Medicare Drug Price Negotiations List 2025: The First 10 Drugs Selected for Cuts

For millions of seniors relying on Medicare Part D, the cost of prescription medication has historically been a significant financial burden. However, due to the Inflation Reduction Act, Medicare now has the legal authority to negotiate prices directly with pharmaceutical companies. After months of back-and-forth discussions between the Centers for Medicare & Medicaid Services (CMS) and drug manufacturers, the final negotiated prices for the first 10 selected drugs have been released.

While the new negotiated prices officially take effect in 2026, the finalized list and the structure of the cuts were solidified in late 2024 and are a major focus for the 2025 healthcare calendar. This article details the specific drugs selected, the percentage of price reductions secured, and how this impacts your wallet.

The First 10 Drugs Selected for Negotiation

The CMS selected these specific medications because they accounted for the highest gross spending in Medicare Part D. In 2023 alone, these 10 drugs represented over $50 billion in Medicare spending.

Here is the finalized list of the first 10 drugs and the negotiated price reductions that have been agreed upon.

1. Januvia (Sitagliptin)

  • Common Use: Treatment of Type 2 Diabetes.
  • Negotiated Discount: 79% off the list price.
  • Details: Januvia saw the steepest percentage cut of all ten drugs. Manufactured by Merck, this drug is a daily oral medication used to help control blood sugar levels. The dramatic drop in the negotiated price is expected to significantly lower costs for the federal government.

2. Fiasp and NovoLog (Insulin Aspart)

  • Common Use: Treatment of Diabetes (Fast-acting insulins).
  • Negotiated Discount: 76% off the list price.
  • Details: Insulin costs have been a major political and social issue for years. While a $35 monthly cap on insulin co-pays is already in effect for Medicare beneficiaries, this negotiation lowers the underlying cost that Medicare pays to Novo Nordisk, which helps stabilize premiums for everyone in the long run.

3. Farxiga (Dapagliflozin)

  • Common Use: Treatment of Type 2 Diabetes, Heart Failure, and Chronic Kidney Disease.
  • Negotiated Discount: 68% off the list price.
  • Details: AstraZeneca’s Farxiga is widely prescribed because it treats multiple comorbid conditions often found in seniors. A 68% reduction is a massive shift for a drug that sees heavy utilization across different medical specialties.

4. Enbrel (Etanercept)

  • Common Use: Treatment of Rheumatoid Arthritis and Psoriasis.
  • Negotiated Discount: 67% off the list price.
  • Details: This injectable biologic is critical for patients managing autoimmune diseases. These types of drugs are notoriously expensive. Lowering the price of Enbrel addresses one of the highest-cost categories in specialty pharmacy.

5. Jardiance (Empagliflozin)

  • Common Use: Treatment of Type 2 Diabetes and Heart Failure.
  • Negotiated Discount: 66% off the list price.
  • Details: Similar to Farxiga, Jardiance is a staple for diabetes management. Boehringer Ingelheim and Eli Lilly manufacture this drug. Given the high prevalence of diabetes in the Medicare population, this 66% cut represents billions in potential savings over the next decade.

6. Stelara (Ustekinumab)

  • Common Use: Treatment of Crohn’s Disease, Psoriasis, and Ulcerative Colitis.
  • Negotiated Discount: 66% off the list price.
  • Details: Stelara is often one of the most expensive line items for patients with severe inflammatory conditions. The negotiation brings the list price down significantly, which will help lower the coinsurance burden for patients who have not yet reached their catastrophic cap.

7. Xarelto (Rivaroxaban)

  • Common Use: Prevention of Blood Clots and Stroke.
  • Negotiated Discount: 62% off the list price.
  • Details: Xarelto is a blood thinner manufactured by Johnson & Johnson. It is widely prescribed for seniors with atrial fibrillation (Afib). Because patients take this daily for years, the cumulative cost is high, making a 62% reduction highly impactful.

8. Eliquis (Apixaban)

  • Common Use: Prevention of Blood Clots and Stroke.
  • Negotiated Discount: 56% off the list price.
  • Details: Eliquis was the single most costly drug for Medicare Part D prior to negotiations, costing the program billions annually. Bristol Myers Squibb and Pfizer produce it. Even a reduction of 56% translates to massive dollar-amount savings due to the sheer volume of prescriptions filled.

9. Entresto (Sacubitril/Valsartan)

  • Common Use: Treatment of Heart Failure.
  • Negotiated Discount: 53% off the list price.
  • Details: Used to reduce the risk of death and hospitalization in patients with chronic heart failure, Entresto is a life-saving medication for many. Novartis will now provide this drug to Medicare at roughly half its previous list price.

10. Imbruvica (Ibrutinib)

  • Common Use: Treatment of Blood Cancers (Leukemia and Lymphoma).
  • Negotiated Discount: 38% off the list price.
  • Details: While this is the lowest percentage cut on the list, Imbruvica has one of the highest per-unit price tags. It is an oral chemotherapy agent. A 38% reduction on a drug that costs nearly $15,000 per month (list price) is still a substantial change in real dollars.

How These Changes Impact Seniors in 2025

It is vital to distinguish between the negotiation timeline and the immediate benefits seniors will see in 2025. While the negotiated prices listed above officially take effect on January 1, 2026, other provisions of the Inflation Reduction Act kick in during 2025 to help you save money immediately.

The $2,000 Out-of-Pocket Cap

Starting in 2025, no Medicare Part D beneficiary will pay more than $2,000 per year in out-of-pocket costs for prescription drugs. This is arguably the most significant immediate change.

  • Before 2025: Seniors could face unlimited costs until they reached the “catastrophic coverage” phase.
  • In 2025: Once your co-pays and deductibles hit $2,000, you pay $0 for covered drugs for the rest of the year.

If you take expensive medications like Imbruvica, Stelara, or Enbrel, you will likely hit this $2,000 cap early in the year and pay nothing for the remaining months.

The “Smoothed” Payment Plan

Also starting in 2025, Medicare introduces the Medicare Prescription Payment Plan. This allows beneficiaries to spread their out-of-pocket costs over the entire year rather than paying a large lump sum at the pharmacy counter in January or February.

For example, if you owe $2,000 for your first refill of the year, you can opt to pay that amount in monthly installments (roughly $166/month) instead of all at once. This helps seniors on fixed incomes manage cash flow more effectively.

Financial Impact on the Medicare Program

The Department of Health and Human Services (HHS) estimates that these negotiations will save the Medicare program $6 billion in the first year alone. Additionally, seniors are expected to save a collective $1.5 billion in out-of-pocket costs in 2026 when the new prices combine with the plan designs.

This reduction in program spending is designed to shore up the Medicare Trust Fund, ensuring the program remains solvent for future generations without raising premiums drastically for current enrollees.

What Happens Next?

The negotiation process is not a one-time event. The Inflation Reduction Act mandates that CMS select more drugs for negotiation in subsequent years.

  • February 2025: CMS will select and announce up to 15 additional Part D drugs for negotiation.
  • 2027: The negotiated prices for this second round of drugs will go into effect.
  • 2028 and beyond: The program expands to include drugs covered under Medicare Part B (drugs administered in a doctor’s office, like chemotherapy infusions), and the number of negotiated drugs increases to 20 per year.

Pharmaceutical companies, including Merck, Bristol Myers Squibb, and Johnson & Johnson, have filed various lawsuits attempting to halt the program, arguing it is unconstitutional. However, courts have so far allowed the implementation to proceed, and the finalized contracts for the first 10 drugs have been signed.

Frequently Asked Questions

When will I see the lower prices for these 10 drugs at the pharmacy? The specific negotiated prices for the 10 drugs listed above take effect on January 1, 2026. However, the $2,000 annual cap on out-of-pocket costs begins on January 1, 2025, which may lower your costs sooner.

Will I lose access to these drugs if the manufacturers pull out? It is highly unlikely. All manufacturers of the selected drugs have agreed to the negotiated prices and signed contracts with the government. Pulling out of Medicare would mean losing access to the massive U.S. senior market, which is financially devastating for these companies.

Does this apply to people with private insurance? Technically, no. These negotiated prices are specific to Medicare Part D. However, market analysts believe that private insurers may use these published Medicare prices as leverage to negotiate better deals for their own commercial plans.

Why was Ozempic or Wegovy not on the list? The list is based on total Medicare spending from previous years (specifically June 2022 to May 2023 for the first round). While Ozempic is a high-spend drug, it faces competition and different coverage rules. However, many experts predict Ozempic or similar GLP-1 agonists could appear on the list released in February 2025 for the next round of negotiations.