Managed Healthcare Executive December 11, 2025
Key Takeaways
- Initial Medicare Part D drug price negotiations may not yield expected savings, with payers likely increasing utilization management to manage costs.
- CMS-negotiated discounts are similar to private PBM negotiations, with modest impact on health plans, raising plan bids by 1.5% to 3%.
- The IRA’s $2,000 out-of-pocket cap affects beneficiaries differently, with some experiencing increased deductibles and coinsurance.
- Future negotiations may have a larger impact, especially with Part B drugs and exemptions for orphan drugs, affecting blockbuster drugs like Keytruda and Opdivo.
Medicare’s first negotiated drug prices, effective January 2026, provide modest discounts, with limited savings for most beneficiaries and some unintended consequences.
As the first wave of negotiated Medicare Part D drug prices takes effect in...
Today's Sponsors
Today's Sponsor