On Jan. 1, Medicare starts paying government-negotiated prices for 15 widely used prescription drugs. The headline number is a big one.
For a month’s supply of Ozempic, Rybelsus or Wegovy, the negotiated price is $274. The list price was $959. That’s a 71% cut, according to the Centers for Medicare & Medicaid Services.
But don’t start planning how to spend the savings yet. That $274 is the price Medicare drug plans pay. It isn’t your copay.
CMS estimates the new prices will save people with Medicare drug coverage about $685 million in out-of-pocket costs, measured under Part D’s standard benefit design. About 5.3 million people on Part D used these drugs in 2024.
Spread evenly across those 5.3 million people, that’s roughly $129 apiece — and it won’t be spread evenly.
Whether you see any of it depends on your plan, and on a decision you make before Dec. 7. Here’s what to know.
1. Find your drug on the list
Here are the 15 drugs, what CMS lists them for, and the list price versus the negotiated price for a 30-day supply. The list prices are the drugmakers’ wholesale prices, based on 2024 prescriptions, not what you paid at the pharmacy.
- Ozempic, Rybelsus, Wegovy (type 2 diabetes, heart disease and obesity): $959 to $274
- Trelegy Ellipta (asthma, COPD): $654 to $175
- Breo Ellipta (asthma, COPD): $397 to $67
- Janumet, Janumet XR (type 2 diabetes): $526 to $80
- Tradjenta (type 2 diabetes): $488 to $78
- Linzess (chronic constipation, IBS with constipation): $539 to $136
- Xifaxan (hepatic encephalopathy, IBS with diarrhea): $2,696 to $1,000
- Vraylar (bipolar disorder, depression, schizophrenia): $1,376 to $770
- Otezla, Otezla XR (psoriasis, psoriatic arthritis, Behcet’s oral ulcers): $4,722 to $1,650
- Austedo, Austedo XR (Huntington’s disease chorea, tardive dyskinesia): $6,623 to $4,093
- Ofev (idiopathic pulmonary fibrosis): $12,622 to $6,350
- Xtandi (prostate cancer): $13,480 to $7,004
- Calquence (leukemia, lymphoma): $14,228 to $8,600
- Ibrance (breast cancer): $15,741 to $7,871
- Pomalyst (multiple myeloma, Kaposi sarcoma): $21,744 to $8,650
The good news: By law, every Medicare drug plan has to include these 15 drugs on its list of covered drugs.
2. Copay or coinsurance? That’s the whole ballgame
Once you’re past any deductible, you typically pay in one of two ways, according to Medicare. A copayment is a fixed dollar amount. Coinsurance is a percentage of the drug’s cost.
If you pay coinsurance, a lower price can mean a smaller bill, because your percentage is now taken from a smaller number. If you pay a flat copay, the price your plan pays may not change what you pay at all.
KFF, a health policy research group, says the copay-versus-coinsurance question is a big part of whether people save.
Here’s a hypothetical from the CPA side of my brain. Pay 25% coinsurance on a $959 drug, and your share is $239.75. Pay 25% on $274, and it’s $68.50.
Real life is less dramatic. Your plan was probably already paying less than the list price, thanks to rebates.
CMS says that measured against what Medicare actually spent after rebates, the 15 drugs together come in about 44% cheaper, not 71%. KFF notes there’s uncertainty about how many people will end up paying less, and by how much.
3. The deductible and the cap still rule
Two numbers shape what you’ll pay in 2027, no matter what Medicare negotiated, according to Medicare:
- No drug plan can have a deductible higher than $700 in 2027, up from $615 in 2026.
- After the deductible, the standard benefit has you covering a quarter of each covered drug’s price until you’ve spent $2,400 out of pocket in 2027, up from $2,100 in 2026. After that, you pay nothing more for covered drugs that year.
In other words, the deductible comes first, and the annual cap puts a ceiling on how much you’ll pay.
That’s why the savings on the priciest drugs here may barely touch your wallet. At $7,004 a month, someone taking Xtandi under the standard benefit would hit the $2,400 cap within two months at either price. If you take one of these drugs, run your own numbers with both limits in mind.
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4. Check your 2027 plan before Dec. 7
Every plan has to cover these drugs, but plans still decide which tier a drug sits on and whether you pay a copay or coinsurance. CMS says it will review whether plans stick these drugs on pricier tiers or make them harder to get.
That’s why open enrollment matters. It runs Oct. 15 through Dec. 7, and any change you make takes effect Jan. 1. Use Medicare’s Plan Finder and enter every drug you take, not just one. Compare the total yearly cost, not just the premium.
Check out the 2027 premiums for Medicare drug plans, and learn why you shouldn’t let a chatbot pick your plan.
If you take a drug that isn’t on the list, or your plan covers it poorly, it can pay to shop around. You can compare prescription savings options here.
Two more things worth knowing. Medicare’s Prescription Payment Plan lets you spread your out-of-pocket drug costs over the year, but Medicare says plainly it won’t lower what you owe.
And if your income is limited, see whether you qualify for Extra Help, which can cover some or all of your Part D premiums, deductibles and coinsurance.
5. Taking Wegovy for weight loss? Different rules
Here’s a wrinkle. Federal law bars Medicare drug plans from paying for drugs when the purpose is weight loss, KFF notes. They cover drugs like Ozempic and Wegovy only for other approved uses, such as type 2 diabetes.
There’s a temporary exception. From July 1, 2026, through Dec. 31, 2027, Medicare’s GLP-1 Bridge covers certain weight-loss drugs — including all forms of Wegovy, but not Ozempic — for a $50 monthly copay for eligible enrollees. Those copays don’t count toward your Part D deductible or your out-of-pocket cap.
If you take Ozempic for diabetes, you’ll keep getting it through your regular drug plan. So before Dec. 7, make sure that plan treats it the way you need it to.
A 71% price cut is real money for Medicare. Make sure some of it ends up in your pocket.
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