Roughly 1.8 million Medicare beneficiaries who depend on 15 high-cost prescription drugs could see lower prices starting January 1, 2028, after the Centers for Medicare and Medicaid Services added those medications to its third round of price negotiations. The selection, announced on January 27, 2026, marks the first time the program has included drugs covered under Medicare Part B, which pays for treatments administered in doctors’ offices and hospital outpatient settings rather than picked up at retail pharmacies.
Why Part B drugs change the negotiation calculus
The first two negotiation cycles targeted only Part D drugs, the kind dispensed through pharmacies and managed by private prescription drug plans. Part B drugs follow a different reimbursement path: Medicare pays providers directly, typically at a percentage above the drug’s average sales price. That distinction matters because manufacturers of Part B drugs face a different set of financial pressures than those selling through pharmacy benefit managers. Despite that structural difference, every manufacturer whose drug was selected chose to participate in the third cycle rather than face steep excise taxes for opting out.
Full participation does not, by itself, prove that the Part B expansion drove higher cooperation. Manufacturers in the earlier Part D-only rounds also opted in after legal challenges failed. The hypothesis that Part B inclusion would measurably increase participation rates cannot be confirmed with available data, because the participation rate has been 100 percent across all three cycles so far. What the Part B expansion does change is the scope of savings: provider-administered drugs such as infusions and injections often carry list prices far higher than retail medications, meaning negotiated discounts could translate into larger dollar reductions per patient.
What CMS confirmed about the 15 selected drugs
According to CMS, approximately 1.8 million people used the 15 selected drugs between November 2024 and October 2025. In its January announcement, the agency said the group includes both Part D prescriptions and Part B treatments and emphasized that the new round represents the first time provider-administered products have been pulled into the negotiation framework. The agency’s selection notice describes the criteria used, including total Medicare spending and the absence of generic or biosimilar competition.
Negotiations are set to take place during 2026, and any resulting maximum fair prices will take effect on January 1, 2028. CMS also released final guidance for the Initial Price Applicability Year 2028, spelling out how it will calculate and apply those maximum fair prices for both Part B and Part D medications. That guidance, detailed in a separate policy document, outlines factors such as clinical benefit, unmet medical need, and research and development costs that negotiators can weigh when proposing prices.
The agency’s primary announcements list the drugs by selection status but do not break down utilization figures by Part B versus Part D. That gap makes it difficult to assess how much of the projected savings will flow to patients receiving infusions or injections in clinical settings versus those filling prescriptions at pharmacies. Without that split, analysts can only infer relative impact based on how much Medicare currently spends on each product and whether it is typically billed through outpatient hospital departments, physician offices, or retail pharmacies.
No manufacturer has issued a public statement beyond the CMS confirmation of opt-in, so the industry’s strategic posture heading into talks is unclear. Companies selling high-cost biologics and injectable therapies have previously warned that aggressive price cuts could dampen investment in follow-on indications or next-generation products. At the same time, patient advocates argue that the current trajectory of specialty drug pricing is unsustainable for both beneficiaries and the Medicare trust fund, especially when treatments can cost tens of thousands of dollars per year.
Political framing versus program mechanics
A separate reporting thread attributed the announcement to the Trump administration, while CMS press materials framed it as an agency action. Both descriptions refer to the same set of 15 drugs and the same January 27, 2026 selection date. The difference is one of political framing rather than substance: the White House issued a related executive directive on lowering prescription costs in 2025, directing federal agencies to use every available authority to bring down prices.
That directive provided political cover for CMS to move aggressively, but the mechanics of the negotiation program are rooted in statutory language rather than presidential orders. The law sets out which drugs can be selected, how many products can be negotiated in each cycle, and the penalties manufacturers face if they refuse to engage. CMS, in turn, is responsible for translating those requirements into operational guidance, timelines, and methodologies for calculating maximum fair prices.
By adding Part B drugs in the third cycle, CMS is testing how far those authorities can reach into segments of the market that have historically been shielded from direct price bargaining. The outcome will determine not only how much Medicare and its beneficiaries save in 2028, but also whether future negotiation rounds continue to expand into other high-cost therapies delivered in clinical settings.
