On January 27, the Centers for Medicare & Medicaid Services, or CMS, announced the next round of 15 medications for the Drug Price Negotiation Program. Under the Inflation Reduction Act of 2022, CMS now has the authority to directly negotiate drug prices.
Entering the third year of the program, it has evolved significantly. With 25 medications previously negotiated between 2024 and 2025, the additional 15 drugs now being negotiated treat conditions like neurological diseases, cancer, autoimmune diseases, respiratory conditions and mental health. Notably, the 2026 selections include Part B therapies for the first time.
Concerns Around Clinician-Administered Therapies
As the program expands to include clinician-administered treatments, a new reimbursement challenge emerges. Unlike drugs picked up at a pharmacy, physician-administered therapies are typically purchased directly by clinicians and administered in the office, meaning physicians must first buy the drug, then seek reimbursement. When considering a negotiated Maximum Fair Price set by CMS, providers may not recoup what they spent, effectively losing money on every patient they treat. Faced with that reality, many physicians – particularly those in independent or community practices – may stop offering these treatments altogether, leaving patients without access to medications their doctor can no longer afford to provide.
The Importance of Community Engagement
To ensure that patient and clinician perspectives are incorporated into the negotiation process, CMS has established several ways to get involved. There is an opportunity to provide written comment on any of the 15 selected therapies (with comments due March 1), participate in a patient roundtable and testify in a clinically focused town hall. These testimony opportunities will take place throughout April, with the negotiated prices being announced later in the fall.
As CMS negotiates these treatments, it is critically important that CMS hears from the people who are most impacted. Clinicians, patients, caregivers and advocates have a real opportunity to make their voice heard and urge a patient-centric approach.