The Centers for Medicare & Medicaid Services has locked in new negotiated prices for a second group of 15 prescription drugs under the Medicare Drug Price Negotiation Program, with the lower prices taking effect January 1, 2027. Novo Nordisk’s Ozempic, Rybelsus and Wegovy anchor the list, with a 30-day supply falling to $274 from a list price of $959. CMS projects the change will save Medicare Part D enrollees an estimated $685 million in out-of-pocket costs once the new prices take hold, on top of the $1.7 billion enrollees already paid out of pocket for these same 15 drugs in a single recent year.
A Second, Larger Round of Negotiated Prices
The Inflation Reduction Act authorized CMS to negotiate prices directly with drug manufacturers for a limited number of high-cost Medicare Part D drugs, phased in as separate annual negotiation cycles rather than one master list. The first cycle covered 10 drugs, with those negotiated prices already in effect since the start of 2026. The second cycle, covering 15 drugs and built from a full year of additional Part D claims data, was announced by CMS in late November 2025, with the negotiated maximum fair prices scheduled to apply starting on the program’s next initial price applicability year, January 1, 2027.
CMS’s own accounting explains why this particular group of drugs was targeted for the second round. The agency found that roughly 5.3 million people with Part D coverage filled at least one of these 15 drugs in 2024, generating $42.5 billion in total gross covered drug spending and $1.7 billion in out-of-pocket costs paid directly by enrollees that year alone. That combination of heavy total spending and heavy beneficiary exposure is the same formula the program used to select its first 10 drugs, which is why semaglutide products and other chronic-disease therapies keep surfacing on these lists ahead of lower-volume medications.
Free retirement updates: Want plain-English help keeping more of your money in retirement? The free Retirement Shield newsletter covers the benefits, deadlines, and money mistakes that cost retirees, a couple times a week. Subscribe free.
Ozempic’s Price Now Depends on Which Federal Deal Applies
Novo Nordisk’s semaglutide products carry the highest profile on the new list, and the negotiated $274 price marks a roughly 71 percent cut from the drug’s $959 list price for a 30-day supply of Ozempic, Rybelsus or Wegovy. But that negotiated number is not necessarily the final word on what Medicare will actually pay, or bill beneficiaries, once 2027 arrives. Around the same time CMS finalized this negotiation cycle, the administration separately struck a “most favored nation” pricing arrangement with Novo Nordisk that set a lower $245 price for the same GLP-1 drugs under Medicare.
Trade press coverage of the announcement reported that CMS has indicated the most-favored-nation price is expected to supersede the Inflation Reduction Act’s negotiated price for covered GLP-1 drugs, given the terms and timing written into that separate deal. That leaves an open question for anyone tracking what a 2027 semaglutide refill will actually cost: two federal price-setting mechanisms now apply to the same drug, and only one of them can govern the transaction at the pharmacy counter once both take effect.
The stakes of that overlap are not trivial. CMS has confirmed the full list of 15 negotiated maximum fair prices that take effect at the start of 2027, and every drug besides the semaglutide products is governed solely by that negotiation, with no competing federal price to sort out. Semaglutide is the exception, and it happens to be the single drug family driving the largest share of both the program’s savings estimate and its underlying spending totals.
Where the $685 Million in Savings Actually Shows Up
CMS’s $685 million estimate is not a flat rebate mailed to enrollees. It is calculated under Part D’s defined standard benefit design, the structure that moves a beneficiary through a deductible phase, an initial coverage phase and a catastrophic phase over the course of a plan year. A lower negotiated price reduces what an enrollee owes in cost-sharing at whichever phase they are in when they fill a prescription, which means the size of an individual’s savings depends on the timing of the refill and how much other drug spending has already accumulated that year.
That structural detail also explains why CMS frames the $685 million as an estimate rather than a guaranteed total. The projection assumes enrollment and utilization patterns similar to 2024’s, the most recent year CMS had complete claims data for when it built the figure. Plan formulary changes, dosage adjustments and shifts in how many beneficiaries fill these particular drugs between now and 2027 could all move the realized savings above or below CMS’s published number.
The overlap with the semaglutide most-favored-nation deal adds a second layer of uncertainty specific to the highest-profile drugs on the list. If the separate $245 price does supersede the negotiated $274 price for Ozempic, Rybelsus and Wegovy before January 1, 2027, the out-of-pocket savings tied to those three products would flow through a different federal pricing mechanism than the one CMS used to calculate its $685 million estimate, even though the underlying dollars saved would still reach the same Part D enrollees.
CMS has not published a companion accounting of how the most-favored-nation arrangement changes its Part D savings math, and the agency’s public statements to date have treated the negotiation program and the manufacturer deal as separate initiatives rather than a combined estimate. That leaves the semaglutide portion of the $685 million figure as the one number on the list most likely to be revised before enrollees see it reflected in an actual pharmacy receipt.
This article was drafted with the assistance of AI tools and reviewed for accuracy before publication.
More Financial Reading
