Close Close
A pharmacy

Life Health > Health Insurance > Medicare Planning

Medicare Lists First 10 Drug Price Negotiation Targets

Your article was successfully shared with the contacts you provided.

What You Need to Know

  • The Medicare Part D drug program has not been able to bargain for lower drug prices.
  • For 2026, Congress will let Medicare try negotiating for lower prices for 10 drugs.
  • The first negotiation list could have a big effect on clients at risk for developing blood clots.

Medicare managers have kicked off what could be at least two years of conflict over what some popular drugs could cost the Medicare Part D prescription drug program in 2026.

The program posted a list of the first 10 drugs that will be the target of the new price negotiation process created by the Inflation Reduction Act of 2022.

For Medicare program managers, the process could lead to desperately needed cost savings.

For your clients, the negotiation process could lead to unpredictable effects on the net cost of some drugs and the availability of drugs — even if your clients aren’t using the drugs on the negotiations target list, and even if they aren’t on Medicare.

What It Means

All kinds of clients, including retirement planning clients and investment strategy clients, may be thinking more about risk-related topics that may feel as if they’re outside your current scope, such as homeowners’ insurance bills and prescription drug costs.

The History

Medicare is a federal program that provides health coverage for 66 million Americans ages 65 or older or who have a disability, are getting kidney dialysis or need a kidney transplant.

The Medicare Part D program came to life in 2006 and now pays for drugs for 29 million people, or 56% of Medicare enrollees. Medicare accounted for $127 billion of the $397 billion the United States spent on prescription drugs in 2022, according to actuaries with the Centers for Medicare & Medicaid Services, the federal agency that runs Medicare.

In the past, because some members of Congress were worried about the huge size of Medicare, federal law kept Medicare from bargaining for better prices with drug manufacturers.

The New Drug Price Negotiation Program

The Inflation Reduction Act of 2022 is supposed to let Medicare managers bargain for lower drug prices.

Because of provisions in the act and the implementing regulations, CMS will start by bargaining for better prices for just 10 drugs, with the prices first directly affecting Medicare Part D drug plans in 2026.

CMS hopes to provide “an initial offer of a maximum fair price” for a selected drug by Feb. 1, 2024; complete negotiations by Aug. 1, 2024; and publish the maximum fair prices Sept. 1, 2024.

The negotiations for Eliquis could have the most dramatic effects: Medicare Part D plans paid $16.5 billion over a year for 3.7 million patients to use the drug to prevent or treat blood clots.

The list also includes popular diabetes drugs such as Jardiance, Januvia and Farxiga.

For a list of the 10 drugs that could be part of the first round of negotiations, see the table below.

Medicare now spends a total of about $50 billion per year on the 10 drugs on the list.


Here are five possible effects of the new Medicare drug price negotiation program.

1. Congressional interest in drug prices may already be pushing manufacturers to hold down prices.

CMS figures show that Medicare drug spending will increase just 2.1% this year, after increasing an average of 6.8% in 2021 and 2022.

U.S. drug spending will increase just 3.6%, after averaging 6.5% for the previous two years.

2. Negotiations could do even more to hold down the cost of the drugs on the first Medicare price negotiation list.

Manufacturers with drugs on the list may not want to get extra congressional attention for increasing prices for those drugs.

3. Supplies of the drugs on the Medicare negotiation list may run low.

If prices for some drugs are lower than manufacturers would like, manufacturers may have no great interest in keeping those drugs on shelves.

Insulin, for example, is already subject to special federal pricing rules, and patients in some areas have reported difficulty in finding the insulin products they want.

4. The list could affect prices and supplies of any drugs that can be used in place of the drugs on the negotiation list.

Possible effects could include changes in the alternative products’ prices and dramatic fluctuations in the availability of the alternative products.

5. The list could affect clients with ordinary commercial health coverage.

Because Medicare is so large, any big changes in supplies and prices of drugs for patients with Medicare could spill over into the general prescription drug market.

If manufacturers have to offer Medicare patients lower prices, they might try to make up the difference by raising prices for health insurers and for employers with self-insured health plans.

To cope with the changes, clients may need to know about the alternatives to the drugs they are taking; pay close attention to their health plans’ drug “formularies,” or lists of covered drugs; look for drug discount coupons on websites like GoodRx; and increase allocations to flexible spending arrangements, health reimbursement arrangements, health savings accounts and other emergency savings arrangements, to make sure they are prepared to pay for preferred drugs out of pocket if using insurance to pay for the drug is not possible.

The First 10 Medicare Drug Price Negotiation Program Targets

Drug Name What the Drug Treats How Much Medicare Part D Paid (June 2022-May 2023) Number of Part D Enrollees Who Used Drug (June 2022-May 2023)
Eliquis .. Prevention and treatment of blood clots.. ..$16,482,621,000.. ..3,706,000..
Jardiance .. Diabetes; Heart failure.. ..$7,057,707,000.. ..1,573,000..
Xarelto .. Prevention and treatment of blood.. ..$6,031,393,000.. ..1,337,000..
Januvia .. Diabetes.. ..$4,087,081,000.. ..869,000..
Farxiga .. Diabetes; Heart failure; Chronic kidney disease.. ..$3,268,329,000.. ..799,000..
Entresto .. Heart failure.. ..$2,884,877,000.. ..587,000..
Enbrel .. Rheumatoid arthritis; Psoriasis; Psoriatic arthritis.. ..$2,791,105,000.. ..48,000..
Imbruvica .. Blood cancers.. ..$2,663,560,000.. ..20,000..
Stelara .. Psoriasis; Psoriatic arthritis; Crohn’s disease; Ulcerative colitis.. ..$2,638,929,000.. ..22,000..
Fiasp; Fiasp FlexTouch; FiaspPenFill; NovoLog; NovoLogFlexPen; NovoLog PenFill.. Diabetes.. ..$2,576,586,000.. ..777,000..

Credit: Adobe Stock


© 2023 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.