IRA Drug Pricing: Are Patients Seeing Savings?
IRA Drug Pricing: Are Patients Seeing Savings?
The Government Negotiated Lower Drug Prices. Are You Actually Paying Less?
5 minute read
The Inflation Reduction Act's drug price negotiation program was years in the making and designed to do something Medicare has never done before: negotiate directly with pharmaceutical manufacturers over drug prices. The first ten negotiated Maximum Fair Prices took effect on January 1, 2026. If you take any of those ten medications and you have Medicare Part D, the savings should theoretically be showing up at your pharmacy. But "should" and "are" are not always the same thing, and the gap between a negotiated price and your actual out-of-pocket cost is worth understanding before you conclude either that the program is working for you or that it is not.
Which Drugs Have Negotiated Prices in 2026
CMS published the Maximum Fair Prices for the first ten drugs selected for Medicare price negotiation.¹ These are the drugs with negotiated prices in effect for 2026:
Eliquis (apixaban), Jardiance (empagliflozin), Xarelto (rivaroxaban), Januvia (sitagliptin), Farxiga (dapagliflozin), Entresto (sacubitril/valsartan), Enbrel (etanercept), Imbruvica (ibrutinib), Stelara (ustekinumab), and insulin products including Fiasp, Fiasp FlexTouch, Fiasp PenFill, NovoLog, NovoLog FlexPen, and NovoLog PenFill.¹
The price reductions from list price vary by drug. According to CMS, the negotiated price for Eliquis represents a significant reduction from its previous list price. Enbrel, Stelara, and Imbruvica also saw substantial negotiated reductions. The full Maximum Fair Price table is published on CMS.gov and lists the exact negotiated price for each drug.¹
A KFF analysis of the negotiated prices found that the reductions range from approximately 38 percent to 79 percent off the list price, depending on the drug, with some of the largest percentage reductions on drugs where the list price was dramatically inflated relative to international benchmarks.²
Why You May Not Be Seeing the Full Savings
Here is where the gap between the negotiated price and your experience at the pharmacy can emerge.
The Maximum Fair Price is the price Medicare pays the manufacturer. Your out-of-pocket cost at the pharmacy is determined by your plan's cost-sharing structure for that drug, including its tier placement, your deductible status, and where you are in the Part D coverage phases.
If your plan places a negotiated drug on a specialty tier and charges 25 or 33 percent coinsurance, your cost-sharing is calculated as a percentage of the drug's cost as your plan accounts for it, not necessarily as a percentage of the Maximum Fair Price directly. Plans have flexibility in how they structure cost-sharing within the rules, and that flexibility means patients on different plans for the same drug may have very different out-of-pocket experiences.
KFF's analysis also notes that some plans may be capturing the negotiated savings through lower premiums across the plan rather than passing them through as lower cost-sharing for the specific negotiated drugs.² This is not necessarily illegal, but it means the patient taking the negotiated drug may not personally see a cost reduction even as the overall plan benefits from lower drug costs.
The $2,000 annual out-of-pocket cap is a cleaner benefit. Once you have paid $2,000 in covered drug costs in 2026, you pay nothing more for covered drugs for the rest of the year. For patients on expensive biologics like Enbrel or Stelara, this cap represents real and tangible protection regardless of how tier placement affects monthly costs.
What the Numbers Look Like
CMS published the specific Maximum Fair Prices for each of the ten negotiated drugs.¹ To give a sense of scale:
Eliquis (apixaban), widely prescribed for atrial fibrillation and blood clot prevention, had a negotiated price that represents a reduction of approximately 56 percent from its list price. For Medicare Part D beneficiaries who take Eliquis daily, this translates to a lower base cost that their plan then applies cost-sharing rules to.
Stelara (ustekinumab), used for Crohn's disease, ulcerative colitis, and psoriasis, saw a negotiated price reduction of approximately 66 percent from list price according to CMS data.¹
Enbrel (etanercept), used for rheumatoid arthritis and psoriasis, saw a negotiated price reduction of approximately 67 percent from list price.¹
Whether these reductions translate to your specific cost-sharing depends on your plan. The most direct way to find out is to look up your medication on your plan's formulary and compare what you paid last year to what you are being charged now.
What This Means for You
If you take one of the ten negotiated drugs and you have Medicare Part D, you should be paying less in 2026 in most plan designs. If you are not seeing lower costs, there are a few things worth doing.
Compare your current plan's cost-sharing for your medication to what you paid last year. Call your plan's member services line and ask specifically how the Maximum Fair Price affects your cost-sharing.
Use Medicare's Plan Finder at Medicare.gov to compare how different Part D plans cover your specific medications. Some plans will have passed through more of the negotiated savings than others. If you qualify for a Special Enrollment Period, switching to a more favorable plan may be an option.
If your drug is on the list and you are still being charged a price that seems inconsistent with the negotiated reduction, ask your plan in writing for an explanation of how the Maximum Fair Price is reflected in your cost-sharing.
If your plan denies coverage of a negotiated drug or changes your cost-sharing structure in a way you believe is inconsistent with your plan's terms, you have the right to file a coverage determination request and, if necessary, an appeal.
Ellen can help you understand your denial and build your appeal. Start here
Frequently Asked Questions
How do I find out if my drug has a negotiated price?
CMS publishes the Maximum Fair Prices for all negotiated drugs on its Medicare Drug Price Negotiation Program page at CMS.gov. You can search by drug name to find out whether your medication is included in the current round of negotiations and what the negotiated price is.
Will more drugs be added to the negotiated list?
Yes. The IRA establishes a schedule for negotiating additional drugs in future years. The second round of negotiations added more drugs with prices taking effect in 2027, and the program will continue to expand in subsequent years. The selection criteria focus on high-expenditure drugs without generic or biosimilar competition, so specialty drugs and biologics are disproportionately represented.
What if my drug does not have a negotiated price yet?
For drugs not yet subject to Medicare negotiation, your costs are still determined by your plan's formulary and cost-sharing structure. The $2,000 out-of-pocket cap applies to all covered Part D drugs in 2026, not just negotiated drugs. If your high-cost medication is not yet negotiated but is covered on your formulary, the cap still protects you from catastrophic spending.
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