Tag Archives for CMS

Medicare Enrolled will see Lower Costs on Select Drugs in 2026

Published in Blackstone Valley Call & Times on December 2, 2025

With Medicare Open Enrollment ending next week, the Centers for Medicare & Medicaid Services (CMS) has announced that last year’s Medicare negotiations produced a net savings of 44%—about $12 billion—on 15 widely used prescription drugs that treat cancer and other serious chronic conditions.

The new Maximum Fair Prices (MFPs) for these 15 drugs will take effect on January 1, 2027. Combined with the 10 drugs already negotiated—whose MFPs take effect January 1, 2026—a total of 25 drugs will have negotiated lower prices. These medications, used to treat conditions such as cancer, diabetes, asthma, and cardiovascular and neurological disorders, represent some of the highest Medicare Part D spending.

The Beginning of Drug Price Negotiations

Three years ago, after President Biden signed the Inflation Reduction Act (IRA) in August 2022, CMS began developing the process for Medicare’s first-ever drug price negotiations. On March 15, 2023, the federal agency issued its initial program guidance and received more than 7,500 public comments from consumer groups, patient advocates, drug manufacturers, and pharmacies. Revised guidance followed on June 30, 2023.

On August 29, 2023, CMS released the first list of 10 high-cost drugs selected for negotiation—marking the first time in Medicare’s history that it could negotiate directly with pharmaceutical companies.

Pharmaceutical industry groups and several companies attempted to block the law in court. In response, 70 organizations and 150,000 petition signers urged Merck, Bristol Myers Squibb, Janssen Pharmaceuticals, Astellas Pharma US, the Pharmaceutical Research and Manufacturers of America (PhRMA), and the U.S. Chamber of Commerce to drop their lawsuits. Multiple organizations also filed amicus briefs supporting the law.

Three years in process, and with courts ultimately allowing the program to proceed, that first round of 10 drugs with negotiated prices will take effect in 2026.

CMS Drug Negotiations Added 15 Drugs

On January 17th, CMS announced it had selected 15 additional drugs for the second cycle of negotiations under Medicare Part D and on November 25th, it was announced that agreements had been reached on all of them. These medications are among the most costly and most commonly used by Medicare beneficiaries, treating conditions such as cancer, diabetes, and asthma. The new round of negotiations is expected to save Medicare billions and strengthen the program’s long-term sustainability.

“This year’s results stand in stark contrast to last year’s,” said CMS Administrator Mehmet Oz, MD, in announcing the second cycle of negotiations.  “Using the same process with a bolder direction, we have achieved substantially better outcomes for taxpayers and seniors in the Medicare Part D program — not the modest or even counterproductive ‘deals’ we saw before.”

“Whether through the Inflation Reduction Act or President Trump’s Most Favored Nation policy, this is what serious, fair, and disciplined negotiation looks like,” adds CMS Deputy Administrator and Medicare Director Chris Klomp. “I’m deeply proud of our team, who execute exceptionally well to bring affordability to the country in everything we do.”

Between January 1 and December 31, 2024, approximately 5.3 million Medicare Part D enrollees used one or more of these 15 drugs. Total gross Part D spending for them was $42.5 billion, representing about 15% of all Part D drug costs.

Anthony Wright, executive director of Families USA, praised the newly released negotiated prices, stating that they show what is possible when “policymakers put patients before corporate profits.” Wright emphasized that these reductions build on the work of establishing the Drug Price Negotiation Program, which aims to provide financial relief to older adults and people with disabilities.

Wright noted that the first and second rounds of negotiated drugs together account for about one-third of Medicare Part D spending, with price reductions ranging from 38% to 85%. In 2027, beneficiaries using these drugs are projected to save $685 million in out-of-pocket costs. He added that the savings support both individual beneficiaries and the long-term sustainability of the Medicare program.

Despite pharmaceutical companies’ continued attempts to limit the program—through lawsuits and legislative provisions such as those in H.R. 1—Wright said the negotiation program remains “the most effective tool currently available to lower drug prices.”

“The Medicare Negotiation Program changed the trajectory of drug pricing in the United States, helping to reduce Big Pharma’s monopoly pricing power, which dictated prices to Americans on Medicare for two decades,” said Merith Basey, executive director of Patients for Affordable Drugs in a statement. “This second round of negotiations — now under President Trump — marks another major milestone, delivering continued savings for patients and taxpayers,” he said.

“The lower negotiated prices are more than numbers on a page. For patients who’ve been forced to work multiple jobs, cut pills in half, or choose between filling a prescription and buying groceries, these lower prices will bring long-overdue relief, flexibility, and stability,” added Basey.

“The requirement that Medicare negotiate lower prices for prescription drugs continues to pay dividends for older Americans and taxpayers,” adds Richard Fiesta, executive director of the Alliance for Retired Americans. “The announcement of lower drug prices for 15 high-priced drugs is a win for more than 5 million seniors who take these drugs to treat asthma, diabetes, lung disease and other serious conditions, and will soon pay less for their medications,” he says.

“The 4.4 million members of the Alliance are pleased that the Trump Administration has followed the law, negotiated these prices, and defended this law in court,” Fiesta says, calling on Congress to increase the number of drugs subject to price negotiations.

While the White House along with aging groups praise the impact of IRA’s Medicare drug negotiation provisions, the Pharmaceutical Research and Manufacturers of America (PhRMA) issued a statement calling it “flawed.”

“Whether it is the IRA or MFN, government price setting for medicines is the wrong policy for America. Price setting does nothing to rein in PBMs who decide which medicines are covered and what patients pay. In fact, many patients are facing additional coverage barriers and paying more out-of-pocket for medicines because of the IRA, warns Alex Schriver, Senior Vice President of Public Affairs.

“These flawed policies also threaten future medical innovation by siphoning $300 billion from biopharmaceutical research, undermining the American economy and our ability to compete globally,” states Schriver, noting that PhRMA members are stepping up to make medicines more affordable by enabling direct purchase at lower prices and investing in U.S. manufacturing and infrastructure.

Lower Drug Cost Legislation Introduced

Congressman John B. Larson (D-CT), a senior member of the House Ways and Means Committee, praised the latest CMS announcement, estimating that both negotiation rounds will save older Americans more than $2 billion per year in out-of-pocket costs. Larson noted that families and seniors continue to struggle with rising prices, especially for prescription drugs.  The lawmaker pushed to enable Medicare to negotiate drug prices to lower drug costs by the enactment of IRA.

Last week, House Democrats introduced the Lower Drug Costs for American Families Act, aimed at closing loopholes in H.R. 1 and further reducing prescription drug prices. The bill (H.R. 6166), introduced November 20 by Ranking Members Frank Pallone Jr. (Energy and Commerce), Richard Neal (Ways and Means), and Bobby Scott (Education and Workforce), has been referred to all three committees.

Key provisions of the bill would:

  • Extend Medicare’s price negotiation authority to all Americans with private insurance—covering more than 164 million people with employer-sponsored plans and over 24 million enrolled in Affordable Care Act plans
  • Apply inflation-based rebate protections to private insurance markets, potentially saving $40 billion over 10 years
  • Increase the number of negotiated drugs from 20 to 50 per year
  • Extend the $2,000 annual out-of-pocket prescription drug cap to privately insured patients
  • Cap insulin costs at $35 per month for those with private insurance
  • Close the orphan-drug loophole that allows companies to avoid negotiation
  • Require consideration of international drug prices to ensure Americans do not pay three to five times more than patients in other countries

Continue the Momentum

According to CMS, the agency will announce the specifics on 15 drugs for the third round of Medicare price negotiations by February 1, 2026. This new round will include drugs paid under Medicare Part B for the first time and will begin with negotiated prices effective January 1, 2028. CMS has already released final guidance for the program and will also use this process to select drugs for renegotiation in previous cycles. IRA also establishes an ongoing process where more drugs will be selected for negotiation in subsequent years.

A Dec. 2024 AARP survey found that almost 3 in 5 adults age 50 and older expressed concern about their ability to afford prescriptions over the near future.  Respondents included both Medicare beneficiaries and younger persons. About 96 percent of the respondents call on the government to do more to lower pharmaceutical prices.

AARP noted that this survey was taken right before a new $2,000 cap on out-of-pocket drug expenses took effect in 2025.

With the announcement of lower drug costs that result from Medicare’s round 2 drug negotiations, there is an  opportunity to build on this momentum for real change. Lawmakers can legislate to put the public’s health above profit by giving consumers more power to negotiate, making competition stronger, and keeping patients from having to pay too much out of pocket.

It is now time for Congress to act.

The ABCs of Surviving Medicare Open Enrollment 

Published in RINewsToday on October 20, 2025

It’s that time. The Medicare Open Enrollment period began last week and runs until December 7th. During this period, Rhode Island’s 243,000 Medicare beneficiaries (data from late 2024 to early 2025) are encouraged to explore their Medicare options, carefully review, compare options, and make necessary changes to their existing Medicare plan for the following year.

During the Medicare Open Enrollment period, you can join a new Medicare Advantage plan or Part D prescription drug plan, switch from Original Medicare to Medicare Advantage, or switch from Medicare Advantage to Original Medicare (with or without a Part D plan).

You can make as many changes as you want during this period. The last change you ultimately make will take effect on January 1, 2026.

Medicare Options

According to Healthinsurance.org, an independent website that provides consumer information and education on health insurance options, here’s a snapshot of Medicare plans chosen by Rhode Island beneficiaries.

As of September 2024, 144,610 Rhode Islanders were enrolled in Medicare Advantage plans. These plans, offered by private health insurance companies, are alternatives to Original Medicare. Medicare Advantage plans cover all the healthcare benefits that Original Medicare covers (e.g., hospital services and outpatient/medical/physician services), but the out-of-pocket costs can differ significantly, as Advantage plans set their own co-pays, co-insurance, and deductibles (within parameters defined by CMS).

Approximately 115,000 to 120,000 Rhode Islanders are enrolled in Original Medicare, representing about 49-51% of the state’s Medicare beneficiaries. Original Medicare, covering individuals aged 65 and older as well as certain younger people with disabilities, is a “fee-for-service” plan composed of two main parts: Part A for hospital insurance (covering inpatient hospital care, skilled nursing care, hospice care, and some home health services) and Part B for medical insurance (covering doctor visits, preventive care, and durable medical equipment). These two parts cover a wide range of medically necessary services, with beneficiaries paying a portion of costs, such as coinsurance and deductibles.

Medicare Part D is an optional prescription drug benefit offered by private insurance companies approved by Medicare. This benefit helps cover the cost of outpatient prescription medications. Approximately 83% of the total 243,377 beneficiaries in September 2024 have some form of prescription drug coverage through a Medicare Part D plan.

Finally, according to the U.S. Centers for Medicare & Medicaid Services, as of 2024, more than 50,000 Medicare beneficiaries in Rhode Island had Medigap policies. These policies are standardized supplemental insurance plans sold by private companies to cover the “gaps” in Original Medicare (Part A and Part B), including deductibles, co-payments, and co-insurance.

Taking a Close Look at Your Current Coverage

Even if you’re satisfied with your current coverage, the state’s Office for Healthy Aging recommends that Medicare beneficiaries closely review and compare their Medicare options to ensure their needs are met in the upcoming year. “Medicare beneficiaries will receive a lot of mail during Medicare Open Enrollment so it is very important to pay attention to any changes in the plan’s costs, including premiums, deductibles, and cost-sharing amounts. Make sure your providers and pharmacies are still in the plan’s network.”

All Medicare beneficiaries (or those approaching Medicare eligibility) can receive free, unbiased counseling from State Health Insurance Assistance Program (SHIP) counselors. These services are voluntary and meant to help people understand the complexity of plans and make informed choices. SHIP counseling is an offered resource, not a condition of having Medicare or enrolling in a plan.

What to Bring to Your SHIP Appointment

You can enroll in Medicare plans or manage your coverage without using OHA or SHIP partners’ counseling.  There is a risk of not choosing the best plan to meet your medical needs, missing savings or subsidies, and increasing stress or confusion in making the right choice.

After making an appointment, a SHIP counselor will request the beneficiary bring their Medicare card, current plan(s) cards, and a list of prescriptions and doctors to the meeting.

The OHA and its nine partners (see box below) are provided with training, certifications, and resources through the federal SHIP grant ensuring they stay up to date on what every Medicare Advantage, Traditional Medicare, and Medicare Part D plan offers.

Every October, OHA and its SHIP partners meet with presenters from Rhode Island’s Medicare Advantage plans to become aware of updates on all the 2026 plan changes.

Changes in 2026

According to AARP, expect some significant changes in 2026. The first Medicare-negotiated drug prices will go into effect for drugs like Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog/Fiasp. Additionally, according to CMS, savings are expected to lower enrollees’ out-of-pocket spending by an estimated $1.5 billion next year. Finally, the new cap on annual out-of-pocket expenses for Part D drugs will increase to $2,100.

You can call 1-800-MEDICARE to make changes by phone. You can also use Medicare’s Plan Finder tool to compare plans at www.medicare.gov/plan-compare to compare options and enroll in some plans online. Alternatively, you can contact plans directly to enroll.

Find a Medicare plan

However, the Office of Healthy Aging cautions, “Unfortunately, we are still waiting for CMS to release some of the 2026 cost and premium changes, and due to the government shutdown, this may be further delayed.”

A Final Note… Beware of Scams and Fraud

Open Enrollment is also prime time for scams. Scammers who claim to represent Medicare may call asking for your Medicare number, Social Security number, or bank information, especially before you enroll. Medicare will never call, email, or text out of the blue to ask for personal information or payment. If you’re unsure, hang up and call 1-800-MEDICARE to verify.

To schedule an appointment with a State Health Insurance Assistance Program (SHIP) Counselor please contact one of the below agencies.

PARTNER AGENCYLOCATIONPHONE NUMBER
Aging Well84 Social St, Woonsocket, RI 02895401-766-3734
Johnston Senior Center1291 Hartford Ave, Johnston, RI 02919401-944-3343
Westbay Community Action Agency487 Jefferson Blvd, Warwick, RI 02886401-921-5237
South Kingstown Senior Center25 St Dominic Rd, Wakefield, RI 02879401-789-0268
Westerly Senior Center39 State St, Westerly, RI 02891401-596-2404
The Aging & Disability Resource Center (ADRC)50 Valley St, Providence, RI 02909401-462-4444
East Bay Community Action Agency100 Bullocks Point Ave, East Providence, RI 02915401-435-7876
Leon Mathieu Senior Center420 Main St, Pawtucket, RI 02860401-728-7582
Progreso Latino626 Broad St, Central Falls, RI 02863401-728-5920
Edward King House35 King St, Newport, RI 02840401-846-7426

Source:  OHA, Oct. 2025

Chair Casey leaves mark on national aging policy. Leadership changes in DC and RI 

Published in RINewsToday on December 16, 2024

Last week, U.S. Sen. Bob Casey (D-PA), Chairman of the U.S. Senate Special Committee on Aging, held his last hearing, entitled “Empowering People with Disabilities to Live, Work, Learn, and Thrive, in SD 106.  This hearing was his swan song as Chairman of the Senate Aging Committee. 

The 3-term Democratic Senator, first elected in 2006, lost his reelection bid for a fourth term to Republican Dave McCormick, a West Point graduate, combat veteran and Bronze star recipient, and a national security expert, and former hedge fund manager.  A recount of votes confirmed that Casey lost by 16,000 votes (3,398,628 to 3,382,423) and he conceded the race on Nov. 21st.

With the dust settling after the Nov. 5th presidential election, Republicans will take control of the legislative agenda of the upper chamber, with a 53-47 majority, and control the house.

According to a Senate Aging Committee, during the upcoming 119th Congress Sen. Tim Scott (R-SC), a former Ranking Member, is expected to replace Casey as chairman on Jan. 3rd, 2025. Former Ranking Member Mike Braun (R-Ind) will leave the Senate after becoming Governor-elect of Indiana. 

An advocate for America’s seniors

During the 118th, the Senate Aging Committee under the helm of Casey held 18 full hearings, five field hearings, and one joint full hearing.  His final hearing, lasting one hour and 46 minutes, highlighted his long record as a champion for people with disabilities, and laid out his vision for how Congress must continue to work to empower them. 

“From the beginning of my time in the Senate, I heard a constant refrain from disability advocates that their needs were not being met—they faced barriers to save for their future, they were being paid well below a living wage, and they could not afford or access the care they needed,” says Casey in his opening statement. “Those refrains, including from some of the people we heard from at today’s hearing, are what inspired me to make people with disabilities a focus of my Senate career and time as Aging Committee Chairman,” he said.

During his 18 years in the Senate, Casey has been one of the foremost champions in Washington for people with disabilities. He created the Stephen Beck Jr. Achieving a Better Life Experience Act (ABLE) program, which has helped hundreds of thousands of families save for long-term care for their disabled loved ones with a tax-advantage savings account. The Associated Press hailed this legislation as “the most important new law for [those with disabilities] in 25 years.  He also made federal websites more accessible for people with disabilities, and propelled the fight for access to home care to the forefront of the national conversation. 

In addition, the Pennsylvania Senator led efforts to improve care in nursing homes by expanding and strengthening oversight over poor-performing facilities while ensuring that nursing homes and long-term care facilities have the resources they need to provide high-quality care to residents. His work has led the Centers for Medicare and Medicaid Services (CMS) to publicly release information about nursing facilities with a documented pattern of poor care, ensuring older adults and their families have the information they 

At the Dec. 12th hearing, Chairman Casey also released a series of issue briefs documenting his record chairing the Aging Committee on making government technology accessible, expanding access to home care, improving nursing homes, lowering prescription drug costs, and ensuring economic security for older adults:

“We have made a lot of progress, from creating the ABLE program to making government technology more accessible,” Casey continued. “But as we heard today, there is still a lot more to do—from expanding access to home care to finally phasing out the subminimum wage,” he added.

Kudos to Casey’s advocacy for America’s disabled Seniors

At the hearing, witnesses from Pennsylvania and national organizations testified about the impact of Casey’s work impacting the disability community in the Commonwealth and around the country.

I want to thank Senator Casey for your leadership. None of the successes I outlined would have been possible without your steadfast championship, advocacy and partnership. It is daunting to think about facing the challenges ahead, particularly the threats to Medicaid, without you at the helm, but we have been emboldened to reimagine what is possible because of your leadership,” says Witness Ai-Jen Poo, President of the National Domestic Workers Alliance and Executive Director of Caring Across Generations.

Witness Neil McDevitt, Mayor of North Wales, Pennsylvania, noted: “Senator Casey, you have been a steadfast ally of North Wales Borough, the Commonwealth of Pennsylvania, and millions of disabled and Deaf Americans. We owe you a debt that can never be repaid.”

“Things are actually changing. We are not yet where we need to be when it comes to disability access and acceptance, but we are getting there. It brings me great joy when I hear of disabled people in my community getting good paying jobs and not being relegated to sheltered workshops for less than minimum wage,” adds Erin Willman, CEO of White Cane Coffee in Warren, Pennsylvania. 

Witness Lydia Brown, Director of Policy, National Disability Institute, told the attending Senators:“Ten years ago, Sen. Casey’s leadership in introducing and passing The ABLE Act changed the game. People whose disabilities began before age 26 can now access a savings vehicle that can conserve up to $100,000 total without their savings counting against them in determining eligibility for SSI and Medicaid. Money in an ABLE account can be used for a wide range of qualified disability expenses, including otherwise unaffordable assistive technology and health care, as well as educational and employment related costs. For many disabled people on Medicaid, an ABLE account is also their only available means to save for retirement.”

A fond farewell 

“Bob Casey served honorably as the chair of the Senate Special Committee on Aging.  He held a wide range of hearings intended to develop a record that could be used to help shape future legislation,” says Max Richtman, President & CEO, National Committee to Preserve Social Security and Medicare who also is a  former staff director of the Senate Special Committee on Aging. Casey had held numerous hearings on issues facing older adults that helped build support for components of the Older Americans Act reauthorization – which just passed the Senate and may be included in the end-of-year package, noted Richtman. 

“Senator Casey also held hearings on disabled older adults, including one with former Social Security Commissioner Martin O’Malley to discuss what the Social Security Administration (SSA) is doing to make the application process easier,” added Richtman, noting that other hearings were held on scammers preying on the elderly – designed to help older adults and their families know what to look for — and protect against.  

“We can only hope that when Republicans assume control of the Senate in January, this committee will continue the serious work of looking after the interests of seniors, who have contributed so much to our society and yet are among our most vulnerable citizens,” says Richtman.

“Leadership Council of Aging Organizations (LCAO) thanks Senator Bob Casey for his leadership and dedication to improving the lives of older Americans through his work on the Senate Aging Committee,” said Debra Whitman, LCAO Chair. “We look forward to collaborating with incoming Chairman Rick Scott to continue addressing the needs and enhancing the well-being of our nation’s growing aging population,” she says.

“As Chairman of the Senate Special Committee on Aging, Senator Bob Casey was a critical champion for seniors. He fought to strengthen Social Security and Medicare, stop elder abuse, and improve conditions in nursing homes. Casey will be greatly missed in the Senate by everyone who cares about senior issues. We urge the next chairman of this invaluable committee to continue his legacy.” Says Nancy Altman, President of Social Security Works.

“It is wonderful to have a Senate Aging Committee and Senator Casey’s terrific advocacy but inexcusable for the House not to restore its counterpart, which Chairman Claude Pepper proved is indispensable,” said Robert Weiner, former Chief of Staff of the House Select Committee on Aging and later a senior White House spokesman.

Announcing job transitions and retirement – in Rhode Island

Two well-known aging advocates have announced their departures.

The Alliance for Better Long-Term Care announces the retirement of Kathleen “Kathy” Heren. She dedicated 26 years to serving Rhode Island’s seniors.  For the past 15 years, Heren has served as the Rhode Island State Long Term Care Ombudsman, tirelessly advocating for the rights and well-being of residents in long-term care facilities across the state. She is known for her “fierce dedication, wisdom, and compassion have made her an unwavering champion for those in need.”

After serving as Executive Director of LeadingAgeRI for over 16 years, James P. Nyberg is leaving the nonprofit to become Senior Advisor at the Boston-based Public Consulting Group.   He will provide his expertise to the company on home and community-based services.

During his tenure, he significantly advanced aging services by advocating for quality, affordable care and fostering partnerships with state and national stakeholders. His leadership has driven innovative initiatives addressing the needs of older Rhode Islanders while supporting workforce development and professional growth among member organizations.

Nyberg ably served as Chair of the state’s Advisory Commission on Aging for over six years.