CMS's Medicare price negotiations start round three
The US federal government has named the next 15 medicines that will be subject to Medicare pricing negotiation and reductions due to come into effect at the start of 2028.
The list has been announced by the Centers for Medicare & Medicaid Services (CMS) shortly after the reductions agreed for the first group of 10 medicines – selected in 2023 – kicked in at the start of this year, despite a series of lawsuits trying to block the scheme. Cuts to a second block of 15 medicines will come into force at the start of 2027.
The latest group are headlined by Eli Lilly's big-selling GLP-1 agonist Trulicity (dulaglutide) for type 2 diabetes – Novo Nordisk's rival Ozempic (semaglutide) was included in round two – while other big brands include Gilead Sciences' HIV therapy Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) and Pfizer's Xeljanz (tofacitinib) for inflammatory conditions, including arthritis and ulcerative colitis.
The full list can be seen below:
- GSK's Anoro Ellipta (umeclidinium bromide/vilanterol);
- Gilead Sciences' Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide);
- AbbVie's Botox; Botox Cosmetic (onabotulinumtoxinA)
- UCB's Cimzia (certolizumab pegol);
- Novartis' Cosentyx (secukinumab);
- Takeda's Entyvio (vedolizumab);
- Johnson & Johnson's Erleada (apalutamide);
- Novartis' Kisqali (ribociclib);
- Eisai/MSD's Lenvima (lenvatinib);
- Bristol Myers Squibb's Orencia (abatacept);
- Otsuka/Lundbeck's Rexulti (brexpiprazole);
- Eli Lilly's Trulicity (dulaglutide);
- Eli Lilly's Verzenio (abemaciclib);
- Pfizer's Xeljanz; Xeljanz XR (tofacitinib); and
- Roche/Novartis' Xolair (omalizumab).
In a departure from the first two rounds, in which all the products were covered and dispensed under Medicare Part D – covering self-administered prescription medicines dispensed in pharmacies – the third tranche includes some drugs (Botox, Entyvio, and Xolair) that are administered by a physician and covered by Part B.
First renegotiation
CMS also said that another drug, Boehringer Ingelheim's type 2 diabetes medicine Tradjenta (linagliptin), has become the first to enter a renegotiation process. It was previously subject to reductions in the second round, but CMS is now seeking a further reduction.
Approximately 1.8 million people used one or more of the 15 drugs through Medicare Part D or Part B between November 2024 and October 2025, said the CMS, and collectively they account for $27 billion in Medicare's prescription drug spending over that timeframe – equivalent to 6% of total Part B and Part D spending.
The Medicare pricing negotiations, introduced as part of former President Joe Biden's Inflation Reduction Act (IRA), are being pursued alongside Trump administration initiatives, including Most-Favoured Nation (MFN) pricing and Direct-To-Consumer sales channels.
