Health Technology Assessment, Again: A Transparent, Evidence-Based Approach For CMS Drug Price Negotiations

The Centers for Medicare and Medicaid Services (CMS) can now negotiate the prices of a set of drugs that represent significant Medicare expenditures. The long-term success of negotiations will depend in part on stakeholders' views on the program's transparency and inclusivity. CMS has completed its first round of price negotiations for ten drugs; the prices will become effective on January 1, 2026. For future rounds, we advocate that CMS adopt a different price negotiation approach, one that embodies the best practices of health technology assessment-the discipline that determines a fair drug price in many settings worldwide. Our proposed framework consists of four components: selection of therapeutic alternatives, assessment of the value of the selected drugs, a decision matrix for weighting multiple negotiation factors, and a deliberation on the accumulated clinical and economic evidence by an independent advisory committee. Patient, caregiver, and other stakeholder engagement is integrated in each component.