Trump Previews Next Medicare drug price negotiations
In a photo illustration, on July 23, 2024, in New York City next to a pill bottle next to a pill bottle will be seen.
Spencer Platt | Getty Images News | Getty pictures
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The Trump administration is already preparing for another round of Medicare's medication price negotiations, but this time it will look a little different.
The US centers for Medicare and Medicaid services published new guidelines for this third cycle on Monday, as the second round of negotiations is in progress. The procedure was set up as part of the signature inflation reducing of the bidges administration as a means of inclusion of the high health costs for older Americans.
CMS plans to announce a list of 15 medication by February 2026, which are entitled to the third prices, which will then start months of the back and forth between the government and the manufacturers if they agree to participation. The new negotiated prices for these products will come into force in 2028.
But here are the biggest changes this time:
- Medicare part B medication – For the first time, the list would be paid within the framework of Medicare Part B that covered medicines in a doctor's office or a hospital – in addition to prescription drugs that are covered under Medicare. Previous rounds only round D medication.
- New negotiation process – CMS can choose to negotiate the prices for certain medication in which the prices for the first and second talks have already been determined, including those with new approved uses or changes in “monopoly status”. The agency will announce all medication selected for the first cycle of the new negotiation, with revised prices for the products come into force in 2028.
- Transparency – CMS aims to increase the transparency of the process and to look for public feedback on topics, such as the agency determines an initial price offer for a medication.
“This draft instruction is crucial for the creation of a transparent, competitive and fair market for prescription medicines that put American patients in the first place,” said Medicare Director Chris Klomp in a press release.
However, the Wall Street analysts focus on another part of the instructions that could cause Problems for MerchantPresent Bristol Myers Squibb And some other pharmaceutical companies.
The leading document indicates that the Trump government could end a problem bypass with which these companies could achieve income from top-dely cancer medication such as Mercks Keytruda and Bristol Myers Squibbs Opdivo.
The plan was to postpone the patients into newer injectable or subcutaneous versions of their cancer medication and continue to burden Medicare for them, even after their original intravenous versions are subject to the new negotiated prices as part of the program. The drug manufacturers have used these subcutaneous versions to dampen the income they would lose through Medicare medicament price negotiations, as well as the upcoming patent failures for the original forms of their medication. For example, important patents for Keytruda runs in 2028.
According to the current rules, complex medication that is known as biologicals can be entitled to the negotiating process after 13 years, but the clock starts for a new version of the drug – such as a subcutaneous form – that adds an additional active ingredient.
Subcutaneous versions of drugs such as OPDIVO are combination products that contain an additional component so that they can be quickly injected instead of slowly infusing like the original intravenous form.
But on Monday CMS said that it was “comments”, as “considering” to group these combination medication with their original versions – if the additional component does not affect how the drug treats the underlying disease. In other words, the agency is considering whether in certain cases two versions of a drug should count as a single product.
This seems to be “somewhat targeted” on products such as subcutaneous keytruda and opdivo, the JPMorgan analysts said in a note on Monday. They said the guidelines lead to “at least the potential for the inclusion” of these medication in future negotiations.
Nevertheless, no changes are final, so it can be too early to predict the effects on drug manufacturers such as Merck and Bristol Myers Squibb.
Feel free to send Annikakim.constantino@nbcuni.com tips, suggestions, ideas and data to Annika.
Latest in healthcare: Unitedhealths Surprise Leadership Shakeup
It is not uncommon for CEO to have changed their companies to return to the lead when things differ from the course.
This week the chairman of the Unitedhealth Group, Stephen Hemsley, took on a page from Bob Igers Playbook DisneyAnd took back the position of the CEO in the company after the abrupt departure of Andrew Witty.
The last six months have been a challenge for Witty after Brian Thompson, CEO of Unitedhealthcare, and disappointing income disappointed in the first quarter. The shares have achieved a low point of four years in the past few weeks, since it has become increasingly clear that the Medicare Advantage of United Medicare Advantage had done a better pricing for increased costs in Medicare this year.
During the eleven -year term of Hemsleys as CEO, the Unitedhealth stock increased by more than 300%when he built the company into a juggernaut in the healthcare sector. After massive growth, the company and the industry were exposed to waves of regulatory pressure and the public examination of their business.
For Hemsley it is a whole new environment to navigate while trying to correct the ship.
Feel free to send tips, suggestions, stories ideas and data to Bertha at Bertha.coombs@nbcuni.com.
The latest in the healthcare system Tech: Openai starts a new benchmark tool to evaluate how AI models do in health scenarios
Openaai started a new rating tool called Healthbench on Monday, a benchmark that tests how artificial intelligence models appear in realistic scenarios for health care.
“If they are effectively developed and used, large-scale models can expand access to health information, support clinicians in providing high quality care and help people to work for their health and those of their communities,” said Openai in a blog post. “To get there, we have to make sure models are useful and safe.”
The company said Healthbench was developed together with 262 doctors from 60 countries. It is based on 5,000 conversations that simulate the interactions between individual users or clinics and AI models. The discussions are divided into seven different topics, including global health, emergency situations and dealing with uncertainty.
If a model reacts to a prompt, each answer against a number of “doctors written by doctors, which are specifically” evaluated for this conversation, will be rated, said Openaai. Healthbench contains 48,562 unique section criteria.
Openai contained an example in which a user said that he did not find his 70-year-old neighbor on the floor. The AI ​​model in this instance asked the user to take measures immediately, and contained eight steps to which they could follow. Healthbench gave this answer on the basis of his section criteria 77%.
Openaai said that Healthbench responses were evaluated by doctors to understand how the model compared to their clinical judgment. The company found that Healthbench “closely matches the classification of the doctors”.
Openaai said it used to evaluate Healthbench to evaluate several existing models, including its own O3, GPT-4.1, O1, GPT-4O and GPT-3.5 models, Xais Grok 3, Google Gemini 2.5 Pro, Anthropics Claude 3.7 Sonnet and Meta's Llama 4 Maverick.
The company found that O3 exceeded other models and said its models improved by 28% at Healthbench.
Openaai said that the complete evaluation suite and the underlying data are available for Healthbench in your Github repository.
“We hope that this will support joint progress in the use of AI systems to improve human health,” said the company.
Read the full blog post here.
Feel free to send tips, suggestions, story ideas and data to Ashley at Ashley.capoot@nbcuni.com.
