Medicare Drug Price Negotiation

Dates are CMS's deadlines; steps CMS describes only by season are marked as such.

Nov 30, 2026

CMS publishes the agreed prices for the 2028 round CMS's deadline to publish any agreed maximum fair prices from the third cycle, including the renegotiated Tradjenta price. CMS 2028 fact sheet

Nov 30, 2026

Renegotiation information: manufacturers must say they will submit Primary manufacturers of drugs selected in 2026, 2027 or 2028 that want to give CMS information on renegotiation eligibility must email CMS by 11:59 p.m. PT. CMS regulations and guidance page

Dec 5, 2026

Final rule for the program takes effect CMS-4215-F codifies the program for the 2029 round and after. CMS issued it November 5; the Federal Register published it November 9, 2026 (document 2026-22792). Federal Register 2026-22792

Dec 10, 2026

Biosimilar delay requests due for the 2029 round Deadline in CMS HPMS, 11:59 p.m. PT. CMS's timeline PDF gives only "December 2026"; the exact day is from CMS's regulations and guidance page. CMS regulations and guidance page

Jan 1, 2027

Round 2 prices take effect; four round 1 drugs leave the list The 15 prices agreed for 2027 apply. CMS lists Stelara, Entresto, Xarelto and NovoLog/Fiasp as removed from the Selected Drug List on this date. CMS selected drugs page

Feb 1, 2027

CMS publishes the list for the 2029 round Up to 20 drugs payable under Part B or covered under Part D, plus any drugs selected for renegotiation and the top-30 negotiation-eligible list. CMS final rule timeline

Feb 28, 2027

Manufacturers sign agreements for the 2029 round Deadline for participating primary manufacturers. CMS final rule timeline

Mar 1, 2027

Manufacturer data due; 2028 price explanations due Manufacturers submit data for the 2029 round, and the public can submit evidence. Also CMS's deadline to publish the explanations of the 2028-round prices. CMS final rule timeline

Jun 1, 2027

CMS sends initial offers for the 2029 round Manufacturers then have 30 days to accept or counter (July 1, 2027). CMS final rule timeline

Sep 30, 2027

CMS sends final offers if no agreement Manufacturers accept or reject by October 31, 2027. The negotiation period ends November 1, 2027. CMS final rule timeline

Nov 30, 2027

CMS publishes the agreed prices for the 2029 round CMS's deadline for the fourth cycle, including any renegotiated prices. CMS final rule timeline

Jan 1, 2028

Round 3 prices take effect Any agreed prices for the 15 selected drugs and the renegotiated Tradjenta price apply. CMS 2028 fact sheet

Mar 1, 2028

2029 price explanations due CMS's deadline to publish the explanation of each agreed 2029-round price. CMS final rule timeline

Jan 1, 2029

Round 4 prices take effect CMS also lists this as the removal date for Xeljanz, after a June 2026 deselection determination. CMS final rule timeline

• May 18, 2026: The Supreme Court denied six manufacturer petitions against the program: AstraZeneca (25-348), Janssen (25-749), Bristol Myers Squibb (25-751), Novo Nordisk (25-761), Boehringer Ingelheim (25-799) and Novartis (25-902). Supreme Court order list
• Aug 26, 2026: The Fifth Circuit affirmed summary judgment for the government in National Infusion Center Association v. Kennedy (No. 25-50661), rejecting nondelegation, Excessive Fines and due process claims by PhRMA and others. Fifth Circuit opinion

Georgetown's litigation tracker lists a petition for rehearing en banc in the Fifth Circuit case, filed October 9, 2026. Arca did not check the court's own docket for the outcome, and did not verify whether other challenges are pending.

Negotiated prices, list prices, discounts, dates and manufacturers are CMS's figures, copied from its fact sheets and its Selected Drug List and Maximum Fair Price data file (November 2, 2026 edition). Arca checked the negotiated prices in that file against this table on Nov 11, 2026; every price for the first two rounds matched. List prices are wholesale acquisition costs for a 30-day supply as CMS reports them; CMS compared the first round with 2023 list prices and the second with 2024.

Medicare spending joins CMS's Medicare Part D and Part B Spending by Drug datasets (2024) to each selected drug by brand name. It is the total paid, before manufacturer rebates. Where a selected drug has several brands, such as Ozempic, Rybelsus and Wegovy, the brands are added. Brand names that CMS does not list under the selected drug, such as Botox Cosmetic or the Kisqali Femara Co-Pack, are left out, so a few totals may run low. Part D and Part B totals are shown separately because they are different programs; the first two rounds covered Part D drugs only.

Statute and rule: Social Security Act sections 1191 to 1198 as added by the Inflation Reduction Act of 2022; final rule CMS-4215-F, Federal Register, November 9, 2026. Arca's public-source mirror holds the same spending data as cms.medicare_part_d_spending and cms.medicare_part_b_spending.

• Whether other challenges to the program are pending, and the outcome of the Fifth Circuit rehearing petition.
• CMS says only that the third-round drugs are "payable under Part B and/or covered under Part D". It does not split them, so the Part B column shows what CMS's spending dataset holds for each brand.
• CMS's third-round fact sheet lists Botox, but its November 2 price data file has no Botox rows. CMS lists a June 2026 deselection determination for Xeljanz with removal on January 1, 2029, and the file still lists Xeljanz for 2028.
• Parent companies are shown for grouping; CMS names the legal entity that signed each agreement, which the table shows under the company.

Which drugs has Medicare negotiated prices for?

CMS has agreed negotiated prices, which the statute calls maximum fair prices, for 25 drugs: 10 from the first round (effective January 1, 2026) and 15 from the second (effective January 1, 2027). The third round selected 15 more drugs, the first to include Part B drugs, and CMS must publish any agreed prices by November 30, 2026.

When do the negotiated prices take effect?

First-round prices took effect on January 1, 2026. Second-round prices take effect on January 1, 2027. Third-round prices, if agreed, take effect on January 1, 2028.

How much lower are the negotiated prices than list prices?

CMS reports the agreed prices for a 30-day supply as 38% to 85% below the list prices it compared them with. The table lists each drug's list price, negotiated price and discount.

Which drugs leave the program?

CMS lists Stelara, Entresto, Xarelto and NovoLog/Fiasp as removed from the Selected Drug List on January 1, 2027 after generic or biosimilar competition. It also lists a June 2026 determination for Xeljanz with removal on January 1, 2029.

Where do these numbers come from?

Prices, selection dates and manufacturers come from CMS's Medicare Drug Price Negotiation Program pages, fact sheets and Maximum Fair Price data file. Medicare spending comes from CMS's Medicare Part D and Part B Spending by Drug datasets on data.cms.gov.