Drug price negotiation is the boogeyman awaiting Big Pharma in 2026. So, which medicines will be subject to the U.S. government’s newfound ability to broker prices—the most impactful measure from last year’s Inflation Reduction Act?
Based on 2021 spending data from the U.S. Centers for Medicare & Medicaid Services (CMS), Moody’s Investors Service has identified which drugs will likely be subject to the negotiations.
The findings are not good news for Pfizer and Bristol Myers Squibb as Eliquis figures to be front and center for Medicare Part D price negotiations. In 2021, CMS paid more than twice as much to supply the blood thinner to seniors as it did for any other medicine.
Total spending by CMS on Eliquis was $12.6 billion in 2021, with that figure excluding rebates and discounts.
Other treatments that look to be destined for Part D negotiations include AbbVie and Johnson & Johnson’s Imbruvica, Novo Nordisk’s Ozempic and a pair of diabetes meds from Eli Lilly—Trulicity and Jardiance.
In 2028, when Medicare Part B drugs become (PDF) subject to the measure, the most likely candidates to be affected are Merck’s cancer megablockbuster Keytruda, which also loses patent protection that year, and BMS’ cancer drug Opdivo, Moody’s says.
While Bayer and Regeneron’s macular degeneration therapy Eylea ranked alongside Keytruda and Opdivo in Part B spending in 2021, it should not be affected in 2028 as it will be subject to biosimilar competition by then. In general, Moody’s expects that drugs set to lose patent protection before February of 2024 will be excluded from negotiations in 2026.
Part D drugs are dispensed by pharmacies, while Part B drugs are provider-administered.
In 2025, another measure that kicks in will be a reduction of prices for particularly pricey Part D drugs. Falling into this catastrophic coverage category, according to Moody’s, are Imbruvica, BMS’ Revlimid and Pfizer’s Ibrance. The average Part D spending per beneficiary in 2021 for each of these drugs was more than $100,000.
In 2026, 10 Part D drugs will become subject to negotiated prices. Each year after that, more medicines will be added to the negotiation list, escalating quickly to include 80 by 2030. In the first year, the maximum negotiated price will range from 40% to 75% of the 2021 average price of the drug.
In September of this year, CMS will identify the 10 drugs that will be affected in 2026. The list will be based on Medicare spending for the period starting in June of last year and ending in May of this year.
Other medicines that Moody identifies as likely to be on the 2026 list include J&J’s Xarelto, GSK’s Trelegy and Astellas’ pair of Xtandi and Myrbetriq.
Projecting further into the future on which Part B drugs will be subject to negotiation by 2028 is more challenging, Moody’s says. But other treatments that could be on that list include J&J’s Darzalex, Takeda’s Entyvio, AstraZeneca’s Imfinzi, UCB’s Cimzia and Roche’s duo of Tecentriq and Ocrevus.