Medicare announces 15 new drugs in pricing discussion: read the list

The Biden administration on Friday released the next round of prescription drugs selected for Medicare price negotiations, including Ozempic, the blockbuster diabetes drug that is also used for weight loss. The drug has faced public backlash over its high price, fueling demand for cheaper alternatives.

The list, which includes 15 drugs, up from 10 last year, is the first step in a negotiation process between Medicare and drugmakers that is expected to take place over the coming months. The new negotiated rates will not come into effect until 2027.

Yet the deliberations — mandated by the Inflation Reduction Act of 2022 — face an uncertain future under the new Trump administration, which has remained silent on its support for the government program.

The drugs selected to be the subject of negotiations are:

• Ozempic; Rybelsus; Wegovy, for type 2 diabetes and weight loss.
• Trelegy Ellipta, a treatment for asthma.
• Xtandi, for prostate cancer.
• Pomalyst, a chemotherapy drug.
• Ibrance, a drug against breast cancer.
• Ofev, for idiopathic pulmonary fibrosis.
• Linzess, a medication for chronic constipation.
• Calquence, a cancer drug.
• Austedo; Austedo XR, for Huntington’s disease.
• Breo Ellipta, a medication for COPD.
• Tradjenta, a diabetes medicine.
• Xifaxan, for diarrhea and irritable bowel syndrome.
• Vraylar, an antipsychotic medication.
• Janumet; Janumet XR, diabetes medications.
• Otezla, a medicine for psoriatic arthritis.

Juliette Cubanski, deputy director of the Medicare policy program at KFF, a nonprofit group that studies health policy issues, said the stakes for the government to get a good deal this year are high.

A KFF survey released Friday found that more than half the public says increasing the number of prescription drugs subject to negotiation is a “top priority,” including nearly half of Republicans.

Ozempic and similar drugs are in high demand, and as Medicare begins covering the drugs for other FDA-approved uses, such as heart disease risk, the cost to taxpayers is expected to rise. (Currently, Medicare is prohibited from covering weight loss medications.)

“Bringing tough negotiations to the bargaining table could potentially save Medicare billions of dollars in the years to come,” Cubanski said.

Drug manufacturers will have a little over a month to agree to participate in negotiations, under penalty of tax sanctions. The only way to avoid the tax is to remove the drug from the Medicare program altogether, a move that would deprive them of a huge share of the market.

In a statement, a spokesperson for Novo Nordisk, the maker of Ozempic and Wegovy, said the drugmaker remained opposed to price negotiations. Nonetheless, the spokesperson said, the government will work with the new administration to “provide meaningful solutions for patients.”

About 5.3 million people with Medicare used these drugs between November 1, 2023 and October 1, 2024, according to the Centers for Medicare and Medicaid Services.

Together, the 15 selected drugs accounted for $41 billion, or 14 percent, of total Medicare Part D spending. Combined with the top 10 drugs already negotiated by Medicare, they account for a third of all Part D spending, according to CMS. Medicare Part D covers prescription drugs that people take on their own, as opposed to those given in a facility, such as chemotherapy.

“We have a chance to negotiate a better deal for the American people,” outgoing Department of Health and Human Services Secretary Xavier Becerra said on a call with reporters. “It’s a big problem. Some people have to cut their pill in half or skip a dose in their prescription so they can extend the length of their prescription.”

Last year, Medicare reached agreements to lower the prices of the 10 most expensive drugs, including Eliquis, an anticoagulant; Imbruvica, a treatment for blood cancer; and NovoLog, a diabetes drug.

The new prices for these drugs are expected to take effect in 2026.

Stacie Dusetzina, a health policy professor at Vanderbilt University in Nashville, Tennessee, said Ozempic’s inclusion this year is “a big deal.”

“This has major budgetary implications for Medicare beneficiaries, Part D plans and taxpayers, because it could significantly expand the use of these drugs among Medicare beneficiaries over time,” Dusetzina said. “This could lead to increased premiums if the number of eligible beneficiaries begins to use these products for weight loss, as these products must be used chronically.»

The pharmaceutical industry has fought the program fiercely through lawsuits, but so far without success.