Billion-dollar drugs’ makers set to face their first US price negotiations

John Tozzi and Nacha Cattan | (TNS) Bloomberg News

Some of the most widely used drugs in the U.S. may be heading for lower prices under Medicare, a move that could save taxpayers billions of dollars and squeeze profits for big pharmaceutical companies.

The U.S. government is preparing to release a list this week of 10 drugs that the health program for the elderly will be able to negotiate prices for — one of the key elements of President Joe Biden’s signature Inflation Reduction Act. Analysts expect Johnson & Johnson’s Xarelto blood thinner and Eli Lilly & Co.’s Jardiance for diabetes to be among the medications chosen.

The ability for the government to haggle over prices is a marked change for pharma companies that have long been able to charge whatever they think a medication is worth, even as most other industrialized companies bargain hard. With the IRA now enabling Medicare to come to the table over products that have long been on the market, drugmakers are girding for the prospect of lower revenue from some of their biggest sellers.

For taxpayers, the savings could be significant: Negotiations could save the U.S. $36.5 billion from 2026 to 2028, according to Wells Fargo Securities. Drugmakers are suing the government to stop the squeeze.

“They’re going to earn less money,” said Spencer Perlman, an analyst with policy research firm Veda Partners. “That’s just a fact.”

Medicare spends more than $200 billion on outpatient prescription drugs annually. Eliquis, the Bristol-Myers Squibb Co. blood thinner used to prevent heart attacks and strokes, cost the program more than $12 billion in 2021 alone.

Under the IRA, the price ceiling for a selected drug will be set somewhere between 75% and 40% of its average price, with steeper discounts for drugs that have been on the market longer. Medicare will halve its costs for the chosen drugs on average, according to Congressional Budget Office estimates. That will lower the health program’s spending total by almost $100 billion through 2031, when annual savings will approach $25 billion.

Predictions Hard

Complexities in the law make it hard to predict precisely which drugs will be affected. Analysts agree on some, but surprises could trigger unusual stock reactions, analysts from Goldman Sachs said. Overall, large pharma stocks have traded at a “depressed level” relative to the broader market, they wrote, and the announcement of the drug list won’t necessarily cause shares in the sector to move.

The list is expected Tuesday, Politico reported, citing unnamed people involved. The White House is planning an event on lowering health-care costs Tuesday with Biden and Vice President Kamala Harris.

The process set in motion this week won’t hit sales until 2026, and even then analysts suggest its early effects will be modest. The law would shave 3% from Bristol’s revenue that year, Bloomberg Intelligence analysts estimate, and 1% or less for the other companies seen undergoing the first round of negotiations. Cowen & Co. analysts deemed the impact “manageable” for pharma companies.

Each year, Medicare will add drugs to its low-cost shopping list, reshaping how medications are made and sold in the U.S. drug market. The government can only negotiate for the drugs that Medicare spends the most on — the top 50 retail prescription drugs and the top 50 administered by physicians. The price cuts don’t apply to other purchasers like private insurers or patients paying cash.

Still, it’s a sea change that pharma companies have dreaded.

“This misguided policy does not strike the right balance between incenting investment and innovation and improving affordability and access,” Merck Chief Executive Officer Robert Davis said earlier this month on a call with analysts.

Taxpayer Win