CMS’ drug price negotiations are advancing, but new indications and exclusivity rules could complicate future pricing cycles.
CMS gained the authority to negotiate list prices with drug manufacturers in 2022 with the Inflation Reduction Act. The law ended a 19-year ban on the government from directly negotiating the price of drug prices in Medicare Part D.
The pharmaceutical industry lobbied hard against the bill and, after its passage, multiple drug manufacturers filed lawsuits against the negotiation provision. Many of those lawsuits have failed. During a March confirmation hearing, CMS Administrator Mehmet Oz, MD, said he would defend the agency’s drug pricing negotiation power in court.
Still, there are uncertainties surrounding future negotiations, including new prices for already negotiated drugs if there is a key change, such as a new indication or shift in market exclusivity. CMS proposed this idea in a draft guidance published May 12.
An executive order from President Donald Trump has also instructed drugmakers to significantly reduce prices to be in line with other nations, but it is unclear how that might affect CMS’ drug pricing negotiation authority.
To be eligible for negotiations, medications must lack generic or biosimilar competition and be on the market for more than 10 years. CMS has already announced the negotiated drugs under Medicare Part D Medicare for 2026 and 2027, and the prices set to take effect Jan. 1, 2026. The 15 drugs in the second cycle are under negotiations.
The first negotiation cycle to include Medicare Part B drugs will be 2028, and CMS can select up to 20 drugs for the 2029 cycle. The agency can currently pick medications under Part D, which are usually distributed in outpatient pharmacy settings. Part B drugs are often injections or infusions administered in a physician’s office or hospital outpatient setting, such as chemotherapy or anesthesia.
The 10 drugs with negotiated prices for 2026:
1. Januvia (Merck)
Indication: Type 2 diabetes
List price in 2023: $527
Negotiated price: $113
2. Fiasp, Fiasp FlexTouch, Fiasp PenFill, NovoLog, NovoLog FlexPen and NovoLog PenFill (Novo Nordisk)
Indication: Type 2 diabetes
List price in 2023: $495
Negotiated price: $119
3. Farxiga (AstraZeneca)
Indication: Type 2 diabetes, heart failure and chronic kidney disease
List price in 2023: $556
Negotiated price: $178
4. Enbrel (Immunex)
Indication: Rheumatoid arthritis, psoriasis psoriatic arthritis
List price in 2023: $7,106
Negotiated price: $2,355
5. Jardiance (Boehringer Ingelheim)
Indication: Type 2 diabetes, heart failure
List price in 2023: $573
Negotiated price: $197
6. Stelara (Janssen)
Indication: Psoriasis, psoriatic arthritis, Crohn’s disease, ulcerative colitis
List price in 2023: $13,836
Negotiated price: $4,695
7. Xarelto (Janssen)
Indication: Blood clot prevention and treatment
List price in 2023: $517
Negotiated price: $197
8. Eliquis (Bristol Myers Squibb)
Indication: Blood clot prevention and treatment
List price in 2023: $521
Negotiated price: $231
9. Entresto (Novartis)
Indication: Heart failure
List price in 2023: $628
Negotiated price: $295
10. Imbruvica (AbbVie/Janssen)
Indication: Blood cancers
List price in 2023: $14,934
Negotiated price: $9,319
The 15 drugs selected for 2027:
1. Ozempic, Rybelsus, Wegovy (Novo Nordisk)
Indication: Type 2 diabetes and chronic weight management
List price: Prices range between $900 and around $1,300 per month
2. Trelegy Ellipta (GSK)
Indication: COPD, asthma
List price: $677.41 for a 30-day supply
3. Xtandi (Astellas/Pfizer)
Indication: Prostate cancer
List price: Around $14,905.77 per month
4. Pomalyst (Bristol Myers Squibb)
Indication: Multiple myeloma
List price: $25,600 for a 21-capsule supply
5. Ibrance (Pfizer)
Indication: HR+/HR2- breast cancer
List price: $15,982.39 for a 21-capsule supply
6. Ofev (Boehringer Ingelheim)
Indication: Idiopathic pulmonary fibrosis
List price: $14,439 for a 60-capsule bottle
7. Linzess (AbbVie/Ironwood)
Indication: IBS with constipation, chronic idiopathic constipation
List price: $567.97 per month
8. Calquence (AstraZeneca)
Indication: Chronic lymphocytic leukemia, small lymphocytic lymphoma
List price: $16,535 for a 60-tablet bottle
9. Austedo, Austedo Extended-Release (Teva)
Indication: Huntington’s disease chorea, tardive dyskinesia
List price: $7,844 for 60 12 mg tablets and $5,232 for a 30-day supply of 12 mg extended release tablets
10. Breo Ellipta (GSK)
Indication: COPD, asthma
List price: A 28-dose inhaler costs around $173.04, and a 60-dose inhaler costs around $434.38
11. Tradjenta (Boehringer Ingelheim)
Indication: Type 2 diabetes
List price: Around $571 for a supply of 30 tablets
12. Xifaxan (Bausch/Salix)
Indication: IBS with diarrhea, hepatic encephalopathy
List price: Around $3,625 for a 60-tablet supply
13. Vraylar (AbbVie)
Indication: Schizophrenia, bipolar I disorder, major depressive disorder adjunct
List price: Around $1,446 for a 30-day supply, depending on dose strength
14. Janumet, Janumet XR (Merck)
Indication: Type 2 diabetes
List price: Around $362 for a 60-tablet supply
15. Otezla (Amgen)
Indication: Psoriatic arthritis, plaque psoriasis, Behcet’s disease
List price: $5,323 for a 30-day supply
Editor’s note: Becker’s pulled the list prices from CMS, drugmaker websites, GoodRx and Drugs.com.
