Quick Takeaway
January 1, 2026 marked a major change in Medicare prescription-drug pricing.
For the first time, negotiated prices under the Medicare Drug Price Negotiation Program took effect for 10 high-spending drugs covered under Medicare Part D.
These medications treat conditions including:
Diabetes
Heart failure
Blood clots
Chronic kidney disease
Arthritis
Psoriasis
Inflammatory bowel disease
and:
Blood cancers.
CMS says approximately 8.8 million Medicare Part D beneficiaries used these drugs in 2023, when the 10 medicines represented about $56.2 billion in gross Part D prescription-drug costs.
Even more significantly, CMS estimated that if the negotiated prices had been in effect during 2023, Medicare would have spent approximately:
$6 billion less
on these drugs after accounting for rebates and certain other payments—about a 22% reduction in aggregate net spending.
But there’s an important distinction:
A lower negotiated price does not mean every Medicare beneficiary’s pharmacy copay falls by the exact same percentage.
Here’s what actually changed.
What Is Medicare Drug Price Negotiation?
Historically, Medicare prescription-drug plans negotiated prices with drug manufacturers through private arrangements.
The Inflation Reduction Act created a new federal process allowing Medicare to directly negotiate prices for certain high-expenditure drugs that meet statutory eligibility requirements.
CMS selected the first:
10 Part D drugs
in 2023.
Negotiations occurred during 2023 and 2024.
The resulting prices are called:
Maximum Fair Prices — MFPs.
Those first negotiated prices became effective:
January 1, 2026.
CMS says manufacturers must make the applicable negotiated price available to eligible individuals and pharmacies, mail-order services and other dispensing entities.
Which 10 Drugs Have Negotiated Prices in 2026?
Here is the complete first group.
| Drug | Common Uses | 2026 Negotiated Price* | 2023 List Price* | Reduction |
|---|---|---|---|---|
| Januvia | Diabetes | $113 | $527 | 79% |
| Fiasp / NovoLog products | Diabetes | $119 | $495 | 76% |
| Farxiga | Diabetes, heart failure, kidney disease | $178.50 | $556 | 68% |
| Enbrel | Arthritis, psoriasis | $2,355 | $7,106 | 67% |
| Jardiance | Diabetes, heart failure, kidney disease | $197 | $573 | 66% |
| Stelara | Psoriasis, Crohn’s disease, ulcerative colitis | $4,695 | $13,836 | 66% |
| Xarelto | Blood-clot prevention/treatment | $197 | $517 | 62% |
| Eliquis | Blood-clot prevention/treatment | $231 | $521 | 56% |
| Entresto | Heart failure | $295 | $628 | 53% |
| Imbruvica | Blood cancers | $9,319 | $14,934 | 38% |
*CMS figures are standardized to a 30-day supply; the comparison uses 2023 list prices, so these percentages should not be interpreted as a guaranteed reduction in an individual patient’s 2026 pharmacy bill.
Let’s look at what these changes mean.
1. Januvia
Used for: Type 2 diabetes
2023 list price: $527
2026 negotiated price: $113
Difference: 79%
Januvia has the largest percentage reduction in this first group when the negotiated price is compared with the 2023 list price used by CMS.
Approximately:
843,000
Medicare Part D beneficiaries used Januvia in 2023.
Medicare’s gross Part D spending on the drug was approximately:
$4.1 billion.
For beneficiaries managing Type 2 diabetes, this is one of the most notable drugs in the first negotiation cycle.
2. Fiasp and NovoLog Insulin Products
The negotiated group includes several related products:
Fiasp
Fiasp FlexTouch
Fiasp PenFill
NovoLog
NovoLog FlexPen
and:
NovoLog PenFill.
Used for: Diabetes
2023 list price: $495
2026 negotiated price: $119
Difference: 76%
Approximately 785,000 Medicare Part D beneficiaries used these products in 2023.
However, insulin has another important protection.
Medicare’s insulin-specific cost-sharing rules can limit what beneficiaries pay for covered insulin.
So don’t assume:
$119 = your insulin copay.
The MFP and your personal out-of-pocket cost are different concepts.
3. Farxiga
Used for:
Type 2 diabetes
Heart failure
and:
Chronic kidney disease.
Farxiga has become important beyond diabetes because of its cardiovascular and kidney-related indications.
2023 list price: $556
2026 negotiated price: $178.50
Difference: 68%
Nearly:
994,000
Part D beneficiaries used Farxiga in 2023, according to CMS.
Medicare’s gross Part D spending was approximately:
$4.34 billion.
4. Enbrel
Used for:
Rheumatoid arthritis
Psoriasis
and:
Psoriatic arthritis.
Enbrel illustrates how dramatic the dollar difference can become with expensive specialty drugs.
2023 list price: $7,106
2026 negotiated price: $2,355
Difference: 67%
That’s a difference of:
$4,751
between the standardized 30-day 2023 list-price figure and the 2026 negotiated price.
Approximately 48,000 Medicare Part D beneficiaries used Enbrel in 2023.
5. Jardiance
Used for:
Diabetes
Heart failure
and:
Chronic kidney disease.
Jardiance was one of the most widely used medications selected for negotiation.
2023 list price: $573
2026 negotiated price: $197
Difference: 66%
About:
1.88 million
Medicare Part D beneficiaries used Jardiance in 2023.
Medicare’s gross Part D spending on it reached approximately:
$8.84 billion.
That’s one reason Jardiance was financially significant enough to become part of the first negotiation cycle.
6. Stelara
Used for:
Psoriasis
Psoriatic arthritis
Crohn’s disease
and:
Ulcerative colitis.
Stelara is another expensive specialty medication.
2023 list price: $13,836
2026 negotiated price: $4,695
Difference: 66%
That’s more than a:
$9,000 difference
between the standardized 2023 list-price comparison and the negotiated 2026 price.
CMS reported approximately 23,000 Medicare Part D beneficiaries used Stelara in 2023.
7. Xarelto
Used for:
Preventing blood clots
Treating blood clots
and reducing certain cardiovascular risks.
2023 list price: $517
2026 negotiated price: $197
Difference: 62%
About:
1.32 million
Medicare Part D beneficiaries used Xarelto in 2023.
That’s a large Medicare population potentially affected by the new pricing structure.
8. Eliquis
Eliquis may be the most recognizable drug on the list.
Used for:
Preventing and treating blood clots.
2023 list price: $521
2026 negotiated price: $231
Difference: 56%
But what’s particularly striking is the number of Medicare users.
Approximately:
3.93 million
Medicare Part D beneficiaries used Eliquis during 2023.
CMS reported roughly:
$18.3 billion
in gross Part D prescription-drug costs for Eliquis that year.
That was by far the largest gross Part D spending figure among the first 10 negotiated drugs.
9. Entresto
Used for: Heart failure
2023 list price: $628
2026 negotiated price: $295
Difference: 53%
Approximately:
664,000
Medicare Part D beneficiaries used Entresto in 2023.
Gross Part D spending reached approximately:
$3.43 billion.
For people managing heart failure, Entresto’s inclusion makes this first negotiation cycle particularly relevant.
10. Imbruvica
Used for: Certain blood cancers
Imbruvica has the smallest percentage reduction among the 10—but don’t let that percentage hide the dollar amount involved.
2023 list price: $14,934
2026 negotiated price: $9,319
Difference: 38%
That’s still a difference of:
$5,615
in the standardized 30-day comparison.
Approximately 17,000 Medicare Part D beneficiaries used Imbruvica in 2023.
Which Drug Received the Biggest Percentage Reduction?
Among the first 10:
Januvia — 79%
has the largest percentage difference between its negotiated 2026 price and the 2023 list price CMS used for comparison.
Next comes:
Fiasp/NovoLog — 76%
followed by:
Farxiga — 68%.
But there’s an important warning.
These percentages compare negotiated prices with:
2023 list prices.
They are not the same as savings compared with what Medicare was actually paying after rebates and discounts.
That’s a crucial distinction.
List Price vs. Net Price
Suppose a medication has a:
$500 list price.
But Medicare’s plans and manufacturers already have rebates or discounts reducing the effective net cost.
A new negotiated price of:
$250
doesn’t necessarily mean Medicare suddenly saves:
50%.
That’s why CMS separately calculated estimated savings compared with Medicare’s prior net spending.
How Much Could Medicare Actually Save?
CMS estimated that if these negotiated prices had existed in 2023:
Medicare net prescription spending would have been approximately $6 billion lower.
That represents about:
22% aggregate net savings
across the 10 drugs—not the much larger headline percentages generated by comparing MFPs with list prices.
This is one of the most important distinctions for consumers reading headlines about Medicare drug negotiations.
What Could Beneficiaries Save?
CMS projected that people with Medicare prescription-drug coverage would save approximately:
$1.5 billion
in out-of-pocket costs in 2026 under its projected benefit design as a result of the first negotiated prices.
That’s substantial.
But individual savings can vary dramatically.
Your personal savings depend on factors including:
Your medication
Your Part D plan
Your pharmacy
Your cost-sharing structure
and:
Where you are in the Part D benefit during the year.
Don’t Expect the Pharmacy Receipt to Say “79% Off”
This deserves emphasis.
Suppose you’re taking Januvia.
You see:
“79% reduction.”
You shouldn’t automatically expect your $100 copay to become:
$21.
That’s not how the comparison works.
The 79% figure compares:
2026 Maximum Fair Price
with:
2023 list price.
Your previous copay may already have reflected negotiated discounts and the structure of your Medicare Part D plan.
What Is the Maximum Fair Price?
The term:
Maximum Fair Price
is the statutory name used for prices negotiated under the Medicare Drug Price Negotiation Program.
For eligible Medicare beneficiaries, manufacturers participating in the program must make the negotiated price available through the applicable system to dispensing entities.
Medicare prescription-drug plans—including standalone Part D plans and Medicare Advantage plans with prescription coverage—must include selected negotiated drugs on their formularies while the applicable requirements are met.
Does This Apply to Medicare Advantage?
Yes—when you have prescription coverage through a:
Medicare Advantage Prescription Drug plan (MA-PD).
CMS states that Medicare prescription-drug plans, including standalone Part D plans and Medicare Advantage prescription-drug plans, are subject to the applicable requirements for selected drugs.
So this isn’t limited to people buying standalone Part D coverage.
Does This Mean the Drugs Are Free?
No.
Negotiated price means:
lower underlying drug price.
It does not mean:
$0 prescription.
Beneficiaries can still have cost-sharing obligations under their Part D coverage.
Your actual pharmacy cost depends on the Medicare prescription-drug benefit and your plan.
Another Major 2026 Protection: The Part D Out-of-Pocket Limit
Drug negotiation isn’t happening in isolation.
Medicare Part D beneficiaries also benefit from broader prescription-drug reforms.
That means someone using expensive medications may benefit from:
negotiated drug prices
plus:
annual Part D out-of-pocket protections
plus:
special insulin cost-sharing protections when applicable.
When evaluating 2026 prescription costs, these policies need to be considered together.
Why Were These Drugs Selected?
The program doesn’t simply pick:
“the most expensive drugs at the pharmacy.”
The law establishes eligibility and selection requirements.
For the first cycle, CMS selected high-expenditure, single-source Part D drugs without generic or biosimilar competition that met the statutory criteria.
CMS considered factors during negotiations including:
Research and development costs
Federal financial support
Production and distribution costs
Sales and revenue data
Patents and exclusivity
and information about:
Therapeutic alternatives
Comparative effectiveness
Unmet medical need
and:
Clinical benefit.
Why Eliquis Is Particularly Important
Of all 10 medications, Eliquis stands out because of sheer utilization.
Nearly:
4 million Medicare Part D beneficiaries
used it in 2023.
And Medicare Part D gross spending on Eliquis alone was approximately:
$18.3 billion.
So even though its headline list-price reduction is smaller than Januvia’s, Eliquis has enormous importance to the Medicare program.
Why Specialty Drugs Matter
Now compare Eliquis with Stelara.
Eliquis:
Millions of users.
Stelara:
Tens of thousands.
But Stelara’s standardized 2023 list price for a 30-day supply was:
$13,836.
That’s why prescription spending isn’t simply about:
number of patients.
A relatively small number of people using very expensive specialty drugs can generate enormous Medicare spending.
A Simple 2026 Comparison
Consider three selected drugs:
Januvia
2023 list price: $527
2026 negotiated price: $113
Jardiance
2023 list price: $573
2026 negotiated price: $197
Eliquis
2023 list price: $521
2026 negotiated price: $231
The headline differences are substantial.
But your personal pharmacy costs still depend on:
your Medicare Part D benefit.
That’s why the smartest comparison isn’t:
“How much did the list price fall?”
It’s:
“What will I actually pay under my plan in 2026?”
Will More Drugs Be Negotiated?
Yes.
The first 10 are only the beginning.
CMS has already moved to subsequent negotiation cycles.
For the 2027 price year, CMS selected 15 additional Part D drugs, including Ozempic/Rybelsus/Wegovy, Trelegy Ellipta, Xtandi, Ibrance, Linzess and others. Their negotiated prices take effect in 2027.
And in January 2026, CMS selected another group for the 2028 cycle, expanding the program to eligible Part B and Part D drugs.
So the program becomes increasingly important over time.
What Medicare Beneficiaries Should Do Now
If you use one of these 10 medications, don’t assume your savings will automatically match the headline discount.
Instead:
- Check your exact medication and dosage.
- Review your 2026 Part D or Medicare Advantage drug coverage.
- Compare your expected pharmacy cost.
- Check whether your preferred pharmacy is in network.
- Review all your medications—not just the negotiated one.
- Compare total annual prescription costs rather than monthly premium alone.
- Ask your plan about cost sharing if your expected price isn’t clear.
CMS confirms the negotiated prices have been effective since January 1, 2026.
Frequently Asked Questions
Which 10 Medicare drugs have negotiated prices in 2026?
The first group includes Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and selected Fiasp/NovoLog insulin products.
When did the negotiated prices begin?
They became effective on:
January 1, 2026.
Which drug received the largest list-price reduction?
Januvia’s negotiated price of $113 represents a 79% reduction from the 2023 list price of $527 used in CMS’s comparison.
Does a 79% negotiated-price reduction mean my copay drops 79%?
No. The percentage compares the negotiated price with a historical list price. Your actual out-of-pocket cost depends on your Part D coverage and other Medicare rules.
How many people used these drugs?
Approximately 8.8 million Medicare Part D beneficiaries used the selected drugs during 2023.
How much could Medicare save?
CMS estimated that if the negotiated prices had been effective in 2023, they would have reduced net covered prescription-drug spending by about $6 billion, or 22% in aggregate, for these drugs.
How much could beneficiaries save?
CMS projected approximately $1.5 billion in out-of-pocket savings in 2026 for people with Medicare prescription-drug coverage under its projected benefit design.
Final Thoughts
The first Medicare-negotiated drug prices are no longer something that’s:
“coming in the future.”
They are now:
in effect.
Since January 1, 2026, negotiated Maximum Fair Prices have applied to the first 10 selected Medicare Part D drugs.
The list includes medications used by millions of Americans for:
Diabetes
Heart disease
Blood clots
Kidney disease
Autoimmune disorders
and:
Cancer.
CMS estimates that the negotiated prices would have reduced net Medicare spending on these medications by approximately $6 billion had they applied in 2023, while beneficiaries are projected to realize about $1.5 billion in out-of-pocket savings in 2026.
But consumers should avoid one major mistake:
Don’t confuse a reduction from list price with your personal pharmacy savings.
Your real question should be:
“What will my Medicare plan charge me for this prescription in 2026?”
That’s the number that ultimately affects your wallet.