The first 10 drugs selected for Medicare price negotiation are Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and the insulin pair Fiasp/NovoLog. These were chosen because they represented the highest-spending drugs in the Medicare Part D program, and their negotiated prices took effect on January 1, 2026.
The Full List of 10 Drugs
The Inflation Reduction Act of 2022 gave Medicare the authority to directly negotiate prices with drug manufacturers for the first time. The government selected these 10 based on total Medicare Part D spending, meaning they were the costliest drugs in the program. Here’s what each one treats:
- Eliquis: A blood thinner used to treat and prevent blood clots and stroke
- Jardiance: An oral medication for type 2 diabetes
- Xarelto: A blood thinner used to treat and prevent blood clots and stroke
- Januvia: An oral medication for type 2 diabetes
- Farxiga: An oral medication for type 2 diabetes, heart failure, and chronic kidney disease
- Entresto: An oral medication for chronic heart failure
- Enbrel: An injection for rheumatoid arthritis, psoriasis, and psoriatic arthritis
- Imbruvica: An oral medication for certain blood cancers, including leukemia and lymphoma
- Stelara: An injection for psoriatic arthritis, Crohn’s disease, and ulcerative colitis
- Fiasp and NovoLog: Insulin injections for type 1 and type 2 diabetes (counted together as one selection)
Three major condition categories dominate the list: diabetes (four drugs), heart and blood vessel conditions (four drugs), and autoimmune or inflammatory diseases (two drugs). One cancer drug rounds it out.
How These 10 Were Chosen
Not every expensive drug was eligible. To qualify for negotiation, a drug had to meet two key requirements. First, it had to be among the highest-spending medications in the Medicare Part D program. Second, it needed to have been on the market long enough: at least 7 years past FDA approval for standard drugs, or 11 years for biologic drugs (which are more complex to manufacture). That built-in waiting period gives manufacturers several years of market exclusivity before their prices become subject to negotiation.
From the pool of eligible drugs, CMS ranked them by total Medicare spending and picked the top 10. These weren’t obscure specialty medications. They’re some of the most widely prescribed drugs in the country, taken by millions of Medicare enrollees every day.
What the Negotiated Prices Mean for Patients
The negotiated prices, officially called “Maximum Fair Prices,” went into effect January 1, 2026. For people enrolled in Medicare Part D prescription drug coverage, this translates to lower out-of-pocket costs at the pharmacy counter, since copays and coinsurance are calculated as a percentage of a drug’s price.
The financial impact is significant at scale. CMS estimated that across a second round of 15 drugs negotiated for 2027, Medicare enrollees would save roughly $685 million in out-of-pocket costs. If those negotiated prices had been applied retroactively to 2024 spending, the program would have saved an estimated $12 billion across those 15 drugs, a reduction of approximately 44%.
What Came After the First 10
The initial round of 10 drugs was always designed as a starting point. A second round selected 15 additional drugs for negotiated prices taking effect in 2027, expanding to include medications covered under Medicare Part B (which covers drugs administered in doctors’ offices and clinics, not just pharmacy prescriptions). CMS used the same approach for the second round: ranking eligible drugs by total Medicare spending across both Part B and Part D, then selecting the 15 highest-ranked medications.
The program is structured to add more drugs in future years, gradually expanding the share of Medicare drug spending subject to negotiated pricing.