the East Room of the White House on August 29, 2023. At the time of this event, the Centers for Medicare and Medicaid Services selected the first batch of prescription drugs for negotiation, under provisions contained in the Inflation Reduction Act. The drugs' negotiated prices, so-called maximum fair prices, have now been posted by CMS.
The next batch of 15 outpatient prescription medicines will be chosen by CMS in February 2025; their MFPs will be applied in 2027. And the following round will include a total of 15 outpatient and physician-administered medications, to be selected in February 2026 with MFPs applied in 2028. Beginning in 2027, the tally of drugs selected—a mix of Part B and D medications—could reach 20 annually if sufficient numbers meet the selection criteria.Trump Vs.
75% for small molecules that have been on the market less than 12 years, and for large molecules on the market 11 to 12 years;40% for all drugs 16 years and more post approval. Furthermore, substantial financial relief is in store starting in 2025 for beneficiaries who enter the catastrophic or high-cost phase of the pharmacy benefit, as their annual out-of-pocket costs will be capped at $2,000.
To counter this potential problem, CMS says it will use its formulary review process—which it conducts each autumn—to assess instances where Part D plans place MFP-negotiated drugs on non-preferred formulary tiers.There’s a lot we don’t know about the negotiation process underlying the determination of MFPs. For instance, it’s unknownit determined for each selected drug by March 1, 2025, that will include a narrative explanation of the negotiation process.