CMS fixed the January 1 start date for Calquence’s negotiated Medicare price more than a year before it takes effect, publishing the figure alongside 14 other drugs in the program’s second cycle back in November 2025. Now that the date is close enough to matter, the numbers are worth restating plainly: the leukemia drug AstraZeneca sells drops from a $14,228 monthly list price to a negotiated $8,600, a cut of about 40 percent, arriving on the same calendar as a third negotiation cycle CMS has already begun for drugs taking effect in 2028. That overlap between one cycle’s start date and the next cycle’s selection is a detail the price figures alone do not explain.
Calquence’s leukemia use, and a January 1 start date CMS set two years ago
Calquence’s active ingredient, acalabrutinib, treats chronic lymphocytic leukemia and small lymphocytic lymphoma, two closely related slow-growing blood cancers that begin in white blood cells and are typically diagnosed in older adults through routine bloodwork rather than through symptoms severe enough to send a patient to a doctor on their own. The drug belongs to a class called Bruton’s tyrosine kinase inhibitors, which block a specific enzyme leukemia cells rely on to survive and multiply, a mechanism distinct from traditional chemotherapy.
AstraZeneca first won FDA approval for Calquence in October 2017, for a different blood cancer, mantle cell lymphoma, before the agency approved it for chronic lymphocytic leukemia in November 2019 and, later still, for combination treatment alongside the drug venetoclax, according to the Food and Drug Administration’s approval announcement for that combination. That October 2017 date, not the later leukemia approval, is what starts the clock the negotiation program uses, giving Calquence more than seven years on the market by the time CMS selected this cycle’s drugs in early 2025.
The January 1, 2027 date is not specific to Calquence; it is the same effective date CMS set for all 15 drugs in the program’s second cycle when the agency published its negotiated-prices fact sheet in November 2025, more than a year before the price actually takes hold at a pharmacy counter. That lag between the announcement and the effective date gives manufacturers, Part D plans and pharmacy systems time to update pricing and billing, and it means the $8,600 figure has been public information for roughly 14 months before it applies to an actual prescription.
The date the price applies, not the date coverage is confirmed: Calquence’s negotiated price starts January 1, but a leukemia plan’s own coverage rules and any prior-authorization requirement do not automatically reset on that date. The Medicare Cost & Coverage Protection Kit’s prior-authorization appeal steps address that separate step. See the prior-authorization steps for a January start in The Medicare Cost & Coverage Protection Kit.
A 40 percent cut that sits at the shallow end of this round’s range
Among the 15 drugs CMS negotiated for this cycle, cuts ranged from a 38 percent reduction on the movement-disorder drug Austedo to an 85 percent reduction on the asthma inhaler Breo, and Calquence’s $14,228-to-$8,600 reduction lands near the shallow end of that spread rather than the middle or the deep end where drugs such as Pomalyst and Xifaxan landed. CMS’s fact sheet does not explain why any single drug’s percentage cut came out where it did, since each price results from a separate set of confidential negotiating factors specific to that drug and manufacturer.
A smaller percentage cut does not necessarily mean a smaller dollar reduction: Calquence’s $5,628 monthly drop is larger in raw dollars than several drugs with steeper percentage cuts but lower starting list prices, a reminder that the percentage figure CMS highlights in its public fact sheet and the dollar figure that actually shows up in Part D’s spending both tell different parts of the same story. A plan actuary pricing next year’s premiums cares more about that dollar figure multiplied across every enrollee filling the prescription than about the percentage CMS chose to headline.
AstraZeneca, a third negotiation cycle, and the officials confirming both
AstraZeneca announced Calquence’s original chronic lymphocytic leukemia approval in a November 2019 statement describing the drug as the company’s second approved treatment for blood cancer at the time, part of a broader push by the company into hematology alongside its established oncology portfolio. AstraZeneca remains the sole manufacturer negotiating with CMS over Calquence’s price, unlike some other drugs in the same cycle that involve co-marketing arrangements between two companies.
CMS’s negotiated-prices fact sheet also reported that the full 15-drug second cycle is projected to save Part D about $12 billion overall, a roughly 44 percent reduction against what those drugs would otherwise have cost the program, with about 5.3 million of the program’s 53 million enrollees having used one of the 15 drugs in 2024. Calquence’s own share of that combined figure is not broken out separately from the other 14 drugs in the published second-cycle figures.
CMS has since moved on to a third negotiation cycle, selecting 15 additional drugs, including for the first time drugs covered under Medicare Part B, for prices that take effect in January 2028. Chris Klomp, CMS’s Deputy Administrator and Director of Medicare, said of that January 27, 2026 announcement that publishing the list of top negotiation-eligible drugs shows the program’s commitment to transparency, a comment tied to the newer round rather than to Calquence’s already-finalized price.
A third negotiation cycle does not change this year’s plan rules
CMS has already selected 15 more drugs for a third negotiation cycle taking effect in 2028, but that later timeline runs separately from whatever prior-authorization or step-therapy rule a Part D plan currently applies to a leukemia prescription like Calquence in the meantime.
The Medicare Cost & Coverage Protection Kit includes the prior-authorization appeal steps and a medication and cost tracker, addressing the plan-level hurdle and the running cost record a blood-cancer prescription creates regardless of which negotiation cycle applies.
Read the appeal steps and open the 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.
