Medicare drug price negotiation: which drugs, and what it means at the pharmacy

What the program is

The Inflation Reduction Act of 2022 gave Medicare the power to negotiate the prices it pays for some high-cost brand-name drugs that have been on the market for years without generic or biosimilar competition. Before that law, Medicare was barred from negotiating drug prices directly.

Each year, CMS picks a set of drugs, negotiates with the companies that make them, and publishes the agreed price, called the "maximum fair price." Small-molecule drugs (usually pills) become eligible at least 7 years after FDA approval, and biologics at least 11 years after licensing. The number of drugs grows over time: 10 for 2026, 15 for 2027, 15 for 2028, and up to 20 a year after that.

The first 10 drugs: prices in effect since January 1, 2026

The first negotiated prices took effect on January 1, 2026, for 10 drugs covered under Medicare Part D. CMS reported that the prices are 38% to 79% lower than the drugs' 2023 list prices. For example, a 30-day supply of Eliquis has a negotiated price of $231, compared with a 2023 list price of $521. Januvia's is $113, compared with $527.

The 10 drugs are:

• Eliquis and Xarelto (blood thinners).
• Jardiance, Farxiga and Januvia (diabetes; Jardiance and Farxiga are also used for heart failure and kidney disease).
• Fiasp and NovoLog (insulin).
• Entresto (heart failure).
• Enbrel and Stelara (autoimmune conditions such as rheumatoid arthritis, psoriasis and Crohn's disease).
• Imbruvica (blood cancers).

The next 15 drugs: prices start January 1, 2027

CMS announced negotiated prices for a second group of 15 Part D drugs in November 2025. These prices take effect on January 1, 2027. CMS estimated they would have saved Medicare about $12 billion, or 44% in net spending, had they applied in 2024. About 5.3 million Part D enrollees used these drugs in 2024. The drugs are:

• Ozempic, Rybelsus and Wegovy (semaglutide, for type 2 diabetes, heart disease risk and weight).
• Trelegy Ellipta and Breo Ellipta (asthma and COPD).
• Janumet and Tradjenta (type 2 diabetes).
• Xtandi, Ibrance, Pomalyst and Calquence (cancers).
• Ofev (a lung disease called idiopathic pulmonary fibrosis).
• Linzess and Xifaxan (digestive conditions; Xifaxan is also used for a liver-related brain condition).
• Austedo (involuntary movement disorders).
• Vraylar (schizophrenia, bipolar disorder and depression).
• Otezla (psoriasis, psoriatic arthritis and Behcet's disease).

What it means for what you pay

This is the part that often gets misunderstood. Negotiation lowers the price Medicare and its drug plans pay. It does not automatically lower your copay. What you pay depends on how your plan is designed:

• If your plan charges coinsurance, a percentage of the drug's price, a lower price usually means you pay less. A study published in October 2026 found most plans used coinsurance for these drugs.
• If your plan charges a flat copay, a set dollar amount per fill, your cost may not change, because the plan sets that amount.
• If you're in your plan's deductible, you pay the plan's price for the drug, so a lower price can help.
• If you already reach Medicare's yearly out-of-pocket cap, which is $2,100 in 2026 and $2,400 in 2027, you won't see extra savings once you hit it. You may reach the cap later in the year, or not at all.
• If you get Extra Help, your copays are already low and set by law, so your costs may not change much.

How much beneficiaries may save

CMS estimated that people with Part D would save about $1.5 billion in out-of-pocket costs in 2026 from the first 10 drugs, and about $685 million in 2027 from the next 15. Those are totals across everyone. Your own savings depend on your plan and which drugs you take.

At the pharmacy, you should pay no more than the negotiated price for an included drug. Drug companies repay pharmacies for the difference after the sale, through a system CMS set up called the Medicare Transaction Facilitator.

What's next: the 2028 drugs

In January 2026, CMS named 15 more drugs for the third round. For the first time, the list includes drugs given in a doctor's office or clinic that are covered under Medicare Part B. It also includes Tradjenta, chosen for renegotiation. The drugs are Anoro Ellipta, Biktarvy, Botox, Cimzia, Cosentyx, Entyvio, Erleada, Kisqali, Lenvima, Orencia, Rexulti, Trulicity, Verzenio, Xeljanz and Xolair.

Prices for this group take effect January 1, 2028. Negotiations for this round end in early November 2026, and by law CMS must announce the prices by November 30, 2026.

Recent legal and policy changes

Several drug companies sued to stop the program. Federal appeals courts ruled against them, and on May 18, 2026, the U.S. Supreme Court declined to hear six of those appeals, leaving the lower-court rulings in place. A few other cases are still pending in lower courts as of late October 2026.

Congress also changed the program in the 2025 budget law. Drugs approved only for rare diseases, known as orphan drugs, are now excluded even if they treat more than one rare disease. The law also delays when some of these drugs can become eligible if they later gain approval for a more common use. KFF reports this change delayed the selection of some cancer drugs that had been expected to be chosen earlier.

Where to get free help

During Medicare Open Enrollment, which runs through December 7, 2026, check that your drug plan for 2027 covers your medicines and compare total costs with the Plan Finder on Medicare.gov. You can call 1-800-MEDICARE (1-800-633-4227) or get free, unbiased counseling from your State Health Insurance Assistance Program (SHIP) at shiphelp.org.