Janumet and Janumet XR will drop from a $526 list price to a negotiated $80 for a 30-day supply on January 1, 2027, an 85 percent cut that Medicare records as the single deepest reduction among the 15 drugs priced in the second round of its Drug Price Negotiation Program. Tradjenta follows immediately behind at an 84 percent cut, from $488 to $78, with Breo Ellipta a distant third at 83 percent. Every discount is measured against each drug’s calendar-year 2024 list price, the baseline the agency used in talks with the manufacturers that agreed to negotiate. The size of the cut on two oral diabetes pills says as much about how the negotiation formula works as it does about the drugs themselves.
How CMS Ranked the 15 Negotiated Prices
The Centers for Medicare & Medicaid Services selected 15 Part D drugs for the second cycle of its Medicare Drug Price Negotiation Program and ran the talks on a fixed calendar: initial offers went out to manufacturers by June 1, 2025, counteroffers came back by July 1, and both sides held negotiation meetings through the summer and fall before the process closed on November 1, 2025. Eight of the 15 drugs settled through those meetings or a follow-up price exchange, seven through a written final offer CMS sent when talks had not closed on their own, and every participating company accepted its resulting price before the statutory deadline passed.
Once all 15 prices were set, the discounts against 2024 list price ranged from 38 percent at the bottom of the list up to the three cuts that now sit at the top: Janumet and Janumet XR, made by Merck Sharp & Dohme LLC, Tradjenta, made by Boehringer Ingelheim Pharmaceuticals, Inc., and Breo Ellipta, made by GlaxoSmithKline Intellectual Property Development Ltd. Those three reductions, each effective January 1, 2027 and measured off a CY2024 list price, are 85 percent for Janumet and Janumet XR, 84 percent for Tradjenta and 83 percent for Breo Ellipta, taking the trio’s combined 30-day price from roughly $1,411 down to $225.
The rest of the second-cycle list shows how wide that spread runs beneath the top three: Linzess drew a 75 percent cut, Trelegy Ellipta 73 percent, and Ozempic, Rybelsus and Wegovy, the single highest-spending drug on the list, landed at 71 percent, while cancer treatments such as Xtandi and Ibrance settled at 48 and 50 percent. Every one of those figures, like Janumet’s, Tradjenta’s and Breo Ellipta’s, is measured against the same 2024 list-price baseline CMS applied across the full set of 15 drugs.
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.
Why the Two Diabetes Pills Landed at the Top
Janumet and Janumet XR combine two oral drugs used to treat type 2 diabetes, and Tradjenta is prescribed for the same condition on its own; both reached the Medicare Drug Price Negotiation Program’s second round as single-source brand tablets without a generic or biosimilar competitor already pulling their price down. In building its initial offer for each drug, CMS said it weighed manufacturer-submitted data on research and development costs and how far those costs had already been recouped, any prior federal financial support the drug had received, the unit cost of producing and distributing it, market and sales figures, and the drug’s patent and FDA exclusivity status.
Beyond that cost data, CMS said it also weighed evidence on therapeutic alternatives for each selected drug, including comparative effectiveness research and unmet medical need, gathered in part from patient-focused roundtable events and a town hall the agency held with patients, caregivers and clinicians during the spring of 2025, before its initial offers went out. That process ran the same way for all 15 drugs, diabetes pills and cancer treatments alike, ahead of the counteroffers and negotiation meetings that followed.
The two diabetes drugs were mid-sized sellers next to the rest of the list: Part D paid out $1,067,594,000 for Janumet and Janumet XR across 239,000 enrollees in 2024, and $1,128,335,000 for Tradjenta across 274,000 enrollees, compared with $15,161,908,000 for Ozempic, Rybelsus and Wegovy across 2,282,000 enrollees. Breo Ellipta, the third-deepest cut on the list, covered 626,000 enrollees and $1,428,106,000 in 2024 spending while treating asthma and chronic obstructive pulmonary disease rather than diabetes.
What the Formulary Rule and the 2027 Effective Date Change
The negotiated prices take effect January 1, 2027, and federal law requires every Medicare prescription drug plan, standalone Part D plans and Medicare Advantage plans with drug coverage alike, to include each of the 15 selected drugs on its formulary once a negotiated price is in place. CMS said it will use its formulary review process to watch for plan practices that could undermine access to any of the 15 drugs once the new prices apply, and the agency is required to publish its own explanation of how each price was reached by March 2026.
About 5.3 million of the 53 million people enrolled in Medicare Part D used one of the 15 selected drugs at some point in 2024, and CMS projects that once the negotiated prices take hold, enrollees under the program’s defined standard benefit design will save a combined $685 million in out-of-pocket costs in 2027. CMS Administrator Chiquita Brooks-LaSure said when the 15 drugs were first selected for negotiation that the effort would “continue to strengthen Medicare for generations to come.”
CMS also published a companion file mapping how each negotiated price applies across the different dosage forms and strengths a single drug can be sold in, since one number for a 30-day supply does not by itself tell a pharmacy what to charge for every package size. The agency’s fact sheet uses Ozempic, Rybelsus and Wegovy as its worked example, showing three separate per-package prices, $276.78 for a one-pen Ozempic package and for a 30-tablet Rybelsus package, and $385.63 for a four-pen Wegovy package, all derived from the same underlying negotiated rate.
CMS reached agreement on all 15 second-cycle prices before the negotiation period closed on November 1, 2025, using a written final offer for seven of the drugs and an accepted counteroffer for the other eight, according to the agency’s own fact sheet on the round. The document also states that each of the 15 prices will be updated in future years by the annual percentage change in the Consumer Price Index for all urban consumers, the same index CMS said it will use going forward for Janumet, Tradjenta, Breo Ellipta and the rest of the list.
Checking a Negotiated Price Against a Pharmacy Receipt
The new negotiated prices apply drug by drug, and a 2027 pharmacy receipt for a different medication will still follow whatever cost-sharing rules a specific Part D or Medicare Advantage plan sets that year. Those rules live across dozens of separate plan documents and state-run assistance programs rather than in the CMS fact sheet itself, so matching what a plan actually bills against what a program is supposed to cover takes checking each document on its own terms.
The Medicare Cost & Coverage Protection Kit is a 10-page kit built around 51 state Medicare cost-help packs, the new Part D out-of-pocket cap, and a medication and cost tracker for lining up a plan’s own charges against what each program covers.
Look up a specific state’s cost-help pack inside 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.
