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With the Senate poised to move forward with a bill allowing the government to negotiate drug prices, analysts say Eli Lilly, AstraZeneca, AbbVie and Johnson & Johnson are among those that stand to lose the most revenue from the proposed legislation.

Now winding its way through the Senate, the draft bill would subject high-cost drugs covered under Medicare Part D to price limits starting in 2026. If it passes, a number of oncology and diabetes brands that sell into Medicare could see major exposure by the end of the decade, analysts from SVB Securities warned in a note issued to clients last Friday.

Small-molecule drugs that are nine or more years from FDA approval, or 13 or more years for biologics, would be eligible for negotiation. 

But since drugmakers often extend their brands’ exclusivity beyond nine or 13 years, their revenue “tail” could be cut short. Take the Type 2 diabetes/obesity drug Mounjaro (tirzepatide), a dual GIP/GLP1 receptor agonist from Lilly that was approved May 13. It’s among the Part D (retail prescription) drugs with the highest percentage of Medicare spend in coming years. 

Mounjaro is expected to lose patent exclusivity in 2036. Under the proposed legislation, however, Medicare could start negotiating Mounjaro’s price in 2031, potentially curtailing revenue five years before biosimilar competition would be expected to kick in.

“Not only would the economics for many drugs be curtailed before loss of exclusivity [LOE], but innovators’ willingness to develop new drugs, in particular small molecule therapies for seniors, would likely diminish,” the SVB team wrote in its note.

Other drugs with a high percentage of Medicare sales that could see their profit tails shortened include J&J’s multiple myeloma drug Darlezex, whose revenue could trail off eight years early; AZ’s lung cancer med Tagrisso and hematology therapy Calquence, both of whose tails could be shortened by six years; and AbbVie’s oncology drug Imbruvica, whose tail could also be winnowed by six years, according to the analysts.

With an estimated LOE in 2037 versus potential negotiation in 2028, Vertex’s cystic fibrosis med Trikafta screened highest in the analysis, with nine years cut off. But a relatively small amount of the drug’s U.S. sales come from Medicare, given that its patient population is skewed well below age 65.

Among other negative considerations flagged by the SVB team, certain products that were expected to “never face biosimilar competition” would face significant tail risk, such as CART-T therapies, vaccines (like GSK’s Shingrix) and certain blood products. Meanwhile, some drugs with relatively high U.S. gross-to-net sales could face “massive payments” to the government, since discount percentages would apply to gross figures. 

And these are just the major drugs that would be affected.

“There could be dozens more small/mid-sized drugs at risk,” SVB cautioned. That’s because the number of drugs on the price-control list will be cumulative, ramping up from 10 in 2026 to 60 by 2029. In 2026 and 2027, Medicare would only negotiate prices for drugs in Part D, but starting in 2028 it could also impact those in Part B, which are physician-administered.

The legislation would allow for two years of negotiation, so drugs will be ranked on sales two years prior to when price controls could start. The Congressional Budget Office estimated $101.8 billion in Medicare savings from the drug negotiation measure alone.

There are some bright spots to the draft legislation for drugmakers, though. Brands set to lose exclusivity by decade’s end – think Pfizer and Bristol Myers Squibb’s blood thinner Eliquis and Merck and AZ’s cancer med Lynparza – face no exposure, or a limited window of price controls. And since Part B drugs are not eligible until 2028, Merck’s oncology megablockbuster Keytruda would likely not see price controls at all, given that it’s set to face biosimilars in 2028.

Much is left to be determined during the next several days, which will see a final draft of the potential legislation. It remains up in the air whether the Senate will pass it by Friday (after which it is scheduled to go on recess) as well as whether the Senate parliamentarian will wave through the “teeth” of the bill enabling the Department of Health and Human Services to force manufacturers to negotiate.

“Don’t be too sanguine,” the analysts advised. “This bill would be a watershed event for U.S. government drug price controls.”