Five Pfizer drugs among first 27 now subject to Medicare inflation rebates, HHS says
The Department of Health and Human Services (HHS) on Wednesday unveiled the first set of 27 Part B prescription drugs, including five from Pfizer, that will be subject to Medicare inflation rebates because their prices rose faster than the rate of inflation.
Seniors receiving the physician-administered drugs beginning in April will have lower coinsurance for these drugs (listed below) and HHS said they may see their out-of-pocket costs for these drugs decrease by as much as $390 per average dose.
“In addition to making drug companies pay Medicare back for increasing their prices faster than inflation, this provision of the Inflation Reduction Act discourages other companies from doing the same, with the goal of reining in excessive drug price hikes year-over-year,” the White House and CMS said in a fact sheet released this morning (in addition to the initial guidance detailing the requirements and procedures for the Medicare Prescription Drug Inflation Rebate Program here).
Moving forward, CMS said, beneficiary coinsurance will be based on the inflation-adjusted payment amount for the following drugs:
Usual suspects like AbbVie’s Humira will be subject to biosimilar competition beginning this year so the price increases will likely come down. But for other drugs without competitors, the price increases continue apace, such as with Gilead subsidiary Kite Pharma’s CAR-T cancer therapy Yescarta.
The five Pfizer drugs include older drugs like the blood thinner Fragmin (dalteparin), which first won FDA approval in 1994; Atgam, which is for allograft rejection in renal transplant patients; and the chemo Nipent (pentostatin), as well as antibacterial drugs, Bicillin L-A and Bicillin C-R.
But CMS doesn’t intend to send the first invoices to drug companies for the 2023 and 2024 rebates until 2025.
In addition to this list, the White House also put out a report Wednesday explaining how seniors will see more than $230 million in savings this year when the more than 3.4 million people with Medicare begin to pay no out-of-pocket costs for recommended vaccines.
“The report also shows that in some cases, some people paid nearly $200 for the shingles vaccine by itself. Again, not anymore,” said HHS Secretary Xavier Becerra on yesterday afternoon’s press call.
Medicare beneficiaries in the Dakotas, Montana and Wyoming will see the biggest savings from the IRA-related change related to no OOP costs for recommended vaccines, HHS said.
Editor’s note: Article updated with a quote from HHS Secretary Becerra and links to the HHS and CMS reports and documents.