Evidence mapPaperPMID 40938639Full record

ArticleJournal of managed care & specialty pharmacy2025

Selected drugs, therapeutic alternatives, and price benchmarks for IPAY 2027 Medicare drug price negotiation.

Sean D Sullivan, Emma M Cousin, Kevin H Li, Nico Gabriel, Kristi Martin

Abstract read
In one paragraph

Article in Journal of managed care & specialty pharmacy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Sean D SullivanThe CHOICE Institute, School of Pharmacy, University of Washington, Seattle.
Emma M CousinThe CHOICE Institute, School of Pharmacy, University of Washington, Seattle.
Kevin H LiThe CHOICE Institute, School of Pharmacy, University of Washington, Seattle.
Nico GabrielSkaggs School of Pharmacy, University of California San Diego.
Kristi MartinCamber Collective, Washington, DC.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundOn or before November 1, 2025, the Centers for Medicare & Medicaid Services (CMS) will report the agreed-upon negotiated prices (maximum fair prices [MFPs]) for the second round of up to 15 Medicare Part D drugs selected for price negotiation (Initial Price Applicability Year 2027).

objectiveTo propose guideline-recommended therapeutic alternatives and estimate price benchmarks that may be considered by CMS for negotiation.

methodsWe identified US Food and Drug Administration (FDA)-approved indications for the 15 drugs selected for negotiation. We used 2022 Medicare claims data to identify drug-specific beneficiary utilization. Medical claims with

resultsFour drugs were identified to have 1 (deutetrabenazine, linaclotide, and nintedanib-esylate) or no (rifaximin) therapeutic alternative. Eight of the 15 selected drugs will have the ceiling price set by the minimum statutory discount. Four products (acalabrutinib, semaglutide, linagliptin, and sitagliptin/metformin) will include therapeutic alternatives and MFPs from the first round of negotiation. The selection of therapeutic alternatives and estimation of price benchmarks by CMS will set the initial conditions for subsequent price negotiation.

conclusionsThese analyses identify the likely ceiling price and various initial price offer scenarios for the second round of Medicare price negotiation. We report price benchmarks and likely therapeutic alternatives to improve transparency around the opaque CMS negotiation process.

Indexed as

BenchmarkingDrug CostsMedicare Part DNegotiatingCenters for Medicare and Medicaid Services, U.S.HumansUnited States

Identifiers

PMID40938639
PMCPMC12467749

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.