Medicare Drug Price Negotiation & Timeline for 2026
What is the Medicare Drug Price Negotiation Program?
In August of 2022, the Inflation Reduction Act (IRA) was signed into law. This new law will assist in lowering health care and prescription drug costs, and has created the Medicare Drug Price Negotiation Program. The program will allow Medicare to negotiate better prescription drug prices, and Medicare has already selected the first ten drugs up for negotiation. For a list of the first round of drugs selected for negotiation, you can read our blog on the topic here. The negotiated maximum fair prices for these drugs will apply beginning in 2026.
How Much Are Americans Expected to Save?
According to a recent CMS article, had this program been in effect in 2023, Medicare could have saved around $6 billion on the 10 selected drugs. They also estimate that Americans paying out-of-pocket for these drugs could save up to $1.5 billion during 2026. Below is a quote from that same CMS article (Negotiating for Lower Drug Prices Works, Saves Billions):
“Americans pay too much for their prescription drugs. That makes today’s announcement historic. For the first time ever, Medicare negotiated directly with drug companies and the American people are better off for it,” said U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra. “Congressional budget estimators (Congressional Budget Office) predicted about $100 billion savings over 10 years from drug negotiations, and a $3.7 billion savings in the first year alone. Today we’re announcing that in our first year of negotiations we are saving Medicare an estimated $6 billion and Americans who pay out of pocket will be saving another $1.5 billion moving forward. Empowering Medicare to negotiate prices not only strengthens the program for generations to come, but also puts a check on skyrocketing drug prices.”
“CMS is proud to have negotiated drug prices for people with Medicare for the first time. These negotiations will not only lower the prices of critically important medications for cancer, diabetes, heart failure, and more, but will also save billions of dollars,” said CMS Administrator Chiquita Brooks-LaSure.
For more information regarding the estimated savings, please see the original CMS article.
Drug Price Negotiation Timeline for 2026
Initial actions for the Medicare Drug Price Negotiation Program:
You can also download the full, original version of the timeline below by clicking here!
October 1, 2023
Deadline for companies of drugs selected for the Negotiation Program to sign agreements to participate in the negotiation process for 2026.
October 2, 2023
Deadline for companies of drugs selected for the Negotiation Program to submit manufacturer-specific data to CMS to consider in the negotiation of maximum fair price.
February 1, 2024
CMS sends initial offers of a maximum fair price with a justification for a selected drug to each company participating in the Negotiation Program. The negotiation period begins.
March 2, 2024
Companies have 30 days from receiving offers of a maximum fair price for a drug to accept the offer or propose a counteroffer, if desired.
August 1, 2024
The negotiation period ends.
September 1, 2024
CMS will publish maximum fair prices for drugs selected for negotiation for 2026.
January 1, 2026
Maximum fair prices are effective for selected drugs.
To view the full, original timeline released by CMS, click here.
To see more information from CMS regarding estimated savings of the Drug Price Negotiation, click here.
For more information regarding the Inflation Reduction Act and Medicare, please visit CMS.gov or give us a call today at (800) 689-2800.
All contracted Agents receive FREE access to SMS-University, the industry’s most trusted, comprehensive online training platform, featuring numerous training modules, white-papers, and clear, concise education tools.
Sources:
https://www.cms.gov/inflation-reduction-act-and-medicare
https://www.smsteam.net/wp-content/uploads/Drug-Price-Negotiation-Timeline-for-2026.pdf
https://www.smsteam.net/hhs-picks-first-drugs-for-medicare-drug-price-negotiation/
https://www.cms.gov/newsroom/press-releases/negotiating-lower-drug-prices-works-saves-billions
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