Medicare's Negotiated Drug Prices: 10 Medications That Cost Less in 2026

For the first time in the program's history, Medicare has directly negotiated the prices of prescription drugs. Under the Inflation Reduction Act signed into law in August 2022, the Centers for Medicare and Medicaid Services gained the authority to negotiate prices for a select group of high-cost Part D medications. The first 10 negotiated prices took effect on January 1, 2026, and the savings for Medicare beneficiaries are substantial.

These 10 drugs represent some of the most widely used and most expensive medications in the Medicare program. Together, they accounted for approximately $50.5 billion in gross Part D spending between June 2022 and May 2023, and they were used by roughly 9 million Medicare enrollees. The negotiated prices are projected to save Medicare $6 billion in the first year alone and reduce out-of-pocket costs for millions of seniors who rely on these medications daily.

This guide covers every drug on the negotiated list, the old versus new prices, how the negotiation process works, the 2026 out-of-pocket cap, the elimination of the coverage gap, and what comes next as CMS expands the program.

Why Medicare Drug Price Negotiation Matters

For decades, Medicare was prohibited by law from negotiating directly with pharmaceutical manufacturers over drug prices. While the Department of Veterans Affairs, Medicaid, and even private insurers could negotiate or receive mandatory rebates, Medicare Part D plans could only work through private plan sponsors who had limited bargaining power. The result was that Medicare — the single largest purchaser of prescription drugs in the United States — often paid some of the highest prices in the world for the same medications.

The Inflation Reduction Act changed that by authorizing CMS to negotiate Maximum Fair Prices for a select number of drugs each year. The law targeted drugs that had been on the market for a long time without generic or biosimilar competition and that represented the highest total spending in the Medicare program. The goal was straightforward: use Medicare's enormous purchasing power to bring down the cost of medications that millions of seniors depend on.

The impact is already being felt. When CMS announced the negotiated prices in August 2024, the reductions ranged from 38% to 79% off the list prices that manufacturers had been charging. For a beneficiary who takes Eliquis twice daily to prevent blood clots, the negotiated price cuts the 30-day cost from $521 to $231. For someone managing Type 2 diabetes with Januvia, the monthly cost dropped from $527 to just $113. These are not hypothetical savings — they are real price reductions built into every Part D plan formulary starting January 1, 2026.

The Complete List of 10 Negotiated Drugs and Their New Prices

Below is every drug selected for the first round of Medicare price negotiations, along with what each medication treats, the 30-day list price that was being charged before negotiation, and the new negotiated Maximum Fair Price. The percentage savings represent the reduction from the list price to the negotiated price.

1. Eliquis (apixaban) — Blood Clot Prevention

• Manufacturer: Bristol Myers Squibb / Pfizer
• Condition treated: Prevention of blood clots and stroke in people with atrial fibrillation; treatment and prevention of deep vein thrombosis and pulmonary embolism
• Previous 30-day list price: $521
• Negotiated Maximum Fair Price: $231 (56% savings)
• Medicare enrollees using this drug: Approximately 3.7 million

Eliquis is the most widely prescribed blood thinner in the Medicare program and was also the single highest-spending drug in all of Part D. Its selection for the first round of negotiations was expected given its enormous cost to the program.

2. Jardiance (empagliflozin) — Diabetes and Heart Failure

• Manufacturer: Boehringer Ingelheim / Eli Lilly
• Condition treated: Type 2 diabetes, heart failure, and chronic kidney disease
• Previous 30-day list price: $573
• Negotiated Maximum Fair Price: $197 (66% savings)
• Medicare enrollees using this drug: Approximately 1.6 million

Jardiance has become a cornerstone treatment for Type 2 diabetes because it not only lowers blood sugar but also reduces the risk of cardiovascular events and slows kidney disease progression. The 66% price reduction makes it significantly more affordable for the Medicare population.

3. Xarelto (rivaroxaban) — Blood Clot Prevention

• Manufacturer: Janssen (Johnson & Johnson)
• Condition treated: Prevention and treatment of blood clots, stroke prevention in atrial fibrillation, and reduction of cardiovascular risk
• Previous 30-day list price: $517
• Negotiated Maximum Fair Price: $197 (62% savings)
• Medicare enrollees using this drug: Approximately 1.3 million

Xarelto is another widely used anticoagulant that competes with Eliquis. Its 62% reduction brings the negotiated price down to the same level as Jardiance, making both available at $197 for a 30-day supply under the Maximum Fair Price.

4. Januvia (sitagliptin) — Type 2 Diabetes

• Manufacturer: Merck
• Condition treated: Type 2 diabetes
• Previous 30-day list price: $527
• Negotiated Maximum Fair Price: $113 (79% savings)
• Medicare enrollees using this drug: Approximately 869,000

Januvia received the largest percentage reduction of any drug on the list at 79%. This DPP-4 inhibitor has been on the market since 2006 and has long been one of the most prescribed diabetes medications in the United States. The negotiated price represents a dramatic reduction from its list price.

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

• Manufacturer: AstraZeneca
• Condition treated: Type 2 diabetes, heart failure, and chronic kidney disease
• Previous 30-day list price: $556
• Negotiated Maximum Fair Price: $178.50 (68% savings)
• Medicare enrollees using this drug: Approximately 799,000

Farxiga belongs to the same SGLT2 inhibitor class as Jardiance and is used for similar conditions. Like Jardiance, it offers cardiovascular and kidney protection beyond blood sugar control, making it a critical medication for patients with multiple chronic conditions.

6. Entresto (sacubitril/valsartan) — Heart Failure

• Manufacturer: Novartis
• Condition treated: Heart failure with reduced ejection fraction
• Previous 30-day list price: $628
• Negotiated Maximum Fair Price: $295 (53% savings)
• Medicare enrollees using this drug: Approximately 587,000

Entresto has become the standard of care for heart failure with reduced ejection fraction, a condition that affects millions of older Americans. Clinical trials showed it reduced the risk of hospitalization and cardiovascular death compared to older therapies. The 53% price reduction makes this life-saving medication more accessible.

7. Enbrel (etanercept) — Autoimmune Conditions

• Manufacturer: Amgen
• Condition treated: Rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, and ankylosing spondylitis
• Previous 30-day list price: $7,106
• Negotiated Maximum Fair Price: $2,355 (67% savings)
• Medicare enrollees using this drug: Approximately 48,000

Enbrel is a biologic TNF inhibitor that has been on the market since 1998. Despite the availability of biosimilars, Enbrel's list price remained extremely high. The negotiated price of $2,355 per month still represents a significant cost, but the 67% reduction is a major improvement for beneficiaries who depend on it.

8. Imbruvica (ibrutinib) — Blood Cancers

• Manufacturer: Pharmacyclics (AbbVie) / Janssen
• Condition treated: Chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), Waldenstrom's macroglobulinemia, and other blood cancers
• Previous 30-day list price: $14,934
• Negotiated Maximum Fair Price: $9,319 (38% savings)
• Medicare enrollees using this drug: Approximately 56,000

Imbruvica is an oral chemotherapy drug used primarily for blood cancers that disproportionately affect older adults. At nearly $15,000 per month, it was one of the most expensive drugs in Part D. Even with the 38% reduction — the smallest percentage on the list — beneficiaries will save over $5,600 per month. Combined with the $2,000 out-of-pocket cap, this negotiated price dramatically limits what patients actually pay.

9. Stelara (ustekinumab) — Autoimmune Conditions

• Manufacturer: Janssen (Johnson & Johnson)
• Condition treated: Plaque psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis
• Previous 30-day list price: $13,836
• Negotiated Maximum Fair Price: $4,695 (66% savings)
• Medicare enrollees using this drug: Approximately 22,000

Stelara is a biologic that targets specific proteins in the immune system (IL-12 and IL-23) and is used for several autoimmune conditions. The 66% reduction brings the monthly cost down by over $9,100, though the drug remains expensive. Beneficiaries taking Stelara will particularly benefit from the $2,000 out-of-pocket cap, which prevents their annual costs from spiraling out of control.

10. Fiasp and NovoLog (insulin aspart) — Diabetes

• Manufacturer: Novo Nordisk
• Condition treated: Type 1 and Type 2 diabetes (rapid-acting insulin)
• Previous 30-day list price: $495
• Negotiated Maximum Fair Price: $119 (76% savings)
• Medicare enrollees using this drug: Approximately 777,000

Fiasp and NovoLog are rapid-acting insulin products used by people with both Type 1 and Type 2 diabetes to control blood sugar around mealtimes. These insulins were grouped together in the negotiations because they share the same active ingredient (insulin aspart). The 76% reduction is one of the largest on the list. Additionally, all insulin products covered under Part D are already subject to the $35 monthly copay cap established by the Inflation Reduction Act, so beneficiaries using these insulins benefit from both protections.

How the Medicare Drug Price Negotiation Process Works

The Medicare Drug Price Negotiation Program established by the Inflation Reduction Act follows a structured, multi-step process. Understanding how CMS selects drugs and arrives at the final negotiated prices helps explain why certain medications were chosen and what beneficiaries can expect going forward.

Step 1: Drug Selection

CMS identifies drugs that meet specific criteria set by the law. To be eligible for negotiation, a drug must be a single-source brand-name product or biologic — meaning it has no generic or biosimilar equivalent on the market. It must have been approved by the FDA for at least 7 years (for small-molecule drugs) or 11 years (for biologics). Most importantly, it must rank among the highest-expenditure drugs in Medicare Part D (or Part B in future rounds). CMS publishes a ranked list and selects the top qualifying drugs.

Step 2: Negotiation Period

Once drugs are selected, CMS enters a formal negotiation period with each manufacturer. The negotiations consider several factors including the drug's clinical benefit, how it compares to therapeutic alternatives, the manufacturer's research and development costs, production and distribution costs, current net prices after existing rebates and discounts, and the drug's impact on federal spending. CMS makes an initial offer, the manufacturer can make a counteroffer, and the two sides negotiate until they reach the Maximum Fair Price or the process concludes.

Step 3: Price Ceiling Guardrails

The law establishes ceiling prices that the negotiated Maximum Fair Price cannot exceed. For drugs that have been on the market for 9 to 12 years, the ceiling is 75% of the drug's average non-federal manufacturer price. For drugs on the market 12 to 16 years, the ceiling drops to 65%. For drugs marketed 16 years or more, the ceiling is 40% of the non-federal manufacturer price. These guardrails ensure that even if negotiations are limited, prices for older drugs cannot remain at their highest levels.

Step 4: Publication and Implementation

After negotiations conclude, CMS publishes the final Maximum Fair Prices. For the first round, prices were announced on August 15, 2024, giving Part D plans several months to incorporate the new prices into their 2026 formularies and benefit designs. The Maximum Fair Prices took effect on January 1, 2026, and all Part D plans and Medicare Advantage prescription drug plans are required to honor them.

Total Savings: What the Numbers Mean for Beneficiaries

The scale of the savings from the first round of Medicare drug price negotiations is significant. According to CMS estimates, if the negotiated prices had been in effect during the June 2022 to May 2023 measurement period, Medicare would have saved approximately $6 billion on these 10 drugs alone. The roughly 9 million Medicare enrollees who use these medications would have collectively saved an estimated $1.5 billion in out-of-pocket costs during that same period.

To put those numbers in perspective, here is what the savings could mean for individual beneficiaries taking some of the most common drugs on the list:

• A beneficiary taking Eliquis could see their annual drug costs reduced by up to $3,480 based on the difference between the old list price and the negotiated price.
• A beneficiary taking Januvia could see the annual cost drop by up to $4,968 — the largest individual dollar savings among the oral medications on the list.
• A beneficiary taking Jardiance could save up to $4,512 annually compared to the previous list price.
• A beneficiary taking Imbruvica could see their plan's annual cost reduced by over $67,000, and combined with the $2,000 out-of-pocket cap, their personal exposure is capped regardless of the drug's total price.

It is important to note that the actual out-of-pocket savings for each beneficiary depend on their specific Part D plan's formulary tier, copay or coinsurance structure, and whether they qualify for Extra Help or other assistance programs. The negotiated prices reduce the base cost upon which your cost-sharing is calculated, so even if you have coinsurance rather than a flat copay, you will pay less than before.

The $2,000 Out-of-Pocket Cap and How It Works With Negotiated Prices

One of the most significant provisions of the Inflation Reduction Act is the annual out-of-pocket spending cap for Part D beneficiaries. This cap, which took effect in 2025 at $2,000, limits the total amount you pay out of pocket for covered prescription drugs in a calendar year. Once you reach that threshold, you pay $0 for covered drugs for the rest of the year. The cap replaces the old catastrophic coverage phase where beneficiaries still owed 5% coinsurance — a percentage that could amount to thousands of dollars for expensive drugs. For more details on how the coverage gap and catastrophic phase have changed, see our detailed guide.

The out-of-pocket cap includes what you pay for your Part D deductible, copayments, and coinsurance for covered drugs. It does not include your monthly Part D premium or any late enrollment penalties. For 2026, the cap amount is being adjusted for inflation and is set at approximately $2,150. CMS publishes the exact inflation-adjusted figure each year.

The negotiated drug prices and the out-of-pocket cap complement each other. The negotiated prices reduce the total cost of the medication, which in turn lowers your copay or coinsurance. This means beneficiaries who take one of the 10 negotiated drugs may spend less overall and may take longer to reach the cap — but they also spend less at each fill. For beneficiaries on extremely expensive drugs like Imbruvica or Stelara who would hit the cap early in the year regardless, the cap provides the critical protection, while the negotiated prices reduce the burden on Medicare and the Part D plans.

Beneficiaries can also take advantage of the Medicare Prescription Payment Plan, which allows you to spread your out-of-pocket drug costs across the year in equal monthly installments. There is no interest and no credit check. This option is especially valuable for people who take expensive medications early in the year and would otherwise face a large upfront cost before the cap kicks in.

The Next Round: 15 Drugs Selected for 2027 Negotiations

The Inflation Reduction Act mandates that CMS expand the Drug Price Negotiation Program in stages. In early 2025, CMS announced the next 15 drugs selected for negotiation, with the resulting Maximum Fair Prices scheduled to take effect on January 1, 2027. This second round includes both Part D drugs and, for the first time, Part B drugs that are administered in clinical settings such as doctor's offices and hospitals.

The 15 drugs selected for the 2027 negotiation round include medications used to treat conditions such as cancer, autoimmune disorders, blood disorders, cardiovascular disease, and more. Among the notable selections are several high-cost specialty drugs that have been a major driver of Medicare spending. CMS is currently in the negotiation phase with these manufacturers, and the final prices will be announced by August 2026.

The expansion schedule laid out in the law is as follows:

• 2026: 10 Part D drugs (prices now in effect)
• 2027: 15 Part D and Part B drugs (negotiations underway)
• 2028: Up to 15 additional Part D and Part B drugs
• 2029 and beyond: Up to 20 drugs per year

Over time, this expanding program is expected to cover a growing share of the most expensive medications used by Medicare beneficiaries, potentially saving the federal government hundreds of billions of dollars over the next decade while meaningfully reducing what seniors pay at the pharmacy counter.

Other Inflation Reduction Act Drug Provisions Already in Effect

The negotiated drug prices are one piece of a broader set of prescription drug reforms included in the Inflation Reduction Act. Several other provisions are already saving money for Medicare beneficiaries. Understanding the four parts of Medicare helps clarify which provisions affect which benefits.

• $35 monthly insulin cap: Since 2023, all insulin products covered under Part D have been capped at $35 per month per prescription. This cap applies regardless of whether you have met your deductible.
• Free recommended vaccines: All vaccines recommended by the Advisory Committee on Immunization Practices are covered at $0 cost-sharing under Part D. This includes the shingles vaccine, which previously could cost over $200 out of pocket.
• Inflation rebates: Drug manufacturers that raise prices faster than the rate of inflation must pay rebates back to Medicare. This provision discourages the kind of above-inflation price increases that have plagued the pharmaceutical market for years and protects beneficiaries from unexpected cost hikes.
• Expanded Extra Help eligibility: The Inflation Reduction Act expanded the Part D Low Income Subsidy (Extra Help) so that beneficiaries with incomes up to 150% of the federal poverty level now qualify for full Extra Help benefits, eliminating the previous partial subsidy tier.

Legal Challenges and the Future of the Program

The Medicare Drug Price Negotiation Program has faced legal challenges from several pharmaceutical manufacturers and industry groups who argue that the program's penalties for non-participation amount to unconstitutional coercion and that the negotiation process violates due process protections. Multiple lawsuits were filed in federal courts across the country beginning in 2023.

As of early 2026, federal courts have largely upheld the program. Several district courts dismissed the industry challenges, finding that Congress acted within its authority under the Spending Clause and that the negotiation program does not constitute a taking of property without just compensation. Appeals are ongoing in some circuits, but the program is proceeding as planned and the first negotiated prices are in effect. CMS has continued to move forward with the second round of selections without interruption.

The pharmaceutical industry has also raised concerns about the potential impact on innovation, arguing that lower drug prices could reduce the incentive to invest in research and development for new medications. Supporters of the program counter that the drugs selected for negotiation have been on the market for many years and that the manufacturers have already recouped their development costs many times over. The debate over balancing affordable access with pharmaceutical innovation will continue as the program expands.

What You Should Do Now

If you are a Medicare beneficiary who takes one or more of the 10 negotiated drugs, the new prices are already in effect as of January 1, 2026. Here are some steps you can take to make sure you are getting the most out of these changes:

1. Review your Part D plan's formulary. Confirm that your medications are covered and check what tier they are on. Even with negotiated prices, your copay or coinsurance can vary depending on the tier assignment.
2. Ask your pharmacist about the new price. When you fill your next prescription, verify that the negotiated Maximum Fair Price is reflected in what you are being charged. If something looks off, contact your Part D plan directly.
3. Consider the Medicare Prescription Payment Plan. If you take expensive medications and want to avoid large out-of-pocket costs early in the year, you can opt into the payment plan through your Part D plan to spread costs into monthly installments with no interest.
4. Check if you qualify for Extra Help. If you have limited income and resources, you may qualify for Extra Help (the Low Income Subsidy), which can reduce your Part D premiums, deductibles, and copays significantly — in some cases to $0. You can apply at ssa.gov or by calling 1-800-772-1213.
5. Compare plans during the next Annual Enrollment Period. Even though negotiated prices apply across all Part D plans, other factors like premiums, deductibles, pharmacy networks, and tier placements for your other medications can vary. Use the Medicare Plan Finder at Medicare.gov to compare your options each fall.
6. Talk to your doctor about your medications. If you are taking a medication that was not included in the first round of negotiations and cost is a concern, ask your doctor whether there is a therapeutic alternative that may be more affordable. There may also be manufacturer assistance programs or state pharmaceutical assistance programs available.

Summary of All 10 Negotiated Drug Prices for 2026

Here is a quick-reference summary of every drug, its previous 30-day list price, the negotiated Maximum Fair Price, and the percentage reduction:

1. Eliquis (apixaban): $521 to $231 — 56% savings
2. Jardiance (empagliflozin): $573 to $197 — 66% savings
3. Xarelto (rivaroxaban): $517 to $197 — 62% savings
4. Januvia (sitagliptin): $527 to $113 — 79% savings
5. Farxiga (dapagliflozin): $556 to $178.50 — 68% savings
6. Entresto (sacubitril/valsartan): $628 to $295 — 53% savings
7. Enbrel (etanercept): $7,106 to $2,355 — 67% savings
8. Imbruvica (ibrutinib): $14,934 to $9,319 — 38% savings
9. Stelara (ustekinumab): $13,836 to $4,695 — 66% savings
10. Fiasp/NovoLog (insulin aspart): $495 to $119 — 76% savings

The Bottom Line

The Medicare Drug Price Negotiation Program represents a historic shift in how the United States manages prescription drug costs for its oldest and most vulnerable citizens. The first 10 negotiated prices, now in effect for 2026, deliver real savings to millions of beneficiaries — with reductions ranging from 38% to 79% off previous list prices. Combined with the $2,000 annual out-of-pocket cap, the $35 insulin cap, free vaccines, and inflation rebates, the Inflation Reduction Act has fundamentally changed the financial landscape of Medicare prescription drug coverage.

As the program expands with 15 more drugs in 2027 and up to 20 per year thereafter, the impact will only grow. If you are enrolled in Medicare or approaching enrollment age, staying informed about these changes can help you make better decisions about your coverage and your budget. For a complete breakdown of all Medicare costs in 2026, including premiums, deductibles, and the out-of-pocket cap, see our comprehensive cost guide.