Five Pfizer drugs among first 27 now subject to Medicare inflation rebates, HHS says

The Department of Health and Human Services (HHS) on Wednesday unveiled the first set of 27 Part B prescription drugs, including five from Pfizer, that will be subject to Medicare inflation rebates because their prices rose faster than the rate of inflation.

Seniors receiving the physician-administered drugs beginning in April will have lower coinsurance for these drugs (listed below) and HHS said they may see their out-of-pocket costs for these drugs decrease by as much as $390 per average dose.

“In addition to making drug companies pay Medicare back for increasing their prices faster than inflation, this provision of the Inflation Reduction Act discourages other companies from doing the same, with the goal of reining in excessive drug price hikes year-over-year,” the White House said in a fact sheet released this morning.

zMoving forward, CMS said, beneficiary coinsurance will be 20% of the inflation-adjusted payment amount for the following drugs:

Usual suspects like AbbVie’s Humira will be subject to biosimilar competition beginning this year so the price will likely come down. But for other drugs without competitors, the price increases continue apace, such as with Gilead subsidiary Kite Pharma’s CAR-T cancer therapy Yescarta, which saw its list price rise by more than $70,000 per dose with that nearly 20% price increase.

The five Pfizer drugs include older drugs like the blood thinner Fragmin (dalteparin), which first won FDA approval in 1994; Atgam, which is for allograft rejection in renal transplant patients; and the chemo Nipent (pentostatin), as well as antibacterial drugs, Bicillin L-A and Bicillin C-R.

In addition to this list, the White House also put out a report Wednesday explaining how seniors will see more than $230 million in savings this year when the more than 3.4 million people with Medicare begin to pay no out-of-pocket costs for recommended vaccines.

Medicare beneficiaries in the Dakotas, Montana and Wyoming will see the biggest savings from the IRA-related change related to no OOP costs for recommended vaccines.

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