TABLE 1.
Comparison of Statutory Minimum Discount and 2020 Average Rebate for All Formulations of Drugs Expected to Face Price Negotiation in 2026
| Brand name | Generic name | Manufacturer | Spending in 2020a (in 2020 USD) | Spending in 2020b (in 2026 USD) | Years since approval | Minimum statutory discount,c % | Estimated PBM rebate in 2020,d % | Minimum savings,e $ |
|---|---|---|---|---|---|---|---|---|
| Eliquis | Apixaban | BMS/Pfizer | 9,936,069,814 | 11,864,186,980 | 13.0 | 25 | 38.7 | |
| Xarelto | Rivaroxaban | Janssen Pharm. | 4,701,314,805 | 5,613,615,740 | 14.5 | 25 | 46.7 | |
| Januvia | Sitagliptin phosphate | Merck Sharp & D | 3,865,087,773 | 4,615,116,931 | 19.2 | 60 | 61.6 | |
| Imbruvica | Ibrutinib | Pharmacyclics | 2,962,909,304 | 3,537,868,658 | 12.1 | 25 | 9.0 | 564,302,391 |
| Jardiance | Empagliflozin | Boehringer Ing. | 2,376,166,292 | 2,837,266,818 | 11.4 | 25 | 59.7 | |
| Enbrel | Etanercept | Amgen | 2,154,714,778 | 2,572,842,129 | 27.2 | 60 | 39.1 | 537,724,005 |
| Symbicort | Budesonide/formoterol | Astrazeneca | 2,135,408,250 | 2,549,789,125 | 19.5 | 60 | 68.3 | |
| Ibrance | Palbociclib | Pfizer US Pharm | 2,108,937,188 | 2,518,181,293 | 10.9 | 25 | 5.7 | 486,972,123 |
| Xtandi | Enzalutamide | Astellas Pharma | 1,968,567,948 | 2,350,573,079 | 13.4 | 25 | 15.0 | 234,822,251 |
| Breo Ellipta | Fluticasone/vilanterol | Glaxosmithkline | 1,504,155,910 | 1,796,040,819 | 12.7 | 25 | 65.4 | |
| Total | 33,713,332,062 | 40,255,481,572 | 1,823,820,770 |
Bold represents drugs for which 2020 average rebates were lower than the statutory discount established by the Inflation Reduction Act. For these drugs, the statutory discount will set the ceiling for the negotiated price. Blank cells represent the remaining 6 drugs for which the current rebate will set the ceiling for the negotiated price.
aGross Part D spending in 2020 obtained from the Centers for Medicare and Medicaid Part D spending dashboard.
bGross Part D spending in 2020 was updated to 2026 USD by using a 3% annual inflation rate, as previously done in the literature.6
cThe Inflation Reduction Act establishes statutory minimum discounts, which until 2030 will equal 25% for drugs marketed for 9-16 years and 60% for drugs marketed for more than 16 years.1 However, if average rebates exceed the minimum statutory discount, the negotiated discount must be greater than the current rebate.
dAverage rebate to payers in 2020, estimated by using a peer-reviewed methodology that isolates discounts negotiated between manufacturers and payers from mandatory discounts under the Medicaid, 340B, and coverage gap programs.10-13 The methodology is summarized in the methods and explained in detail in Supplementary Exhibit 1 (available in online article).
eMinimum savings represent the savings achieved at the ceiling of the negotiated price. Savings may, however, be greater if negotiations achieve prices below the ceiling.
BMS = Bristol Meyers Squibb; DOAC = direct oral anticoagulant; PBM = pharmacy benefit manager; TKI = tyrosine kinase inhibitor; TNF = tumor necrosis factor; USD = US dollars.