A Medicare patient filling a 30-day supply of Eliquis, the blood thinner prescribed to millions of Americans with atrial fibrillation, used to face a list price north of $500 a month. As of January 1, 2026, the federal government’s negotiated price for that same prescription is $231. That single reduction, applied across the roughly 3.7 million Medicare beneficiaries who take Eliquis, represents the most visible result of a program that has never existed before: direct negotiation between Medicare and pharmaceutical manufacturers over what the government pays for brand-name drugs.
Ten medications are now subject to Maximum Fair Prices set through the Medicare Drug Price Negotiation Program, established by the Inflation Reduction Act of 2022. The Centers for Medicare and Medicaid Services estimates the negotiated prices will reduce out-of-pocket costs for Medicare beneficiaries by approximately $1.5 billion in 2026 alone. Five months in, the program is fully operational, and the legal challenges that once threatened to block it have been exhausted.
The 10 drugs and what patients now pay
CMS selected these 10 drugs because they carried some of the highest total spending in Medicare Part D and had no generic or biosimilar competition. The agency published detailed explanation files for each drug, outlining how the Maximum Fair Price was calculated based on clinical benefit, therapeutic alternatives, unmet medical need, and manufacturer-reported research and development costs.
Below are the 10 drugs, their uses, and the negotiated prices CMS published, alongside the percentage discount from prior list prices:
- Eliquis (apixaban) – blood clots and stroke prevention in atrial fibrillation. Negotiated price: $231 per month, a 56% reduction. Manufactured by Bristol-Myers Squibb and Pfizer.
- Jardiance (empagliflozin) – type 2 diabetes and heart failure. Negotiated price: $197 per month, a 66% reduction. Manufactured by Boehringer Ingelheim and Eli Lilly.
- Xarelto (rivaroxaban) – blood clots and stroke prevention. Negotiated price: $197 per month, a 62% reduction. Manufactured by Janssen (Johnson & Johnson).
- Januvia (sitagliptin) – type 2 diabetes. Negotiated price: $113 per month, a 74% reduction. Manufactured by Merck.
- Farxiga (dapagliflozin) – type 2 diabetes, heart failure, and chronic kidney disease. Negotiated price: $178.50 per month, a 68% reduction. Manufactured by AstraZeneca.
- Entresto (sacubitril/valsartan) – heart failure. Negotiated price: $295 per month, a 53% reduction. Manufactured by Novartis.
- Enbrel (etanercept) – rheumatoid arthritis and other autoimmune conditions. Negotiated price: $2,355 per month, a 38% reduction. Manufactured by Amgen.
- Imbruvica (ibrutinib) – blood cancers including chronic lymphocytic leukemia. Negotiated price: $9,319 per month, a 38% reduction. Manufactured by AbbVie and Janssen.
- Stelara (ustekinumab) – psoriasis, psoriatic arthritis, and Crohn’s disease. Negotiated price: $4,695 per administration, a 66% reduction. Manufactured by Janssen (Johnson & Johnson).
- Fiasp and NovoLog insulin products (insulin aspart) – diabetes. Negotiated price: $119 per month, a 76% reduction. Manufactured by Novo Nordisk. (Note: a separate IRA provision already caps insulin copays at $35 per month for Medicare Part D enrollees, so many patients were already paying less than the list price before negotiations took effect.)
Across all 10 drugs, the negotiated discounts range from 38% to 79% off the prices manufacturers were previously charging Medicare. For Eliquis alone, which had the highest Part D spending of any single medication, the reduction applies to millions of prescriptions filled each year.
How the lower prices reach patients at the pharmacy
The Inflation Reduction Act requires Medicare Part D plan sponsors to charge beneficiaries based on the Maximum Fair Price when prescriptions are filled at in-network pharmacies. CMS’s official announcement made clear that this requirement applies regardless of a plan’s formulary tier structure, and the agency can impose civil monetary penalties on plans that fail to pass the savings through.
The negotiated prices also work alongside another major IRA provision: the $2,000 annual cap on out-of-pocket prescription drug spending for Medicare Part D enrollees, which took effect in 2025. Together, the two policies mean that beneficiaries taking expensive brand-name medications face substantially lower total costs than they did just two years ago. Consider a patient on Entresto for heart failure: not only is the per-prescription price roughly half what it was, but even if that patient takes multiple costly medications, total annual out-of-pocket spending cannot exceed $2,000.
The legal fight is over
Pharmaceutical manufacturers mounted an aggressive legal campaign against the negotiation program almost immediately after the IRA became law. Companies including Merck, Bristol-Myers Squibb, Johnson & Johnson, AstraZeneca, and Novo Nordisk, along with industry groups like PhRMA and the U.S. Chamber of Commerce, filed lawsuits in federal courts across the country. Their core arguments: that the program violated the First Amendment by compelling speech, the Fifth Amendment by taking property without just compensation, and the Eighth Amendment’s prohibition on excessive fines.
Federal district and appellate courts rejected those claims in a series of rulings throughout 2024 and 2025. In May 2026, the Supreme Court declined to hear the remaining petitions for review. That decision left the lower-court rulings intact and removed the last judicial obstacle to the program’s operation.
What the data does not yet show
The $1.5 billion savings figure is a CMS projection based on modeling, not a count of actual pharmacy transactions. The agency has not released beneficiary-level claims data for 2026, so independent researchers cannot yet verify whether real-world savings are tracking the estimate. That data is unlikely to become available before late 2026 or 2027.
Open questions remain about how Part D plans and pharmacy benefit managers are adjusting. While plans must honor the negotiated prices, they retain discretion over formulary placement, prior-authorization requirements, and tier assignments. Some health-policy analysts have flagged the possibility that plans could use these tools to steer patients toward or away from certain negotiated drugs, or that plans could restructure premiums in response to lower drug unit costs. CMS has not published data on formulary changes tied specifically to the negotiation program.
Perhaps the most consequential unknown is whether lower prices are improving medication adherence. Decades of research have documented that high out-of-pocket costs cause patients to skip doses, split pills, or abandon prescriptions entirely, particularly for chronic conditions like diabetes and heart failure. If the negotiated prices reduce that behavior, the downstream health benefits could be significant. But adherence data from 2026 prescriptions will take months to compile, and isolating the effect of price negotiations from other concurrent policy changes, including the $2,000 spending cap, will require careful study design.
Will private insurers see lower prices too?
One of the most closely watched questions in health policy is whether Medicare’s negotiated prices will pull down what commercial insurers pay for the same drugs. The logic is straightforward: if Medicare is paying 56% less for Eliquis, employer-sponsored plans and their pharmacy benefit managers gain leverage to demand comparable discounts. Some health economists expect exactly that kind of gravitational effect over time.
Others are skeptical. Manufacturers could try to offset lost Medicare revenue by holding firm on commercial pricing or shifting costs elsewhere in the supply chain. So far, there is no published evidence pointing clearly in either direction. The major drugmakers have offered only general public statements about their commitment to patient access, and the contract negotiations between insurers and manufacturers that would reveal any shift happen largely behind closed doors. This question will likely take years to resolve.
The second round of 15 drugs heads toward 2027 prices
The 10 drugs now subject to negotiated prices are only the first cohort. CMS selected a second batch of 15 drugs for negotiation in 2025, with those Maximum Fair Prices scheduled to take effect in 2027. The second round includes drugs covered under both Part D (pharmacy drugs) and Part B (physician-administered drugs), expanding the program’s reach. CMS has indicated the program will continue to grow in subsequent years, eventually covering dozens of high-cost medications.
For the roughly 50 million Americans enrolled in Medicare Part D, five months of the program have delivered a concrete, measurable change at the pharmacy counter: lower posted prices on 10 drugs that collectively accounted for more than $50 billion in gross Medicare spending in the year before negotiations began, according to CMS data. Whether those lower prices translate into better health outcomes, broader market shifts, and durable savings for taxpayers are questions the evidence has not yet answered. The program’s full impact will be written in claims data, adherence rates, and contract terms that are still being generated.
Warren Cohen is a finance writer based in Phoenix, Arizona, covering personal finance topics including credit, banking, and beginner investing. He earned his degree in business administration from Arizona State University and began his career working in consumer finance, where he gained direct experience with lending and credit systems. He now writes for personal finance websites and fintech platforms, focusing on clear, practical content that helps readers make informed financial decisions.
