Medicare Price Negotiation: The First 10 Drugs Revealed

You’ve heard about major prescription drug price cuts coming from Medicare, and you want to know which medications are on the list. This guide breaks down the first 10 drugs selected for price negotiation, explaining what they treat, how the program works, and when you can expect to see potential savings.

Understanding the Medicare Drug Price Negotiation Program

For the first time, Medicare has been given the power to directly negotiate the prices of certain high-cost prescription drugs. This authority comes from the Inflation Reduction Act, a law designed to lower healthcare costs for millions of Americans. The goal is simple: to make essential medications more affordable for seniors and others on Medicare.

The process involves the Centers for Medicare & Medicaid Services (CMS) negotiating with drug manufacturers to establish a fair maximum price for medications covered under Medicare Part D. This is a significant change aimed at reducing out-of-pocket expenses for beneficiaries and saving taxpayer dollars. The first round of negotiations is underway, with the new, lower prices set to take effect in 2026.

The 10 Drugs Selected for Price Negotiation

Here is the official list of the first 10 drugs selected by CMS for price negotiation. These medications were chosen based on their high total spending under Medicare Part D. They treat a range of common conditions, including heart disease, diabetes, blood clots, and autoimmune disorders.

1. Eliquis (Apixaban)

  • What it treats: Eliquis is an anticoagulant, or blood thinner. It is widely prescribed to prevent blood clots, strokes, and embolism in patients with atrial fibrillation (AFib) that is not caused by a heart valve problem. It’s also used to treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE).
  • Manufacturer: Bristol Myers Squibb / Pfizer

2. Jardiance (Empagliflozin)

  • What it treats: Jardiance is primarily used to manage blood sugar levels in adults with type 2 diabetes. It has also been approved to reduce the risk of cardiovascular death in adults with type 2 diabetes and known heart disease, as well as to treat certain types of heart failure.
  • Manufacturer: Boehringer Ingelheim / Eli Lilly

3. Xarelto (Rivaroxaban)

  • What it treats: Similar to Eliquis, Xarelto is a blood thinner used to prevent and treat blood clots. Its uses include reducing the risk of stroke in people with AFib, treating DVT and PE, and preventing blood clots in people who have recently had knee or hip replacement surgery.
  • Manufacturer: Johnson & Johnson (Janssen)

4. Januvia (Sitagliptin)

  • What it treats: Januvia is a medication for adults with type 2 diabetes. It helps control high blood sugar by increasing the levels of natural substances called incretins, which helps the body produce more insulin when needed and reduces the amount of sugar made by the liver.
  • Manufacturer: Merck

5. Farxiga (Dapagliflozin)

  • What it treats: Farxiga is used to improve blood sugar control in adults with type 2 diabetes. Additionally, it is prescribed to reduce the risk of hospitalization for heart failure in adults with type 2 diabetes and established cardiovascular disease. It is also approved to treat certain types of heart failure and chronic kidney disease.
  • Manufacturer: AstraZeneca

6. Entresto (Sacubitril/Valsartan)

  • What it treats: Entresto is a combination medication used to treat certain types of heart failure. It works to relax blood vessels and reduce sodium and fluid retention, which helps the heart pump blood more effectively and reduces strain on the cardiovascular system.
  • Manufacturer: Novartis

7. Enbrel (Etanercept)

  • What it treats: Enbrel is a biologic medication used to treat several autoimmune conditions. These include moderate to severe rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and moderate to severe plaque psoriasis. It works by blocking a substance in the body that can cause inflammation.
  • Manufacturer: Amgen

8. Imbruvica (Ibrutinib)

  • What it treats: Imbruvica is a targeted therapy used to treat certain types of cancer, primarily blood cancers. This includes chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), and Waldenström’s macroglobulinemia.
  • Manufacturer: AbbVie / Johnson & Johnson

9. Stelara (Ustekinumab)

  • What it treats: Stelara is another biologic medication for autoimmune diseases. It is approved to treat plaque psoriasis, psoriatic arthritis, Crohn’s disease, and ulcerative colitis by targeting specific proteins involved in the inflammatory process.
  • Manufacturer: Johnson & Johnson (Janssen)

10. Fiasp; Fiasp FlexTouch; Fiasp PenFill; Novolog; Novolog FlexPen; Novolog PenFill (Insulin Aspart)

  • What it treats: This group includes various brand-name insulin products containing insulin aspart. It is a fast-acting insulin used to manage high blood sugar levels in adults and children with type 1 and type 2 diabetes.
  • Manufacturer: Novo Nordisk

The Timeline for Savings

It is very important to understand the timeline for these price changes. While the list of drugs has been announced and negotiations are happening, the new, lower prices will not be available at the pharmacy until January 1, 2026.

Here is a simple breakdown of the key dates:

  • September 2023: CMS announced the first 10 drugs selected for negotiation.
  • September 2024: CMS will publish the maximum fair prices that were negotiated with manufacturers.
  • January 1, 2026: The negotiated prices for these 10 drugs will officially take effect for Medicare beneficiaries.

This means that while relief is on the way, the cost of these specific medications will not change immediately. The program will continue to expand, with more drugs being selected for negotiation in the coming years.

Frequently Asked Questions

Why were these specific drugs chosen? These 10 drugs were selected because they accounted for the highest total spending for Medicare Part D over a one-year period (from June 1, 2022, to May 31, 2023). They are single-source drugs without generic or biosimilar competition, meaning Medicare and its beneficiaries have been paying high prices for years.

Will more drugs be added to the negotiation list? Yes. The law outlines a plan to add more drugs over time. Up to 15 more Part D drugs will be selected for negotiation for 2027, another 15 drugs (from Part B and Part D) for 2028, and up to 20 more drugs each year after that.

How much will I save on these medications? The exact savings are not yet known. The final negotiated prices will be made public in September 2024. The goal of the program is to create significant price reductions, which will directly lower the out-of-pocket costs for Medicare beneficiaries who rely on these important medications.

What if my medication is not on this list? If your prescription drug is not on this initial list, it may be selected for negotiation in a future year. In the meantime, you can explore other options for saving money, such as talking to your doctor about generic alternatives, using prescription discount cards, or seeing if you qualify for your state’s Pharmaceutical Assistance Program or the Extra Help program for Part D.