Medicare Negotiates Prices and Saves People Billions
The Inflation Reduction Act of 2022 made several changes that affect Medicare beneficiaries. One of the most significant empowers Medicare to negotiate the prices of single-source drugs that don’t have generic competition or similar alternatives available. The negotiations are rolling out in rounds.
While most people think of Medicare as a benefit for retired workers receiving Social Security benefits, it’s important to remember that Social Security disability (SSD) recipients are also entitled to Medicare benefits after two years. Here’s what retirees and SSD recipients receiving Medicare benefits can expect.
Round One Drugs
To start, Medicare will be targeting 10 drugs. These 10 drugs alone account for more than $50 billion in Medicare Part D expenditures. Between June of 2022 and May of 2023, more than 8 million Part D participants took at least one of these drugs. Their share of the cost was more than $3.4 billion, or an average of about $412 each.
The first-round drugs are:
- Eliquis, for the prevention and treatment of blood clots–more than 3.7 million participants took this drug during that one-year period
- Jardiance, for diabetes and heart failure–more than 1.5 million participants took this drug during that one-year period
- Xarelto, for prevention and treatment of blood clots–more than 1.3 million participants took this drug during that one-year period
- Januvia, for diabetes–more than 850,000 Medicare Part D participants took this drug during that one-year period
- Farxiga, for diabetes, heart disease and chronic kidney disease–nearly 800,000 participants took this drug during that one-year period
- Entresto, for heart failure–more than 550,000 recipients took this drug during that one-year period
- Enbrel, for rheumatoid arthritis, psoriasis, and psoriatic arthritis–nearly 50,000 participants took this drug during that one-year period
- Imbruvica, for blood cancers–20,000 recipients took this drug during that one-year period
- Stelara, for psoriasis, psoriatic arthritis, Crohn’s disease and ulcerative colitis–more than 20,000 participants took this drug during that one-year period
- Fiasp and NovoLog insulin products, for diabetes–more than 750,000 participants took this drug during that one-year period
Medicare recipients can look forward to cost savings starting in 2026. The U.S Department of Health and Human Services has also released final guidance for the second round of negotiations, which will impact 2027 pricing.
Medicare and Social Security Disability (SSD)
The first step toward qualifying for Medicare benefits is to successfully apply for Social Security retirement benefits or SSD benefits. If you are considering applying for SSD or have been denied SSD benefits, Disability Help Group can help. Our experienced advocates have deep knowledge of the SSD application and appeals processes and the type of evidence required to prove your claim. To learn more, call 800-800-3332 or fill out our contact form.
