Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES is a thought leader in the field of diabetes and has the opportunity to share her expertise as a podcast host, along with colleague Natalie Bellini, DNP, as part of HCP Live and Diabetes Dialogue’s educational series. In a recent program episode, “What Medicare Drug Price Negotiations Mean for Diabetes”, Dr. Isaacs and Dr. Bellini provide an informative and lively discussion on the newly announced Medicare Medication Price negotiation program.
What is this Medicare Drug Hubbub all about?
In order to improve the affordability of medications for those 65 and older with Medicare Part D, the Centers for Medicare & Medicaid Services (CMS), announced the first 10 drugs covered under Medicare Part D selected for negotiation as part of the Inflation Reduction Act,
The drugs chosen include the 10 drugs with the highest gross annual spending total, accounting for $50.5 billion in total Part D gross covered prescription costs per year and more than $3.4 billion in out-of-pocket costs.
Diabetes Medications Included:
There are four diabetes medications included among the ten drugs named for price reductions in this first go-round, which if approved, would take effect in January 2026.
The diabetes agents chosen for negotiation include:
In the podcast, Dr. Isaacs and Dr. Bellini, comment on the lack of any GLP-1 or GLP-1 /GIP combo medications in the initial list and are curious about the inclusion of two SGLT-2 inhibitors and no basal insulin. In addition, there was some head-scratching around including insulin in the negotiations, since there is already a $35 Medicare payment cap on insulin therapy.
This group of medications was chosen in part, because according to CMS statistics, these agents accounted for more than $16 billion in total Part D spending from June 1, 2022, through May 31, 2023, which served as the evaluation period for the decision-making process.
As far as when this program will start, negotiated prices for the selected drugs will be announced by September 1, 2024, and those prices will come into effect starting January 1, 2026. The long-term goal is to expand this program as part of the Inflation Reduction Act. By 2027, the goal is to have 15 more medications covered under Part D for negotiation and up to 15 more drugs for negotiation in 2028, including drugs covered under Part B and Part D, and up to 20 more drugs for each year after.
Expect push backs from pharmaceutical companies. Drugmakers have said the new provisions are unconstitutional and have filed a series of lawsuits to try to stop them.
Thank you to hosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes. Click this link to listen to the complete program episode, “What Medicare Drug Price Negotiations Mean
If you want to meet Diana in person and benefit from her expert knowledge, she will be co-teaching at our three-day DiabetesEd Specialist Training Program in San Diego on October 11-13th. You won’t want to miss her ADA Standards of Care update, along with her expertise on diabetes medications and her hands-on diabetes technology explanations.
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, networking, games with prizes, and “aha” moments in beautiful San Diego.
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Attendees will leave this conference with new tools and a more complete understanding of the latest advances in diabetes care, from medications to technology to Medical Nutrition Therapy!
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