10 Expensive Medications Set for Medicare Price Reductions Starting January 1, 2026

Starting January 1, 2026, millions of Medicare beneficiaries will see lower out-of-pocket costs for 10 widely prescribed medications under the Inflation Reduction Act's first round of negotiated drug prices. These reductions mark the initial implementation of government-led price talks between the Centers for Medicare & Medicaid Services (CMS) and pharmaceutical manufacturers. The selected drugs treat some of the most common and costly chronic conditions affecting older adults and people with disabilities. The list includes treatments for heart disease, diabetes, blood clots, cancer, and autoimmune disorders—conditions that often require long-term use and carry high annual costs for patients and the Medicare program. Negotiations focused on drugs with high total Medicare spending, no generic or biosimilar competition, and at least 7 years on the market (11 years for biologics). The resulting maximum fair prices will apply to Medicare Part D plans and certain Part B drugs.

The 10 Medications and Their 2026 Price Reductions

  1. Eliquis (apixaban) – Used to prevent strokes and blood clots in people with atrial fibrillation and after hip/knee replacement.
    Current average Medicare payment: approximately $521 per month.
    2026 maximum fair price: significantly lower, reducing out-of-pocket costs for many enrollees.
  2. Jardiance (empagliflozin) – Treats type 2 diabetes and reduces heart failure and kidney disease risk in diabetic patients.
    High monthly spending in Part D.
    2026 price: reduced, easing costs for seniors managing diabetes and related complications.
  3. Xarelto (rivaroxaban) – Prevents blood clots and strokes, commonly prescribed after surgery or for atrial fibrillation.
    Another high-cost anticoagulant.
    2026 negotiated price: lower, benefiting patients on long-term therapy.
  4. Januvia (sitagliptin) – Controls blood sugar in type 2 diabetes.
    Widely used oral medication.
    2026 price cut: reduces monthly expenses for many on fixed incomes.
  5. Farxiga (dapagliflozin) – Manages type 2 diabetes and supports heart and kidney health.
    Similar mechanism to Jardiance.
    2026 reduction: lowers costs for chronic condition management.
  6. Entresto (sacubitril/valsartan) – Treats heart failure with reduced ejection fraction.
    Often prescribed when other therapies fall short.
    2026 price: more affordable, supporting adherence in heart failure patients.
  7. Imbruvica (ibrutinib) – Treats certain blood cancers (chronic lymphocytic leukemia, mantle cell lymphoma).
    High-cost oral oncology drug.
    2026 negotiated price: substantial decrease for eligible Medicare users.
  8. Stelara (ustekinumab) – Treats plaque psoriasis, psoriatic arthritis, Crohn’s disease, and ulcerative colitis.
    Injectable biologic with high annual cost.
    2026 reduction: eases burden for autoimmune condition patients.
  9. Fiasp / NovoLog (insulin aspart products) – Rapid-acting insulin for diabetes management.
    Critical for blood sugar control.
    2026 price: lower, supporting consistent use among insulin-dependent beneficiaries.
  10. Enbrel (etanercept) – Treats rheumatoid arthritis, psoriasis, and other autoimmune diseases.
    Long-standing biologic with high lifetime costs.
    2026 negotiated price: reduced, improving access for chronic users.

These 10 drugs represent some of the highest Medicare spending categories in recent years. The negotiated prices will become the maximum amount Medicare plans can pay manufacturers, often translating to lower copays, coinsurance, or out-of-pocket maximums for enrollees.

How the Reductions Work for Beneficiaries

In 2026, the lower prices apply in two main ways:

  • For Part D drugs: plans negotiate with manufacturers using the maximum fair price as the ceiling. Many enrollees will see reduced copays in the initial coverage phase and potentially lower costs in the catastrophic phase.
  • For Part B drugs (if applicable): providers purchase at or below the maximum fair price, which can lower coinsurance for patients.

The Inflation Reduction Act also includes other changes taking effect around the same time:

  • Annual out-of-pocket cap for Part D drugs at $2,000 (already in place but continuing).
  • Insulin cost capped at $35 per month for covered products.
  • No cost-sharing for adult vaccines recommended by ACIP.

These combined changes aim to reduce financial strain for seniors and people with disabilities who rely on multiple medications.

Practical Impact for Patients

Many beneficiaries with these conditions stand to benefit:

  • Lower monthly costs for blood thinners help those with atrial fibrillation or clotting disorders stay on therapy.
  • Reduced prices for diabetes medications support better adherence and fewer complications.
  • More affordable biologics for autoimmune diseases allow continued treatment without skipping doses.
  • Heart failure patients maintain access to Entresto without prohibitive out-of-pocket expenses.

Patients should check with their Part D plan or Medicare Advantage plan in late 2025 for updated formularies and cost-sharing details. Pharmacists and plan customer service lines can also clarify how the new prices affect individual coverage.

Looking Ahead

The January 1, 2026, effective date for these negotiated prices marks the first major milestone in the Inflation Reduction Act’s drug pricing provisions. Additional drugs will enter negotiations in future years, expanding the impact.

For now, the 10 medications listed offer meaningful relief for many who manage chronic conditions with high-cost prescriptions. Reviewing plan options during the 2026 Annual Enrollment Period (October 15–December 7, 2025) helps ensure the right coverage aligns with these changes.

Staying informed through Medicare.gov, plan mailings, and local State Health Insurance Assistance Programs (SHIP) provides the clearest picture of how these reductions affect individual costs.