Three of the first ten drugs Medicare negotiated prices for will drop out of the program on January 1, 2027, one year after their negotiated prices took effect. The Centers for Medicare & Medicaid Services (CMS) lists Stelara, Entresto and Xarelto as removed from the negotiation program with a removal effective date of January 1, 2027. Medicare’s annual open enrollment, which runs October 15 through December 7, is when a Part D enrollee can switch plans before that date arrives.

Why CMS took the three drugs out

A drug stays in the negotiation program only while it has no generic or biosimilar competitor. CMS says a selected drug will no longer be subject to the negotiation process once the FDA has approved a generic that identifies the drug as its reference drug, or licensed a biosimilar that identifies it as the reference product, and the generic or biosimilar is being marketed. CMS’s table gives the timing of the determination for all three as October 2025.

The National Community Pharmacists Association, summarizing the decision in December 2025, said regulators found the three drugs now face generic or biosimilar competition. It names the makers as Novartis for Entresto, a chronic heart failure medicine, Janssen for Stelara, an anti-inflammatory medicine, and Bayer and Janssen for Xarelto, a blood clot medicine.

The question for anyone in a Part D plan who takes Xarelto, Entresto or Stelara is which 2027 plan costs the least for those particular prescriptions. A plan’s charge for each drug is listed in that plan’s own coverage for 2027, and the comparison has to be made by December 7, since a plan must receive the request by that date for coverage to start on January 1.

Open enrollment closes December 7, and the plan chosen by then is the one that covers Xarelto, Entresto or Stelara from January 1. The 2027 Medicare Open Enrollment Decision Kit includes a cost calculator spreadsheet that compares plans on cost, drugs and doctors, and the Open Enrollment calendar.

Compare 2027 plan costs for these three drugs with the Decision Kit’s calculator →

What Medicare paid for the three drugs in 2026

All three were in the first group of ten drugs, and their negotiated prices became effective on January 1, 2026. CMS’s fact sheet on those prices gives these figures for a 30-day supply, compared with each drug’s 2023 list price:

• Stelara: $13,836 list price, $4,695 negotiated, a 66 percent discount
• Entresto: $628 list price, $295 negotiated, a 53 percent discount
• Xarelto: $517 list price, $197 negotiated, a 62 percent discount

Those are prices for 2026. Once the drugs leave the program, what an individual enrollee pays at the pharmacy counter depends on the enrollee’s own drug plan.

What open enrollment lets a Part D member change

Medicare.gov says open enrollment is the time to join, drop or switch a Medicare Advantage plan, with or without drug coverage, and, for people in Original Medicare, to join, drop or switch a Medicare drug plan. A Part D plan needs either Part A or Part B to join. Coverage chosen in the window starts January 1.

Other negotiated prices start the same day

January 1, 2027 is also the date a second group of negotiated prices takes effect. CMS’s fact sheet for 2027 lists, among others, Ozempic, Rybelsus and Wegovy at $274 for a 30-day supply compared with $959, Trelegy at $175 compared with $654, and Linzess at $136 compared with $539. Those are different drugs from the three leaving, so an enrollee who takes one of them is in a different position from an Xarelto or Entresto patient.

Extra Help in 2027

Enrollees with limited income can also check Medicare’s Extra Help program. Medicare.gov says that in 2027 qualifying beneficiaries pay $0 for plan premiums and deductibles, with copayments capped at $5.80 for generic drugs and $14.40 for brand-name drugs. The income and resource limits on the page are 2026 figures: $23,940 in income and $18,090 in resources for an individual, and $32,460 and $36,100 for a couple. People with full-benefit Medicaid, a Medicare Savings Program or SSI qualify automatically, Medicare.gov says.

Re-checking Part D plan costs before December 7

Medicare’s free comparison route is Plan Finder. Medicare.gov says to enter every prescription taken regularly so the tool can estimate monthly and yearly costs for each plan, and to select Enroll for the plan chosen. Its joining a plan page gives the open enrollment dates, October 15 to December 7, and says coverage starts January 1.

The list to bring to the comparison is each drug with its dose, the pharmacy used, and the current plan’s cost for the same drugs, so the 2027 numbers have something to be measured against. Free counseling is available from the local State Health Insurance Assistance Program, or by calling 1-800-MEDICARE (1-800-633-4227).

The watch-for item is the plan itself, not the drug. A plan can look cheapest for most prescriptions and cost more once Xarelto or Entresto is on the list, which is why the drugs go in first.

December 7 closes the 2027 plan choice for these drugs

An enrollee who misses the date stays in a plan whose 2027 costs for Xarelto, Entresto or Stelara were never compared. The 2027 Medicare Open Enrollment Decision Kit gives the cost calculator spreadsheet for comparing plans on cost, drugs and doctors, and the Open Enrollment calendar that keeps October 15 to December 7 in view.

Run the 2027 drug-plan cost calculator before the December 7 close →

This article was produced with AI assistance and edited for accuracy against the sources linked above.