Medicare Drug Price Negotiation: 15 Lower Prices Start in 2027

Fifteen more drugs get Medicare-negotiated prices on January 1

Medicare's drug price negotiation program is getting much bigger. On January 1, 2027, negotiated prices take effect for 15 more Part D drugs, including the semaglutide drugs Ozempic, Rybelsus and Wegovy. That brings the number of drugs with negotiated prices to 25.114 The Centers for Medicare & Medicaid Services (CMS) announced the prices on November 25, 2025, and the agency says it reached agreement with drugmakers on all 15 drugs in the second round.1613

The cuts are large on paper. Measured against 2024 list prices for a 30-day supply, the new prices are 38% to 85% lower.18 Semaglutide drops from $959 to $274, or 71%. Trelegy Ellipta falls from $654 to $175. Janumet falls from $526 to $80, the biggest cut in this round.1610 The cancer drugs remain expensive even after the cuts: Pomalyst falls from $21,744 to $8,650, and Xtandi falls from $13,480 to $7,004.16

The timing matters. Medicare open enrollment opened October 15 and runs through December 7, so beneficiaries are choosing 2027 coverage now.25 What they see while shopping will show how much of the headline discount reaches them.

Who saves, and how much

The reporting agrees on CMS's own estimates. If the prices had applied in 2024, they would have saved Medicare about $12 billion. Enrollees are expected to save about $685 million in out-of-pocket costs in 2027.51 CMS puts the savings at about 44% compared with spending net of rebates.31 A Brookings analysis came to a similar figure of about $12.5 billion.

The percentages differ depending on the starting point. USA Today, citing Goldman Sachs, put the projected 2027 savings at 36% of net spending, compared with 22% in the first round.5 An analysis in the Journal of Managed Care & Specialty Pharmacy found the negotiated prices were 15% to 60% below estimated U.S. net prices, with a median of 38%.32 These figures don't conflict. The 71% and 85% numbers compare against list prices, which almost nobody actually pays. The more modest figures compare against prices after rebates. The second comparison gives a better sense of how much money really changes hands.

The gap between $12 billion for the program and $685 million for patients matters too. Most of the savings go to Medicare and, through it, to taxpayers. Patients see a much smaller share. Brigham and Women's Hospital researcher Benjamin Rome told NPR the bigger savings this round come partly from which drugs were picked and partly from CMS learning from the first round.8 CMS Administrator Mehmet Oz said the agency had used "the same process with a bolder direction."5

The negotiated price is not your copay

Coverage aimed at consumers keeps returning to one warning: $274 is not a national copay for Ozempic. What a patient pays still depends on the plan's deductible, tier placement, cost-sharing formula and prior authorization rules.2 Plans must include the selected drugs on their formularies, but they can still charge copays or coinsurance and require step therapy.27

Patients who pay coinsurance, a percentage of the price, gain the most. Under the standard Part D benefit, 25% coinsurance on a $959 drug is about $240. On a $274 drug it is about $69.3 Patients who pay the full price while working through their deductible also gain. CMS says eligible enrollees will not pay more than the negotiated price at the pharmacy.33 People who already hit the annual out-of-pocket cap may not save anything over the year. They may simply reach the cap later.3

Other 2027 changes cut the other way. The Part D out-of-pocket cap rises from $2,100 to $2,400, and the maximum deductible rises from $615 to $700.39 For many people on expensive drugs, especially the cancer drugs, a $300 higher cap could offset much of what they save from lower prices. The program lowers prices, but other parts of the Part D benefit are getting more expensive at the same time.

Medicare Advantage gets cheaper on paper

Premiums show the most visible change. CMS projects the weighted average Medicare Advantage premium will fall 16.5%, from $14.37 to $12.00 a month. The drug part of those premiums falls about 38%, from $11.32 to $7.00.2229 Stand-alone Part D plans are going the other way, rising slightly from about $35.09 to $36.00 a month as a temporary premium stabilization program ends.297

The base beneficiary premium rises from $38.99 to $41.33. Insurers' average bid jumped about 24%, but a 6% annual cap on the base premium limits how much that increase reaches enrollees.7 The negotiated prices apply to stand-alone drug plans and to Medicare Advantage plans with drug coverage alike, and both must cover all 15 drugs.16

The low Medicare Advantage premiums deserve some skepticism. Consumer comparison guides report that insurers kept premiums down partly by raising other costs. In-network out-of-pocket limits can reach $9,850. Drug deductibles are rising. About one in ten current members is expected to lose their plan as carriers leave some counties.24 Plan counts are about flat at roughly 5,500 nationwide, and CMS projects enrollment of about 34 million, or 47.4% of Medicare enrollees.29 The $12 average premium is real, but it is a weak way to judge what a plan will actually cost.

The GLP-1 complication

Semaglutide is the biggest drug on the list. About 2.3 million Part D enrollees used it in 2024, and Medicare spent roughly $15.2 billion on it before rebates.3 The coverage shows confusion about how the negotiated price fits with the Trump administration's separate "most favored nation" deals.

In November 2025, the White House announced agreements under which Ozempic and Wegovy would be offered to Part D plans at $245 a month. Coverage would expand to some beneficiaries with obesity, with a $50 monthly copay.6 That is below the $274 negotiated price. Vanderbilt health policy professor Stacie Dusetzina told NBC News that Medicare should have secured the lower deal for taxpayers and beneficiaries.5 Health Affairs pointed out more open questions. Rybelsus was left out of the most-favored-nation deal, and there is no public way to compare the two prices or to know how plans will handle them.6

The two programs work differently. The $50 bridge copay does not count toward the deductible or the $2,400 cap, and Extra Help (the low-income subsidy) cannot reduce it.3 The bridge program also covers Eli Lilly's Zepbound and expires at the end of 2027.10 Novo Nordisk has also said it will cut its U.S. list price for the three drugs to $675 a month starting January 1, 2027.16 This leaves a patient facing three different prices for the same drug, with different rules for each.

Pharmacies, hospitals and the 340B question

Some of the costs show up in places patients rarely see. Pharmacy Times argues that the Medicare Transaction Facilitator, the system meant to repay pharmacies for selling drugs at negotiated prices, pays dispensing fees far below what it costs to fill a prescription. Part D fees average about $0.65, while dispensing costs about $15 at retail and about $90 for specialty drugs. The outlet warns this could push independent and rural pharmacies to close. It is an advocacy argument, but it points to a real risk: lower drug prices could come with fewer pharmacies for patients to use.

For hospitals and clinics in the 340B discount program, the negotiated price is not always the lowest available. Based on pricing data, one estimate found that about 41% of the active formulations of the 15 drugs appear to have 340B prices below the negotiated price.15 As negotiation expands, how the two discounts interact will matter more to hospital finances. The third round adds drugs given in doctors' offices and hospitals under Part B, including Botox, Entyvio and Xolair, with prices taking effect in 2028.13 Patients' Part B costs are also rising: the premium is projected at $209.50 a month in 2027, up from $202.90.21

The Medicaid side gets little coverage. The closest link in the reporting is the low-income subsidy, which cannot reduce the GLP-1 bridge copay.3 Separately, new Medicare eligibility limits for some noncitizens begin in January 2027, and the Congressional Budget Office projects about 100,000 people will lose coverage.27

Still far above other countries' prices

The best reading of the 2027 round is that the program works but has clear limits. CMS reached agreement on every drug, and the discounts are deeper than in the first round.135 Even so, the journal analysis found the negotiated prices are still a median 108% higher than adjusted list prices in the countries Medicare plans to use as benchmarks. The average gap between U.S. and foreign prices narrowed from 5.8 times to 3.3 times.32

For beneficiaries, the most important number is what their own plan charges, not the negotiated price, and there are only weeks left to check it. Lower drug prices are arriving alongside a higher out-of-pocket cap, higher deductibles and a messy separate track for GLP-1 drugs. The program cuts what Medicare pays for these drugs, but much less of that saving reaches what patients pay at the pharmacy.