Medicare must publish by Nov. 30 any prices it negotiated for 15 more drugs, including the diabetes drug Trulicity and the HIV drug Biktarvy, and those prices would take effect on Jan. 1, 2028. The window for talks with drugmakers closed on Nov. 1. CMS has not announced a third-round price yet, so the Nov. 30 posting is the first time the agreed figures, if any, become public.
Prices exist only for drugs where the manufacturer and the agency reached an agreement. The agency calls each agreed figure a maximum fair price, and it is the most Medicare drug plans and, for office-administered drugs, Original Medicare and Medicare Advantage plans can pay for the drug.
The 15 drugs and how many people take them
CMS’s fact sheet on the third round, issued Jan. 27, lists the drugs by Medicare spending from November 2024 through October 2025. Trulicity leads at about $4.9 billion across 617,000 enrollees, followed by Biktarvy at about $3.9 billion for 101,000. The rest are Orencia, Cosentyx, Erleada, Kisqali, Entyvio, Verzenio, Botox, Lenvima, Xolair, Rexulti, Xeljanz, Anoro Ellipta and Cimzia.
Together the 15 drugs account for about $27.0 billion, roughly 6% of Medicare Part B and Part D spending, and about 1,777,000 people used them. Some are widely taken: 390,000 enrollees used Botox, 281,000 used the COPD inhaler Anoro Ellipta and 119,000 used the depression and schizophrenia drug Rexulti. CMS also selected Tradjenta, a diabetes drug already negotiated for 2027, for renegotiation.
Anyone who takes one of these drugs should know that a lower negotiated price does not automatically mean a lower pharmacy bill. The Medicare Rights Center explains that cost sharing depends on the price the plan already negotiated, the drug’s formulary tier and the plan’s cost-sharing structure. For high-use drugs a modest price cut can produce large program savings while copayments change little or not at all.
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How the Nov. 30 publication works
The deadline comes from the Inflation Reduction Act. Under 42 U.S.C. 1320f-4, the Secretary of Health and Human Services must publish each maximum fair price by Nov. 30 of the year two years before the price takes effect. An explanation of how the statute’s factors were applied is due by March 1 of the year before, which for this round is March 1, 2027.
The law also sets what happens afterward. Each later year’s price is the prior year’s price increased by the change in consumer prices for the 12 months ending in July. A price that is settled after the publication date must be published within 30 days of the decision.
The negotiation steps are in 42 U.S.C. 1320f-3. Manufacturers submit data by March 1, the Secretary sends a written initial offer by June 1, and the manufacturer has 30 days to accept or counter. All negotiations end before Nov. 1 of the year the drug list was published, which is why the fact sheet marks Nov. 1, 2026 as the close.
What the program has delivered so far
According to the Associated Press, as carried by WTOP, prices for the first 10 negotiated drugs took effect at the start of this year, and CMS announced prices for a second set of 15 in November, effective in 2027. Those include Ozempic, Rybelsus and Wegovy. This third round would bring the total to 40 drugs, and it is the first to include Part B drugs, such as those infused or injected in a doctor’s office.
The reaction to the Jan. 27 announcement split along familiar lines. CMS Administrator Dr. Mehmet Oz said that “for too long, seniors and taxpayers have paid the price for skyrocketing prescription drug costs.” AARP chief executive Dr. Myechia Minter-Jordan called it a “significant step forward,” while Elizabeth Carpenter of the drug industry group PhRMA said the law “continues to show why government price setting is the wrong approach for Americans.”
The fact sheet notes that certain orphan drugs are excluded from selection under amendments made by Public Law 119-21.
Why Jan. 1, 2028 matters for this winter’s plan choice
The third-round prices do not touch the plan a member picks by Dec. 7. Plan costs for 2027 reflect the second round’s negotiated prices on the 15 drugs that take effect Jan. 1, 2027, not the Trulicity and Biktarvy figures due Nov. 30. The new prices will show up in plan formularies and premiums for 2028, not in the plans being sold now.
That timing gives the Nov. 30 posting a practical use. A member who takes one of the 15 drugs can note the published price, then see in next year’s plan documents whether the formulary tier or the copay for that drug moves. Until then, the 2027 decision turns on whether a plan covers the drug, at what tier and at which pharmacies.
A drug missing from the Nov. 30 posting would be one without an agreed price, and its 2028 outcome would stay open. Members should treat the list as a record of which of the 15 drugs have agreed prices, not as a promise of lower copays.
Taking one of the 15 drugs?
The negotiated price that lands Nov. 30 will not change what a plan charges for Trulicity or Biktarvy in 2027. That cost is set by the plan’s tier for the drug, and the choice of plan closes Dec. 7.
The 2027 Medicare Open Enrollment Decision Kit is built for that choice. It includes a cost calculator spreadsheet that compares plans on cost, drugs and doctors, along with the Open Enrollment calendar, so the dates for the 2027 decision sit in one place.
Part 2 of the kit, the Drug and Doctor Coverage Check, is where a member lists the prescriptions that matter and tests each plan against them.
Get the drug-and-doctor cost calculator and open-enrollment calendar for the 2027 plan choice →
This article was produced with AI assistance and edited for accuracy against the sources linked above.
