The Centers for Medicare & Medicaid Services has opened a third round of drug price negotiations by naming the exact medicines it plans to target for lower prices starting in 2028. Fifteen brand-name drugs made the list, chosen because Medicare spends more on them than on almost anything else it covers, and roughly 1.8 million people with Medicare Part B or Part D used at least one of them between November 2024 and October 2025. For a retiree managing arthritis, cancer, HIV, diabetes or a breathing condition with one of these medicines, the more useful question is not the negotiation calendar but which specific drug, for which condition, actually made the cut.
Autoimmune and Inflammatory Disease Drugs Dominate the List
Five of the fifteen selected drugs treat autoimmune or inflammatory conditions that typically require years of continuous treatment rather than a short course. According to CMS’s official announcement, the group includes Cosentyx, used for psoriasis, psoriatic arthritis and ankylosing spondylitis; Cimzia, prescribed for Crohn’s disease, rheumatoid arthritis, psoriatic arthritis and psoriasis; Orencia, used for rheumatoid arthritis and psoriatic arthritis; Entyvio, for ulcerative colitis and Crohn’s disease; and Xeljanz along with its extended-release version Xeljanz XR, used across rheumatoid arthritis, psoriatic arthritis and ulcerative colitis. Across the full fifteen-drug group, CMS said patients used these medicines to manage conditions including cancer, psoriatic arthritis and HIV, and that the group accounted for roughly $27 billion in combined Medicare Part B and Part D spending over the twelve months the agency reviewed. Biologic drugs for chronic autoimmune disease are exactly the category the negotiation program was built to reach, since Medicare cannot substitute a generic version while a biologic remains under patent protection.
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Four Cancer Drugs Join the Negotiating Table
Cancer treatment makes up the second-largest cluster on the list. Erleada treats prostate cancer, Kisqali and Verzenio are both used for certain forms of breast cancer, and Lenvima is prescribed across several cancer types, including thyroid, kidney and liver cancers. These are specialty medicines that typically carry list prices in the tens of thousands of dollars a year, and older patients on Medicare Part D or Part B for one of them are the population CMS specifically cited when it said the fifteen selected drugs serve people managing serious, ongoing illness rather than short-term conditions. A negotiated price does not change a cancer diagnosis or a treatment plan; it changes what Medicare and, indirectly, the beneficiary’s plan pay for the drug once a new maximum fair price takes hold.
Biktarvy, Trulicity, Anoro Ellipta and Xolair Cover HIV, Diabetes, COPD and Asthma
The remaining named drugs in the headline span four more common conditions among older Americans. Biktarvy is a once-daily HIV treatment, and its inclusion reflects a Medicare population that is older and living longer with HIV than in past decades. Trulicity is prescribed for type 2 diabetes. Anoro Ellipta is a maintenance inhaler for chronic obstructive pulmonary disease, a condition that disproportionately affects older adults with a history of smoking or long-term lung exposure. Xolair is used for moderate to severe asthma that has not responded to standard inhaled treatment, and separately for chronic hives that do not clear with antihistamines. Rounding out the list, Rexulti is used alongside other treatment for major depressive disorder and for schizophrenia. Each of these is a maintenance medicine a beneficiary is likely to take for years, which is part of why Medicare’s spending on the group is so concentrated.
Botox’s Medical Uses Are Also in Scope
Botox and Botox Cosmetic appear on the same list, and the therapeutic version is easy to mistake for the cosmetic one it shares a brand name with. The medical form is administered by a physician for indications such as chronic migraine and certain muscle-spasticity conditions, uses that fall under Medicare Part B because they are injected in a clinical setting rather than picked up at a retail pharmacy. That distinction matters for how a negotiated price flows through: Part B drugs are billed by the administering provider and reimbursed by Medicare directly, a different pathway than a Part D pharmacy claim, even when the same brand name covers both a medical and a cosmetic use.
Tradjenta Faces a Separate Renegotiation Track
Tradjenta, a type 2 diabetes drug, is not one of the fifteen newly selected drugs and should not be counted alongside them. CMS selected it instead for the negotiation program’s first-ever renegotiation, meaning it already carries a negotiated price from an earlier cycle and is now being revisited under a separate process built into the same law. Both tracks land on the same clock: CMS said negotiations tied to the third cycle will run through 2026, with any resulting negotiated or renegotiated prices taking effect January 1, 2028, for both the fifteen newly selected drugs and Tradjenta’s renegotiated price.
What a Negotiated Maximum Fair Price Changes at the Pharmacy
A negotiated maximum fair price sets a ceiling on what the government pays for a drug; it does not automatically set a retiree’s copay. For a Part D drug, out-of-pocket cost still runs through a beneficiary’s own plan and its coverage stages. Medicare’s rules cap the Part D deductible at $615 in 2026 for plans that charge one, and once that deductible is met, a beneficiary generally pays 25% coinsurance on covered drugs until total out-of-pocket spending reaches $2,100 for the year, after which catastrophic coverage takes over and out-of-pocket costs for covered Part D drugs stop for the rest of the calendar year. A lower negotiated price can reduce what a plan pays for a drug overall, which can influence premiums and formulary placement, but it works through those existing cost-sharing stages rather than replacing them. For a Part B drug like Botox’s therapeutic form, cost sharing instead runs through Part B’s own coinsurance structure rather than a Part D plan’s tiers. Beneficiaries on any of the fifteen selected drugs, or on Tradjenta, will not see a price change at checkout before the new prices take effect in 2028, and the size of any savings will still depend on which plan they are enrolled in and how that plan applies the new maximum fair price.
This article was produced with the assistance of AI and reviewed by The Financial Wire editorial team.
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David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
