Medicare’s power to negotiate drug prices is now written into federal regulation, and the first drugs it went after treat diabetes, heart failure and blood clots. Those are conditions Black adults carry at higher rates than anyone else in the country.
The Centers for Medicare and Medicaid Services published the final rule on Nov. 5. It takes effect Dec. 5. It largely turns the program’s existing guidance into permanent rules, with new provisions on drugs sold in fixed combinations and on new formulations, and a price floor for small biotech companies. Negotiation under the codified rules begins in 2029. Two Part D policies are also written in: plans must cover medicines that have a negotiated price, and they cannot be made to overpay the pharmacies that dispense them.
Here is why that matters to Black readers. The CDC’s National Diabetes Statistics Report puts diagnosed diabetes at 12.2% of Black adults and 7.1% of white adults in 2021 to 2023. Of the first ten drugs Medicare negotiated, seven are for diabetes, heart failure or clots: Eliquis, Xarelto, Entresto, Jardiance, Farxiga, Januvia and NovoLog.
Their negotiated prices took effect for Part D patients in January. The discounts run from 38% to 79% off the 30-day list price, according to CMS. The agency estimated that about 9 million people with Medicare use at least one of the ten drugs, and that enrollees would save $1.5 billion a year in out-of-pocket costs.
Drugmakers fought the program in court. On May 18, the Supreme Court declined to hear a series of industry appeals challenging it.
The gap in the rule is in who can see whether it works. The agency’s savings estimates are national totals, with no breakdown of how much reaches Black enrollees. Without a breakdown by race, nobody outside the agency can check whether a price cut on paper becomes a filled prescription at the counter.
The program was Congress’s answer to years of list-price increases. Nine of the first ten drugs rose in price between 2018 and 2023, from 20% for Farxiga to 55% at the top of the range. Making negotiation permanent takes it out of the reach of a future administration that wants to quietly let it lapse.
That is a win for patients, and the paper’s view is that CMS should finish the job: publish uptake and out-of-pocket costs for the negotiated drugs by race, and do it before 2029, when the next round of prices is set. The rule takes effect Dec. 5.
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