Medicare Enrolled will see Lower Costs on Select Drugs in 2026

Published in Blackstone Valley Call & Times on December 2, 2025

With Medicare Open Enrollment ending next week, the Centers for Medicare & Medicaid Services (CMS) has announced that last year’s Medicare negotiations produced a net savings of 44%—about $12 billion—on 15 widely used prescription drugs that treat cancer and other serious chronic conditions.

The new Maximum Fair Prices (MFPs) for these 15 drugs will take effect on January 1, 2027. Combined with the 10 drugs already negotiated—whose MFPs take effect January 1, 2026—a total of 25 drugs will have negotiated lower prices. These medications, used to treat conditions such as cancer, diabetes, asthma, and cardiovascular and neurological disorders, represent some of the highest Medicare Part D spending.

The Beginning of Drug Price Negotiations

Three years ago, after President Biden signed the Inflation Reduction Act (IRA) in August 2022, CMS began developing the process for Medicare’s first-ever drug price negotiations. On March 15, 2023, the federal agency issued its initial program guidance and received more than 7,500 public comments from consumer groups, patient advocates, drug manufacturers, and pharmacies. Revised guidance followed on June 30, 2023.

On August 29, 2023, CMS released the first list of 10 high-cost drugs selected for negotiation—marking the first time in Medicare’s history that it could negotiate directly with pharmaceutical companies.

Pharmaceutical industry groups and several companies attempted to block the law in court. In response, 70 organizations and 150,000 petition signers urged Merck, Bristol Myers Squibb, Janssen Pharmaceuticals, Astellas Pharma US, the Pharmaceutical Research and Manufacturers of America (PhRMA), and the U.S. Chamber of Commerce to drop their lawsuits. Multiple organizations also filed amicus briefs supporting the law.

Three years in process, and with courts ultimately allowing the program to proceed, that first round of 10 drugs with negotiated prices will take effect in 2026.

CMS Drug Negotiations Added 15 Drugs

On January 17th, CMS announced it had selected 15 additional drugs for the second cycle of negotiations under Medicare Part D and on November 25th, it was announced that agreements had been reached on all of them. These medications are among the most costly and most commonly used by Medicare beneficiaries, treating conditions such as cancer, diabetes, and asthma. The new round of negotiations is expected to save Medicare billions and strengthen the program’s long-term sustainability.

“This year’s results stand in stark contrast to last year’s,” said CMS Administrator Mehmet OzMD, in announcing the second cycle of negotiations.  “Using the same process with a bolder direction, we have achieved substantially better outcomes for taxpayers and seniors in the Medicare Part D program — not the modest or even counterproductive ‘deals’ we saw before.”

“Whether through the Inflation Reduction Act or President Trump’s Most Favored Nation policy, this is what serious, fair, and disciplined negotiation looks like,” adds CMS Deputy Administrator and Medicare Director Chris Klomp. “I’m deeply proud of our team, who execute exceptionally well to bring affordability to the country in everything we do.”

Between January 1 and December 31, 2024, approximately 5.3 million Medicare Part D enrollees used one or more of these 15 drugs. Total gross Part D spending for them was $42.5 billion, representing about 15% of all Part D drug costs.

Anthony Wright, executive director of Families USA, praised the newly released negotiated prices, stating that they show what is possible when “policymakers put patients before corporate profits.” Wright emphasized that these reductions build on the work of establishing the Drug Price Negotiation Program, which aims to provide financial relief to older adults and people with disabilities.

Wright noted that the first and second rounds of negotiated drugs together account for about one-third of Medicare Part D spending, with price reductions ranging from 38% to 85%. In 2027, beneficiaries using these drugs are projected to save $685 million in out-of-pocket costs. He added that the savings support both individual beneficiaries and the long-term sustainability of the Medicare program.

Despite pharmaceutical companies’ continued attempts to limit the program—through lawsuits and legislative provisions such as those in H.R. 1—Wright said the negotiation program remains “the most effective tool currently available to lower drug prices.”

“The Medicare Negotiation Program changed the trajectory of drug pricing in the United States, helping to reduce Big Pharma’s monopoly pricing power, which dictated prices to Americans on Medicare for two decades,” said Merith Basey, executive director of Patients for Affordable Drugs in a statement. “This second round of negotiations — now under President Trump — marks another major milestone, delivering continued savings for patients and taxpayers,” he said.

“The lower negotiated prices are more than numbers on a page. For patients who’ve been forced to work multiple jobs, cut pills in half, or choose between filling a prescription and buying groceries, these lower prices will bring long-overdue relief, flexibility, and stability,” added Basey.

“The requirement that Medicare negotiate lower prices for prescription drugs continues to pay dividends for older Americans and taxpayers,” adds Richard Fiesta, executive director of the Alliance for Retired Americans. “The announcement of lower drug prices for 15 high-priced drugs is a win for more than 5 million seniors who take these drugs to treat asthma, diabetes, lung disease and other serious conditions, and will soon pay less for their medications,” he says.

“The 4.4 million members of the Alliance are pleased that the Trump Administration has followed the law, negotiated these prices, and defended this law in court,” Fiesta says, calling on Congress to increase the number of drugs subject to price negotiations.

While the White House along with aging groups praise the impact of IRA’s Medicare drug negotiation provisions, the Pharmaceutical Research and Manufacturers of America (PhRMA) issued a statement calling it “flawed.”

“Whether it is the IRA or MFN, government price setting for medicines is the wrong policy for America. Price setting does nothing to rein in PBMs who decide which medicines are covered and what patients pay. In fact, many patients are facing additional coverage barriers and paying more out-of-pocket for medicines because of the IRA, warns Alex Schriver, Senior Vice President of Public Affairs.

“These flawed policies also threaten future medical innovation by siphoning $300 billion from biopharmaceutical research, undermining the American economy and our ability to compete globally,” states Schriver, noting that PhRMA members are stepping up to make medicines more affordable by enabling direct purchase at lower prices and investing in U.S. manufacturing and infrastructure.

Lower Drug Cost Legislation Introduced

Congressman John B. Larson (D-CT), a senior member of the House Ways and Means Committee, praised the latest CMS announcement, estimating that both negotiation rounds will save older Americans more than $2 billion per year in out-of-pocket costs. Larson noted that families and seniors continue to struggle with rising prices, especially for prescription drugs.  The lawmaker pushed to enable Medicare to negotiate drug prices to lower drug costs by the enactment of IRA.

Last week, House Democrats introduced the Lower Drug Costs for American Families Act, aimed at closing loopholes in H.R. 1 and further reducing prescription drug prices. The bill (H.R. 6166), introduced November 20 by Ranking Members Frank Pallone Jr. (Energy and Commerce), Richard Neal (Ways and Means), and Bobby Scott (Education and Workforce), has been referred to all three committees.

Key provisions of the bill would:

  • Extend Medicare’s price negotiation authority to all Americans with private insurance—covering more than 164 million people with employer-sponsored plans and over 24 million enrolled in Affordable Care Act plans
  • Apply inflation-based rebate protections to private insurance markets, potentially saving $40 billion over 10 years
  • Increase the number of negotiated drugs from 20 to 50 per year
  • Extend the $2,000 annual out-of-pocket prescription drug cap to privately insured patients
  • Cap insulin costs at $35 per month for those with private insurance
  • Close the orphan-drug loophole that allows companies to avoid negotiation
  • Require consideration of international drug prices to ensure Americans do not pay three to five times more than patients in other countries

Continue the Momentum

According to CMS, the agency will announce the specifics on 15 drugs for the third round of Medicare price negotiations by February 1, 2026. This new round will include drugs paid under Medicare Part B for the first time and will begin with negotiated prices effective January 1, 2028. CMS has already released final guidance for the program and will also use this process to select drugs for renegotiation in previous cycles. IRA also establishes an ongoing process where more drugs will be selected for negotiation in subsequent years.

A Dec. 2024 AARP survey found that almost 3 in 5 adults age 50 and older expressed concern about their ability to afford prescriptions over the near future.  Respondents included both Medicare beneficiaries and younger persons. About 96 percent of the respondents call on the government to do more to lower pharmaceutical prices.

AARP noted that this survey was taken right before a new $2,000 cap on out-of-pocket drug expenses took effect in 2025.

With the announcement of lower drug costs that result from Medicare’s round 2 drug negotiations, there is an  opportunity to build on this momentum for real change. Lawmakers can legislate to put the public’s health above profit by giving consumers more power to negotiate, making competition stronger, and keeping patients from having to pay too much out of pocket.

It is now time for Congress to act.

Many Seniors Struggle with High Cost of Medications

Published in the Pawtucket Times on June 18, 2001

Many seniors are struggling to pay the spiraling cost of prescription drugs as a politically divided Congress seeks a solution by crafting a bipartisan prescription drug benefit tied to Medicare.

Until this issue is addressed, a tragedy occurs in many communities across the nation.

Often, the high cost of prescription drugs has forced seniors on fixed incomes into not taking their medications at all or using only partial doses.

Noncompliance in taking medication can lead to hospitalization, nursing home admission or premature death.

According to the Families USA study released in June 2001, costly prescriptions continue to hit seniors hard in their pocketbook.

The report found that 50 of the most heavily prescribed drugs for seniors on average rose more than twice the rate of inflation in the year ending January 2001.

On average, the researchers found that prices increased by 6.1 percent from January 2000 to January 2001, though the rate of inflation excluding energy in that time period was 2.7 percent.

Furthermore, the 18-page report stated that seniors are most affected by any prescription drug price  increase.

Although older persons represent just 13 percent of the total nation’s population, they account for 34 percent of all prescribed medications dispensed and 42 percent of all prescription drug spending.

Of the 50 drugs used more frequently by seniors, the average annual cost per prescription as of January 2001 was $ 956, the report noted.

Drug prices rose significantly over the one-year period of the study.

The report findings revealed that the cost of Synthroid, a synthetic thyroid agent, rose by 22.6 percent; 22.5 percent for Alphagan, commonly used to treat glaucoma; 15.5 percent for Glucophage, prescribed for treating diabetes; and 12.8 percent for Premarin, used estrogen replacement.

While rising drug costs are national, Rhode Island fiscal nets are in place to make prescription drugs more affordable to low-to-moderate income seniors, says Susan Sweet, consultant and advocate for a variety of nonprofit agencies and minority groups.

Many aging advocates and state legislators know Sweet as “the mother of the Rhode Island Pharmaceutical Assistance to the Elderly Program (RIPAE).”

“Rhode Island is one of a handful of states that has responded to senior’s concerns and anxieties about the high cost of prescription drugs,” Sweet says.

In 1985, the Rhode Island General Assembly moved to assist elders with rising prescription drug costs by enacting RIPAE.

Initially, the RIPAE program covered only medications purchased by low-income seniors to treat hypertension, cardiac conditions and diabetes.

In the past fifteen years, the General Assembly has expanded the program,” Sweet adds, to over the cost of prescription drugs to treat glaucoma, Parkinson’s disease, high cholesterol, cancer, circulatory insufficiency, asthma, chronic respiratory conditions, Alzheimer’s disease, depression, incontinence, infections, arthritic conditions and prescription vitamins and mineral supplements for renal patients.

Additionally, the RIPAE Plus Program, proposed by Lt. Governor  Charles Fogarty with House and Senate leadership, allowed moderate income seniors to purchase prescription drugs at a lower rate that is negotiated by the state.

The state also pays a portion of the remaining cost of the drug based on the senior’s income level.

“The innovations in RIPAE have made Rhode Island a leader in assisting seniors to stay healthy and independently,” Sweet says.

With the end approaching to this year’s session of the General Assembly, lawmakers are considering legislation to again expand the RIPAE Program, states Fogarty, who authored the legislation.

Fogarty’s RIPAE Next Step would cover all FDA-approved prescribed drugs, excluding cosmetic and experimental drugs, cap out-of-pocket expenses at $ 1,500 annually, and open up the program to people age 55 and over who are receiving Social Security Disability Insurance.

While no one really opposes the passage of RIPAE expansion this year, ultimate passage of the entire legislative proposal is really a question of competing budget needs and limited state dollars, Sweet comments.

House Finance Chair Tony Pires (D-Pawtucket) remembers a time in the mid-1990s when Governors Bruce Sundlun and Linc Almond attempted to roll back the RIPAE program by calling for an increase in the senior’s co-pay and limiting access to benefits.

“The General Assembly made it very clear that it did not want to reduce state support, but rather moved to increase benefits,” Rep. Pires said.

“This year we’ll be expanding the list of drugs to include prescription drugs used to treat osteoporosis,” Rep Pires tells The Times, adding that House leadership also supports an out-of-pocket prescription drug cap of $ 1,500 annually.

With the RIPAE Next Step’s price tag of $ 3.5 million dollars. “We can’t afford to pay for an open formulary program yet because of budgetary limitations,” Rep. Pires states.

In upcoming legislative sessions, coverage for gastrointestinal drugs will seriously be considered, he adds.

“In the upcoming years the state’s pharmaceutical assistance program will remain a top priority to the General Assembly, Rep. Pires says. “There will be an expansion of coverage to a full formulary when more state monies become available, he adds.

Currently, Lt. Governor Fogarty estimates that more than 170,000 Medicare beneficiaries in Rhode Island, who do not meet the state’s pharmaceutical assistance program’s income eligibility requirements, lack comprehensive prescription drug coverage.

With an aging population, Congress and state lawmakers must roll up their sleeves to find innovative ways of making prescription drugs affordable.