For the first time in the program’s history, Medicare sets prices on some of its most expensive drugs instead of accepting them. The first ten negotiated prices went live January 1, 2026. Fifteen more land January 1, 2027, and a third batch of fifteen is being negotiated right now for 2028.
The headline numbers are real, and they are large. What they mean for the person standing at a pharmacy counter is a much narrower question, and it is the one most coverage skips. All figures below come from CMS’s own published fact sheets, current as of September 2026.
What the Medicare Drug Price Negotiation Program Is
The Inflation Reduction Act of 2022 gave CMS the authority to negotiate directly with manufacturers on a short list of high-spending drugs that have no generic or biosimilar competitor. Before this, Medicare was legally barred from negotiating drug prices at all.
CMS picks drugs by ranking qualifying single-source drugs by total Medicare spending, then selecting from the top. Small-biotech drugs, certain orphan drugs and low-spend drugs are excluded. Drugs must be at least 7 years past FDA approval (11 years for biologics).
The negotiated result is called the Maximum Fair Price, or MFP. CMS publishes it two ways: as a single price for a 30-day equivalent supply, which is the number you see in headlines, and as a per-package price tied to each National Drug Code, which is the number pharmacies actually work from. The MFP file is updated on the CMS selected drugs page and was last refreshed May 26, 2026.
Once an MFP exists, every Part D plan is required to cover that drug, in all its dosage forms and strengths. That coverage mandate is arguably as valuable as the price itself, because it removes the drug from the formulary lottery.
The 2026 List: 10 Drugs, Prices Effective January 1, 2026
CMS agreed prices with all ten manufacturers on August 1, 2024. Prices below are for a 30-day supply, compared against calendar year 2023 list price (wholesale acquisition cost).
| Drug | Maximum Fair Price (2026) | 2023 list price | Discount |
|---|---|---|---|
| Januvia | $113 | $527 | 79% |
| Fiasp / NovoLog | $119 | $495 | 76% |
| Farxiga | $178.50 | $556 | 68% |
| Enbrel | $2,355 | $7,106 | 67% |
| Jardiance | $197 | $573 | 66% |
| Stelara | $4,695 | $13,836 | 66% |
| Xarelto | $197 | $517 | 62% |
| Eliquis | $231 | $521 | 56% |
| Entresto | $295 | $628 | 53% |
| Imbruvica | $9,319 | $14,934 | 38% |
About 8.8 million Part D enrollees used these ten drugs in 2023, accounting for $56.2 billion, roughly 20% of all Part D gross covered drug costs. CMS estimates the negotiated prices would have saved $6 billion (22% of net spending) had they applied in 2023, and projects $1.5 billion in savings for Part D enrollees in 2026.
One thing to note: these MFPs are the CY 2026 values. Each year after the first, CMS updates every MFP by the annual increase in CPI-U, so the 2027 versions of these numbers will be slightly higher.
The 2027 List: 15 Drugs, Prices Effective January 1, 2027
Negotiations closed November 1, 2025 with agreement on all 15. Prices are per 30-day supply against 2024 list price.
| Drug | Maximum Fair Price (2027) | 2024 list price | Discount |
|---|---|---|---|
| Ozempic / Rybelsus / Wegovy | $274 | $959 | 71% |
| Trelegy Ellipta | $175 | $654 | 73% |
| Xtandi | $7,004 | $13,480 | 48% |
| Pomalyst | $8,650 | $21,744 | 60% |
| Ofev | $6,350 | $12,622 | 50% |
| Ibrance | $7,871 | $15,741 | 50% |
| Linzess | $136 | $539 | 75% |
| Calquence | $8,600 | $14,228 | 40% |
| Austedo / Austedo XR | $4,093 | $6,623 | 38% |
| Breo Ellipta | $67 | $397 | 83% |
| Xifaxan | $1,000 | $2,696 | 63% |
| Vraylar | $770 | $1,376 | 44% |
| Tradjenta | $78 | $488 | 84% |
| Janumet / Janumet XR | $80 | $526 | 85% |
| Otezla / Otezla XR | $1,650 | $4,722 | 65% |
About 5.3 million Part D enrollees used these in 2024, $42.5 billion in gross costs. CMS estimates $12 billion in net savings (44%) had the prices applied in 2024, or about $8.5 billion (36%) once Coverage Gap Discount Program spending is counted, and projects $685 million in out-of-pocket savings for enrollees in 2027.
CMS also publishes package-level MFPs. For the semaglutide group, that works out to $276.78 for one Ozempic 4 mg/3 mL pen, $276.78 for 30 Rybelsus 7 mg tablets, and $385.63 for a 4-pen box of Wegovy 2.4 mg. Those numbers differ from the $274 headline because the headline is a 30-day equivalent and the package prices follow real package sizes.
The 2028 List: First Part B Drugs
On January 27, 2026, CMS selected 15 more drugs for the third cycle, and for the first time the list includes drugs paid under Part B, not just Part D: Anoro Ellipta, Biktarvy, Botox and Botox Cosmetic, Cimzia, Cosentyx, Entyvio, Erleada, Kisqali, Lenvima, Orencia, Rexulti, Trulicity, Verzenio, Xeljanz/Xeljanz XR and Xolair. Tradjenta was separately selected for the program’s first renegotiation.
Those 15 drugs accounted for $27.0 billion in combined Part B and Part D spending between November 2024 and October 2025, about 6% of the total, across roughly 1.78 million enrollees. CMS confirmed on March 13, 2026 that every manufacturer signed a participation agreement by the February 28, 2026 deadline. Negotiations run through November 1, 2026, and any agreed prices take effect January 1, 2028.
CMS also published a top-50 negotiation-eligible list for this cycle. The 15 selected drugs are simply the top 15 on it, which tells you roughly what the next few cycles will look like.
What You Actually Pay at the Counter
This is the part that trips people up. The Maximum Fair Price is not a copay. It is a ceiling on the price at which the drug is transacted inside Medicare. Manufacturers are required to make that price available to the pharmacies, mail-order services and other dispensing entities that fill the prescription, typically through a refund mechanism after the fill.
Your own share is whatever your plan’s cost sharing rules say. Under the defined standard Part D benefit, you pay 100% until you meet the deductible (no more than $615 in 2026, rising to $700 in 2027 per CMS’s CY 2027 Rate Announcement), then 25% coinsurance until your out-of-pocket spending reaches $2,100 in 2026 ($2,400 in 2027), then nothing for the rest of the year.
So a standard-benefit enrollee taking Eliquis in 2026 pays roughly $58 a month in the coinsurance phase, 25% of the $231 MFP, rather than $231. But most real plans use flat copay tiers rather than straight coinsurance. As KFF points out, if your plan charges you a fixed dollar copay for that drug, a lower negotiated price may not change your bill at all. The savings land on the plan and on Medicare instead.
Two practical consequences. First, if you pay coinsurance on an expensive selected drug, negotiation lowers your monthly cost directly. Second, a lower price means you burn through the $2,100 out-of-pocket cap more slowly, which can mean paying something in months when you previously would have hit catastrophic coverage and paid nothing. Whether you come out ahead over a full year depends on your whole drug list.
Negotiated Prices vs. Cash Discount Programs
Readers routinely conflate this program with the most-favored-nation drug pricing deals and TrumpRx. They are separate mechanisms with separate rules.
| Medicare Maximum Fair Price | MFN deals and TrumpRx | |
|---|---|---|
| Legal basis | Inflation Reduction Act statute | Executive action plus voluntary manufacturer agreements |
| Who it covers | Medicare Part D enrollees (Part B added in 2028) | Cash-paying patients; government beneficiaries generally excluded |
| Price set by | CMS negotiation, published annually | Manufacturer, benchmarked to other developed nations |
| Counts toward your Part D deductible and cap | Yes | No, per Medicare.gov |
| Where you buy | Any pharmacy, through your plan | Manufacturer direct-pay channels or a coupon at retail |
If you have Medicare, using a discount card instead of your plan for a selected drug means those dollars do not count toward your deductible or out-of-pocket maximum. Medicare.gov says this plainly. Compare both prices before you decide.
Who This Helps and Who It Does Not
It helps Part D enrollees who take one of the 25 drugs already priced, especially anyone paying coinsurance rather than a flat copay, and anyone whose plan previously made a selected drug hard to get. If you are on Farxiga, Eliquis or Jardiance now, or Ozempic or Trelegy next year, check your plan’s 2027 formulary during open enrollment rather than assuming.
It does nothing for people without Medicare. The MFP is not available to cash payers, and it does not apply to commercial insurance. If you are uninsured, your levers are manufacturer assistance programs, discount cards, and cash pharmacies like Cost Plus Drugs or mail order.
It also does not solve cash-flow timing. If your negotiated-price drug still costs you several hundred dollars in January, the Medicare Prescription Payment Plan spreads that across the year, and Extra Help can cut your costs to a few dollars per fill if you qualify on income and assets.
Bottom Line
Twenty-five drugs now have Medicare-negotiated prices, with 15 more in negotiation for 2028 and up to 20 new selections per year after that. The discounts off list price are steep, from 38% to 85%. But the Maximum Fair Price is a wholesale ceiling, not a receipt. Look up your specific plan’s cost sharing for your specific drug, compare it against the cash price, and treat the negotiated list as a reason to re-shop your plan rather than a guaranteed cut to your bill.