Lower Medicare Drug Prices Take Hold as a New Rule Locks In Future Rounds

Millions of people on Medicare are seeing lower prices on some well known prescription drugs, and the government has now set permanent rules for the program behind those prices. On November 5, the Centers for Medicare and Medicaid Services issued a final rule, known as CMS-4215-F, that writes the drug price negotiation program into formal regulation for 2029 and beyond. The rule takes effect December 5.

The program lets Medicare bargain directly with drug makers over the price of certain high cost medicines. The first ten drugs got negotiated prices that took effect January 1, 2026. The list includes well known treatments for blood clots, diabetes, heart failure, and arthritis, such as Eliquis, Jardiance, and Januvia.

It helps to understand what the negotiated price is. By law it is called a maximum fair price. It is a ceiling, the highest price that must be made available to people on Medicare and to the pharmacies that fill the prescriptions. It is not necessarily what a plan pays, and it is not the same as your own cost at the counter.

The figures CMS released compare the new prices with each drug's 2023 list price. On that basis, Januvia, a diabetes drug, has a negotiated price of about $113 for a 30-day supply, down about 79 percent from its 2023 list price of $527. The blood thinner Eliquis has a negotiated price of about $231, down about 56 percent from $521.

What you actually pay at the pharmacy is a separate matter. It still depends on your plan's deductible and cost tiers. The good news is that a new yearly cap limits total out-of-pocket drug spending to $2,400 in 2027.

The program keeps moving. A second group of 15 drugs gets negotiated prices on January 1, 2027. CMS says it will select up to 20 more Part D or Part B drugs by February 1, 2027, for prices that would take effect in 2029. If you take any of these medicines, it is worth checking how your plan handles them.