A prescription that cost $527 for a 30-day supply in 2023 now rings up at $113 at pharmacies across the country, and Januvia is only one of ten drugs where that math changed on January 1, 2026. The Centers for Medicare & Medicaid Services spent 2024 negotiating directly with manufacturers under the Inflation Reduction Act, and by mid-September 2026 those negotiated prices have been sitting at the pharmacy counter for more than eight months. Roughly 8.8 million of the 54 million people enrolled in Medicare Part D used one of the ten drugs in 2023, a group spanning diabetes, heart failure, blood clots, psoriasis and blood cancer.
The Ten Drugs and What Changed on January 1
Januvia, the Merck diabetes pill, anchors the list at $113 for a 30-day supply, a 79% cut from its $527 2023 list price. Fiasp and NovoLog, Novo Nordisk’s insulin products, fell to $119 from $495. Farxiga dropped to $178.50, and Jardiance and Xarelto both fell to $197, each a reduction of roughly two-thirds from their prior list prices. At the other end of the price scale, the biologics Enbrel, Stelara and Imbruvica remain expensive even after negotiation — Imbruvica alone still lists at $9,319 for a 30-day supply, down from $14,934.
Those figures come from CMS’s own accounting of the negotiation, which also shows Eliquis falling to $231 from $521 and Entresto to $295 from $628. The agency calls the new figures Maximum Fair Prices, the term used in the Inflation Reduction Act, and says manufacturers are required to make that price available to eligible individuals and to every pharmacy, mail-order service and other entity that dispenses the drug. Standalone Part D plans and Medicare Advantage prescription drug plans are required to keep all ten drugs on their formularies now that a negotiated price exists for each one.
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Where the Biggest Enrollment Sits: Jardiance, Eliquis and Farxiga
Enrollment varies enormously across the list. Jardiance, prescribed for diabetes, heart failure and chronic kidney disease, reached 1.88 million Part D enrollees in 2023 and generated $8.84 billion in total Part D drug costs that year, the largest total of the ten. Eliquis, the Bristol Myers Squibb blood-clot medication, had the largest enrollee count at 3.93 million people and $18.28 billion in total costs — close to a third of the $56.2 billion the ten drugs generated combined during 2023.
By contrast, three of the biologics touch far fewer households: Enbrel reached 48,000 enrollees, Stelara 23,000 and Imbruvica 17,000. Those smaller populations still carried real weight in household budgets. Part D enrollees paid $3.9 billion out of pocket for the ten drugs combined in 2023, against $18.9 billion in total Part D out-of-pocket spending on every covered drug that year, meaning these ten prescriptions alone accounted for roughly a fifth of what retirees paid directly at the counter.
A Discount Range From 38 Percent to 79 Percent
The size of the cut varies as much as the enrollment does. Januvia’s 79% reduction is the deepest on the list, followed by the Novo Nordisk insulins at 76% and Farxiga at 68%. Imbruvica, the blood-cancer drug from Pharmacyclics, saw the smallest percentage cut at 38%, even though its dollar reduction — more than $5,600 off a 30-day supply — is the largest in raw terms of any drug on the list.
Enbrel and Stelara fall in between, discounted 67% and 66% respectively, though both carried list prices already in the thousands of dollars before negotiation began. The percentage and the dollar figure tell different stories depending on where a household sits: someone paying coinsurance on a $178.50 Farxiga prescription sees a smaller absolute cut than someone whose Stelara bill fell by more than $9,100, even though Farxiga’s percentage discount looks larger on paper.
Manufacturers Kept Suing Through 2026 — the Rollout Held
Drug companies did not accept the program quietly. Merck, Bristol Myers Squibb, Novartis, Novo Nordisk, AstraZeneca, Boehringer Ingelheim, Janssen and other manufacturers filed a string of lawsuits beginning in 2023, arguing that the negotiation process amounted to an unconstitutional taking of their property and that its “voluntary” structure was coercive in practice.
None of those challenges stopped the January 1 rollout. According to Georgetown Law’s Health Care Litigation Tracker, courts have issued decisions rejecting manufacturers’ constitutional claims in cases spanning the Third, Fifth and D.C. Circuits, with several rulings granting summary judgment to the federal government. Two newer challenges, from AbbVie and AstraZeneca, remained in active briefing as of September 2026, with a summary-judgment hearing and a briefing deadline both scheduled for the coming weeks — but no court has issued an order blocking the negotiated prices already in effect at pharmacies.
How the $1.5 Billion Estimate Was Built, and What Comes Next
CMS built its enrollee-savings projection by comparing the negotiated prices against the standard Part D benefit design projected for 2026, arriving at an estimated $1.5 billion saved this year by people using the ten drugs. That projection sits alongside separate savings from the $2,000 annual out-of-pocket cap that took effect under the same law. Looking backward, the agency estimated that if the negotiated prices had applied during 2023 instead, net Medicare spending on the ten drugs would have run about $6 billion lower, a 22% reduction from actual 2023 spending.
The negotiated prices are not frozen going forward. CMS says each year’s price for the ten drugs will be adjusted by the change in the Consumer Price Index for All Urban Consumers, and a second round of negotiations covering a new set of drugs is already underway, with results due to take effect in 2027 — the next test of whether the program CMS documented in its own fact sheet keeps holding up in court and at the pharmacy register.
Tracking Medication Costs and Appeals After a Negotiated-Price Change
The negotiated prices cover only ten drugs, and a Medicare Part D formulary can still deny coverage, require prior authorization or move a drug to a different tier the following plan year. Nothing in CMS’s fact sheet walks a beneficiary through what to do when a pharmacy quotes a different price than the one published, or when a plan requires an appeal before it will cover a negotiated drug. Those steps typically live in scattered plan documents that few people read before a prescription comes due.
The Medicare Cost & Coverage Protection Kit lays out the prior-authorization appeal steps, explains the new Part D out-of-pocket cap, and includes a medication and cost tracker for keeping every prescription price on record.
See the appeal steps and the cost tracker in The Medicare Cost & Coverage Protection Kit.
AI-assisted research and drafting; reviewed by an editor.
