Boxes of the drug Trulicity, manufactured by Eli Lilly and Company, sit on a pharmacy counter in Provo, Utah, on January 9, 2020.
George Frey | Reuters
A version of this article first appeared in CNBC's Healthy Returns newsletter, bringing the latest healthcare news directly to your inbox. Subscribe here to receive future editions.
The Trump administration is kicking off the year with another round of negotiations over Medicare drug prices.
But for the first time they include treatments administered in doctors' offices, including some for type 2 diabetes, HIV, cancer and arthritis.
These are drugs covered by Medicare Part B. Only retail drugs covered by Part D were eligible for discussions during the previous two rounds of discussions.
The negotiated prices for the 15 drugs chosen this year will take effect in 2028. They reflect the highest-spending drugs on a list of the 50 drugs most eligible for negotiation, which the administration also published in full.
About 1.8 million beneficiaries used these drugs between November 2024 and October 2025, and they accounted for about $27 billion in Medicare Parts B and D spending, according to a statement from the Centers for Medicare & Medicaid Services.
The new negotiated prices aim to significantly reduce out-of-pocket costs for millions of Medicare beneficiaries.
On the other hand, should the manufacturers of these treatments worry about their income?
According to some analysts, several companies may not need to do so.
In a note on Monday, Leerink Partners analyst David Risinger said that for 14 of the drugs, Medicare revenue exposed to the negotiations represents only 0% to 3% of the companies' global sales in 2027.
He estimates that only GileadBiktarvy, a once-daily prescription pill that treats HIV, gains significant sales from Medicare, accounting for about 8% of Gilead's estimated global revenue by 2027.
Notably, Eli LillyTrulicity GLP-1 injection, used to treat diabetes, was selected. The weekly medication is a predecessor to the company's best-selling anti-obesity drug, Zepbound, and its diabetes counterpart, Mounjaro.
Here is a complete list of the 15 drugs, what they do and who makes them:
- I miss Ellipta, chronic obstructive pulmonary disease, caused by GSK
- biktarvi, HIV, made by Gilead Sciences
- Botox and Botox Cosmetic, various cosmetic and therapeutic uses, including chronic migraines, made by Abvie
- cimzia, rheumatoid arthritis, Crohn's disease and other autoimmune conditions, prepared by UCB
- Cosentyx, autoimmune diseases, including plaque psoriasis, caused by Novartis
- Entyvio, active ulcerative colitis and Crohn's disease, prepared by Takeda
- Erleada, Prostate cancer, manufactured by Janssen Biotech
- Kisqali, breast cancer, manufactured by Novartis
- Lenvima, various advanced cancers, prepared by Eisai
- Orencia, rheumatoid arthritis and psoriatic arthritis, made by Bristol-Myers Squibb
- rexulti, schizophrenia, Otsuka pharmaceuticals
- Trulicity, Type 2 diabetes, Eli Lilly
- Verzenio, breast cancer, Eli Lilly
- Xeljanz and Xeljanz XR, rheumatoid arthritis and many other inflammatory conditions, caused by Pfizer
- xolair, asthma and other allergies, manufactured by Genentech
President Donald Trump has downplayed the negotiating program, a key pillar of the Biden administration's signature Inflation Reduction Act. Instead, Trump has focused on the voluntary drug pricing agreements that pharmaceutical companies have signed with him in recent months.
We'll be sure to follow the negotiations, so stay tuned for our coverage.
Kaiser Permanente to pay historic $556 million settlement for Medicare Advantage fraud
Pictured at a Kaiser Permanente healthcare facility in Anaheim, California, US, on October 3, 2023, more than 75,000 Kaiser Permanente healthcare workers could go on strike from October 4 to 7 across the United States.
Mike Blake | Reuters
In other news this month, Kaiser agreed to pay a record $556 million settlement over Medicare Advantage fraud allegations, the largest of its kind.
I sat down with attorneys Mary Inman and Hamsa Mahendranathan, who represented whistleblower James Taylor, a longtime Kaiser Permanente physician, to discuss the record settlement.
Taylor filed her lawsuit in 2014, which the Justice Department then took up and consolidated with other cases.
“We're all feeling the impact of how expensive healthcare is, and it's a real waste of government resources when entities involved in Medicare Advantage are paid more than they should,” Mahendranathan told CNBC. “Those are our health care dollars and they should go where they are needed, right?”
The settlement announced Jan. 14 resolves years-long allegations that Kaiser – the Oakland, California-based company that operates dozens of hospitals and insures millions of people – exaggerated how sick its Medicare Advantage members were by applying inaccurate diagnosis codes that employees added to their charts after patient visits.
The government pays Medicare Advantage insurers more for sicker patients. But over the past decade, critics, several whistleblower lawsuits, government investigations and other investigations have alleged that the system encourages aggressive coding practices across health plans to illegally boost revenue.
Federal prosecutors alleged that Kaiser pressured doctors to add diagnoses even when conditions were not actually treated during patient visits, in violation of Medicare rules. The Justice Department specifically accused Kaiser of withdrawing about $1 billion in taxpayer money from this practice between 2009 and 2018.
In a statement on its website, Kaiser said it settled the case “to avoid the delay, uncertainty and cost of protracted litigation.” The company did not admit any crime or liability.
Inman told CNBC that the signal the settlement “sends to the industry is really important, and that is that the Department of Justice is not backing down from serious enforcement actions in the Medicare Advantage space, specifically with the manipulation of risk scores.”
On Monday, the Trump administration signaled that it may take a tougher approach to Medicare Advantage insurers than the industry had expected.
The Centers for Medicare and Medicaid Services proposed nearly flat payment rates for Medicare Advantage insurers next year, well below Wall Street expectations. The agency also cracked down on aggressive coding practices that can inflate payments.
Together, the measures aim to curb excessive payments in the private Medicare program. Name actions like UnitedHealth Group and human The news sank.
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