The First 10 Negotiated Drugs
The Centers for Medicare & Medicaid Services (CMS) selected 10 high-cost, widely used drugs for the first round of negotiations. The negotiated prices take effect on January 1, 2026, and apply to all Medicare Part D and Medicare Advantage prescription drug plans.
| Drug Name (Brand) | Used to Treat | Est. Savings |
|---|---|---|
| Eliquis (apixaban) | Blood clots, stroke prevention | ~38–42% |
| Xarelto (rivaroxaban) | Blood clots, atrial fibrillation | ~35–40% |
| Jardiance (empagliflozin) | Type 2 diabetes, heart failure | ~45–50% |
| Januvia (sitagliptin) | Type 2 diabetes | ~40–45% |
| Farxiga (dapagliflozin) | Type 2 diabetes, heart failure, CKD | ~48–52% |
| Entresto (sacubitril/valsartan) | Heart failure | ~42–46% |
| Enbrel (etanercept) | Rheumatoid arthritis, psoriasis | ~55–60% |
| Imbruvica (ibrutinib) | Blood cancers (CLL, lymphoma) | ~35–40% |
| Stelara (ustekinumab) | Psoriasis, Crohn disease | ~50–55% |
| Fiasp / NovoLog (insulin aspart) | Diabetes (insulin) | ~65–70% |
Average Savings: 45–55%
Medicare estimates these negotiated prices will reduce spending by approximately $6 billion in 2026 and $98.5 billion over 10 years. Beneficiary out-of-pocket costs for these drugs are expected to drop by 38–79% depending on the medication.
How Negotiations Work
The Inflation Reduction Act (IRA), signed into law in August 2022, gave Medicare the authority to negotiate drug prices directly with manufacturers for the first time. Here is how the process works:
Step 1: Drug Selection (Spring)
CMS identifies the highest-cost, most-used drugs that have been on the market for at least 9 years (13 years for biologics) without generic competition. The first 10 drugs were announced in August 2023.
Step 2: Negotiation Period (Summer–Fall)
CMS and manufacturers engage in formal negotiations using a framework that considers research costs, manufacturing, and therapeutic benefit. Manufacturers must participate or face steep tax penalties.
Step 3: Price Announcement (Fall)
By September 1 of the year before implementation, CMS publicly announces the negotiated prices. These are binding maximum fair prices (MFPs) that all Medicare plans must honor.
Step 4: Implementation (January 1)
Starting January 1 of the implementation year, all Part D plans and Medicare Advantage plans with drug coverage must apply the negotiated prices. Beneficiaries see lower copays and coinsurance immediately.
What Beneficiaries Should Expect
The 2026 negotiated prices will bring noticeable changes to Medicare prescription drug coverage. Here is what you need to know:
Lower Copays on Certain Medications
If you take one of the negotiated drugs, your out-of-pocket costs will decrease significantly — in some cases by more than 50%. This applies to both copayments and coinsurance.
Formularies May Shift
Plans may adjust which tier these drugs appear on or change prior authorization requirements. Review your 2026 formulary to confirm continued coverage and cost-sharing.
Savings Apply Gradually Across Plans
While negotiated prices are mandatory, each Part D plan sets its own cost-sharing structure. Compare plans during Open Enrollment to maximize your savings in 2026.
Important Note About Generic Alternatives
These negotiated prices apply to the brand-name versions. If a generic or biosimilar becomes available, it may be even cheaper. Always ask your pharmacist or doctor about lower-cost alternatives.
Next Steps: 2027–2028 Expansion
The drug negotiation program expands significantly in the coming years, covering more medications and delivering even greater savings to Medicare beneficiaries.
15 Additional Drugs
CMS will negotiate prices for 15 more drugs, selected in 2024, with negotiated prices taking effect January 1, 2027. This second wave will focus on additional high-cost medications for chronic conditions.
20 Additional Drugs
By 2028, Medicare will negotiate prices for 20 additional drugs, bringing the total to 45 medications with negotiated prices. This includes Part B drugs covered under medical benefits.
Long-Term Impact
By 2029 and beyond, Medicare will negotiate prices for up to 20 new drugs annually. The Congressional Budget Office estimates this will save Medicare $98.5 billion over 10 years while lowering premiums and out-of-pocket costs for all beneficiaries.
Related 2026 Medicare Changes
Continue exploring how Medicare drug coverage is evolving in 2026.