Medicare Ozempic Price: $245 MFN Deal Supersedes $274 Rate

Two prices for one drug

The Centers for Medicare & Medicaid Services (CMS) has published the second round of negotiated "maximum fair prices" (MFPs) under the Medicare Drug Price Negotiation Program. The prices cover 15 high-cost Part D drugs and take effect January 1, 2027. 125 The most closely watched entry was Novo Nordisk's semaglutide family: Ozempic, Rybelsus and Wegovy. CMS set its 30-day price at $274, against a list price of roughly $959, a 71% reduction. 34

The complication is that $274 is no longer Medicare's lowest price for these drugs. Weeks before the negotiated figures came out, the administration announced a most-favored-nation (MFN) arrangement that put Medicare's price at $245. CMS has reportedly confirmed that, because of how the two deals' terms and timelines line up, the MFN price for covered GLP-1 drugs is expected to supersede the negotiated one. 2 The headline result of a statutory negotiation may therefore never be the price Medicare actually pays.

The scale of the second round

The overall numbers are large. About 5.3 million Part D enrollees used the 15 selected drugs in 2024. Those drugs accounted for $42.5 billion in gross covered costs and $1.7 billion in beneficiaries' out-of-pocket spending. 2 CMS projects about $685 million in out-of-pocket savings for beneficiaries under the standard benefit design. 2 The government expects total savings of $8.5 billion to $12 billion a year. 5 Alongside the semaglutide group, the list includes cancer, COPD and irritable bowel syndrome treatments. 5

Semaglutide is the biggest single item. CMS data show roughly $15.2 billion in 2024 Medicare spending on the group and about 2.28 million users. 4

The process followed the statute's structure. CMS sent initial offers with written justifications by June 1, 2025, drawing on factors such as therapeutic alternatives and production and distribution costs. Manufacturers then had 30 days to accept or counter. 4 The program will keep growing: 15 more drugs will be selected for 2028 and 20 for 2029. 5

What patients will actually pay

The $274 figure is easy to misread as a copay, and it is not one. Part D plans must carry Ozempic on their formularies. However, they keep control over deductibles, tier placement, coinsurance, prior authorization and step therapy. 3 The negotiated price lowers the cost that flows into the plan's benefit design, but the design itself stays in place. 3

For beneficiaries, the gap between the MFN price and the negotiated price may matter less than which tier their plan assigns the drug to. Coverage rules for weight-loss indications will also shape what they pay.

The 340B wrinkle

Another pricing system complicates the picture further. One analysis of National Drug Code data found that 36 of the 89 active NDC formulations for the 15 drugs, about 41%, appear to have 340B ceiling prices below their new MFPs. 1 For roughly a third of the NDCs, the gap between the MFP and the 340B price exceeds $100 per package. 1 The analysis did not say which products were affected. 1 Still, it suggests that some safety-net providers already buy certain formulations for less than Medicare's new negotiated rate. That raises practical questions about how the two programs will interact at the pharmacy counter and in reimbursement.

Reading the outcome

The sources agree on the basic numbers. Where they differ is in emphasis. Consumer- and pharmacy-focused coverage highlights savings and patient costs. 235 Reporting aimed at 340B providers stresses that the MFPs are not always the floor. 1

Taken together, the story is less about a single price cut than about overlapping pricing mechanisms competing for the same drug. Medicare now has a statutory negotiated price, a separately brokered MFN price, and 340B ceiling prices, and these sit inside plan designs that still decide what patients owe.

The semaglutide outcome suggests the formal negotiation program may increasingly act as a backstop rather than the main lever, at least for drugs where the administration strikes direct deals. That could help taxpayers if the MFN deals consistently undercut negotiated prices. It also makes the program's results harder to judge on their own terms, and harder for beneficiaries to translate into what they will pay. The 2027 price on paper is $274, but the price that actually applies is expected to be $245, and individual plans will still determine the final cost to patients.