Starting on Wednesday, January 1st, Americans with Medicare will benefit from a $2,000 out-of-pocket spending cap on prescription drugs thanks to President Biden’s Inflation Reduction Act. That means that 19 million seniors and people with disabilities with Medicare are expected to save an average of $400 per year, in addition to savings from other provisions of the law. In August, the Biden-Harris Administration announced lower prescription prices for the first ten drugs that have been negotiated by Medicare. These new, lower prices take effect in 2026, and will cut the price of some of the most expensive and most commonly used drugs nearly 40 and 80%.
Today’s action builds on the progress the Biden-Harris Administration has already made lowering health care costs, including the Inflation Reduction Act’s $35 insulin cap, making recommended vaccines free for seniors, and requiring drug companies to pay a rebate when they raiseprescription prices faster than the rate of inflation. President Biden took on Big Pharma and won and because of this law, costs are going down for drugs that treat heart disease, cancer, diabetes, blood clots, and more
“I believe that health care should be a right – not a privilege – and throughout my presidency I have advanced that goal. This week, we take another step closer to an America where everyone can afford the quality health care they need, as Medicare’s new $2,000 cap on prescription drug costs from my Inflation Reduction Act goes fully into effect.
“Before I took office, people with Medicare who took expensive drugs could face a crushing burden, paying $10,000 a year or more in copays for the drugs they need to stay alive. When I took on Big Pharma and won, we changed that, capping seniors’ out-of-pocket spending on drugs they get at the pharmacy for the first time ever. Costs were capped at about $3,500 in 2024, and in just the first six months of the year, this policy saved people with Medicare $1 billion in cost-sharing. On January 1, 2025, the cap on drug costs fully phases in, and costs are now capped at $2,000 per year. As a result, 19 million people are expected to save an average of $400 each. That’s a game changer for the American people.
“My Inflation Reduction Act has changed Medicare for the better, and as a result Americans will have more money back in their pockets in the years to come.”
The Biden-Harris Administration is proposing a new rule to significantly expand coverage of anti-obesity medications for Americans with Medicare and Medicaid. Tens of millions of Americans struggle with obesity. An estimated 42 percent of the U.S. population has obesity, which is now widely recognized as a chronic disease, with increased risk of all-cause mortality and multiple related comorbidities such as diabetes, cardiovascular disease, stroke, some cancers, and more.
Over the past few years, there have been major scientific advancements in the treatment of obesity, with the introduction of new life-saving drugs. These anti-obesity medications can help prevent the development of Type 2 diabetes. Furthermore, these drugs reduce deaths and sickness from heart attack and other cardiovascular outcomes by up to 20%. But for too many Americans, these critical treatments are too expensive and therefore out of reach. Without insurance coverage, these drugs can cost someone as much as $1,000 a month.
Currently, Medicare and Medicaid cover the use of AOM’s for certain conditions, like diabetes. This proposal would expand access to these innovative medications for obesity, which is widely recognized as a disease and help an estimated 3.4 million Americans with Medicare. Medicare coverage would reduce out-of-pocket costs for these prescription drugs by as much as 95 percent for some enrollees. Approximately 4 million adult Medicaid enrollees would also gain new access to these medications. This proposal would allow Americans and their doctors to determine the best path forward so they can lead healthier lives, without worrying about their ability to cover these drugs out-of-pocket, and ultimately reduce health care costs to our nation.
Since taking office, the President has built on, strengthened, and protected Medicare, Medicaid, and the Affordable Care Act, by signing laws such as the American Rescue Plan Act and the Inflation Reduction Act to lower prescription drug costs and health insurance premiums. The President is proud of the fact that the Inflation Reduction Act allows Medicare to negotiate down the price of drugs, a tool that will help Medicare lower the cost of some of the most expensive medications in the program. That power to negotiate drug prices is critical because Americans pay two to three times more than people in other countries for their prescription drugs. An analysis from the Department of Health and Human Services (HHS) finds international prices for anti-obesity medications are much lower than U.S. list prices and generally lower than U.S. net prices for these same medications. It’s unacceptable that Americans – especially those without insurance coverage for these drugs — are forced to pay so much more for life-saving medications. The proposed rule would be implemented at the same time as a comprehensive agenda to lower the costs of drugs, including the drug price negotiation program and increased market competition. We can lower drug prices and improve health outcomes for Americans.
Thanks to the President’s efforts, seniors are already seeing lower prescription drug costs with insulin capped at $35, free vaccines, and out-of-pocket costs for prescription drugs capped at $2,000 starting in 2025. Already this year, nearly 1.5 million people with Medicare Part D saved nearly $1 billion in out-of-pocket prescription drugs costs in the first half of 2024 because of the Biden-Harris Administration’s Inflation Reduction Act. Furthermore, HHS has reached agreement with drug manufacturers for the first ten negotiated drugs, with new prices that are reduced between 38 to 79 percent starting in 2026.
The President’s new actions are all in addition to an already impressive track record on fighting for the health care of Americans across the nation. The Biden-Harris Administration’s National Strategy on Hunger, Nutrition, and Health focused on ending hunger and reducing diet-related diseases such as obesity. One of the Strategy’s pillars is integrating nutrition and health, which recognizes the opportunities within Medicare and Medicaid to support beneficiaries’ access to nutritious foods, obesity counseling, and other nutrition-related services. Obesity is a multi-faceted disease and we need to work on all levels from prevention to treatment to address this persistent challenge.
New negotiated drug prices are expected to save millions of seniors and other Medicare beneficiaries $1.5 billion in out-of-pocket costs in the first year of the program alone. This fact sheet was provided by the White House:
For far too long, Americans have paid more for their prescription drugs than any developed nation. Today, the Biden-Harris Administration is delivering on its promise to lower out-of-pocket drug costs for seniors and save money for Americans. That’s because Medicare has the power to negotiate prescription drug prices for the first time in history thanks to the Inflation Reduction Act, which was signed into law by President Biden with Vice President Harris casting the tie-breaking vote. Because Medicare is now able to negotiate lower prescription drug prices for seniors and people with disabilities, American taxpayers are expected to save $6 billion on prescription drug costs, and people enrolled in Medicare are expected to save $1.5 billion in out-of-pocket costs in 2026 alone. President Biden and Vice President Harris took on Big Pharma and won, and now millions of seniors and others on Medicare will soon see their drug costs go down on some of the most common and expensive prescription drugs that treat heart disease, cancer, diabetes, blood clots, and more.
HHS Announces Negotiated Prices for Medicare Drugs
HHS has reached agreements with all participating manufacturers on new negotiated, lower drug prices for the first 10 drugs selected for the Medicare drug price negotiation program. After manufacturers have steadily increased the list prices of all 10 of these drugs since they went on the market, these new prices will cut the list price of these drugs between 38 and 79 percent.
The new prices will go into effect for people with Medicare Part D prescription drug coverage in 2026:
Drug Name
Commonly Treated Conditions
Number of Medicare Enrollees Who Used the Drug in 2023
Drug List Price in 2023 for 30-day Supply
Negotiated Price for 2026 for 30-day Supply
Savings (%)
Eliquis
Prevention and treatment of blood clots
3,928,000
$521
$231
$290 (-56%)
Jardiance
Diabetes; Heart failure; Chronic kidney disease
1,883,000
$573
$197
$376 (-66%)
Xarelto
Prevention and treatment of blood clots; Reduction of risk for patients with coronary or peripheral artery disease
These ten drugs are among those with highest total spending in Medicare Part D. If the negotiated prices had been in effect during 2023, Medicare would have saved an estimated $6 billion. When the negotiated prices go into effect in 2026, people enrolled in Medicare Part D are estimated to save $1.5 billion in out-of-pocket costs.
Millions of Part D enrollees that depend on these treatments to treat life-threatening conditions including diabetes, heart failure, and cancer are also expected to see lower out-of-pocket costs for these drugs. For example, a Medicare enrollee who takes Stelara for their arthritis and pays $3,459 on their drug today for a 30-day supply would pay only $1,174 in 2026. Many seniors and people with disabilities on Medicare who take these drugs will also benefit from the Inflation Reduction Act’s $2,000 cap on out-of-pocket spending, which will be fully in effect in 2025, saving 19 million beneficiaries an average of $400 per year, in addition to these savings from the negotiated drug prices.
More drugs will be selected each year as part of Medicare’s drug price negotiation program. Medicare will select up to 15 additional drugs covered under Part D for negotiation in 2025, up to an additional 15 Part B and D drugs in 2026, and up to 20 drugs every year after that.
Building on Progress Lowering Health Care Costs
Every day, millions of Americans are saving money on health care costs because of the Biden-Harris Administration’s actions.
People with Medicare are saving an average of $70 in out-of-pocket costs on vaccines like shingles and Tdap because President Biden’s Inflation Reduction Act made recommended vaccines free for beneficiaries, including the 10.3 million enrollees who received a free vaccine in 2023.
All 3.4 million Medicare Part D enrollees who filled an insulin prescription in 2023 had their insulin costs capped at $35 per month, saving some seniors hundreds of dollars for a month’s supply.
Some seniors and other Medicare beneficiaries taking drugs covered under Part B for which manufacturers have hiked prices faster than inflation are saving up to $4,593 in lower coinsurance this quarter thanks to the new Medicare inflation rebates.
Starting this year, Part D enrollees no longer pay 5% co-insurance when they reach the catastrophic phase of their benefit and have their out-of-pocket drug costs capped at about $3,500. In just the first quarter of 2024, over 260,000 people benefited from this cap.
Millions of American are saving an average of about $800 per year on health insurance premiums because of savings from the American Rescue Plan that the Inflation Reduction Act extended, helping drive the nation’s uninsured rate to historic lows under the Biden-Harris Administration.
Check out the Biden-Harris Administration’s Savings Explorer to see how some of the Administration’s policies are helping Americans save money on annual expenses – from health care to junk fees, grocery costs and more.
Continuing to Lower Prescription Drug Costs
People with Medicare will continue to see their prescription drug costs go down as more provisions of the Inflation Reduction Act go into effect next year. Nearly 19 million seniors and other Part D beneficiaries are projected to save $400 per year on prescription drugs when the out-of-pocket cap drops to $2,000 in 2025, and 1.9 million enrollees with the highest drug costs will save an average of $2,500 per year. And the lower prices negotiated for the high-spend drugs announced today will go into effect in 2026.
The President’s Budget for Fiscal Year 2025 builds on this success by significantly increasing the pace of negotiation, bringing more drugs into negotiation sooner after they launch, expanding the $2,000 out-of-pocket prescription drug cost cap beyond Medicare and into the commercial market, and other steps to build on the Inflation Reduction Act drug provisions. The Budget also includes proposals to curb inflation in prescription drug prices and extends the $35 cost-sharing cap for monthly prescriptions of insulin to the commercial market to lower drug costs for all Americans.
Statement from President Joe Biden on Lower Prescription Drug Prices
For years, millions of Americans were forced to choose between paying for medications or putting food on the table, while Big Pharma blocked Medicare from being able to negotiate prices on behalf of seniors and people with disabilities. But we fought back – and won.
Today, for the first time in history, my Administration is announcing that Medicare has reached agreements on new, lower prices with the manufacturers of all 10 drugs selected for the first round of drug price negotiation. When these lower prices go into effect, people on Medicare will save $1.5 billion in out-of-pocket costs for their prescription drugs and Medicare will save $6 billion in the first year alone. It’s a relief for the millions of seniors that take these drugs to treat everything from heart failure, blood clots, diabetes, arthritis, Crohn’s disease, and more – and it’s a relief for American taxpayers.
This historic milestone is only possible because of the Inflation Reduction Act, which passed with the leadership of Democrats in Congress, and with Vice President Harris casting the tie-breaking vote in the Senate – without a single Republican voting for it. We showed that major progress can be made for the American people when we work together to take on special interests, even as Big Pharma continues to go to court to try to block lower prices for consumers. But the Vice President and I are not backing down. We will continue the fight to make sure all Americans can pay less for prescription drugs and to give more breathing room for American families.
Statement from Vice President Kamala Harris on Lower Prescription Drug Prices
Every American should be able to access the health care they need no matter their income or wealth. That is why President Biden and I fought to lower the costs of health care with our Inflation Reduction Act, transformational legislation that I was proud to cast the tie-breaking vote on in the Senate. During the two years since President Biden signed this landmark bill into law, we have cut prescription drug costs, capped the cost of insulin at $35 a month, and lowered premiums for seniors and people with disabilities on Medicare – helping millions of families get the care they deserve.
Today, we are building on our work to lower costs and increase access to affordable prescription drugs by announcing that the Biden-Harris Administration has reached agreements with all participating manufacturers to lower prices for the first 10 drugs selected for the Medicare price negotiation program – from those that treat cancer to those that treat diabetes, heart disease, and blood clots. Thanks to our historic work to allow Medicare to negotiate lower drug prices, millions of Americans who rely on these drugs will save on their out-of-pocket costs. While people enrolled in Medicare are expected to save $1.5 billion in 2026 alone, American taxpayers will also save an estimated $6 billion.
Today’s announcement will be lifechanging for so many of our loved ones across the nation, and we are not stopping here. Additional prescription drugs will be selected each year as part of our Medicare drug price negotiation program. This includes up to 15 additional drugs covered under Medicare Part D for negotiation in 2025, up to an additional 15 Part B and Part D drugs in 2026, and up to 20 drugs every year after that.
From my time as Attorney General of California and a U.S. Senator, I have consistently worked to lower the costs of prescription drugs and fought to protect patients. As Attorney General, I held Big Pharma accountable for their deceptive and illegal practices. The record-breaking settlements that I won – for the people – amounted to more than $7 billion against pharmaceutical companies for their unsafe and unfair tactics. President Biden and I will never stop fighting for the health, wellbeing, and financial stability of the American people.
This fact sheet analyzing the House Republicans’ proposed 2025 budget that would target Medicare, Social Security, the Affordable Care Act (Obamacare), repeal caps on drugs and cut taxes for the wealthy, is provided by the White House:
In his State of the Union Less than two weeks ago, President Biden laid out his vision for an economy that gives the middle class a fair shot. He also warned that congressional Republicans “will cut Social Security and give more tax cuts to the wealthy,” that they continue to oppose the Affordable Care Act, and that they are siding with Big Pharma over hardworking families.
On Wednesday, Republican Study Committee – which represents 100% of House Republican leadership and nearly 80% of their members – just proposed yet another budget that would cut Medicare, Social Security, and the Affordable Care Act , as well as increase prescription drug, energy, and housing costs – all while forcing tax giveaways for the very rich onto the country. Their plan would even raise the Social Security retirement age.
Like President Biden promised in the Capitol, “If anyone here tries to cut Social Security or Medicare or raise the retirement age I will stop them.”
He’s keeping that promise by standing against this new House Republican budget. He knows the last thing we should do is raid Medicare and Social Security while giving more giant tax cuts to the wealthy and big corporations.
What’s more, House Republicans’ plan would raise energy costs and send our new manufacturing jobs back overseas by gutting other crucial elements of the Inflation Reduction Act, raise housing costs, and allow big companies to rip off consumers with junk fees.
President Biden has a different vision for how we move into the future: make the wealthy, big corporations, and special interests pay their fair share while protecting and strengthening Medicare and Social Security. Extending the Affordable Care Act tax credits he delivered to lower health care costs and cover more Americans than any time in history. Making the economy work for the middle class by investing in America and the industries of the future, while lowering key costs that working families face. And expanding Medicare’s ability to negotiate lower drug costs.
80% of House Republicans released a Budget that:
Cuts Medicare and Social Security while putting health care at risk for millions
Calls for over $1.5 trillion in cuts to Social Security, including an increase in the retirement age to 69 and cutting disability benefits.
Raises Medicare costs for seniors by taking away Medicare’s authority to negotiate prescription drug costs, repealing $35 insulin, and the $2,000 out-of-pocket cap in the Inflation Reduction Act
Transitions Medicare to a premium support system that CBO has found would raise premiums for many seniors.
Cuts Medicaid, the Affordable Care Act, and the Children’s Health Insurance Program by $4.5 trillion over ten years, taking coverage away from millions of people, eroding care for seniors, children, and people with disabilities, and taking us back to the days where people could be denied care for pre-existing conditions and charged more for health insurance simply for being a woman.
Rigs the economy for the wealthy and large corporations against middle class families
Passes $5.5 trillion in tax cuts skewed to the wealthy and large corporations, including permanently extending tax cuts in the Trump tax law, repealing the minimum tax on billion-dollar corporations the President signed into law, eliminating the estate tax for the wealthiest Americans, providing a massive tax cut for billionaire investors, and making it easier for the wealthy and large corporations to get away with cheating on their taxes.
Kills jobs and investment in communities throughout the country – including Red States – by eliminating the clean energy tax credits in the Inflation Reduction Act.
Makes it easier for companies and banks to rip consumers off with unfair and hidden junk fees by eliminating the Consumer Financial Protection Bureau.
Raises housing costs by cutting funding for rental assistance, cutting funding for programs that help build housing, and raising mortgage costs for first-time homebuyers.
In response to the Republican budget plan, President Biden issued a statement : “My dad had an expression, ‘Don’t tell me what you value. Show me your budget, and I’ll tell you what you value.’ The Republican Study Committee budget shows what Republicans value. This extreme budget will cut Medicare, Social Security, and the Affordable Care Act. It endorses a national abortion ban. The Republican budget will raise housing costs and prescription drugs costs for families. And it will shower giveaways on the wealthy and biggest corporations. Let me be clear: I will stop them.
“My budget represents a different future. One where the days of trickle-down economics are over and the wealthy and biggest corporations no longer get all the breaks. A future where we restore the right to choose and protect other freedoms, not take them away. A future where the middle class finally has a fair shot, and we protect Social Security so the working people who built this country can retire with dignity. I see a future for all Americans and I will never stop fighting for that future.”
The White House provided this fact sheet detailing actions President Biden has taken, and new actions he is taking to lower prescription drug and health care costs, expand access to health care and protect consumers, even as Republicans voted against giving Medicare the ability to negotiate drug prices and their presumed presidential nominee, Trump, is renewing calls to repeal the Affordable Care Act (Obamacare), which now has enabled a record 21 million to obtain health insurance, 9 million more than when Biden took office, and as he moves to negotiate for a $2000 cap on out-of-pocket prescription drug costs for all, not just Medicare recipients and expand the number of drug prices being negotiated from 10 to as many as 50 a year. –Karen Rubin, [email protected]
President Biden believes that health care is a right, not a privilege, and since day one, he has delivered health care to millions more Americans while also lowering health care costs. The President continues to build on, strengthen, and protect Medicare, Medicaid, and the Affordable Care Act, signing laws such as the American Rescue Plan Act and the Inflation Reduction Act to lower prescription drug costs and health insurance premiums. Thanks to the President’s efforts, more Americans have health insurance than under any other President, and are better protected against surprise medical bills and junk fees. Seniors are already seeing lower prescription drug prices with insulin capped at $35, free vaccines, and out-of-pocket costs for prescription drugs capped at $2,000 starting in 2025. And the Administration is well on its way to lower the cost of range of drugs as Medicare negotiates over the prices of prescription drugs for the first time ever. The Biden-Harris Administration has also taken steps to make sure consumers aren’t scammed by junk insurance and have better access to mental health care.
However, the President is not just resting on these accomplishments. He’s fighting to deliver even lower costs and better health care to Americans. That’s why the Biden-Harris Administration is acting to lower prescription drug costs, keep health insurance premiums low, expand access to health care, especially mental health care coverage, and continue to protect Americans from getting ripped off.
Taking on Big Pharma to Deliver Lower Prescription Drug Costs for Seniors and Families
After decades of opposition, President Biden enacted a law that finally takes on Big Pharma and gives Medicare the power to negotiate drug prices. President Biden’s Inflation Reduction Act will save millions of seniors money on some of the costliest prescription drugs on the market. Meanwhile, Big Pharma also executed over $135 billion in mergers and acquisitions in 2023 alone, while passing the cost to consumers. And eight of the 10 drugs selected for this year’s negotiation program raised their prices in 2024 – after all 10 drugs were already priced three to eight times higher in the United States than in other countries. President Biden knows how the Inflation Reduction Act is delivering for American families, and his Administration will continue the fight to lower health care costs for more Americans.
Announcing that Manufacturers of 10 Drugs Remain at the Negotiating Table. Last month, for the first time in history, Medicare has made offers on the fair price for 10 of the most widely used and expensive drugs. Medicare is no longer taking whatever price for these drugs that the pharmaceutical companies demand. This week CMS announced that manufacturers for all 10 selected drugs are participating in drug price negotiation, with all manufacturers having submitted counteroffers and negotiations continuing. Later this year, new, negotiated prices for the first 10 prescription drugs selected for the negotiation program will be announced.
Let Medicare Negotiate Drug Prices for at least 50 Drugs Every Year. Medicare should not be limited to negotiating just 20 drugs per year. Instead, the President is proposing that Medicare be able to negotiate prices for the major drugs that seniors rely on, like those used for treating heart disease, cancer, and diabetes. The Budget cuts federal spending by $200 billion increasing the number of drugs Medicare can select for negotiation and bringing more drugs into the negotiation process sooner, and other reforms.
Expand Cap on Out-of-Pocket Prescription Drug Costs. When the $2,000 out-of-pocket cap on prescription drugs applies in Medicare in 2025, nearly 19 million seniors and other beneficiaries are projected to save $400 per year on prescription drugs. The President is calling on Congress to expand the $2,000 out-of-pocket cap to all private insurance so that all Americans have the peace of mind that comes with knowing that they won’t have to choose between filling their prescription or putting food on the table.
Capping Medicare Cost-Sharing at $2 for Common Generic Drugs. Medicare will be launching a new model to limit Medicare Part D cost-sharing for certain generic drugs to $2. As Medicare prepares to launch the model, today HHS published a list of dozens of generic drugs for the model, including drugs like statins to treat high cholesterol, beta-blockers for high blood pressure, and platelet inhibitors to prevent blood clots. In his budget, the President is calling on Congress to limit Medicare cost-sharing to $2 for high-value generic drugs for all Medicare plans.
Access to Cell & Gene Therapies. In January, HHS announced that sickle cell disease will be the first focus of the Cell and Gene Therapy (CGT) Access Model. Under this model, CMS will negotiate with manufacturers on behalf of state Medicaid programs to increase affordable access to potentially lifesaving and life-changing treatment, and lower health care costs for some of the nation’s most vulnerable populations. Today, CMS is releasing the Request for Applications for drug manufacturers of cell and gene therapies to participate in the model.
Expand the IRA’s Requirement that Drug Companies Pay Rebates When They Increase Prices Faster than Inflation. Thanks to the IRA, drug manufacturers must now pay rebates to Medicare if their price increases for certain drugs exceed inflation. The President is calling on Congress to require those rebates for commercial drug sales, as well as sales to Medicare. That will save the federal government billions of dollars, further curb prescription drug price inflation, and reduce health insurance premiums for people with private health insurance coverage.
Putting High-Quality Health Care Within Reach
Today, more Americans have health insurance than under any President. The President’s efforts to lower health insurance premiums have led to record-breaking enrollment in the Affordable Care Act’s Marketplaces, with over 21 million people signing up for coverage – 9 million more than when the President took office. The Biden-Harris Administration isn’t stopping there and is building on this incredible success by:
Keeping Health Insurance Premiums Low. Thanks to the President’s American Rescue Plan and Inflation Reduction Act, millions of Americans are saving on average $800 a year on premiums. The Biden-Harris Administration is committed to keeping health insurance premiums low, giving families more breathing room and the peace of mind that health insurance brings. To do that, the President is calling on Congress to make the expanded premium tax credits that the Inflation Reduction Act extended permanent. Without Congressional action, millions of Americans will see their health insurance premiums spike by hundreds or thousands of dollars starting in the fall of 2025.
Closing the Medicaid Coverage Gap. The President continues to call on Congress to provide Medicaid-like coverage to people in the 10 states that have not adopted Medicaid expansion as well as keeping Medicaid expansion enrollees covered.
Keeping Kids Covered. Investing in our nation’s children is a top priority for the President. Research shows that when children have health insurance, they thrive: they’re healthier, they do better in school, and are more likely to succeed in adulthood. Keeping children covered is the right thing to do, which is why the President wants to make sure that children can never lose coverage due to red tape from birth until they turn age 6, and that families only have to submit Medicaid paperwork once every three years.
Closing Research Gaps in Women’s Health Research.In November 2023, the President and the First Lady launched the first-ever White House Initiative on Women’s Health Research to fundamentally change how our nation approaches and funds women’s health research. Women make up more than half the population but have been understudied and underrepresented in health research for far too long. As part of the initiative, the President during the State of the Union will call on Congress to make bold, transformational investments in women’s health research.
Making Home Care More Available. Thanks to the American Rescue Plan, President Biden delivered $37 billion to all states to expand access to home care and improve the quality of caregiving jobs. The Biden-Harris Administration is taking steps to improve the quality of Medicaid home care services and to make sure home care workers get a bigger share of Medicaid payments for these critical services. The President remains committed to further improving and expanding Medicaid home care services, and is calling on Congress to do their part to allow the hundreds of thousands of older adults and individuals with disabilities on Medicaid home care waiting list to remain in their homes and stay active in their communities while continuing to improve the quality of jobs for caregivers.
Ensuring Access to Mental Health Care. Ensuring robust access to mental health care has been a bipartisan priority for almost 15 years, including the enactment of mental health parity requirements which require health plans to cover mental health care benefits at the same levels as physical health care benefits. Yet today, too many Americans still struggle to find and afford the care they need. The President is committed to tackling the mental health crisis in this country, which means making health plans do their part and providing agencies with the needed support to make sure they’re doing so. The Biden-Harris Administration is working to finalize the mental health parity rule, which would close existing loopholes as well as ensure health plans evaluate access to mental health care in their networks, and make changes if it’s found to be inadequate. In addition, the President is calling on Congress to further increase access to mental health care by expanding coverage in Medicare and private insurance, applying the mental health parity requirements to Medicare beneficiaries, and extending Medicare incentive programs to address mental health provider shortages.
Cracking Down on Junk Insurance, Surprise Bills and Fees, and Confusing Health Care Pricing
Nothing infuriates the President more than seeing Americans get ripped off. That’s why the Biden-Harris Administration has prioritized implementing surprise billing protections, preventing 1 million Americans from receiving surprise medical bills every single month. The President has also taken steps to prevent Americans from being ripped off by junk insurance that preys on vulnerable citizens by closing loopholes to ensure consumers know what they’re buying and can get the health coverage that best meets their needs. But more can be done to protect consumers, which is why the President intends to:
Prevent More Surprise Medical Bills. Today, Americans are protected from receiving medical bills for most emergency care and air ambulance services as well as when consumers didn’t know they were getting care from an out-of-network provider despite doing their homework and going to an in-network facility for treatment. The President wants to further protect consumers by applying surprise billing protections to ground ambulance providers. The last thing people should worry about during an emergency is an unexpected bill for their ambulance ride.
Crack Down on Junk Insurance. Last year, the Biden-Harris Administration proposed a monumental rule to help millions of Americans access high-quality, affordable health insurance and protect consumers from being discriminated against because of pre-existing conditions. Making sure Americans aren’t scammed into low-quality coverage, and charged more or denied life-saving care is a key priority for the Administration, which is why we are working to finalize proposed rules that limit the availability of junk insurance.
Honoring America’s Commitment to Seniors
The President has always believed that Medicare and Social Security are a promise—a rock-solid guarantee generations of Americans have counted on to be able to retire with dignity and security. The President will reject any efforts to cut the Medicare or Social Security benefits that seniors and people with disabilities have earned and paid into their entire working lives. The Budget honors that ironclad commitment—not only by rejecting benefit cuts, but by embracing reforms and investments that will protect and strengthen both programs. The President is committed to working with Congress to ensure Medicare and Social Security remain strong for their beneficiaries, now and in the future.
Securing Medicare. In his budget, the President is calling on Congress to ensure that high-income individuals contribute their fair share to Medicare and directs revenue from the Net Investment Income Tax into the HI trust fund as was originally intended. In addition, the President has proposed to direct savings from further lowering drug costs into the Medicare trust fund. If Congress were to heed the President’s call and enact these reforms, it would substantially extend solvency for the Medicare HI Trust Fund, guaranteeing seniors the benefits they have been promised.
Protects Seniors’ Health and Dignity. As President Biden pledged to do two years ago in the State of the Union, the Biden-Harris Administration is “set[ting] higher standards for nursing homes and make sure your loved ones get the care they deserve and that they expect.” The nursing home industry receives billions of dollars of taxpayer funding each year, but for too long, many facilities have not had the staff required to give residents safe, high-quality care. That is changing. HHS has proposed a new rule establishing a federal floor for nursing home staffing, so that owners cannot cut staffing to unsafe levels simply to turn a profit. This includes a proposal for every facility to have a Registered Nurse on site 24/7, in addition to minimum number of registered nurses and nurse aides to assist with care. Earlier this year, HHS also finalized a rule to increase transparency in nursing home ownership, making it easier for residents and their loved ones to hold facilities accountable. The final rule was just submitted to the Office of Management and Budget for review
Strong Record on Expanding and Strengthening Health Care Nationwide
The President’s new actions are all in addition to an already impressive track record on fighting for the health care of Americans across the nation. Over the last three years, the President has:
Expanded health insurance through the ACA Marketplaces to an additional nine million Americans and helped over one million people in Missouri, North Carolina, Oklahoma, and South Dakota gain Medicaid coverage.
Extended postpartum Medicaid coverage to nearly 700,000 women across 44 states and the District of Columbia.
Kept children covered continuously in Medicaid and CHIP for a full year.
Made it easier for people to enroll in the ACA Marketplaces and Medicaid, including for older adults that are covered by both Medicaid and Medicare.
Made critical vaccines free for all Medicare beneficiaries as well as adults enrolled in Medicaid, with seniors on Medicare saving on average $70 in out-of-pockets for vaccines.
Lowered maximum out of pocket costs for Americans with employer and ACA coverage by an average of $400.
Capped out-of-pocket costs at $35 for a month’s supply of insulin for seniors and people with disabilities on Medicare.
Lowered coinsurance for seniors that took the 47 drugs covered by Medicare Part B that hiked prices faster than inflation in 2023, with some enrollees saving as much as $618 per dose.
President Biden’s Inflation Reduction Act cracks down on Big Pharma price gouging, saving some seniors thousands of dollars per dose of medication. Meanwhile, Congressional Republicans push for giveaways to drug industry
President Biden visited the National Institutes of Health Clinical Center in Washington, D.C. to announce that dozens of pharmaceutical companies will be required to pay rebates to Medicare for outrageous price hikes on prescription drugs that over 750,000 seniors take per year. For the last quarter of 2023, 48 Medicare Part B drugs raised their prices faster than inflation, and some drug companies raised prices of certain medications faster than inflation for every quarter over the last year. President Biden’s Inflation Reduction Act cracks down on this exorbitant price gouging, requiring these companies to pay rebates back to Medicare, saving seniors who take these drugs between $1 and $2,786 per dose on their medication.
President Biden vowed to lower prescription drug costs for seniors and families – and he is delivering on that promise. His Inflation Reduction Act finally allows Medicare to directly negotiate lower prescription drug prices, capped the cost of insulin for Medicare beneficiaries at $35, made recommended adult vaccines free, requires drug companies to pay rebates if they raise prices faster than the rate of inflation, and locked in savings of $800 per year on health insurance for nearly 15 million Americans. While Republicans in Congress fight tooth and nail to repeal the Inflation Reduction Act and put money back in the pockets of Big Pharma, President Biden won’t back down from the fight to lower costs for hardworking Americans and make sure every family has access to affordable health care.
The Biden-Harris Administration announced:
The Department of Health and Human Services (HHS) announced a new list of 48 Medicare Part B drugs that raised their prices faster than inflation, and may be subject to inflation rebates in the first quarter of 2024 as a result of the Inflation Reduction Act. President Biden’s prescription drug law cracks down on price gouging from Big Pharma, requiring companies to pay back Medicare if they raise prices on seniors at a higher rate than inflation. Starting in January, some Medicare beneficiaries who take these 48 prescription drugs – including drugs used to treat cancer and fight infections – will have lower coinsurance than what they would have paid otherwise, and their out-of-pocket costs may decrease by $1 to as much as $2,786 per average dose.
Over the last four quarters, 64 drugs in total had prices that increased faster than inflation and may be subject to inflation rebates because of the Inflation Reduction Act. Some drugs, such as Signifor, used to treat an endocrine disorder, raised prices faster than inflation every quarter since the Inflation Reduction Act’s inflation rebate provision went into effect. Some Medicare beneficiaries who take Signifor could save $311 per monthly dose starting January because of the law.
The Administration is focused on making sure medications developed with taxpayer funds are available to Americans at reasonable prices. On average, Americans pay 2 to 3 times more than consumers in other developed countries for prescription drugs. Last week, the Administration announced a proposal to put drug companies on notice if products developed using federal funds are not made available to the public on reasonable terms, including based on price. The proposal would promote the federal government’s ability to license a patent — such as those used to create life-saving drugs — to a competitor with the goal of increasing competition and bringing costs down for families.
Building off last week’s announcement, today HHS announced that the Administration for Strategic Preparedness and Response (ASPR) is making fair pricing a standard part of contract negotiations for medical products developed or purchased as part of its commitment to obtain best value for the US taxpayer. In September 2023, ASPR finalized a Project NextGen contract agreement for a potentially life-saving COVID-19 treatment being developed by Regeneron stating if the product is commercialized, its list price in the United States will be equal to or less than its retail price in comparable global markets. Since then, ASPR has also included similar language in recent agreements with CastleVax, Codagenix and Gritstone Bio, developers of the first three vaccines selected for development within Project NextGen. These clauses will be in effect if and when a company’s candidate vaccine is selected to move into ASPR-supported Phase 2b trials to evaluate clinical safety and efficacy.These actions are the result of a successful and collaborative approach by ASPR and its industry partners and show HHS’s commitment to keep Americans from paying unfair prices for the care they need.
HHS is releasing new data on the ten drugs selected for Medicare Drug Price Negotiation. For Medicare enrollees who take these drugs, their out-of-pocket spending on the 10 drugs selected for negotiation represents, on average, over half of their total Part D out-of-pocket spending. The report shows that total Medicare spending on the 10 drugs more than doubled from 2018 to 2022 – a rate that was 3 times faster than all Part D drugs over the same period. The report also shows that 7 of the 10 drugs selected received direct at least one form of federal support towards their drug development or utilized a federal-funded invention for their development.
After decades and hundreds of billions of dollars spent by Big Pharma to block Medicare from directly negotiating lower prescription drug prices for people with Medicare, President Biden’s Inflation Reduction Act finally got it done. In total in 2022, Medicare Part D beneficiaries paid $3.4 billion in out of pocket costs for the 10 drugs selected for negotiation, and some paid over $6,000 per year for just one of the drugs on the list. Negotiated prices will go into effect for seniors in 2026. Today’s announcements build off the actions the Administration has already taken to lower prescription drug costs for millions of seniors and families because of President Biden’s Inflation Reduction Act. In 2023 alone:
The Inflation Reduction Act saved nearly 15 million Americans an average of $800 in 2023 because of health insurance savings the law locked in.
The Inflation Reduction Act capped the cost of insulin at $35 per covered insulin product for Medicare beneficiaries, saving an estimated 1.5 million seniors on Medicare $500 on average in 2023 on insulin costs.
The Inflation Reduction Act made recommended vaccines – like the shingles vaccine – free for the 50.5 million seniors with Medicare Part D, and made recommended, approved adult vaccines free for all adults in the Children’s Health Insurance Program, and nearly all full-benefit adults enrolled in traditional Medicaid. Seniors on Medicare who received a Part D vaccine saved an average of $70 on vaccines in 2023.
The Inflation Reduction Act saved many seniors on Medicare as much as $618 per average dose on 47 prescription drugs in 2023 because of the law’s provision requiring drug companies to pay rebates on certain drugs if they raise prices for those drugs faster than the rate of inflation. Starting in 2024, some seniors who take 48 prescription drugs could see savings of as much as $2,786 per average dose because those 48 drugs raised their prices faster than inflation in the last quarter of 2023.
In the coming months and years, the Inflation Reduction Act will continue to deliver cost-savings to millions of Americans, including:
In 2024, Part D enrollees will no longer pay 5% co-insurance when they reach the catastrophic phase of their benefit – meaning that some beneficiaries’ prescription drug costs will be capped at about $3,500 next year.
When the $2,000 out-of-pocket cap on prescription drugs applies in 2025, nearly 19 million seniors and other beneficiaries are projected to save $400 per year on prescription drugs. 1.9 million enrollees with the highest drug costs will save an average of $2,500 per year because of this provision of the Inflation Reduction Act.
Millions of seniors could save money when negotiated prices of the first group of drugs selected for the Inflation Reduction Act’s Medicare Price Negotiation program are scheduled to go into effect in 2026. In 2022, seniors spent $3.4 billion in out-of-pocket costs on the first ten drugs selected for negotiation – used to treat common conditions like diabetes, Crohn’s disease, arthritis, blood clots and more. A report released last week shows that had the Medicare price negotiation program been in effect in 2021, Part D out of pocket costs would have declined 23% for people taking the ten costliest drugs at the time.
The Congressional Republican Agenda on Prescription Drugs: Giveaways to Big Pharma and Higher Costs for Seniors and Families
While President Biden has taken historic action to reduce prescription drug costs for seniors and for working-age people who get health insurance through their jobs, Congressional Republicans are actively fighting to roll back the reforms the President signed into law and to keep Big Pharma’s taxes low.
Congressional Republicans’ agenda for Big Pharma giveaways includes:
Repealing prescription drug inflation rebates. The Inflation Reduction Act (IRA) cuts costs for Medicare and seniors by requiring pharmaceutical companies to pay a rebate to Medicare if they increase prices faster than inflation. Dozens of Republicans have signedonto legislation that would revoke the rebate requirement.
Give away over $10 billion per year to pharmaceutical companies.
Taking away Medicare’s ability to negotiate prescription drug prices. The IRA finally gave Medicare the authority to directly negotiate with drug companies on the high prices they charge for prescription drugs. Republican Chairs and Ranking Members of the committees with jurisdiction over Medicare have publiclycommitted to repealing this authority, which would allow Big Pharma to go back to charging seniors exorbitant prices for life-saving drugs.
Increase federal deficits by $14 billion per year.
Give away over $20 billion to pharmaceutical companies per year.
Opposing caps on insulin prices. Monthly insulin costs for Medicare beneficiaries are now capped at $35—providing certainty and critical cost savings for seniors who in some cases were paying as much as $400 for a month’s supply of insulin. The Republican Study Committee budget, as well as the House Budget Committee-passed budget plan, propose to repeal this and other IRA drug price reforms.
Repealing this provision would mean the 1.5 million Medicare beneficiaries who use insulin could see their annual costs rise by an average of $500.
Protecting Big Pharma’s ability to avoid paying taxes. President Biden negotiated a historic agreement with over 130 countries that would enable the U.S. and its partners to ensure Big Pharma and other multinationals pay at least a minimum tax rate and has proposed that the U.S. implement that agreement with a 21% minimum tax rate on multinationals. Congressional Republicans are not only blocking the U.S. from implementing the global minimum tax agreement and vowing to never raise taxes on Big Pharma and other multinationals by implementing it, they also traveledtoEurope this summer to try to persuade other countries to withdraw from the global agreement and keep taxes low for Big Pharma and other multinationals.
Blocking implementation of the President’s international tax reform proposals means:
Protecting a system in which Big Pharma can lower its taxes to under 12% by shifting profits offshore.
The U.S. would lose out on hundreds of billions in savings from adopting the President’s proposals to implement the international agreement. Based on a PhRMA-funded analysis, nearly $100 billion of the savings – or almost one-fifth of the total revenue – from implementing the President’s 21% minimum tax proposal would come from cracking down on pharmaceutical industry tax avoidance
The Biden-Harris Administration is proposing important steps to strengthen Medicare Advantage and the Medicare Prescription Drug Benefit Program (Part D). As part of his Bidenomics agenda, President Biden has worked to increase competition in the health care industry and other sectors, lower costs for families, and make sure every American has access to affordable, high-quality health care.
The Centers for Medicare & Medicaid Services’ (CMS’) proposed rule will help people with Medicare select and enroll in coverage options that best meet their health care needs by preventing plans from engaging in anti-competitive steering of prospective enrollees based on excessive compensation to agents and brokers, rather than the enrollee’s best interests. The proposed guardrails protect people with Medicare and promote a competitive marketplace in Medicare Advantage, consistent with the goals of President Biden’s historic Executive Order on Promoting Competition in the American Economy.
The proposed rule will also improve access to behavioral health care by adding a new facility type that includes several behavioral health provider types to Medicare Advantage network adequacy requirements. CMS is also proposing policies to increase the utilization and appropriateness of supplemental benefits to ensure taxpayer dollars actually provide meaningful benefits to enrollees. Additionally, the proposed rule would improve transparency on the effects of prior authorization on underserved communities and proposes more flexibility for Part D plans to more quickly substitute lower cost biosimilar biological products for their reference products.
“The Biden-Harris Administration remains committed to making health care more affordable and accessible for all Americans. By ensuring Medicare recipients have the information they need to make critical decisions about their health care coverage, we are doing just that,” said U.S. Department of Health and Human Services Secretary Xavier Becerra. “Promoting competition in the marketplace helps to lower costs and protect access to care while making the whole process more transparent and accountable.”
“CMS continues to improve the Medicare Advantage and Part D prescription drug programs and maintain high-quality health care coverage choices for all Medicare enrollees,” said CMS Administrator Chiquita Brooks-LaSure. “People with Medicare deserve to have accurate and unbiased information when they make important decisions about their health coverage. Today’s proposals further our efforts to curb predatory marketing and inappropriate steering that distorts healthy competition among plans.”
CMS has previously taken unprecedented steps to address predatory marketing of Medicare Advantage plans, such as banning misleading TV ads. Many people on Medicare rely on agents and brokers to help navigate Medicare choices. CMS is concerned that some Medicare Advantage plans are compensating agents and brokers in a way that may circumvent existing payment rules, inappropriately steer individuals to enroll in plans that do not best meet their health care needs, and lead to further consolidation in the Medicare Advantage market. To further protect people with Medicare through stronger marketing policies and to promote a competitive marketplace in Medicare Advantage, CMS is proposing added guardrails to plan compensation for agents and brokers, including standardization. These proposals are consistent with the statutory requirement that CMS develop guidelines to ensure that the use of compensation creates incentives for agents and brokers to enroll individuals in the Medicare Advantage plan that is intended to best meet their health care needs.
CMS also proposes to strengthen and improve access to behavioral health care by adding a new facility type, which includes marriage and family therapists, mental health counselors, addiction medicine clinicians, opioid treatment providers, and others, to CMS’ Medicare Advantage network adequacy requirements. This proposed addition builds on changes finalized last year to strengthen these requirements and would ensure people with Medicare Advantage can access vital mental health and substance use disorder treatment.
“The people we serve are at the center of the Medicare program, and we work each day to make sure the program works for them. Agents and brokers play an important role in guiding people with Medicare to the option that is tuned in to their medical needs. Our proposals on how plans compensate agents and brokers seek to support a competitive marketplace that best serves people with Medicare,” said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare.
Currently, 99% of Medicare Advantage plans offer at least one supplemental benefit. Over time, the benefits offered have become broader in scope and variety, with more rebate dollars directed toward these benefits. CMS is committed to ensuring these offerings are effectively reaching enrollees and actually meeting their needs, and not just used for attracting enrollees. In today’s rule, CMS proposes requiring Medicare Advantage plans to send a personalized notification to their enrollees mid-year of the unused supplemental benefits available to them to encourage higher utilization. Furthermore, CMS is proposing additional requirements designed to help ensure that benefits offered as special supplemental benefits for the chronically ill (SSBCI) are backed by evidence. CMS is also proposing new marketing and transparency guardrails around these benefits. These proposals will help ensure a robust and competitive Medicare Advantage marketplace made up of plan options with meaningful benefits.
Additionally, CMS is concerned that certain prior authorization policies may disproportionately inhibit access to needed care for underserved enrollees. To provide additional safeguards, CMS is proposing to require that Medicare Advantage plans include an expert in health equity on their utilization management committees and that the committees conduct an annual health equity analysis of the plans’ prior authorization policies and procedures. This analysis would examine the impact of prior authorization on enrollees with one or more of the following social risk factors—eligibility for Part D low-income subsidies, dual eligibility for Medicare and Medicaid, or having a disability—compared to enrollees without these risk factors. These analyses would have to be posted publicly to improve transparency into the effects of prior authorization on underserved populations. To further promote health equity, CMS is also proposing to streamline enrollment options for individuals with both Medicare and Medicaid, providing more opportunities for integrated care.
To support competition in the prescription drug marketplace, CMS is also proposing to provide more flexibility to substitute biosimilar biological products other than interchangeable biological products for their reference products to give people with Medicare more timely access to lower-cost biosimilar drugs. This proposal would permit Part D plans to treat such substitutions as maintenance changes so that the substitutions apply to all enrollees, not only those who begin the therapy after the effective date of the change, following a 30-day notice.
There will be a 60-day comment period for the notice of proposed rulemaking, and comments must be submitted at one of the addresses provided in the Federal Register no later than January 5, 2024. The proposed rule can be accessed at the Federal Register at https://www.federalregister.gov/public-inspection/current.
View a fact sheet on the proposed rule at cms.gov/newsroom.
View the CMS Blog Important New Changes to Improve Access to Behavioral Health in Medicare at https://www.cms.gov/blog.
In the immortal words of President Biden as VP when President Obama signed the Affordable Care Act (Obamacare) into law, this is a big f—kg deal.
For the first time, thanks to President Biden’s Inflation Reduction Act – the historic law lowering health care costs – Medicare is able to negotiate the prices of prescription drugs.
Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced the first 10 drugs covered under Medicare Part D selected for negotiation. The negotiations with participating drug companies will occur in 2023 and 2024, and any negotiated prices will become effective beginning in 2026. Medicare enrollees taking the 10 drugs covered under Part D selected for negotiation paid a total of $3.4 billion in out-of-pocket costs in 2022 for these drugs.
“For far too long, pharmaceutical companies have made record profits while American families were saddled with record prices and unable to afford life-saving prescription drugs. But thanks to the landmark Inflation Reduction Act, we are closer to reaching President Biden’s goal of increasing availability and lowering prescription drug costs for all Americans,” said HHS Secretary Xavier Becerra. “Although drug companies are attempting to block Medicare from being able to negotiate for better drug prices, we will not be deterred. The Biden-Harris Administration will continue working to ensure that Americans with Medicare have access to innovative, life-saving treatments at lower costs.”
The Biden-Harris Administration has made lowering prescription drug costs and improving access to innovative therapies a key priority. Alongside other provisions in the new law that increase the affordability of health care and prescription drugs, allowing Medicare to negotiate prescription drug prices will strengthen the program’s ability to serve people with Medicare now and for generations to come. The negotiation process will consider the selected drug’s clinical benefit, the extent to which it fulfills an unmet medical need, and its impact on people who rely on Medicare, among other considerations, such as costs associated with research and development as well as production and distribution for selected drugs. As a result of negotiations, people with Medicare will have access to innovative, life-saving treatments at lower costs to Medicare.
The selected drug list for the first round of negotiation is:
These selected drugs accounted for $50.5 billion in total Part D gross covered prescription drug costs, or about 20%, of total Part D gross covered prescription drug costs between June 1, 2022 and May 31, 2023, which is the time period used to determine which drugs were eligible for negotiation. CMS will publish any agreed-upon negotiated prices for the selected drugs by September 1, 2024; those prices will come into effect starting January 1, 2026. In future years, CMS will select for negotiation up to 15 more drugs covered under Part D for 2027, up to 15 more drugs for 2028 (including drugs covered under Part B and Part D), and up to 20 more drugs for each year after that, as outlined in the Inflation Reduction Act.
“We’ve reached this milestone because of the Inflation Reduction Act– one of the most significant laws ever enacted, and one that passed with the leadership of Democrats in Congress,” President Biden stated. “We took on Big Pharma and special interests, overcoming opposition from every Republican in Congress, and the American people won.”
When implemented, prices on negotiated drugs will decrease for up to 9 million seniors. These seniors currently pay up to $6,497 in out-of-pocket costs per year for these prescriptions. In addition, the nonpartisan Congressional Budget Office reports that this will save taxpayers $160 billion by reducing how much Medicare pays for drugs through negotiation and inflation rebates.
“This plan is a key part of Bidenomics, my economic vision for growing the economy from the middle out and the bottom up – not the top down. And it’s working.,” Biden stated. “That’s why Big Pharma has already filed eight lawsuits against my Administration, and spent nearly $400 million last year to try to stop our progress. Let me be clear: I am not backing down. There is no reason why Americans should be forced to pay more than any developed nation for life-saving prescriptions just to pad Big Pharma’s pockets. For many Americans, the cost of one drug is the difference between life and death, dignity and dependence, hope and fear. That is why we will continue the fight to lower healthcare costs – and we will not stop until we finish the job.”
HHS Announces First Set of Drugs Selected for Medicare Price Negotiation
For the first time ever, HHS announced ten drugs selected for Medicare drug price negotiation:
Drug Name
Commonly Treated Conditions
Total Part D Gross Covered Prescription Drug Costs from June 2022-May 2023
Number of Medicare Part D Enrollees Who Used the Drug from June 2022-May 2023
Average Part D Covered Prescription Drug Costs Per Enrollee
Eliquis
Prevention and treatment of blood clots
$16,482,621,000
3,706,000
$4,448
Jardiance
Diabetes; Heart failure
$7,057,707,000
1,573,000
$4,487
Xarelto
Prevention and treatment of blood clots; Reduction of risk for patients with coronary or peripheral artery disease
These ten drugs are among those with highest total spending in Medicare Part D – $50 billion in total part D gross covered drug cost s- or 20% of total part D gross covered drug costs june 1, 2022, may 31, 2023. More than 8 million Part D enrollees depend on these vital treatments to treat life-threatening conditions including diabetes, heart failure, and cancer, but many struggle to access their medications because of prohibitive costs.
Medicare drug price negotiation will result in lower out-of-pocket costs for seniors and will save money for American taxpayers. Negotiations for the first group of selected drugs will begin in 2023, with negotiated prices going into effect in 2026.
Out-of-Pocket Costs for Drugs Covered Under Part D Selected for Drug Price Negotiation, by State
Today HHS also released a report showing that 9 million Medicare Part D enrollees took the drugs covered under Part D selected for negotiation and paid a total of $3.4 billion in out-of-pocket costs for these drugs in 2022. For enrollees without additional financial assistance, average annual out-of-pocket costs for these drugs were as high as $6,497 per enrollee in 2022.
To view a state-by-state breakdown of the number of Medicare enrollees who use the prescription drugs selected for negotiation and their out-of-pocket costs, visit HHS’s website.
Continuing to Lower Prescription Drug Costs
Every day, millions of seniors are saving money on prescription drug costs because of the Biden Administration’s actions. People with Medicare are saving an average of $70 in out-of-pocket costs on vaccines like shingles and Tdap because President Biden’s Inflation Reduction Act made recommended vaccines free for beneficiaries starting this past January. Nearly four million seniors and others on Medicare with diabetes started to see their insulin costs capped at $35 per month this past January, saving some seniors hundreds of dollars for a month’s supply. And some seniors taking drugs covered under Part B for which manufacturers have hiked prices faster than inflation are saving up to $449 in lower coinsurance this quarter thanks to the new Medicare inflation rebates.
People with Medicare will continue to see their prescription drug costs go down as more provisions of the Inflation Reduction Act go into effect in the coming years. Part D enrollees will no longer pay 5% co-insurance when they reach the catastrophic phase of their benefit starting in 2024. Nearly 19 million seniors and other Part D beneficiaries are projected to save $400 per year on prescription drugs when the out-of-pocket cap drops to $2,000 in 2025, and 1.9 million enrollees with the highest drug costs will save an average of $2,500 per year. And the lower prices negotiated for the high-spend drugs selected today will go into effect in 2026.
The President’s Budget for Fiscal Year 2024 builds upon the Inflation Reduction Act to continue lowering the cost of prescription drugs. For Medicare, this includes further expanding the newly established negotiation authority by extending it to more drugs and bringing drugs into negotiation sooner after they launch. The Budget also includes proposals to curb inflation in prescription drug prices and cap the prices of insulin products at $35 for a monthly prescription in the commercial market to lower drug costs for all Americans.
The ability to negotiate drug prices is historic. For decades, Big Pharma lobbyists (three for every one member of Congress) and Congressional Republicans stopped Medicare from saving taxpaying, hardworking families money by negotiating lower drug costs.
The result of that blockade was that Americans were forced to pay the highest prices for medicines in the world, despite the fact that taxpayers subsidize Big Pharma’s research and development.
“This is a game-changer for Americans who are being overcharged for medicines they need and a game-changer for Medicare because it will spend less taxpayer money to deliver the same benefits,” stated Deputy Press Secretary and Senior Communications Adviser Andrew Bates.
“This comes after President Biden also beat Big Pharma by capping the price of insulin at $35 per month for Medicare recipients. Big Pharma has spent nearly $400 million lobbying to stop these reforms.”
However, as the Biden Administration takes these newest historic actions to lower drug costs for Americans and strengthen Medicare, Congressional Republicans continue to side with Big Pharma’s price gouging and cuts to Medicare benefits instead.
Not only do congressional Republicans want to take the new benefits being announced today away from Americans with repeal legislation (just as they spent years trying to repeal the Affordable Care Act – Obamacare) – they are even siding with Big Pharma’s lawsuits to stop them in their tracks, Bates said.
Congressman Morgan Griffith endorsed their suits, saying, “every drug manufacturer probably ought to sue because it is, on its face, an unconstitutional taking.”
And reporters have frequently noted that in their opposition to this breakthrough for seniors, congressional Republicans are parroting Big Pharma’s talking points and “echoing arguments the pharmaceutical industry has made for years.”
After unsuccessfully voting to block President Biden’s plan to let Medicare negotiate lower drug costs, Congressional Republicans have sought to repeal it, in alignment with Big Pharma. In the midterms, they campaigned on repealing Medicare’s new power but shut their ears to voters’ message back to them.
This summer alone, the Republican Study Committee, which represents over three quarters of House Republicans, unveiled yet another repeal plan.
The handouts Congressional Republicans are pursuing for Big Pharma would explode our deficit, weaken Medicare, and subject more American seniors and families to price gouging for life-saving medicines, Bates said.
“Across the board, the hallmark of congressional Republicans’ trickle-down economic agenda is to increase costs and financial burdens shouldered by hardworking Americans in exchange for welfare payoffs to the super rich and multinational corporations. In this case, Big Pharma.
“Their philosophy is the polar opposite of Bidenomics, which is based on rewarding hard work and growing our economy by growing the middle class. Not leaching off the middle class for an extreme rightwing scheme to redistribute income upward.
“We should be bolstering Medicare’s ability to lower drug costs for families, instead of trying to erase them.
“This fight is far from over. President Biden is pushing to expand Medicare’s capacity to negotiate lower drug costs, which he released a concrete plan for in his budget,” Bates said.
This fact sheet on the impact on health care coverage, benefits and protections under the Congressional Republicans’ plans was provided by the White House:
President Biden’s top priority is to lower costs for the American people. He was proud to sign the Inflation Reduction Act into law, taking on Big Pharma to allow Medicare to negotiate prescription drug costs for the first time, capping seniors’ drug costs at the pharmacy and the cost of insulin, and lowering health insurance premiums for people who get coverage through the Affordable Care Act. President Biden and Congressional Democrats are committed to protecting and strengthening Social Security and Medicare.
Congressional Republicans have a very different vision. They have promised to strip Medicare of the right to negotiate drug prices and remove the $2,000 cap on out-of-pocket pharmacy expenses. Florida’s Republican Senator and Chair of the National Republican Senatorial Committee Rick Scott has championed a plan to put Medicare, Medicaid, and Social Security on the chopping block every five years. Further, Congressional Republicans have repeatedly pledged to hold the American economy hostage by refusing to raise the debt limit unless they can cut Social Security and Medicare benefits that tens of millions of Americans have already paid into.
Here’s what Congressional Republicans’ plan would mean:
Part I: Putting Bedrock Programs like Social Security and Medicare on the Chopping Block and Threatening the Global Economy Unless Those Programs Are Cut
All Medicare, Medicaid, and Social Security beneficiaries would see their benefits threatened under Sen. Rick Scott’s plan to put those programs on the chopping block every five years. Sen. Ron Johnson’s vision of putting them up for a vote every year would make that even worse.
Congressional Republican leaders have also repeatedly said they will use the debt limit as leverage to cut these bedrock programs. Congressional Republicans have supported Medicare and Social Security cuts including:
Transforming Medicare benefits into a voucher where seniors would get a fixed amount of money to purchase a private health plan (Better Way Plan) or offering beneficiaries the option to transition to a premium support system (Republican Study Committee FY 2023 Budget) – which could lead to hundreds or thousands of dollars in additional out of pocket costs for seniors throughout the country.
Part II: Repealing the Prescription Drug and Health Care Provisions in the Inflation Reduction Act
President Biden has worked for decades to let Medicare negotiate drug prices, and that is finally happening thanks to the Inflation Reduction Act. This will save billions of dollars for both Medicare beneficiaries, who will see reduced premiums and out-of-pocket costs, and the federal government. Kaiser Family Foundation estimates suggest that some 5 to 7 million beneficiaries each year use the types of high-cost drugs that could be subject to negotiation and will directly face higher cost sharing if these provisions are repealed.
The Inflation Reduction Act also requires prescription drug companies to pay rebates if they increase drug prices faster than inflation. According to an analysis by the Department of Health and Human Services, the cost of 1,200 prescription drugs rose faster than inflation in the last year alone – some prescription drugs increasing by $1000 in just one year. If Congressional Republicans repeal the Inflation Reduction Act, drug companies will be able to continue raising prices without paying a rebate, rather than putting that money back into Americans’ pockets.
Before the Inflation Reduction Act, Medicare beneficiaries with conditions like cancer, multiple sclerosis, and lung disease could face thousands of dollars in out-of-pocket prescription drug costs per year. Thanks to President Biden and Congressional Democrats’ Inflation Reduction Act, those costs will be capped at $2,000 per year, saving over 1 million beneficiaries an average of over $1,300 per year. If Congressional Republicans get their way and repeal the law, over 1.4 million Medicare beneficiaries will pay more each year – thousands of dollars more in some cases – for drugs at the pharmacy.
Drug manufacturers have raised insulin prices so rapidly over the last few decades that some Medicare beneficiaries struggle to afford this life-saving drug that costs less than $10 a vial to manufacture. Today, Medicare beneficiaries are enrolling in plans that must cap the out-of-pocket cost of insulin at no more than $35 per month per prescription, a protection they will lose if the law is repealed.
The Inflation Reduction Act saves 13 million Americans an average of about $800 per year on their health care premiums, by continuing the improvements to Affordable Care Act (ACA) premium tax credits enacted in the American Rescue Plan. By making health care more affordable, these improvements have expanded coverage to millions of people, helping bring the uninsured rate to an all-time low. Starting today, during Open Enrollment season, Americans can choose health insurance plans that lock in the Inflation Reduction Act’s cost savings for 2023. But Congressional Republicans would repeal this assistance, drive premiums higher, and jeopardize the progress the Biden Administration has made in driving the uninsured rate to a historic low. Older Americans would see especially large premium spikes; in most states, annual premiums for a 60-year old making $60,000 would more than double to over $10,000.
To mark the start of Medicare Open Enrollment season, President Biden highlighted how seniors can take advantage of the Inflation Reduction Act’s cost-saving provisions as they shop for new health insurance plans. The President also signed an Executive Order directing the Department of Health and Human Services to explore additional actions it can take to lower prescription drug costs to build on his Administration’s work lowering costs for working and middle-class families.
Americans are squeezed by the cost of living – that’s been true for years and is a key reason the President ran. Health care costs in particular are driving inflation. Too many Americans face challenges paying for prescription drugs. On average, Americans pay two to three times as much as people in other countries for prescription drugs, and one in four Americans who take prescription drugs struggle to afford their medications. Nearly three in ten American adults who take prescription drugs say that they have skipped doses, cut pills in half, or not filled prescriptions due to cost.
The Inflation Reduction Act – which President Biden and Congressional Democrats delivered – tackles that problem and locks in on average $800 per year lower health care premiums for 13 million families, lowers seniors’ prescription drug prices, and caps their out of pocket expenses for prescription drugs at $2,000 per year. The Inflation Reduction Act protects Medicare beneficiaries from catastrophic drug costs by phasing in a cap for out-of-pocket costs at the pharmacy, establishing a $35 monthly cap per prescription of insulin, requiring companies who raise prices faster than inflation to pay Medicare a rebate, and allowing Medicare to negotiate prices for high-cost prescription drugs for the first time ever. Republicans in Congress, meanwhile, have said their top priority is to repeal the Inflation Reduction Act, ending these cost-saving provisions and raising prices for tens of millions of Americans.
To further lower health care costs, earlier this week, the Treasury Department took action to fix the so-called “family glitch” rule that was making it harder for families to afford health care coverage for their spouse or child. About 1 million Americans will either gain coverage or see their insurance become more affordable as a result of the new rule.
Lowering Medicare Costs This Open Enrollment Season
Starting this January, seniors and other Medicare beneficiaries will begin to see the benefits of these cost-saving measures. Because of the Inflation Reduction Act:
A month’s supply of insulin will be capped at $35 starting on January 1, 2023.
Medicare beneficiaries will pay $0 out of pocket for recommended adult vaccines covered by their Part D plan, including the shingles vaccine – which costs seniors up to $200.
Prescription drug companies that try to raise their prices faster than inflation will be required to pay Medicare a rebate.
Earlier this year, HHS released a report showing that the price of 1,200 prescription drugs rose faster than inflation in just the last year. For example, one manufacturer of a drug used to treat high blood pressure and heart failure, used by millions of Medicare beneficiaries, increased the drug’s price by nearly 540 percent in 2022. Another drug used to treat autoimmune conditions increased by $1000 just this year.
During Medicare Open Enrollment – running from October 15 to December 7 – seniors and other beneficiaries will be able to choose drug coverage that reflects these new cost-savings, putting money back into their pockets.
Medicare beneficiaries should visit Medicare.gov or call 1-800-MEDICARE to review their options for the coming year, and make sure their health and prescription drug coverage is right for them.
Using HHS’ Innovation Center to Further Bring Down Costs
As the Biden-Harris Administration works to implement the Inflation Reduction Act, President Biden will sign an Executive Order today directing the Department of Health and Human Services to consider additional actions to further drive down prescription drug costs. That includes leveraging the “Innovation Center” at HHS, created by the Affordable Care Act, which has authority to test new ways of paying for Medicare services that improve the quality of care while lowering costs.
Under the Executive Order, HHS will have 90 days to submit a formal report outlining any plans to use the Innovation Center’s authorities to lower drug costs and promote access to innovative drug therapies for Medicare beneficiaries. This action would build on the Inflation Reduction Act’s landmark drug pricing reforms and help provide additional breathing room for American families.
