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Medicare Negotiation List Surprises Highlight The Importance Of Current Spending Data

 
• By Cathy Kelly

Some drugs recorded significant increases in Medicare gross spending between the periods covered by publicly available data and what CMS had access to internally, which contributed to their unexpected presence on the list.

medicare drug surprise
Nobody Likes Surprises • Source: Shutterstock

The fact that AstraZeneca PLC’s Farxiga and Janssen Pharmaceuticals Inc.’s Stelara are among the 10 drugs targeted by the Centers for Medicare and Medicaid Services for the first round of Medicare price negotiation surprised at least some industry watchers.

But stakeholders may have been more prepared if there had been broader access to the same Medicare spending data that CMS used to prioritize drugs with the highest levels of spending. The list of 10 drugs that will be subject to negotiated prices beginning in 2026 was released by CMS on 29 August

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