A 30-day supply of Ozempic, Wegovy or Rybelsus will carry a Medicare price of $274 starting January 1, 2027, a 71 percent cut from the $959 list price that has defined Novo Nordisk’s semaglutide line for years. The Centers for Medicare & Medicaid Services finalized that figure under the second cycle of the Medicare Drug Price Negotiation Program, the mechanism the Inflation Reduction Act created to negotiate prices directly with manufacturers instead of relying on plan-level rebates. Fourteen other drugs reach their own negotiated prices on the same January date, but the semaglutide group is the first true household name to go through the process.
How CMS Landed on $274
CMS confirmed the figure on its Selected Drugs and Negotiated Prices page, listing $274 as the maximum fair price against the $959 reference figure the agency uses to calculate the size of the discount. The semaglutide line joins Trelegy Ellipta, Xtandi, Pomalyst, Ibrance, Ofev, Linzess, Calquence, Austedo, Breo Ellipta, Tradjenta, Xifaxan, Vraylar, Janumet and Otezla as the fifteen drugs selected for the program’s second price applicability year, all effective the same January date.
The three products share the same active ingredient but serve different purposes on their FDA labels: Ozempic and Rybelsus are approved for type 2 diabetes, while Wegovy carries a chronic weight-management indication with an additional label for reducing cardiovascular risk in adults with heart disease. All three fall under the same negotiated price because CMS negotiates by ingredient and dosage form rather than by individual brand indication, which is why a single $274 figure applies across the group despite the different reasons a doctor might prescribe one over another.
Negotiations for this round ran through most of 2025, with the agency locking the final number in December after a series of closed-door meetings with Novo Nordisk that CMS is not required to make public. A manufacturer that declines to negotiate in good faith faces an excise tax steep enough on the drug’s U.S. sales that participation has functioned, in practice, as the only viable option since the program’s first cycle set prices for ten other drugs in 2026.
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What the Lower Price Means for a Beneficiary’s Bill
The $274 figure is the price the manufacturer and Medicare settle on before the standard Part D benefit structure applies its own deductible, coinsurance and out-of-pocket cap, so it is not automatically what a beneficiary pays at the pharmacy counter. A beneficiary who has already met the annual deductible and sits in the initial coverage phase pays 25 percent coinsurance on a covered drug, which brings the semaglutide copay down from roughly $240 today to about $69 once the negotiated price applies — a meaningful monthly difference for someone managing diabetes with an ongoing prescription.
Because the negotiated price also lowers the total drug cost that counts toward the $2,100 annual out-of-pocket threshold CMS finalized for the Part D redesign, a beneficiary taking one of the fifteen negotiated drugs may take longer to reach the point where the plan covers 100 percent of costs for the rest of the year. That tradeoff cuts the other way for people whose spending was driven mostly by these drugs in the first place: a lower per-fill cost means less total spending, which for many will mean reaching the catastrophic phase later but paying less to get there.
Medicare Advantage prescription drug plans are bound by the same negotiated price as standalone Part D plans, since the maximum fair price applies across the entire Medicare program rather than plan by plan. An enrollee in an MA-PD plan who currently pays a higher tier copay for semaglutide should see that tier cost fall in January without needing to switch plans during the annual enrollment period that closes each December, though plan formularies could still shift which specific semaglutide product sits in a given tier.
A Separate, Lower Price Already Applies to Weight-Loss Use
The $274 negotiated price is not the only figure attached to these drugs this year. Since July 2026, a temporary Medicare pilot program has offered Wegovy specifically for weight-loss indications at a flat $50 monthly copay, under a separate most-favored-nation pricing agreement the Trump administration struck directly with Novo Nordisk and Eli Lilly. That arrangement runs through a different eligibility gate tied to body mass index and comorbidities rather than the standard Part D benefit design, and it exists alongside — not instead of — the negotiated price that takes effect for diabetes and other approved uses in January.
The distinction matters because a beneficiary using semaglutide for type 2 diabetes moves through the standard Part D benefit and the new $274 negotiated price, while a beneficiary using Wegovy strictly for weight loss under the pilot program pays the flat $50 copay instead, regardless of the negotiated price. CMS has not indicated that the two pricing tracks will merge before the pilot program’s scheduled end in December 2027, leaving two different prices attached to the same molecule depending on why a doctor prescribed it.
What happens after 2027 remains unresolved on both fronts. The negotiated price under the Inflation Reduction Act is permanent once it takes effect, subject only to the adjustments CMS can make in later negotiation cycles, but the weight-loss pilot program is explicitly temporary and was extended once already after insurers balked at the cost of a longer-term replacement. A beneficiary relying on either price track has no guarantee that the specific mechanism keeping their monthly cost down will still exist in its current form once the pilot expires.
For now, the January 1 effective date is fixed, and CMS has listed no contingency for delaying it the way earlier drug-pricing proposals have stalled in litigation. Manufacturers who negotiated in this cycle have exhausted their appeal options, and the agency’s public list of selected drugs and negotiated prices stands as the operative record a pharmacy or plan sponsor will use to calculate what a beneficiary owes starting on that date.
This article was drafted with AI assistance and edited for accuracy.
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