Departed Biden Medicare Chief Lauds Landmark Drug Negotiations

Meena Seshamani’s Medicare swan song ended on a note of bravura.

After leading the Center for Medicare, within the Centers for Medicare & Medicaid Services at the HHS, Seshamani’s work to help launch the Medicare prescription drug negotiations unit concluded last week with the announcement that 15 costly drugs, including Novo Nordisk blockbusters Wegovy and Ozempic, are slated for talks. The resulting negotiated prices will take effect in 2027.

“It has been the opportunity of a lifetime to lead Medicare through this historic time,” Seshamani said in an interview at Bloomberg Law’s Arlington, Va., headquarters hours after the announcement. “In the past more than three and a half years, we’ve made more improvements to the Medicare program than in prior decades.

“And what matters to me is that I can continue that momentum with whatever I do next.”

With training and experience as a health-care administrator, health economist, physician and college professor, Seshamani’s diverse background could lead her down many paths.

But first up on her agenda: a two-city West Coast trip to watch her son play in a volleyball tournament. After that, she wants to resume her efforts as a health-care change agent “to really drive change for the whole system. That’s something that I want to continue. And so it’s just a question of what the opportunity will be.”

‘Open’ and ‘Responsive’

Seshamani and the entire CMS executive leadership team under Biden will be remembered as engaged administrators, said Marc Samuels, CEO of ADVI Health, a consulting firm.

“While not everyone was happy with every policy, the CMS team was open, engaged, responsive, and respectful,” Samuels said in an email. “It was the kind of openness that hasn’t existed since” former CMS Administrator Tom Scully’s open-door forums.

Samuels said he “expects the same environment to continue” under Mehmet Oz, who President-elect Donald Trump has pegged to lead CMS.

Seshamani’s tenure at Medicare came as the program underwent a massive shift that saw 54% of eligible beneficiaries enrolled in private Medicare Advantage plans in 2024, while the share of traditional, fee-for-service enrollees continues to shrink.

Seshamani played a pivotal role in implementing the provisions of the Democrats’ Inflation Reduction Act that allow government officials to negotiate with pharmaceutical giants over the price Medicare pays for some of the most expensive and widely used drugs by beneficiaries.

Her behind-the-scenes work to stand up the Medicare Drug Rebate and Negotiations Group included monthly technical calls and regular strategic calls with a variety of health-care players, all with a different stake in how the law was implemented.

“My team was always willing to meet with people, and when we would meet with people, we would say, ‘What are the things that you think we should know about implementing this law—the good, the bad and the ugly?’” she said. “At the end of the day, everyone has their perspective, and then my job is to look at all of those perspectives and try to find common paths forward.”

The negotiations group features some 100 people with backgrounds in pharmacy, insurance, economics, and other specialties.

“It was really important to me to have that diversity of perspectives and experience because that’s how you’re going to stand up a program that is thoughtful, sustainable, and trying to move the needle in a way that can make sense for the market,” she said.

Changes Likely

While Medicare’s drug negotiation infrastructure will be Seshamani’s signature accomplishment, its fate—amid lawsuits and drug industry pushback—is unclear under Trump, who is being sworn into office Monday.

Seshamani said changes are likely to follow.

“I think there will be continued opportunities for iteration, and my hope is that the way that we have set up the program is the theme moving forward,” Seshamani said.

“Markets change and the needs of people change,” she added. “It would not be wise to say, ‘What we did in year one should be set in stone, and that’s the way it should be forever.’ You have to have that ability to be agile and to adjust.”

If confirmed, Oz would be at the helm of Medicare drug negotiations. Medicare’s fate could also be influenced by Robert F. Kennedy Jr., Trump’s pick to lead the Department of Health and Human Services.

Seshamani urged the new administration to trust the agency’s mission-driven staff of career experts, help various players in the health care eco-system to work together, and “keep the people that you serve at the center” of all their work.

“Everybody wants innovative cures and therapies that people need, and they only work if people can access them at a price they can afford,” she said.