|Verified for the 2026 Plan Year
Quick Answer: Effective January 1, 2026, Medicare’s first-ever negotiated Maximum Fair Prices (MFPs) are active for 10 high-cost drugs, yielding manufacturer discounts between 38% and 79%. For New York seniors, these lower base costs work alongside the new $2,100 annual out-of-pocket cap and the Medicare Prescription Payment Plan to stabilize monthly pharmacy costs. However, actual out-of-pocket copays depend on your specific plan’s formulary tiers.
The Medicare negotiated drug price program changes how selected high-cost medications are priced for people enrolled in Medicare drug coverage. It is designed to set lower maximum prices for certain prescriptions commonly used to manage serious, long-term health conditions.
Medicare beneficiaries may notice these negotiated prices when reviewing prescription costs under a Part D or Medicare Advantage drug plan. Created under the Inflation Reduction Act, the program allows Medicare to negotiate directly with participating pharmaceutical manufacturers before prices take effect.
Understanding which medications are included can help beneficiaries compare plans and anticipate their prescription expenses for the coming year. This guide explains the selected drugs, their negotiated prices, potential savings, and steps to confirm how a plan applies the new pricing.
Prescription Drug Costs Are Crushing Seniors – But That’s Starting to Change
More than 8 million Medicare beneficiaries spend thousands of dollars each year on just 10 widely prescribed medications. For seniors on fixed incomes, that expense is not a minor inconvenience; it is a monthly financial strain that forces real trade-offs between medication and basic needs.
Working with Medicare beneficiaries every day, we hear the same concern: prescription costs are consuming a growing share of retirement income. The federal government has taken direct action. Under the Inflation Reduction Act, signed into law in August 2022, Medicare now has the legal authority to negotiate drug prices directly with pharmaceutical manufacturers, making Medicare negotiated drug prices a reality for the first time in the program’s history.
Could your prescription costs drop significantly in 2026? Below, we break down which 10 drugs made the negotiated price list, exactly how much the savings are, and how to confirm your plan reflects these lower costs.
Note on Pricing: Prices in this article reflect CMS’s officially published Maximum Fair Prices for 2026. Individual savings will vary based on your specific plan, cost-sharing structure, and pharmacy. Verify your coverage at medicare.gov or contact your plan directly.
What Is the Medicare Drug Price Negotiation Program?
The Medicare Drug Price Negotiation Program, established under the Inflation Reduction Act, gives the Centers for Medicare and Medicaid Services (CMS) the legal authority to negotiate directly with drug manufacturers on behalf of Medicare enrollees. The result of each negotiation is a Maximum Fair Price (MFP), the ceiling price any Medicare Part D or Medicare Advantage plan can charge for that drug.
Think of the MFP as a legally binding price ceiling. Just as a regulated utility cannot charge above a government-set rate, drug manufacturers must honor the Maximum Fair Price for Medicare-covered patients once negotiations are finalized.
These 10 drugs collectively accounted for $50.5 billion in total Medicare Part D drug costs, roughly 20% of all Part D spending. That is why CMS targeted them first: no other group of drugs offered as much combined savings potential for beneficiaries.
The annual out-of-pocket cap for Part D enrollees, introduced at $2,000 in 2025 and adjusted to $2,100 for 2026, works alongside these negotiated prices to deliver the most meaningful prescription cost protection in Medicare’s history. Additionally, for 2026, the maximum Part D deductible has been adjusted to $615.
To help manage these upfront costs—such as the 2026 maximum Part D deductible of $615—seniors can utilize the Medicare Prescription Payment Plan (M3P). This free, voluntary program allows you to spread your out-of-pocket pharmacy expenses into predictable monthly payments throughout the year. Plus, starting in 2026, participation in M3P automatically renews annually so you won’t experience coverage gaps.
How Does Medicare Negotiate Drug Prices With Manufacturers?
The process follows three clear steps:
- Drug Selection: CMS identifies high-cost drugs with no generic or biosimilar competition and for which market forces have not lowered prices on their own.
- Negotiation Window: CMS presents manufacturers with an offer based on clinical value, evidence about alternative treatments, and market data. Participation is mandatory under federal law; manufacturers who refuse face an escalating excise tax.
- Maximum Fair Price: Once finalized, the MFP becomes the legally binding ceiling. Your Part D cost-sharing is then calculated against this lower price, not the old list price.
Which 10 Medications Are on the 2026 Medicare Negotiated Price List?
We have followed the Medicare pharmaceutical price negotiation program since its creation, and the 2026 results are significant. CMS reports discounts ranging from 38% to 79% compared to 2023 list prices, with meaningful reductions on medications that millions of seniors depend on daily to manage chronic conditions.
Medicare Negotiated Drug Prices – 2026 Savings at a Glance
The table below reflects CMS’s officially published Maximum Fair Prices, effective January 1, 2026.
| Drug Name | Condition Treated | 2023 List Price (30-day) | MFP 2026 (30-day) | Price Reduction |
|---|---|---|---|---|
| Eliquis (apixaban) | Blood clots, atrial fibrillation | $521 | $231 | 56% |
| Jardiance (empagliflozin) | Type 2 diabetes, heart failure | $573 | $197 | 66% |
| Xarelto (rivaroxaban) | Blood clots, arterial disease | $517 | $197 | 62% |
| Januvia (sitagliptin) | Type 2 diabetes | $527 | $113 | 79% |
| Farxiga (dapagliflozin) | Diabetes, heart failure, and kidney disease | $556 | $178 | 68% |
| Entresto (sacubitril/valsartan) | Heart failure | $628 | $295 | 53% |
| Enbrel (etanercept) | Rheumatoid arthritis, psoriasis | $7,106 | $2,355 | 67% |
| Imbruvica (ibrutinib) | Blood cancers | $14,934 | $9,319 | 38% |
| Stelara (ustekinumab) | Crohn’s disease, psoriasis | $13,836 | $4,695 | 66% |
| Fiasp/NovoLog (insulin aspart) | Type 1 and Type 2 diabetes | $495 | $119 | 76% |
*Note: List prices represent 2023 Wholesale Acquisition Costs per 30-day supply before any plan cost-sharing or secondary coverage is computed.
💡 2026 Real-Life Scenario: Lower Costs for Eliquis and Jardiance
Meet Maria: A senior living in Brooklyn, Maria manages both atrial fibrillation and Type 2 diabetes. Her daily treatment plan requires both Eliquis and Jardiance.
The Outcome: Based on 2023 retail list prices, the combined cost of these medications was approximately $1,094 per month. Under the 2026 Maximum Fair Prices, the underlying baseline cost drops to approximately $428 per month—a massive $666 monthly reduction for the program.
However, as a Licensed NY Broker, I must highlight a critical compliance nuance that national platforms overlook. Because the Inflation Reduction Act caps all Medicare Part D out-of-pocket spending at $2,100 for the entire 2026 plan year, Maria will never pay $428 per month for a full twelve months. Instead, she will reach her $2,100 out-of-pocket maximum by her fifth month of fills. From month six onward, her covered prescription costs drop to $0. Her total yearly prescription exposure is locked at $2,100—which she can spread into equal monthly installments of $175 using the Medicare Prescription Payment Plan (M3P).
Eliquis carries particular weight in this round. Medicare Part D spent approximately $18.3 billion on it for nearly 4 million beneficiaries in 2023 alone. Januvia delivers a 79% price reduction, the widest discount in the first negotiation round, offering relief for seniors managing Type 2 diabetes who have had no lower-cost generic option available.
More Medicare Drug Price Negotiations Are on the Way
The Inflation Reduction Act requires CMS to negotiate prices for an expanding number of drugs each year:
- 2027 (Prices Already Finalized): CMS has officially announced the second round of 15 selected drugs with negotiated prices taking effect January 1, 2027. Most notably, the popular GLP-1 drugs Ozempic, Rybelsus, and Wegovy will see a massive 71% discount, dropping their average 30-day supply price from $959 down to just $274! Other upcoming 2027 negotiated drugs include Trelegy Ellipta (73% discount), Breo Ellipta (83% discount), and Linzess (75% discount).
- The “Generic Exit” Nuance: In a major development, three of our 2026 negotiated drugs, Stelara, Xarelto, and Entresto, will exit the negotiation list on January 1, 2027, as newly launched, highly competitive generic alternatives hit the market.
- 2028: Another 15 high-cost drugs will be selected for negotiation.
- 2029 and Beyond: Up to 20 new drugs will be selected annually to keep lowering out-of-pocket burdens.
If your medication is not on the current list, it may be included in a future round.
Who Qualifies for Medicare Negotiated Drug Prices – And How To Verify Yours
The plan type determines whether the Maximum Fair Price applies to you, and we find that this is where beneficiaries encounter significant confusion. Does your current plan actually reflect the Medicare-negotiated drug price, or are you still paying the old rate?
Which Medicare Plans Apply the Negotiated Drug Prices?
The MFP applies to beneficiaries enrolled in:
- Original Medicare with a standalone Part D plan – Your plan must include negotiated drugs on its formulary and apply the MFP.
- Medicare Advantage with drug coverage (MA-PD) – Your plan must cover negotiated drugs and honor the MFP.
- Medicare Advantage without drug coverage – Negotiated prices do not apply because there is no Part D drug benefit.
One critical nuance to understand: the MFP is a price ceiling for what plans pay, not a flat rate every beneficiary automatically receives. Your actual out-of-pocket cost still depends on your plan’s formulary tier and cost-sharing structure.
The NY Advantage: Because Life143 is headquartered in New York, we always remind our local clients about EPIC (Elderly Pharmaceutical Insurance Coverage). This NY State program works in tandem with your Medicare Part D plan to help cover drug deductibles and copayments. When paired with the 2026 negotiated prices, New York seniors have an unprecedented opportunity to maximize their monthly savings.
Licensed NY Broker Compliance Note: The New York Safety Net
In New York State, Medicare beneficiaries have unique protections and local programs that national articles frequently ignore. While the federal Maximum Fair Prices (MFP) lowers the baseline cost of these 10 drugs, New York’s Elderly Pharmaceutical Insurance Coverage (EPIC) program acts as a critical secondary payer. EPIC can further reduce or eliminate your Part D deductibles and copayments if you meet income eligibility requirements.
Additionally, pursuant to New York Department of Financial Services (DFS) guidelines, all cost-sharing estimates must be cross-verified against the specific plan’s formulary, as network deviations are common in areas such as Queens, Manhattan, and Staten Island.
How To Check if Your Plan Reflects the 2026 Negotiated Price
Take these three steps before or during Open Enrollment:
- Visit medicare.gov/plan-compare and enter your current prescriptions.
- Review the formulary tier and estimated cost-sharing for each drug under your plan.
- If the price seems inconsistent with the MFP, contact your plan directly and ask how the negotiated price is being applied to your formulary tier.
Important Date: Open Enrollment runs October 15 through December 7, your window to switch to a plan with more favorable negotiated drug coverage if your current plan falls short.
Make Sure Your Medicare Plan Reflects Your 2026 Drug Savings
Medicare negotiated drug prices may lower costs for certain high-cost prescriptions, but your actual savings still depend on your Part D or Medicare Advantage drug plan. Formulary tiers, cost-sharing rules, pharmacy pricing, and annual out-of-pocket limits can all affect what you pay when you fill your medications.
Reviewing your Medicare drug coverage before or during Open Enrollment can help you confirm whether your plan correctly applies the new negotiated prices. It can also help you compare other plan options if your current coverage does not provide the prescription savings or pharmacy access you need.
Need help checking whether your Medicare plan supports your prescription needs?
Contact Life143 to speak with a licensed New York Medicare advisor. We help local beneficiaries review plan formularies, verify tier placement, calculate true out-of-pocket costs, and combine Part D savings with programs like EPIC—ensuring your 2026 coverage supports your health and your budget.
Frequently Asked Questions About Medicare Drug Price Negotiation
