A significant change is coming for some people who receive prescription drug coverage through Medicare Part D. Beginning January 1, 2027, Medicare-negotiated prices will take effect for 15 additional high-cost medications used to treat conditions such as diabetes, asthma, chronic obstructive pulmonary disease, cancer, digestive disorders, and mental health conditions.
These medications join the first 10 drugs with negotiated prices that took effect in 2026, bringing the total to 25. However, a negotiated price is not the same as a guaranteed copayment. Understanding that distinction will be important when reviewing your prescription coverage for 2027.
What Is a Medicare-Negotiated Price?
Through the Medicare Drug Price Negotiation Program, the Centers for Medicare & Medicaid Services negotiates directly with participating manufacturers of certain high-cost medications that do not have generic or biosimilar competition.
The resulting amount is officially called a “maximum fair price.” Manufacturers must make that negotiated price available for eligible Medicare Part D prescriptions beginning on the applicable date. Medicare prescription drug plans and Medicare Advantage plans that include drug coverage must also include the selected medications on their formularies.
Which Medications Are Included for 2027?
The second group includes the following medications:
- Ozempic, Rybelsus, and Wegovy: Used for approved indications involving type 2 diabetes, cardiovascular disease, and obesity or overweight.
- Tradjenta: Used to treat type 2 diabetes.
- Janumet and Janumet XR: Used to treat type 2 diabetes.
- Trelegy Ellipta: Used to treat asthma and chronic obstructive pulmonary disease, or COPD.
- Breo Ellipta: Used to treat asthma and COPD.
- Xtandi: Used to treat prostate cancer.
- Pomalyst: Used to treat multiple myeloma and Kaposi sarcoma.
- Ibrance: Used to treat certain forms of breast cancer.
- Calquence: Used to treat certain forms of leukemia and lymphoma.
- Ofev: Used to treat idiopathic pulmonary fibrosis and certain other chronic lung conditions.
- Linzess: Used to treat chronic constipation and irritable bowel syndrome with constipation.
- Xifaxan: Used to treat hepatic encephalopathy and irritable bowel syndrome with diarrhea.
- Austedo and Austedo XR: Used to treat tardive dyskinesia and chorea associated with Huntington’s disease.
- Vraylar: Used to treat conditions including bipolar disorder, major depressive disorder, and schizophrenia.
- Otezla and Otezla XR: Used to treat plaque psoriasis, psoriatic arthritis, and oral ulcers associated with Behçet’s disease.
Coverage can depend on the condition being treated and other plan requirements. Being on this list does not mean Medicare will cover a medication for every possible use.
How Much Lower Are the Negotiated Prices?
CMS compared the negotiated prices for a standardized 30-day supply with the medications’ 2024 list prices. Across the 15 selected drugs, the reductions range from approximately 38% to 85%.
Some examples include:
- The negotiated price for Ozempic, Rybelsus, and Wegovy is listed at $274, compared with a 2024 list price of $959—a difference of approximately 71%.
- Trelegy Ellipta is listed at $175, compared with $654—a difference of approximately 73%.
- Linzess is listed at $136, compared with $539—a difference of approximately 75%.
- Janumet and Janumet XR are listed at $80, compared with $526—a difference of approximately 85%.
These figures compare Medicare’s negotiated prices with previous manufacturer list prices. They do not represent a new flat copayment or guarantee that every person taking the medication will pay the amount shown.
CMS reports that approximately 5.3 million people with Medicare Part D used one or more of these medications during 2024. Collectively, beneficiaries spent approximately $1.7 billion out of pocket on them. CMS estimates that the negotiated prices could produce approximately $685 million in beneficiary out-of-pocket savings during 2027 under the standard Part D benefit.
What Could This Mean at the Pharmacy?
The amount you personally pay for a medication may still depend on several factors, including:
- Your Medicare prescription drug plan
- The plan’s copayment or coinsurance structure
- Whether you have met your deductible
- Your dosage and prescribed quantity
- The pharmacy you use
- Any prior authorization or other coverage requirements
- Whether you receive Extra Help with prescription costs
Someone whose plan charges coinsurance based on a medication’s price could see a different effect than someone whose plan uses a fixed copayment. In some cases, a plan’s negotiated cost may already have been below the previous list price.
The new prices should reduce the underlying cost of these medications within Medicare, but they will not affect every beneficiary in exactly the same way.
What Should You Do Before 2027?
Do not stop taking or change a medication because of its negotiated price. Decisions about your prescriptions should always be made with your doctor or other qualified healthcare provider.
When 2027 plan information becomes available, review each medication you take using its exact name, dosage, quantity, and frequency. Check whether it is covered, what cost-sharing applies, whether your pharmacy participates in the plan’s network, and whether the plan requires prior authorization or another coverage step.
Your medications are only one part of choosing Medicare coverage, but they can have a major effect on your overall healthcare costs. Preparing an accurate prescription list now will make it easier to understand how these negotiated prices and your plan’s other coverage rules could affect you in 2027.
The Bottom Line
Medicare’s negotiated prices for these 15 medications represent an important change in how some of the program’s highest-cost prescriptions are priced. They may help lower costs for Medicare and many beneficiaries, but the amount saved will vary from person to person.
As you prepare for the year ahead, watch for official information from Medicare and your current plan. Carefully reviewing your prescriptions alongside your other healthcare needs will help you understand what these changes may mean for you.