiasp FlexTouch, Fiasp PenFill, NovoLog, NovoLog FlexPen, NovoLog PenFill — all treatments for diabetes)

According to the Act, more drugs would gradually be added to the list, with their negotiations going into effect each subsequent year after 2026.

However, the U.S. Chamber of Commerce and drugmakers have filed suit in an effort to halt the negotiations before they even start.

How to save money on prescription drugs — before 2026

The Medicare drug price negotiation program does stand a chance of lowering prescription costs for many U.S. patients. However, three years is a long time to wait for those savings when some of these drugs cost several hundred dollars to fill — and as mentioned, lawsuits threaten the efficacy of the program in the first place.

Whether or not the Medicare drug price negotiations come to fruition, there are actionable ways to save money on the cost of prescription drugs right now. Here are some of the easiest ways to lower the cost of your medications.

Shop around for the best Medicare Part D plan

If you qualify for Medicare, you should know that it isn’t one size fits all. Costs and benefits of the Part D plan, which is prescription drug coverage offered through private insurers, can range substantially depending on which carrier you choose.

So it’s worth shopping around to find a plan that will cover the drugs you need at a cost that makes sense for you. Keep in mind, too, that you may be able to bundle Part D coverage with Part A and/or B as part of a Medicare Advantage plan.

Try an online pharmacy

Not everyone is comfortable having their prescription medications shipped to them from a faceless online dealer — but those who are might reap rewards. Increasingly, online pharmacies like Amazon Pharmacy, Birdi and BlinkRx are making it both cheaper and easier to fill your prescriptions.

Many of these offer drug-specific discounts, as well as extra savings for those who don’t have insurance drug coverage. Along with the savings of the direct-to-consumer business model, many of these companies are able to keep their prices low by — you guessed it — negotiating with drugmakers.

Clip prescription coupons

Just like cereal and cake mix, you can find coupons for prescription drugs these days — though likely not in your regular Sunday mailer. Instead, you’ll need to turn to companies like GoodRx, which can also help you price-compare the cost of your drugs at different pharmacies.

It is worth keeping in mind, however, that GoodRx was recently the subject of a Federal Trade Commission complaint stating that the company violated privacy laws by sharing sensitive information with companies like Facebook and Google. GoodRx agreed to pay a $1.5 million fine and to stop sharing this information with advertisers, but the settlement is still pending court approval.

Enroll in your pharmacy’s discount program

Finally, if you’re loyal to a brick-and-mortar pharmacy, consider enrolling in their discount program — or asking if they have one. Many big pharmacies, like Walmart and Walgreens, offer prescription discount clubs at no cost or for a small flat fee each year that might easily pay for itself in savings. If you patronize a local mom-and-pop pharmacy, inquire at the counter if they offer any discounts or have such a program. While the answer may be "no," it never hurts to ask.

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