Medicare's First Negotiated Part B Drug Prices Are Due November 30 as the MFN Pricing Model Shrinks From $11.9 Billion to $440 Million in Savings
By November 30 the Centers for Medicare & Medicaid Services must publish the negotiated prices for the third group of drugs under the Medicare drug price negotiation program. For the first time the list includes drugs given in doctors’ offices, covered by Medicare Part B: Botox, Entyvio, Orencia, Xolair and Cimzia among them. The 15 drugs cost Medicare $27 billion over twelve months to October 2025. The new prices take effect in 2028.
On September 30 CMS finalized a separate model meant to tie some Part B drug prices to lower prices abroad, the “most favored nation” approach. Its projected savings fell from $11.9 billion in the proposal to about $440 million, after drugmakers that signed pricing deals with the White House were exempted.
Photo: APK, CC BY 4.0 via Wikimedia Commons
How negotiation works
The 2022 Inflation Reduction Act lets Medicare negotiate prices for a set number of high-cost drugs that have been on the market for years without generic competition. The first ten drugs’ prices took effect in January 2026. CMS estimated savings of about $6 billion, or 22%.
The second group of 15, priced in November 2025 for 2027, came with discounts of 38% to 85%. CMS says Medicare’s costs for them fall 44%, about $12 billion a year. Semaglutide, sold as Ozempic and Wegovy, was among them: $274 a month for Ozempic against a list price of $959.
The 40 drugs selected so far accounted for $125 billion, or 36% of Medicare Part B and D drug spending in 2024. Drugmakers’ legal challenges have failed: in May 2026 the Supreme Court declined to hear six cases.
Two tracks
The administration has run its own drug pricing effort in parallel, through deals with individual companies, covered in our post on FDA and drug pricing. In November 2025 Eli Lilly and Novo Nordisk agreed to a Medicare price of $245 a month for their obesity and diabetes drugs, below the $274 the negotiation program set for Ozempic. How the two prices interact in 2027 hasn’t been made clear.
The 2025 tax and spending law also changed negotiation. It widened an exclusion for drugs that treat rare diseases, which keeps cancer drugs such as Keytruda off the list for longer. CBO estimated that change costs $8.8 billion over ten years.
What’s coming
CMS proposed rules in June to write the program into regulation and to choose up to 20 drugs for 2029, with the list due by February 1, 2027. A final rule is expected this fall. The Part D version of the most favored nation model is still under review at the White House budget office.
Why it matters
Medicare spends more than $1 trillion a year, and prescription drugs are its fastest-growing part. The negotiation program is written into law and its savings are counted by CBO. The company deals are faster and can go further on a single drug, but they’re voluntary and can change with each administration. The November prices for Part B drugs will show how far the statutory track reaches into the most expensive medicines Medicare buys.