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Innovation is the only defence against drug price crackdown

US reforms will put Big Pharma under pressure but innovative companies will retain their pricing power

The US market is the engine of the global pharmaceutical industry. Its exceptionally high drug prices help deliver as much as three-quarters of the sector’s global profits. But taxpayer-funded Medicare is set to pull back the throttle. The first round of formal drug price negotiations — enabled by the 2022 Inflation Reduction Act — kicks off this week.  

The haggling concerns 10 treatments, including cancer, stroke and diabetes medications, which together cost Medicare some $50bn a year. Price cuts will be revealed in September, assuming lawsuits brought by manufacturers do not derail the programme. The impact could be significant for companies such as Bristol Myers Squibb. Its blood thinner Eliquis is expected to account for more than a quarter of sales in 2026, according to Visible Alpha. 

The 10 drugs up for US price negotiations
DiseaseDrugManufacturerAnnual cost to Medicare*
Blood clotsEliquisBMS/Pfizer$16.5bn
Diabetes/heart failureJardianceBoehringer/Eli Lilly$7.1bn
Blood clotsXareltoJ&J$6bn
DiabetesJanuviaMerck$4bn
DiabetesFarxigaAstraZeneca$3.3bn
Heart failureEntrestoNovartis$2.9bn
Rheumatoid arthritisEnbrelAmgen$2.8bn
Blood cancerImbruvicaAbbVie/J&J$2.7bn
Psoriasis/Crohn’s diseaseStelaraJ&J$2.6bn
DiabetesFiasp/NovoLogNovo Nordisk$2.6bn
Source: FT research/Centers for Medicare and Medicaid Services

*Total gross covered prescription drug costs under Medicare Part D.

Many medicines were already facing competition as patents expire. The average impact should be modest enough, even as the programme is rolled out to save Medicare an estimated $100bn over 10 years. Medicare accounts for 15 per cent of global drug sales, according to Morningstar. The US Congressional Budget Office expects negotiations to lower its average drug price by 8-9 per cent in 2031, net of rebates and discounts.

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