Medicare to Adjust Prices for 10 Costly Meds in 2026: What Patients Should Know
Patients considering prescription costs need clear information about future changes. Medicare is making significant moves to negotiate prices for 10 high-cost medications starting in 2026. The article breaks down which drugs are affected, how the changes will impact patient finances, and what steps beneficiaries should take now to prepare.
For many people who rely on Medicare, the cost of brand‑name prescriptions has grown into a major financial strain. Starting in 2026, the federal government plans to adjust prices for 10 particularly costly medications using a new negotiation process. Understanding what is changing, which drugs are involved, and how the rules work can help patients prepare for the impact on their out‑of‑pocket costs.
This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalized guidance and treatment.
What is on the Medicare drug negotiation list 2026?
The Medicare drug negotiation list 2026 refers to the first set of 10 high‑spending drugs in Medicare Part D that the federal government has selected for price negotiations. These medicines are widely used by people with conditions such as heart disease, type 2 diabetes, blood clots, cancer, and autoimmune disorders.
Under current law, these negotiations are part of the Inflation Reduction Act. The government and manufacturers will work through a structured timetable to agree on a maximum fair price that Medicare plans can pay for each of the selected drugs starting in 2026. The goal is to slow spending growth in the program and eventually reduce what many beneficiaries pay at the pharmacy counter, especially for drugs without close generic competition.
Which high-cost Medicare drugs are affected?
The affected high-cost Medicare drugs on the initial list are among those that account for a large share of total Part D spending. The list includes brand‑name medications such as Eliquis and Xarelto (blood thinners), Jardiance and Farxiga (type 2 diabetes and heart failure), Januvia (type 2 diabetes), Entresto (heart failure), Enbrel and Stelara (autoimmune and inflammatory conditions), Imbruvica (a cancer treatment), and certain insulin products like Fiasp and related formulations.
These drugs are typically used over long periods, sometimes for life, and many do not yet have lower‑cost generic or biosimilar versions widely available. As a result, they can generate very high spending for Medicare and significant coinsurance or copayments for patients who use them year after year.
How Medicare price negotiations work under current law
To understand how Medicare price negotiations work, it helps to look at the basic steps. First, the government identifies drugs with high total spending that meet certain age and competition criteria, such as being on the market for several years without a generic or biosimilar alternative. From that pool, it selects a limited number of drugs for negotiation.
Manufacturers then receive an initial offer from Medicare for a maximum fair price. Both sides can exchange information and counteroffers during a structured negotiation period. The law sets upper limits on the negotiated price based on a percentage of the drug’s existing average price and how long the product has been on the market. If a company declines to participate, it can face significant financial penalties. Once a price is finalized, Medicare Part D plans must treat that price as the maximum they will pay for the drug, starting in the applicable year.
Reducing prescription costs in 2026 for patients
Patients often ask what reducing prescription costs in 2026 will look like in practical terms. For the drugs on the negotiation list, the expectation is that lower prices paid by Medicare plans will eventually lead to lower coinsurance amounts, since coinsurance is usually calculated as a percentage of the drug’s negotiated price. The exact savings will depend on each plan’s design, the patient’s total drug spending during the year, and whether they reach the new annual out‑of‑pocket cap that is also being phased in.
To give a sense of current price levels before negotiation, the table below summarizes approximate monthly retail price ranges for several of the selected drugs as of 2024. These are broad estimates and do not reflect what any individual patient will pay after insurance, discounts, or assistance programs.
| Product/Service | Provider | Cost Estimation |
|---|---|---|
| Eliquis (apixaban) | Bristol Myers Squibb / Pfizer | Roughly 500–600 USD per month before insurance |
| Xarelto (rivaroxaban) | Johnson & Johnson (Janssen) | Roughly 500–600 USD per month before insurance |
| Jardiance (empagliflozin) | Boehringer Ingelheim / Eli Lilly | Roughly 550–650 USD per month before insurance |
| Farxiga (dapagliflozin) | AstraZeneca | Roughly 500–600 USD per month before insurance |
| Januvia (sitagliptin) | Merck | Roughly 500–600 USD per month before insurance |
| Entresto (sacubitril/valsartan) | Novartis | Roughly 600–750 USD per month before insurance |
| Enbrel (etanercept) | Amgen | Often several thousand USD per month before insurance |
| Stelara (ustekinumab) | Janssen (Johnson & Johnson) | Often tens of thousands of USD per dose before insurance |
| Imbruvica (ibrutinib) | AbbVie / Janssen | Commonly over 10,000 USD per month before insurance |
| Fiasp and related insulin products | Novo Nordisk | Commonly several hundred USD per month before insurance |
Prices, rates, or cost estimates mentioned in this article are based on the latest available information but may change over time. Independent research is advised before making financial decisions.
Negotiated prices in 2026 are expected to be lower than current levels, but the exact amounts and the share of savings passed on to individual patients will depend on final agreements and how Part D plans apply them. Beneficiaries may still see different costs at different pharmacies or under different plan options, so reviewing plan materials during annual enrollment will remain important.
Impact of Medicare Part B changes for patients
The impact of Medicare Part B changes is related but somewhat different from the 2026 negotiation list, which initially focuses on Part D drugs dispensed at retail or mail‑order pharmacies. Part B generally covers drugs administered in clinical settings, such as infusions given in a doctor’s office or hospital outpatient department.
Recent law has introduced inflation‑based rebates for certain Part B drugs whose prices rise faster than general inflation. When this happens, patient coinsurance may be calculated from a lower adjusted price, which can reduce what people pay for some office‑administered therapies. In future years, the negotiation authority is expected to expand to include a limited number of Part B drugs as well, which could further influence costs for patients receiving treatments such as infusions or injections under Part B coverage.
For patients, the combined effect of Part D negotiation, Part B inflation rebates, and other policy changes such as annual caps on out‑of‑pocket spending should gradually make very high prescription bills less common. However, the pace and size of savings will vary by individual, depending on their health conditions, specific medications, and choice of Medicare coverage.
In the years leading up to 2026 and beyond, patients and caregivers may benefit from staying informed through plan notices, talking with pharmacists and clinicians about lower‑cost alternatives where medically appropriate, and keeping track of evolving Medicare rules. As Medicare adjusts prices for these 10 costly medications and expands its tools to manage spending, the landscape of prescription drug costs is likely to shift, with long‑term implications for both program finances and household budgets.
