Your Guide to Medicare's 2026 Prescription Drug Discounts

If you’re on Medicare, you may have heard talk about big changes coming to prescription drug costs. It’s true. Thanks to new government initiatives, the prices of some common medications are set to decrease starting in 2026. This guide will explain exactly what’s happening, list the first drugs affected, and show you how to stay informed.

Why Are Prescription Drug Prices Changing?

The changes are part of the Inflation Reduction Act, a law that gave Medicare the power to negotiate directly with drug manufacturers for the first time. The goal is simple: to lower the cost of high-expenditure prescription drugs for millions of seniors and other Medicare beneficiaries.

This new authority is being rolled out in phases. The first round of negotiations is already underway, and the new, lower prices for the selected drugs will take effect on January 1, 2026. This is not a one-time event; Medicare will continue to negotiate prices for more drugs in the years to come, providing ongoing relief for beneficiaries. This program is a significant shift in how drug prices are determined for the Medicare population.

The First 10 Drugs Selected for Price Negotiation

The most important question for many is: “Is my medication on the list?” The Centers for Medicare & Medicaid Services (CMS) announced the first 10 Medicare Part D drugs selected for negotiation. If you take any of these medications, you are likely to see lower out-of-pocket costs for them beginning in 2026.

Here is the official list, along with what each drug is commonly used to treat:

• Eliquis (Apixaban): A widely used anticoagulant, or blood thinner. It is prescribed to prevent blood clots, strokes, and embolism in patients with atrial fibrillation and those who have had certain types of surgery.
• Jardiance (Empagliflozin): Primarily used to manage blood sugar levels in adults with type 2 diabetes. It is also prescribed to reduce the risk of cardiovascular death in adults with type 2 diabetes and known heart disease.
• Xarelto (Rivaroxaban): Another common blood thinner. It is used to treat and prevent blood clots, including deep vein thrombosis (DVT) and pulmonary embolism (PE), and to reduce the risk of stroke in people with atrial fibrillation.
• Januvia (Sitagliptin): A medication used to improve blood sugar control in adults with type 2 diabetes. It works by increasing the levels of natural substances that help control blood sugar.
• Farxiga (Dapagliflozin): Used to treat type 2 diabetes, heart failure, and chronic kidney disease. It helps the kidneys remove glucose from the bloodstream, which lowers blood sugar levels.
• Entresto (Sacubitril/Valsartan): A combination medicine used to treat certain types of heart failure. It helps relax blood vessels and makes it easier for the heart to pump blood to the body.
• Enbrel (Etanercept): An injectable biologic medicine used to treat several autoimmune conditions, including rheumatoid arthritis, psoriatic arthritis, and plaque psoriasis.
• Imbruvica (Ibrutinib): A targeted therapy medication used to treat certain types of cancer, including mantle cell lymphoma and chronic lymphocytic leukemia (CLL).
• Stelara (Ustekinumab): A biologic medication prescribed for treating plaque psoriasis, psoriatic arthritis, Crohn’s disease, and ulcerative colitis.
• Fiasp; NovoLog (Insulin Aspart): A rapid-acting insulin used to manage blood sugar levels in people with type 1 and type 2 diabetes. This includes both the Fiasp and NovoLog brands of insulin aspart.

How to Check if Your Medications Are Included

The most direct way to see if your prescriptions will be cheaper is to compare your medication list with the 10 drugs listed above.

1. Review Your Prescriptions: Make a list of all the prescription medications you currently take. Check the names on the bottles.
2. Compare with the Negotiation List: Carefully check if any of your medications match the brand names on the list above. For example, if you take Eliquis for atrial fibrillation, your drug is part of the first negotiation round.
3. Talk to Your Doctor or Pharmacist: Your healthcare providers are your best resource. During your next visit or call, ask them if any of your drugs are on the Medicare negotiation list. They can confirm the details and discuss what this might mean for you.

What Happens Next? The Timeline for Lower Prices

Understanding the timeline helps clarify when you will see the savings. The process isn’t instant, but it is moving forward on a set schedule.

• September 2023: CMS announced the first 10 drugs selected for negotiation.
• Late 2023 - Summer 2024: CMS and the drug manufacturers engage in a negotiation process to agree on a new “maximum fair price.”
• September 1, 2024: CMS will publish the new, lower prices for these 10 drugs.
• January 1, 2026: The negotiated prices officially take effect. At this point, Medicare beneficiaries taking these drugs will start to see the savings reflected in their out-of-pocket costs.

More drugs will be added to the negotiation list in the coming years. Medicare plans to negotiate prices for up to 15 more Part D drugs for 2027, another 15 for 2028, and up to 20 more drugs for 2029 and each year after.

Other Important Medicare Cost-Saving Changes

The drug negotiation program isn’t the only change designed to make healthcare more affordable. Another major provision of the Inflation Reduction Act is already helping beneficiaries.

Starting in 2025, there will be a $2,000 annual cap on out-of-pocket prescription drug costs for people with Medicare Part D. This means that no matter how expensive your medications are, you will not have to pay more than $2,000 per year for them. This provides a crucial financial safety net for those with very high drug costs.

Frequently Asked Questions

What if my drug is not on this first list? Don’t worry. This is just the first round. Medicare will select more drugs for negotiation in the coming years. Continue to monitor official announcements from Medicare.gov. Also, talk to your doctor about whether there are lower-cost generic or alternative therapeutic options available for you now.

How much money will I actually save? The exact savings for each drug are not yet known. The final negotiated prices will be published by September 1, 2024. The amount of savings will depend on the final price and your specific Medicare Part D or Medicare Advantage plan coverage.

Does this affect Medicare Advantage plans? Yes. If you have a Medicare Advantage plan that includes prescription drug coverage (MA-PD), these negotiated prices will apply to you just as they do for those with a standalone Part D plan.