Medicare's negotiated drug prices: what changed in 2026, what changes in 2027, and what it means at a Grand Junction pharmacy

Sources: CMS — Final CY 2026 Part D Redesign Program Instructions (fact sheet) (deductible, coinsurance and out-of-pocket threshold for the CY2026 defined standard benefit) · CMS — Negotiated Prices for Initial Price Applicability Year 2026 (PDF table of maximum fair prices) · KFF — How Medicare's New Drug Price Negotiation Program Could Expand Access to Selected Drugs (September 26, 2023) · KFF — Key Facts About Medicare Drug Price Negotiation (March 11, 2026). The Eliquis arithmetic is an illustration of the defined standard benefit, not any plan's actual cost sharing; actual plan list prices in 2026 may differ from the 2023 figure CMS published. Plan year 2026.

Three consequences follow from that table.

The people who gain most are on coinsurance for a mid-priced drug. Someone paying 25% for Eliquis, Xarelto, Jardiance or Entresto every month, and not reaching the cap, sees the biggest percentage change in their own bill. KFF's 2023 analysis found the three specialty drugs — Enbrel, Imbruvica and Stelara — sat on specialty tiers with median coinsurance of 30–33% in virtually every plan, so those users also pay a share of a smaller number; but at thousands of dollars a month, the $2,100 cap does most of the work for them, and the year-end total barely moves.

The people who may see no change are on a flat copay. Six of the ten — Eliquis, Xarelto, Entresto, Farxiga, Januvia, Jardiance — were most often placed on preferred brand tiers with a fixed copay in 2023, per KFF. A plan can leave that copay where it was, raise it, or lower it; the negotiated price changes the plan's cost, not necessarily yours. This is not a loophole so much as the way tiered benefits work, and it is why "contact your plan" is the honest instruction.

Insulin is its own case. Fiasp and NovoLog have a negotiated price of $119, but your cost sharing for a covered insulin was already capped at $35 a month under the same 2022 law, so the negotiated price mostly changes what the plan pays. If you use one of those insulins, your counter price should not have gone up, and if it did, call the plan.

One more group to name: people without Medicare drug coverage. The negotiated price is available to people enrolled in a Medicare drug plan buying the drug through it. If you have Original Medicare and never enrolled in Part D, or you rely on a non-Medicare employer or retiree plan, the MFP is not your price. We cover the cost of waiting in our guide to the Part D out-of-pocket cap, which is the other half of the same law.

Every plan has to cover them — with one asterisk

Before 2026, whether your plan covered a given brand-name drug at all was a formulary decision the plan made each year. For the selected drugs, that decision has been taken away. Federal law requires Part D plans, including the drug benefit inside Medicare Advantage plans, to cover every selected drug with a negotiated price, in every dosage form and strength.

KFF measured what that did. In its February 2026 analysis, 100% of Part D enrollees had coverage of all ten first-cycle drugs in 2026. The change was starkest where coverage had been thin: in 2025, only 24% of enrollees were in a plan that covered Fiasp and 32% for NovoLog; both are now universal. Imbruvica's two dosage strengths, covered for about 50% of enrollees in 2025, are covered for all. Nine of the ten drugs showed improved coverage in 2026 over 2025. For a Mesa County household that had been paying cash for a drug their plan left off the list, or switching brands to stay on formulary, that is arguably a bigger change than the price itself.

The asterisk: coverage is not the same as unrestricted access. Plans can still use prior authorization and similar management tools on the selected drugs. KFF's 2023 analysis found that virtually every enrollee with coverage of Enbrel, Imbruvica or Stelara faced a prior authorization requirement, and nothing in the negotiation program removed the plan's ability to require one. If your drug needed a form last year, expect the form this year. What the plan cannot do is decline to cover the drug or leave a strength off the list.

Sources: KFF — The IRA Has Improved Coverage of Drugs Selected for Medicare Price Negotiation (February 11, 2026) · KFF — How Medicare's New Drug Price Negotiation Program Could Expand Access to Selected Drugs (September 26, 2023) · KFF — Key Facts About Medicare Drug Price Negotiation (March 11, 2026) · Medicare.gov — How do drug plans work?. Plan year 2026.

What changes on January 1, 2027

The second cycle ended on November 1, 2025, and every one of the 15 companies reached agreement with CMS. These prices apply to 2027, which means they are part of the plan year you will be choosing during the Annual Enrollment Period this fall. Here is the full list, with the 2024 list price CMS measured against and the number of Part D users in 2024.

Source: CMS — Negotiated Prices for Initial Price Applicability Year 2027 (PDF table of maximum fair prices). Negotiated price is the agreed maximum fair price for a 30-day supply, calendar year 2027; list price is the 2024 list price for a 30-day supply; user counts rounded to the nearest thousand. Effective January 1, 2027. Drugs listed in CMS's order.

The numbers behind the table, per CMS: 5.3 million of the 53 million people with Part D used at least one of these drugs in 2024. They accounted for $42.5 billion in gross Part D drug costs, about 15% of the program, and enrollees paid $1.7 billion out of pocket for them. Had the 2027 prices been in effect in 2024, CMS estimates net Medicare spending on them would have been $12 billion lower, about 44% (or $8.5 billion and 36% counting the old coverage-gap discount program). CMS projects enrollees will save an estimated $685 million in 2027 under the standard benefit.

Four things stand out for a Western Slope reader.

• Ozempic and Rybelsus are the biggest item on the list — 2.3 million Part D users in 2024, $15.2 billion in gross costs, and a price of $274 against a $959 list. Wegovy shares the price because it is the same molecule, but Medicare still does not cover a drug prescribed for weight loss alone; the negotiated price applies to its Medicare-covered uses, such as reducing cardiovascular risk. KFF found that fewer than 1% of Part D enrollees were in a plan covering Wegovy in 2026, for that reason.
• Two inhalers, Trelegy Ellipta and Breo Ellipta, are on the list — 1.9 million users between them, at $175 and $67. In a county where 7.0% of adults report COPD and 11.5% current asthma, that is a lot of kitchen counters.
• Three more diabetes drugs join the four already negotiated: Tradjenta at $78, Janumet at $80, and Ozempic/Rybelsus. Someone on Januvia now and Janumet next year has both drugs under negotiated prices.
• The cancer drugs carry the biggest dollar reductions and the smallest counter changes. Xtandi, Ibrance, Calquence and Pomalyst are all priced between $7,000 and $8,650 a month negotiated. Anyone on them reaches the annual cap early regardless; the saving there is Medicare's.

Practically, the 2027 prices arrive on the same calendar as everything else that changes your drug costs. Your plan's Annual Notice of Change has to reach you by September 30 and will list your 2027 cost sharing by tier; 2027 plans post on Medicare.gov on October 1; and the Annual Enrollment Period runs October 15 – December 7. If one of the fifteen is your drug, that letter is where you find out whether your plan passed the price through as a lower copay, moved the drug to a different tier, or left it alone.

2028: the first Part B drugs

On January 27, 2026, CMS named the third cycle: 15 drugs whose negotiated prices will take effect January 1, 2028. They are Trulicity, Biktarvy, Orencia, Cosentyx, Erleada, Kisqali, Entyvio, Verzenio, Botox, Lenvima, Xolair, Rexulti, Xeljanz, Anoro Ellipta and Cimzia. About 1,777,000 people with Part B or Part D coverage used them in the twelve months ending October 2025, and they accounted for $27.0 billion in spending, about 6% of the two programs combined. Companies had until February 28, 2026 to decide whether to participate, and CMS also selected Tradjenta, negotiated for 2027, for renegotiation.

The new element is Part B. The first two cycles covered only drugs you fill at a pharmacy. This cycle includes drugs "payable under Medicare Part B," which are given in a doctor's office or infusion clinic — Botox for chronic migraine and spasticity, Orencia and Cimzia for rheumatoid arthritis, Xolair for asthma, Entyvio for Crohn's disease. Under Original Medicare, Part B drugs are paid at 80% after the Part B deductible, with the 20% coinsurance on you and no annual cap unless a Medigap policy or a Medicare Advantage plan's out-of-pocket limit supplies one. A negotiated price on a Part B drug therefore reaches Original Medicare patients through a different door than the Part D prices do: a lower base means a lower 20%. The mechanics will be spelled out in CMS guidance before 2028; for now the useful fact is that the list exists and your doctor's office will eventually be working from it.

Sources: CMS — Selected Drugs for Initial Price Applicability Year 2028 (fact sheet, January 27, 2026) · CMS — Selection of drugs for the third cycle of the Medicare Drug Price Negotiation Program, including first-ever Part B drugs (press release) · KFF — Key Facts About Medicare Drug Price Negotiation (March 11, 2026) (cycle schedule). Retrieved September 2026.

Who this touches in Mesa County

In calendar year 2025, CMS counted 41,023 Medicare beneficiaries in Mesa County, and 32,438 of them — 79% — had Medicare drug coverage: 14,995 through a stand-alone Part D plan alongside Original Medicare, and 17,443 through a Medicare Advantage plan with drug coverage. Both groups are inside the negotiation program, because the coverage requirement applies to every Medicare drug plan. The split that matters more is Extra Help: 26,122 of those enrollees received no low-income subsidy in 2025, and 6,316 did. People with Extra Help already pay set copays of a few dollars, so the negotiated price barely touches them; the 26,122 paying full plan cost sharing are the ones whose counter price can move.

Which drugs matter here is a health question, and the CDC's PLACES estimates for Mesa County answer it. The table maps the county's most common chronic conditions to the negotiated drugs that treat them, now and next year.

Sources: CDC PLACES — Local Data for Better Health, County Data, 2025 release, crude prevalence among adults, Mesa County, Colorado (2023 BRFSS data, 2025 release; PLACES county population 159,681) · CMS — Negotiated Prices for Initial Price Applicability Year 2026 (PDF table of maximum fair prices) · CMS — Negotiated Prices for Initial Price Applicability Year 2027 (PDF table of maximum fair prices). Drug-to-condition pairings are CMS's "commonly treated conditions"; a condition does not imply any particular drug is prescribed for it. High cholesterol, at 31.8% of screened adults, has no drug on either list.

Two observations. First, the blood thinners are the local story. Eliquis was filled by 3.9 million people with Part D in 2023 and Xarelto by 1.3 million, and both are prescribed for atrial fibrillation and clot prevention — conditions that ride along with the 31.1% of Mesa County adults with high blood pressure, the 6.7% with coronary heart disease and the 3.5% who have had a stroke. An older county with a lot of heart disease is a county with a lot of Eliquis, and Eliquis is the drug where the difference between a coinsurance tier and a copay tier is most likely to show up on a real receipt. Second, the 2027 list reaches into the lungs: with 7.0% of adults reporting COPD and 11.5% current asthma, the two Ellipta inhalers are the drugs most worth checking in the October letter.

The tool that ties it together is the one you already have. Medicare.gov's Plan Finder prices your exact drug list against every plan sold in ZIP 81501 and shows your estimated annual cost, cap included; when the 2027 plans post on October 1, it will price the fifteen new negotiated drugs too. Whether you shop it yourself or sit down with us, the drug list is the input, not the plan name.

Sources: CMS — Medicare Monthly Enrollment (data.cms.gov), calendar year 2025 annual county figures · CDC PLACES — Local Data for Better Health, County Data, 2025 release · Medicare.gov — Find health & drug plans.

Six things to do before October 15

The Annual Enrollment Period runs October 15 – December 7, and the changes you make take effect January 1, 2027. Here is the drug-price homework, in order.

1. Write down every prescription you take, with the strength and how often you fill it. Then circle any that appear in the two tables above. If nothing is circled, the negotiation program does not change your 2027 yet — but the rest of this list still applies.
2. For each circled drug on the 2026 list, find out what you are paying now and why. Look at a recent receipt or your plan's Explanation of Benefits. Is it a percentage or a flat amount? If it is a percentage of a price that is still near the old list price, call the plan — the negotiated price should be the basis.
3. When the Annual Notice of Change arrives by September 30, go to the tier chart first. Find each circled drug's tier for 2027 and its cost sharing. For the fifteen new drugs, this is the first time the negotiated price is in the plan's math. A drug that moved from a copay tier to a coinsurance tier, or the reverse, can cost more or less than you expect.
4. Run your list through Medicare.gov's Plan Finder on or after October 1. Enter every drug, your pharmacy and ZIP 81501, and compare the estimated annual total, not the premium. The $2,100 cap (rising to $2,400 in 2027, per CMS's CY2027 Rate Announcement) is built into the estimate.
5. Check Extra Help before you check plans. If your income is limited, the Part D Low-Income Subsidy sets your copays at a few dollars regardless of the negotiated price, and it does more for you than any formulary change. Our Extra Help guide walks the 2026 limits.
6. If the year-end total still lands hard in one month, look at the Medicare Prescription Payment Plan. It spreads your cost sharing across the year without reducing it; our Mesa County guide explains when it helps and when it does not.

If none of your drugs is on either list, the useful takeaway is the calendar: up to 20 more drugs get selected every year from here, the list is published each winter, and the price lands two years later. The drug you take in 2030 may be on it.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options. Bemis Insurance is a licensed independent insurance agency. Not connected with or endorsed by the United States government or the federal Medicare program. This article is education, not advice — confirm your own coverage, costs, eligibility and deadlines with Medicare.gov, with your plan, or with a licensed agent before you act. Figures above are the negotiated maximum fair prices, list prices, user counts and savings estimates published by CMS for initial price applicability years 2026 and 2027 and the drugs CMS selected for 2028; the CY2026 Part D defined standard benefit parameters from CMS's Final CY 2026 Part D Redesign Program Instructions; Medicare.gov's January 2026 fact sheet; plan tier placement, cost sharing and coverage findings published by KFF; CMS county enrollment counts for calendar year 2025; and CDC PLACES county estimates from the 2025 release. Each is linked to its source. The Eliquis cost-sharing arithmetic illustrates the defined standard benefit and is not a quote of any plan's cost sharing. Drug names appear as published by CMS; their inclusion is not a recommendation to take, stop or switch any medication — talk to your prescriber. Plan formularies, tiers and cost sharing are set by each plan and change every year.

Sources

• CMS — Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability Year 2026 (fact sheet)
• CMS — Negotiated Prices for Initial Price Applicability Year 2026 (PDF table of maximum fair prices)
• CMS — Negotiated Prices for Initial Price Applicability Year 2027 (PDF table of maximum fair prices)
• CMS — Selected Drugs for Initial Price Applicability Year 2028 (fact sheet, January 27, 2026)
• CMS — Selection of drugs for the third cycle of the Medicare Drug Price Negotiation Program, including first-ever Part B drugs (press release)
• CMS — Medicare Drug Price Negotiation Program (program page)
• CMS — Selected Drugs and Negotiated Prices
• CMS — Final CY 2026 Part D Redesign Program Instructions (fact sheet)
• Medicare.gov — Your Medicare in 2026: What You Need to Know (CMS Product No. 12229, January 2026)
• Medicare.gov — How do drug plans work?
• Medicare.gov — How much does Medicare drug coverage cost?
• KFF — How Medicare's New Drug Price Negotiation Program Could Expand Access to Selected Drugs (September 26, 2023)
• KFF — The IRA Has Improved Coverage of Drugs Selected for Medicare Price Negotiation (February 11, 2026)
• KFF — Key Facts About Medicare Drug Price Negotiation (March 11, 2026)
• CMS — Announcement of Calendar Year (CY) 2027 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies (Attachment V: 2027 Part D out-of-pocket threshold)
• CMS — Medicare Monthly Enrollment (data.cms.gov)
• CDC PLACES — Local Data for Better Health, County Data, 2025 release
• Medicare.gov — Find health & drug plans
• Medicare & You 2026 (official handbook)
• Colorado Division of Insurance — Senior health care and Medicare (SHIP)
• SHIP National Technical Assistance Center — find your local SHIP