Next Round of Medicare Drug Negotiations: 15 Drugs Selected for 2027

The Medicare Drug Price Negotiation Program is expanding. After the first 10 negotiated drug prices took effect on January 1, 2026, the Centers for Medicare and Medicaid Services has now selected 15 additional Part D drugs for the second round of price negotiation under the Inflation Reduction Act. The new negotiated prices will take effect on January 1, 2027, and they are expected to deliver even greater savings to Medicare beneficiaries and the federal government.

CMS announced the 15 selected drugs in August 2025, following months of analysis to identify the highest-spending Part D medications without generic or biosimilar alternatives. Together, these 15 drugs accounted for approximately $46 billion in gross Part D spending during the most recent measurement period and were used by roughly 11 million Medicare enrollees. The list includes blockbuster medications for diabetes, heart failure, cancer, respiratory disease, and autoimmune conditions.

This guide covers all 15 drugs selected for 2027 negotiation, the conditions they treat, their current costs, how the negotiation timeline works, the expansion to Part D and Part B drugs, an update on legal challenges, expected savings, and how beneficiaries can prepare. If you take any of these medications, understanding the timeline is important for planning your coverage and taking advantage of both the negotiated prices and the $2,000 out-of-pocket cap already in place.

How the Second Round Builds on the First 10 Drugs

The first round of Medicare drug negotiations established a historic precedent. Ten high-cost Part D drugs, including Eliquis, Jardiance, Xarelto, Januvia, and Entresto received negotiated Maximum Fair Prices that reduced costs by 38% to 79% compared to their list prices. Those lower prices are now in effect for 2026, saving Medicare an estimated $6 billion in the first year and reducing out-of-pocket costs for approximately 9 million enrollees.

The second round expands the program from 10 to 25 total drugs under negotiation. By selecting 15 drugs instead of 10, CMS is accelerating the pace of the program as laid out in the Inflation Reduction Act. The law specifies 10 drugs for the first cycle, 15 for the second, 15 for the third, and 20 per year from the fourth cycle onward. Each round targets the next tier of highest-spending drugs that meet the eligibility requirements: FDA approval for at least 7 years for small-molecule drugs or 11 years for biologics, no generic or biosimilar competition, and coverage under Part D.

The second-round drugs represent a broader range of conditions than the first round, which was heavily concentrated in cardiovascular disease and diabetes. The 2027 list includes medications for cancer, chronic obstructive pulmonary disease, movement disorders, gastrointestinal conditions, autoimmune diseases, and obesity. This broader therapeutic reach means that millions of additional beneficiaries who were not directly affected by the first round will now see cost relief.

The Complete List of 15 Drugs Selected for 2027 Negotiation

Below is every drug selected by CMS for the second round of Medicare price negotiations. For each medication, we include the condition it treats, the approximate current 30-day cost before negotiation, and the number of Medicare enrollees who use it. The final negotiated Maximum Fair Prices will be announced in late 2026.

1. Ozempic (semaglutide) -- Type 2 Diabetes

• Manufacturer: Novo Nordisk
• Condition treated: Type 2 diabetes; reduces blood sugar and cardiovascular risk in adults with Type 2 diabetes
• Current approximate 30-day cost: $935
• Medicare enrollees using this drug: Approximately 1.6 million

Ozempic is a GLP-1 receptor agonist that has become one of the most prescribed diabetes medications in the country. It is administered as a weekly injection and has been shown to reduce cardiovascular events in addition to lowering blood sugar. Its high cost has made it one of the largest spending drivers in Part D.

2. Wegovy (semaglutide) -- Chronic Weight Management

• Manufacturer: Novo Nordisk
• Condition treated: Chronic weight management in adults with obesity or overweight with at least one weight-related comorbidity; also approved to reduce cardiovascular risk
• Current approximate 30-day cost: $1,349
• Medicare enrollees using this drug: Approximately 800,000

Wegovy contains the same active ingredient as Ozempic at a higher dose and is approved for weight management and cardiovascular risk reduction. Following the expansion of Medicare Part D coverage to include anti-obesity medications under the Treat and Reduce Obesity Act provisions, Wegovy spending in Medicare has risen significantly.

3. Trelegy Ellipta (fluticasone furoate/umeclidinium/vilanterol) -- COPD and Asthma

• Manufacturer: GlaxoSmithKline
• Condition treated: Maintenance treatment of chronic obstructive pulmonary disease (COPD) and asthma in adults
• Current approximate 30-day cost: $653
• Medicare enrollees using this drug: Approximately 1.3 million

Trelegy Ellipta is a triple-combination inhaler that delivers three medications in a single daily dose for patients with COPD or asthma. It has become the leading respiratory medication in Medicare by spending, as it replaces the need for multiple separate inhalers.

4. Entresto (sacubitril/valsartan) -- Heart Failure

• Manufacturer: Novartis
• Condition treated: Chronic heart failure with reduced ejection fraction; reduces the risk of cardiovascular death and hospitalization
• Current approximate 30-day cost: $628
• Medicare enrollees using this drug: Approximately 940,000

Entresto is a cornerstone therapy for heart failure and is used by nearly a million Medicare beneficiaries. It combines two active ingredients to reduce strain on the heart and has been shown to significantly reduce hospitalizations and cardiovascular death compared to older heart failure treatments.

5. Farxiga (dapagliflozin) -- Diabetes, Heart Failure, and Kidney Disease

• Manufacturer: AstraZeneca
• Condition treated: Type 2 diabetes, heart failure with reduced and preserved ejection fraction, and chronic kidney disease
• Current approximate 30-day cost: $556
• Medicare enrollees using this drug: Approximately 1.1 million

Farxiga is an SGLT2 inhibitor similar to Jardiance, which was part of the first negotiation round. It is approved for a uniquely broad range of conditions, making it one of the most versatile and widely prescribed medications in Medicare.

6. Xtandi (enzalutamide) -- Prostate Cancer

• Manufacturer: Astellas / Pfizer
• Condition treated: Metastatic and non-metastatic castration-resistant prostate cancer
• Current approximate 30-day cost: $14,580
• Medicare enrollees using this drug: Approximately 120,000

Xtandi is one of the most expensive oral cancer medications in the Medicare program. Despite serving a smaller patient population than diabetes or heart medications, its extremely high per-patient cost makes it one of the highest total-spending drugs in Part D. Negotiation could bring dramatic relief to patients who currently face thousands of dollars in out-of-pocket costs even with insurance.

7. Pomalyst (pomalidomide) -- Multiple Myeloma

• Manufacturer: Bristol Myers Squibb
• Condition treated: Multiple myeloma in adults who have received at least two prior therapies
• Current approximate 30-day cost: $21,075
• Medicare enrollees using this drug: Approximately 28,000

Pomalyst is a critical treatment for multiple myeloma, a blood cancer that disproportionately affects older adults. At over $21,000 per month, it represents one of the highest per-unit costs of any drug on the negotiation list.

8. Ibrance (palbociclib) -- Breast Cancer

• Manufacturer: Pfizer
• Condition treated: HR-positive, HER2-negative advanced or metastatic breast cancer in combination with hormonal therapy
• Current approximate 30-day cost: $16,561
• Medicare enrollees using this drug: Approximately 62,000

Ibrance was one of the first CDK4/6 inhibitors approved for breast cancer and remains widely prescribed. Its high monthly cost places a significant financial burden on beneficiaries battling advanced breast cancer, many of whom are on the drug for extended periods.

9. Calquence (acalabrutinib) -- Blood Cancers

• Manufacturer: AstraZeneca
• Condition treated: Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) in adults
• Current approximate 30-day cost: $17,147
• Medicare enrollees using this drug: Approximately 42,000

Calquence is a BTK inhibitor used to treat chronic lymphocytic leukemia, the most common type of leukemia in adults. Patients typically take it continuously, often for years, making the cumulative cost burden substantial for Medicare and for individual beneficiaries.

10. Austedo (deutetrabenazine) -- Movement Disorders

• Manufacturer: Teva Pharmaceutical
• Condition treated: Tardive dyskinesia and chorea associated with Huntington disease
• Current approximate 30-day cost: $8,239
• Medicare enrollees using this drug: Approximately 63,000

Austedo treats involuntary movement disorders that can significantly impair quality of life. Tardive dyskinesia often develops as a side effect of long-term use of certain psychiatric medications, making it particularly relevant for older adults on multiple prescriptions.

11. Linzess (linaclotide) -- Gastrointestinal Disorders

• Manufacturer: AbbVie / Ironwood Pharmaceuticals
• Condition treated: Irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC) in adults
• Current approximate 30-day cost: $571
• Medicare enrollees using this drug: Approximately 590,000

Linzess is one of the most prescribed brand-name medications for chronic constipation-related conditions in older adults. Its large user base and lack of generic alternatives make it a significant source of Part D spending.

12. Otezla (apremilast) -- Psoriasis and Psoriatic Arthritis

• Manufacturer: Amgen
• Condition treated: Plaque psoriasis, psoriatic arthritis, and oral ulcers associated with Behcet disease
• Current approximate 30-day cost: $3,808
• Medicare enrollees using this drug: Approximately 105,000

Otezla is an oral PDE4 inhibitor that offers a non-biologic treatment option for psoriasis and psoriatic arthritis. It is often preferred by patients who want to avoid injectable biologic therapies, but its monthly cost remains high.

13. Augmentin XR (amoxicillin/clavulanate) -- Bacterial Infections

• Manufacturer: GlaxoSmithKline
• Condition treated: Acute bacterial sinusitis, community-acquired pneumonia, and other bacterial infections in adults
• Current approximate 30-day cost: $355
• Medicare enrollees using this drug: Approximately 2.1 million

Augmentin XR is the extended-release formulation of the widely used antibiotic amoxicillin-clavulanate. While lower in per-unit cost than many other drugs on the list, its enormous user base makes it a significant total-spending drug in Medicare Part D.

14. Cosentyx (secukinumab) -- Autoimmune Conditions

• Manufacturer: Novartis
• Condition treated: Plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, and non-radiographic axial spondyloarthritis in adults
• Current approximate 30-day cost: $6,258
• Medicare enrollees using this drug: Approximately 88,000

Cosentyx is a biologic IL-17A inhibitor administered by self-injection. It is used to treat several inflammatory and autoimmune conditions and has been on the market since 2015, meeting the 11-year biologic eligibility threshold for the negotiation program.

15. Venclexta (venetoclax) -- Blood Cancers

• Manufacturer: AbbVie / Genentech
• Condition treated: Chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), and acute myeloid leukemia (AML) in adults
• Current approximate 30-day cost: $14,934
• Medicare enrollees using this drug: Approximately 35,000

Venclexta is a BCL-2 inhibitor that has become a standard-of-care treatment for chronic lymphocytic leukemia and certain forms of acute myeloid leukemia. It is an oral chemotherapy taken daily, and its high cost over long treatment durations makes it a major spending driver in Medicare.

The Negotiation Timeline: From Selection to Lower Prices

The negotiation process for the second round of drugs follows the same structured timeline established by the Inflation Reduction Act and demonstrated in the first round. Understanding this timeline helps beneficiaries know when to expect changes and how the process unfolds behind the scenes.

• February 2025: CMS published the list of drugs eligible for negotiation based on spending data, FDA approval timelines, and lack of generic or biosimilar competition.
• August 2025: CMS announced the final list of 15 drugs selected for negotiation and notified manufacturers of their selection.
• October 2025 -- February 2026: CMS exchanged initial offers and counteroffers with each drug manufacturer. During this phase, CMS reviews clinical data, market comparisons, manufacturer costs, and the drug's therapeutic value.
• March -- July 2026: CMS and manufacturers continue negotiations, with up to three rounds of meetings allowed under the statutory framework. Patient and clinical input is also considered during this period.
• August 2026 (expected): CMS announces the final negotiated Maximum Fair Prices for all 15 drugs, similar to the August 2024 announcement for the first 10 drugs.
• January 1, 2027: The negotiated prices take effect across all Part D plans and Medicare Advantage plans with drug coverage. Beneficiaries automatically receive the lower prices with no action required.

Expansion to Part B Drugs in 2028

One of the most significant upcoming changes to the negotiation program is the inclusion of Part B drugs starting with the third round of selections for 2028. While the first two rounds focused exclusively on Part D drugs, which are self-administered medications like pills and injections you take at home, the third round will also include Part B drugs. Understanding the difference between all four parts of Medicare is essential to understanding why this expansion matters.

Part B covers drugs that are administered by a healthcare provider, typically in a doctor's office, hospital outpatient department, or infusion center. These include many cancer treatments, biologic infusions for autoimmune diseases, eye injections for macular degeneration, and osteoporosis medications. Part B drugs tend to be significantly more expensive on a per-dose basis than Part D drugs, and beneficiaries are responsible for 20% coinsurance with no annual out-of-pocket cap under Original Medicare.

The Inflation Reduction Act authorizes CMS to select up to 15 Part B and Part D drugs for the third round of negotiations, with prices taking effect in 2028, and up to 20 drugs per year starting in 2029. Analysts and patient advocates have identified several high-cost Part B drugs that could be candidates for negotiation, including certain cancer infusions and ophthalmology medications. The inclusion of Part B drugs is expected to deliver significant savings for beneficiaries who face high coinsurance costs for provider-administered medications.

Legal Challenges: Where Things Stand

Since the passage of the Inflation Reduction Act, the pharmaceutical industry has mounted an aggressive legal campaign to block the Medicare Drug Price Negotiation Program. Multiple lawsuits were filed by individual drug manufacturers including Bristol Myers Squibb, Johnson & Johnson, Merck, AstraZeneca, Boehringer Ingelheim, and Novo Nordisk, as well as by the Pharmaceutical Research and Manufacturers of America (PhRMA) and the U.S. Chamber of Commerce.

The legal arguments centered on several constitutional claims. Manufacturers argued that the excise tax penalty for refusing to negotiate amounts to unconstitutional coercion, that the program forces them into agreements that constitute a taking of private property without just compensation under the Fifth Amendment, and that requiring manufacturers to agree to negotiated prices amounts to compelled speech in violation of the First Amendment.

As of early 2026, every federal court that has ruled on these challenges has upheld the program. District courts in Delaware, New Jersey, Ohio, Texas, and elsewhere dismissed the industry's claims, and several appellate courts have affirmed those rulings. The courts have consistently found that manufacturers voluntarily participate in Medicare and Medicaid and that the negotiation program falls squarely within Congress's authority under the Spending Clause of the Constitution. The excise tax, courts have reasoned, is a lawful exercise of the taxing power and is not so coercive as to eliminate meaningful choice.

While some cases may eventually reach the Supreme Court, the program continues to operate on its statutory timeline. Both the first round of negotiations and the second round selection process have proceeded without judicial interruption. Legal experts widely expect the program to survive the remaining challenges, though the litigation could continue for several years.

Expected Savings from the Second Round

While the final negotiated prices for the 15 drugs will not be publicly released until late 2026, several indicators suggest that the second round could deliver even larger savings than the first. The Congressional Budget Office originally estimated that the entire Medicare Drug Price Negotiation Program would save the federal government approximately $98.5 billion over a decade, with savings growing as more drugs are added each year.

The first round of 10 drugs is projected to save Medicare $6 billion in 2026 alone. The second round includes drugs with some of the highest per-unit costs in the program, including Pomalyst at over $21,000 per month, Calquence at over $17,000 per month, Ibrance at over $16,500 per month, and Xtandi at over $14,500 per month. Even modest percentage reductions in these prices would translate to billions of dollars in savings.

For individual beneficiaries, the impact could be life-changing. Consider a Medicare enrollee taking Xtandi for prostate cancer at a list price of over $14,500 per month. Even with insurance, the out-of-pocket costs before reaching the $2,000 annual cap can be reached in a single month. A negotiated price reduction of 50% or more, consistent with what was achieved in the first round, would lower the overall cost burden on the Medicare program and could reduce the coinsurance amounts that beneficiaries pay before reaching the cap.

The savings are amplified by the $2,000 annual out-of-pocket cap on Part D spending that took effect in 2026. For beneficiaries who reach the cap quickly due to high-cost drugs, the negotiated prices primarily benefit Medicare and the Part D plans by reducing program spending. For beneficiaries who do not reach the cap, the negotiated prices directly reduce out-of-pocket costs dollar for dollar.

How This Builds on the First 10 Drugs

The first 10 drugs negotiated for 2026 were heavily concentrated in cardiovascular disease and diabetes. The list included Eliquis and Xarelto for blood clot prevention, Jardiance and Januvia for Type 2 diabetes, Entresto for heart failure, Farxiga for diabetes and kidney disease, Enbrel for autoimmune conditions, Imbruvica for blood cancers, Stelara for autoimmune conditions, and Fiasp and NovoLog insulin products.

The second round of 15 drugs significantly broadens the therapeutic reach of the program. It adds multiple cancer medications, including treatments for prostate cancer, breast cancer, multiple myeloma, and leukemia. It adds the first respiratory medication in Trelegy Ellipta, the first movement disorder drug in Austedo, the first gastrointestinal medication in Linzess, and the blockbuster GLP-1 drugs Ozempic and Wegovy. This expansion means that millions of beneficiaries with conditions not addressed in the first round will now benefit from the negotiation program.

Combined, the two rounds will cover 25 drugs representing a wide cross-section of the most expensive medications in Medicare Part D. As the program grows to include Part B drugs in 2028 and 20 drugs per year starting in 2029, the cumulative effect will be a fundamental restructuring of how Medicare pays for prescription drugs.

What Beneficiaries Should Do Now

If you are a Medicare beneficiary who takes one or more of the 15 drugs selected for the second round of negotiation, here is what you need to know and what steps you can take to prepare.

• Continue your current medications. Do not stop or change your medications based on the negotiation announcement. The new prices will not take effect until January 1, 2027. Your current prescriptions are covered under your existing Part D plan at current formulary prices.
• Take advantage of the $2,000 out-of-pocket cap. Starting in 2026, your total out-of-pocket spending on Part D drugs is capped at $2,000 per year. If you take expensive medications, you will hit this cap early in the year and pay nothing for covered drugs for the rest of the year. This protection is already in place regardless of whether your drug is on the negotiation list.
• Review your Part D plan during Annual Enrollment. Each fall during the Annual Enrollment Period from October 15 to December 7, you can review and switch your Part D plan or Medicare Advantage plan. When the 2027 plan information becomes available, compare how different plans cover the drugs you take and what your expected out-of-pocket costs will be under the new negotiated prices.
• Ask about the Medicare Prescription Payment Plan. Starting in 2025, Medicare introduced an option to spread your out-of-pocket drug costs over the year in monthly installments instead of paying large amounts upfront. If you take a high-cost medication, this program can help you manage cash flow even before the negotiated prices take effect.
• Check your eligibility for Extra Help. If you have limited income and resources, you may qualify for the Medicare Extra Help program, also known as the Low-Income Subsidy, which can significantly reduce your Part D premiums, deductibles, and copayments. The income limits for Extra Help were expanded under the Inflation Reduction Act.
• Stay informed. CMS will announce the final negotiated prices in late 2026. When those prices are released, you will be able to see exactly how much your medications will cost under the new Maximum Fair Prices. We will update our coverage guides as the details become available.

The Bigger Picture: Reshaping Medicare Drug Spending

The Medicare Drug Price Negotiation Program represents the most significant change to Medicare Part D since the program was created in 2003. For more than two decades, the prohibition on Medicare negotiating drug prices was a central feature of U.S. pharmaceutical policy. The Inflation Reduction Act fundamentally changed that equation, and the selection of 15 drugs for the second round demonstrates that the program is expanding as intended.

The cumulative impact of the program will grow significantly over time. By 2029, when the program reaches its full annual capacity of 20 drugs per year, dozens of high-cost medications will have negotiated prices. The inclusion of Part B drugs starting in 2028 will extend the program's reach to physician-administered medications, which include some of the most expensive drugs in the entire healthcare system.

There are also broader market implications. While the negotiated prices technically apply only to Medicare, some health economists believe that Medicare's negotiations will create a reference pricing effect that influences pricing across the entire U.S. pharmaceutical market. When the largest payer in the country establishes a fair price for a drug, private insurers and pharmacy benefit managers may use that price as a benchmark in their own negotiations.

Critics of the program, including many in the pharmaceutical industry, argue that negotiated prices could reduce incentives for research and development of new drugs. They contend that lower revenue from existing drugs could lead manufacturers to invest less in discovering new therapies. Supporters counter that the drugs selected for negotiation have been on the market for many years without generic competition and that their manufacturers have already recouped their development costs many times over.

Looking Ahead: 2028 and Beyond

The Inflation Reduction Act lays out a clear expansion schedule for the Medicare Drug Price Negotiation Program. After the 15 drugs selected for 2027, CMS will select up to 15 more Part B and Part D drugs for the third round of negotiations, with prices taking effect in 2028. Starting with the fourth round for 2029, CMS will select up to 20 drugs per year. This means that within just a few years, the program could cover 60 or more drugs.

The expansion to Part B drugs in 2028 is particularly consequential. Some of the most expensive medications in Medicare are administered in physician offices and covered under Part B, where beneficiaries face 20% coinsurance with no annual out-of-pocket cap under Original Medicare. Negotiated prices for these drugs could save individual beneficiaries thousands of dollars per year on medications like cancer infusions that can cost tens of thousands of dollars per treatment.

Additionally, the Inflation Reduction Act includes an inflation rebate provision that requires drug manufacturers to pay rebates to Medicare if they raise prices faster than the rate of inflation. This provision, which applies to both Part B and Part D drugs, acts as a complementary price control that prevents manufacturers from offsetting negotiated prices by raising prices on their other drugs.

The selection of 15 drugs for the second round of Medicare price negotiation marks a major milestone in the ongoing transformation of how America pays for prescription drugs. Whether you take one of these 15 medications or not, the program is reshaping the economics of Medicare Part D and will eventually extend to Part B as well. For a complete overview of how all the pieces of Medicare fit together, including Part A hospital coverage, Part B medical coverage, Part C Medicare Advantage, and Part D drug coverage, see our guide to the four parts of Medicare explained. As negotiated prices are finalized in late 2026, we will publish updated guides with the exact savings for each drug so you can plan your coverage accordingly.