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Upcoming Medicare Drug-Price Negotiations: An Investment Perspective

Many countries, among them Canada, Japan, the United Kingdom, Germany, and France, negotiate directly with pharmaceutical companies to set prices of vital prescription medications on behalf of their respective residents. Although each country uses a different system and methodology to negotiate, for many years, all have successfully obtained lower prices by using the bargaining power represented by the collective potential markets of their entire respective populations.

On October 1, 2023, the United States will attempt to do something similar, albeit on a far more limited scale initially. This marks a significant break from policy set in 2003 with the creation of Medicare Part D, which allowed Medicare to offer prescription-drug benefits to plan participants (primarily comprised of elderly Americans). Part D contracts with private-sector pharmacy benefits managers (PBMs) to deliver these benefits.

The PBMs, in turn, negotiate with pharmaceutical companies to determine the prices they and plan participants will collectively pay for the medications. The federal legislation that created Medicare Part D included a “non-interference” clause prohibiting Medicare and the Secretary of Health and Human Services (HHS), under whose aegis Medicare is administered, from getting in...

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