Medicare Drug Price Negotiations: Which Prescription Costs Are Dropping?

Medication costs account for a large portion of people’s healthcare costs. Many older people have their drugs covered by the Medicare Part D drug plan.

However, even with covered prescriptions, some older people cannot take their drugs because of cost. The high costs of prescriptions can pose a health risk to patients choosing between necessary medication and affording food or rent.

Medicare’s drug price negotiations can reduce the cost of many common drugs. The Centers for Medicare & Medicaid Services has announced a list of common drugs for price negotiations to set the maximum fair price. For more information about how Medicare drug price negotiations can save you money, talk to a local elder law attorney.

Medicare Drug Coverage

The Centers for Medicare & Medicaid Services (CMS) administers Medicare benefits for eligible people aged 65 and older. Eligible individuals can get traditional Medicare (Parts A and B) or Medicare Advantage (Part C). Private insurance companies operate Medicare Advantage plans to provide the same coverage as traditional Medicare, often combined with other benefits.

Medicare Part D is an optional prescription drug benefit for eligible Medicare beneficiaries. Part D is a cost-sharing program to help lower the high costs of medication. Private insurance companies provide drug benefits for prescriptions filled by plan participants. Pharmacies and drug manufacturers often reimburse much of the Medicare prescription drug costs through rebates.

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Understanding the Medicare Drug Price Negotiation Program

President Joe Biden signed the Inflation Reduction Act (IRA) in August 2022. The law expanded benefits and lowered drug costs for many Medicare beneficiaries. As part of the IRA, Medicare had a way to negotiate with the drug companies to reduce the costs of many common drugs prescribed to plan beneficiaries.

The Medicare Drug Price Negotiation Program allows CMS to negotiate the prices of common, high-expenditure, single-source drugs that lack generics or biosimilars. The first round of price negotiations went into effect on January 1, 2026.

For example, Eliquis is a blood clot treatment and prevention drug with over 3.7 million Medicare Part D enrollees. The total annual covered prescription drug costs for Medicare Part D enrollees in 2022 to 2023 were over $16.4 billion. Drug price negotiations reduced the 30-day supply cost from $521 in 2023 to $231 in 2026.

Medicare Part D Drugs for 2027 Negotiations

On January 17, 2026, CMS announced the 15 Part D drugs as part of the second round of price negotiations. These drug negotiation rates will take effect for the applicability year 2027. These 15 drugs include:

1. Ozempic/Rybelsus/Wegovy
2. Trelegy Ellipta
3. Xtandi
4. Pomalyst
5. Ibrance
6. Ofev
7. Linzess
8. Calquence
9. Austedo/Austedo XR
10. Breo Ellipta
11. Tradjenta
12. Xifaxan
13. Vraylar
14. Janumet/Janumet XR
15. Otezla

First Round of Medicare Part D Drugs Negotiations in Effect in 2026

In 2023, Medicare announced its first list of 10 Part D drugs targeted for price negotiations. In August 2024, CMS had its first round of negotiations for 10 Part D Drugs:

1. Eliquis
2. Jardiance
3. Xarelto
4. Januvia
5. Farxiga
6. Entresto
7. Enbrel
8. Imbruvica
9. Stelara
10. Fiasp/NovoLog

The negotiated prices lowered the costs from 38 percent (for Imbruvica) to 79 percent (for Januvia). These negotiations lowered Part D list prices from $113 (Januvia) up to $9,319 (Imbruvica) for a 30-day supply.

Negotiating Your Own Prescription Drug Prices

As a patient, you have fewer options to negotiate your drug costs. However, there are options to lower prices for your expensive medications.

The most common way is to talk to your doctor. Tell your doctor that you are having trouble affording the out-of-pocket costs of your medication. Your doctor may be able to get samples or direct you to rebate options. Your doctor could also offer a lower-cost alternative that provides similar benefits.

Talk to an elder care attorney about your legal options if the costs of prescriptions are too high or Medicare denies your drug coverage. If your Medicare Advantage plan tries to change your prescription for cost reasons, your attorney can file a formulary exception claim. CMS has already negotiated the maximum fair price (MFP) for the selected drugs, and it should be considered a fair price.

If you are taking a drug that is now under the negotiated drug price change, check your billing to make sure you aren’t paying the older price. You can find this information on your Explanation of Benefits (EOB). Some patients are still charged the old list price instead of the lower negotiated price.

Medicare Advantage providers use artificial intelligence (AI) to review claims. These computer algorithms base their decisions on generalized patient information rather than your individual case review.

The insurance company can deny coverage for your drugs prescribed by your doctor based on the availability of an older generic drug. Talk to your doctor about obtaining documentation to appeal the claim and show that the prescribed drug is medically necessary.

Get Legal Help to Lower Drug Costs

You have options to try to lower your drug costs, but an attorney can open up additional avenues when your insurance provider tries to deny your claims. An attorney can explain your legal options and help you take action to lower your prescription drug costs.

When your Part D plan provider denies a medically necessary drug, your attorney can file an appeal with your insurance provider. Medicare and insurance providers approve the majority of denied claim appeals, either in full or in part. Filing an appeal is often your best chance to have your insurance company approve a denied claim.

For legal advice on your concerns about drug costs, talk to an experienced elder law attorney.