Policy Update: CMS Selects 10 Drugs for Medicare Price Negotiation, 2022 MSSP Results Released

September 12, 2023

Conference season has arrived, and Aledade recently had the opportunity to present policy-related presentations at the National Association of Community Health Centers (NACHC) Community Health Institute conference. A panel of CHC experts, including Dr. Susan Ward-Jones, Judd Semingson, and Kim Schwartz (all health center CEOs), spoke to the value of not only scalable tools to make their health centers more efficient, but also flexible funding to supplement federal dollars that they use towards staff incentive programs and social drivers of health services, among others. An overall theme of the conference was storytelling and highlighting multiple avenues for CHCs to participate in public policy advocacy.

We look forward to the big show for us, the National Association of ACOs (NAACOS) fall conference. As a reminder all practices and CHCs that partner with Aledade on ACOs are also members of NAACOS.

MSSP Results Highlights

Last week, CMS released the final results for the Medicare Shared Savings Program in performance year 2022. The program saved Medicare $1.8 billion last year compared to spending targets for the year, marking the 6th consecutive year MSSP has generated overall savings and high-quality performance results. Three of Aledade member ACOs were in the top 4 for savings rate, and 5 were in the top 10.

CMS announces list of 10 drugs subject to Medicare price negotiation in 2026

Earlier this month, CMS announced its list of 10 drugs that Part D and pharmaceutical companies will negotiate prices on over the next year as part of the Inflation Reduction Act. The negotiated prices will take effect in 2026.

The 10 drugs are:

  • Apixaban (Eliquis)
  • Empagliflozin (Jardiance)
  • Rivaroxaban (Xarelto)
  • Sitagliptin (Januvia)
  • Dapagliflozin (Farxiga)
  • Sacubitril/valsartan (Entresto)
  • Etanercept (Enbrel)
  • Ibrutinib (Imbruvica)
  • Ustekinumab (Stelara)
  • Insulin aspart (Fiasp, Fiasp FlexTouch, Fiasp PenFill, NovoLog, NovoLog FlexPen, NovoLog PenFill)

The announcement noted that these drugs accounted for about one-fifth of total Part D–covered prescription drug costs between June 1, 2022, and May 31, 2023, or approximately $50.5 billion. During the negotiation process, Medicare and the manufacturers will need to consider each drug’s clinical benefit, indication for unmet clinical need, and impact on Medicare beneficiaries.

State Policy Corner

Aledade physicians across the country are starting their advocacy early! Dr. Eric Hansen from California and Dr. Umar Bowers from North Carolina had virtual and hybrid visits with their state representatives and discussed the significance of supporting independent primary care in our country’s efforts to improve health care, as well as the need to support the health care workforce. Aledade ACO members: reach out to our state policy team if you’re interested in hosting an elected legislator for a site visit at [email protected]