Cancer, Diabetes Drugs — And Botox — On List For Medicare Price Negotiations
CMS has identified 15 prescription drugs to target for lower prices in 2028: Anoro Ellipta, Biktarvy, Botox, Cimzia, Cosentyx, Entyvio, Erleada, Kisqali, Lenvima, Orencia, Rexulti, Trulicity, Verzenio, Xeljanz, and Xolair. Plus, the fallout from a largely flat Medicare Advantage reimbursement increase.
NBC News:
Medicare Will Negotiate The Price Of Botox And 14 Other Drugs This Year
The Trump administration on Tuesday announced the next round of prescription drugs up for Medicare price negotiations. The list includes Botox and the GLP-1 drug Trulicity. The negotiations stem from President Joe Biden’s Inflation Reduction Act of 2022, which gave the Centers for Medicare and Medicaid Services the authority to haggle over prices on the costliest prescription drugs each year. The results from the first round of negotiated prices went into effect this year. The drugs selected for this round of negotiation accounted for about $27 billion in total prescription drug spending under Medicare Part B and Part D, according to CMS. (Lovelace Jr., 1/27)
On Medicare Advantage rates —
Healthcare Dive:
CMS Official Defends Flat Medicare Advantage Rate Proposal For 2027
The Trump administration’s top Medicare official is coming to the defense of the 2027 Medicare Advantage rate notice, after the rule sparked a wave of backlash from the health insurance sector. “Make no mistake. Let me not mince words in the least. We are massively in support of Medicare Advantage,” Medicare Director Chris Klomp said during a Paragon Health Institute event on Tuesday. (Parduhn, 1/27)
The Wall Street Journal:
Health Insurers In Shock After Medicare Holds Line On 2027 Payments
Wall Street believed the Trump administration was going to take a friendly approach to Medicare insurers. Now, investors think the industry might be in for a rough ride. Shares of big insurers plunged after The Wall Street Journal first reported that the Medicare agency was proposing 2027 Medicare insurer rates well below analysts’ expectations. (Wilde Mathews, 1/27)
MedPage Today:
Medicare Advantage Plans, Providers Blast Near-Flat Proposed 2027 Pay Rate
Medicare Advantage (MA) plans and the providers in their networks are crying foul over potentially getting virtually no reimbursement increase from the program in 2027. On Monday, the Centers for Medicare & Medicaid Services (CMS) announced that the proposed reimbursement for MA in 2027 would be "a net average year-over-year payment increase of 0.09%, or over $700 million in MA payments to plans in calendar year 2027," according to a fact sheet. The agency softened the blow a bit by adding, "When considering estimated risk score trend in MA driven by coding practices and population changes, the expected average change in payments will be 2.54%." (Frieden, 1/27)
In related news from UnitedHealth Group —
Bloomberg:
UnitedHealth Forecasts 2026 Revenue Drop On Shrinking Business
UnitedHealth Group Inc. forecast a decline in 2026 revenue, the first annual contraction in more than three decades, as the insurer falters in its attempt to rebuild confidence with investors after a stunning fall last year. The news was the second blow to shareholders in as many days. Late Monday, the US proposed holding payments to private Medicare plans flat next year, a huge disappointment that caused the stock to tumble as much as 10% in after-hours trading. (Tozzi, 1/27)
On the ACA, Medicaid Expansion, and SNAP —
NBC News:
Many ACA Enrollees Switched To Cheaper Bronze Health Care Plans. Here's Why That Could Be Risky
Kate Bivona and her husband don’t know what they would do if either gets seriously sick or injured. Until recently, that wasn’t the case. But beginning in January, the monthly cost of her Affordable Care Act insurance jumped by about $300 — making it too expensive for them to afford. Bivona and her husband dropped down to a bronze plan, cutting their bill by more than half but leaving them with an $18,000 annual deductible. “We would have to take out a loan,” said Bivona, a 37-year-old musician in Arizona. “We don’t have that kind of money, maybe a couple of thousand dollars in savings.” (Lovelace Jr., 1/27)
MedPage Today:
Medicaid Expansion Linked To Lower Mortality In Breast Cancer
Medicaid expansion under the Affordable Care Act (ACA) was associated with lower overall mortality among women with breast cancer, according to a retrospective cohort study. (Bassett, 1/27)
Chicago Tribune:
New SNAP Work Requirements Start Feb. 1
Kenneth Robinson has gotten used to counting dollars and cents at the grocery store. He can afford eggs with the $150 he receives a month in SNAP benefits, so they stay in his cart. Ground beef or fish, on the other hand, may have to go back on the shelf after he counts prices in line, the 61-year-old Englewood resident said. (Johnson, 1/27)
