What 10 drugs are being negotiated by Medicare?

The standard 2026 Medicare Costs increase the Part B monthly premium to $202.90 and set the Part D out-of-pocket prescription drug cap at $2,100.

Cost and Premium Adjustments

• Part B Premium: The standard monthly premium rises to $202.90 (up from $185), and the annual deductible increases to $283.
• Part A Deductible: The inpatient hospital deductible increases to $1,736 per benefit period.
• Part D Drug Cap: The maximum out-of-pocket spending limit for Part D prescription drugs rises to $2,100, up from $2,000 in 2025.
• Part D Deductible: The maximum allowable annual deductible for prescription drug plans increases to $615.

Prescription Drug Program Updates

• Drug Price Negotiations: Newly negotiated prices take effect for the first 10 high-cost medications selected under the Medicare Drug Price Negotiation program.
• Payment Plan Renewal: Enrollees using the voluntary Medicare Prescription Payment Plan to spread out-of-pocket costs over the year are automatically renewed if they participated previously.

Policy and Pilot Changes

• Prior Authorization Pilot: A 6-year pilot program tests prior authorization requirements for specific Original Medicare Part B items and services across six states.
• Directory Error Protections: A special enrollment period protects beneficiaries who select a Medicare Advantage plan based on inaccurate online provider directory info.

Several major brand-name drugs are losing patent exclusivity or seeing their first generic approvals and market launches in 2026.

Key Medications Slated for Generic or Biosimilar Availability in 2026

• Januvia (sitagliptin) and Janumet (sitagliptin/metformin): Merck's blockbuster diabetes medications face generic competition following patent and litigation settlements.
• Farxiga (dapagliflozin): The FDA approved the First Generic Drug Approvals for dapagliflozin tablets in April 2026.
• Pomalyst (pomalidomide): Bristol Myers Squibb's multiple myeloma drug faces expected generic market entries in 2026.
• Xtandi (enzalutamide): Generic enzalutamide received final FDA approval in early 2026 for commercial rollout.
• Xolair (omalizumab): Biosimilar competition for Roche's biologic asthma and allergy treatment is expected to launch in the second half of 2026.
• Brilinta (ticagrelor): Slated for generic market transition during 2026.
• Entresto (sacubitril/valsartan): Novartis faces patent expirations for this crucial heart-failure medication.

(Note: For high-demand medications like Ozempic/Wegovy [semaglutide] or Mounjaro/Zepbound [tirzepatide], true FDA-approved retail generics are delayed due to complex device and secondary patent layering well into the future, meaning current low-cost alternatives are typically unregulated compounded peptides rather than official generics.) You can review a broader tracking list via Drugs.com Generic Approvals.

The first 10 drugs selected by Medicare for price negotiations under the Inflation Reduction Act—with negotiated prices taking effect in 2026—are Eliquis, Enbrel, Entresto, Farxiga, Fiasp/NovoLog, Imbruvica, Januvia, Jardiance, Stelara, and Xarelto.

The First 10 Negotiated Drugs

These medications treat conditions including blood clots, diabetes, heart failure, arthritis, and cancers. For detailed indications per drug, refer to the Medicare Drug Price Negotiation Program fact sheet.

Review the official Medicare 2027 Publication for complete details on upcoming adjustments.

The 7 major changes coming to Medicare for 2027 include:

• Part D Out-of-Pocket Cap Increase: The maximum out-of-pocket spending limit for covered prescription drugs rises from $2,100 to $2,400. After hitting this cap, beneficiaries pay nothing for covered prescriptions for the rest of the year.
• New Lower Drug Prices: Medicare adds 15 newly negotiated medications to its price-reduction list (including GLP-1s like Ozempic and Wegovy, alongside specific cancer and diabetes therapies) starting January 1, 2027.
• Standard Part D Deductible Rise: The maximum annual deductible for Part D prescription drug plans increases to $700.
• Part B Premium and Deductible Adjustments: The standard Part B monthly premium rises to an estimated $209.50, and the annual deductible increases to around $292–$310.
• Electronic Prior Authorizations: Medicare Advantage plans must implement standardized electronic prior authorization tools to speed up treatment approvals starting January 1, 2027.
• Login and Security Updates: Medicare.gov expands authentication options by adding ID.me, CLEARme.com, and Login.gov.
• Eligibility and Residency Rules: Eligibility requirements tighten to mandate specific U.S. residency statuses, impacting noncitizen eligibility for certain enrollees.

The single medication that costs Medicare the highest total amount overall is the blood thinner Eliquis (apixaban), with total spending reaching over $12 billion to $20 billion annually.

Highest Total Spending (Part D and Part B)

• Eliquis (apixaban): Costs Medicare the most in total aggregate Part D spending (used for preventing blood clots and strokes).
• Eylea: Tops Medicare Part B spending for provider-administered drugs, costing billions for macular degeneration treatments.

Highest Cost Per Patient / Per Claim

When looking at the highest cost per user or per prescription claim rather than total national spending:

• Specialty oncology and biologic drugs like ibrutinib (Imbruvica) and ustekinumab cost upwards of $110,000 to $130,000 per patient annually before recent price negotiations.
• Certain specialty generics like lenalidomide (a Revlimid generic for blood cancer) cost nearly $14,000 per single prescription fill, making it the most expensive generic burden on the system.