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As many in the industry now know, the Inflation Reduction Act (IRA) is the most significant reform of Medicare prescription drug coverage since the creation of Part D and has wide-ranging implications for the healthcare industry. They do not have biosimilar or generic competition available in the market.
Attention deficit hyperactivity disorder (ADHD) drug Vyvanse (lisdexamfetamine dimesylate) , manufactured by Takeda, also is facing generic competition. In the respiratory area with inhalers, it’s tough to get drugs approved, so the competition comes slowly,” he said. Starting in 2026, the provision will affect 10 Part D drugs.
While more expensive than type 2 diabetes drugs, blood thinners follow a similar pattern of high prescription volumes. The dearth of cancer drugs (only blood cancer drug Imbruvica made this first list) stems from CMS only pursuing negotiations for Part D drugs in 2026 and 2027, then expanding to Part B drugs in 2028. With 27.5%
These high prices are the result of multiple factors: theyre derived from living organisms making them sensitive and complex for both manufacturers and patients, research requires advanced technology to test for safety and effectiveness, and theyre in high demand without much competition. Starting in 2019, the US market was valued at $4.5
Pharma has gone to court again and again to delay generic competition of biologic drugs. One company AbbVie has used the courts to stop competition of its top drug Humira. Another biologic, Enbrel, on the market since 1998, will not have its $5 billion in sales challenged until the end of 2028.
In April 2022, we released an article describing proposed policies from the federal government that could impact prescription drug pricing. The facts: All Part D beneficiaries will pay $0 out of pocket for prescriptions in the catastrophic phase. On August 16, 2022, President Biden signed the Inflation Reduction Act (IRA) into law.
Moreover, the initial set of negotiated prices represents the first step of a process that eventually will reshape the pricing and reimbursement landscape for prescription drugs under Medicare as CMS gradually replaces private payers as the chief negotiating partner for some of the drug industry’s largest-selling treatments.
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