What Are the 10 Drugs Negotiated by Medicare?

The first ten drugs selected for Medicare price negotiation under the Inflation Reduction Act are Eliquis (apixaban), Jardiance (empagliflozin), Xarelto (rivaroxaban), Januvia (sitagliptin), Farxiga (dapagliflozin), Entresto (sacubitril/valsartan), Enbrel (etanercept), Imbruvica (ibrutinib), Stelara (ustekinumab), and NovoLog (insulin aspart). Announced in August 2023, these drugs collectively cost Medicare over $50 billion in a single year, and their negotiated prices took effect in January 2026. The list covers some of the most commonly prescribed and most expensive medications in the country, spanning blood thinners, diabetes treatments, heart failure drugs, cancer therapy, and autoimmune medications.

What Each Drug Treats

The ten drugs fall into a handful of therapeutic areas, with diabetes and cardiovascular disease dominating the list. Here is what each one does:

Eliquis (apixaban): A blood thinner used to prevent strokes in people with atrial fibrillation and to treat or prevent blood clots. It was the highest-spending drug in all of Medicare Part D.
Xarelto (rivaroxaban): Another blood thinner with similar uses to Eliquis, though the two differ in dosing and some clinical outcomes.
Jardiance (empagliflozin): A diabetes medication that lowers blood sugar and also has approved uses for heart failure and chronic kidney disease.
Farxiga (dapagliflozin): Works through the same mechanism as Jardiance and is approved for type 2 diabetes, heart failure, and chronic kidney disease.
Januvia (sitagliptin): An older diabetes drug that works differently from Jardiance and Farxiga, helping the body regulate blood sugar after meals.
NovoLog (insulin aspart): A rapid-acting insulin used by people with type 1 or type 2 diabetes who need mealtime insulin injections.
Entresto (sacubitril/valsartan): A heart failure medication that combines two active ingredients to reduce the strain on the heart.
Enbrel (etanercept): An injectable biologic used for autoimmune conditions like rheumatoid arthritis, psoriatic arthritis, and plaque psoriasis.
Imbruvica (ibrutinib): A cancer drug used primarily for certain blood cancers, including chronic lymphocytic leukemia and mantle cell lymphoma.
Stelara (ustekinumab): A biologic used for moderate-to-severe psoriasis, psoriatic arthritis, and Crohn’s disease.

Four of the ten drugs treat diabetes in some form, which reflects both how common the disease is among Medicare enrollees and how expensive long-term drug therapy for it has become. The two blood thinners, Eliquis and Xarelto, were the two single largest sources of Medicare Part D spending on the entire list.

How CMS Selected These Ten

The Inflation Reduction Act laid out specific rules for which drugs could be selected. CMS was required to choose from among the drugs with the highest total gross spending in Medicare Part D, but several categories of drugs were excluded from consideration. A drug had to have been on the market long enough without a generic or biosimilar competitor, it could not be approved solely for a rare (orphan) disease indication, and it could not be derived from whole human blood or plasma.¹ The law specified that only Part D drugs (those you pick up at a pharmacy) were eligible in the first two rounds, with Part B drugs (those administered by a doctor, like infusions) becoming eligible starting in 2028.²

In practice, this meant CMS started with a ranked list of Part D drugs by total spending, then eliminated any that had not been approved long enough or that had a generic available. The ten drugs that remained at the top of the spending list after those exclusions were the ones selected. Between June 2022 and May 2023, these ten accounted for about $50.5 billion in Medicare spending, and Medicare enrollees paid roughly $3.4 billion in out-of-pocket costs for them in 2022 alone.³

The Negotiated Prices and How They Compare

CMS announced the negotiated “Maximum Fair Prices” in August 2024, and they went into effect on January 1, 2026. The discounts varied widely depending on the drug. Some prices dropped by more than half, while others saw more modest reductions. For example, Januvia’s negotiated price came in at roughly $113 for a 30-day supply, a steep drop from its list price of over $500. Jardiance landed at about $197, Eliquis at around $231, and NovoLog at roughly $119. The cancer and biologic drugs remained expensive in absolute terms but still saw significant percentage cuts: Imbruvica’s negotiated price was about $9,319 per month, down from nearly $15,000, and Stelara dropped to around $4,695 from roughly $13,800.

The overall spending reduction from these negotiations is meaningful but not transformative on its own. One projection estimated that negotiation would reduce 2026 Medicare Part D net spending on the ten drugs by about $2.3 billion, roughly a 9% reduction compared to what would have been spent without negotiation.⁴ A separate analysis estimated minimum savings of $3.2 billion in 2026 from the ten Part D drugs.⁵ The difference between those figures reflects different assumptions about existing rebates, which brings up an important wrinkle.

Why Existing Rebates Complicate the Savings Picture

The list prices of these drugs are not what Medicare was actually paying before negotiation. Drug manufacturers had already been giving rebates to pharmacy benefit managers and Medicare plans, and for some of the ten drugs, those rebates were substantial. When you compare the new negotiated prices to what Medicare was already paying after rebates, the savings look smaller than the headlines suggest.

This is especially true for the blood thinners and some diabetes drugs. For drugs like Eliquis and Xarelto, existing rebates already brought the effective price down considerably, so the negotiated price did not represent as dramatic a shift behind the scenes as it appeared on paper. The negotiation program generated the biggest new savings for drugs where prior rebates were small relative to the discount the law now requires. An analysis found that for four of the ten drugs, the minimum discount mandated by the IRA actually exceeded what manufacturers had previously been rebating. Those four were Enbrel (now subject to a 60% minimum discount, versus an estimated prior rebate of about 39%), and three cancer or specialty drugs: Imbruvica, the cancer drug palbociclib (which was anticipated but ultimately not on the final list), and enzalutamide, all subject to a 25% minimum discount with prior rebates well below that threshold. Just the mandated minimum discounts on those drugs with low prior rebates would generate about $1.8 billion in savings based on their historical spending.⁶

In short, the program’s impact is largest where the drug market was least competitive before negotiation. Drugs that already faced pressure from alternatives or had high rebate agreements saw smaller incremental savings from the new negotiated prices.

How CMS Set Its Price Offers

CMS did not simply pick a number. The agency used a combination of statutory price ceilings, existing net prices, and data on how each drug performs compared to its therapeutic alternatives. The law defines ceiling prices based on how long a drug has been on the market: drugs approved for 9 to 16 years face a ceiling of 75% of their average non-federal price, while those on the market longer face steeper mandatory discounts.

For some drugs, these statutory ceilings were the binding constraint. For Imbruvica and Stelara, the ceiling prices themselves likely determined the initial offers because those ceilings were already below what CMS could negotiate purely on clinical grounds.⁷ For others, clinical evidence played a larger role. Eliquis and Xarelto, for instance, have branded competitors and well-studied differences in outcomes like bleeding risk and stroke prevention, giving CMS leverage to compare prices across similar drugs.⁸ Entresto and rivaroxaban faced an additional dynamic: both have therapeutic alternatives that are available as generics, which gave CMS the option to set a negotiated price reflecting the availability of much cheaper substitutes.⁷

For two diabetes drugs, dapagliflozin (Farxiga) and sitagliptin (Januvia), the situation was trickier. Their statutory ceilings and the net prices of their therapeutic alternatives were similar to or higher than the drugs’ own current net prices, meaning CMS had to lean on other negotiation factors to achieve savings at all.⁷

What Changes for Patients at the Pharmacy

If you take one of these ten drugs and you are on Medicare Part D, you may see a lower price at the pharmacy counter starting in 2026. But the negotiated prices interact with another major provision of the Inflation Reduction Act: the $2,000 annual cap on out-of-pocket spending for Part D enrollees, which also took effect in 2026.

For people who take expensive specialty drugs, that $2,000 cap is actually the bigger deal. Research has found that for Part D enrollees using specialty medications, the annual out-of-pocket cap produces a much larger reduction in costs than the negotiated drug prices alone.⁹ Someone taking Imbruvica for blood cancer, for example, might have faced five-figure annual out-of-pocket costs before these changes. The $2,000 cap slashes that regardless of whether the drug’s negotiated price dropped by 20% or 40%.

For people on less expensive drugs from the list, such as Januvia or Eliquis, the negotiated price reductions can make a more noticeable difference in monthly copayments and coinsurance, especially for enrollees who were not previously hitting the catastrophic coverage threshold. A forecasting model for Louisiana estimated that Medicare patients could save an average of about $1,064 over the first five years of the program from negotiated prices on non-insulin diabetes drugs alone.¹⁰

Underuse of Some of These Drugs Before Negotiation

One underappreciated aspect of the negotiation program is that high prices were keeping some of these drugs out of the hands of people who would benefit from them. Entresto is a good example. It is considered a first-line treatment for a common type of heart failure, yet before the IRA, the estimated share of eligible Medicare patients actually receiving it was strikingly low, around 3.6%. In commercial insurance plans, where cost barriers tend to be lower, roughly four times as many eligible patients were prescribed the drug.¹¹ Prior authorization requirements and high copayments were both factors. Lowering the negotiated price for Entresto could help close that gap, though the extent to which it does will depend on how insurers adjust their formularies and cost-sharing in response.

The Fight Over Innovation

Pharmaceutical companies have pushed back hard against the negotiation program, arguing that lower drug revenue will reduce their incentive and ability to invest in developing new treatments. Several companies filed lawsuits challenging the law’s constitutionality, arguing among other things that the program amounts to forced price-setting rather than genuine negotiation.³ Those legal challenges were ultimately unsuccessful, and the program proceeded on schedule.

The innovation question is more nuanced than either side tends to acknowledge. One analysis published in Nature Biotechnology concluded that the IRA’s reduction in overall industry revenue would be modest and would not affect most top-selling drugs. The researchers argued that changes in the financial viability of drug-development projects would be concentrated in medicines where Medicare is a major purchaser and where the expected return on investment was only marginally positive before the law passed.¹² In other words, the vast majority of drug development pipelines would not be affected, but a subset of projects targeting diseases common in older adults might see funding pulled.

A separate project-level analysis painted a more concerned picture. Using an illustrative case study, researchers modeled how Medicare negotiation at the nine-year mark after approval would affect the financial viability of a drug at different stages of development. They found a roughly 40% reduction in the drug’s projected value at launch. The impact was even more severe for drugs still in early-stage development, such as preclinical or Phase 1 trials, because the lower expected revenue gets discounted more heavily when the payoff is further in the future. The authors suggested the long-term effect on innovation could be larger than what short-term data or broad industry-level analyses capture.¹³

These two perspectives are not necessarily contradictory. The industry-wide view is that total revenue takes a small hit and most blockbuster drugs remain profitable. The project-level view is that for certain types of drugs, especially small-molecule drugs in early development aimed at diseases prevalent in people over 65, the math gets harder. Whether that shift leads to meaningfully fewer new drugs reaching patients is something that will play out over the next decade and is genuinely difficult to predict.

How the Program Expands From Here

The ten drugs negotiated for 2026 are just the beginning. The law requires CMS to select 15 additional drugs for negotiation in each of the next two cycles, with negotiated prices taking effect two years after selection. Starting in 2029, the pool expands to include Part B drugs, which are typically administered in doctor’s offices or hospitals, such as infused cancer therapies and injectable biologics. After 2029, the program scales up to 20 new drugs per year.²

As more drugs enter the negotiation pipeline, the cumulative savings are projected to grow substantially. One analysis estimated that by 2029, when 60 Part D and Part B drugs would be subject to negotiated prices, the program could save Medicare roughly $16 billion annually. That same analysis found that expanding eligibility rules further, for instance by selecting drugs based on net spending rather than gross spending, or by including drugs that already face generic competition, could roughly double or triple the savings.⁵

The second batch of 15 drugs, selected in early 2025 for prices taking effect in 2027, has already been announced and includes several more blockbuster medications. Researchers who modeled the selection criteria before the announcement found that the process is fairly predictable: rank drugs by spending, apply the exclusion filters, and the selections largely follow the list in order.¹ That predictability matters for the pharmaceutical industry because companies can see years in advance whether their drugs are likely to be selected, which affects their pricing strategies and their decisions about when to launch generics or biosimilars.

Drugs That Nearly Made the List

Because the selection process is formulaic, several drugs were close to the cutoff but did not make the initial ten. Some were excluded because a generic or biosimilar had recently been approved, which automatically disqualified them. Others fell just below the spending threshold. The exclusions reveal some interesting policy trade-offs. A drug with a biosimilar on the market might still cost Medicare enormous sums if the biosimilar has not yet gained meaningful market share, but the law treats the mere existence of a competitor as sufficient reason to exclude the drug from negotiation. Researchers have noted that modifying this rule to include drugs with generic or biosimilar competitors that have not yet meaningfully reduced spending could more than double the program’s savings in its first year.⁵

The orphan drug exclusion is another area of debate. A drug approved for only a single rare disease is exempt from negotiation, but a drug that started as an orphan product and later gained approval for additional, more common conditions is not exempt. This creates an incentive structure where manufacturers might be cautious about seeking additional indications for orphan drugs, since doing so could expose the product to negotiation. Whether this dynamic actually discourages indication expansion remains to be seen, but it is a design wrinkle that policymakers and researchers have flagged.

1
PubMed Central. Drugs anticipated to be selected for the Medicare Drug Price Negotiation Program in 2025
2
JAMA Health Forum. Simulated Medicare Drug Price Negotiation Under the Inflation Reduction Act of 2022
3
JAMA. Medicare’s Historic Prescription Drug Price Negotiations
4
Value in Health. Spending Impact of the First 10 Drugs Selected for Medicare Drug Price Negotiation in the United States
5
JAMA Internal Medicine. Examining Opportunities to Increase Savings From Medicare Price Negotiations
6
Journal of Managed Care & Specialty Pharmacy. Estimated discounts generated by Medicare drug negotiation in 2026
7
PubMed. Integrating Price Benchmarks and Comparative Clinical Effectiveness to Inform the Medicare Drug Price Negotiation Program
8
PubMed. Informing the United States Medicare Drug Price Negotiation for Apixaban and Rivaroxaban: Methodological Considerations for Value Assessments Many Years After Launch
9
PubMed Central. Inflation Reduction Act Provisions and Medicare Part D Out-of-Pocket Costs for Specialty Drugs
10
Pharmacoeconomics and Policy. What is the impact of Inflation Reduction Act negotiated prices for non-insulin diabetes drugs on Louisiana Medicare costs? A forecasting model analysis
11
PubMed. Prior Authorization, Copayments, and Utilization of Sacubitril/Valsartan in Medicare and Commercial Plans in Patients With Heart Failure With Reduced Ejection Fraction
12
PubMed. Medicare price negotiation and pharmaceutical innovation following the Inflation Reduction Act
13
PubMed. The Impact of the Inflation Reduction Act on Investment in Innovative Medicines: A Project-Level Analysis