The Centers for Medicare & Medicaid Services named 15 drugs on January 27 for the third cycle of the Medicare Drug Price Negotiation Program, the first cycle to include medicines billed under Medicare Part B rather than only the Part D pharmacy benefit. Negotiations with the manufacturers run through 2026, and any agreed-upon prices take effect January 1, 2028. Roughly 1.8 million Medicare enrollees used the selected drugs between November 2024 and October 2025, spending an estimated $27 billion combined, about 6 percent of all Medicare Part B and Part D drug spending in that period.
Fifteen Drugs, From Diabetes Shots to Cancer Treatments
Trulicity, Eli Lilly’s weekly injection for type 2 diabetes, topped the list with $4.9 billion in combined Part B and Part D spending and 617,000 users in the twelve-month window CMS used to rank eligibility. Biktarvy, Gilead’s once-daily HIV treatment, ranked second at $3.9 billion and 101,000 users, and Orencia, Bristol-Myers Squibb’s injectable treatment for rheumatoid and psoriatic arthritis, ranked third at $2.45 billion and 72,000 users.
The remaining twelve selected drugs are Cosentyx, Erleada, Kisqali, Entyvio, Verzenio, Botox and Botox Cosmetic, Lenvima, Xolair, Rexulti, Xeljanz and Xeljanz XR, Anoro Ellipta, and Cimzia. CMS built the list by ranking up to 50 of the highest-spending Part B drugs and up to 50 of the highest-spending Part D drugs by combined expenditure and selecting the top 15, after excluding five drugs that manufacturers had shown qualified for a small-biotech exception. Botox and Botox Cosmetic reached the widest population of the fifteen, with 390,000 users despite ranking ninth by dollar volume, while Lenvima, a treatment for thyroid, kidney and liver cancers, served only about 10,000 people at $1.09 billion in spending.
Where the help is written down: The programs that lower Medicare costs each run on a different form and a different office, and no single notice lists them together. See the state cost-help packs in The Medicare Cost & Coverage Protection Kit.
The First Part B Drugs Enter Negotiation
The first two negotiation cycles covered only drugs dispensed through the Part D pharmacy benefit, the pills and self-injected treatments filled at a retail pharmacy counter. This third cycle is the first to reach drugs payable under Part B, the benefit that covers medicines a clinician administers in an office or infusion center, such as Botox for chronic migraine and overactive bladder, Orencia and Cimzia for autoimmune conditions, and Entyvio for Crohn’s disease and ulcerative colitis. CMS says that distinction matters because Part B and Part D drugs are now ranked together by combined spending, so a physician-administered biologic can qualify for negotiation on the same footing as a self-administered pill.
The pharmacy-counter effect of that shift is not identical across the two benefits. Part D enrollees pay toward a fixed annual out-of-pocket cap once they meet their deductible, so a lower negotiated price mainly shows up as a smaller dent in that yearly total. Part B enrollees typically pay 20 percent coinsurance on the Medicare-approved amount for each infusion or injection after meeting the annual Part B deductible, so a lower negotiated price for a drug like Botox, Orencia or Entyvio changes the coinsurance bill an enrollee owes at the clinic that same visit, not just a cap reached later in the year.
“For too long, seniors and taxpayers have paid the price for skyrocketing prescription drug costs,” CMS Administrator Dr. Mehmet Oz said in the agency’s announcement. “CMS is taking strong action to target the most expensive drugs in Medicare, negotiate fair prices, and make sure the system works for patients—not special interests. This approach delivers real savings while strengthening accountability across the program.”
Alongside the selected-drug list, CMS published a companion list of the 50 highest-spending negotiation-eligible drugs under Part B and Part D combined, a disclosure the agency had not made in the first two cycles. CMS Deputy Administrator and Director of Medicare Chris Klomp called the new list evidence of the program’s “commitment to transparency,” saying the eligibility criteria and negotiation policies behind it are designed to keep the program responsive to market changes while delivering fairness and value for patients.
Manufacturer Participation and the Road to 2028 Prices
On March 13, CMS confirmed that the manufacturers of all 15 selected drugs, plus Boehringer Ingelheim, which makes Tradjenta, the one drug chosen for renegotiation, had signed agreements to participate rather than face the statutory penalties tied to non-participation. The list spans large and mid-sized drugmakers, including Gilead Sciences for Biktarvy, AbbVie for Botox, Eli Lilly for both Trulicity and Verzenio, Bristol-Myers Squibb for Orencia, and Genentech for Xolair, each of which met the February 28 deadline to sign on.
The process now moves through a defined federal calendar: CMS must send each participating manufacturer an initial price offer with a written justification by June 1, negotiation meetings and any counteroffers continue through the fall, and the negotiation period closes November 1. CMS must publish any agreed-upon maximum fair prices by November 30 and a full narrative explanation of the negotiation process by March 1, 2027, ahead of the prices taking effect on January 1, 2028.
The stakes of that calendar are visible in what happened after the program’s second cycle, which also covered 15 drugs and reached final agreement with every one of them, with those negotiated prices set to take effect January 1, 2027. CMS estimates that if the second cycle’s negotiated prices had applied in 2024, they would have cut net covered prescription drug costs by about $8.5 billion, or roughly 36 percent, on those drugs alone. That is the scale of reduction CMS is now pursuing on Trulicity, Botox and the other 13 drugs selected for the cycle ending in 2028.
Negotiated Prices and the Pharmacy Counter
The prices CMS negotiates for Trulicity, Botox, Xolair and the other twelve selected drugs will not reach a pharmacy counter or an infusion clinic until January 2028, leaving the current mix of Part B coinsurance, Part D formulary tiers and prior-authorization rules in place for two more plan years. Enrollees taking any of the fifteen selected drugs, or a therapeutic alternative to one of them, are still working within that current cost-sharing structure while the negotiation and renegotiation calendar plays out through 2026. Tracking what a specific drug costs under a specific plan, and what happens when a plan changes a formulary or a prior-authorization rule, remains a separate problem from the negotiated-price headline.
The Medicare Cost & Coverage Protection Kit is a 10-page kit built around a medication and cost tracker for exactly that gap between now and 2028.
Compare current prescriptions against the medication and cost tracker in The Medicare Cost & Coverage Protection Kit.
This article was researched and drafted with the assistance of AI and reviewed by The Money Overview editorial team.
