Medicare finalized negotiated 2027 prices for 15 more prescription drugs on November 25, 2025, with individual cuts from the 2024 list price ranging from about 38% to nearly 85% depending on the medication. Two of the highest-volume drugs on the list, the respiratory therapy Trelegy Ellipta and the diabetes drug Janumet, see reductions of roughly 73% and 85% respectively when the new prices take effect January 1, 2027. The cuts are the second round completed under the price negotiation authority Congress created in 2022, following the first group of 10 drugs whose negotiated prices already took effect in 2026.
The Second Round of Medicare’s Drug Price Negotiations
Direct price negotiation is itself a recent power: not until the Inflation Reduction Act took effect could Medicare bargain with manufacturers over what it pays, rather than simply covering whatever price a plan and a drugmaker settled on between themselves — a shift from the program’s hands-off posture since Part D began in 2006. Only “single-source” drugs, generally meaning branded products with no generic or biosimilar competitor, are eligible, which is why the list skews toward complex or biologic-adjacent therapies rather than widely genericized medications.
The process behind this round involved the Centers for Medicare and Medicaid Services and each manufacturer exchanging offers and counteroffers, backed by evidence each side submitted supporting its proposed price. CMS said the final prices for seven of the 15 drugs came from a manufacturer’s revised counteroffer, while the other eight companies accepted CMS’s written final offer outright, a split that suggests genuine back-and-forth rather than a price simply imposed unilaterally.
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The 15-drug list spans a wide range of conditions beyond diabetes and respiratory disease. Cancer treatments Xtandi, Pomalyst, Ibrance, and Calquence are on it, alongside gastrointestinal drugs Linzess and Xifaxan, the movement disorder treatment Austedo, the depression medication Vraylar, and the psoriasis drug Otezla. That breadth reflects the eligibility rule rather than any targeting of a particular disease category: any single-source, high-expenditure drug without generic or biosimilar competition can be selected for negotiation, regardless of what condition it treats, as long as it meets the spending thresholds CMS uses to build each year’s list.
Why Janumet and Tradjenta See Steeper Cuts Than Others on the List
The size of the cut varies enormously by drug rather than following a single formula. Merck’s Janumet, a combination diabetes medication, drops from a $526 list price to a $80 negotiated price for a 30-day supply, the steepest reduction on the list at roughly 85%. Boehringer Ingelheim’s Tradjenta and GSK’s Breo Ellipta follow closely, each cut by more than 80%. At the other end, Teva’s Austedo and AstraZeneca’s Calquence see reductions closer to 38% and 40%, still substantial but far from the deepest cuts on the same list.
Trelegy Ellipta, GSK’s widely used asthma and COPD inhaler, falls roughly in the middle of that range at about 73%, moving from a $654 to a $175 monthly list price. The wide spread reflects how each drug’s original list price, sales volume, and negotiating dynamics differed; a drug like semaglutide, the ingredient in Novo Nordisk’s Wegovy and Ozempic, was negotiated in this same round to a similarly steep cut, but its size and market profile made it the subject of separate White House attention that the other 14 drugs on this list did not receive.
This round follows the first group of 10 drugs Medicare negotiated in 2024, whose lower prices took effect at the start of 2026, a list that included blood thinners, diabetes treatments, and blockbuster autoimmune drugs. Comparing the two rounds shows the negotiation program scaling up rather than tapering off: each successive year adds a new batch of high-cost medications to the negotiated list while the previous year’s batch remains in effect, so the cumulative share of Medicare’s drug spending running through negotiated rather than list pricing keeps growing rather than resetting.
What the Savings Mean for Beneficiaries Versus the Program
CMS estimated that, had these prices been in effect during 2024, aggregate Medicare spending on the 15 drugs would have fallen by about 44%, or roughly $12 billion, with beneficiaries’ own out-of-pocket costs dropping by an estimated $685 million. Those are program-wide totals, not a guarantee about what any individual person taking one of these drugs will personally save, since a beneficiary’s actual costs depend on their specific plan’s cost-sharing structure and where they fall in the year’s coverage phases.
The practical effect for most beneficiaries will show up as lower coinsurance on the affected drugs starting in January 2027 rather than a lump-sum rebate or an automatic check, since the negotiated price lowers what the drug costs the plan, which in turn lowers the percentage-based cost sharing a member pays. For someone taking Trelegy for COPD or Janumet for diabetes, the size of that reduction could be meaningful, but for someone not taking any of the 15 named drugs, this particular round changes nothing about their own costs.
This round also sets a precedent for what comes next: CMS has already begun negotiating a third round covering an additional 15 high-expenditure drugs for 2028, a group that for the first time will include physician-administered drugs covered under Part B rather than only the pharmacist-dispensed drugs covered under Part D. Each successive round expands how much of the Medicare drug landscape operates under negotiated rather than list pricing, a structural shift that outlasts any single year’s list of medications.
This article was researched and drafted with the assistance of artificial intelligence.
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