Starting January 1, 2027, Medicare’s prescription drug program will pay a federally negotiated price for Trelegy Ellipta, the once-daily inhaler that millions of older Americans use to manage chronic obstructive pulmonary disease and asthma. The negotiated figure comes in at $175 for a medicine that carried a $654 list price, one of 15 drugs in a second round of Medicare price negotiations. For the roughly 1.3 million beneficiaries who fill Trelegy prescriptions, the change reaches a recurring cost that has strained budgets built around a fixed monthly income.
How the second negotiation round reached a COPD inhaler
The price cuts flow from the Inflation Reduction Act, which for the first time gave Medicare the authority to negotiate directly with manufacturers on a set of high-spending drugs. The first round covered 10 medicines with prices that take effect in 2026. Trelegy sits in the second group, a slate of 15 drugs whose negotiated prices were selected and finalized by federal health officials and scheduled to begin in 2027.
Across those 15 drugs, the negotiated prices amount to roughly a 44 percent aggregate reduction against what Medicare spent on the same medicines in 2024, a year in which the program’s outlay on this group ran to about $12 billion. Federal health officials announced the selected drugs and their finalized prices as the program’s second negotiation round. Trelegy, made by GSK, is among the most visible names on the list because respiratory disease is common among people in their late 60s and 70s, and because the inhaler is a maintenance therapy that patients typically take every day rather than for a short course.
The negotiated amounts are ceiling prices that manufacturers must honor for Medicare, not retail stickers pulled from a pharmacy shelf. They govern what the program and its drug plans use as the basis for what enrollees ultimately pay, which is why the gap between a $654 list price and a $175 negotiated price matters well beyond the accounting.
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Why $175 versus $654 lands hard for COPD patients
Chronic obstructive pulmonary disease is a progressive condition, and the inhalers that keep it in check are not optional. That makes a maintenance drug like Trelegy a fixed line in a household budget rather than a one-time expense, and it explains why respiratory medications so often show up in stories about seniors splitting doses or skipping refills to stretch a month. A price anchored near $175 instead of $654 changes the arithmetic of staying on therapy.
The negotiated price also feeds into the broader restructuring of Medicare drug costs that arrived alongside it. Beginning in 2025, out-of-pocket spending on covered Part D drugs was capped at $2,000 a year, with the ceiling indexed to rise modestly thereafter. Reporting on the second round noted that a lower negotiated price for a high-volume inhaler helps reduce how quickly patients hit that annual cap, which can matter for anyone taking several prescriptions at once.
For a beneficiary managing COPD along with the heart or blood-pressure medications that frequently accompany it, the combined effect is what counts. A cheaper anchor price on the single most expensive item in the cabinet slows the pace at which the yearly out-of-pocket total climbs toward its limit.
The reach of a single inhaler helps explain why Trelegy drew attention among the 15 drugs. Respiratory illness is widespread in the Medicare population, and a maintenance therapy taken every day generates steady, predictable spending rather than the occasional expense of a short-term prescription. When a drug is filled month after month by more than a million people, even a moderate reduction per prescription compounds into a large figure across the program, and into meaningful relief for the households paying a share of each refill.
Where the change shows up inside a Part D plan
The negotiated prices apply to drugs covered under Medicare Part D, the prescription benefit that beneficiaries buy through private plans rather than a single government menu. Because those plans set their own formularies, tiers, and cost-sharing, the negotiated price is the floor the plan works from, not a flat copay every enrollee will see printed on a receipt. The federal government publishes the full list of selected drugs and their negotiated prices so patients and plans can see the same numbers.
That structure is the reason two people taking Trelegy could still pay different amounts in 2027, depending on which plan they hold and whether they have reached the annual cap. It is also why the fall enrollment window carries weight: plans adjust formularies and cost-sharing every year, and a beneficiary who wants the negotiated price reflected cleanly will need to confirm that Trelegy remains a covered drug on whatever plan they choose for 2027.
The negotiated price does not erase the value of shopping plans, either. A drug can move between formulary tiers from one year to the next, and a plan that covered Trelegy on favorable terms in 2026 could place it differently in 2027, which changes what a patient pays even against the lower baseline. Comparing plans on the specific drugs a household actually takes, rather than on premiums alone, remains the surest way to capture the benefit the negotiation was meant to deliver.
The larger question the second round leaves open is durability. Manufacturers have contested the negotiation program in court, and future rounds will add more drugs each year, so the roster of medicines carrying a negotiated price is set to keep growing. For an older reader whose monthly costs turn on a single inhaler, the near-term takeaway is narrower and more concrete: the anchor price on Trelegy is scheduled to fall sharply on the first day of 2027, and confirming plan coverage during open enrollment is how that reduction actually reaches the pharmacy counter.
This article was produced with AI assistance and reviewed by The Money Overview editorial team.
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