On Jan. 1, Medicare’s negotiated prices for 15 more drugs take effect, including the semaglutide products Ozempic, Wegovy and Rybelsus. They join the 10 drugs whose first-round negotiated prices took effect this year. For hospital pharmacies, the date matters twice: several of the same drugs also move to rebate-only 340B pricing that day if the program takes effect as scheduled.
Here are six things to know:
- The drugs: The second round covers 15 Part D drugs: semaglutide (Ozempic, Rybelsus and Wegovy), Trelegy Ellipta, Xtandi, Pomalyst, Ibrance, Ofev, Linzess, Calquence, Austedo and Austedo XR, Breo Ellipta, Tradjenta, Xifaxan, Vraylar, Janumet and Janumet XR, and Otezla. CMS selected the drugs in January 2025 and announced the negotiated prices in November 2025.
- The discounts: The negotiated prices are 38% to 85% below each drug’s 2024 list price. Janumet has the deepest cut at 85%, followed by Tradjenta at 84%. Semaglutide’s negotiated price is $274 for a 30-day supply, down 71% from a $959 list price. Separately, Novo Nordisk will lower the U.S. list price of Wegovy, Ozempic and Rybelsus to $675 a month starting Jan. 1.
- The stakes: The 15 drugs accounted for about $42.5 billion in Part D spending in 2024 for about 5.3 million Medicare enrollees. CMS estimates enrollees will save about $685 million in out-of-pocket costs in 2027.
- The 340B overlap: The 340B rebate pilot is limited to drugs selected for Medicare price negotiation. Several of the 2027 drugs are covered by the rebate plans HRSA approved Oct. 1, including Bristol Myers Squibb’s Pomalyst, Boehringer Ingelheim’s Ofev and Tradjenta, and AbbVie’s Linzess and Vraylar. Unless a court or Congress steps in, hospitals will start paying wholesale acquisition cost for those drugs on Jan. 1 and waiting for 340B rebates. Drugmakers say the pilot is meant to keep them from paying both a 340B discount and a Medicare negotiated price on the same drug, and PhRMA puts that duplication at $5.2 billion in 2027. The AHA and four hospitals sued Oct. 9 to block the pilot. An earlier version of the pilot was halted by the same court in 2025 and later withdrawn by HHS. In Congress, a bipartisan House bill would delay the pilot through 2028. The pilot also lands as CMS weighs a proposed 2027 cut to 340B drug payments, which health systems told the agency would cost them as much as $109 million a year.
- One drug leaves the program: CMS listed Stelara, from the first negotiation round, for removal effective Jan. 1 because biosimilar versions are now on the market.
- What’s next: The third round, the first to include Part B drugs, covers 15 drugs selected this year, with negotiated prices taking effect in 2028. The program remains in effect after the Supreme Court let the negotiations stand.
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