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As Medicare prepares to negotiate prices for its first batch of medicines, an advocacy group argues the agency should factor in controversial patent maneuvers for one drug that will have cost the program nearly $2 billion in additional spending by 2026.

At issue is the Enbrel medication sold by Amgen for treating rheumatoid arthritis and other ailments. The drug was one of 10 selected by Medicare officials for price negotiations, which are designed to create so-called maximum fair prices that will go into effect in three years. But Public Citizen maintains Medicare officials should consider the ongoing cost of the patenting tactics when negotiating a price.

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Here’s the backstory: Enbrel was the centerpiece of a 2002 deal in which Amgen acquired another company called Immunex that had developed the medicine. Later, Amgen reworked old patent applications and, by doing so, succeeded in extending patent protection for the medicine from 2019 until 2029, according to an analysis by the advocacy group.

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