Ten prescription drugs now carry federally negotiated price caps under Medicare, marking the first time the U.S. government has ever used its bargaining power to lower drug costs for seniors. As of January 1, 2026, medications like Eliquis, Januvia, Jardiance, and Entresto cost significantly less for the roughly 9 million Medicare enrollees who rely on them — with discounts ranging from 38 to 79 percent off their 2023 list prices. For someone taking Januvia for type 2 diabetes, the 30-day supply dropped from $527 to $113, a 79 percent reduction that represents the single largest discount in the first round.
These negotiated prices are the result of the Inflation Reduction Act of 2022, which authorized Medicare to negotiate directly with pharmaceutical manufacturers for the first time in the program’s history. The savings are not trivial: an estimated $1.5 billion per year in out-of-pocket costs for beneficiaries, and roughly $6 billion annually for the Medicare program overall. An AARP analysis from December 2025 found that costs dropped an average of 51 percent across stand-alone Part D prescription drug plans carrying these medications. This article breaks down exactly which drugs are affected, what the new prices look like, who benefits most, and what is coming next — including 15 additional drugs set for price caps in 2027 and a third round that will expand negotiations to physician-administered Part B drugs for the first time.
Table of Contents
- Which Medicare Drugs Got Negotiated Price Caps This Year?
- How Much Will Medicare Beneficiaries Actually Save on These Medications?
- What Does This Mean for Dementia Patients and Their Caregivers?
- How to Check Whether Your Medicare Plan Covers These Negotiated Prices
- What the Drug Companies Are Fighting and What Could Change
- The Second Round — 15 More Drugs Getting Price Caps in 2027
- What Comes After 2027 — Part B Drugs and the Expanding Program
- Conclusion
- Frequently Asked Questions
Which Medicare Drugs Got Negotiated Price Caps This Year?
All ten medications in the first round are Part D drugs, meaning they are dispensed at pharmacies rather than administered in a doctor’s office. The list reads like a greatest hits of chronic disease management in older adults: Eliquis and Xarelto for blood clots, Jardiance and Farxiga for diabetes and heart failure, Entresto for heart failure, Enbrel for rheumatoid arthritis, Stelara for autoimmune conditions, Imbruvica for blood cancers, Fiasp and NovoLog for insulin-dependent diabetes, and Januvia for type 2 diabetes. These were selected because they represent some of the highest-cost, most-prescribed drugs in the Medicare Part D program. The discounts vary widely. Januvia’s 79 percent price reduction leads the pack, while Imbruvica’s 38 percent discount is the smallest of the group.
In dollar terms, the specialty drugs saw the largest absolute drops — Stelara fell from $13,836 to $4,695 per 30-day supply, and Enbrel went from $7,106 to $2,355. For a Medicare beneficiary paying coinsurance on Stelara, that price difference translates into thousands of dollars a year staying in their pocket rather than going to the pharmacy counter. It is worth noting that these negotiated prices apply specifically to Medicare beneficiaries. If you are on a commercial insurance plan or paying out of pocket without Medicare, these caps do not apply to you. The prices are also based on negotiations with specific manufacturers, so generic alternatives, where they exist, may or may not be cheaper depending on your plan’s formulary.
How Much Will Medicare Beneficiaries Actually Save on These Medications?
The headline numbers are encouraging, but actual savings depend on where you fall in Medicare’s coverage structure. If you have a Part D plan, your copay or coinsurance is calculated as a percentage of the drug’s negotiated price. So when Eliquis drops from $521 to $231, your 25 percent coinsurance in the coverage gap goes from roughly $130 to about $58 per month. Over a year, that adds up. However, if you already qualified for the Low-Income Subsidy (Extra Help) or were paying flat copays rather than percentage-based coinsurance, your out-of-pocket amount may not change as dramatically.
The people who benefit most from these negotiated prices are those in the “donut hole” coverage gap or those paying coinsurance percentages on high-cost drugs. There is also a separate provision under the Inflation Reduction Act that caps total Part D out-of-pocket spending at $2,000 per year starting in 2025, which interacts with these price reductions in ways that vary by individual. The broader Medicare program saves substantially regardless. CMS estimates $6 billion per year in reduced spending across these ten drugs alone. That money either reduces pressure on Part D premiums or gets redirected to other parts of the program. For the 9 million enrollees taking these medications, the collective out-of-pocket savings of $1.5 billion annually works out to an average of roughly $167 per person per year — though individual savings will be much higher or lower depending on the specific drug, dosage, and plan design.
What Does This Mean for Dementia Patients and Their Caregivers?
None of the ten drugs in the first negotiation round are dementia-specific medications, but several are directly relevant to brain health and the daily medical management of people living with cognitive decline. Blood thinners like Eliquis and Xarelto are frequently prescribed to older adults with atrial fibrillation, a condition that significantly increases stroke risk — and stroke is a leading cause of vascular dementia. Keeping someone reliably on their blood thinner because they can actually afford it is not a minor consideration. Diabetes medications make up nearly half the list.
Januvia, Jardiance, Farxiga, and the Fiasp/NovoLog insulin products all address type 2 diabetes, which research has consistently linked to elevated dementia risk. Poorly controlled blood sugar accelerates cognitive decline, and medication nonadherence due to cost is one of the most common reasons blood sugar goes uncontrolled in older adults. A caregiver managing a loved one’s diabetes alongside their dementia now faces a meaningfully lower prescription bill for several of these drugs. For families already stretched thin by the costs of dementia care — which the Alzheimer’s Association estimates at over $300,000 in lifetime caregiving costs — any reduction in the monthly medication burden matters. If your parent or spouse takes Jardiance at $197 instead of $573, that is $376 per month freed up for home care, adult day programs, or simply keeping the lights on.
How to Check Whether Your Medicare Plan Covers These Negotiated Prices
The negotiated prices apply across all Medicare Part D plans, but the way your specific plan handles them can differ. Your first step is to log into Medicare.gov and use the Plan Finder tool to look up your current plan’s formulary. Confirm that the drug you take is listed and check what tier it falls on. A drug on a preferred brand tier will typically have a lower copay than one on a specialty tier, even with the negotiated price in effect. If you find that your plan places one of these drugs on a high cost-sharing tier despite the negotiated price reduction, it may be worth comparing plans during the next Open Enrollment period.
The negotiated price is the same regardless of which Part D plan you choose, but the copay or coinsurance structure varies. Some plans charge a flat $47 copay for a preferred brand, while others charge 25 or 33 percent coinsurance — and 25 percent of $231 is very different from 25 percent of $4,695. For people on Enbrel or Stelara, choosing a plan with a flat copay structure rather than percentage-based coinsurance could save hundreds of dollars per fill. Also worth knowing: the $2,000 annual out-of-pocket cap on Part D spending means that even if you take multiple expensive medications, your total yearly cost is now bounded. If you are taking both Eliquis and Jardiance, the combined negotiated prices reduce how quickly you hit that cap, effectively giving you more months of the year where you pay nothing at the pharmacy.
What the Drug Companies Are Fighting and What Could Change
Pharmaceutical manufacturers have not accepted these negotiations quietly. Several companies, including those making Eliquis and Entresto, filed lawsuits challenging the constitutionality of the negotiation program, arguing it amounts to forced price-setting rather than genuine negotiation. As of early 2026, courts have largely ruled against these challenges, but the legal landscape is not fully settled. There is also a practical limitation worth understanding: negotiated prices apply only to the specific brand-name drug listed.
If a manufacturer reformulates a drug or introduces a new version, that reformulated product would not automatically be subject to the same negotiated price. Critics have warned that this creates an incentive for companies to make minor modifications to existing drugs and relaunch them at higher prices, a tactic sometimes called “evergreening.” Whether the program’s future rounds will address this loophole remains to be seen. For beneficiaries, the more immediate concern is what happens if the political environment shifts. The Inflation Reduction Act’s drug negotiation provisions were passed on a party-line vote, and future Congresses could theoretically scale back or repeal the program. While the prices for 2026 are locked in and the 2027 round is already underway, the long-term trajectory of the program depends on sustained political support and the outcome of ongoing litigation.
The Second Round — 15 More Drugs Getting Price Caps in 2027
CMS announced the second batch of 15 Part D drugs on January 17, 2025, with negotiated prices published by November 30, 2025, and set to take effect January 1, 2027. The marquee additions are Ozempic and Wegovy, the GLP-1 receptor agonists used for diabetes and obesity that have dominated headlines for the past two years. The second round also includes treatments for asthma, COPD, cancer, and other chronic conditions.
The financial stakes are even larger this time. Total Medicare spending on these 15 drugs was $40.7 billion between November 2023 and October 2024, and 5.3 million beneficiaries used them during that period. If the negotiated discounts are in the same range as the first round, the savings could dwarf the $6 billion annual figure from the initial ten drugs. For dementia caregivers managing a loved one with multiple chronic conditions, the expanding list of negotiated medications means a growing share of the monthly pharmacy bill may come down over the next few years.
What Comes After 2027 — Part B Drugs and the Expanding Program
The third cycle of negotiations will break new ground by including Part B drugs for the first time. Part B covers medications administered in a doctor’s office or clinic — think infusions, injections, and chemotherapy agents. These are often among the most expensive drugs in medicine, and until now they have been entirely outside the scope of negotiation. For patients receiving infusion therapies for cancer, autoimmune diseases, or other serious conditions, this expansion could be significant.
The program is also set to grow in scale. The law requires negotiation of 15 drugs for each of 2027 and 2028, then 20 drugs per year from 2029 onward. Over the next decade, this means the majority of the highest-cost drugs in Medicare could eventually be subject to negotiated pricing. That trajectory matters for long-term care planning — if you are a caregiver building a financial plan for a loved one’s care over the next five to ten years, factoring in gradually declining prescription costs is reasonable, though not guaranteed.
Conclusion
The first round of Medicare drug price negotiation has delivered real, measurable savings for millions of beneficiaries. Ten drugs now cost between 38 and 79 percent less than their 2023 list prices, with the steepest discounts falling on diabetes medications that are commonly prescribed alongside dementia care. The $2,000 annual out-of-pocket cap adds another layer of financial protection.
For caregivers managing complex medication regimens, these changes mean fewer impossible choices between prescriptions and other necessities. Looking ahead, the program is expanding — 15 more drugs in 2027, Part B drugs entering negotiation for the first time, and 20 drugs per year from 2029. The practical step right now is to review your or your loved one’s Part D plan, confirm that negotiated prices are reflected, and compare plans during the next enrollment period to make sure the cost-sharing structure works in your favor. These savings do not happen automatically in every case; they reward people who take the time to understand their coverage.
Frequently Asked Questions
Do I need to do anything to get the new negotiated prices on my Medicare drugs?
No. The negotiated prices are automatically applied through your Part D plan as of January 1, 2026. However, your actual out-of-pocket cost depends on your plan’s copay or coinsurance structure, so it is worth checking your plan details on Medicare.gov.
Are any Alzheimer’s or dementia drugs included in the negotiated price list?
Not in the first or second rounds. However, several drugs on the list — particularly blood thinners and diabetes medications — are commonly prescribed to people with dementia for related health conditions. Future rounds may include dementia-specific treatments as the program expands.
Will Ozempic and Wegovy have negotiated prices?
Yes. Both are included in the second round of negotiations, with prices set to take effect January 1, 2027. The negotiated prices were published by November 30, 2025.
Does the negotiated price apply if I have Medicare Advantage instead of Original Medicare?
Yes. Medicare Advantage plans that include Part D coverage are subject to the same negotiated drug prices. Your specific copay will depend on your plan’s formulary and cost-sharing rules.
What if my drug is not on the negotiated list?
The Inflation Reduction Act includes other cost protections beyond negotiation, including the $2,000 annual out-of-pocket cap on Part D spending and inflation-based rebates that penalize manufacturers for raising prices faster than inflation. These apply to all Part D drugs, not just the negotiated ones.
Could these negotiated prices be reversed or repealed?
It is theoretically possible through new legislation, but the 2026 prices are contractually locked in with manufacturers. The program faces ongoing legal challenges from pharmaceutical companies, though courts have so far upheld its legality.
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For more, see NIH MedlinePlus — cognitive testing.
