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mrmoore1951
Contributor ⭐
April 9, 2025

Renegotiated Part D Drug prices

  • April 9, 2025
  • 4 replies
  • 1855 views

Under the Biden Admin, the cost of insulin was reduced to $35 a month.  Under the same policy, the cost of the drug Eliquis was scheduled to be reduced in Jan 2026.  Will this reduction still be implemented or has the Trump Admin taken away this much needed relief from high priced medicines?

    4 replies

    GailL1
    GailL1
    Community Champion ⭐⭐⭐
    April 9, 2025

    It is still there and will begin in Jan 2026 like you said.  The next group of meds have already been announced to be negotiated in 2025 for implementation in 2027.

     

    The only way this would change is if the law is changed however, this drug is manufactured by Bristol-Myers Squibb and Pfizer. The medication is produced in the following locations: United States, Canada, Australia, and Puerto Rico

    so I don’t know if the ones that we may have to get from Canada or Australia would be higher if the tariffs are still in effect at the time this pricing goes into effect.  We should have enough produced in the US and Puerto Rico to cover the demand.

    Eliquis is a biologic drug and it is now being produced as a biosimilar - that’s like a generic for regular chemical drugs so it should start to get even cheaper in the years ahead.

    IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna
    M
    mrmoore1951Author
    Contributor ⭐
    April 9, 2025

    Thank you for the quick response.  Do we know what the negotiated price will be come january?  So far this year we've paid $1326 for my husband's prescription, so any relief will be appreciated.

      GailL1
      GailL1
      Community Champion ⭐⭐⭐
      April 9, 2025

      $ 231 for a 30 day supply that is  56% off a list price of $ 521 for a 30 day supply.

      CMS.gov - Medicare Drug Negotiations Effective for 2026  

       

      Remember that Part D has a $ 2000 maximum out of pocket for COVERED drugs that are on the plan’s formulary.  

       

      • Annual deductible. The enrollee pays 100% of their gross covered prescription drug costs (GCPDC) until the deductible of $590 for CY 2025 is met.
      • Initial coverage. The enrollee pays 25% coinsurance for covered Part D drugs. The sponsor typically pays 65% of the cost of applicable drugs and 75% of the cost of all other covered Part D drugs. The manufacturer, through the Discount Program, typically covers 10% of the cost of applicable drugs. This phase ends when the enrollee has reached the annual OOP threshold of $2,000 for CY 2025. 
      • Catastrophic. The enrollee pays no cost sharing for covered Part D drugs. Sponsors typically pay 60% of the costs of all covered Part D drugs. The manufacturer pays a discount, typically equal to 20%, for applicable drugs. CMS pays a reinsurance subsidy equal to 20% of the costs of applicable drugs and equivalent to 40% of the costs of all other covered Part D drugs that are not applicable drugs.

      CMS.gov - Final CY 2025 Part D Redesign Program Instructions Fact Sheet 

      IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna
      papawofboo
      papawofboo
      Community Champion ⭐
      April 9, 2025

      My wife and I take Eliquis, we have different plans but it went down in price in both plans. I don't know what is going to happen with pricing on the back end of the year but right now they are down.

      Papaw of Boo
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