(Removes word “embargo” from headline)
By Ahmed Aboulenein
WASHINGTON, Dec 18 (Reuters) – Americans enrolled in Medicare will pay about 50% less out of pocket in 2026 for some drugs including Pfizer and Bristol Myers Squibb’s blood thinner Eliquis and Merck & Co’s diabetes drug Januvia, a study in the five most populous U.S. states suggested.
Medicare negotiated prices kick in next month for 10 drugs, a first for former President Joe Biden’s signature Inflation Reduction Act of 2022. Medicare covers over 67 million people aged 65 and older or with disabilities.
The report estimates that out-of-pocket costs for the 10 drugs will fall nearly 50% in 2026 versus 2025 in all 56 stand-alone prescription drug plans in California, Florida, Texas, New York, and Pennsylvania, the analysis of public Medicare spending data found.
Seven of the drugs are expected to cost below $100 per month by 2026, up from two under that amount in 2025.
However, patients taking the three priciest drugs; Amgen’s rheumatoid arthritis treatment Enbrel, AbbVie’s leukemia therapy Imbruvica, and Johnson & Johnson’s Crohn’s disease medicine Stelara, will still face higher out-of-pocket costs ranging from around $600 to $2,800 a month.
The law also has a new lower Medicare out-of-pocket drug spending cap, set at $2,100 per year in 2026.
Out-of-pocket costs include co-pays, flat fees, and coinsurance, which is a percentage of the drug price. Savings stem mainly from lower coinsurance tied to negotiated prices, and some co-pay changes related in particular to lower insulin prices.
AARP, the lobbying group for older Americans, said further research is needed to determine whether the findings extend to the broader Medicare market. The study noted considerable variation in savings between plans.
The other drugs included in the first round of negotiations are J&J’s Eliquis rival Xarelto, Boehringer Ingelheim and Eli Lilly’s diabetes drug Jardiance, and insulin from Novo Nordisk.
The drugs are used by nearly 9 million people on Medicare prescription drug plans who paid as much as $6,500 per year for these prescriptions before the IRA’s passage. Four of the drugs were not covered by all Medicare drug plans in 2025 but will be universally covered in 2026 under IRA mandates.
The U.S. Centers for Medicare & Medicaid Services estimates the negotiated prices could save enrollees a collective $1.5 billion in out-of-pocket expenses in 2026.
(Reporting by Ahmed Aboulenein; editing by Caroline Humer and Nick Zieminski)
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