More AstraZeneca drugs to be added to US IRA list, Barclays predicts

AstraZeneca PLC (NASDAQ:AZN) faces several negative headwinds for US sales of some of its drugs from the new Inflation Reduction Act’s rules on negotiated price cuts, according to Barclays (LON:BARC), with a lesser impact for GSK PLC (LON:GSK).

Key measures in the new rules, according to analysts at the bank, include capping annual price increases to inflation rates, altering coverage gap rebates, and initiating direct drug price negotiation from 2026.

Direct drug price negotiation becomes effective in 2026 for the first 10 drugs, with 15 more added in 2027, 15 more in 2028 and then 20 a year from 2029 onwards.

The first list of 10 drugs was announced on Tuesday with “limited impact” on EU pharma for the products, which includes Novartis (LON:0QLR)’ Entresto, AstraZeneca’s Farxiga and Novo’s Novolog/Fiasp.

The IRA’s impact on the EU pharma remains “manageable” despite potential 50% price cuts on negotiated drugs, the analysts added.

An analysis of potential future lists led Barclays to expect inclusion of GSK’s Ellipta drugs and AZN’s Calquence in the 2027 list; AZN’s Imfinzi in 2030, among others.

The forecast is that the act, effective from 2026, will reduce EU pharma’s 2030 sales by 1.5% and sector earnings per share by 4% on average, with variance between zero and 8% on EPS.

“We see a more modest [net present value] impact, given the majority of products facing cuts are close to loss of exclusivity,” the analysts said.

Barclays sees a net headwind for specialty care drugs including AstraZeneca’s blockbuster oncology medicines Tagrisso and Lynparza due to the implementation of a 20% rebate in the catastrophic phase above the $8,100 drug cost threshold, along with an impact for one Novartis drug.

On the reduction in coverage gap rebates and establishment of catastrophic coverage rebates, AstraZeneca is seen to have the “biggest negative impact” of -0.5% in 2025 and -1% in 2030, the analysts estimated.